卫生部办公厅关于印发呼吸内镜诊疗技术管理规范（2012年版）的通知

各省、自治区、直辖市卫生厅局，新疆生产建设兵团卫生局：为加强呼吸内镜诊疗技术临床应用与管理，规范呼吸内镜临床诊疗行为，保证医疗质量和医疗安全，我部组织制定了《呼吸内镜诊疗技术管理规范（2012年版）》（可从卫生部网站医政管理栏目下载）。现印发给你们，请遵照执行。     

2012年内镜诊疗管理和技术交流大会

2012年11月23-24日北京国家会议中心会议内容主会场内容1.中国内镜医疗行业规范化管理政策及思路内容包括:中国内镜医师准入标准探索与交流、建立中国内镜医疗技术临床应用准入机制和规范管理的思路、四级内镜医师规范化培训及考核情况介绍等。2.德国、日本等内镜医师及诊疗技术准入管理内容包括:内镜医师的准入制度及相关政策实践经验介绍、内镜诊疗技术规范化管理经验介绍等。3.内镜诊疗技术的最新发展及展望分会场内容设立呼吸内科、消化科、普外科、骨科、泌尿外科、胸外科、妇科、儿科、小儿外     

SpyGlass DS系统在临床诊疗中的应用研究进展

随着当今科学技术的革新,内镜诊疗技术也得到了突飞猛进的发展。2015年SpyGlass DS系统的出现将内镜诊疗带到了一个新的高度,其凭借成像清晰、视野宽广、性能优良等特点已成为胆胰系统疾病诊断与治疗的新生力量。本文就目前SpyGlass DS系统在临床诊断和治疗中的应用效果进行综述。     

消息

内镜诊疗技术临床应用规范化管理项目泌尿外科专家工作会在沪召开2014年5月25~26日,卫生部人才交流服务中心在上海组织召开泌尿外科内镜诊疗技术专家工作会。内镜诊疗技术临床应用规范化管理项目泌尿外科专家组成员、四级泌尿外科内镜诊疗技术培训教材编写专家等70余人参加了此次会议。会上,卫生部人才交流服务中心副主任张俊华介绍了内镜诊疗技术临床应用规范化管理项目近期工作进展,希望泌尿外科内镜专家组继续发挥表率和示范带头作用,做好教材和基地评审资料审定工作。     

准入与培训制度是解决问题的根本

笔者认为此案例中存在两个最为普遍的问题：第一,内镜医师的准入和规范化培训,即什么样的临床医师能成为内镜医师,如何对内镜医师进行规范化的培训和教育,从而提高内镜医师的整体水平和临床能力,从而更安全合理地服务于患者;第二,如何促进内镜诊疗技术以及内镜诊疗领域的新进展新成果在内镜医师或普通临床医师,尤其是基层临床医师中的推广和应用,从而保证更多的患者能享受到微创诊疗技术进步所带来的益处。     

首届国际呼吸内镜诊疗大会在沪举行

由上海交通大学附属胸科医院主办,上海市医学会肺癌学组和卫生部呼吸内镜培训基地承办的“首届国际呼吸内镜诊疗大会暨肺癌诊疗新技术新进展学习班”于6月24日～26日在上海举行。与会者交流与分享了呼吸内镜新技术、诊疗技术的进展。     

规范管理 共谋发展 全国内镜诊疗技术临床应用规范化管理政策解读会侧记

为规范全国内镜诊疗技术临床应用,促进各地内镜诊疗技术临床应用管理和培训的交流学习,卫生部人才交流服务中心在国家卫生和计划生育委员会的指导下,于2014年6月20日在云南昆明召开全国内镜诊疗技术临床应用规范化管理政策解读会西南、西北片区会议。卫生部人才交流服务中心内镜项目管理人员,西南西北片区省（区、市）卫生计生委负责医政医管相关工作的人员,     

纤维支气管镜在小儿呼吸疾病中的应用

纤维支气管镜（纤支镜）在成人呼吸系疾病诊断、治疗中具有十分重要的价值,目前我国中等以上医院已先后开展了此项检查。随着技术的提高,诊疗措施不断改进,设备日趋完善,已部分代替了胸外剖胸探查或肺活检诊断肺部疾病;也是呼吸内科一项诊疗技术的重大突破。７０年代...     

浅析抗生素在呼吸系统疾病治疗中的应用

在当代,随着医学研究的深入,抗生素在临床治疗中的使用日益普遍。呼吸内科作为医院诊疗中重要科室,抗生素临床用药问题受到广大医师和患者的关注,它在决定患者病情治疗效果的同时,也影响到患者治疗的经济负担。本文分析了呼吸内科抗生素临床用药的现状,并对临床用药中的一些细节和注意事项进行了探讨。     

2012年内镜诊疗管理和技术交流大会

2012年11月23-24日北京国家会议中心会议内容主会场内容1.中国内镜医疗行业规范化管理政策及思路内容包括:中国内镜医师准入标准探索与交流、建立中国内镜医疗技术临床应用准入机制和规范管理的思路、四级内镜医师规范化培训及考核情况介绍等。2.德国、日本等内镜医师及诊疗技术准入管理内容包括:内镜医师的准入制度及相关政策实践经验介绍、内镜诊疗技术规范化管理经验介绍等。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.