Humanitarianism from Below: Sowa Rigpa,the Traditional Pharmaceutical Industry,and Global Health

ABSTRACT

In this article I explore, for the first time, the relationship between Sowa Rigpa (Tibetan medicine) and global health, tracing “the global” in ethical discourses and pharmaceutical innovation practices of Tibetan medical practitioners. I argue that Sowa Rigpa’s engagement with the world and its global health activities outside China can be understood as a form of “humanitarianism from below,” while its industrialization in China aligns with global health in different ways. In providing new insights into recent developments of Sowa Rigpa, I aim to decenter the notion of humanitarianism and contribute to a broader understanding of global health.     

医联体联合病房云医疗业务系统设计与应用

为实现医联体上下级医疗机构之间医疗业务的无缝衔接,华中科技大学同济医学院附属武汉市中心医院利用互联网技术,构建了上下级医疗机构之间的信息共享与交换机制,研发了医联体联合病房云医疗业务应用系统。该系统实现了上下级医疗机构的医疗资源与数据信息共享,方便患者就医,提高医疗服务水平。     

“I'm Leaving”: Factors That Impact Against Medical Advice Disposition Post-Trauma

BackgroundDischarge against medical advice (AMA) is an important, yet understudied, aspect of health care—particularly in trauma populations. AMA discharges result in increased mortality, increased readmission rates, and higher health care costs.ObjectiveThe goal of this analysis was to determine what factors impact a patient's odds of leaving the hospital prior to treatment.MethodsWe performed a retrospective analysis of the National Trauma Data Bank on adult trauma patients (older than 14 years) from 2013 to 2015. Of the 1,770,570 patients with known disposition, excluding mortality, 24,191 patients (1.4%) left AMA. We ascertained patient characteristics including age, sex, race, ethnicity, insurance status, ETOH, drug use, geographic location, Injury Severity Score (ISS), injury mechanism, and anatomic injury location. Multivariate logistic regression models were used to determine which patient factors were associated with AMA status.ResultsUninsured (odds ratio [OR] 2.72; 95% confidence interval [CI] 2.58–2.86) or Medicaid-insured (OR 2.50; 95% CI 2.37–2.63) trauma patients were significantly more likely to leave AMA than patients with private insurance. Compared to white patients, African-American patients (OR 1.06; 95% CI 1.02–1.11) were more likely, and Native-American (OR 0.62; 95% CI 0.52–0.75), Asian (OR 0.59; 95% CI 0.49–0.69), and Hispanic (OR 0.80; 95% CI 0.75–0.85) patients were less likely, to leave AMA when controlling for age, sex, ISS, and type of injury.ConclusionsInsurance status, race, and ethnicity are associated with a patient's decision to leave AMA. Uninsured and Medicaid patients have more than twice the odds of leaving AMA. These findings demonstrate that racial and socioeconomic disparities are important targets for future efforts to reduce AMA rates and improve outcomes from blunt and penetrating trauma.     

美国药品成本管理策略对我国医疗机构药品费用控制启示

目的：为控制我国药品费用的不合理增长和促进医疗机构药学服务提供参考。方法：分析美国卫生系统药师协会制定的药品成本管理策略，对比我国医疗机构卫生现状，从而提出完善医疗机构药学工作，进行药品控费的建议。结果：美国药品成本管理策略建议医疗机构基于往年采购量（或金额）和使用量（或金额）开展药品预算管理；规范临床药师素质及临床药学服务质量的同时常态化开展交互治疗；成立药师参与临床治疗且获取医务人员支持的治疗小组；制定药品处方集并将成本较低、效果明显的药品纳入电子处方管理系统；建立药品使用替换制度，严格规范药品替换流程。结论：我国医疗机构可以开展药品预算研究来控制药品使用金额；通过提升临床药师技能来增强药师职业认知；加强药师医师沟通以明确两者职能分工；注重药师处方集制定并管控药品不合理使用；完善药品替换制度来规范药品使用管理。     

基于二维码的电子诊疗卡系统的设计

目的构建一个以二维码作为电子诊疗卡替代医院传统诊疗卡的系统。方法依托医院微医疗平台,对患者唯一标识和时间戳进行MD5计算生成字符串,并以此内容生成二维码作为电子诊疗卡,同时对HIS进行相应改造,实现电子诊疗卡在全院的应用。结果利用时间戳和MD5签名生成二维码保证了电子诊疗卡加密的唯一性、时效性,医院每年节约成本5万元,患者每次就诊时间减少5 min,提升了患者满意度。结论本文构建的二维码电子诊疗卡系统,解决了使用实体诊疗卡过程中经常出现的忘带卡和重复办卡等问题,提高了医院服务质量,改善了患者就医体验。