我国煤矿矿山医疗救护工作的SWOT分析

运用SWOT方法分析了目前我国矿山医疗救护工作的整体优势，认识到当前矿山医疗救护工作创新能力不足是面临的主要劣势，剖析了创新发展的机遇和一些结构性威胁，并提出了相应的发展策略。     

航空医疗救援体系建设的规划布局与选点定位问题

构建航空医疗救援体系必须要有战略思维才能做好顶层设计,在科学规划、合理布局中解决选点定位问题。从自然环境、服务人口、交通设施、民航存量、产业结构、受灾概率、平战结合、对外交往、发展需求、综合效益等10个方面加以论述,以促进体系规划布局与选点定位更加科学合理。

     

基于移动云的急救医疗信息协同平台设计

现代急救医疗要求在正确的时间和地点,将正确的信息交接给正确的人,因此建立一套覆盖急救医疗全程,既能满足单一环节信息支持,又能满足各环节信息协同的管理平台,对提高城市急救能力及重大灾难救援能力起着重要作用。但由于急救医疗服务具有涉及部门多、参与人员多、流转过程多、地域跨度大的特点,信息交互共享涉及不同系统间的信息标准和规范、异构信息系统间的互操作性、跨机构系统间的信息协同等问题,因此具有很大的实施难度。文章探讨利用移动云技术构建低成本、高效率、高安全性的分布式信息资源整合方案,实现各类信息跨业务系统、跨机构、跨地域的在线存储、创建、编辑、共享及协同管理。     

澳大利亚飞行医生服务及其对我国的启示

飞行医生是澳大利亚医疗服务体系的一大特色，对提高其居民的医疗服务可及性具有十分重要的作用。介绍澳大利亚“飞行医生”服务的发展历程及其对其他国家或地区的影响，探讨其对我国医疗急救与医疗服务体系改革、解决农村偏远地区卫生技术人才匮乏问题的启示。     

大型公立医院建设区域医疗协同体系的实践与探索

随着国家医疗卫生体制改革不断深化,以大型医院为核心建立区域医疗协同体系,显得尤为重要和迫切。徐州医科大学附属医院以集团化运作、托管、技术支持等多种合作模式和县级以及基层乡镇卫生院建立互动的协同关系,累积了一定的实践经验。本文通过调查对比建立协作关系前后核心医院和成员医院发展的情况,总结和分析出核心医院推动区域医疗协同体系建设的六项关键措施,即提升成员医院等级、加强人才培养、技术支援、专科建设、硬件支持、公共项目合作。以期为推动区域医疗联体的发展提供参考。     

论以居民健康为中心的医疗卫生服务提供体系建设

目前我国医疗卫生服务体系已无法完全满足居民与日俱增的健康需要与需求,急需构建以居民健康为中心的整合型医疗卫生服务提供体系,包括分级诊疗模式与社区契约服务。针对医疗卫生服务体系在发展过程中所受制约,建议进一步调整完善我国的医疗卫生服务提供体系,加强机构建设与人才培养,尤其是慢病急救医疗服务体系与慢病专项人才梯队的构建;在继续推动整合型医疗卫生服务提供体系的发展中,要加强医保、医疗服务供方和需方三方联动,保证以居民健康为中心的整合型医疗卫生服务体系的构建没有短板、有效运行。     

基于京津冀一体化构想下的中医医疗联盟模式探讨

在中央提出京津冀协同发展的重大战略背景下,为了适应区域医疗均质化和医改的需要,为区域内百姓提供更优质的医疗服务,试构想创建中医医疗联盟。在医疗一体化建设方面,北京中医医院有着很好的中医联盟建设基础,试从北京中医医院医疗联盟建设的角度,对京津冀一体化构想下的医院托管模式进行探讨。     

严重创伤院前急救体系概况与进展

<正>现代创伤多为高速高能引起的严重多发伤、复合伤,易漏诊误治,致残率及死亡率高,是我国城市和农村人口死亡的五大原因之一[1]。院前急救是创伤救治体系"三环理论"(院前急救医疗环、院内急救环、危重病ICU环)中的一个基本环节,也是非常重要的一环,有效的院前急救可降低死亡率[2]。近年来,随着我国急救医疗体系和灾难医疗救援的逐步建立,院前急救医疗体系(EMSS)初见规模,大部分三级医     

西部地区县级医疗机构网络医疗供给影响因素研究

目的 了解西部县级医疗机构网络医疗供给意愿和现状,为西部推广网络医疗提供发展策略。方法 对云南省某县县级医疗机构的153名医生进行问卷调查。结果 81.7%的受访医生愿意向患者提供网络医疗服务,15.0%提供过相应服务,质量安全、推广路径、服务能力成为主要的发展瓶颈。结论 目前西部农村地区医生提供网络医疗服务的意愿与实际提供比例差距较大,应制定网络医疗的法律法规、完善诊疗规范和监管体系、加快网络医疗平台建设,规范网络医疗培训。     

医疗安全监控系统在卫生监督工作中的作用

医疗安全监督是卫生监督的重要组成部分,发展和完善医疗安全监督模式是卫生监督体系改革的重要任务之一。医疗安全监控系统的建立将医疗安全监督模式由以往事后监管、被动监督转变为事前防范、主动预防的新型监督模式。在实际的医疗安全监督工作中,真正体现了服务、教育、处罚相结合的卫生监督工作理念。     

Quality Improvement Report: Six year audit of cardiac arrests and medical emergency team calls in an Australian outer metropolitan teaching hospital

Problem In-hospital cardiac arrest often represents failure of optimal clinical care. The use of medical emergency teams to prevent such events is controversial. In-hospital cardiac arrests have been reduced in several single centre historical control studies, but the only randomised prospective study showed no such benefit. In our hospital an important problem was failure to call the medical emergency team or cardiac arrest team when, before in-hospital cardiac arrest, patients had fulfilled the criteria for calling the team.Design Single centre, prospective audit of cardiac arrests and data on use of the medical emergency team during 2000 to 2005.Setting 400 bed general outer suburban metropolitan teaching hospital.Strategies for change Three initiatives in the hospital to improve use of the medical emergency team: orientation programme for first year doctors, professional development course for medical registrars, and the evolving role of liaison intensive care unit nurses.Key measures for improvement Incidence of cardiac arrests.Effects of the change Incidence of cardiac arrests decreased 24% per year, from 2.4/1000 admissions in 2000 to 0.66/1000 admissions in 2005.Lessons learnt Medical emergency teams can be efficacious when supported with a multidisciplinary, multifaceted education system for clinical staff.     

我国现行医疗卫生政策的相关问题分析

医疗卫生是构建和谐社会的重要因素之一,也是关乎百姓切身利益的重大问题之一,近年来,医疗体制的不断改革,医疗卫生的相关政策的不断出台,已经大大地改善了我国广大人民群众的“看病难,看病贵”等问题,增加了医保的覆盖人群,减轻了城市低收入人群及农村的医疗负担,但是,我们仍面临着巨大的挑战,新的问题也不断涌现,医疗卫生政策不适应现在的医疗需求发展、经济发展不均衡、不同层次群众的医疗需求有差异等,都是医疗卫生改革中面临的问题,医疗改革的不断推进势在必行。我国的医疗保障制度覆盖率已经达到95％,但是,现行的医疗保障制度的还不能从根本上解决人民群众的“就医难,治病贵”的问题,其他医疗保险不能与现行的医疗保障制度相适应,从而,影响了我国整体的医疗水平的提高。     

电子健康档案管理探讨

电子健康档案管理以健康需求为导向,以电子健康档案为基础,以电子网络为依托提供个性化的健康服务。在新医改的大背景下,电子健康档案管理通过“早预防、早诊断、早治疗”,降低医疗费用,提高人们的生活质量,营造和谐的社会氛围,贯彻落实科学发展观,以适应全面建设小康社会的需求。     

End-of-life care issues in advanced dementia

Appropriate management of advanced dementia requires it to be recognised as a terminal condition that needs palliative care. Interventions during this stage should be carefully chosen to ensure the improvement or maintenance of the quality of life of the person with dementia. Advanced care planning is an important aspect of dementia care. Carers and relatives should be educated and encouraged to actively participate in discussions related to artificial nutrition, cardiopulmonary resuscitation (CPR) and other medical interventions.     

Recommendations for ensuring early thrombolytic therapy for acute myocardial infarction. The Heart and Stroke Foundation of Canada,the Canadian Cardiovascular Society and the Canadian Association of Emergency Physicians for the Emergency Cardiac Care Coalition.

OBJECTIVE: To recommend practical steps to ensure early thrombolytic therapy and thereby reduce mortality and morbidity associated with acute myocardial infarction (AMI). OPTIONS: Various factors were considered that influence time to thrombolysis related to patients, independent practitioners and health care systems. OUTCOMES: Reduction in morbidity and mortality associated with AMI. EVIDENCE: Early initiation of thrombolytic therapy reduces morbidity and mortality associated with AMI. The ECC Coalition analysed the factors that might impede early implementation of thrombolytic therapy. VALUES: Published data were reviewed, and recommendations were based on consensus opinion of the Emergency Cardiac Care (ECC) Coalition. The ECC Coalition comprises 20 professional, nongovernment and government organizations and has a mandate to improve emergency cardiac care services through collaboration. BENEFITS, HARMS AND COSTS: Early thrombolytic therapy reduces morbidity and mortality associated with AMI. Implementation of the recommendations will result in reduced time to thrombolytic therapy, streamlining of current practices and enhanced cooperation among health care professionals to expedite care. Depending on existing practices, implementation may require protocol development, and public and professional education. Although costs are associated with educating the public and health care professionals, they are outweighed by the financial and social benefits of reduced morbidity and mortality. RECOMMENDATIONS: Early recognition of AMI symptoms by the public and health care professionals, early access to the emergency medical services system and early action by emergency care providers in administering thrombolytic therapy (within 30 minutes after the patient''s arrival at the emergency department). VALIDATION: No similar consensus statements or practice guidelines for thrombolytic therapy in Canada are available for comparison.     

Categorization of Hospital Emergency Services—Developing Valid Criteria

In a pilot project sponsored by the California State Emergency Medical Services Authority, validated, verifiable criteria were developed for the vertical categorization of hospital emergency services in 11 different groupings of medical and surgical emergencies. We describe the development of an assessment process and categorization criteria to identify the most appropriate receiving facility for interfacility transfer and, in selected instances, field triage of patients with different levels of severity of illness or injury. We propose that this facility assessment project be used in the critical care planning process for the eventual vertical categorization of hospital emergency services in California and as a template for similar projects in other states.     

A planning framework based on system theory and GIS for urban emergency shelter system: A case of Guangzhou,China

The urban emergency shelter is of great significance to disaster prevention and mitigation. In China, the demand is enormous for emergency shelters while their construction generally lags behind the economic and social development, which has resulted in heavy casualties and economic losses. This article considers emergency shelters as a complete system from systemic perspective and also proposes a planning framework for emergency shelter system, including the function, hierarchy, type, scale, layout, standard, and supporting-service system of the shelters. Then, an empirical study applying the framework in GIS platform in the urban emergency shelter planning of Guangzhou city was conducted and highly valued by local experts and citizens as a feasible scheme to guide the construction of emergency shelters, indicating that the framework is an appropriate tool for urban emergency shelter planning.     

Educating Internists in Emergency Medicine

The education of internists in emergency medicine needs to be thoughtfully planned by those involved in their education. Objectives for their emergency medicine rotation include the recognition and initial treatment of true medical and surgical emergencies, clinical experience with and knowledge of common acute primary care problems, the ability to handle several patients with problems having different degrees of urgency, effective use of consultants in the follow-up and management of difficult patients and a knowledge of and clinical experience with the prehospital care system. A curriculum should be designed to give the resident a core of didactic material in addition to supervised clinical experience. The rotation should be evaluated by both residents and faculty from internal medicine and emergency medicine to determine if it is accomplishing the objectives set forth.     

Use of a Hospital Emergency Service by Children and Adolescents for Primary Care

This study was planned to determine the extent to which the emergency service of a large general hospital in Vancouver was providing a primary medical care function for children and adolescents. The data were collected during 14-day study periods in each season of the year. Medical data and physician urgency rating were obtained on all patients. Demographic and socioeconomic data and data pertaining to patterns of medical care were obtained by interview of a one-third sample.The study identified a group of patients receiving primary medical care for non-urgent and non-traumatic conditions. This group resided close to the hospital and had lower socioeconomic indices than the remainder of the patients.The trend to utilize the emergency department for reasons other than the accident and emergency function was confirmed. These findings will be incorporated in the planning of the New Children''s Hospital in Vancouver with the provision of separate facilities for the care of non-urgent attenders.     

Exploring local consequences of two land-use alternatives for the supply of urban ecosystem services in Stockholm year 2050

Ecosystem services (ESs) are gaining ground in urban policy as a key to attaining sustainable cities. However, strategic and land-use planners need operational and accessible tools to better understand the consequences of policy and planning measures. Based on a study of the City of Stockholm and its surrounding region, we argue that spatially explicit land-use mapping is a good base for modeling and visualizing the supply of urban ESs provided by different patterns of Service Providing Units. By adding more detailed characteristics of land use through the concept of Service Providing Elements (SPEs), and by assessing synergies and trade-offs between these attributes, implications for the supply of ESs at different scale levels could be identified and discussed. Detailed land-use mapping and ES modeling were applied to two future land-use alternatives. The supply of eight urban ESs was found to vary significantly between the two alternatives depending on the ratios of different SPEs, even within identical land-use classes. One of the land-use alternatives had significantly higher potential for food and energy provision, much higher air cooling and air quality regulation capacity especially in densely built areas, showed less surface sealing, and provided better conditions for mental recreation. The exception was supply of physical recreation opportunities, where the other land-use option had an advantage. These differences became more accentuated when we zoomed in on two local urban areas. Based on these findings, our main conclusion is that, in order to provide planning and policy-making with an adequate knowledge base, it is necessary to move beyond land-use classes, as defined by European data sets like Urban Atlas, and toward tools capable of capturing more detailed aspects of land use and its relations to the supply of urban ESs. This should be made a priority, especially in early stages of planning and policy formation, and also used to support development of urban by-laws, procurement arrangements, neighborhood and building certification, etc. The approaches used in the study can serve as a valid starting point for further development of such tools and methods compatible with planners’ ordinary working modes. However, to make such progress possible, the ecosystem service research community needs to step up to the challenge of delivering locally specific and useful data on how urban land-use links to ES supply, including synergies and trade-offs between different ESs.