超高清医学影像远程显示方案的设计与实现

从放射科320排CT超高清医学影像远程共享的实际需求出发，分析并解决了超高清影像远程无损传输和操控的技术难题，设计并实现了320排CT超高清影像远程传输和操控的整套解决方案，方案安全、稳定、有效，完全满足实际需求，有效提高了医疗服务的效率和质量，对其他超高清影像传输需求也具有很好的借鉴意义。     

Access to health care for ethnic minority populations

This paper reviews the research evidence on access to health care by ethnic minority populations, and discusses what might need to be done to improve access to services. Research on the process of care, and the quality of care received, is considered as well as studies examining uptake of services. Changes in legal context are increasing the pressure on healthcare organisations to examine and adapt their services to ensure equitable access. Examples presented include a new UK population cancer screening programme. The main challenges for clinicians, managers, and policy makers in ensuring equitable access are discussed.     

放射性介入操作中患者和工作人员辐射剂量及健康危险

介入放射学在过去20多年来迅速的发展,其在临床上的应用日益广泛,给患者带来了巨大的利益。与此同时,由介入诊断治疗操作中所导致的辐射剂量已引起人们越来越多的关注,尤其是考虑到该项操作的频率不断增加和日趋复杂化,而患者接受的剂量可能大到能引起患者的皮肤和眼晶体损伤,而工作人员也可受照剂量高到诱发机体产生一系列生物学效应,因而辐射防护问题已引起了国内外的重视。本文的研究主要集中于两个方面:目前放射性介入操作中的剂量水平、操作人员和患者的辐射危险。     

Reconfiguring a hospital towards general practice: the case of Peamount

Background  The decline in incidence of tuberculosis in Ireland has led Peamount Hospital to reconfigure its services towards the needs of general practice. Aims  To ascertain views of local GPs on their current use of Peamount, and how the hospital might best serve their future needs. Methods  Self-administered postal questionnaires sent to 151 GPs practicing in Peamount’s catchment area, to determine their current use of services, and likely future use of proposed services. Total valid response rate 64% (n = 84). Results  Responses indicated a lack of awareness of many services currently available, with a concomitant under-use of these services. The majority of GPs would use planned future services, particularly expanded radiology services. Conclusions  This survey promoted awareness among GPs of services available at Peamount. It informed the planning of future services and promoted a culture of involving local GPs in the planning of services of which they will be the users.     

基于即时通信工具的远程医疗系统架构

目的：探索常态化、市场化的远程医疗服务模式,推广远程医疗应用、提高远程医疗资源利用率。方法：引入即时通信工具,跨越医院间的系统架构差异,结合远程医疗多媒体模块,整合专线网和宽带网,实现医院间远程医疗业务随时随地交互。结果：实现全互通互联、随时随地信息获取、常态化运营的全开放远程医疗系统。结论：全开放远程医疗系统将对传统的医疗业务产生重大影响,并产生巨大的经济、社会和管理效益。     

社区安宁疗护服务项目成本测算研究

背景　安宁疗护项目面临总体经费补偿不足问题,致使安宁疗护服务发展受限,而合理的补偿依赖于对安宁疗护服务项目成本的精确核算。现有研究对安宁疗护补偿分析,多从机构收支缺口入手,缺乏对各项成本消耗的精确核算。目的　测算社区安宁疗护服务项目成本,为安宁疗护服务项目的合理补偿提供参考。方法　以上海市静安区静安寺街道社区卫生服务中心2018年开展的安宁疗护服务项目为研究对象,进行服务项目成本数据的采集和测算。结果　共234项服务项目,检验项目合并后共179项,成本46.5（23.0,84.0）元。其中,总成本最低的为人工辅助通便（1.3元）,最高的为Ⅰ级护理（401.7元）。179项服务中共包含138项收费项目,仅37项（26.8%）成本低于收费价格;3项（2.2%）成本等于收费价格;成本高于收费价格的有98项（71.0%）,包含全科14项、中医7项、护理32项、放射27项、心电B超4项、检验14项。结论　社区安宁疗护服务项目经费投入需重视分类补偿,且全科、中医、护理、放射、心电B超、检验等安宁疗护服务项目补偿不足。     

发展中国家开放存取发展现状

从开放存取期刊和开放存取知识库两方面,比较分析了发展中国家开放存取资源的数量、质量、发展速度和学科分布,提出了促进我国开放存取进一步发展的策略,如加大国家层面支持、提升开放获取认同度、整合开放获取资源等。     

具有执行力的开放获取政策实施策略研究

以推动开放获取政策落地为切入点，从政策主要制定者的特点出发，对政策的执行环境、利益相关者、不同类型机构开放获取政策的实施方案等方面进行了分析。分析结果显示，任何机构都要慎重对待强制性开放获取政策，将其作为科研人员知识产权的保护墙，关注具体执行，适当加强政策的监测和评估。科研教育机构要加强标准和设施的通用性及合规性，重视机构内外联系，建立相应的激励机制，促使机构成员逐步形成开放获取观念。科研资助机构应公开并明确开放获取政策及其实施细则，提供可操作的行动纲领与指南。     

构建医院网络准入系统的解决方案

贵港市人民医院网络信息系统经过近三年的建设,已经具备了一定的网络规模,为了有效保证医院信息化刚络和医疗业务信息系统的安全,建立一个牢固的立体安全防护体系,以达到更加完善的网络系统安全,针对网络准入系统的建设提出方案。     

开放获取质量管理与政策要素分析

目的：研究开放获取质量管理政策，分析开放出版质量管理的积极因素与消极因素，评估开放存储的数字内容所处的政策环境，为我国制定开放获取质量管理政策提供借鉴。方法：论述开放获取质量管理方式，梳理相关政策要素及其内容。结果：开放获取质量管理的核心在于具有质量保障的开放获取政策内容，这种政策内容对质量管理的支持力度决定了开放获取质量管理的政策环境。结论：开放出版期刊质量与开放存储数字内容质量的评估要素，可为相关机构制定与完善开放获取质量管理政策提供思路。     

实验性兔羊水栓塞的影像学与病理学观察

目的建立兔羊水栓塞(Amniotic Fluid Embolism,AFE)模型,并观察其影像学与病理学改变。方法选择雌性白兔20只,模型组(n=15)注射羊水原液制备AFE模型,按实验进展时间分为:8 h组、24 h组、48 h组,分别于建模前及相应的3个时段进行胸部X线摄影和肺部CT扫描,随后对肺组织进行肉眼和光镜检查。对照组(n=5)注射生理盐水,于注射前和注射8 h后进行影像学及病理学检查。结果模型组的X线、CT表现从注射后8 h开始有不同程度心影增大,肺野透过度增高,肺部炎性改变;48 h改变较为明显。病理学观察:肉眼见肺脏体积随时间变化逐渐缩小,质地较坚实;心脏体积不同程度增大;光镜见不同程度的肺不张和肺水肿,肺小动脉和毛细血管内有胎脂类和黏液,肺间质增厚,肺泡腔萎缩,肺间质及肺泡腔内可见明显的出血。结论兔AFE模型有明显的影像学与病理学改变,临床开展影像学检查有助于该病的早期诊断,该模型是研究AFE较有价值的动物模型。     

A global travelers' electronic health record template standard for personal health records

Tourism as well as international business travel creates health risks for individuals and populations both in host societies and home countries. One strategy to reduce health-related risks to travelers is to provide travelers and relevant caregivers timely, ongoing access to their own health information. Many websites offer health advice for travelers. For example, the WHO and US Department of State offer up-to-date health information about countries relevant to travel. However, little has been done to assure travelers that their medical information is available at the right place and time when the need might arise. Applications of Information and Communication Technology (ICT) utilizing mobile phones for health management are promising tools both for the delivery of healthcare services and the promotion of personal health. This paper describes the project developed by international informaticians under the umbrella of the International Medical Informatics Association. A template capable of becoming an international standard is proposed. This application is available free to anyone who is interested. Furthermore, its source code is made open.     

The health care resource allocation debate. Defining our terms

The problem of health care distribution in the United States demands immediate action. Many different solutions have been proposed to slow rising health care costs and to improve access to care for the poor and uninsured. Debate among proponents of these various proposals might be advanced if a common language were adopted with regard to certain key terms instead of the various meanings currently assigned to these terms. For this reason, we propose and defend the following three definitions: (1) rationing is the societal toleration of inequitable access to health services acknowledged to be necessary by reference to necessary-care guidelines; (2) health care needs are desires for services that have been reasonably well demonstrated to provide significant net benefit for patients with specified clinical conditions; and (3) basic benefit plans are insurance packages that provide for all and only acknowledged health care needs, again by reference to appropriate clinical guidelines.     

腹腔镜内侧入路右半结肠癌根治术与开腹手术的对照研究

目的 对比腹腔镜内侧入路右半结肠切除术和开放右半结肠切除术的临床效果.方法 分析同期行腹腔镜内侧入路右半结肠切除术30例（腔镜组）和行传统开放右半结肠切除术（开腹组） 27例的临床资料, 比较两组的手术时间、术中出血量、清除淋巴结数、术后肛门排气时间、术后住院时间、术后并发症等指标.结果 两组的手术时间、清除淋巴结数及术后并发症发生率差异无统计学意义; 腔镜组的出血量（47.1±45.8）ml明显少于开腹组（90.3±50.7）ml（P〈0.05）; 术后肛门排气时间腔镜组（24.3±7.9）h小于开腹组（63.2±16.1）h（P〈0.05）; 术后住院时间腔镜组（ 7.1±1.2） d短于开腹组（12.5±2.8） d（P〈0.05）.结论腹腔镜内侧入路右半结肠癌根治术安全有效, 符合微创手术切口小、患者痛苦轻、康复快的优点及肿瘤根治原则.     

Open Access Publishing in the Field of Medical Informatics

The open access paradigm has become an important approach in today’s information and communication society. Funders and governments in different countries stipulate open access publications of funded research results. Medical informatics as part of the science, technology and medicine disciplines benefits from many research funds, such as National Institutes of Health in the US, Wellcome Trust in UK, German Research Foundation in Germany and many more. In this study an overview of the current open access programs and conditions of major journals in the field of medical informatics is presented. It was investigated whether there are suitable options and how they are shaped. Therefore all journals in Thomson Reuters Web of Science that were listed in the subject category “Medical Informatics” in 2014 were examined. An Internet research was conducted by investigating the journals’ websites. It was reviewed whether journals offer an open access option with a subsequent check of conditions as for example the type of open access, the fees and the licensing. As a result all journals in the field of medical informatics that had an impact factor in 2014 offer an open access option. A predominantly consistent pricing range was determined with an average fee of 2.248 € and a median fee of 2.207 €. The height of a journals’ open access fee did not correlate with the height of its Impact Factor. Hence, medical informatics journals have recognized the trend of open access publishing, though the vast majority of them are working with the hybrid method. Hybrid open access may however lead to problems in questions of double dipping and the often stipulated gold open access.     

发展中国家开放存取发展现状研究——以DOAJ和OpenDOAR为例

发展中国家是世界上最众多的国家,其信息资源发展在全球起着至关重要的作用。自开放存取兴起至今,发展中国家的开放存取都获得一定的发展。从开放存取期刊和开放存取知识库两方面出发,对发展中国家开放存取资源的数量、质量、发展速度和学科分布进行比较分析,并提出促进我国开放存取进一步发展的方法。     

Police and Criminal Evidence Bill and the BMA

The British Medical Association's efforts against controversial clauses in the pending Police and Criminal Evidence Bill have resulted in a government offer to amend legislation that would otherwise threaten the confidential nature of medical records and the physician patient relationship. The BMA maintains that if police were allowed complete access to medical records, treatment would be jeopardized because patients might withhold vital information from their physicians, and physicians would be reluctant to record potentially damaging information about their patients.     

OA视角下高校图书馆与公共图书馆联合科研项目管理服务探讨——基于江苏高校图书馆与公共图书馆调研

文章提出了高校图书馆与公共图书馆联合科研项目管理并开放存取(OA)的服务策略,以使图书馆学术服务更上一层楼。采取网站调研与问卷调查相结合的方法,网站调研主要针对江苏高校图书馆与公共图书馆科研项目管理的现状,问卷调查主要围绕高校图书馆与公共图书馆联合科研项目管理并OA的阻滞因素。网站调研结果显示,高校图书馆在项目管理方面更具主导性,公共图书馆在联合管理方面更具优势,但都未推出完整的科研项目管理服务,更无法谈及项目内容与数据的OA。问卷调查结果显示,高校馆与公共馆对联合科研项目管理的价值与意义侧重不同,且在联合的模式上也有一定分歧,但是在联合管理的具体阻滞因素方面,高校馆与公共馆均认可的是政策支持、资源版权、共享政策、资金来源。建议以"独立构建再联合"的方式,在联合统一检索平台集成一个科研数据管理子平台,且在联合平台提供覆盖科研项目全周期的学术服务。     

Open access fibresigmoidoscopy: a comparative audit of efficacy

A total of 541 open access referrals for fibresigmoidoscopy over five years were compared with 495 hospital initiated procedures during the same period. The number of open access fibresigmoidoscopies doubled during the five years but diagnostic yield remained unchanged at about 40% and was similar to that of the hospital initiated procedures. Colorectal carcinoma was seen in 64 open access patients compared with 47 hospital referred patients, the proportion of Dukes's type A lesions being similar (34%) in both groups. Polyps, colitis, and diverticular disease were equally common in open access and hospital referred patients. Fibresigmoidoscopy failed to detect disease in only 12 patients (1.2%) and the procedure was unsatisfactory in only 54. Referral was considered justified in 475 (88%) open access patients, and only 54 (17%) patients with normal appearances at endoscopy required further investigations. Diagnostic yields were low (19%; 30/156 cases) in open access patients under 40 and in patients with abdominal pain, constipation, or abdominal pain with constipation (0-17%). Most of these young patients presumably suffer from the irritable bowel syndrome and do not justify fibresigmoidoscopy. In contrast, there was a high diagnostic yield (90-100%) in patients of all ages referred for diarrhoea and rectal bleeding, altered blood from the rectum, and rectal bleeding associated with abdominal pain. Open access fibresigmoidoscopy is an effective service that should be freely available to general practitioners.