基于Vensim仿真的远程医疗推广策略分析

目的:促进医疗资源下沉,为远程医疗的推广提供一定参考。方法:构建了围绕环境、医院、技术三个维度的远程医疗推广系统动力学模型,并以河南省远程医疗的发展情况验证了模型的有效性。结果:通过对设置的情景进行仿真分析发现,建立年轻化的医生团队可以在短时间内促进远程医疗的推广;将远程教育纳入继续教育学分体系在短时间内并不会对远程医疗产生明显的推动作用,但是在较长时间内会对远程医疗的推广产生较大作用;对患者进行信息安全保障一定程度上可以提高对远程医疗推广的作用,但是效果并不明显。     

公立医院高质量发展背景下医疗联合体合作策略研究

目的:以博弈理论为基础,通过对医联体内核心医院和成员医院进行效益矩阵分析,明确合作中最优发展策略,提出医联体在组建中的帕累托改进措施。方法:以公立医院高质量发展为背景,从博弈论的视角以医联体建设中核心医院和成员医院是否真正合作作为博弈点,探讨合作中的决策行为,建立博弈模型,分析收益矩阵。结果:政府的奖惩机制和不合作的"不正当"收益对核心医院和成员医院影响最大。结论:从政府、核心医院和成员医院的角度,提出加强政府奖惩机制、构建双赢合作机制、建立紧密型城市医疗集团、成员医院提升技术能力等措施,对组建策略进行帕累托改进。     

“互联网+医疗”在医院创新文化建设中的应用

随着信息化技术的不断发展,"互联网+"技术在医疗方面得到广泛应用。"互联网+"时代背景下,医院文化建设与医疗工作越来越紧密,从理论到方法、从内容到载体都有所变革。自2016年起,江西省人民医院探索以"互联网+医疗"为依托,以构建医院文化交流平台、发挥示范引领作用、打造专科品牌效应、营造良好舆论氛围等一系列创新措施为重点,积极拓展医院文化建设新领域。目前,省外对接解放军总医院、中日友好医院、北京天坛医院、中美国际等国内外知名医院,省内覆盖85家市县级医院,建立起"乡镇级-县市级-省级-国家级-中美国际"五级远程医疗协作网,搭建了一个文化交流平台,可提供远程视频会诊、远程心电监护、远程病理诊断、远程影像诊断、远程医学教育、远程护理等医疗服务。据统计,截至11月底,累计完成远程会诊500余例、远程心电监护41 609人次、远程教学(包括远程手术示教) 12. 9万人次,促进优质医疗资源共享,推进分级诊疗落地,有效缓解群众看病就医难题,取得了良好的医院创新文化建设效果。     

辽宁省县级医院医疗技术纵向整合现状调查分析

通过对辽宁省县级医院医疗技术纵向整合情况的调查,了解到开展医疗技术纵向整合有效地促进了调查县县级医院医疗技术水平的提高,但整合机制和制度有待进一步完善,应建立信息化整合工作平台,并加大财政支持力度。     

沂蒙山地区远程医疗现状调查及对策研究

目的通过对沂蒙山地区开展远程医疗现状问卷调查,研究分析影响阻碍远程医疗发展的因素,为该地区远程医疗工作进一步发展提供切实可行的、有针对性的建议。方法结合调研目标,运用自行设计的问卷进行在线式调查,并对调查结果进行汇总和分析。结果该地区已开展远程医疗工作的医院占63.69%,业务内容以临床交互式视频会诊和离线式影像会诊为主。大多数医院重视并支持远程医疗工作,但发展水平和应用水平不均衡,影响和制约发展的因素也较多,尤以基层医疗机构最为突出。结论促进远程医疗城乡一体化协调发展,需要提高医务人员的思想认识、加大相关服务配套、扩大专网覆盖、打破"信息孤岛"、完善收费、保障医保补偿机制和健全相关法律法规体系等。     

我国远程医疗发展现状调查研究

目的进一步掌握目前我国远程医疗建设和开展情况,推动远程医疗服务持续健康发展。方法采用问卷调查的方法,从远程医疗基础设备建设、远程医疗政策保障与制度建设、远程医疗业务开展情况及远程教育培训开展情况等方面,对我国远程医疗建设发展情况进行调查研究。结论近几年,我国远程医疗得到了很好的普及和发展,建议在日后的工作中加强远程医疗政策标准规范的制定和完善;加大公众宣传力度,提高社会认知度;加大投入,引入多种运营模式,建立长效运行机制,确保远程医疗持续发展。     

破除“以药补医”——医改新政策下非公立医院的艰难决策

文章记录了仪征市公立医院试点取消药品加成,实行药品"零差价",部分提高医疗服务价格,同时加大政府对公立医院支持力度等一系列医药价格改革新举措对非公立医院的影响,分析了破除"以药补医",优化医院价值结构对医院发展的内在机制和意义,阐述了非公立医院积极参与此项医改的思路和理论依据,为深化医改总结经验。     

改善患者就医用药体验 “互联网+医疗健康”来助力

正利用互联网技术对健康状态进行监测、推动"互联网+精准健康科普"、支持开展"互联网+老年健康服务"……不久前发布的《健康中国行动(2019-2030年)》明确"互联网+医疗健康"在推进健康中国行动中所发挥的重要作用。挂号难、排队时间长曾是被很多患者诟病的就医痼疾,而改善患者就医体验、提升医疗服务水平正是健康中国行动文件的题中之义。健康中国行动文件提出,促进"互联网+医疗健康"发展,创新服务模式。加大政府投入力度,强化支持引导,确保行动落实到位。作为公立医院国家队中的一员,北京协和医院利用"互联网+"解决挂号难问题的做法值得借鉴。北京协和医院原党委书记姜玉新说,北京协和医院秉持"以患者为中心"的理念,持续改进预约挂号服务。通过不断探索和完善,医院建立了一套多途     

广东省中、西医医院医疗设备和建筑面积的对比研究

对广东省2007年至2018年间的中、西医医院的医疗设备数量和建筑面积进行了对比研究,并得出结论:广东建设中医药强省目标的实现尚需进一步加大对中医医院的财政拨款与支持力度.     

浅谈基于区域卫生信息平台的远程医疗系统建设及应用

介绍广州市基于区域卫生信息平台的远程医疗系统建设目标、技术架构及主要功能,并结合广州市第一人民医院以及花山医院试点建设成效,探讨远程医疗服务应用模式。通过建设远程会诊、远程诊断、远程教育、双向转诊和远程预约等多元化的远程医疗应用,促进大型医院优质资源共享共用,缓解医疗卫生资源分布不均衡、促进解决群众"看病难、看病贵"等问题,从而提高基层医院医疗服务水平及提高疑难重症救治水平。     

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.     

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.     

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.     

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.     

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.