山东省远程医学系统的建设及实现

远程医学是使用远程通讯技术和计算机多媒体技术提供的医学信息服务。它包括远程会诊、远程教育、远程医学信息服务等医学诊疗及医学学术活动。随着现代通讯技术及计算机技术的发展和广泛应用,今后医院间的会诊和其他学术活动都能通过远程医学网络来实现。为了加快山东省远程医学网络的建设,我们同山东省电信局共同合作,建立了基于ATM(非同步传送模式网络)的山东远程医学网络。此网络自1998年底开通以来,已进行了近百例病人的远程会诊及远程教学活动,它的建立对提高我省医疗卫生保健水平,促进医疗、教学、科研、科普全面发展,具有积极的社会及经济效益。     

基于远程医疗的脑卒中专科护士门诊构建

脑卒中严重威胁世界人民健康,已成为重大公共问题,迫切需要构建脑卒中专科护理门诊以满足其长期的护理服务需求。基于目前国内外脑卒中专科护理门诊的发展现状,主要从远程医疗与脑卒中专科护理门诊构建的必要性,远程脑卒中专科护理门诊的建设条件、业务内容、就诊流程、质量保障、意义和展望等方面探讨远程医疗视角下脑卒中专科护理门诊的构建思路,为脑卒中的预防、诊疗和康复提供新视角。     

远程医疗会诊浅析

远程医学使用远程通讯技术和计算机多媒体技术实现异地之间的医学信息交流和诊疗服务,它通过现代传输媒体进行医学活动,包括医学教育、培训、学术交流、临床会诊、手术现场指导等。目前国内外使用较多、影响较大的是———远程医疗会诊。远程医疗会诊是为那些在本地区不能得到优质的医疗服务、不能确诊的疑难杂症和对大病、重病进行诊疗指导以及健康状况监测等提供帮助。它通过声音图像的电视直播,把相关的检验结果以及诊疗情况输送给相关专家,专家也可与患者或临床医师直接交谈,问病施治。远程医疗会诊对病人来说,可在医生指导下有针对性地…     

远程医学在医院建设中存在的问题与对策

远程医学是运用计算机网络、远程通信和多媒体技术,远距离提供医疗、影像、心电、保健、教学、病例讨论、学术会议、学术讲座、医学信息等的医疗服务模式,是医学与信息科学不断融合的产物,其与临床学科紧密结合,实现医患双方之间的信息交流[1].远程医学为人们带来了一种新颖的就医方式,使不同地域间医务人员的交流更加便捷,也给各地患者提供了更方便、更高效的诊疗服务.我院远程医学中心成立于1996年,经过16年的发展,已成为全国全军最大的远程医学中心.早在1988年,我院就通过卫星系统与德国某家医院进行了神经外科远程病例讨论,这是国内首例运用卫星系统开展的远程医疗服务[2].从20世纪90年代初开始,远程医学被列入了国家信息基础设施建设计划,由此远程医学获得了快速发展,并首先在军事医学领域取得了重大进展.     

浅议远程会诊前的准备

远程医疗会诊是异地双方医务人员通过计算机、通讯传输网络来进行沟通、讨论、交流的医疗方式,随着医学诊疗技术、计算机技术、网络与通讯技术的迅猛发展,远程医学(Telemeclicine)已成为现代医疗技术发展的方向和代表。     

浅议远程医学的进展、局限和展望

1远程医学的发展和应用1.1远程医学的发展1988年由美国首次提出[1],广义上讲是使用远程通信技术和计算机多媒体技术使医师和患者双方可以突破传统面对面的空间限制,在异地就可以进行的医学信息服务;20世纪60年代初     

简讯

国家卫计委：推进医疗机构远程医疗服务 国家卫生计生委近日发布了《关于推进医疗机构远程医疗服务的意见》,对远程医疗服务进行了规范：远程医疗服务是一方医疗机构邀请其他医疗机构,运用通讯、计算机及网络技术,为本医疗机构诊疗患者提供技术支持的医疗活动。医疗机构运用信息化技术,向医疗机构外的患者直接提供的诊疗服务,属于远程医疗服务。远程医疗服务项目包括：远程病理诊断、远程医学影像（含影像、超声、核医学、心电图、肌电图、脑电图等）诊断、远程监护、远程会诊、远程门诊、远程病例讨论及省级以上卫生计生行政部门规定的其他项目。     

远程医学与病案现代化管理技术

远程医学 (Telemedicine) ,从广义上讲是医学与现代通讯学、电子学相结合的新学科 ,它使用远程通讯技术和计算机多媒体技术为医学提供信息和服务。它包括远程会诊、咨询、教学、学术会议、影像资料传输、医学数据库检索等。从狭义上讲 ,是指远程医疗 ,包括远程影像学、远程诊断及会诊、远程护理等医疗活动。发达国家在这一领域的发展已有近 40年的历史 ,在我国虽然时间较短 ,但经过近几年的发展 ,也初步走上了正轨 ,为许多患者及网上求医者提供了服务。而病案现代化管理技术的发展 (如 :光盘存储技术、电子病案、多媒体电子病案记录系统等 …     

加强医院远程医疗平台管理的实践探讨

远程医疗是指通过现代的计算机多媒体技术与现代远程通讯技术来实现异地医疗服务的系统平台。我国从20世纪80年代末才开始探索远程医疗技术．但至今该项技术在我国仍处在发展阶段121。我院的远程医疗会诊系统平台建成于2005年10月．在不到4年的时间里,已经由最初的单一申请单位发展到综合诊疗型远程会诊单位．其会诊量在全军也名列前茅．这些进步都得益于我院对远程医疗平台的有效管理。     

安徽省首家心脏远程观护中心落户六安市人民医院

9月18日,六安市人民医院心脏远程观护中心揭牌暨开诊仪式举行。此中心是安徽省首家。它的建成,开启了六安市医疗远程诊疗服务的先河,标志着六安市人民医院远程诊疗技术和信息化建设迈上一个新的台阶。     

Availability of Diagnostic and Treatment Services for Acute Stroke in Frontier Counties in Montana and Northern Wyoming

CONTEXT: Rapid diagnosis and treatment of ischemic stroke can lead to improved patient outcomes. Hospitals in rural and frontier counties, however, face unique challenges in providing diagnostic and treatment services for acute stroke. PURPOSE: The aim of this study was to assess the availability of key diagnostic technology and programs for acute stroke evaluation and treatment in Montana and northern Wyoming. METHODS: In 2004, hospital medical directors or their designees were mailed a survey about the availability of diagnostic technology, programs, and personnel for acute stroke care. FINDINGS: Fifty-eight of 67 (87%) hospitals responded to the survey. Seventy-nine percent (46/58) of responding hospitals were located in frontier counties, with an average bed size of 18 (11 SD). Of the hospitals in frontier counties, 44% reported emergency medical services prehospital stroke identification programs, 39% had 24-hour computed tomography capability, 44% had an emergency department stroke protocol, and 61% had a recombinant tissue plasminogen activator protocol. Thirty percent of hospitals in frontier counties reported that they met 6-10 of the criteria established by the Brain Attack Coalition to improve acute stroke care compared to 67% of hospitals in the nonfrontier counties. CONCLUSION: A stroke network model could enhance care and improve outcomes for stroke victims in frontier counties.     

A model for costs of stroke services

In industrialised countries, stroke is one of the most common causes of death and handicap, and the costs for stroke services are high. However, rational planning of stroke services and estimation of the costs of their provision are complex, even when generic pathways for stroke diagnosis and treatment are well understood. The reason is the chronic nature of cerebro-vascular disease and the cumulative effect of disabling brain injury. In this paper we describe development of a computer model for estimating the costs of stroke services, intended for use by planners and purchasers of stroke care services. The model operates by incrementing patients' experience of stroke events and their outcomes in annual steps, and is calibrated using Swedish data. We demonstrate the cost consequences by simulating three different policy changes. The model facilitates comparisons between stroke prevention, treatment and rehabilitation, and we conclude that by combining the three policy options it is possible to reduce the costs for stroke services markedly.     

The Burden of Stroke in Kurdistan Province,Iran From 2011 to 2017

ObjectivesThe aim of this study was to calculate the burden of stroke in Kurdistan Province, Iran between 2011 and 2017.MethodsIncidence data extracted from the hospital information system of Kurdistan Province and death data extracted from the system of registration and classification of causes of death were used in a cross-sectional study. The World Health Organization method was used to calculate disability-adjusted life years (DALYs).ResultsThe burden of stroke increased from 2453.44 DALYs in 2011 to 5269.68 in 2017, the years of life lost increased from 2381.57 in 2011 to 5109.68 in 2017, and the years of healthy life lost due to disability increased from 71.87 in 2011 to 159.99 in 2017. The DALYs of ischaemic stroke exceeded those of haemorrhagic stroke. The burden of disease, new cases, and deaths doubled during the study period. The age-standardised incidence rate of ischaemic stroke and haemorrhagic stroke in 2017 was 21.72 and 20.72 per 100 000 population, respectively.ConclusionsThe burden of stroke is increasing in Kurdistan Province. Since health services in Iran are based on treatment, steps are needed to revise the current treatment services for stroke and to improve the quality of services. Policy-makers and managers of the health system need to plan to reduce the known risk factors for stroke in the community. In addition to preventive interventions, efficient and up-to-date interventions are recommended for the rapid diagnosis and treatment of stroke patients in hospitals. Along with therapeutic interventions, preventive interventions can help reduce the stroke burden.     

Stroke services are increasingly effective

Since the first Consensus Statement on the treatment of stroke (UK, 1988) and the European Helsingborg Declaration on the treatment of stroke (1995), 69 stroke services have been geographically spread in the Netherlands; these consist of an integrated hospital stroke unit, a nursing home rehabilitation unit, and home care. The Dutch stroke services have improved their outcomes in a cost-effective way in comparison with the usual care. Consensus on patient-oriented outcomes--arranged in order of the International Classification of Functioning, Disability and Health--is recommended.     

Centralisation of acute stroke services in London: Impact evaluation using two treatment groups

The bundling of clinical expertise in centralised treatment centres is considered an effective intervention to improve quality and efficiency of acute stroke care. In 2010, 8 London Trusts were converted into Hyper Acute Stroke Units. The intention was to discontinue acute stroke services in 22 London hospitals. However, in reality, provision of services declined only gradually, and 2 years later, 15% of all patients were still treated in Trusts without a Hyper Acute Stroke Unit. This study evaluates the impact of centralising London's stroke care on 7 process and outcome indicators using a difference‐in‐difference analysis with two treatment groups, Hyper Acute and discontinued London Trusts, and data on all stroke patients recorded in the hospital episode statistics database from April 2006 to April 2014. The policy resulted in improved thrombolysis treatment and lower rates of pneumonia in acute units. However, 6 indicators worsened in the Trusts that were meant to discontinue services, including deaths within 7 and 30 days, readmissions, brain scan rates, and thrombolysis treatment. The reasons for these results are difficult to uncover and could be related to differences in patient complexity, data recording, or quality of care. The findings highlight that actual implementation of centralisation policies needs careful monitoring and evaluation.     

Can competition improve hospital quality of care? A difference-in-differences approach to evaluate the effect of increasing quality transparency on hospital quality

Public reporting on the quality of care is intended to guide patients to the provider with the highest quality and to stimulate a fair competition on quality. We apply a difference-in-differences design to test whether hospital quality has improved more in markets that are more competitive after the first public release of performance data in Germany in 2008. Panel data from 947 hospitals from 2006 to 2010 are used. Due to the high complexity of the treatment of stroke patients, we approximate general hospital quality by the 30-day risk-adjusted mortality rate for stroke treatment. Market structure is measured (comparatively) by the Herfindahl–Hirschman index (HHI) and by the number of hospitals in the relevant market. Predicted market shares based on exogenous variables only are used to compute the HHI to allow a causal interpretation of the reform effect. A homogenous positive effect of competition on quality of care is found. This effect is mainly driven by the response of non-profit hospitals that have a narrow range of services and private for-profit hospitals with a medium range of services. The results highlight the relevance of outcome transparency to enhance hospital quality competition.

     

广东省脑卒中患者对心理服务需求的现状调查

目的:了解脑卒中患者的心理服务需求及其影响因素。方法:对广东省内8所医院就诊的452例脑卒中患者进行问卷调查,对数据主要进行卡方检验及Logistic回归分析。结果:有33.6%的脑卒中患者存在心理问题,15.7%患者需要心理咨询或治疗,19.9%患者希望医院提供心理服务。年龄、脑卒中疾病的每月总费用和首次确诊脑卒中时间是脑卒中患者心理问题发生率的主要影响因素(P<0.05)。年龄、职业和脑卒中疾病的每月总费用为脑卒中患者心理服务需求的主要影响因素(P<0.05)。结论:医院专业团队在制定个性化慢性病管理方案时应适当增加心理服务的内容,从而帮助脑卒中患者解决心理问题,提升生活质量。     

Cardiac administration taking off at hospitals

The growth of cardiac services, advances in diagnosis and treatment technology, and the high revenues derived from cardiology services have created an administrative vacuum in hospitals. About 5,500 cardiac administrators are now filling that role, but demand for such administrators likely will rise as advanced cardiac services become available at more hospitals.     

Exploring changing needs following minor stroke

Medical advances have led to many of the severe consequences of stroke being averted. Consequently, more people are being discharged from hospital following treatment for what is classed as minor stroke. The needs of people with minor stroke have received little research attention. The aim of the current study was to conduct an exploratory prospective needs analysis to document the unmet health, rehabilitation and psychosocial needs of a recently hospitalised minor stroke cohort approximately 2 weeks (T1) and 2 months (T2) post‐hospital discharge. An exploratory cohort design was used to explore the unmet health, service and social needs of 20 patients with minor stroke. Participants completed questionnaires (Survey of Unmet Needs and Service Use, Mayo‐Portland Adaptability Inventory‐4, Exeter Identity Transition Scales, RAND 36‐Item Health Survey 1.0) at T1 and T2. Nine participants reported unmet needs at T1 and seven participants reported unmet needs at T2. Between T1 and T2, there was a significant improvement in perceived role limitations due to physical health. Participation in society was significantly better at T2. In conclusion, patients with minor stroke report health, service and social needs that are unmet by existing services. This patient cohort urgently requires co‐ordinated services to detect and manage these unmet needs.     

脑卒中住院患者医疗服务满意度调查及分析

目的了解脑卒中住院患者医疗服务满意度现状及影响因素,为对策制定提供参考。方法对山东省某市某三级甲等医院2011年10～12月的脑卒中住院患者进行现场问卷调查。结果脑卒中住院患者医疗服务总体满意度为73.5%。维护患者安全(80.5%)、维护患者权利(79.3%)、医疗技术(77%)、服务态度(77%)满意度高于总体满意度,是医院的竞争优势;医疗费用满意度最低(40.2%),是医院改进的重点;服务环境(67.8%)及服务流程(62.1%)也需要改进,但应量力而行。结论维护患者安全及权利应长抓不懈;高超的医疗技术及良好的服务态度应继续保持并持续提升;医院应加强收费管理,增进费用的公开透明程度;应努力保持环境的干净、整洁、舒适;应重点加强服务环节的管理,努力提供优质、高效的服务。