美国“家庭医院”项目对中国“互联网+家庭病床”建设的启示

介绍美国“家庭医院”项目的研究概况、运营模式。概述我国“互联网+家庭病床”建设现状,认为我国“互联网+家庭病床”建设可以借鉴美国“家庭医院”项目的特色,创建医院-社区联动服务模式,打造“第三方医疗团队”以及研发“互联网+家庭病床”工具包等。     

中医院“互联网+”医疗服务与管理现状的研究

“互联网+”医疗服务模式在各大西医院的发展已经初具规模,而且整体发展速度较快,各类研究文献层出不穷。但是针对中医院开展“互联网+”医疗服务的现状,还没有展开广泛而深入的研究。中医因其学科专业特点,在养生保健、治未病、重大疾病治疗和康复等领域都有不可替代的重要作用,这也决定了中医院的“互联网+”医疗服务模式与西医院有着较大的差别。文章以山西省S医院（省级公立三甲中医院）为主要研究对象,重点研究山西省公立三甲中医院“互联网+”医疗服务开展的现实状况、存在问题及问题产生的原因,并在此基础之上提出进一步的发展建议。     

面向区域医疗的互联网医院平台的设计与应用

目的 创新区域医疗互联网+医疗健康服务模式,优化健康服务流程,统筹整合优质医疗卫生资源.方法 基于互联网医院和数据中心,通过服务模式创新及医疗资源开放等举措,形成资源整合及能力提升的医院集团互联网医院平台.结果 实现互联网+居民就医、互联网+在线诊疗、互联网+健康评估、互联网+分级诊疗、互联网+医疗协同、互联网+远程诊...     

基于比较优势的移动医疗促医患关系改善

目的 分析移动医疗和“互联网+”及其他影响医患关系因素的比较优势来助推医患关系新变化.方法 比较研究的方法.包括①在明确移动医疗概念及其与“互联网+”异同的基础上,分析移动医疗与“互联网+”的比较优势;②分析移动医疗与影响医患关系各因素的比较优势.结果 医患关系新变化表现为患者线上咨询预约,医生线下精准诊疗.患者由被动...     

医联体互联网医院支付结算系统研究

目的:医联体互联网医院支付结算系统的建设旨在落实“互联网+医疗健康”示范区建设,落实分级诊疗和资源下沉,降低医疗费用,提升居民幸福感。方法:根据该地区及医院的实际情况,某省级人民医院构建以区域医院为主体的医联体收费管理和统一支付结算服务平台,深度整合各级医疗服务机构资源,打通各级医疗机构支付结算体系,统一线上线下全流程的就医服务模式。结果:通过对医联体“互联网+医疗服务”模式的探索,逐步实现线上远程医疗、慢病管理、支付结算等全流程就医服务。结论:将患者、医疗机构、金融机构三方联通,打造医疗全流程闭环服务,对在实践中落实“互联网+医疗健康”示范区建设,落实分级诊疗和资源下沉等具有重要意义。     

基于微信公众号就医服务模式的探讨

面对公立医院“看病难”的现状,微信作为互联网时代的社交工具,已被应用到人们的日常生活中,医院通过建立微信公众号,通过主动推送医疗信息,实现微信预约挂号?微信挂号?微信分诊排队?微信实时自助缴费?微信医患沟通等功能,是对现有医院医疗服务流程进行再造,打破现有医疗服务必须在院内完成的现状,将原有的院内的医疗服务向公众日常使用的手机上拓展?医院需要充分应用现有安全软硬件技术,在基于”互联网+”的微信服务新技术应用与信息安全中找到平衡点,为患者提供优质?便捷的医疗服务?     

基于“互联网+”医护联动延伸服务模式的构建及实践效果△

目的：探索构建基于“互联网 + ”的医护联动延伸服务模式,并评价其应用效果。方法：以“互联网+护理”及“互联网云门诊”为基础,通过建立医护服务组织架构、制定规范制度流程、确定运行模式、筑牢全程安全风险防控等,构建医护联动延伸服务模式,为患者提供院内外延续的医疗护理健康管理服务,满足患者持续动态医疗护理服务需求。结果：2021年3月~2022年 2月开展“互联网+服务”项目30项,完成“互联网+护理服务”514次,完成医护联动服务413次,未发生不良事件,患者满意度为97.24±2.56分（满分100分）。结论：实施基于“互联网+”的医护联动延伸服务模式,实现了线上线下医疗护理服务有效对接,使医疗卫生资源下沉,上下联动,把大医院医生引到基层,为城乡居民提供立体化、连续性的医疗护理健康服务,运行有效。     

医院开展“互联网+医疗健康”服务的实践与思考

目的：依托“互联网+”技术,提升医疗服务质量和水平。方法：对医院利用“互联网+”在优化诊疗流程、助推分级诊疗、强化医院管理三个方面开展的实践进行分析探讨。结果：医院依托互联网技术,改善了患者就医体验,实现了医疗资源共享,提高了工作效率。结论：利用“互联网+医疗”,探索创新医疗服务新模式,可为患者提供更优质的医疗服务。     

“互联网+全科医师”服务模式的探索与实践

在“互联网+”新形势下,为优化医疗资源配置、转变服务理念、优化就医流程、规范分级诊疗,充分体现“以患者为中心”服务理念,十堰市太和医院全科医师团队开展“互联网+全科医师”线上诊疗服务工作。现对该模式相关流程内容进行介绍,为我国医疗卫生机构开展”互联网+全科医师”服务提供参考。     

"互联网+"医疗服务供给:模式比较及优化路径

当前,我国处在"互联网+"医疗高速发展时期,出现了多种供给模式.本文以案例的形式,比较分析"互联网+"医疗服务的三种供给模式——实体医院的线上扩展模式(H模式)、实体医院与互联网医疗平台的服务融合模式(H+I模式)、区域性医疗云平台模式(DHI模式),提出"互联网+"医疗服务供给的优化路径:提升"互联网+"医疗服务质量...     

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.     

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.     

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.     

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.     

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.     

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.