使用VB开发医疗设备维修管理系统

使用VB语言和Access数据库对医疗设备维修管理系统进行设计,将系统结构划分为基本信息、维修管理、库存管理、报表打印、系统管理等5项功能模块,实现了设备信息登记、查询、维修情况、配件管理、报表打印、权限管理等功能。系统使用后运行稳定,大幅度提高了医学工程人员的工作效率,进一步加强了设备科的综合管理职能。     

Accidents of toddlers and youngsters

The Public Health Department in Biberach an der Riss developed a questionnaire to investigate the incidence of accidents in children under school-starting age (6 years). This questionnaire was presented to the parents of more than 2,300 prospective first-graders from the town and rural district on the occasion of the pre-school medical examination 2000. As this examination is mandatory for all children starting school, and as the questions were answered by all the parents with very few exceptions (language reasons), a complete survey can be assumed. The investigation confirmed the results of last year: The incidence of children who suffered an accident requiring medical attention before reaching school age is approximately 33 %; boys are predominantly involved. The scene of accidents also changes with increasing age from living quarters to outside areas. The most frequent type of accidents are, of course, falls, resulting especially in injuries to the head and face. Scalds and burns, in particular at the age of 2, occur more frequently in the Biberach district than described in other up-to-date investigations in Germany. For this reason efforts have to be made to reduce this number over the next years. About 11 % of accidents occur in the streets or involve traffic, a result which is also higher in comparison to other investigations. According to the statement of parents, more than two-thirds of accidents are caused by the children themselves, including babies and toddlers. At the time of the accident 40 % of the children were without parental control, and 20 % completely alone.A great number of the accidents could certainly have been prevented. That is why the results of the study should be made available to all those responsible for the care and wellbeing of this age group. The last section of the paper deals with the most urgent needs of action to be implemented in the long run for the sake of the health of our children.     

A probability-based aid for teaching medical students a logical approach to diagnosis

In this paper we present a method of teaching medical students a logical approach to diagnosis. By using the independent Bayes method, commonly employed in decision aids, students can be made aware of how information on each new symptom affects what is likely in the light of what is known already. This approach is used for the diagnosis of thoracic symptoms in patients with normal chest X-rays and an example is given. Extensions of the system to incorporate information from investigations and error costs are discussed.     

Registration of clinical trials: a statement from the International Committee of Medical Journal Editors

Altruistic motives and trust are central to scientific investigations involving people. These prompt volunteers to participate in clinical trials. However, publication bias and other causes of the failure to report trial results may lead to an overly positive view of medical interventions in the published evidence available. Registration of randomised controlled trials right from the start is therefore warranted. The International Committee of Medical Journal Editors has issued a statement to the effect that the 11 journals represented in the Committee will not consider publication of the results of trials that have not been registered in a publicly accessible register such as www.clinicaltrials.gov. Patients who voluntarily participate in clinical trials need to know that their contribution to better human healthcare is available for decision making in clinical practice.     

Former Military Officers from the Republic of Vietnam Now Living in the United States (US): Exploring their Perceptions of the US Healthcare System

Few studies have focused on perceptions of healthcare among Vietnamese who came to the United States (US) as refugees. A 48-item survey that included information on demographics, health status, and satisfaction with healthcare [including the Patient Satisfaction Questionnaire-18 (PSQ-18)] was sent to 49 former Vietnamese military officers, who are now living in the US, based on their current geographic residence. A total of 22 of 49 delivered questionnaires were completed and returned, yielding a response rate of 45%. The survey was sent in Vietnamese and English, and all except one was completed in Vietnamese. In response to “Language barriers have prevented me from accessing health care when I need it,” 77% of respondents acknowledged that this was “sometimes” the case even today. Most respondents otherwise viewed the healthcare system favorably, but cost concerns were an issue: 28% strongly agreed or agreed with the statement, “I have to pay for more of my medical care than I can afford.” In contrast, only 9% described that they would have strongly agreed or agreed to this statement upon first arriving to the US. Write-in comments revealed themes that centered on language barriers, favorable impressions of healthcare in the US, financial concerns, and patriotism towards the US. Further study of this aging population of Vietnamese Americans might help shed light on concerns faced by other refugee populations who have arrived more recently.     

Health characteristics and utilization of public sector health facilities among migrant agricultural workers in Orange County, New York

Publicly subsidized medical clinics were established to provide migrant farmworkers with minimal access to mainstream medical care. Nevertheless, migrant farmworkers delay treatment of health problems and refrain totally from use of medical facilities. The present study explores the health status and utilization of subsidized migrant clinics by farmworkers in a vegetable production county (Orange County) in upstate New York. Multivariate analysis indicated that economic resources, mental health status, health insurance coverage, language, education and utilization of acute care facilities are important predictors of these decisions.     

Equity in specialist waiting times by socioeconomic groups: evidence from Spain

In countries with publicly financed health care systems, waiting time—rather than price—is the rationing mechanism for access to health care services. The normative statement underlying such a rationing device is that patients should wait according to need and irrespective of socioeconomic status or other non-need characteristics. The aim of this paper is to test empirically that waiting times for publicly funded specialist care do not depend on patients’ socioeconomic status. Waiting times for specialist care can vary according to the type of medical specialty, type of consultation (review or diagnosis) and the region where patients’ reside. In order to take into account such variability, we use Bayesian random parameter models to explain waiting times for specialist care in terms of need and non-need variables. We find that individuals with lower education and income levels wait significantly more time than their counterparts.     

Replacing positivism in medical geography

Revisiting debates about philosophical approaches in medical geography suggests that logical positivism may have been prematurely discarded. An analysis of authoritative texts in medical geography and their sources in human geography shows that logical positivism has been conflated with Comtean positivism, science, empiricism, quantification, science politics, scientism and so on, to produce the "standard version" of the all-purpose pejorative "positivism", which it is easy to dismiss as an evil. It is argued that the standard version fails to do justice to logical positivism, being constructed on sources which are at some distance from the logical positivist movement itself. An alternative approach is then developed, an historically and geographically situated interpretation of logical positivism as a deliberately and knowingly constructed oppositional epistemology within an oppressive and anti-scientific culture predicated on idealist intuitionism. Contrasting the standard version with this alternative reading of logical positivism suggests that much may have been lost in human, and thus, medical geography, by throwing out the logical positivist baby with the "positivism" bath water. It is concluded that continuing to unpack the standard version of logical positivism may identify benefits from a more nuanced appreciation of logical positivism, but it is premature to take these to the level of detailed impacts on the kinds of medical geographies that could be done or the ways of doing them.     

Communication skills competencies: definitions and a teaching toolbox

BACKGROUND: Doctors' interpersonal and communication skills correlate with improved health care outcomes. International medical organisations require competency in communication skills. The Accreditation Council for Graduate Medical Education (ACGME) developed a toolbox for assessing this competency and 5 others, yet none initially for teaching these skills. PURPOSE AND METHODS: The original focus in the development of the ACGME competencies was evaluation. This paper represents a significant step toward defining methods for teaching communication skills competencies. A total of 16 medical education leaders from medical schools worldwide, participating in the 2003 Harvard Macy Institute Program for Physician Educators, worked together to: (1) further define the ACGME competency in interpersonal and communication skills; (2) delineate teaching strategies for each level of medical education; and (3) create a teaching toolbox to integrate communication skills competencies into medical curricula. Four subgroups defined subcompetencies, identified teaching strategies for undergraduate, graduate and postgraduate medical training and brought their work to the larger group. The expanded communication competencies and teaching strategies were determined by a consensus of the larger group, presented to 80 Harvard Macy Scholars and Faculty for further discussion, then finalised by consensus. CONCLUSION: The teaching toolbox expands the ACGME core communication competencies, adds 20 subcompetencies and connects these competencies to teaching strategies at each level of medical training. It represents the collaboration and consensus of a diverse international group of medical education leaders in a variety of medical specialities and institutions, all involved in teaching communication skills. The toolbox is applicable globally across different settings and specialities, and is sensitive to different definitions of health care.     

河北省继续医学教育体系运行状态评价及可持续发展研究

本文分析了河北省继续医学教育体系的工作状况,认为该体系的运行是有效的.同时研究了目前存在的主要问题,认为在未来的继续医学教育工作中应进一步加强制度化,要科学定位继续医学教育在医院发展中的地位,遵循市场化规律,形成适合各类机构卫生技术人员的继续医学教育模式.     

Crossing diagnostic borders: herpes encephalitis complicated by cultural and language barriers

BACKGROUND: The patient who complains of vague mental status changes requires extra vigilance in that the underlying condition might itself affect the patient's ability to communicate well and relate a medical history. The differential diagnosis of delirium is broad, ranging from the benign to the potentially fatal. The diagnostic uncertainty inherent in primary care is compounded when language and cultural differences interfere with physician-patient communication. METHODS: We undertook a MEDLINE-assisted review of the medical literature concerning herpes simplex encephalitis. Additionally, we performed an Internet search of several government Web sites to find current legal and federal guidelines concerning the use of medical interpreters. RESULTS AND CONCLUSIONS: We recount the case of a young Eastern European immigrant who complained initially of vague mental status changes and was found to have herpes simplex encephalitis. Diagnosis could have been made sooner had the physician been familiar with the patient's baseline mental status or had cultural and language barriers not stood between the physician and the patient and his mother. Herpes simplex encephalitis is a rare, but specific, cause of delirium for which prompt diagnosis and treatment with intravenous acyclovir can prevent death or serious sequelae.     

UK consensus statement on the content of communication curricula in undergraduate medical education

Context The teaching and assessment of clinical communication have become central components of undergraduate medical education in the UK. This paper recommends the key content for an undergraduate communication curriculum. Designed by UK educationalists with UK schools in mind, the recommendations are equally applicable to communication curricula throughout the world. Objectives This paper is intended to assist curriculum planners in the design, implementation and review of medical communication curricula. The document will also be useful in the education of other health care professionals. Designed for undergraduate education, the consensus statement also provides a baseline for further professional development. Methods The consensus statement, based on strong theoretical and research evidence, was developed by an iterative process of discussion between communication skills leads from all 33 UK medical schools conducted under the auspices of the UK Council of Clinical Communication Skills Teaching in Undergraduate Medical Education. Discussion How this framework is used will inevitably be at the discretion of each medical school and its implementation will be determined by different course designs. Although we believe students should be exposed to all the areas described, it would be impractical to set inflexible competency levels as these may be attained at different stages which are highly school‐dependent. However, the framework will enable all schools to consider where different elements are addressed, where gaps exist and how to generate novel combinations of domains within the communication curriculum. It is hoped that this consensus statement will support the development and integration of teaching, learning and assessment of clinical communication.     

基于Jieba分词的医疗设备信息查询一站式服务系统设计

目的:设计基于Jieba分词的医疗设备信息查询一站式服务微信平台,以方便临床一线人员查询与梳理医疗设备信息相关资料、标准及各种资讯。方法:建立基于Jieba分词的微信平台系统架构,采用Python的Wxpy模块进行系统设计。使用Jieba分词进行消息处理,设计基于微信的聊天机器人,利用Python语句进行资料反馈和数据库查询。结果:基于微信的聊天机器人可提供设备管理相关资料的精准查询,能够在临床自然语言要求下,进行同质化答复管理。医疗设备资产库备有1万余条数据集,设定文件大小最大<10 M,查询设备资产的返回时间<2 s。结论:医疗设备信息查询一站式服务微信平台系统的设计,能够针对临床文字需求进行同质化答复,既可方便临床一线人员查询设备信息相关资料,还可有效提高医疗设备的管理效率。     

新《医院会计制度》会计报表数据变化及应用解析

2012年各期会计报表即将出来,由于新制度规定固定资产要计提折旧,冲销应收医疗款中以前一年度医保欠费,当年无法收回的医保欠费冲减当年医疗收入,使新的报表数据变化很大,在利用报表进行财务分析时只有充分考虑这些因素,才能得出客观全面的分析资料。     

Cancer prevention trials in China and Finland.

Intervention studies are now viewed as a useful and necessary approach to understanding the relation between nutrition and cancer. Over 20 such studies have been initiated in the past 7 years. Foreign countries may be an attractive site for such investigations, mainly because of desirable population characteristics such as unusually high rates of the cancer being studied, low dietary intake of potential chemopreventive nutrients, stability of the population, and high compliance, and also because of favorable logistical aspects including existing medical, social, or governmental structures that facilitate delivery of the intervention, ongoing cancer registries for endpoint determination, and reduced cost. The three basic elements of an intervention trial, identification and recruitment of a study population, delivery of the intervention and assessment of compliance, and ascertainment of endpoints, are the same in a foreign country as in the United States, but there are a number of special considerations, most notably communication difficulties due to language differences and distance between collaborators, which complicate foreign trials both before and during implementation. The basic elements and status of ongoing trials in China and Finland are presented.     

Communicating diabetes in Australian print media: a change in language use between 2010 and 2014?

Objective: To assess if language used by Australian print media has changed in accordance with the 2011 Diabetes Australia position statement: a new language for diabetes. Methods: Five prominent Australian newspapers were reviewed to retrieve articles from 2010 and 2014 that focused on diabetes or discussed diabetes in detail. Individual terms or phrases used within each article were categorised as preferred language, neutral language or language to avoid. Results: 111 and 79 diabetes‐specific articles were retrieved for 2010 and 2014, respectively. A significant decrease (p<0.05) was observed in diabetes articles using language to avoid in 2014 (45.6%) compared to 2010 (70.3%); accompanied by a significant increase (p<0.05) in diabetes articles using preferred language. There was no significant increase in articles that only used preferred language with or without neutral language, indicating that most articles commonly use both preferred language and language to avoid. Conclusions and implications: The Australian print news media has increased use of preferred language when communicating about diabetes, but have not eliminated the use of language to avoid. To realise the goals of the language position statement, continued championing of the recommendations by the health community is needed to ensure awareness and adoption.     

ISO14155:2011标准简介及其在我国应用前景的展望

医疗器械新产品在上市以前,为了确认产品安全有效,一般应对其进行临床研究。世界各国对如何进行医疗器械临床研究的要求都是非常严格的,如FDA、欧盟和我国的监管部门等都已颁布了医疗器械临床研究的相关法规或指令。ISO14155标准是用于世界范围内医疗器械的临床研究标准,其主要内容是评价医疗器械在人体应用的安全性并确认其使用的有效性。ISO 14155:2011是医疗器械临床研究的临床质量管理规范(GCP),与前版标准相比,新版标准内容更加丰富,要求更高,实用性和可操作性更强。因此,其在我国也将具有良好的应用前景。     

The majority of bold statements expressed during grand rounds lack scientific merit

CONTEXT: Frequently, during grand rounds and other medical conferences, bold statements are made regarding 'exotic medical facts'. Such exotic expert opinions are frequently voiced with great conviction and are usually subsequently assimilated by junior staff as medical fact. METHODS: The level of scientific evidence for each exotic expert opinion expressed during daily grand rounds over a 4-month period was evaluated. If, following a short discussion of the statement, any doubt as to the merits of the claim persisted, the person who made the statement was asked to perform a search in the medical literature on the subject. RESULTS: In total, 25 cases of exotic expert opinion were identified during the study period. Of these, 22 statements were made by senior staff and 3 by residents. Careful review of the literature showed only 8 of the statements were actually evidence-based. In 17 cases the available literature actually contradicted the statement (n = 13) or no literature on the subject could be located (n = 4). Although opinions were most often expressed by staff members, the reviews of their merits were more often performed by residents. CONCLUSIONS: The vast majority of exotic expert opinions expressed by senior staff members during grand rounds are not evidence-based. Thus, great care must be taken to ensure that exotic expert opinion is not accepted as factual without careful review. Furthermore, this study shows that although seniority is (as expected) associated with a higher incidence of voicing exotic expert opinion, it is negatively associated with reviewing the merits of such opinion.     

Performance criteria for evaluation of medical teachers

Evaluation of medical teachers must be related systematically to individualized objectives that are derived from a specific statement of the goals of the medical school. This paper describes the application of management-by-objectives to the problem of assessment of performance of medical teachers. The approach provides for the identification of significant objectives and rates performance in relation to achievement of outcomes rather than of activities.