两种适用医院信息系统容灾与数据备份的方案

医院数据灾难恢复是医院业务连续性计划的一部分,其中最为关键是建立医院数据容灾系统和数据备份,如何实现各系统紧密配合的一体化医疗信息系统,以及医院信息系统的容灾建设将成为各医院信息中心的重点。本文就医院信息系统容灾与数据备份进行探讨。     

Making a bad thing worse: effects of communication of results of an epidemiological study after an aviation disaster

Cognitions attributing health complaints to disaster exposure are associated with more severe health complaints and are therefore a promising target for interventions. Little is known about the best strategy to modify such cognitions following exposure to a technological disaster at the community level. In 1992, a Boeing 747 crashed in a residential area in Amsterdam, the Netherlands. Persisting rumours about the possible toxic cargo of the plane led to increasing health concerns among the residents and rescue workers involved in the disaster. The current study investigates (a) the effectiveness of providing information on the health consequences of exposure to the aviation disaster to residents and rescue workers with varying degrees of exposure to the disaster, and (b) individual characteristics which may moderate the effectiveness of the health information provided. A total of 1019 rescue workers and 453 residents involved with varying degrees in the disaster participated in an epidemiological investigation and 1736 rescue workers and 339 residents, all involved, participated in an individual medical examination. Participants were assessed at baseline and 6 weeks after communication of the results of the epidemiological study. Main outcome measures evaluated health anxiety, somatic sensitivity, reassurance by a physician, psychopathology, post-traumatic stress symptoms, fatigue and quality of life. All participants reported elevated levels of psychopathology and fatigue, increased anxiety and uncertainties about their health 6 weeks after communication of the study results irrespective of the degree of exposure to the disaster. In particular, the conviction that health complaints were caused by toxic exposure was related to more severe health complaints and worries in both rescue workers and residents. Our study shows that communication about the health consequences of exposure to an aviation disaster at the community level has no symptom reducing or reassuring effects. Tailoring of the communication to individual characteristics such as existing expectancies may enhance its impact.     

Disaster preparedness among families of children with special health care needs

Families with children with special health care needs may present a challenge for disaster responders. This study examined the level of personal disaster preparedness among this at-risk population in relation to the general population, and explores whether special health care needs or perception of disaster risk affects preparedness levels. A convenience sample of 145 families presenting to an urban tertiary care children's hospital was surveyed using a previously validated instrument to gather information on levels of preparedness and factors influencing preparedness. In spite of significant special health care needs and concern about disasters, families remain unprepared for a disaster event. Health care and psychosocial support workers are in a unique position to increase preparedness levels in this at-risk population.     

Is Previous Disaster Experience a Good Predictor for Disaster Preparedness in Extreme Poverty Households in Remote Muslim Minority Based Community in China?

Disaster preparedness is an important preventive strategy for protecting health and mitigating adverse health effects of unforeseen disasters. A multi-site based ethnic minority project (2009–2015) is set up to examine health and disaster preparedness related issues in remote, rural, disaster prone communities in China. The primary objective of this reported study is to examine if previous disaster experience significantly increases household disaster preparedness levels in remote villages in China. A cross-sectional, household survey was conducted in January 2011 in Gansu Province, in a predominately Hui minority-based village. Factors related to disaster preparedness were explored using quantitative methods. Two focus groups were also conducted to provide additional contextual explanations to the quantitative findings of this study. The village household response rate was 62.4 % (n = 133). Although previous disaster exposure was significantly associated with perception of living in a high disaster risk area (OR = 6.16), only 10.7 % households possessed a disaster emergency kit. Of note, for households with members who had non-communicable diseases, 9.6 % had prepared extra medications to sustain clinical management of their chronic conditions. This is the first study that examined disaster preparedness in an ethnic minority population in remote communities in rural China. Our results indicate the need of disaster mitigation education to promote preparedness in remote, resource-poor communities.     

Psychosocial care following the firework disaster in Enschede; the lessons from the Bijlmer airline disaster

When the psychosocial-care scheme for victims of the firework explosion in Enschede, the Netherlands (2000) was set up, lessons learned from the Bijlmer airline disaster (Amsterdam 1992) were put into practice. The aftermath of this incident showed that psychological and physical health problems can still occur many years later. The main failure of the aftercare of the Bijlmer disaster lay in the coordination of aid and the monitoring of health problems. In Enschede steps were taken to redress these problems. An information and advice centre (IAC) was set up to monitor the well-being of the victims, and to provide them with information and, where necessary, assistance. It is responsible for limiting the effects of the disaster. A total of 13,000 people have consulted the IAC. A residents' association was formed. This gave the victims a common voice during the process of attempting to restore normality in their lives. A specialized mental health-care unit was founded to treat disaster-related disorders using evidence-based treatments. So far approximately 1,300 people have consulted this body. A longitudinal study has been set up to map the consequences of the disaster and to advise aid organizations. This will also give information on the extent to which these methods have been able to limit the long-term consequences.     

上海市金山区临床护士灾害护理能力现况调查及影响因素研究

目的调查上海市金山区临床护士的灾害护理能力及灾害应急知识掌握现状,探讨临床护士灾害护理能力的影响因素。方法通过便利抽样法,选取金山区5所二级及以上医院及11家社区卫生服务中心的1270名临床护士作为研究对象,采用一般资料调查表、临床护士灾害护理能力评估工具及灾害应急知识量表进行问卷调查,采用多元线性回归模型分析灾害护理能力的影响因素。结果收到有效问卷1263份,回收率为99.44%。1263名临床护士的灾害护理能力总分为(204.64±43.88)分,其中备灾能力均分最高,减灾/预防能力均分最低;临床护士灾害应急知识总分(134.97±30.60)分,其中事故指挥系统均分最高,特殊护理及隔离、去污均分最低。多元线性回归分析结果显示:相比三级医院,社区医院的护士灾害护理能力得分较低(β=-5.966,P=0.017);相比其他科室,急诊/ICU护士的灾害护理能力得分较高(β=5.765,P=0.029);护士灾害应急知识总分越高者,其灾害护理能力得分越高(β=1.000,P<0.001)。结论上海市金山区临床护士灾害护理能力、灾害应急知识储备整体处于中等偏上水平,在减灾/预防能力及恢复/重建能力上仍有待进一步提升。护理管理者可通过提升护士灾害应急知识水平、加强对急诊和ICU以外科室的护士以及三级医院以下护士的培训,提升临床护士的灾害护理能力。     

汶川地震灾后长久性防疫队伍的建立及运行机制探讨

地震灾后如何建立一支撤不走的防疫队伍,真正承担灾后长期的防病工作,是灾后防病工作的迫切要求。为适应灾后防疫形势的需要,该地在防疫工作中,充分整合多方资源,实行分级负责、划片包干、责任到单位、任务到人头的组织形式,加强社区人员和外援队伍能力建设,实行疾控、卫生监督和社区联动工作机制。具体动作中,实行划片操作、社区实施、重点突击、跟随督导、内部督查、信息及时反馈、药械方便提供等运作机制,逐渐建立起了一支以当地为主,能有效承担责任区域内防病工作的撤不走的防疫队伍,探索和建立了切实可行的运行机制,有效保护了灾区人民的生命健康。     

医院信息系统容灾方案的设计与实施

目的：设计一套针对医院信息系统的容灾方案。方法：采用冗余备份技术、双机热备技术、集群和负载均衡技术,来实现医院信息系统的数据容灾和应用容灾。结果：设计方案达到了数据容灾和应用容灾的效果,一定程度上保证了业务的连续性。结论：提高了系统的可靠性和可用性。     

Learning from Each Other

Summary

Australian social workers in health care have become important members of hospital disaster response teams. The development of the role and its integration into the mainstream disaster response has progressed over the last two decades. Recent international events have given affirmation to the importance of this role.

The development of national and state based disaster management plans in Australia began in the mid 1970s. Recognition of the need for experienced, skilled workers to provide emotional support, practical assistance and grief and bereavement counselling has resulted in the inclusion of social workers in several key parts of the disaster management response including the specialised area of disaster victim identification.

Following the Bali Bombing in October 2002, social workers worked with the police missing persons unit to provide support to families and facilitate the collection of ante mortem information.

The process by which new services come about can be intricate and complex. In the field of health social work, the contribution of international programs such as the Mt. Sinai Leadership Enhancement Program cannot be underestimated. As the Social Work Director of Westmead Hospital, one of the largest hospital social work departments in the country, participating in this program provided opportunities to share professional experience with international colleagues, many of whom are experts in their field.

The social work role in disaster response has become internationally recognised and is an example of how collaboration and shared information and learning can result in a profession working together to support key principles and values of practice for the benefit of those in need.     

信息系统容灾技术的应用设计与比较

目的：探索减轻任何不可预知事件对信息系统正常运行灾难性影响的容灾方案,提高数据管理的安全性、可靠性。方法：根据医院信息化建设的实际情况,针对存储镜像、主机镜像、数据库镜像技术等3种容灾技术的原理和特点,进行了分析和比较。结果：基于存储镜像技术的客灾技术,具有可支持各种应用和操作系统、故障恢复机制简单、易于操作、管理方便、性价比合理的特点。结论：根据具体需求,合理地选择一种或综合采用多种容灾技术,这样才能建设成安全、可靠的信息系统容灾体系。     

Disaster recovery for electronic data: are you prepared?

Disasters that affect medical data may come in many forms, but those that can harm sensitive computer information are not necessarily dramatic. Even so, the problems that can arise if data is lost can be severe. This article discusses the issues of how to recover data once an information technology disaster has occurred and how to prevent or guard against disaster. Not all disasters are preventable, but many are. Even if a disaster is not preventable, certain practices in advance can ease the process of recovery.     

医院物理备用数据库异地搭建探讨

目的：建立医院异地容灾备份数据库,提高医院信息系统的数据应急和容灾抗灾能力。方法：运用Oracle 11g Data Guard相关配置,采用最大性能模式,搭建物理备用数据库,实现异地容灾。结果：Oracle 11g物理备用数据库成功搭建。实现了异地的应用级容灾。结论：该物理备用数据库很好地满足了数据库异地容灾的需求,保障了医院业务数据库服务的可用性和可靠性。     

ISEA2007 panel: integration of better exposure characterizations into disaster preparedness for responders and the public

An expert panel was convened in October 2007 at the International Society for Exposure Analysis Annual Meeting in Durham, NC, entitled "The Path Forward in Disaster Preparedness Since WTC-Exposure Characterization and Mitigation: Substantial Unfinished Business!" The panel prospectively discussed the critical exposure issues being overlooked during disaster responses and highlighted the needs for an optimal blending of exposure characterizations and hazard controls within disaster settings. The cases were made that effective and timely exposure characterizations must be applied during responses to any disaster, whether terrorist, manmade, or natural in origin. The consistent application of exposure sciences across acute and chronic disaster timelines will assure that the most effective strategies are applied to collect the needed information to guide risk characterization and management approaches. Exposure sciences must be effectively applied across all phases of a disaster (defined as rescue, reentry, recovery, and rehabitation-the four Rs) to appropriately characterize risks and guide risk-mitigation approaches. Failure to adequately characterize and control hazardous exposures increases the likelihood of excess morbidity and mortality. Advancing the infrastructure and the technologies to collect the right exposure information before, during, and immediately after disasters would advance our ability to define risks and protect responders and the public better. The panel provided conclusions, recommendations, and next steps toward effective and timely integration of better exposure science into disaster preparedness, including the need for a subsequent workshop to facilitate this integration. All panel presentations and a summary were uploaded to the ISES(1) website (http://www.iseaweb.org/Disaster_Preparedness/index.php).     

The Benefits of Designing a Stratification System for New York City Pediatric Intensive Care Units for Use in Regional Surge Capacity Planning and Management

Accurate assessment of New York City (NYC) pediatric intensive care unit (PICU) resources and the ability to surge them during a disaster has been recognized as an important citywide emergency preparedness activity. However, while NYC hospitals with PICUs may be expected to surge in a disaster, few of them have detailed surge capacity plans. This will likely make it difficult for them to realize their full surge capacity both on individual and regional levels. If the pediatric resources that each NYC PICU hospital has can be identified prior to a disaster, this information can be used to both determine appropriate surge capacity goals for each PICU hospital and the additional resources needed to reach those goals. City agencies can then focus citywide planning efforts on making these resources available and more easily anticipate what a hospital will need during a disaster. Communication of this hospital information both prior to and during a surge situation will be aided by a stratification system familiar to both city planners and hospitals. The goal of this project was to design a NYC PICU surge stratification system that would aid physicians, hospitals and city agencies in regional surge capacity planning for critical pediatric patients. This goal was demonstrated through two objectives. The first identified major factors to consider when designing a stratification system. The second devised a preliminary system of PICU stratification based on clinical criteria and resources.     

山区地震灾后疾病预防控制工作模式探索

目的探索建立一套山区地震灾害发生后疾病预防控制工作能够在较短时间内迅速有效持续开展的防病工作模式。方法利用云南省彝良县“9·7”地震和四川省芦山县”4．20”地震灾后卫生防病工作中探索性建立并运行的方式和方法、各项工作中取得的效果进行整理、分析、总结。结果国家、省、市、县、军队、省外援助疾控队伍共500多人,在统一指挥、管理、要求、信息、方案“五统一”模式下,做了6个方面风险评估,根据灾区传染病流行风险等级,对灾情较重的乡镇、行政村实行细分任务、分片包干、入村蹲点,责任到人。彝良灾后43天内报告法定传染病254例,较上年同期（247例）仅上升2．83％;芦山报告乙丙类法定传染病9种54例,与前三年同期比较,报告病例数下降65．46％,无死亡,取得无传染病暴发流行的阶段性成果;无突发公共卫生事件发生;无灾后传染病死亡病例。结论在西南地区的山区探索一套独特的地震灾后防病工作模式,通过有效评估灾区防病风险,有序开展灾后防病工作,实现大灾之后无大疫。     

Committed to Working for the Community: Experiences of a Public Health Nurse in a Remote Area During the Great East Japan Earthquake

We examined the experiences of a public health nurse (PHN) in a rural area affected by the Great East Japan Earthquake. We used an ethnographic method to obtain in-depth information about her experiences, from which six themes were developed. The PHN risked her life to protect members of the community, but she remained anxious to see her own young children as soon as possible. Nevertheless, she was strongly committed to helping community members and continued to work for them. We suggest creating a practical system to allow PHNs to obtain information about the safety of their own families during a disaster.     

医院数据中心与容灾中心架构设计及实践应用

目的：建立基于医院HIS的应用级容灾中心架构,确保医院信息、数据服务不间断。方法：基于存储级数据镜像复制,在容灾存储上架设医院各类应用的容灾服务器,并根据实际运行环境定制不同应用的容灾与恢复机制,整体上形成应用级容灾架构。结果：能满足异地数据容灾要求并可实现HIS各项服务功能不间断运行。结论：该容灾架构搭建方式简单易行,是具有实用价值的医院信息容灾模式。     

浅谈信息系统的容灾

本文主要介绍了我们在实施医院信息化过程中,为提高信息系统的容灾能力而采取的一些措施,主要包括数据的备份与复制、灾难检测和系统迁移。随着网络技术的发展,容灾技术也不断向前发展,其未来发展趋势侧重于业务连续性和持续数据保护两个方面。     

利用遥感技术对洪涝灾区县界定分级的研究

目的 借助遥感技术，对洪涝灾区县界定分级指标和标准进行研究，为洪涝灾害救灾防病提供科学依据。方法 选择洪涝灾区县界定分级指标，依据1998年江西省洪涝灾害3次遥感淹没资料描述性分析的结果，确定洪涝灾区县界定分级标准。结果 依据遥感资料可以将洪涝灾区县划分成3大类：3次遥感资料中有1次遥感淹没面积超过6700hm^2的灾区县属于一类灾区县；3次遥感淹没面积均低于6700hm^2的灾区县属于二类灾区县；3次遥感资料均未显示有淹没存在的其它上报灾区县属于三类灾区县。结论 借助遥感、地理信息系统技术可以实现对洪涝灾区县及时、准确的界定分级，为洪涝灾害救灾防病疫情统计服务。     

北川县小坝乡汶川大地震灾后卫生防病状况调查

[目的]了解地震灾区灾后卫生防病工作状况,为开展灾后卫生援助,为灾后重建提供可靠依据。[方法]2008年7月,在北川县小坝乡的乡中心卫生院、乡驻地及各村进行调查。[结果]小坝乡震后公共卫生资源受到严重破坏,环境卫生、饮水卫生、饮食卫生均存在一定隐患,目前尚未出现相关疾病的暴发疫情。[结论]灾后小坝乡的公共卫生状况急需改善。