实现农村医疗救助与新农合制度对接的难点分析

农村医疗救助制度和新农合制度是是我国目前农村医疗保障制度建设中相辅相成,不可相互替代的两种制度.然而实际运行中,由于两者的制度设计不同,两种制度的医疗保障对象、补偿服务难对接上,管理机制难协调统一.只有明确两种制度对接中的难点所在,采取有针对性的措施,才能实现两种制度的无缝对接,真正降低农民疾病经济风险,提高农民健康水平.     

基于“军卫一号”的信息系统集成的研究

在我国大多数医院信息系统的研制还不能遵循HL7标准的条件下，以医院某个比较成熟的大系统做为标准实现各子系统集成，是一种符合中国国情的切实可行的集成方式。     

Reducing the risk of Legionnaires' disease

Many common aquatic bacteria like Legionella pneumophila are able to colonize man-made water systems. Poorly maintained systems or those that are seldom used provide ideal sites for growth and often also provide the means for aerosolizing the organism. Compounds leached from construction materials and the by-products of other organisms can be used as food by the Legionellaceae and can thus aid their growth. Keeping water systems clean and well serviced, keeping hot water at or above, and cold water below, recommended temperatures and additionally in cooling towers maintaining the required levels of biocide, will reduce or prevent the growth of legionellas. To be certain that the control measures are successful microbiological and chemical monitoring should be done. The results of this and the maintenance work undertaken should be kept in a log so that failures in treatment can be quickly seen and remedial action taken before any risk of infection arises. Adhering to these simple guidelines will go a long way to removing the risk of infection and will also provide systems that are more efficient and thus cheaper to run.     

Building information linkages between the physician and the hospital

The economics and complexity of health care will continue to require better and faster methods of information access. As a multipurpose resource, physician networks can offer a host of benefits to institutions, caregivers, and patients. Early entrants into this technological arena can expect some degree of competitive advantage by attracting physicians who want sophisticated support systems and by expediting referrals for specialized care. Whether or not this proves to be of long-term merit, the need for administrative and patient care information systems will likely increase in the future. In this respect, innovation is purely a point in time.     

The quest for the Holy Grail of systems

Software agents like Edify can be used to retrieve (and store) information from most online systems, without having to access each system's database. These techniques allow information integration (display) into Windows applications or in new reference and information retrieval applications or Web pages. These techniques can be used to bridge the gap until the Holy Grail of systems is built (and works).     

A critical review of the remuneration systems for pharmacists

This paper provides a critical review of different systems of remunerations of pharmacists which exist in various countries: the percentage mark-up, the graduated mark-up, the capitation system, the fee for service system and mixed system. In these different systems, we refer to the various ways the provisions of pharmaceutical services are paid and reimbursed rather than how persons who physically deliver the services are paid. Therefore, the differences among various types of remuneration may not impact directly the level of responsibility and motivations of the various employees or owners in contact with the patient. The dispensing service remains the essential service of the pharmacist in all systems. However, according to the types of remuneration, the revenue of the pharmacist can be more or less linked to the volume and the price of drugs. Capitation systems, professional allowance and fees in particular can be used to shift the objective of the pharmacist towards increased professionalism. In each system, policy makers, when they can negotiate with the whole national profession, can use the remuneration system to achieve public policy objectives such as cost containment, better drug use, or provisions of large packages of services. This paper discusses to what extent each system can contribute to such objectives. In order to achieve public policy objectives, it may be time to shift the valuation of pharmaceutical services towards more safe and effective therapy instead of safe and effective drugs.     

Problems with the re-use of enteral feeding systems—a study of the effectiveness of a range of cleaning and disinfection procedures

Although many manufacturer's state that their systems are 'single-use only', some authors are now recommending that enteral feed delivery systems can be re-used, particularly in the home, in order to reduce the expense of enteral feeding.
The purpose of this study was to evaluate the effectiveness of a range of currently recommended cleaning and disinfection procedures in removing bacteria from five commonly used enteral feeding systems. The systems used were, a collapsible, top-fill reservoir with integral giving set, a plastic enteral nutrition bag with side port and integral giving set, and three different types of rigid plastic reservoirs with separate giving sets.
The systems were filled with 1000-ml portions of feed experimentally contaminated with either Klebsiella aerogenes or Escherichia coli and the feed perfused through the systems for 15 h; viable counts increased from 10²-^-10³ to 10⁷-^-10⁹ cfu ml^-1. The systems were then cleaned by a range of methods including rinsing and/or immersing them in sterile water, sterile water and detergent, and/or disinfection with hypochlorite solutions. When the systems were refilled with sterile feed it was found that residual bacteria in the systems multiplied to yield levels ≤10⁹ cfu ml^-1 after 15 h.
The results of the present study demonstrate that none of the methods tested can be recommended as being totally effective in removing bacteria from contaminated systems.     

Whole System in the Room: Toward Systems Integration in Healthcare

How might systems integration be furthered in healthcare? The paper addresses this by exploring critically the potentials of appreciative inquiry for accelerating systems integration through a large group intervention. We analyze a one-day dialog workshop to get “the whole system in the room” to improve cancer care in a regional health authority in south west Sweden. Seeing systems integration as socialization and enhanced common understandings, we suggest that discourse may play a crucial role in bringing together the various stakeholders in the system. Our analysis of the group discussions of the event demonstrates however that the degree of shared understanding can vary considerably across the discussion themes of appreciative inquiry. We argue that the “patient,” as a linguistic artifact, can act as a boundary signifier that enables those present to interact in a meaningful and coherent way but that this stops short of systems integration.     

Public health for the people: participatory infectious disease surveillance in the digital age

The 21^st century has seen the rise of Internet-based participatory surveillance systems for infectious diseases. These systems capture voluntarily submitted symptom data from the general public and can aggregate and communicate that data in near real-time. We reviewed participatory surveillance systems currently running in 13 different countries. These systems have a growing evidence base showing a high degree of accuracy and increased sensitivity and timeliness relative to traditional healthcare-based systems. They have also proven useful for assessing risk factors, vaccine effectiveness, and patterns of healthcare utilization while being less expensive, more flexible, and more scalable than traditional systems. Nonetheless, they present important challenges including biases associated with the population that chooses to participate, difficulty in adjusting for confounders, and limited specificity because of reliance only on syndromic definitions of disease limits. Overall, participatory disease surveillance data provides unique disease information that is not available through traditional surveillance sources.     

Strengthening public health surveillance and response using the health systems strengthening agenda in developing countries

There is increased interest in strengthening health systems for developing countries. However, at present, there is common uncertainty about how to accomplish this task. Specifically, several nations are faced with an immense challenge of revamping an entire system. To accomplish this, it is essential to first identify the components of the system that require modification. The World Health Organization (WHO) has proposed health system building blocks, which are now widely recognized as essential components of health systems strengthening.With increased travel and urbanization, the threat of emerging diseases of pandemic potential is increasing alongside endemic diseases such as human immunodeficiency virus (HIV), tuberculosis (TB), malaria, and hepatitis virus infections. At the same time, the epidemiologic patterns are shifting, giving rise to a concurrent increase in disease burden due to non-communicable diseases. These diseases can be addressed by public health surveillance and response systems that are operated by competent public health workers in core public health positions at national and sub-national levels with a focus on disease prevention.We describe two ways that health ministries in developing countries could leverage President Obama's Global Health Initiative (GHI) to build public health surveillance and response systems using proven models for public health systems strengthening and to create the public health workforce to operate those systems. We also offer suggestions for how health ministries could strengthen public health systems within the broad health systems strengthening agenda. Existing programs (e.g., the Global Vaccine Alliance [GAVI] and the Global Fund Against Tuberculosis, AIDS, and Malaria [GFTAM]) can also adapt their current health systems strengthening programs to build sustainable public health systems.     

Specific features of design of digital X-ray diagnostic apparatuses on the basis of CCD matrices

Specific features of modern digital screen-optics-CCD-matrix systems are considered. Characteristics of single- and multi-matrix systems are analyzed. It is shown that all disadvantages of single-matrix systems as compared to multi-matrix systems can be eliminated using modem high-efficiency CCD matrices.     

Optical imaging the "Right" way

Optical imaging systems can help lead the way to the computer-based patient record. This article addresses several security clearance issues that these systems raise and tells how one facility responded to them.     

Time to learn: the outlook for renewal of patient-centred education in the digital age

BACKGROUND: Major forces in society and within health systems are fragmenting patient care and clinical learning. The distancing of physician and trainee from the patient undermines learning about the patient-doctor relationship. The disconnection of care and learning from one successive venue to another impedes the ability of trainees to learn about illness longitudinally. METHODS: As a conceptual piece, our methods have been those of witnessing the experiences of patients, practitioners, and students over time and observing the impact of fragmented systems and changing expectations on care and learning. We have reflected on the opportunities created by digital information systems and interactive telemedicine to help renew essential relationships. RESULTS: Although there is, as yet, little in the literature on educational or health outcomes of this kind of technological enablement, we anticipate opportunities for a renewed focus on the patient in that patient's own space and time. Multimedia applications can achieve not only real-time connections, but can help construct a "virtual patient" as a platform for supervision and assessment, permitting preceptors to evaluate trainee-patient interactions, utilization of Web-based data and human resources, and on-line professionalism. CONCLUSIONS: Just as diverse elements in society are capitalizing upon digital technology to create advantageous relationships, all of the elements in the complex systems of health care and medical training can be better connected, so as to put the patient back in the centre of care and the trainee's ongoing relationship to the patient back in the centre of education.     

Integration challenges. What you can do to smooth the transition

As the focus in healthcare delivery shifts to building a seamless continuum of care, many organizations are turning to integrated delivery systems as a way to provide high-quality healthcare while keeping costs down. Although these systems can take many forms, they often encounter similar roadblocks once the components are put into place. Healthcare Executive talked with several consultants and healthcare executives about some of the challenges you can address before and during integration to help you avoid those roadblocks later.     

Raw energy--nutrition of the future?

'Normal' life can be maintained on a diet incapable of producing high level health. Such high levels can, however, be achieved by the consumption of what McCarrison called 'the unsophisticated foods of Nature', when given in their natural state. The implications for contemporary society are reviewed. This nutritional value of foods is traced back to energy and to the two physical laws which govern energy. Schrodinger's examination of this problem highlighted the contrast between the entropy of energy in physical systems and biological order. Schrodinger spoke of neg-entropy, referring to the reversal of entropy in the affairs of living systems. This philosophical paradox is discussed.     

医疗保险制度改革的新视角——基于美国医疗过失诉讼与医疗保险关联性的分析路径

医疗过失诉讼制度与医疗保险制度在制度目的与参与主体层面具有很强的同一性.医疗服务提供者在这两种制度中的不同力量以及医患双方利益的联动性是医疗过失诉讼制度与医疗保险制度相关联的纽带.医疗过失诉讼制度对美国传统医疗保险与管理式医疗保险都有明显的阻碍作用.我国医疗保险制度改革宜重视这两种制度的关联性并建议协同改革这两种制度.     

Along the data-information continuum: pitfalls and opportunities

Opportunities and problems in hospital information have been reviewed. At this juncture, it is clear that problems exist in much of the data that administrators and regulators accept as valid. This is due in part to the lack of attention to clinical information systems compared with financial and other management systems. At individual institutions, opportunities exist not only to upgrade the quality of data collected, but also to enhance the integration of these data to provide better clinical information. If this process can occur in an environment of cooperation between larger teaching institutions, larger clinically sophisticated databases can be constructed to better evaluate medical practice and clinical care.     

童年期逆境对非稳态负荷影响的作用机制研究进展

非稳态负荷(allostatic load,AL)主要与压力应激有关,而童年期逆境(adverse childhood experiences,ACEs)作为童年时期常见的应激源能对其产生严重且持久的影响.AL能够反映个体多个生理系统的综合磨损情况.该文主要综述了经历ACEs的个体对其AL各系统的影响和作用机制,以及A...     

Advancing the state of data integration in healthcare

There is growing consensus that clinical information systems will provide the bridge to advancing the integration of information systems in healthcare. In spite of developments in technology that have enabled some organizations to integrate clinical information with care delivery in ways that can promote safer, more efficient patient care, the majority of healthcare has yet to achieve this goal. Why aren't we there yet?