职工医保患者住院费用项目分析

目的研究影响职工医保住院费用、自负费用的主要部分,从而为医院控制住院费用,医保主管部门制定完善医疗保险三个目录提供理论依据和政策基础。方法对费用组成进行医保类别分类,对构成比或率进行分析。结果医保乙类项目支出为职工医保住院患者的主要支出,自费项目使用得到较好控制;职工个人承担费用比例和费用额仍偏高主要原因是乙类项目首先自负费用偏高,还与病种、病情的危重程度有关。结论建议医疗保险目录中适当增加到甲类药品品种,适当提高诊疗技术尤其是危重患者监护抢救项目的限额支付标准．适时纳入成熟的新技术新项目;不同科室、不同病种应制定不同的费用控制措施。     

北京某三甲医院医疗保险自费项目的现状调查与分析

目的探讨目前北京某三甲医院的自费项目情况,找出主要的自费项目及其科室分布,为更好地控制自费比例提供依据。方法对2006年7月774例按项目付费的医保出院患者的自费项目进行调查,观察其自费比例和自费构成等指标。结果自费比例6.38%,其中,药品自费比例为2.64%,诊疗项目自费比例为3.74%。结论控制自费金额绝对值是有效控制自费比例的方法;自费项目监控包括吻合器缝合器、镇痛泵等诊疗项目方面及即复宁和人血白蛋白等药品方面。     

医患之间的法律关系

医患之间法律关系的性质近年来可说是争论纷纷、莫衷一是。有人认为医疗卫生是公益福利事业，医方履行的是一种社会公共职务，因而，医患关系是行政法律关系；有人认为医患之间是医疗服务合同关系；有人认为医患关系中患者是花钱买健康而且处于弱者地位，医患关系是消费关系。笔者认为，这几种说法都有失偏颇，医患关系有狭义和广义之分，广义的医患关系指的是医务人员（包括参与医疗活动的医院全体职工）在从事医疗事业中和患者（包括其代理人、近亲属以及利害关系）之间的关系，而这里的医疗包括医疗诊治，医疗科研和教学、医疗后勤管理等；狭义的医患关系仅指医生在为患者提供诊治技术和知识而建立的关系。医患法律关系不能一概而论，应根据医疗工作的不同含义、不同环节作具体的界定。     

提高线上医疗服务平台居民健康服务利用的机制探讨

选取3个线上医疗服务平台,进行服务内容、服务规模和平台发挥成效的关键靶点对比分析。认为,线上医疗服务平台通过打造一体化服务模式,打通医患之间信息壁垒,增强医患之间医疗连续性,有助于提高患者对于医生的依从性,提高居民的健康素养,提升医患之间的信任,但在实际药品流通上,存在着法律漏洞与风险,医生资格审查不够严谨,医生行为准则缺乏规范,医患矛盾的责任划分不够清晰、明确。因此,推动线上线下服务相结合,是互联网医疗开展的工作重点。     

某省级医院执行《江苏省医保药品目录》效果研究

目的 分析某省级三甲医院对《江苏省基本医疗保险药品目录》的执行效果.方法 选取江苏省某省级三级医院为研究对象,比较分析城镇职工医保患者和自费患者的药品使用情况.结果 新版《医保药品目录》能基本满足该院临床治疗需求,对门诊医保患者费用控制具有显著作用,但对住院医保患者的药品费用控制效果不明显,对不同疾病药品费用控制效果不一.结论 建立和完善严格的用药考核制度,需加强中高档药物使用的监管,并增加相应的适应症限制,应考虑将临床治疗可供选择、药价适应的药品纳入目录.     

信息不对称视野下的全科医生制度

我国目前医疗体系的一个显著特点就是医生与病人的关系基本上是随机配对,一次性的医患关系,医生面临着创收与医生的专业服务价值被低估的压力,形成了严重扭曲的医生激励与控制机制,导致了一系列难以解决的医疗问题,如“红包”、“用药过量”、“药价虚高”、“药品回扣”和“医患关系紧张”等。建立全科医生制度,在医生与患者之间建立起一个能够长期合作的关系,将形成良好的医生激励与控制机制,改善或解决目前存在的医患关系紧张等一系列问题,为建设和谐社会创造有利条件。1 医疗市场是一个信息明显不对称的市场信息不对称理论认为参与市场交易活动的人不具有完全     

基于Spring Boot框架的医院“双通道”处方流转系统设计与实现

目的：设计医院“双通道”处方流转系统，解决患者需到零售药店自费购买谈判药品的问题。方法 ：该系统采用浏览器/服务器（Browser/Server,B/S）架构，使用前后端分离的模式进行开发，以Oracle 10g作为数据库，通过SM4算法进行数据加密。其中前端采用Vue.js框架搭建，使用Element UI构建用户界面，通过AJAX调用后端的RESTful接口并使用JS对象简谱（JavaScript objection notation,JSON）进行数据交互；后端使用Spring Boot和MyBatis框架搭建。整个系统主要由就诊开方、处方详情查询、处方撤销3个功能模块组成。结果：经实际应用，该系统可实现医生按照赋予的权限开具药品处方、药师前置审方后自动上传至医保电子处方平台，患者可以直接去定点药店取药和结算，而且整个过程可追溯，达到了预期目标。结论：该系统能够满足参保患者的合理用药需求，确保患者及时合理地使用进入医保目录的谈判药品。     

珠海市某医院医保病人和自费病人住院费用结构对比分析

目的 了解影响住院患者人均费用的主要构成部分,为医院管理者控制住院费用的过度增长,合理降低患者住院费用提供参考.方法 采用灰色关联法,结合Excel和SPSS 11.1汇总分析2002～2006年住院患者病案首页费用信息.结果 影响患者人均住院主要费用成分依次是:药品费、检验费、输血费和放射费.结论 药品、护理、床位费用是影响医保患者和自费患者人均住院费用的主要因素;相对自费患者而言,护理、化验、检查是对医保患者更重要的人均住院费用影响因素.     

珠海市某医院医保病人和自费病人住院费用结构对比分析

目的了解影响住院患者人均费用的主要构成部分,为医院管理者控制住院费用的过度增长,合理降低患者住院费用提供参考。方法采用灰色关联法,结合Excel和SPSS 11.1汇总分析2002~2006年住院患者病案首页费用信息。结果影响患者人均住院主要费用成分依次是:药品费、检验费、输血费和放射费。结论药品、护理、床位费用是影响医保患者和自费患者人均住院费用的主要因素;相对自费患者而言,护理、化验、检查是对医保患者更重要的人均住院费用影响因素。     

基于倾向指数匹配的患者对医患沟通认知的差异研究

目的应用倾向指数方法,从患者的视角,按照接诊医生的不同态度进行分组,探讨两组患者对医患沟通的内容和作用的差异性。方法通过自行设计的调查问卷,共调查对象总数是1210例,其中认为接诊医生态度好和态度生硬的分别为240例和970例。倾向指数按照1:1的比例匹配后,符合匹配结果的调查对象共460例,其中认为接诊医生态度好和态度生硬的各为230例。基线资料匹配后均达到了均衡。对匹配后的患者对医患沟通的内容和作用进行分析比较。结果匹配后的两组患者对医患沟通的作用差异无统计学意义,但在医患沟通内容方面两组的差异性有统计学意义。结论认为接诊医生态度好的患者更愿意和医生沟通诊断结果(69.6%)和病情演变(47.8%),认为接诊医生态度生硬的患者更愿意和医生沟通治疗方案(52.2%)和病情演变(47.8%)。     

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.