四川省内异地就医联网结算管理实践探索

四川省内基本医疗保险异地就医联网结算试点工作已全面启动.四川省肿瘤医院作为首批联网试点医院,积极顺应联网结算需求,完善服务内涵、畅通服务流程,全面落实了实现异地就医即时结算的主要措施,极大方便了异地就医人群.异地就医联网结算是一项全新工作,针对运行中存在的问题提出建议,为完善异地医保的服务与管理提供参考.     

基于门诊一卡通的市医保实时结算系统设计与应用

目的:设计基于门诊一卡通的市医保实时结算系统,减少手工核算的误差,提高工作效率.方法:根据市医保中心提供的接口函数动态库的调用规则与医院信息系统(hospital information system,HIS)内部数据结构要求,采用C#语言,以Oracle 10g为基础进行设计.结果:该系统实现了门诊医保患者持卡就医费用的实时结算功能.结论:该系统简化了门诊医保工作流程,实现了数据信息互通,大大提高了患者的满意度和医院的医保监管力度.     

新农合即时结报工作的实践与思考

通过阐述湖南省新农合即时结报工作现行状况,分析存在的问题,思考相应的对策:严格把控退出机制、政策宣传从基层做起、确保参合信息录入质量、提高医院即时结报服务水平、建立健全信息沟通工作机制等,以期促进新农合即时结报制度的完善,为深入推进新农合即时结报工作提供参考依据。     

Imperial expansion,public investment,and the long path of history: China’s initial political unification and its aftermath

The Neolithic (ca. 8000–1900 B.C.) underpinnings of early Chinese civilization had diverse geographic and cultural foundations in distinct traditions, ways of life, subsistence regimes, and modes of leadership. The subsequent Bronze Age (ca. 1900–221 B.C.) was characterized by increasing political consolidation, expansion, and heightened interaction, culminating in an era of a smaller number of warring states. During the third century B.C., the Qin Dynasty first politically unified this fractious landscape, across an area that covers much of what is now China, and rapidly instituted a series of infrastructural investments and other unifying measures, many of which were maintained and amplified during the subsequent Han Dynasty. Here, we examine this historical sequence at both the national and macroscale and more deeply for a small region on the coast of the Shandong Province, where we have conducted several decades of archaeological research. At both scales, we examine apparent shifts in the governance of local diversity and some of the implications both during Qin–Han times and for the longer durée.Two millennia ago, two empires, situated at the opposite ends of Eurasia, dominated their respective regions (1). To the west, Rome was in the process of expanding its conquests across Europe, whereas to the east, the Han, having assumed power following the short-lived Qin Dynasty, ruled over most of what is today China. Although at their peaks these polities were roughly comparable in spatial extent, the political legacies that followed their declines were markedly different (2). Whereas the bounds of the Roman Empire were never historically reconstituted, Chinese regions, after the initial Qin unification (221 B.C.), were reintegrated perpetually into one political unit, despite intermittent periods of disunity (3). From the founding of the empire to its early 20th-century dissolution, the area from the Mongolian steppe to the South China Sea was ruled by a single authority for roughly half this period (1, 2, 4).Why humans cooperate in large, often relatively durable social groupings is a key question for contemporary research (5, 6). Thus the repeated historical renegotiation of China’s continent-scale political consolidations remains a scholarly focus after more than a generation of attention (3, 4, 7, 8). One perspective (3, 4) places great emphasis on biogeography and defensive concerns, specifically the persistent, perceived military threat of mobile peoples along China’s northern frontier. Although northern invasions did occur periodically during China’s history (3, 8) and military threat does provide strong incentives for collective action (3, 9, 10), many questions, however, remain unanswered. Why, in China, was the military challenge met by successful, albeit not always long-lived, political reconstitutions (threats from mobile peoples had no such collaborative effect in Europe) (1)? Why did areas distant and less threatened by the northern frontier reintegrate, and why did the repeated reestablishment of empire reunify a landscape close to the limits achieved originally by the Qin? These unanswered questions belie a problematic but oft-held premise: that widespread cooperation was somehow easy to attain in China, perhaps because the populace shared a long-standing cultural tradition or ethnic identity (11).In contrast, we argue that Chinese collective identities (12), which became social building blocks of large-scale political integration, were constructed, as evidenced elsewhere (13, 14), and certainly were not primeval. We recount processes and events, both before and after the initial Qin unification, that underpinned the making of more overarching Chinese collective identities, subsuming strong elements of local customary diversity (15). To assess this sequence, we examine multiple analytical scales. First, we synthesize documentary histories (which generally reflect the perspectives of governing and elite principals) and archaeological overviews to recapitulate the transitional sequence that ran from diverse networks of agricultural communities across China during the Neolithic (ca. 8000–1900 B.C.) to the Qin unification. Then, to assess the ways in which political edicts and governance practices played out for lives on the ground, we review the findings from one region of China (the coast of Shandong Province), eventually conquered and integrated by the Qin–Han, where we are conducting a systemic regional archaeological settlement pattern survey (16–18). Through this multiscalar investigation, we evaluate both shifting strategies of governance and the ways that they were negotiated and received in one local context.     

Genome-wide evidence of Austronesian–Bantu admixture and cultural reversion in a hunter-gatherer group of Madagascar

Linguistic and cultural evidence suggest that Madagascar was the final point of two major dispersals of Austronesian- and Bantu-speaking populations. Today, the Mikea are described as the last-known Malagasy population reported to be still practicing a hunter-gatherer lifestyle. It is unclear, however, whether the Mikea descend from a remnant population that existed before the arrival of Austronesian and Bantu agriculturalists or whether it is only their lifestyle that separates them from the other contemporary populations of South Madagascar. To address these questions we have performed a genome-wide analysis of >700,000 SNP markers on 21 Mikea, 24 Vezo, and 24 Temoro individuals, together with 50 individuals from Bajo and Lebbo populations from Indonesia. Our analyses of these data in the context of data available from other Southeast Asian and African populations reveal that all three Malagasy populations are derived from the same admixture event involving Austronesian and Bantu sources. In contrast to the fact that most of the vocabulary of the Malagasy speakers is derived from the Barito group of the Austronesian language family, we observe that only one-third of their genetic ancestry is related to the populations of the Java-Kalimantan-Sulawesi area. Because no additional ancestry components distinctive for the Mikea were found, it is likely that they have adopted their hunter-gatherer way of life through cultural reversion, and selection signals suggest a genetic adaptation to their new lifestyle.Located 400 km of the East African coast, Madagascar has been referred to as “the single most astonishing fact of human geography” (1, 2). Despite its proximity to Africa, less than 10% of the vocabulary of the Malagasy language is from African languages (mainly Sabaki, a branch of Bantu) (3–5). In contrast, 90% of Malagasy vocabulary belongs to the Barito (6) or other subgroups of Austronesian languages of Island Southeast Asia (7–9). Although being less specific, genetic studies have generally confirmed the dual ancestry of the Malagasy population (10–14).Low genetic differentiation of the Malagasy mtDNA and Y chromosome lineages from related lineages observed in present day Bantu and Austronesian populations support a model drawn from linguistic evidence that the Malagasy gene pool has been derived predominantly from these two dispersals of agriculturalist populations. As shown by linguistic and phylogenetic studies on cattle and crop names and their genetic diversity, both agricultural populations have apparently brought their way of life once they had settled in Madagascar (15, 16).Although one archaeological report claims the presence of anthropic artifacts as early as 4,000 y ago (17), most research points to first human impact on the Malagasy environment around 2,400 y ago (18), which would still be before the Bantu expansion reached the East African coast (19). In addition, European traveler reports and putative archaeological artifacts support hunter-gatherers living in the south of the island until the 16th century (20–23). It has been speculated that these hunter-gatherer groups were the remnants of a pre-Bantu settlement of Madagascar (24). The cause of disappearance of the hunter-gatherers after the 16th century is unknown, but the two most likely scenarios that can be contemplated involve either a cultural shift or population replacement.Traditions concerning the dispersal of a sedentary way of life and agriculture in the south of the island relate to the Sakalava expansion (25). These traditions recount that in the 17th century, leaders, soothsayers, and migrants from the arabo-islamized Temoro population from the southeastern coast of Madagascar colonized the southern regions of Madagascar with the intention of creating new cities and kingdoms, such as Maroserana and Andrevola (25, 26). A few decades later, new Sakalava kingdoms emerge on the southeast coast and gradually spread throughout southern Madagascar, which coincides with the disappearance of hunter-gatherer populations (25).The survival in Madagascar of a modern hunter-gatherer population was believed to be a myth (24, 25). However, there are a variety of hunter-gatherer groups scattered across the island that have been studied and mapped since the 1920s, particularly in the Tsiribihina region (southwest Madagascar) under the names Vazimba and Beosi (27). In the Mikea forest (south of the Mangoky River, southern Madagascar) one population, the Mikea, still live as hunter-gatherers. Earlier writers thought the Mikea were descended from ancient forager groups who have maintained their way of life up to the present (24, 25, 27, 28), but most modern scholarship argues the Mikea reverted back to the forest for political or economical reasons, such as Sakalava royalty pressure or French colonization (29–31).We address here the question of whether and to what extent the Mikea share their genetic ancestry with their neighboring Malagasy populations with a sedentary lifestyle. Specifically, we aim to detect in the Mikea patterns of genetic diversity assignable to a population that would predate Austronesian and Bantu incursions. Alternatively, we consider the scenario by which it is only their subsistence strategy that separates the Mikea from other contemporary populations in southern Madagascar.To answer these questions, we performed a genome-wide analysis of 21 Mikea individuals, 24 individuals from a nearby Vezo population, and 24 individuals of the Temoro population, using Illumina HumanOmniExpress BeadChips, and compared the data with Southeast Asian and African populations. Based on this dataset, we have: (i) studied the genetic distance between the three Malagasy populations; (ii) tested the existence and age of admixture patterns; and (iii) tested the Mikea genome for any adaptive signal that may be associated with the hunter-gather way of life.     

尿液常规干化学检验的影响因素分析

目的通过分析尿液常规检验的影响因素来建立尿液分析的标准化。方法按全国临床检验操作规程(第二版)的推荐方法进行尿液常规检验,并在多种人为干扰因素下进行尿液常规干化学分析。结果尿液常规干化学分析有多种影响因素。结论在实际工作中必须遵照标准化的操作规程进行操作,排除多种影响因素,才能更好地分析检验结果和服务临床。     

Medical malpractice experience of Taiwan: 2005 versus 1991

Background: Medical malpractice litigation has become an important issue worldwide. Although many epidemiological studies have been carried out, most studies were conducted cross-sectionally in developed countries and focused on malpractice litigation. We conducted nationwide surveys to investigate physicians' experiences associated with malpractice in 1991 and 2005, respectively.
Methods: By stratified systemic sampling, questionnaires were mailed to physicians in 1991 and 2005. Physicians were asked about the experience of medical malpractice and outcomes of malpractice. The outcomes of the malpractice were classified as resolution, settlement and lawsuit. We also collected physicians' demographic and professional characteristics.
Results: The prevalence of malpractice experience decreased from 44.1% in 1991 to 36.0% in 2005 ( P  = 0.004). The estimated annual malpractice claims decreased from 0.14 to 0.10 per physician in 1991 and 2005, respectively ( P  < 0.001). Physicians 45–64 years of age, obstetrician/gynaecologists and surgeons had significantly higher risk of malpractice. Compared with 1991, malpractice claims in 2005 were more likely to be brought into courts (23.1% in 2005 vs 15.7% in 1991, odds ratio (OR) = 1.48, P  = 0.020). In litigation cases, malpractice events in 2005 had more than triple the risk of 1991 to be sued in both civil and criminal courts (12.4% in 2005 vs 4.1% in 1991, OR = 3.31, P  < 0.001).
Conclusion: Compared with 1991, medical malpractice experiences were decreasing in prevalence, but increasing in severity in 2005. Additional studies, especially among different legal systems, are necessary to confirm these observations.     

九洲灾民安置点卫生防疫的组织与实施

通过对绵阳九洲灾民安置点的地理、气候条件、人员结构、基础卫生设施等的不同特点分析、判断易发疾病，从而分别在传染源、传播途径、易感人群各环节采取综合预防控制措施，达到了从5月12日设置起用至7月1日终末消毒完成时止该安置点内无大的疫情发生，实现了“大灾之后无大疫”的阶段性目标。     

民事诉讼和解的瑕疵及其救济

根据英美法等国家的理念,诉讼和解为私法行为,达成的和解协议亦为私法上的契约.因此,在英美法系国家,如果诉讼和解具有瑕疵,只能援用撤销合同的理由进行.在大陆法系国家和地区,诉讼和解兼具私法行为与诉讼行为的性质.如果诉讼和解具有瑕疵,存有提起再审、继续审判、提起新诉和提起执行异议之诉四种方法寻求救济.     

Guiding industry settlements of opioid litigation

Background: The recent $270 million settlement of Purdue Pharmaceuticals and the State of Oklahoma on March 26, 2019 concerning the state’s opioid litigation is a harbinger of industry settlements to come. Thousands of opioid-related cases with impending trial dates may stimulate opioid manufacturers, distributors, and retailers to seek new deals to escape historic liability.

Objectives: Against a backdrop of massive damage potential of a two decade opioid epidemic, reaching appropriate settlements is key. Parties to opioid lawsuits must balance an array of factors to assure industry accountability while preserving access to opioids among legitimate patients seeking palliative care.

Methods: We examined major bases for opioid litigation across the U.S. Thousands of cases have been filed against opioid manufacturers, distributors, pharmacies, pharmacy benefit managers, and others. Hundreds of these cases are consolidated in a federal district court in Cleveland, Ohio where trials are scheduled as early as October 2019. Grounds for litigation are highly varied.

Results: Multiple factors underlying responsible settlements include (1) a primary focus on contemporary treatment and prevention strategies supplemented by research innovations; (2) primary access to life-saving treatments for at-risk individuals; (3) fair and equitable allocation of settlement resources; (4) dedication to lawful, efficacious interventions; (5) cross-sharing of industry data and practices to promote good faith compliance; and (6) continued assurance of access to palliative care for deserving patients.

Conclusions: Negotiated settlements must align with highly effective public health priorities. Crafting wise settlement agreements is necessary to assign responsibility for huge public harms and ensure future treatments that are prudent and efficacious.