解读“十一五”规划纲要

疫情实现计算机自动预警 [规划]建立健全突发公共卫生事件应急机制,提高疾病预防控制和医疗救助能力。 [解读]卫生部表示,将完善全国传染病疫情网络直报,加强疫情报告信息的分析利用。健全突发公共卫生事件应急机制。完善各级卫生行政部门的应急预案。完善预测预警指挥决策系统．逐步实现计算机自动预警。     

卫生应急指挥平台在应对突发公共卫生事件中的作用

探讨卫生应急指挥平台在应对突发公共卫生事件中的功能,通过对卫生应急指挥平台应急准备、监测预警、应急处置、结案评估这四个功能的阐述,结合应急指挥现状,提出公共卫生应急指挥平台通过调用卫生应急资源实现平战结合的管理应用,实现卫生行业内外资源的联动,以提供信息畅通、反应快捷、指挥有力、责任明确的应急处置为基本手段,通过整合资源,提高卫生资源的利用率,形成高效、快速、畅通的公共卫生信息指挥体系,并提出几点建议。     

“MOH—WHO突发公共卫生事件预警专家论坛”在琼举办

为建立健全突发公共卫生事件预警系统，形成统一指挥、功能齐全、反应灵敏、运转高效的应急机制，提高保障健康安全和处置突发公共卫生事件的能力，卫生部卫生应急办公室与世界卫生组织于2005年2月28日～3月1日在海口市联合举办“MOH—WHO突发公共卫生事件预警专家论坛”，     

突发疫情部队药材保障问题及措施

近年来，不断发生的灾害和重大传染病的暴发和流行，对我军卫勤保障提出了更高的要求。军队药材保障是我军应对突发事件的物资保障体系的重要组成部分。在各类突发事件及重大疫情暴发流行过程中，我军的药材保障机构积极发挥作用，完成了部队应急药材的保障任务，同时也对我军应急药材保障提出了新要求。目前，我军应急药材保障能力与应对重大疫情还不太适应。针对突发疫情对药材保障提出的新课题，应重视军地联合、进一步完善和健全应急药材保障体系，针对可能发生的突发公共卫生事件有预见性地制定出应急药材保障方案，建立医药器械应急物品救援快速反应系统，增强药材应急保障系统的快速反应能力。     

基于地理信息系统的军队药材联勤保障决策支持系统设计

目的:适应新时期军队卫勤保障信息化发展的要求,寻找军队药材保障的辅助决策工具。方法:以地理信息系统、决策支持系统和计算机技术为支持,从数据库、模型库、方法库、知识库以及人机对话系统5个方面进行设计。结果:军队药材联勤保障决策支持系统实现了药材保障资源信息的快速图上查询、信息分析和对军队药材保障的辅助决策功能。结论:本系统是平时和战时军队药材高效保障的有效辅助决策工具。     

药剂科在突发性公共卫生事件中的应急反应

突发公共卫生事件是指“突然发生,造成或者可能造成社会公众健康严重损害的重大传染病疫情、群体性不明原因疾病、重大食物和职业中毒以及其他严重影响公众健康的事件。有效预防、及时控制和消除突发公共卫生事件及其危害,指导和参与各类突发公共卫生事件的应急处理及抢救工作,最大程度地减少突发公共卫生事件对公众健康造成的危害,保障公众身心健康与生命安全。医院起着决定性的作用,而药剂科是确保此项工作顺利完成的保障,突发公共卫生事件的应对是一个动态发展过程,一般包括预防与应急准备、监测与预警、应急处置与救援等环节。为确保药剂科在突发事件中做到及时、安全、准确的完成抢救配合工作,要作到第一时间做出应急反应。     

卫生应急平台办公自动化建设

为加强突发公共卫生事件的应急指挥能力,提高卫生系统自动化办公和应急管理水平,针对卫生应急管理的特点,以关键技术应用、应急网络承载建设、数据共享与交换为手段,阐述其设计原理、数据分配、硬件设备及组成模式,设计出自动化平台的总体框架。集视频音频、网络通讯、综合显示、指挥调度和预警联动为一体,构建了性能优越、功能强大的突发公共卫生事件应急指挥视讯系统自动化办公平台,实现卫生部门之间应急管理、视频会议和文件传输等功能,保证了应对突发公共卫生事件中指挥整体协调能力和统揽全局的管理控制能力。     

卫勤综合数据库建设的问题与对策

运用网络技术，加快发展具有我军特色的卫勤指挥自动化建设，对提高卫勤指挥水平和辅助决策水平具有重要的意义。在建设卫勤指挥自动化系统中，当务之急是建设好电子信息资源的综合数据库，因为这是建设整个卫勤指挥自动化的源头，是各部门实现信息共享、资源优化的前提。     

部队卫生防疫防护支撑平台的构建及运行环境

目的针对部队卫生防疫人才队伍现状,立足部队卫生防疫工作的特点和需求,构建部队卫生防疫防护保障支撑平台,为强化部队卫生防疫人员学习、训练提供技术平台,为部队卫勤机构提供辅助决策依据。方法以现有最新军事预防医学理论、技术等成果为基础,结合部队卫生防疫工作的实际,采用目前较为先进的计算机技术和手段研制开发成支撑平台。结果平台由基础知识、基本技能、防护系统、保障预案、卫生标准、资源信息等6个数据库和系统维护管理模块构成。每个功能模块可自成系统,又可互相衔接与融合,将基础与应用、平时与战时、保障与管理、咨询与学习训练提高有机结合起来,设计开发成单机版、网络版、手机版,以满足不同用户的需要。具有内容全面、信息量大、高效实用、智能化强、扩充性好、便于维护等特点。结论该平台是做好部队卫生防疫工作的技术支撑平台,有利于部队卫生防疫人员开展多样化业务学习、训练,有助于提高部队卫生防疫防护保障能力和标准化、信息化建设水平。     

应对突发公共卫生事件信息网络建设的探讨

《突发公共卫生事件应急条例》的制定与实施，不仅对应急流行病学调查、传染源隔离、医疗救护、现场处置、监督检查、监测检验、卫生防护等具有重要的法律依据，而且对加强突发事件中的信息收集、分析报告、通报预警等都具有十分重要的指导意义。然而，如何编织和建立及时、有效、畅通的卫生信息传递网络和疫情预警机制，是亟待解决的关键问题。     

急诊患者家属的卫生服务需求调查

目的 了解不同年龄、不同性别、不同文化程度、不同职业急诊患者家属的卫生服务需求,为更好地满足急诊患者家属的各项需求提供理论依据.方法 采用〈急诊患者及家属的卫生服务需求调查表〉对就诊于银川市3所三甲医院急诊科的患者家属共160名进行卫生服务需求问卷调查.结果 急诊患者家属对＂工作人员技能娴熟＂、＂就医环境＂和＂先进急救设备＂的需求较高,对＂仪表、态度、文明＂、＂知道目前做何检查＂和＂知晓费用＂的需求较低.不同性别、不同年龄、不同文化程度、不同职业患者家属对急诊服务总需求差异无统计学意义（P〉0.05）;而急诊患者家属文化程度不同、职业不同对医院设施设备及服务流程的需求有差异、家属年龄不同对治疗、检查、费用的需求有差异、家属为女性者在治疗、检查、费用、与医护人员沟通交流等方面的需求均高于男性,且差异均有统计学意义（P〈0.05）.结论 不同年龄、不同性别、不同文化程度、不同职业的急诊患者家属对卫生服务的总需求相同,而对四个层次的需求略有差异.     

Antídotos: guía de utilización y stock mínimo en el servicio de urgencias

ObjectiveTo develop a guide for antidotes and other medications used to counteract poisoning, and define the stock in an emergency department, as a safety priority for the part-time pharmacist assigned to the unit.MethodA search of specialist databases and web portals of the Spanish Society of Toxicology and the British National Poisons Information Service, as well as toxicology databases, TOXICONET, information from other hospitals, tertiary sources, Micromedex and Medline.ResultsThe Guide contains 42 active ingredients and is accessible to the Pharmacy and Emergency departments in electronic format. A minimum emergency stock was agreed based on the daily treatment of a 100 kg patient. This information, including updated expiry dates, is available at the emergency department antidote stock facilities and in electronic format. On a monthly basis, the pharmacist reviews the need to replace any drugs, due to their expiry date or lack of use.DiscussionThe lack of evidence from high quality antidote studies, the variability due to the difficulties of updating sources and some geographical differences in their use means that decision-making can be difficult.It would be useful to have minimum quantity recommendations from societies of toxicology, regulatory agencies and organisations such as the Joint Commission on the Accreditation of Healthcare Organisations. It would also be useful to have a suprahospital risk assessment to optimise management and ensure the availability of antidotes which are expensive, have a limited shelf life, or of which demand is difficult to forecast.     

关于稳定院前急救机构医务人员队伍的几点思考

院剪急救机构医务人员队伍的稳定性问题已成为制约院前医疗急救事业发展的瓶颈。针对当前院前急救机构医务人员队伍不稳定的现状和成因,要稳定院前急救医务人员队伍,需要加大财政投入力度,不断提高收入待遇,需要增加急救机构编制,充实急救人员数量,需要提升专业发展空间,畅通急救医生出路。     

Human and Rodent Homologies in Action Control: Corticostriatal Determinants of Goal-Directed and Habitual Action

Recent behavioral studies in both humans and rodents have found evidence that performance in decision-making tasks depends on two different learning processes; one encoding the relationship between actions and their consequences and a second involving the formation of stimulus–response associations. These learning processes are thought to govern goal-directed and habitual actions, respectively, and have been found to depend on homologous corticostriatal networks in these species. Thus, recent research using comparable behavioral tasks in both humans and rats has implicated homologous regions of cortex (medial prefrontal cortex/medial orbital cortex in humans and prelimbic cortex in rats) and of dorsal striatum (anterior caudate in humans and dorsomedial striatum in rats) in goal-directed action and in the control of habitual actions (posterior lateral putamen in humans and dorsolateral striatum in rats). These learning processes have been argued to be antagonistic or competing because their control over performance appears to be all or none. Nevertheless, evidence has started to accumulate suggesting that they may at times compete and at others cooperate in the selection and subsequent evaluation of actions necessary for normal choice performance. It appears likely that cooperation or competition between these sources of action control depends not only on local interactions in dorsal striatum but also on the cortico-basal ganglia network within which the striatum is embedded and that mediates the integration of learning with basic motivational and emotional processes. The neural basis of the integration of learning and motivation in choice and decision-making is still controversial and we review some recent hypotheses relating to this issue.     

对教学医院急诊医学教学独特性的思考

本着探索如何从急诊医学学科独特性出发,搞好教学医院急诊医学临床教学工作的目的,该研究采用病例与技能培训相结合的方法,对实习医师、轮转住院医师和培训全科医师以及进修医师使用不同的教程,通过实践发现,分层教学对不同需求的医师或医学生均取得了明显效果。研究结果证实,教学医院急诊医学教学独特性的积极思考与实践,有助于满足不同层面的需求,有利于全面提高卫生人才的急救理论和技能水平。     

基于AHP-DEMATEL和QFD的发热门诊智慧药事服务模式再造研究

目的 基于质量功能展开(quality function deployment,QFD)原理,结合层次分析法(analytic hierarchy process,AHP)与决策试验和评价试验法(decision-making trial and evaluation laboratory,DEMATEL)的混合模型,指导发热门诊智慧药事服务模式再造。方法 采用问卷调查收集患者原始需求数据,运用AHP-DEMATEL方法计算,然后进行同行竞争性评估和质量规划,确定患者需求的最终权重,之后将患者需求转化为相应的服务质量特性,并构建质量屋,根据分析结果,制定再造方案并实施。结果 以全自助取药和患者分流为特点的新模式实施后,患者平均取药时间由257 s缩短至102 s,患者平均等候注射时间由945 s缩短至323 s,同时避免药师与患者的直接接触,极大程度降低了交叉感染风险,患者满意度从88.50%提升至95.73%,另一方面药师满意度达到99.26%,医护人员满意度达到98.12%。药师人力成本投入下降95.8%,管理时间成本投入下降81.8%,调剂正确率提升至100%。结论 运用AHP-DEMATEL和QFD方法能确定影响高品质智慧药事服务的关键质量特性,为新模式再造提供决策依据和改进方向,从而显著提升药学服务质量,加强感染防控工作的药学保障。     

中国卫生应急体系建设的现状与分析

中国卫生应急管理分两个阶段,第一阶段建国初期到2002年,第二阶段是从2003年SARS疫情爆发至今,逐步构建了以"一案三制"的核心内容的应急体系,并在实战中不断完善.但基层卫生应急管理有待加强。     

Employing Drug Delivery Strategies to Overcome Challenges Using TLR7/8 Agonists for Cancer Immunotherapy

Quantitative Systems Toxicology (QST) models, recapitulating pharmacokinetics and mechanism of action together with the organic response at multiple levels of biological organization, can provide predictions on the magnitude of injury and recovery dynamics to support study design and decision-making during drug development. Here, we highlight the application of QST models to predict toxicities of cancer treatments, such as cytopenia(s) and gastrointestinal adverse effects, where narrow therapeutic indexes need to be actively managed. The importance of bifurcation analysis is demonstrated in QST models of hematologic toxicity to understand how different regions of the parameter space generate different behaviors following cancer treatment, which results in asymptotically stable predictions, yet highly irregular for specific schedules, or oscillating predictions of blood cell levels. In addition, an agent-based model of the intestinal crypt was used to simulate how the spatial location of the injury within the crypt affects the villus disruption severity. We discuss the value of QST modeling approaches to support drug development and how they align with technological advances impacting trial design including patient selection, dose/regimen selection, and ultimately patient safety.

     

Heroin and amphetamine users display opposite relationships between trait and neurobehavioral dimensions of impulsivity

The multidimensional construct of impulsivity is implicated in all phases of the addiction cycle. Substance dependent individuals (SDIs) demonstrate elevated impulsivity on both trait and laboratory tests of neurobehavioral impulsivity; however our understanding of the relationship between these different aspects of impulsivity in users of different classes of drugs remains rudimentary. The goal of this study was to assess for commonalities and differences in the relationships between trait and neurobehavioral impulsivity in heroin and amphetamine addicts. Participants included 58 amphetamine dependent (ADIs) and 74 heroin dependent individuals (HDIs) in protracted abstinence. We conducted Principal Component Analyses (PCA) on two self-report trait and six neurobehavioral measures of impulsivity, which resulted in two trait impulsivity (action, planning) and four neurobehavioral impulsivity composites (discriminability, response inhibition efficiency, decision-making efficiency, quality of decision-making). Multiple regression analyses were used to determine whether neurobehavioral impulsivity is predicted by trait impulsivity and drug type. The analyses revealed a significant interaction between drug type and trait action impulsivity on response inhibition efficiency, which showed opposite relationships for ADIs and HDIs. Specifically, increased trait action impulsivity was associated with worse response inhibition efficiency in ADIs, but with better efficiency in HDIs. These results challenge the unitary account of drug addiction and contribute to a growing body of literature that reveals important behavioral, cognitive, and neurobiological differences between users of different classes of drugs.     

Atrial fibrillation

In 2000, some 2.3 million Americans were affected by atrial fibrillation, and that number is expected to rise as our population ages. Atrial fibrillation is both a reflection of active physiologic stressors on the body and a marker of future cardiac disease progression. The disorganized atrial activity that characterizes atrial fibrillation affects cardiac function, metabolic demand, and quality of life. However, our understanding of the etiology and treatment of this condition continues to advance with the result of recent large-scale clinical trials. Diabetes, hypertension, congestive heart failure, valvular disease, and myocardial infarction are all risk factors in the development of atrial fibrillation. And the diagnosis confers a five-fold increase in the incidence of stroke. (Patients at increased risk for stroke include those with congestive heart failure, hypertension, age greater than 75, diabetes, and previous stroke.) Anticoagulation is a critical action in most cases of atrial fibrillation, as data show a 68% relative risk reduction of stroke when patients are treated with warfarin. Prior to recent trials, achieving sinus rhythm was thought to invariably improve symptoms, cardiac function, and mortality. The adverse effects of antiarrhythmic medications are now being recognized, and treatment strategies emphasizing ventricular rate control have been recommended in recent clinical practice guidelines. This shift in thinking is influencing both outpatient and emergency department management. Controlling the ventricular rate in atrial fibrillation increases cardiac output, decreases the metabolic demand of the heart, and avoids the potentially dangerous side effects of rhythm-control drugs. Rate-control agents should be selected based on the clinical profile of individual patients. A well-chosen subset of patients may benefit from either chemical or electrical cardioversion; this appears to be a reasonably safe procedure and can be accomplished on an outpatient basis. Understanding causal etiologies, managing risk for stroke (and need for anticoagulation), addressing rate, and assessing the risks of cardioversion are key elements in a comprehensive approach to atrial fibrillation.