上海市三级甲等综合医院腹膜透析中心家庭访视工作现状调查

目的：调查上海市三级甲等综合医院腹膜透析中心家庭访视工作现状及存在的问题，为相关工作的顺利开展提供参考。方法：2021年9月，采用自行设计的“腹膜透析中心家庭访视调查问卷”，对上海市19所三级甲等综合医院腹膜透析中心进行问卷调查。结果：有17所医院开展了患者家庭访视工作，14所医院已制定了腹膜透析家庭访视相关制度，年均家庭访视人次数仅为13人次。参与访视的医护人员以腹膜透析专职护士为主，其次为腹膜透析专职医生。家庭访视内容主要为观察患者居家腹膜透析操作环境、操作规范性、并发症处理、家属支持情况、容量管理、饮食指导等。18所医院认为开展家访有困难，8所医院认为家访后续监测存在困难。结论：上海市大部分三级甲等综合医院腹膜透析中心开展了家庭访视工作，但家庭访视人员以腹膜透析专职护士为主，家庭访视工作的开展受人力资源与结构、患者居住地、经济费用等因素的影响。     

上海市三级甲等综合医院腹膜透析中心 家庭访视工作现状调查*

摘 要：目的：调查上海市三级甲等综合医院腹膜透析中心家庭访视工作现状及存在的问题，为相关工作的顺利开展提 供参考。方法：2021年9月，采用自行设计的“腹膜透析中心家庭访视调查问卷”，对上海市19所三级甲等综合医院腹膜透 析中心进行问卷调查。结果：有17所医院开展了患者家庭访视工作，14所医院已制定了腹膜透析家庭访视相关制度，年均 家庭访视人次数仅为13人次。参与访视的医护人员以腹膜透析专职护士为主，其次为腹膜透析专职医生。家庭访视内容主 要为观察患者居家腹膜透析操作环境、操作规范性、并发症处理、家属支持情况、容量管理、饮食指导等。18所医院认为开 展家访有困难，8所医院认为家访后续监测存在困难。结论：上海市大部分三级甲等综合医院腹膜透析中心开展了家庭访视 工作，但家庭访视人员以腹膜透析专职护士为主，家庭访视工作的开展受人力资源与结构、患者居住地、经济费用等因素的 影响。     

新冠肺炎疫情下医院运营状况调查与分析

目的探讨新冠肺炎疫情对医院运营产生的影响。方法通过调查问卷的方式对医院运营情况进行调研，通过对回收问卷进行归纳汇总得出结果。 结果新冠肺炎疫情发生期间，所有被调查医院的业务量和运营收入都出现大幅下滑，90%以上的医院现金流吃紧，疫情期间医院的运营压力加大。结论医院应树立风险管理意识，做到平战结合；应开展多种业务模式，提升抗风险能力；应改变发展模式，加强运营管理。建议通过增加财政补贴等方式保障医院宽松的运营环境     

新冠疫情背景下医疗机构退休老同志生活状况、心理变化调查分析

目的：研究医疗机构退休老同志在经历新冠疫情时期的生活情况变化和面对新冠疫情的心理变化，为开展心理干预提供数据支持。方法：采用横断面调查的方法，随机抽取苏州市范围内医疗机构退休老同志220名，发放调查问卷进行匿名调查，调查问卷的各项目分布情况使用百分率和构成比等指标进行描述，各不同分层人群的变化情况发生率采用卡方检验进行分析。结果：发送问卷220份，回收问卷212份，回收率96.36%。87.26%（185/212）的受试者表示，疫情对正常的生活节奏产生了影响。76.43%（162/212）的受试者表示疫情影响了正常的睡眠；18.87%（40/212）的受试者表示产生了食欲不振等饮食方面的问题；82.55%（175/212）的人表示疫情使原本的社交方式发生了改变；58.96%（125/212）的受试者表示新冠疫情导致了心理状况的负向变化，主要体现在25.00%（53/212）的受试者表示其发生焦虑、抑郁等心理变化，12.26%（26/212）的受试者产生了重复洗手、重复居所环境消毒的强迫症状，7.55%（16/212）的受试者表示发生了植物神经紊乱的躯体症状。经统计分析，生活和心理状况发生的负向变化与年龄分层存在显著相关性（P＜0.05）。结论：新冠疫情对医疗机构退休老同志的生活状况和心理状况都造成了负面影响，子女亲属、单位离退办等管理人员应主动关心关爱医疗机构退休老同志出现的心理问题。     

河南省远程医疗业务系统建设及应用

目的 了解河南省远程医疗业务系统建设与应用效果，为河南省远程医疗发展提供建议。方法 2019年10月—2020年12月，采用自行设计的调查问卷对河南省二级、三级医疗机构的业务系统建设及业务开展情况进行调研，并采用描述性分析方法对不同等级医疗机构远程医疗建设情况进行分析。结果 河南省三级医院远程会诊系统、远程教育系统建设占比达100.0%，其中远程教育系统2019年占比较2018年上升30.0个百分点，二级医院除远程会诊系统之外，其余远程医疗业务系统建设占比下降。远程教育服务人次最多，服务1 000人次以上的三级医院占50.0%，二级医院占5.0%。三级医院普通会诊响应时长在12 h以内的占比提升16.5个百分点，紧急会诊响应时长在2 h以内的占比提升26.6个百分点。结论 远程医疗在三级医院发展速度较快，在二级医院普及速度放缓，并存在基础建设工作推进困难以及平台、数据标准不统一的问题。应引导大型医院、企业点对点帮扶基层医疗卫生机构，在各级医院推广远程教育，提高医护工作者远程服务意识，并加强医疗系统标准化建设工作，促进数据互联互通，提高远程医疗业务便捷度。     

甘肃省市县级医院病理科现状调查及远程诊断需求分析

目的 了解甘肃省市县级医院病理科设备、人员及业务现状,分析各医院对开展远程病理诊断的需求情况。方法 整群抽样选取甘肃省95家市县级医院为调查对象。自行设计问卷进行相关调查。采用Excel表格进行数据整理分析。结果 共调查三级医院9家,二级医院86家。三级医院均设立病理科并配备病理医师及技师且均具备阅片、切片制作能力;二级医院中仅有60.47%设立病理科,其中病理医师的配备率仅25.00%,而具有阅片能力的占75.00%,78.85%配有病理技师,其中具备制片能力的占73.33%。被调查医院中每年病理诊断需求量达千例及以上的占65.26%,但75.58%的二级医院中制片及阅片均在院外完成。被调查医院现均已具备或改造后具备开展远程病理诊断基础条件,3家二级医院已开展远程病理诊断,94.74%的医院因“无数字病理扫描设备”而未开展;82家医院“非常愿意”开展远程病理,其中“会诊质量”及“设备费用”分别是三级医院及二级医院对开展远程病理工作最担心的问题。结论 甘肃省二级医院病理诊断能力较低,极其适合开展远程病理诊断工作且具备基本条件,但缺乏切片扫描仪等相关设备     

江苏省三级医院感染管理专职人员现状调查

2010年7月,江苏省医院感染管理质控中心,对全省三级医院医院感染管理专职人员现状进行了调查,报道如下。1资料与方法采用书面问卷形式进行调查。通过省卫生厅行政发文,所有三级医院感染管理专职人员从省厅网站下载问卷调查表,填写后由各市卫生局或质控中心汇总上报到省质控中心。调查内容:专职人员年龄、学历、职称、原专业、从事感染管理时间、发表论文及兼任工作等。     

2017-2021年60项疫苗临床试验项目伦理初始审查结果分析

目的 分析疫苗临床试验项目伦理初始审查出现的问题，为规范疫苗临床试验方案设计和知情同意书等的制订，研究项目的开展以及为伦理审查提供借鉴。方法 选择某疾病预防控制中心医学伦理委员会2017-2021年期间受理审查的疫苗临床试验项目，采用现场资料调查法，统计5年内受理审查的项目，描述分析初始审查通过率及通过方式，以及研究方案、招募告知书、知情同意书等伦理审查时存在的常见问题。结果 2017-2021年共审查60项疫苗临床试验项目，其中，初始审查一次性通过率为3.33%,96.67%的项目审查意见均为做必要修正后同意。修改意见中方案修改所占比重最高（60.13%），主要问题集中于与研究目的有关的研究设计（15.69%）、入排标准（12.42%）和试验背景介绍（11.76%）。知情同意书中出现较频繁的问题包括风险考虑（10.46%）、治疗与补偿（9.15%）和语言表达（7.19%）。结论 疫苗临床试验项目初始审查一次性通过率不高，规范性欠佳、问题涉及方面较多。伦理审查对规范方案设计、保护受试者安全和权益、提高项目质量具有重要作用。     

我国医院远程医疗服务收费情况分析

目的 分析我国医院远程医疗服务收费情况，以完善远程医疗服务收费制度，推动远程医疗规范化发展。方法 2020年10—11月面向全国26个省（自治区、直辖市）组织开展线上问卷调查。选取问卷中远程医疗服务收费项目及其与医疗保险对接情况、收费标准制定、收费依据、费用支付与结算方式等内容，统计分析不同地区医院远程医疗服务收费情况。结果 71.3%的医院开展了远程医疗服务收费，收费项目主要为远程会诊、远程教育、远程病理诊断、远程影像诊断和远程心电诊断。主要按照医院级别和专家职称收费，分别有59.1%的东部地区医院、69.2%的中部地区医院和68.5%的西部地区医院收费标准由行政管理部门统一制定。此外，34.6%的收费医院将远程医疗纳入医疗保险报销范畴。结论 大部分医疗机构开展了远程医疗服务收费，但收费机制相对模糊，与医疗保险的对接政策也相对缺乏，应加快远程医疗服务收费政策制定，合理化远程医疗服务收费，建立健全远程医疗服务收费机制，促进远程医疗服务收费工作的规范化发展。     

新冠病毒防控期间精神病专科医院防控措施和医疗资源调查分析

目的 了解精神病专科医院对新冠病毒防控等突发公共卫生事件的医疗卫生资源和防控措施落实情况。方法 采用自制调查问卷,对浙江省11所地市级二级和三级精神疾病专科医院的63名不同层级、不同岗位的医务人员进行了新冠疫情防控措施和医疗资源的现况进行调查。结果 新冠病毒防控期间精神病专科医院在防疫的基础设施设备的完善率为60.66%～39.35%;医疗机构疫情防控措施16个项目的落实情况：9项措施落实率达到100.0%;4项措施落实率98.4%～88.5%;3项措施落实率为83.6%～62.3%。常见的各类基本防疫物质缺乏率为18.0%～11.5%,整体抗疫防控物质基本完备。但是疫情防控开始阶段,各类基本防疫物质缺乏率高达75.4%。结论 精神病专科医院应对突发公共卫生事件在基础设施、物资保障、措施落实等存在不力现况,所以医院要进一步提高应对突发事件的管理意识,国家有关部门只有重视专科医院应对突发公共卫生事件体制机制建设,才能充分履行此类医院机构在应对突发公共卫生事件中的医疗救助职能。     

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.