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。     

基于64位Windows 2003和Oracle 10g RAC的“军卫一号”数据库的升级

目的：完成＂军卫一号＂数据库平台升级,解决服务器负载过重及数据库并发连接数过多导致数据库无法连接的难题。方法：操作系统升级为Windows 2003（64位）,Oracle数据库从8.17升级为10g（64位）,并建立RAC,通过多进程、分用户的导出/导入模式完成数据迁移。结果：实现了＂军卫一号＂数据库的高性能和高可用性。结论：基于64位Windows平台、将数据库从Oracle 8.17升级为64位10g RAC是一个投入少、效益高的好办法。     

通过局域网实现异地自动备份HIS数据库的方法

目的:寻找一种安全可靠的异地备份医院数据库的方法。方法:通过FTP方式实现局域网内自动异地备份数据库。结果:经过安装调试,局域网内多台PC每天定时备份服务器数据库。结论:通过局域网异地备份医院数据库的方法安全、可靠,切实可行。     

计划免疫及计免保偿网络化管理探讨

目的：提高计划免疫工作效率和管理水平。方法：根据国家计划免疫管理技术规范入本地实际情况，采用计算机网络技术、数据库管理技术，对计划免疫和计免保偿进行网络管理。结果：提高了计划免疫管理的质量和工作效率，提高了报表的及时性、准确性、一致性和完整性，实现了异地建卡异地接种，实现了卫生行政部门及卫生防疫机构对计划免疫的现场监督监测。结论：该系统的成功运用，为计划免疫工作探索出了一条现代化、规范化管理方法。     

“军卫一号”实现Oracle8i到Oracle10g升级方法

目的：介绍Oracle数据库由Oracle8i升级到Oracle10g的一种完整实现方法及重点注意事项。方法：采用手工可控的方式,利用数据库自带的Exp/Imp工具,实现了数据库的跨平台、跨版本升级。结果：成功实现了Oracle数据库由32位Windows2000 Server系统下的Oracle8.1.6升级到64位Windows2003 Server系统下的Oracle10.2.0.4。结论：在节奏可控的方式下完成数据库的跨平台、跨版本升级,升级过程清晰明了,数据库升级过程的未知风险较少,适合推广应用。     

“军卫一号”数据库“瘦身”方法设计

目的：实现“军卫一号”数据库“瘦身”,提高整个系统的运行速度。方法：离线式整理表空间,降低高水位线,或在线式重建表空间,缩减数据文件。结果：2种方法都可成功实现数据库的“瘦身”,且能使系统平稳运行。结论：2种方法都具有可行性,且可操作性强,可提高整个“军卫一号”系统的运行效率。     

64层螺旋CT轴位薄层扫描在颞骨检查中的临床价值

目的：评价多平面重建技术（MPR）与容积再现技术（VRT）对正常内耳的显示能力。方法：将40名非内耳疾病志愿者分别采用HRCT扫描（20例，40耳）和轴位薄层扫描（20例，40耳），后者行MPR和VRT重建，并且，将前者轴、冠状扫描图像与相应的重建图像的显示质量进行统计评分处理，验证能否达到各向同性。结果：两组图像均达到各向同性（P〉0.05）,MPR图像清晰显示了正常内耳的内部骨性结构，半规管、耳蜗、听骨链和面神经管等结构实现了最佳同层显示，VRT图像清晰显示了正常内耳的空间立体结构。结论：MPR和VRT可清晰显示正常内耳结构，对内耳病变的诊断有重要帮助。     

“军卫一号”数据库从Oracle8．17到Oracle 10g的升级实现

目的：将“军卫一号”数据库从Oracle8．17升级到Oracle10g。方法：在充分测试的基础上，通过建立数据库链接，实现数据迁移。结果：成功实现了数据库升级，系统运行速度大大提高。结论：在现有技术条件下。将32位的Oracle8．17升级到64位Oracle10g数据库，具有可操作性，升级后效益明显。     

“军卫一号”数据库从8i到10g的迁移

目的：实现＂军卫一号＂数据库从Oracle8i到Oracle10g的迁移。方法：利用Oracle的导出/导入工具实现数据库迁移。结果：成功实现了数据库迁移。结论：在数据量不大的情况下,该方法步骤简单,可操作性强,数据库宕机时间可接受,适合中小医院推广应用。     

江苏省异地就医现状分析及对策研究

目的通过调查江苏省各统筹地区异地就医人数、费用发生情况,分析目前江苏省异地就医的现状及存在的问题,从而探寻有效解决江苏省异地就医问题的途径与方法。方法调查数据采用Excel软件建立数据库,采用SPSS11．0、Excel等软件对异地就医发生数、人员主要流向、费用情况等方面进行描述性统计分析。结果江苏省异地就医登记人数为281700人,其中退休人群所占比重较大：就医流向以省内为主,省外为辅。从发生费用来看,异地就医者医疗费用的自付比例较本地就医人群要高,负担较重。结论建立省级数据交换中心,实施数据管理与传输,协调各地异地就医管理,切实解决异地就医问题。     

Shallow, Non-pumped Wells: A Low-Energy Alternative for Cleaning Polluted Groundwater

This modeling study evaluated the capability of non-pumped wells with filter media for preventing contaminant plumes from migrating offsite. Linear configurations of non-pumped wells were compared to permeable reactive barriers in simulated shallow homogeneous and heterogeneous aquifers. While permeable reactive barriers enabled faster contaminant removal and shorter distances of contaminant travel, non-pumped wells also prevented offsite contaminant migration. Overall, results of this study suggest that discontinuous, linear configurations of non-pumped wells may be a viable alternative to much more costly permeable reactive barriers for preventing offsite contaminant travel in some shallow aquifers.     

A survey of environmental safety issues at 20 medical clinics

In the study described in this article, the authors performed safety walk-throughs or inspections for 20 clinics located both inside a major medical center clinic (onsite) and away from the main clinic site (offsite). A checklist was used to evaluate compliance with institutional, local, state, and federal guidelines and regulations. The results obtained at onsite clinics were compared with the results from offsite clinics. Findings suggested no overall difference in the number of yes (desirable) answers. A marginally significant difference, however, was observed between the onsite and offsite clinics with regard to knowledge of infection control and waste/infection control questions. The walk-throughs helped create an improved working relationship between clinic personnel and environmental safety personnel, allowed for correction of safety issues, enabled an informal training opportunity, and increased institutional compliance with guidelines and regulations.     

Chlorpyrifos-Treated Crops in the Vicinity of Surface Water Contamination in the San Joaquin Valley, California, USA

Due to frequent contamination of streams in the San Joaquin Valley, California, USA, with the insecticide chlorpyrifos, researchers are working to identify crop-specific management practices that will reduce the offsite movement of this compound into surface waters. To guide this effort, crops treated with chlorpyrifos in the vicinity of contaminated streams were identified; walnut, alfalfa, and almond were the primary crops identified. Use was higher on walnut and almond, but due to irrigation practices offsite movement in surface runoff may be more likely from alfalfa. Based on these findings, development of management practices to reduce off-site movement of chlorpyrifos in irrigation runoff from treated alfalfa fields is recommended.     

Uncertainty in transport factors used to calculate historical dose from 131I releases at the Savannah River Site

During the 1950's, atmospheric release of 131I was one of the largest contributors to offsite dose at the Savannah River Site. Computer models used to estimate offsite dose involve the use of many parameters with wide ranges of uncertainty. The overall uncertainty in dose can be estimated by propagating the uncertainty of each parameter through the model. A major component of the calculational model can be solved for a given release scenario and condensed into a transport factor, which, when multiplied by the air concentration (or deposition) and the appropriate dose conversion factor, can be used to estimate a specific pathway dose. Uncertainties are estimated for the period of 1955-1961 for all parameters contributing to the 131I transport factor for each pathway. The overall transport factor including all pathways has ranges characterized by maximum-to-minimum ratios (95% to 5%) of about 40. The parameter shown to have the greatest impact on the transport factor calculation was the fraction of elemental iodine released.     

Emergency drugs in general practice

General practitioners need the knowledge, skills, drugs and equipment for managing medical emergencies. Clinics need treatment rooms and doctor's bags that enable emergencies to be managed onsite and offsite respectively. Rural medical generalists may provide more advanced emergency management in their local hospitals. In managing emergencies, GPs may be working with paramedics, therefore it helps to be familiar with their skills and with the drugs they carry.     

Pseudomonas dermatitis/folliculitis associated with pools and hot tubs--Colorado and Maine, 1999-2000

During 1999-2000, outbreaks of Pseudomonas aeruginosa dermatitis and otitis externa associated with swimming pool and hot tub use occurred in Colorado and Maine. This report summarizes these outbreaks and provides recommendations for swimming pool and hot tub operation and maintenance, particularly when using offsite monitoring of water disinfectant and pH levels or when cyanuric acid is added to pools as a chlorine stabilizer.     

Illness associated with drift of chloropicrin soil fumigant into a residential area--Kern County, California, 2003

Chloropicrin is the fourth most commonly used soil fumigant in California. Exposure to chloropicrin causes eye and respiratory tract irritation, vomiting, and diarrhea. This report describes an investigation by the California Department of Pesticide Regulation (CDPR) and the Kern County Agriculture Commissioner (KCAC) into illnesses associated with the offsite drift of chloropicrin in Kern County. A total of 165 persons experienced symptoms consistent with chloropicrin exposure. The findings underscore health risks associated with fumigants and the usefulness of procedures adopted in California to ensure both prompt identification of exposure events and timely notification of the affected public.     

Radiological risk from consuming fish and wildlife to Native Americans on the Hanford Site (USA)

Historical operations at the Hanford Site (Washington State, USA) have released a wide array of non-radionuclide and radionuclide contaminants into the environment. As a result of stakeholder concerns, Native American exposure scenarios have been integrated into Hanford risk assessments. Because its contribution to radiological risk to Native Americans is culturally and geographically specific but quantitatively uncertain, a fish and wildlife ingestion pathway was examined in this study. Adult consumption rates were derived from 20 Native American scenarios (based on 12 studies) at Hanford, and tissue concentrations of key radionuclides in fish, game birds, and game mammals were compiled from the Hanford Environmental Information System (HEIS) database for a recent time interval (1995-2007) during the post-operational period. It was assumed that skeletal muscle comprised 90% of intake, while other tissues accounted for the remainder. Acknowledging data gaps, median concentrations of eight radionuclides (i.e., Co-60, Cs-137, Sr-90, Tc-99, U-234, U-238, Pu-238, and Pu-239/240) in skeletal muscle and other tissues were below 0.01 and 1 pCi/g wet wt, respectively. These radionuclide concentrations were not significantly different (Bonferroni P>0.05) on and off the Hanford Site. Despite no observed difference between onsite and offsite tissue concentrations, radiation dose and risk were calculated for the fish and wildlife ingestion pathway using onsite data. With median consumption rates and radionuclide tissue concentrations, skeletal muscle provided 42% of the dose, while other tissues (primarily bone and carcass) accounted for 58%. In terms of biota, fish ingestion was the largest contributor to dose (64%). Among radionuclides, Sr-90 was dominant, accounting for 47% of the dose. At median intake and radionuclide levels, estimated annual dose (0.36 mrem/yr) was below a dose limit of 15 mrem/yr recommended by the United States Environmental Protection Agency (USEPA), as well as below a dose limit of 100 mrem/yr proposed by the International Commission on Radiation Protection (ICRP). Similarly, lifetime cancer risk (1.7E−5), calculated with median inputs, was below risk levels corresponding to these dose limits. However, our dose and risk estimates apply to only one pathway within a multidimensional exposure scenario for Native Americans. On the other hand, radiation dose and risk corresponding to onsite tissue concentrations were not significantly different from those corresponding to offsite (background) concentrations. Recognizing uncertainties in exposure and toxicity assessments, our results may facilitate informed decision making and optimize resource allocation within a risk assessment framework at the Hanford Site.     

Burnout and Associated Factors Among Health Care Workers in Singapore During the COVID-19 Pandemic

ObjectivesThe strain on health care systems due to the COVID-19 pandemic has led to increased psychological distress among health care workers (HCWs). As this global crisis continues with little signs of abatement, we examine burnout and associated factors among HCWs.DesignCross-sectional survey study.Setting and ParticipantsDoctors, nurses, allied health professionals, administrative, and support staff in 4 public hospitals and 1 primary care service in Singapore 3 months after COVID-19 was declared a global pandemic.MethodsStudy questionnaire captured demographic and workplace environment information and comprised 3 validated instruments, namely the Oldenburg Burnout Inventory (OLBI), Safety Attitudes Questionnaire (SAQ), and Hospital Anxiety and Depression Scale (HADS). Multivariate mixed model regression analyses were used to evaluate independent associations of mean OLBI-Disengagement and -Exhaustion scores. Further subgroup analysis was performed among redeployed HCWs.ResultsAmong 11,286 invited HCWs, 3075 valid responses were received, giving an overall response rate of 27.2%. Mean OLBI scores were 2.38 and 2.50 for Disengagement and Exhaustion, respectively. Burnout thresholds in Disengagement and Exhaustion were met by 79.7% and 75.3% of respondents, respectively. On multivariate regression analysis, Chinese or Malay ethnicity, HADS anxiety or depression scores ≥8, shifts lasting ≥8 hours, and being redeployed were significantly associated with higher OLBI mean scores, whereas high SAQ scores were significantly associated with lower scores. Among redeployed HCWs, those redeployed to high-risk areas in a different facility (offsite) had lower burnout scores than those redeployed within their own work facility (onsite). A higher proportion of HCWs redeployed offsite assessed their training to be good or better compared with those redeployed onsite.Conclusions and ImplicationsEvery level of the health care workforce is susceptible to high levels of burnout during this pandemic. Modifiable workplace factors include adequate training, avoiding prolonged shifts ≥8 hours, and promoting safe working environments. Mitigating strategies should target every level of the health care workforce, including frontline and nonfrontline staff. Addressing and ameliorating burnout among HCWs should be a key priority for the sustainment of efforts to care for patients in the face of a prolonged pandemic.