江苏省医联体发展的实践与思考

近年来医改背景下江苏省各地开展多种模式医联体建设,以"院府合作"、集团化整合发展、建设共享中心等方式切实构建因地制宜的医联体政策措施,形成独具特色的江苏经验。文章通过梳理江苏省医联体建设中的有效措施、配套政策、经验成果及现存问题,提出医联体建设亟待从管理体制、运行机制角度完善同向激励机制,改革人事管理体制,发挥信息化网络优势引导各级医疗机构各司其职,为进一步推动医联体发展提供理论依据。     

“3+2+1”医联体模式的探索与实践:以西电集团医院互联网医联体为例

分级诊疗是当前我国医疗卫生领域的重点工作,对公立医院改革以及解决百姓就医的问题产生重大影响。按照“基层首诊、双向转诊、急慢分治、上下联动”的思路构建紧密型医联体,在基层医院施行干部“双兼制”方案。以西电集团医院构建的“3+2+1”一体化医疗服务模式医联体为研究对象,深入探讨该医联体的建设方法、建设成效、具体问题以及解决办法,为继续强化推进互联网医联体工作提供理论支持。     

公立医院医联体党建联盟建设的持续实践与探索

在全面加强公立医院党的建设背景下,多地医疗机构把党建延伸到医联体建设中,探索建立医联体党建联盟,在党建与业务融合发展方面形成了丰富经验。本文通过宿迁市第一人民医院医联体党建联盟为例,深入总结分析医联体建设过程中经验做法和存在问题,提出下一步对策建议,为深化医联体党建建设提供有益经验和借鉴。     

我国医联体发展模式交易成本分析

新医改以来,大型公立医院大规模扩张,但基层医疗机构改革成效甚小,仅靠医疗服务中的市场和价格机制很难解决看病难的问题。为解决大医院人满为患,基层服务能力不足问题,国家大力推广医联体的建设,使优质医疗资源有效下沉,提升基层医疗水平。文章结合我国当前医联体建设的发展模式,以交易成本理论为视角,分析了医联体交易成本的要点,并对医联体内不同对象交易成本进行探讨,在此基础上提出优化医联体建设等相应建议和意见。     

三级医院参与医联体建设的思考

结合江苏省医联体建设的现状,分析目前医联体建设过程中存在的障碍。提出了适当放宽三级医院考核指标,鼓励医联体内龙头医院收治疑难危重病人;建立医师多点执业激励与安全保障机制;同时建立、健全医联体运行的考核制度等措施,以提高三级医院参与医联体建设的积极性,促进医联体更加高效的运转。     

成都市医联体的实践探索与思考

随着新一轮医药卫生体制改革的逐步推进,加快形成有序就医的分级诊疗体系已是大势所趋。医联体作为优化区域医疗卫生资源、提高服务效率、促进形成分级诊疗制度的重要手段,逐渐成为各方关注的热点与焦点,笔者总结了成都市两种不同医联体模式的具体实践情况,对成都市在推行医联体过程中遇到的问题进行思考,以期为行政部门制定医联体的相关政策提供参考。     

医院医联体建设的影响因素

伴随着人口老龄化以及国家二胎政策的开放,我国不同地区对医疗资源建设需求进一步增大,医院医联体建设能够改善医疗资源紧张问题,并能充分发挥医联体优势。医联体建设能够逐步推动我国不同地区医疗分级诊疗制度的实施,但是医院医联体建设在具体实施过程中,由于不同医疗服务体制、医疗服务人员思想等方面的差异性,严重影响到医院医联体建设的顺利开展。主要探讨医院医联体建设的影响因素,结合医院实际情况,对医院医联体建设现状进行分析,通过对影响医院医联体建设相关因素分析,进而给出管理对策,旨在不断加强医院医联体建设质量,充分发挥医疗资源优势,解决群众看病难问题。     

医改背景下三级综合性医院医联体发展状况及对策探讨△

目的：分析医改背景下三级综合性医院医联体发展状况，为促进医联体建设提供依据。方法：从三级综合性医院医联体建设所面临的机遇与挑战两部分进行分析。结果：三级综合性医院医联体建设的机遇主要有资源优势、政策倾向、医疗事业发展需要；挑战主要有：三级综合性医院考核指标、医疗服务下沉的激励与保障机制、医联体内部差异与信息化程度等方面的影响。结论：三级综合性医院应明确自身发展定位，充分利用优势资源，完善医院及医联体相关考核标准与激励保障机制，加强与成员单位之间的交流，促进医联体信息化发展。     

某县级公立医院医联体运作成效分析

本文以山西省某县级公立医院为例,在医联体托管模式下对运作机制、具体成效进行分析总结,围绕现有环境下医联体推进过程中的优劣势建设、发展过程中的问题研究提出对策建议,以期为完善医联体托管模式的经营管理水平、医疗服务能力提供新视角。     

基于共生理论的城市医联体绩效的影响因素及路径分析

目的：探索城市医联体绩效实现高水平的影响因素和路径,为我国城市医联体绩效管理提供参考依据。方法：基于共生理论的基本要素构建城市医联体影响因素框架,利用25个城市医联体典型案例,通过清晰集定性比较方法,分析影响城市医联体绩效的关键因素和路径。结果：协作制度、机构间资源互补度、业务关联度、经济关联度、考核激励、政府支持和信息平台均是影响城市医联体绩效的前因条件,并形成了业务融合型、管理融合型、组织合并型3种高水平绩效的城市医联体类型。结论：城市医联体应坚持医保医疗改革协同发展,以学科和健康服务为触点,以资源协同治理为核心,加强信息化建设,完善政府正向考核激励,提高城市医联体建设水平,促进城市医联体成为四个共同体。     

Trends in meningococcal disease in Italy in 1988

Meningococcal disease in Italy decreased 15% in 1988 from the previous year (290 vs. 342 cases). The decline was particularly evident in military cases (1.7/100,000 in 1988 vs. 5/100,000 in 1987) reflecting the full coverage of bivalent serogroup (A + C) meningococcal polysaccaride vaccine in army recruits, achieved since January 1988. The highest proportion of cases was seen in people older than 25 years of age (25%). Serogroup C constituted 60% of the isolates, while 19% belonged to serogroup B. The proportion of strains resistant to sulphonamides was 45%, while 15% were resistant to Minocycline and none to Rifampin. Out of the five military cases, only one (due to serogroup C) was attributable to the vaccine failure. A single coprimary case, but no secondary cases occurred among civilians. These findings are consistent with the trends reported in Italy in the previous years.     

Benzene in blood and phenol in urine in monitoring benzene exposure in industry

Determinations of benzene concentration in blood and of phenol in urine were made by head-space gas chromatography techniques on samples taken near the end of the work day from two groups of workers potentially exposed to low levels of benzene in the work-place atmosphere. Preliminary results suggest that benzene in blood is more reliable than phenol tests for assessing both exposure and uptake of benzene. Normal values of phenol in urine (10 mg/liter or less) were found in nearly all those cases in which benzene was detected in the blood.     

2015年郑州市饮用水放射性水平状况调查

目的了解郑州市不同地区、不同季节、不同水源类型的放射性水平。方法分别于丰水期和枯水期采集郑州市区黄河水源水、井水源水、丹江口水源水、出厂水和末梢水各一份;以县为单位,每单位采集出厂水、末梢水、水库水、河水、井水各1份,按《生活饮用水生活标准检验方法》(GB/T 5750.13-2006)检测饮用水中总α和总β放射性水平,依据《生活饮用水卫生标准》(GB 5749-2006)进行判定。结果丰水期、枯水期水体总α、总β放射性水平均低于国家标准限值。结论郑州市不同水源类型均处于正常的天然放射性本底水平。     

Occupational stress in nurses in psychiatric institutions in Taiwan

Nurses are known to be exposed to occupational stress. However, occupational stress is not well documented for nurses in psychiatric institutions in Taiwan. A cross-sectional study was conducted to explore the work-related stress and risk factors of nurses in psychiatric institutions in Taiwan. A structured questionnaire was distributed to nurses at five state-owned psychiatric hospitals in Taiwan in 2001. Demographic information, working environment, and personal health status were inquired. Occupational stress was assessed based on the Chinese version of Job Content Questionnaire (JCQ). General health status and mental health were evaluated by the International Quality of Life Assessment Short Form-36 (IQOLA SF-36). A total of 573 questionnaires were disseminated to nurses and 518 (90.4%) were satisfactorily completed by nurses, including 408 female full-time nurses who had been in their current work for more than 6 months. In the past one month, 17.2% of nurses reported being under significant stress often or always. Assault episodes were reported by 45.1% of nurses in the past 6 months. Among the nurses, 16.9%, 25.2%, 50.0%, and 7.8% belong to the "High strain", "Low strain", "Active", and "Passive" groups, respectively. Perceived occupational stress was associated with young age, widowed/divorced/separated marital status, high psychological demand, low workplace support, and threat of assault at work. Lower general health score was associated with low job control, high psychological demand, and perceived occupational stress. A lower mental health score was associated with low job control, high psychological demand, low workplace support, and perceived occupational stress. We concluded that nurses in psychiatric institutions are under significant stress related to work factors.     

Changes in nursing administration in supporting transplantation in Brazil

This historical and bibliographic study aimed to understand how Nursing was organized to support care in transplantation. The HISA, LILACS, BDENF, PERIENF and DEDALUS databases were consulted, and thirteen references were found, ten of which were scientific articles, two were master's dissertations and one was a doctoral thesis. The span of time chosen for study ranges from the date of the first kidney transplant in Brazil (1965), to the date of publication of the last scientific article found in the databases mentioned above (2003). After reading these articles, the ones that were similar in topic were grouped together, thus creating the thematic axis for the presentation of the results. The results showed that the Nursing profession has played an important and active role in transplants ever since the first procedure in 1965.     

2019年中国肿瘤流行病学研究进展

恶性肿瘤已成为中国居民的主要死因之一。近些年来,中国政府积极推进肿瘤预防和控制领域的研究工作,取得了很大的进步。本文简要汇总中国在肿瘤流行病学领域的研究进展,具体包括2019年的肿瘤负担、癌症危险因素及其干预、筛查和早期发现、癌症防治专项行动(2019-2022年)方案等方面,以期为我国肿瘤防治工作的有效开展提供技术支撑和理论依据。     

2012年绵阳市蔬菜中农药残留状况

目的 了解绵阳市2012年市售蔬菜中农药残留情况,为食用蔬菜监管提供依据.方法 全部样品均按照GB/T 5009-2003的方法进行农药的残留检测.依据GB 2763-2005《食品中农药最大残留限量》进行判定.结果 2012年共检测蔬菜165份,农药检出率和超标率分别为72.12％和23.64％.豆类、根茎类、叶菜类、瓜果菜类和食用菌类蔬菜检测农药残留超标率分别为8.00％、23.53％、36.00％、5.26％和27.03％,差异有统计学意义(x2=11.41,P＜0.01).不同种类农药超标率差异有统计学意义(x2 =62.42,P＜0.01).夏季和冬季蔬菜农药超标率差异无统计学意义(x2=3.44,P＞0.05).结论 绵阳市叶菜类蔬菜中农药残留情况较为严重,应采取有效措施,加强蔬菜的监督管理,从源头禁止高毒农药的使用,加大蔬菜种植、销售环节的监测,确保市民食用蔬菜的安全.