A Report on State Public Health Work Based on a Survey of State Boards of Health

Professor Winslow has collected in this paper some very interesting comparative statistics with regard to state health laboratories. The progress of public health laboratories in the United States has indeed been remarkable in the last few years. While we may congratulate ourselves on our advance, it is obvious that in many instances much may yet be done to make laboratory of greater value to the citizens of the state.     

Core functions and capabilities of state public health laboratories: a report of the Association of Public Health Laboratories.

Emerging natural and man-made threats to the health of the nations population require development of a seamless laboratory network to address preventable health risks; this can be achieved only by defining the role of public health laboratories in public and private laboratory service delivery. Establishing defined core functions and capabilities for state public health laboratories will provide a basis for assessing and improving quality laboratory activities. Defining public health laboratory functions in support of public health programs is the beginning of the process of developing performance standards for laboratories, against which state public health laboratories, and eventually local public health and clinical laboratories, will establish and implement best laboratory practices. Public health is changing, and as apart of that change, public health laboratories must advocate for and implement improvements for public health testing and surveillance. These changes are outlined also in the Association of Public Health Laboratories consensus report (Association of Public Health Laboratories. Core functions and capabilities of state public health laboratories: a white paper for use in understanding the role and value of public health laboratories in protecting our nation's health. Washington, DC: Association of Public Health Laboratories, 2000).     

The state and territorial public health laboratory: program activities, organization and prospects for the future.

During the past two years we have studied the characteristics of state and territorial public health laboratories in an attempt to develop guidelines for considering reorganization of laboratory services in Massachusetts. Only a few recent monographs have dealt with this topic and, to our knowledge, the functional and organizational characteristics of these laboratories have not been reviewed. The state public health laboratory system affords an excellent example of applied laboratory science or technology organized to provide basic public health services. In this paper the programs and organization of the state public health laboratory are reviewed, and a functional basis more responsive to society's current needs is suggested.     

Horwitz方程在比对试验质量评估中的应用

[目的 ]通过生物样品的比对试验 ,提高获得认可的职业健康检查医疗卫生机构生物样品检测实验室的检验水平和质量控制水平。 [方法 ] 3 4家实验室按标准方法检验尿铅、尿汞比对试样 ,采用国际通用的Horwitz方程对比对试验结果进行分析、评定。 [结果 ]参加比对试验的实验室只有两家没有达到要求 (即 -2 相似文献   

PulseNet: the molecular subtyping network for foodborne bacterial disease surveillance, United States

PulseNet, the national molecular subtyping network for foodborne disease surveillance, was established by the Centers for Disease Control and Prevention and several state health department laboratories to facilitate subtyping bacterial foodborne pathogens for epidemiologic purposes. PulseNet, which began in 1996 with 10 laboratories typing a single pathogen (Escherichia coli O157:H7), now includes 46 state and 2 local public health laboratories and the food safety laboratories of the U.S. Food and Drug Administration and the U.S. Department of Agriculture. Four foodborne pathogens (E. coli O157:H7; nontyphoidal Salmonella serotypes, Listeria monocytogenes and Shigella) are being subtyped, and other bacterial, viral, and parasitic organisms will be added soon.     

Health data collection and verification in a collaborative model: development of a position paper on cardiac catheterization laboratories by the Rocky Mountain Heart Consortium

The framework of cooperation and collaboration enabled a unique voluntary organization of health care providers and consumers to develop and publish a position paper regarding the utilization of cardiac catheterization laboratories in the state of Colorado. The collection and analysis of valid, consistent, and comparable administrative health data provided the basis for recommendations regarding current utilization of cardiac catheterization laboratories, assessment of need by geographic area, and development of criteria for the establishment of additional laboratories. The article describes the methodology used to collect and analyze health data on a statewide basis, the issues of data reliability and validity that resulted, and the process of public release of such data.     

医学实验室认可标准在放射科质量管理中的应用探讨

放射科质量管理在整个医院管理和医疗改革中占据重要地位。加强放射科质量管理,将其上升到质量体系层次,是当前国内放射科质量管理体制改革的关键。广东省中医院放射科针对国内放射科实际情况,参考医学实验室认可标准(ISO 15189:2003(E)《医学实验室-质量和能力的专用要求》),对放射科质量管理中的各个环节进行了一系列开创性的探索和尝试。其实践为推进医疗卫生体制改革,寻求适合我国国情的放射科质量管理模式提供了有益的借鉴。     

THE EFFECT OF HOSPITAL–PHYSICIAN INTEGRATION ON HEALTH INFORMATION TECHNOLOGY ADOPTION

The US federal government has recently made a substantial investment to enhance the US health information technology (IT) infrastructure. Previous literature on the impact of IT on firm performance across multiple industries has emphasized the importance of a process of co‐invention whereby organizations develop complementary practices to achieve greater benefit from their IT investments. In health care, employment of physicians by hospitals can confer greater administrative control to hospitals over physicians' actions and resources and thus enable the implementation of new technology and initiatives aimed at maximizing benefit from use of the technology. In this study, I tested for the relationship between hospital employment of physicians and hospitals' propensity to use health IT. I used state laws that prohibit hospital employment of physicians as an instrument to account for the endogenous relationship with hospital IT use. Hospital employment of physicians is associated with significant increases in the probability of hospital health IT use. Therefore, subsidization of health IT among hospitals not employing physicians may be less efficient. Furthermore, state laws prohibiting hospitals from employing physicians may inhibit adoption of health IT, thus working against policy initiatives aimed at promoting use of the technology. Copyright © 2012 John Wiley & Sons, Ltd.     

Standardization of pulsed-field gel electrophoresis protocols for the subtyping of Escherichia coli O157:H7, Salmonella, and Shigella for PulseNet

Standardized rapid pulsed-field gel electrophoresis (PFGE) protocols for the subtyping of Escherichia coli O157:H7, Salmonella serotypes, and Shigella species are described. These protocols are used by laboratories in PulseNet, a network of state and local health departments, and other public health laboratories that perform real-time PFGE subtyping of these bacterial foodborne pathogens for surveillance and outbreak investigations. Development and standardization of these protocols consisted of a thorough optimization of reagents and reaction conditions to ensure that the protocols yielded consistent results and high-quality PFGE pattern data in all the PulseNet participating laboratories. These rapid PFGE protocols are based on the original 3-4-day standardized procedure developed at Centers for Disease Control and Prevention that was validated in 1996 and 1997 by eight independent laboratories. By using these rapid standardized PFGE protocols, PulseNet laboratories are able to subtype foodborne pathogens in approximately 24 h, allowing for the early detection of foodborne disease case clusters and often aiding in the identification of the source responsible for the infections.     

Surveillance übertragbarer Krankheiten auf der Grundlage des Infektionsschutzgesetzes in Deutschland durch den öffentlichen Gesundheitsdienst

By the Protection against Infection Act new instruments were established for infectious disease surveillance in Germany. The main innovations were a shift of responsibility for notifications from clinicians to laboratories, the validation of cases by means of case definitions in local public health departments, and the electronic transmission of single case data via state health departments to the Robert Koch Institute. Four years after the Protection against Infection Act was enacted, its implementation was successful from the perspective of state and national health authorities. This was proven by the detection and successful investigation of several diffuse outbreaks. However, further improvements seem necessary and the following points should be considered in a revision of the act: reduction of time limits for data transmission, unambiguous regulation of responsibilities and for data exchange in non-localized outbreaks as well as for international exchange of case data, and introduction of an obligation for clinicians to supply local public health departments with complementary information regarding laboratory reports on demand. The public health sector can contribute to a further improvement of the surveillance system by working to better inform clinicians and laboratories and therewith motivate them to comply with their obligations for notifying diseases and by promoting the scientific evaluation of the system, in particular concerning potential underreporting.     

Policy and procedural guidelines for the health and safety of workers in virus laboratories.

Through the use of a (a) a questionnaire, designed to elicit background information, (b) a serological survey, designed to obtain a picture of virus dissemination, and (c) a library review, designed to gain insight into the area of virus laboratory problems, the state of hazard in animal virus laboratories at Yale was evaluated. On the basis of this evaluation, a series of recommended guidelines for protecting the health and safety of workers in those laboratories was formulated.     

Guidelines for biosafety laboratory competency: CDC and the Association of Public Health Laboratories

These guidelines for biosafety laboratory competency outline the essential skills, knowledge, and abilities required for working with biologic agents at the three highest biosafety levels (BSLs) (levels 2, 3, and 4). The competencies are tiered to a worker's experience at three levels: entry level, midlevel (experienced), and senior level (supervisory or managerial positions). These guidelines were developed on behalf of CDC and the Association of Public Health Laboratories (APHL) by an expert panel comprising 27 experts representing state and federal public health laboratories, private sector clinical and research laboratories, and academic centers. They were then reviewed by approximately 300 practitioners representing the relevant fields. The guidelines are intended for laboratorians working with hazardous biologic agents, obtained from either samples or specimens that are maintained and manipulated in clinical, environmental, public health, academic, and research laboratories.     

分级诊疗制度下独立医学实验室的发展分析

为优化医疗资源配置,引导优质医疗资源下沉,形成科学有序的就医格局,我国将建立分级诊疗制度作为医改的重要内容推进。分级诊疗制度的推进为独立医学实验室发展带来了前所未有的机遇,独立医学实验室将在实现区域医疗资源共享方面发挥重要作用。但是,我国独立医学实验室的发展较国外差距还很大,同样面临很多挑战。     

Continuous improvement and TQM in health care: an emerging operational paradigm becomes a strategic imperative

Argues that US health care is in a state of crisis. Escalating costs account for 13 per cent of GNP, making health care the third largest industry in the USA, and spending is expected to increase. Claims health-care providers need to control rising costs, improve productivity and flexibility, adopt appropriate technologies, and maintain competitive levels of quality and value. States that TQM may provide an environment that will focus on quality of patient care and continuous quality improvement at all levels of the organization including the governing body, the administrative, managerial, and clinical areas. Any new national or state health-care plan will force providers to be more efficient while maintaining quality standards. Concludes that it will be strategically imperative that health-care providers ranging from family physicians to major medical centres and suppliers ranging from laboratories to pharmaceutical firms establish methods for making rapid continuous improvement and total quality management the cornerstone of the strategic planning process.     

Accreditation of medical laboratories

In Hungary, the National Accreditation Body was established by government in 1995 as an independent, non-profit organization, and has exclusive rights to accredit, amongst others, medical laboratories. The National Accreditation Body has two Specialist Advisory Committees in the health care sector. One is the Health Care Specialist Advisory Committee that accredits certifying bodies, which deal with certification of hospitals. The other Specialist Advisory Committee for Medical Laboratories is directly involved in accrediting medical laboratory services of health care institutions. The Specialist Advisory Committee for Medical Laboratories is a multidisciplinary peer review group of experts from all disciplines of in vitro diagnostics, i.e. laboratory medicine, microbiology, histopathology and blood banking. At present, the only published International Standard applicable to laboratories is ISO/IEC 17025:1999. Work has been in progress on the official approval of the new ISO 15189 standard, specific to medical laboratories. Until the official approval of the International Standard ISO 15189, as accreditation standard, the Hungarian National Accreditation Body has decided to progress with accreditation by formulating explanatory notes to the ISO/IEC 17025:1999 document, using ISO/FDIS 15189:2000, the European EC4 criteria and CPA (UK) Ltd accreditation standards as guidelines. This harmonized guideline provides 'explanations' that facilitate the application of ISO/IEC 17025:1999 to medical laboratories, and can be used as a checklist for the verification of compliance during the onsite assessment of the laboratory. The harmonized guideline adapted the process model of ISO 9001:2000 to rearrange the main clauses of ISO/IEC 17025:1999. This rearrangement does not only make the guideline compliant with ISO 9001:2000 but also improves understanding for those working in medical laboratories, and facilitates the training and education of laboratory staff. With the official acceptance of ISO 15189 the clauses of this harmonized guideline fulfill the requirements of the new international standard as well. Accreditation of medical laboratories in Hungary may not only facilitate quality improvement of laboratory services, but also the development of a quality-based purchasing and reimbursement policy of the health insurance fund.     

THE SCOPE OF A FEDERAL DEPARTMENT OF HEALTH

What an up-to-date Federal Health Department should undertake to do, is set down by Dr. Bryce in eight direct statements. Among the functions are; to direct legislation, collect information, educate the public, stimulate baby hygiene, establish nursing systems, look after immigrant inspection, and equip health research laboratories.     

THE SCOPE OF A FEDERAL DEPARTMENT OF HEALTH

What an up-to-date Federal Health Department should undertake to do, is set down by Dr. Bryce in eight direct statements. Among the functions are; to direct legislation, collect information, educate the public, stimulate baby hygiene, establish nursing systems, look after immigrant inspection, and equip health research laboratories.     

专人行使健康教育在妇科病房中的应用探讨

目的探讨专人行使健康教育在妇科病房中应用的效果。方法从2007年7月~2008年6月在我院妇科住院患者中随机抽取100例患者为观察组,对患者行专人健康宣教;同时抽取100名同病种的患者为对照组,对患者行传统健康宣教。两组患者的年龄、病种、病情、文化程度等方面差异无显著性。结果观察组对健康教育内容掌握情况及行为实施情况均明显高于对照组,差异有统计学意义;观察组对科室整体满意度也明显高于对照组,差异有统计学意义。结论专人行使健康教育的效果明显好于传统的健康教育方法,值得推广。     

CANCER AND THE PUBLIC HEALTH

This article by Doctor Wood is especially interesting to health workers and indeed to all readers of the Journal on account of the fact that it treats in a concise manner some of the fundamental points of importance known at the present time regarding this devastating disease. It is particularly suggestive as it indicates various ways in which state and local health authorities can direct their activities so that the people may be informed of the fact that early cancer is curable in most instances.