多院区综合医院应对新冠肺炎救治策略研究

大型多院区综合医院一般都具有较强的空间集中性、人口密集性和影响辐射性,在新发重大传染病暴发的情况下,大型多院区综合性医院必然成为新发重大传染病救治的前沿部门和关键环节,其救治策略直接对新发重大传染病的最后结果造成很大的影响。以泰州市某三甲多院区综合医院救治新冠肺炎为例,总结出多院区综合医院"集中患者、集中专家、集中资源和集中救治"的管理策略,供相关单位参考借鉴。     

大型综合医院原址改扩建进度控制

文章以四川大学华西医院主业务院区原址改扩建为案例,从科学编制规划、合理分工、分项落实等方面总结论述了大型综合医院原址改扩建进度控制的综合措施。     

多院区医疗服务模式的研究与探索

近年来,由于患者就医需求及医疗资源规划等原因出现了多院区的医疗服务模式。本文对国内外关于多院区就医的研究进行了回顾,总结了国内多院区管理现状和面临的问题,并展开分析讨论。我国多院区建设还处于探索阶段,应错位发展分院区医疗特色,建设主院区主导下一体化文化氛围,保证同质化医疗服务。     

医院文化多院区同质化探索研究

目的 通过分析医院文化多院区建设现状,探索医院文化多院区建设的影响因素,有针对性地提出多院区文化融合发展策略。方法 运用Cite Space对当前多院区文化进行文献年度统计和知识图谱分析,同时以浙江省某公立口腔医院为例,对110名员工进行问卷调查,开展医院文化多院区建设影响因素分析。结果 从2020年起,医院文化多院区的研究文献开始增加,2020—2022年期间,年度发文量快速增长,关键词知识图谱显示,公立医院多院区的研究方向逐渐多样化,“文化建设”突现的时间为2019—2020年,突现强度为1.47,多院区文化建设成为多院区研究的热点关键词。根据Pearson相关分析显示,医院文化多院区建设与多院区医疗服务、多院区党工团组织建设、多院区形象宣传和多院区人力分布具有相关性(P<0.01)且呈正相关。结论 医院文化多院区建设相关研究逐渐火热,随着医院不断扩张,多院区文化建设还需加强党建引领,丰富文化建设形式,统筹学科规划,多院区同质化管理医疗质量,文化体系求同存异,建立统一品牌形象。     

医护人员对某大型公立医院“一院多区”管理模式的认知评价

目的 探讨医护人员对大型公立医院“一院多区”管理模式的认知与看法，为公立医院高质量发展下“一院多区”的规划、设置与管理提供依据。方法 通过半结构化访谈和扎根理论，对河南省某大型公立医院20名医护人员访谈内容进行记录、分析和关键词归纳。采用NVivo 12软件对纳入访谈资料的104个初始观点进行提取。结果 医护人员对“一院多区”的看法涉及协同保障机制、体系建设、院区文化3个核心维度，资源配置、协同能力、制度支撑、政策支持、文化建设和院区定位6个主范畴。结论 在“一院多区”建设中，要在各院区精准定位、各有所长的基础上，加强院区间协作能力建设，科学配置资源，并以文化建设作为支撑、以协同管理制度作为保障，推动“一院多区”可持续发展。     

多院区同质化管理的难点与对策分析

多院区医院已发展成为医疗卫生资源合理配置的重要途径,而同质化管理是多院区发展亟待解决的问题。多院区医院可分为垂直化、扁平化及混合型管理模式,在推进多院区医院同质化管理过程中,各院区之间管理权责、文化融合、学科设置、医疗服务水平、信息化建设方面等存在难点。针对这些问题,提出在制定总体战略规划、制度及标准流程基础上,统筹安排人、财、物等各项资源要素,以实现多院区同质化发展。     

公立医院多院区差异化布局的探索与思考

公立医院一院多区发展模式成为热点和趋势。为了避免多院区设置不合理导致的院区间内耗、区域医疗资源配置失调加剧等问题，加强分院区规划布局应成为建设多院区的前提与重点。以华中科技大学同济医学院附属协和医院长达20年的具体实践为例，系统阐述了专科扩容型院区、兼并型院区、新建型院区的建设原因、目标、路径、成效等，提供了差异化布局路线的实践蓝本，以期对公立医院一院多区发展有所助益。     

多院区医疗集团智慧医院建设路径研究

信息化建设对医疗机构长足发展和医疗卫生体制改革具有重要的意义,在公立医院高质量发展促进行动中,明确了信息化建设为支撑的作用,明确了信息化建设为重要支撑,构建电子病历、智慧服务、智慧管理“三位一体”的智慧医院体系。针对优质医疗资源扩容和区域均衡发展要求,以及大型综合性医院向单体多院区医疗集团模式的转变,因整体规划、管理体制、业务协同、应用思维等差异,智慧医院规划建设的难度将会增加。本研究从规划原则、标准依据、方案分享以及智慧医院思维培养的角度进行研究,探索了多院区医疗集团智慧医院建设的路径。     

妇幼保健机构单体多院区管理模式的探索和实践

单体多院区模式是公立医院未来发展的方向。此研究选取安徽省妇幼保健院为研究对象,从系统论视角,按照系统思维,从系统的层次性、整体性及动态性等方面对单体多院区管理模式进行探索和实践,为后疫情时代卫生行政部门、妇幼保健机构及综合医院等对单体多院区管理提供借鉴。     

基于平疫结合理念的综合性医院设计思路分析

结合武汉大学人民医院洪山院区设计实例,重点阐述其总体布局、流线、气流组织、给排水等方面的设计理念,为新建大型综合医院的设计工作提供参考。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.