医疗体系中外展社区服务的重要性

院外医护服务在香港医疗体系中起着重要作用。院外医护医疗工作者如社区护士、家庭服务志愿者和社会工作者来自于社区的助人网络。 院外医护人员的优点是: (1)延长医护服务的连续性;(2)缓解病人的心理压力;(2)监察病情;(4)推广健康教育知识。     

我国中央层面家庭医生签约服务政策量化评价：基于PMC指数模型

背景 我国人口老龄化形势日益严重,家庭医生签约服务对助推分级诊疗制度建设、建立合理有序就医秩序发挥着重要作用,目前学者对家庭医生签约服务政策的研究主要集中于定性评价,较少有学者利用工具聚焦代表性政策对各篇进行定量评价。目的 定量评价我国中央层面的6篇家庭医生签约服务相关政策,分析政策优劣,在此基础上,提出促进我国家庭医生签约服务高质量发展的对策和措施,助力健康中国战略实施。方法 于2022-04-30,以“家庭医生”为关键词在北大法宝数据库进行全文检索,并在国务院网站进行相关内容检索,检索时限为2015-01-01至今。采用ROSTCM 6.0软件进行文本挖掘,然后以其结果为依据选择其中具有代表性的中央层面家庭医生签约服务相关政策,并基于政策一致性评价（PMC）指数模型对其进行量化评价。结果 依据纳入与排除标准检索获得相关政策32篇,家庭医生签约服务领域排名前5位的高频关键词为“签约服务”（274次）、“健康”（272次）、“医疗”（264次）、“家庭医生”（225次）、“签约”（180次）,以其为依据共选择中央层面有代表性的家庭医生签约服务相关政策6篇,分别标记为P1～P6。政策量化...     

营养不良老年人非药物干预临床实践指南

老年人是营养不良的高发人群,营养不良与众多不良临床结局密切相关,严重影响老年人的身体健康和生活质量,给家庭和社会造成沉重负担。因此,采取有效措施改善老年人的营养不良至关重要,非药物干预是改善营养状况的重要措施。然而,国内尚无专门针对营养不良老年人的非药物干预临床实践指南,因此,中国老年护理联盟、国家老年医学中心和国家老年疾病临床医学研究中心的营养专家,通过对老年人营养不良最新的国内外文献的全面检索与分析,采用推荐意见评估、制订及评价(GRADE)分级体系制订了本指南,针对营养不良老年人非药物干预提出9条推荐意见,以期能够改善老年人营养不良状况,提高生活质量。本指南侧重于可经口进食的营养不良老年人,聚焦于肠内营养,肠外营养不在本指南讨论范围内。     

Measurement of functional ability and health status in the arthritic patient

Chronic arthritis may have great impact on the patient but also on his or her family, relatives and friends. The assessment of the consequences of chronic arthritis and the effect of therapy not only in terms of physical, but also psychological and social dimensions deserves more attention. Functional ability and health status can be measured using a questionnaire or ‘instrument’, high-lighting important aspects not quantified with more traditional measurements. In this paper, arguments to apply such instruments more frequently are given. Health status instruments can be used not only to assess beneficial but also deleterious (side-)effects of therapeutic interventions. The properties are summarized of the most frequently used instruments assessing functional ability and health status. Many of these instruments have been evaluated sufficiently for validity and reliability; their sensitivity to detect change seems to be satisfactory. Therefore it is advisable to choose an internationally accepted, frequently used instrument, reflecting the area of interest.     

Recent data and their analysis from the Toshiba multiphasic-health-screening centre

An automated multiphasic-health-test system has been opened in Japan for the early detection and treatment of disease in adults. The centre utilises system simulation, digital computation and automated medical equipment, and has made it possible to handle many examinees daily, and to retrieve their data easily. This paper reports many new data and their analysis.     

Transient aphasia with lithium toxicity

A case of transient aphasia in a 48-year-old woman is described. The aphasia occurred when progressive renal insufficiency led to accumulation of lithium to toxic levels, and was associated with well-known clinical findings of lithium toxicity.     

The morphogenesis of testicular degeneration induced in rats by orally administered 2,5-hexanedione

The neurotoxic hexacarbon 2,5-hexanedione (2,5-HD) produces testicular atrophy in experimental animals. To examine the morphogenesis of the testicular lesion, 1.0% 2,5-HD was provided in the drinking water of adult F-344 rats for up to 6 weeks. After 3 weeks of administration, there were occasional large vacuoles in the basal region of the germinal epithelium. At 4 weeks, these vacuoles were much larger and more numerous; electron microscopy demonstrated that they were derived from the smooth endoplasmic reticulum. The vacuoles were preferentially associated with stages 12, 13, 14, and 1 of the spermatogenic cycle. Additionally, at 4 weeks there was a significant decrease in the number of tubules in stages 7 and 13, and a concomitant increase in the percentage of tubules in stages 3, 5, and 6. By Week 5, most Golgi-phase and cap-phase spermatids were visibly affected, showing margination of nuclear chromatin, and were becoming dissociated from Sertoli cells. Frequent multinucleated giant cells were seen and electron microscopy of these cells suggested that they were derived from fused spermatocytes or spermatids. After 6 weeks, fewer giant cells were present, most tubules contained cellular debris, and many showed empty lumina encircled by a thin ring of cytoplasm near the basement membrane. Interstitial tissue appeared unaffected. These studies indicate that the Sertoli cell is probably an initial target for 2,5-HD action in the testis.     

Double nondisjunction during karyotypic progression of chemically induced Syrian hamster cell lines

The karyotypic evolution of three chemically induced cell lines of Syrian hamster embryo in culture are described. The only karyotypic alteration of one clone was a trisomy of chromosome #11, which presumably arose by nondisjunction after carcinogen treatment. A pure population of cells with the trisomy was observed repeatedly upon karyotyping of cells at the first three passages after cloning. However, at a late passage, apparently normal diploid cells appeared in the culture, which we propose resulted from a second nondisjunction of one chromosome #11, reverting the cells from trisomy 11 to disomy 11. The karyotypic evolution of two other cell lines also involved double nondisjunction, which resulted in duplication of a translocated chromosome and concurrent loss of the normal nonrearranged chromosome. Taken together with the reported findings of others, the results indicate that double nondisjunction is a mechanism in karyotypic progression during neoplastic development.     

Information security concepts and practices: the case of a provincial multi-specialty hospital

In recent years, major and widely accepted information security understandings and achievements confirm that the problem is complex. They clarify that technologies are fundamental tools, but management processes have even bigger relevance, as also prestigious international magazines dossier clearly explained recently. Such a magazine attention outlines the wide impact that the subject has on watchful decision makers. ISO17799 is an emerging standard in information security. In principle there are no reasons for considering it not applicable to the health care sector. In practice, because of both the just conceptual level of the standard and the peculiarities of the health care data and institutions, a lot of analysis and design work need to be invested any time a health care institution decides to deal with the subject. CEN/ENV 12924 is another emerging standard certainly more on the spot of the health care. Nevertheless, it also asks for evident further investigation. The practical case of information security design, implementation, management, and auditing inside a multi-specialty provincial Italian hospital will be described.     

Some notes on uncertainty; Federal policy and innovation

The legislative background and current responsibilities of the new National Center for Health Care Technology (NCHCT) are discussed. The NCHCT's charge is to consider the stage of development, the actual or potential risks, costs and rate of use of health care technology. The role of Government in supporting new technologies, stimulating innovation and encouraging application of research products is considered. These issues are discussed in the context of the uncertainty inherent in planning and the formulation of public policy.