Acute care hospitals and community health

Hospital boards and executives must resist the pressure to become all things health in the community. Hospital executives must educate their boards about the importance of concentrating on their core business and avoiding entangling and potentially risky ventures in peripheral and unrelated activities. They can and should participate in community health initiatives, but such efforts should, at most, be incidental to delivery of acute care services. The Drucker quote at the beginning of this column should be a warning to all who would venture even a short distance from their core business.     

新型农村合作医疗筹资额及补偿比的测算与分析

利用基线调查的数据,采用卫生经济学的研究方法,并且借助于SPSS统计软件,对江西省农村居民医疗服务利用、费用及影响因素进行详尽的分析,为新型农村合作医疗的决策者和基层工作者提供了方法上的指导。研究得出的主要结论如下:第一,不同层次农村居民医疗服务利用及费用呈明显的偏态分布,因此合作医疗的目标人群应是所有的农村居民;第二,要加强农村基层卫生机构的建设;第三,要因地制宜地确定合作医疗筹资及补偿标准;第四,要强化各级政府对新型农村合作医疗的财政支持。     

诚信医院医德医风建设的方法

本文研究并实践了创建诚信医院建设中为病人服务的两种方法，一是诚信医院的医德医风建设必须为病人想，视病人为亲人，为亲人服务是无私的；二是诚信医院医德医风必须围病人转，病人需要什么服务，医院就必须提供什么服务。     

Ethical and hygiene aspects of the reprocessing of medical devices in Germany

Based on safety and quality principles, for each medical device (MD), regardless of its declared status as single- or multi-use device, careful considerations must be made. This includes assessment whether reprocessing is economical and ecological meaningful, and technical feasible. So far, however, in Germany reprocessing of declared single use MD is legally allowed, provided that the above aspects are well covered. The purpose of this paper is to elucidate, when circumstances allow reprocessing of declared single-use MD. For reprocessing of single use MD the following preconditions must be fulfilled:

• The security level of the reprocessed MD must be equivalent to the status of the newly delivered item; this means that a patient is not exposed to a higher risk through a reprocessed disposable MD than through the new, i.e. un-processed product.
• The reprocessing must be based on a detailed risk assessment and risk analysis, and must be described in detail regarding selection of the reprocessing method. Additionally, all necessary safety- and quality assurance measures must be stated.
• The reprocessing measure needs to be accompanied with a quality management system which determines and documents the responsibility of all stages of reprocessing; where the corresponding reprocessing procedures are well defined; and the efficacy of the procedure is proven by product-specific or product-group-specific tests and reports. The process must be validated according to recognised methods of science and technology, taking into account potential negative influences of the reprocessing on the properties of the material and the technical and functional safety. For reprocessing of MDs of the category Critical C the quality assurance must be certified by an accredited certifying body.

     

Oral contraception: risks and benefits

Summary Data on the risks and benefits of using the oral contraceptive continue to accumulate. Because of continuing changes in the formulation and dosage of both the estrogens and progestins, the medical community must constantly re-evaluate all older data when considering current risk/benefit ratios. The changes in pill formulation have led to increased acceptability with a reduction of both nuisance and serious long-term side effects. The risks must be balanced against the major contraceptive and non-contraceptive benefits that are provided by the pill. Although both the benefits and risks have been documented in the literature, both the physician and the patient are being overwhelmed by press reports stressing mainly the negative aspects of the pill.It is incumbent on all physicians to periodically review the sources and validity of all medical reports on the pill. While the benefits of the pill outweigh the risks, the physician must be constantly aware of the changing world literature in order to optimize his/her prescribing patterns.This article was first published in theJournal of the Society of Obstetricians and Gynecologists of Canada, Volume 12, No. 1, pp. 9–15, January 1990, and is reprinted here by permission of the Society.     

收容精神病人治疗中的伦理问题

“收容精神病人”是指政府管理部门收容并送来医院救治的精神病患者。对于收容精神病人的治疗,医院应当坚持社会效益第一、病人利益至上的原则,按人道主义精神,精心治疗。同时,政府应该在立法上予以重视。社会各界的帮助、公安、民政部门的配合参与,有利于此项工作开展。家属必须善待精神病人。     

Psychosocial Issues of Children and Families with HIV/AIDS

The complex psychosocial issues for families who have a child diagnosed with HIV infection present a series of unique challenges for all health care providers. All members of the interdiciplinary team must be knowledgeable about these factors in providing all aspects of care to the child within the context of the family unit. Fear and secrecy are at the core of all persons living with HIV and AIDS, and health care providers must respond with compassion, empathy and sensitivity. The issues that will be discussed address the multiple factors that most frequently impact on a family's ability to function following their child's diagnosis of HIV infection or clinical AlDS and through the bereavement process. Concerns related to school attendance and the use of community services will be highlighted.     

Medical records and medical information in the U.K.—Issues and prospects

Medical care in the remainder of this century will increasingly demand improved information systems and better coordination among the various providers of care. One part of the solution must lie in giving the patients themselves all or part of their records as the only way of ensuring that all those involved in their care are adequately informed. For doctors themselves, the format of the clinical notes remains a major stumbling block to many developments, although improved systems are spreading. The Lloyd George envelope in general practice presents a particular problem which requires both long term solution and short term paliation. The changing computer technology is making possible new approaches, but also bringing new problems and a need for increased adaptability. Changes in organization and difficult decisions about the relation between centralized and decentralized services will be required. Planning in all areas must take a wide view to achieve systems which serve the interests and needs of all concerned: planners, health workers and, most importantly, the patients themselves.     

军队优秀中青年医学科技人员成长与培养教育探讨

军队优秀中青年医学科技人员是实现军队医院现代化建设的关键。提出了军队中青年医学科技人员应具备的各种基本素质和能力，阐明了培养选择机制中公平竞争的重要性及培养过程中应注意的导向问题。     

The theory and methodology of provider profiling

Physician profiling is the comparison of physician practice patterns to determine the existence and effects of significant differences in outcomes. To optimize care quality, these comparisons can be used to influence provider behavior through awareness when outcomes are poor or do not warrant provider expenditures. To maximize the value of such a technique, the underlying bases for comparison and the uses of derived data must be understood. Several factors must be considered or controlled for when determining comparable providers. Additionally, the worth or significance of findings must also be understood. This paper seeks to provide information in these two areas for the benefit of those responsible for managing care at all levels.     

Health information and health insurance

In summary, the need for protection of personal privacy, especially when it comes to sensitive medical information, should be regulated to prevent unnecessary and unauthorized dissemination. At the same time, in the interests of optimal patient care at the least expense, regulations, procedures and technology must be in place to allow ready access by all professionals having responsibility for providing and managing this care. In addition, the system must provide for similar ease and right of access to insurers and their representatives who have contracted with the client for necessary health benefits.     

Human factors in the development and implementation of telerehabilitation systems

Telemedicine services must be designed and implemented with the users in mind. When conducting telerehabilitation, factors such as age, education and technology experience must be taken into account. In addition, telerehabilitation must also accommodate a range of potential patient impairments, including deficits in language, cognition, motor function, vision and voice. Telerehabilitation technology and treatment environments should adhere to universal design standards so as to be accessible, efficient, usable and understandable to all. This will result in improved access to a wider range of telerehabilitation services that will facilitate and enhance the rehabilitative treatment and recovery of people living with varying levels of injury, impairment and disability.     

Criteria for management and use of instrumental techniques

The measurement of various parameters--be it plain temperature readings or determination of pesticides, drug monitoring or measurement of contaminants in air or water--must be carried out precisely and accurately. After purchase of the instrument, the installation qualification and the operation qualification, both produced by experts in the manufacturing company, are used to ensure correct use of the instrument. The standard operating procedures for instrument management must be sufficiently detailed to allow the operator to use the instrument correctly and, above all, must contain all the information necessary for accurate and precise calibrations. From 2002, the Food and Drug Administration will no longer accept submission of paper dossiers, so that pharmaceutical companies wishing to register a product in the USA will be obliged to submit the dossier electronically. This will involve the validation of all the software used in the management and operation of all instruments. It can be assumed that the EMEA will shortly follow the FDA, so that the validation of instrument software systems will become the rule and create new responsibilities for operators and inspectors.     

全球卫生治理面临的挑战及其应对策略

人人享有健康是一项基本人权。全球卫生治理的使命就是要在全世界范围内促进“人人享有健康”。目前,全球卫生治理面临诸多重大挑战,如治理主体众多但目标不一致导致领导权威难以确立,以国家为中心的国际体制使跨国集体行动的达成存在一定困难,各国对公共卫生事项设置的优先顺序存在分歧,全球卫生资金投入不足且分配不均,全球卫生治理严重缺乏国际协调,全球卫生治理基本框架尚未完全形成等。为了应对挑战,建议深化全球卫生改革,提高全球卫生治理的能力与效率;国际社会与各国政府必须审思与重构自身卫生法律与政策,把重点放在促进卫生公平而非提高经济竞争力上;各国政府必须重点关注民生和民权,重视非卫生领域政策与卫生政策的协调,从根本上改善健康的决定因素;增加全球卫生治理的透明度、建立新型问责制,增强世界卫生组织的权威性;在全球层面构建全球卫生治理基本框架,增强全球卫生治理的有序性。     

强化医院全面管理 走内涵发展之路

强调医院的全面管理要突出四个意识:首位意识、法规意识、改革创新意识和市场意识;提出要强化四方面管理:思想管理、质量管理、人才和学科管理、财务和物资管理。     

学习《指导意见》更新观念 开创妇幼保健工作的新局面

贯彻《关于城镇医药卫生体制改革的指导意见》,必须认清改革的新形势给妇幼保健机构提出的新问题 ,更新观念 ,理清生存与发展的思路。其中最重要的是必须坚持妇幼卫生工作方针 ,发挥保健工作的优势 ,正确实行保健与临床相结合。同时 ,要优化资源配置 ,建立完善的妇幼卫生服务体系 ,加强基层网络和服务队伍建设 ,合理规划 ,明确各级妇幼保健机构的职责和功能、任务。要依据《母婴保健法》的规定 ,积极争取政府的政策支持。     

Transfusions of blood and blood products and virus infections

Transfusions of blood and blood products are commonly used in medicine, but being biological materials they carry a risk of transmitting infections--viral, bacterial, parasitic, as well as prions. Laboratory tests used for screening of donated blood for viral infections at present cannot detect all infectious units. Criteria for selection of blood donors therefore must be very strict, while methods of inactivation of viruses and laboratory assays for detection of their presence must be improved. Indications for blood transfusion should be restricted.     

The billing process: improving efficiency and effectiveness

Physician practices as well as hospital and other health care institutions must work diligently to maintain viability given the economic severity of today's health care arena. Operational reviews, system reviews, and periodic internal audits all contribute to helping a practice be as efficient and effective as possible. Practices must make a conscious and continual effort to work toward meeting their established objectives. Versatile and flexible computerized systems seem to be a frequently chosen alternative for practices of all sizes to maximize reimbursement and streamlining the operational aspects of the practice. If the decision is made to purchase a computer system, it will require a team of energetic, enthusiastic people committed throughout the scope of the project. System conversion and implementation may take from two weeks to six months depending on vendor, practice size, and specialty. Ample training, conversion, and installation assistance must be arranged with the vendor. Dedication, hard work, and long hours are crucial to ensure success. The system's return on investment can be realized, yielding financial controls and operational stability. The end result is to make the practice more efficient, giving the physician more time to concentrate on the optimal mission--patient care.     

Alcohol problems in pregnancy and childhood--where do we go from here?

The awareness of potential damage to the foetus caused by maternaldrinking during pregnancy creates the need for a planned programmeof education for young women of child-bearing age. Preventionof foetal damage might best be achieved by commencing the educationprocess with schoolchildren and adolescents but preconceptionand antenatal clinics must necessarily be ‘foci of attention’.Thought must be directed to the content of the material presentedand efforts made to tailor the information for target groups.A prime need is the proper instruction of all those who willbe involved as educators to ensure a balanced approach. Primary prevention must be the mainstay of our efforts in themanagement of obstetric, neonatal and developmental problemsresulting from alcohol consumption during pregnancy.     

Physician outcome measurement: review and proposed model.

As health care moves from a free-for-service environment to a capitated arena, outcome measurements must change. ABC Children's Medical Center is challenged with developing comprehensive outcome measures for an employed physician group. An extensive literature review validates that physician outcomes must move beyond revenue production and measure all aspects of care delivery. The proposed measurement model for this physician group is a trilogy model. It includes measures of cost, quality, and service. While these measures can be examined separately, it is imperative to understand their integration in determining an organization's competitive advantage. The recommended measurements for the physician group must be consistent with the overall organizational goals. The long-term impact will be better utilization of resources. This will result in the most cost effective, quality care for the health care consumer.