2010年临朐县企业职业病危害状况及服务需求调查

[目的]了解临朐县企业职业病危害与职业卫生的服务需求状况,为制定职业卫生管理机制和应对策略提供依据。[方法]2010年3~5月,选择临朐县91家存在职业病危害因素的企业,对工作场所有害因素进行检测,对工人进行职业健康体检和职业健康服务需求调查。[结果]在91家企业合计检测2 263个点,职业病危害因素合格的2 114个点,平均合格率为93.42%。检测合格率,噪声为91.51%,空气总粉尘为96.45%,一氧化碳为99.38%,二氧化碳为100.00%,硫酸为96.30%,氢氧化钠为96.15%,苯(甲苯、二甲苯)为86.49%,甲醛为6/6,硫化氢为9/9,高温为94.74%,氯气为5/5。检查接触噪声的1 838人,纯音听力异常率为32.10%,其中职业性听力损伤观察对象检出率为28.89%,轻度听力损伤罹患率为2.99%,中度听力损伤罹患率为0.22%;检查接触苯的815人,苯中毒观察对象检出率为3.56%,慢性轻度苯中毒检出率为0.98%,慢性中度苯中毒检出率为0.12%;检查接触粉尘的718人,观察对象检出率为0.28%。在8 752名调查对象中,上岗前、在岗期间接受过职业安全卫生知识培训的分别占41.00%、12.85%。[结论]临朐县企业存在较严重的职业病危害因素,职业卫生服务水平有待提高。     

新型农村合作医疗服务外包的实践分析

新型农村合作医疗是由政府主导实施的基本医疗保障制度,在运行过程中遇到两个问题:难以有效核查异地就诊病例,难以解决经办人员的编制.而福建省晋江市将新型农村合作医疗进行服务外包,实行"筹、监、办"相分离的运行模式,充分利用保险公司的全国性互助稽查网络核查异地就诊病例,并且建立外伤和疑难案件调查制度,为新型农村合作医疗的持续健康发展提供了有益的思路.     

酶工程实验教学模式创新初探

《酶工程》是高校生物技术、食品、生物工程等专业的主干课,是一门技术应用性很强的学科,而实验课作为联系理论与实践的桥梁,尤为重要。文章分析了传统酶工程实验教学中存在的问题,提出了革新思路。     

构建医学研究平台提升医院科技创新能力

科技创新是医院提高核心竞争力的关键,是保持医院前进不竭的动力,没有科技创新,就没有医院的发展。科研平台是医院科技创新的基础条件,是培养、吸引科技创新人才,锻造科研团队的基地。文章结合实践阐述了绍兴市人民医院在科技创新中注重科研平台的构建,以及医学科技创新平台在促进医院科研人才队伍建设,提升医院科技创新能力和综合实力方面起到的重要作用。     

上海市社区宫颈癌筛查服务利用影响因素研究

目的:了解上海市社区妇女宫颈癌筛查服务利用情况,并探讨影响社区妇女宫颈癌筛查服务利用的因素。方法:通过整群抽样方法选取社区妇女,采用结构式问卷调查共4 703名社区妇女,采用单因素和非条件logistic多因素方法分析服务利用影响因素。结果:社区妇女宫颈癌筛查既往参加率为44.6%,3年内参加率仅为25.4%。影响因素包括年龄、文化程度、家庭年收入、单位曾提供筛查服务、社区曾提供筛查服务、医生推荐、周围人影响、亲戚肿瘤病史。结论:构建社区宫颈癌筛查的环境氛围是提高社区妇女利用宫颈癌筛查服务,降低宫颈癌发生的关键。     

显著改善医疗费用对居民收入公平性的恶化:“总额预算+按服务单元付费”组合支付方式预期效果之一

为科学论证"总额预算+按服务单元付费"组合支付方式对于消除百姓高额医疗费用风险,改善医疗费用所致居民收入公平性恶化的效果,研究借鉴GINI系数原理与方法,利用居民大规模家庭入户调查数据,分析发现按项目付费方式下医疗费用使居民收入公平性恶化了12.61%,而组合支付方式可缓解此种恶化的82.60%,效果显著,且改善作用远大于现行医疗保障的作用(20.68%)。     

“总额预算+按服务单元付费”组合支付方式的现实设计

为了验证"总额预算+按服务单元付费"组合支付方式在实际推广过程中的现实可操作性,研究以"协调各方利益,实现预期效果"为目标,设计了简单易操作的适用于全国、省、市、县,乃至单个医疗机构的设计思路和方法,并运用华东地区某省卫生财务年报资料进行了现实模拟设计,测算得2009年华东地区某省医疗机构的业务收入总额医疗费用应控制在400.5亿元之内,不同类型和级别的医疗机构中,以城市医院为例,其门诊次均费用和住院床日费用的收费标准分别为228.5元和697.3元。证明"总额预算+按服务单元付费"组合支付方式是易操作可推广的,为组合式支付方式的现实实行、实现医改突破提供技术支撑。     

The unmet needs: How future technologies will address current limitations of bioresorbable scaffold technology

First‐generation bioresorbable scaffolds (BRS), represented by the three marked‐approved devices (Absorb BVS 1.1, DESolve NX, and DREAMS) have demonstrated, in low to moderate angiographic scenarios, similar efficacy to current generation metallic drug‐eluting stents. However, a trend toward more device thrombosis have been observed, especially when the scaffolds are used in off‐label situations. Among the main shortcomings of this novel technology, we highlight: (1) Increased strut thickness (≥150 μm) and crossing profile; (2) low resistance to overexpansion; (3) lack of radiopacity, and; (4) special storage requirements. In order to overcome these limitations and improve their acute performance and midterm safety, a dozen of novel BRS are currently under research, in different stages of development. In the present review, we address three of these new technologies, pointing out their innovative features and initial clinical results. © 2016 Wiley Periodicals, Inc.     

Understanding How Newly Implemented Rehabilitation Best Practices Are Sustained: A Realist Review

ObjectiveWe conducted a realist review to understand how (mechanism) and in what circumstances (context) evidence-based practices are sustained in rehabilitation (outcome).Data SourcesMEDLINE, Embase, reference lists, and targeted websites.Study SelectionTwo independent reviewers calibrated study selection; then 1 reviewer screened all titles and abstracts, while the second reviewer screened a random 20%. We repeated this process for full texts. We included 115 documents representing 61 implementation projects (8.9% of identified documents). Included documents described implementation projects in which physical therapists, occupational therapists, and/or speech-language pathologists were the target users of an evidence-based practice.Data ExtractionTwo reviewers repeated the independent process described in study selection to extract basic study and sustainability characteristics as well as context, mechanism, outcome, and strategy text.Data SynthesisUsing basic numerical analyses, we found that only 54% of evidence-based practices in rehabilitation are sustained. Furthermore, while authors who reported sustainability planning sustained the practice 94% of the time, sustainability planning in rehabilitation is rare (only reported 26% of the time). Extracted text was synthesized using the realist technique of inductive and deductive retroduction in which context, mechanism, outcome, and strategy text are combined into narrative explanations of how sustainability works. To inform these explanations, we applied normalization process theory and the theory of planned behavior. Collectively, the 52 identified narratives provide evidence for 3 patterns: (1) implementation and sustainability phases are interconnected, (2) continued use of the evidence-based practice can be interpreted as the ultimate sustainability outcome, and (3) intermediate sustainability outcomes (ie, fit/alignment, financial support, benefits, expertise) can become contextual features influencing other sustainability outcomes.ConclusionsImplementation teams can use the narrative explanations generated in this review to optimize sustainability planning. This can sustain practice changes and improve quality of care and patient outcomes. Future research should seek to iteratively refine the proposed narrative explanations.     

Adapting Gerontechnological Development to Hospitalized Frail Older People: Implementation of the ALLEGRO Hospital-Based Geriatric Living Lab

Gerontechnology aims at improving the functioning of older people and their carers in their daily lives as well as improving gerontological practices. To promote gerontechnology innovation in the hospital and bridge the gap between gerontechnology developers and hospitalized frail older patients, our objective was to create and implement a hospital-based geriatric living lab. We designed a hospital-based living lab, providing reflexive workshops bringing around the table gerontechnology users and developers, supplemented with an experimental hospital room receiving both the users and the devices to be tested. Three different types of users were distinguished: seriously ill older inpatients, professional hospital caregivers, and informal carers. Three different kinds of devices were also distinguished: prototypes under development, new services and/or care organizations, and new uses. Finally, we were able to open in 2018 the Angers Living Lab En GéRiatrie hOspitalière (ALLEGRO) hospital-based geriatric living lab. ALLEGRO offers the organization of "idea incubator workshops" for users and developers, together with one “experimental hospital room” equipped with validated devices to provide reference measures used as a standard to test the diagnostic efficacy of prototypes. The room is intended to accommodate one older inpatient with severe acute organic failures. No patient selection is planned at admission, apart from consent to research. Until now, no refusal to participate in a study was noted. In conclusion, we offer a new and unprecedented hospital-based geriatric living lab to improve hospital care for older inpatients and to promote successful aging through gerontechnology.