上海市医疗机构设置规划研究

在分析上海市医疗资源配置、需求与利用现状的基础上,结合未来发展需求,探讨了上海市"十二五"期间医疗资源配置的总体目标、原则、规划重点及各级卫生行政部门的主导作用.

Abstract：

Based on the current status of allocation, demands and utilization of medical care resources and the needs for future development in Shanghai, the overall objectives, principles, key plans of allocation of medical care resources in the 12th Five-years Plan in Shanghai and the leading role of health bureaus at all levels were discussed.     

上海市宝山区2010年托幼机构基本情况调查

目的了解托幼机构软硬件配置情况,为预防传染病传播,规范托幼机构的管理和制定卫生安全措施提供依据。方法用上海市疾病预防控制中心设计的托幼机构基础资料调查表,对该区托幼机构进行普查,在现场用问卷方式展开调查。结果该区的203家托幼机构中,其中注册类有124家,占61.08%;非注册类79家,占38.92%。注册类托幼机构的幼儿工作人员比、隔离室配置、室内通风等情况均优于非注册类托幼机构。结论由于该区属城乡接合部,托幼资源紧张,非注册类托幼机构较多且由于其投入不足,软硬件配置相对较差,同时工作人员缺乏防病专业知识,极易造成传染病在托幼机构中的传播。应针对性地强化托幼机构办学审查,加大监督、监测力度。     

浦东新区医疗机构设置规划研究

目的:制定浦东新区医疗机构设置规划。方法:在前期调查的基础上,进行卫生管理者的咨询,以确定医疗机构的设置规划。结果:制定浦东新区医疗机构设置规划的指导思想、基本原则、发展目标和规划方案。讨论:医疗机构设置规划应满足多层次、多样化的医疗服务需求,其实施需要政府和相关部门的保障措施。     

Mapping variability in allocation of Long-Term Care funds across payer agencies in OECD countries

IntroductionLong-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions).ObjectivesThis cross-country study highlights to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae.MethodsQualitative data were collected through a questionnaire filled by experts from 17 OECD countries.Results11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations.Discussion and conclusionsA minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions.     

Filtering big data from social media – Building an early warning system for adverse drug reactions

ObjectivesAdverse drug reactions (ADRs) are believed to be a leading cause of death in the world. Pharmacovigilance systems are aimed at early detection of ADRs. With the popularity of social media, Web forums and discussion boards become important sources of data for consumers to share their drug use experience, as a result may provide useful information on drugs and their adverse reactions. In this study, we propose an automated ADR related posts filtering mechanism using text classification methods. In real-life settings, ADR related messages are highly distributed in social media, while non-ADR related messages are unspecific and topically diverse. It is expensive to manually label a large amount of ADR related messages (positive examples) and non-ADR related messages (negative examples) to train classification systems. To mitigate this challenge, we examine the use of a partially supervised learning classification method to automate the process.MethodsWe propose a novel pharmacovigilance system leveraging a Latent Dirichlet Allocation modeling module and a partially supervised classification approach. We select drugs with more than 500 threads of discussion, and collect all the original posts and comments of these drugs using an automatic Web spidering program as the text corpus. Various classifiers were trained by varying the number of positive examples and the number of topics. The trained classifiers were applied to 3000 posts published over 60 days. Top-ranked posts from each classifier were pooled and the resulting set of 300 posts was reviewed by a domain expert to evaluate the classifiers.ResultsCompare to the alternative approaches using supervised learning methods and three general purpose partially supervised learning methods, our approach performs significantly better in terms of precision, recall, and the F measure (the harmonic mean of precision and recall), based on a computational experiment using online discussion threads from Medhelp.ConclusionsOur design provides satisfactory performance in identifying ADR related posts for post-marketing drug surveillance. The overall design of our system also points out a potentially fruitful direction for building other early warning systems that need to filter big data from social media networks.     

2013—2018年我国新创办科技期刊统计分析

【目的】 详细分析2013—2018年我国新创办的151种科技期刊的多项统计数据,为今后科技期刊出版资源配置提供参考。【方法】 通过年检资料、问卷、实地调研、样刊阅读、公开数据查阅、相关数据库检索等方式对这些新创办科技期刊的出版经营数据进行采集和统计分析。【结果】 我国科技期刊地域分布不均衡状况有进一步加重趋势,相当一部分新创办科技期刊在编辑队伍建设和稿源拓展方面有待改进,学/协会和高校已经成为创办科技新刊的主要力量,英文科技期刊已经成为创办新刊的主要方向(占53.6%),学科领域和行业划分的精细化以及高校“双一流”建设等,将对期刊出版资源产生很大需求。【结论】 今后期刊出版资源的配置应该重点关注科技期刊地域分布不均衡、主办单位的人力财力投入不充分等问题,同时为国家相关学科发展战略提供所需的支撑。     

2015年中国大陆放疗基本情况调查研究

目的 为进一步了解当前中国大陆地区放疗基本情况,合理配置放疗人才及设备资源,有效促进中国放疗发展,中华医学会肿瘤放疗学分会进行了第7次调查。方法 2015年10月8日到2015年12月期间,专门成立放疗基本信息调查办公室,通过各省主委提供本省放疗单位、名单及联系方式,采用专用数据填报系统通过互联网完整、快速、高效的完成调查。结果 截至2016年1月20日(1)单位:1413家;(2)人员:52496人,其中放疗医师15841人(高级职称4824人)、技师8454人(高级职称260人)、物理师3294人(高级职称562人)、维修师938人(高级职称120人);(3)放疗设备:直线加速器1931台,⁶⁰Co远距离治疗机96台,X刀171台,γ刀210台,近距离治疗机439台,X线模拟定位机1051台,CT 1353台,MRI 642台,MLC 978套,TPS 1922套,放疗网络974家;(4)质控设备:剂量仪1729台,电离室2143台,二维矩阵935台,三维剂量验证仪540台,三维水箱596台,仿真体摸844套,等效水体摸1168套;(5)治疗情况:病床数102171张(含综合医院肿瘤科病床),每日治疗76612人次,每年治疗919339人次。结论 调查结果显示中国大陆地区近年来放疗单位、放疗人员和设备均呈明显增加,放疗单位及设备分布、放疗人员结构趋于合理,但局部地区仍存在放疗设备尚不能满足医疗需求、专业技术人员缺乏等现实问题。     

医联体背景下医务人员对开展多点执业的意向调查研究

目的　探索在医联体背景下,医务人员对多点执业的意向及优势的认识,分析合理引导医生开展多点执业的路径。方法　2017年3—4月,以上海市4家三级医院的临床医生、医技人员、护理人员、科研人员、医院管理人员等为调查对象。调查内容包括调查对象基本情况,以及对开展多点执业的优势、对医生和医院的相关影响的认识。结果　本次研究共发放500份问卷,回收有效问卷422份（其中临床医生256名）,有效率为84.4%。当前,仅11名（4.3%）临床医生已在两个及以上的医疗机构开展多点执业,30名（7.1%）调查对象不赞成多点执业。多数调查对象认为,开展多点执业具有促进医疗人力资源合理流动〔72.0%（304/422）〕、缓解三级医院就医拥挤的现状〔64.7%（273/422）〕、提高医疗服务可及性〔69.7%（294/422）〕、提高患者满意度〔52.6%（222/422）〕的优势,并认为多点执业在我国具有广阔的前景〔59.5%（251/422）〕。多数调查对象认为,开展多点执业能提高医生收入〔76.3%（322/422）〕、工作积极性〔74.2%（313/422）〕、医术水平〔54.0%（228/422）〕和增加医生工作负担〔46.2%（195/422）〕,分别有20.4%（86/422）、23.5%（99/422）的调查对象认为开展多点执业会对医生晋升或职业发展造成阻碍、分散医生精力导致医疗差错和风险。多数调查对象认为,开展多点执业对一级或二级医院更有利〔76.8%（324/422）〕、会缩小民营医院与公立医院的差距〔56.2%（237/422）〕,分别有45.0%（190/422）、50.9%（215/422）的调查对象并不认为开展多点执业对三级医院不利、会削弱医院的品牌特色。结论　多数调查对象认为多点执业具有促进医疗人力资源合理流动、缓解三级医院就医拥挤的现状、提高医疗服务可及性、提高患者满意度等实际的社会价值,并且具有一定的动机开展多点执业。如果在医联体平台上运用激励机制、权益保障等举措合理引导医生开展多点执业,有助于医联体内医疗卫生资源的合理配置,具有较为显著的社会意义。     

Locoregional therapy response in patients with hepatocellular cancer waiting for liver transplantation: Only selection or biological effect?

Locoregional treatments(LRT) represent a broad strategy used for reducing the risk of drop-off and contextually improving the survivals in patients with hepatocellular cancer receiving a liver transplantation(LT). However, it is not sufficiently clear if LRT are only a surrogate of tumor aggressiveness or if they consent a real benefit in terms of tumor stabilization. A recent study by Pommergaard et al reported the results from the European Liver Transplant Registry. Patients receiving LRT before LT had better 5-year survival rates respect to no-LRT cases(69.7% vs 65.8%; P 0.001). When the number of LRT was tested, one-to-two treatments were connected with improved survivals respect to no treatment [hazard ratio(HR) = 0.85 and 0.71, respectively]. The efficacy of LRT was also reported in the presence of larger tumors(HR = 0.78) and micro-macrovascular invasion(HR = 0.71). The results observed in the present study are partially in discordance with other analyses showing a detrimental effect of LRT. The main problem in the interpretation of these results is connected with the possible initial selection biases present in the studies. The most recent guidelines suggest to perform LRT before the transplant, but the level of evidence is typically low due to the absence of prospectively designed studies.