微山湖区域免疫规划人力资源现况调查分析与对策

目的为加强免疫规划专业人员队伍建设,为科学配置免疫规划人力资源提供参考依据,对微山湖区域2010年免疫规划的管理和免疫专业技术人员现状进行调查和分析。方法设计了统一的调查表,采用机构调查和个人问卷调查相结合的方法,收集微山湖区域免疫规划人力资源配置情况和工作人员的基本信息,将数据录入数据库后进行统计分析。结果微山湖区域15处乡镇（街道）,17处预防接种门诊,从事免疫规划工作人员为132人。工作人员与人口总数之比为1．79／万。高级职称占0．76％,中级职称占18．94％,初级职称占53．79％,无职称占26．52％。大学本科学历占12．88％,大专学历占34．09％,中专学历占46．97％,无学历者占6．06％。从事免疫规划5年内人员占29．55％,5～9年占31．06％,10～19年占18．94％,20年以上占20．45％。结论微山湖区域免疫规划工作人员现状不适应免疫规划的进程和当前扩大国家免疫规划的发展和需求。为此,卫生行政部门应加强宏观管理,在现有条件下进行适当的调控及合理配置,以满足免疫规划工作的需要。     

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.     

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。     

Mechanical ventilation in critically ill cancer patients: outcome and utilisation of resources

Intensive care is increasingly being used in the management of cancer patients. It is important that a disproportionate share of special care resources is not expended on futile care of terminally ill patients. A requirement for mechanical ventilation has been stated to affect survival in cancer patients. The objectives of this study were to determine our hospital utilisation of ICU facilities and the prospects of a successful outcome in cancer patients with a need for ventilatory support. The Norwegian Radium Hospital is a 400-bed cancer hospital with a 12-bed combined postoperative and intensive care unit (PO/ICU). For each patient admitted to the PO/ICU, patient data including diagnosis, therapeutic interventions, use of resources and outcome are entered in a computerised database. We reviewed all 10,051 patients admitted during a 5-year period, focusing on the patients receiving ventilatory support. There were 347 patients who were treated with mechanical ventilation, 228 patients only for a short period postoperatively after extensive surgery. A further 119 patients (mean age 68 years, mean SAPS 33.5) were treated with mechanical ventilation for more than 24 h or died during treatment in the ICU; 65 patients (55%) were admitted after elective surgery, 24 (20%) after surgical emergencies and 30 (25%) after medical emergencies. Metastatic disease was present in 59% of them. These 119 patients comprised 1.18% of all patients admitted to the PO/ICU, but utilised 28% of all resources. They included 34 patients (29%) who died during the ICU stay, while 69 patients (58%) were still alive after 6 months. The ICU mortality in different groups was: surgical patients 24%, gynaecological patients 9%, oncological patients 63%. The mortality in the age group >70 years was 15%. The role of ICU facilities, including mechanical ventilation, is important for optimal supportive care in cancer patients. Our results indicate that this treatment modality should not generally be restricted in critically ill cancer patients. The quality of life of the patients who survived should be of interest to those involved in further medical and ethical decisions concerning the level of care in the ICU. Electronic publication: 12 January 1999     

Allocation of health care resources in the neonatal and perinatal area �CCPS Symposium 1996

There have been publically expressed concerns about the costs and allocation of neonatal and perinatal health care resources in Canada and elsewhere for the past 15 years. This paper reports information from a symposium held during the 1996 Canadian Paediatric Society (CPS) annual meeting sponsored by the CPS Section on Perinatal Medicine. Experts in perinatal epidemiology, health care economics, public policy and finance, and consumer perspectives on the outcomes of neonatal and perinatal intensive care explored the following questions: How should the need for health care resources in the neonatal and perinatal area be objectively determined? When there are competing needs between the maternal-newborn area and other areas, how should these be rationalized? What evidence should be used (or should be available) to support the present use of resources? What evidence should be available (or is needed) to change or introduce new uses of resources? The conclusions indicated that there are no generally accepted methods to determine the allocation of health care resources but that considerations need to include population characteristics, desired outcomes, achievable results, values, ethics, legalities, cost-benefit analyses and political objectives. Information from families and adolescents who required the use of high technology and/or high cost programs will contribute individual, family and societal values that complement cost-efficacy analyses.     

Impact of local donor and regionalization on a German transplantation center

Optimal allocation of donor organs is an ongoing matter of debate. We report on the impact of the foundation of UNI NRW, a close transplant collaboration of seven university centers with the intention of improving donor organ allocation, on the heart transplant program in Münster. All donor organs retrieved were offered first to the patients within this region before going into the Eurotransplant (ET) Foundation pool. The heart transplant program data were prospectively (for 1997) and retrospectively (for 1996) analyzed with regard to donor organ availability and allocation. There was a slight decrease in the number of donor hearts offered and accepted within the UNI NRW region in 1997 as compared to in 1996. However, due to the significantly lower organ export rate, the number of heart transplantations performed in UNI NRW rose from 47 to 72 procedures. In Münster, only six donor organs (16 %) were procured from outside UNI NRW in 1997, and these were, in part, due to special urgency requests. In conclusion, the institutionalization of UNI NRW within the framework of ET offers more flexibility, decreases total ischemic time, and may help to lower costs. Received: 26 May 1998 Received after revision: 22 September 1998 Accepted: 12 October 1998     

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.     

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.     

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。