从远程医疗信息传输谈下一代远程医疗系统建设

分析了远程医疗系统现状及存在问题,提出了建立基于IPv6的下一代远程医疗系统的解决方案,并论述了基于IPv6技术建立远程医疗系统的设备状况、成功案例以及新系统的优势。     

介绍几种外军新研发的卫生装备（三）

1卫勤指挥、控制、通信及远程医疗系统（SMART-MC3T） 卫勤指挥、控制、通信及远程医疗系统（SMART—MC3T）一般与车辆配合使用，可通过卫星通讯支持远程医疗，进行卫勤指挥、通信和远程医疗。从1998年开始装备，其后进行了一系列改进。该系统主要硬件包括：一台军用笔记本、防水包装箱、全色谱通信电缆、     

基于VPN技术的区域性远程医疗系统的构想

本文详细分析了目前国内远程医疗系统在网络通讯和视频会议系统建设中所采用的一些主流技术的基本情况,提出了一套以VPN技术为基础,以软件视频会议系统为主要实现手段的区域性远程医疗系统的建设方案。     

DireCtShoW技术在远程医疗系统中的应用

研究了Microsoft公司的DirectShow技术的特点及其在远程医疗系统中的应用。设计了基于该技术的远程医疗系统框架．并在设计的系统上实现了医学多媒体数据的实时采集、编码和传输。     

P2P-SIP技术以及在远程医疗系统中的应用

介绍P2P-SIP网络系统的结构及功能以及在远程医疗系统中的应用。P2P-SIP技术充分利用了SIP协议和P2P技术各自的特点,解决了传统远程医疗系统的实时性和拓展性问题,具有很好的应用前景。     

远程医疗系统车载化应用及发展趋势

远程医疗是当今世界最重要、发展最快的两大领域医学和通信技术的结合。回顾远程医疗系统及其车载化应用的发展概况,重点介绍车载化系统的构成,详细介绍车载化系统研制过程中解决的一些关键技术问题,并对远程医疗系统车载化应用的发展进行展望。     

建设我军远程口腔医疗系统的初步研究

目的：建设远程口腔医疗系统可以有效利用军内和民间口腔医疗资源,为偏远或战时复杂危险战场环境的部队提供精良的口腔卫生勤务保障服务。方法：对比国内外远程口腔医疗系统建设情况,对前景和存在的问题进行初步分析。结果：通过参考大量国内外文献,对建设远程口腔医疗系统进行了全方位的分析,初步构想了军内未来远程口腔医疗系统。结论：由于各种因素,军内远程口腔医疗系统研究还处于迟滞状态,还需要加紧加快研究,并尽早投入应用。     

国内远程医疗系统建设进展与展望

本文介绍了国内远程医疗系统建设的进展状况，在对现有远程医疗系统分类分析和比较的基础上，按照规模列举了国内一些典型的远程医疗系统，并对各个系统的主要功能特点进行了分析。最后对国内远程医疗发展的前景进行了展望。     

适合中国国情的远程家庭医疗系统研究

介绍了远程医疗在国内外的发展概况。探讨了中国远程家庭医疗的发展方向，提出了一种适合中国国情的远程家庭医疗系统，并对该系统的组成、工作原理及关键组成部分：远程家庭监护仪及远程计算机中心处理系统进行了介绍。     

建设农村远程医疗系统的意义和实现

近几年,我国省市级医院大都建立远程医疗中心或开通了远程医疗系统,而最需要远程医疗服务的农村基层医院在这方面的工作却大大地落后了,因此加快农村远程医疗系统的建设势在必行.建设农村远程医疗系统的意义主要有三个方面:改善医疗资源的配置,提高农村卫生保健水平,降低农民的医疗费用.随着宽带网在乡村的建设和使用,农村远程医疗系统的实现就变得简单易行了,在管理上应严格按照卫生部发布的文件精神进行,同时加强专业人才的培训.     

What Is a Valid Mapping Algorithm in Cost-Utility Analyses? A Response From a Missing Data Perspective

ObjectivesAlthough numerous mapping algorithms from a non–preference-based measure to a target health utility measure have been developed and applied in cost-utility analyses (CUAs), conditions for a mapping algorithm to work well in a CUA are still unclear. In this research, we formulate the mapping problem as a missing data problem and clarify these conditions.MethodsWe defined a valid mapping algorithm based on the purpose of mapping (ie, not for prediction but for CUA), and derived a sufficient set of conditions for a valid mapping algorithm. We also conducted a simulation study to investigate properties of a mapping algorithm under situations where the conditions are satisfied and violated.ResultsThe derived sufficient conditions indicate that the complete overlap of the source measure with the target health utility measure is important and that a covariate that is omitted from a mapping algorithm but has an effect on the target health utility measure not captured by the source measure may invalidate a mapping algorithm. The conditions cannot be verified from data in a CUA but can be supported using external data. A simulation study showed that when at least 1 of the 3 conditions was violated, a mapping algorithm provided biased health utility estimates in a CUA, and that prediction accuracy did not necessarily reflect performance of a mapping algorithm in a CUA.ConclusionThe derived conditions provide a fundamental basis for better practices in developing and selecting a mapping algorithm.     

Component-Resolved Diagnosis of Hazelnut Allergy in Children

Hazelnuts commonly elicit allergic reactions starting from childhood and adolescence, with a rare resolution over time. The definite diagnosis of a hazelnut allergy relies on an oral food challenge. The role of component resolved diagnostics in reducing the need for oral food challenges in the diagnosis of hazelnut allergies is still debated. Therefore, three electronic databases were systematically searched for studies on the diagnostic accuracy of specific-IgE (sIgE) on hazelnut proteins for identifying children with a hazelnut allergy. Studies regarding IgE testing on at least one hazelnut allergen component in children whose final diagnosis was determined by oral food challenges or a suggestive history of serious symptoms due to a hazelnut allergy were included. Study quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Eight studies enrolling 757 children, were identified. Overall, sensitivity, specificity, area under the curve and diagnostic odd ratio of Cor a 1 sIgE were lower than those of Cor a 9 and Cor a 14 sIge. When the test results were positive, the post-test probability of a hazelnut allergy was 34% for Cor a 1 sIgE, 60% for Cor a9 sIgE and 73% for Cor a 14 sIgE. When the test results were negative, the post-test probability of a hazelnut allergy was 55% for Cor a 1 sIgE, 16% for Cor a9 sIgE and 14% for Cor a 14 sIgE. Measurement of IgE levels to Cor a 9 and Cor a 14 might have the potential to improve specificity in detecting clinically tolerant children among hazelnut-sensitized ones, reducing the need to perform oral food challenges.     

Dose--schedule finding in phase I/II clinical trials using a Bayesian isotonic transformation

A dose-schedule-finding trial is a new type of oncology trial in which investigators aim to find a combination of dose and treatment schedule that has a large probability of efficacy yet a relatively small probability of toxicity. We demonstrate that a major difference between traditional dose-finding and dose-schedule-finding trials is that while the toxicity probabilities follow a simple nondecreasing order in dose-finding trials, those of dose-schedule-finding trials may adhere to a matrix order. We show that the success of a dose-schedule-finding method requires careful statistical modeling and a sensible dose-schedule allocation scheme. We propose a Bayesian hierarchical model that jointly models the unordered probabilities of toxicity and efficacy and apply a Bayesian isotonic transformation to the posterior samples of the toxicity probabilities, so that the transformed posterior samples adhere to the matrix-order constraints. On the basis of the joint posterior distribution of the order-constrained toxicity probabilities and the unordered efficacy probabilities, we develop a dose-schedule-finding algorithm that sequentially allocates patients to the best dose-schedule combination under certain criteria. We illustrate our methodology through its application to a clinical trial in leukemia and compare it with two alternative approaches.     

Mothers with disabilities

This paper is a collection of personal experiences regarding motherhood expressed by six women who have a disability. The article discusses the challenges of motherhood and the difficulties imposed by the presence of a disability. It confronts the notion that a good mother must be physically active with her children and focuses on the personal relationship between mother and child as the essence of parenting. The article further discusses the importance of peer support and the value that can be obtained by participating in a broader network of people with similar concerns. The author has led support groups for parents with and without a disability. She has been an active disability rights advocate and a founding member of many leading disability organizations and programs. She has a Masters degree in the Arts from Harvard and is married to a man with a visual disability. The couple have two children.     

Psychological Meaning of a Woman with a Hysterectomy Among Mexican Physicians and Women

The psychological meaning of women who have had a hysterectomy, and attitudes toward them, were explored in 121 Mexican gynecologists, 155 women who had undergone a hysterectomy, and 115 women who had not had a hysterectomy. The surveys were completed between January and May 2011. Both groups of women defined a woman who had had a hysterectomy using words with positive meanings (healthy, happy, reassured, and complete), as well as words with negative meanings (sad, incomplete, and irritable). However, the participants who had not had a hysterectomy defined a woman who had had a hysterectomy using more negative words and showed more negative attitudes toward such a woman with a hysterectomy than those women who had undergone a hysterectomy. Among participants who had undergone a hysterectomy, those who were premenopausal prior to the surgery and those who had undergone bilateral salpingo-oophorectomy defined a woman who had had a hysterectomy in a more negative manner and showed the most negative attitudes. The gynecologists did not use words with emotional content regarding women who had had a hysterectomy and showed more neutral attitudes toward such a woman than did both groups of women. These findings could be helpful in designing support programs for women facing a hysterectomy.     

Usual source of care in preventive service use: a regular doctor versus a regular site

OBJECTIVE: To compare the effects of having a regular doctor and having a regular site on five preventive services, controlling for the endogeneity of having a usual source of care. DATA SOURCE: The Medical Expenditure Panel Survey 1996 conducted by the Agency for Healthcare Research and Quality and the National Center for Health Statistics. STUDY DESIGN: Mammograms, pap smears, blood pressure checkups, cholesterol level checkups, and flu shots were examined. A modified behavioral model framework was presented, which controlled for the endogeneity of having a usual source of care. Based on this framework, a two-equation empirical model was established to predict the probabilities of having a regular doctor and having a regular site, and use of each type of preventive service. PRINCIPAL FINDINGS: Having a regular doctor was found to have a greater impact than having a regular site on discretional preventive services, such as blood pressure and cholesterol level checkups. No statistically significant differences were found between the effects a having a regular doctor and having a regular site on the use of flu shots, pap smears, and mammograms. Among the five preventive services, having a usual source of care had the greatest impact on cholesterol level checkups and pap smears. CONCLUSIONS: Promoting a stable physician-patient relationship can improve patients' timely receipt of clinical prevention. For certain preventive services, having a regular doctor is more effective than having a regular site.     

Developing service user involvement in the South Korean disability services: lessons from the experience of community care policy and practice in UK

This paper considers the scope for the integration of service user involvement within services for people with disabilities in South Korea at a time of rapid development in social policy and practice. Using the UK experience of introducing community care and a mixed economy of service provision over the last 14 years, this paper considers the barriers to service user involvement inherent in the South Korean context and concludes that in a society where there is a shortage of services and a provider-orientated delivery system where most services are delivered by voluntary organisations, more public services are needed and a 'democratic' rather than a consumerist approach to user involvement is required. Some elements of the UK system could inform the development of a systematic approach to user involvement in South Korea, notably the right to assessment within a care management structure, the setting of quality care standards and inspection processes and a complaints procedure.     

A framework for clinical general practice and for research and teaching in the discipline

This paper uses three typical case stories from general practice to demonstrate that a GP simultaneously considers four dimensions when making a diagnosis and planning subsequent treatment of a patient in the consultation: (i). a biomedical dimension; (ii). a culture and context dimension; (iii). a medico-psychological dimension; and (iv). a network and social dimension. By taking this diagnostic and therapeutic approach, the GP adds value to the total performance of the health care system. It is demonstrated that a GP needs theoretical, research-based knowledge and skills within all four dimensions, and that it is necessary for a GP to work together with both medical and non-medical disciplines when defining the research and teaching agenda. It is stressed that consultation and communication skills are important tools for any doctor, and the value of continuity of care is discussed. Finally, the implications of the diagnostic approach with respect to planning research and teaching programmes are discussed, and the need for a better balance is stressed.     

Instructional Insights: Restructuring the Fieldwork Experience: One Clinic's Journey

Although there are standards for occupational therapy education, there are no universal standards for the affiliated fieldwork settings, only guidelines from the educational institutions. As a result, a student learning experience often varies dramatically from facility to facility. Several factors that may affect the clinical experience include the preparedness of a student, the willingness of a clinic to work through potential student challenges, and the theoretical foundation a clinic has built for disseminating occupational therapy practice skills. This article highlights the journey of one clinic through a redesign of the occupational therapy fieldwork program and outlines the steps taken to transform student experiences and improve program success. Starting with a self-directed review of the fieldwork process, and through a combination of program redesign, application of a theoretical foundation, and refocus toward a competency-based program, the student success rate at this acute rehabilitation hospital drastically improved and achieved positive feedback from all involved.     

Sexually Dimorphic Effects of a Western Diet on Brain Mitochondrial Bioenergetics and Neurocognitive Function

A Western diet (WD), high in sugars and saturated fats, impairs learning and memory function and contributes to weight gain. Mitochondria in the brain provide energy for neurocognitive function and may play a role in body weight regulation. We sought to determine whether a WD alters behavior and metabolic outcomes in male and female rodents through impacting hippocampal and hypothalamic mitochondrial bioenergetics. Results revealed a sexually dimorphic macronutrient preference, where males on the WD consumed a greater percentage of calories from fat/protein and females consumed a greater percentage of calories from a sugar-sweetened beverage. Both males and females on a WD gained body fat and showed impaired glucose tolerance when compared to same-sex controls. Males on a WD demonstrated impaired hippocampal functioning and an elevated tendency toward a high membrane potential in hippocampal mitochondria. Comprehensive bioenergetics analysis of WD effects in the hypothalamus revealed a tissue-specific adaption, where males on the WD oxidized more fat, and females oxidized more fat and carbohydrates at peak energy demand compared to same-sex controls. These results suggest that adult male rats show a susceptibility toward hippocampal dysfunction on a WD, and that hypothalamic mitochondrial bioenergetics are altered by WD in a sex-specific manner.