专题论坛二——数字化医院的设备及应用

主持人的话 现代电子、计算机及网路技术的发展,为医院信息化及影像医学信息化提供了可能。 PACS作为图像归档、传输及保存系统提供数据影像数据共享的可能性。RIS作为放射学信息系统主要涉及影像学科的信息管理,包括登记、财务、检     

医疗影像设备系统的质量控制与维护管理

在医疗科技不断发展的今天,临床上很多诊疗工作越来越依赖于医疗影像设备系统,对各大医院而言,医疗影像设备系统已经成为了医院中不可或缺的物资要素。为保障医院内各种诊疗工作的顺利开展,医院除了要结合现实需求进行最新的医疗影像设备系统配置,更需要在日常的工作中做好对医疗影像设备系统的质量控制和维护管理。基于此,文章分析了关于医疗影像设备系统的质量控制和维护管理对策,以提高医疗影像设备的功能发挥,确保医院的医疗服务水平提升。     

医院院系统网络建设概况

现阶段，医院已完成了以财务核算为主的医院管理信息系统的建设，正在逐步完善和建设面向临床诊疗的医院临床管理系统。以财务核算为主的信息管理系统，网络传输的数据大多为数字信息，数据量相对而言比较小，对网络的要求不高，存储与调用都能较迅速地完成，很少在网络传输上发生问题。而在面向临床管理的信息系统应用阶段，由于网络传输的内容增加了许多媒体影像信息，     

医院影像资料信息系统的开发和管理

医院影像资料信息化系统，也即PACS系统，是目前医院研究的热门，但大多局限在医院内部。作者所在医院利用油田已建成的发达局域网开发的医院影像资料信息化系统，不但实现了医院内部影像资料各科室的共享，同时也实现了油田各医院间影像信息的交流和远程会诊。提高了医院医疗服务质量，真正实现了为医生、患者服务。整个系统运行管理良好，收到了良好的社会效益和经济效益。     

医院智慧财务报销模式的探讨

医院财务智慧报销模式以数据共享为基础,线上审批、线上报销、会计核算、财务报表,报销查询等环节一体化全程内控,重构了财务报销链,极大地简化了报销流程,全过程远程透明监管,提高了工作效率和安全性.智慧财务报销模式将传统财务线下报账模式转变为线上支付一体化管理模式,连接了分散的财务资源,实现财务系统间的数据交换,将财务数据融入医院大数据平台,促进医院财务管理进一步规范化、标准化、智慧化,为建立智慧医院财务管理奠定基础.     

建立非营利性医院财务分析体系的探讨

文章就非营利性医院财务分析系统建立的前提和目标进行了研究.对如何建立财务效益分析、发展能力分析等一般财务分析指标提出观点,并提出建立医院运营能力、药品、人才等方面专项财务分析指标的设想,以建立非营利性医院财务分析的指标体系.     

信息化是新的革命

美国退伍军人健康信息系统,综合了以患者为中心的健康档案系统、以医疗服务人员为中心的服务提供与评价系统和以现代企业财务管理制度为核心的管理财务系统。并在此基础上,将病人信息、医生信息、财务信息,医院所有物流信息等都整合为一个大的管理信息系统网络,     

基于协同理论的医院财务信息化建设趋势分析

当前医院信息化建设业务流程与财务流程相互独立、相互分散,数据之间缺乏有效沟通。以协同理论思维为指导,将医院财务与业务信息化统一谋划、系统建设,建立基于开放性、实时性、标准性、决策性和共享性的财务信息化协同管理模式,实现财务和业务的有机融合。     

医院网络化图文报告传输系统的研发与应用

目的：通过医院网络化图文报告传输系统应用实现患者医技检查信息集中管理,信息共享,提高医技科室信息统计管理;构建各个影像学科图像及文本信息整合,实现在统一ID、统一界面及统一索引下涵盖医疗、教学和科研信息的管理;为医院全面数字化、信息化奠定基础。方法连接医院各影像科室现有主要影像设备,建立服务器集群和大容量集中存储系统,建立多级数据安全体系保障;建立数据的备份及容错系统,建立数据转移、恢复措施;在系统内部建立统一全面的用户权限管理;建立多种影像调阅模式,提供多种影像后处理功能;连接放射线科、超声科、腔镜科、核医学科、病理科、心电室等影像科室,与HIS系统及电子病历系统的进一步融合;建立整个图文报告传输系统系统的系统安全机制。结果通过网络化图文报告传输系统的应用,达到了影像数据在临床各科室的共享,实现了从病人信息登记-影像数据获取-传输-存储-查询-阅读-诊断/电子报告-存储等各应用层次的全程控制与管理,方便了患者就诊,真正体现了医院以病人为中心的全面信息管理的理念,为方便病人,服务病人做出了积极的探索。结论网络化图文报告传输系统项目建设实现了整个医院影像诊疗过程数字化、网络化,优化了医院业务流程,提高了工作效率及诊疗质量,更好的体现了“以病人为中心”的服务宗旨。     

基于深圳市云计算公共服务平台的医院影像系统的构建

介绍了国内外医院影像系统的发展现状与趋势,阐述了通过医院影像系统和云平台的对接,将数据库中的影像和文本信息传送到云中心并进行数据分类,给患者提供随时查询、下载自己影像检查结果的功能,从而降低医院开支,方便患者,使患者便捷、快速地获取检查结果成为可能。该项目的成立以及应用将会带动整个医疗行业中云应用的进一步推广,并可以为广大患者带来实在、体贴的便利,让患者真正体会到深圳鹏云存储给人民带来的利益。     

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.