西安市雁塔区区域卫生分级诊疗信息平台建设探索

为响应国家卫计委全面推进分级诊疗工作的号召,解决百姓看病难、看病贵以及医疗资源不均衡的问题,西安市雁塔区作为陕西省城市医院分级诊疗首个试点,探索组建了以西安交通大学第一附属医院为核心的区域医疗联合体,并且将区域内各个医疗卫生机构的医疗资源整合在一起,搭建起地方区域分级诊疗信息共享平台。通过区域卫生分级诊疗信息平台的建立,实现了区域内医疗卫生机构基本业务信息系统数据的交换和共享,解决了医疗机构、卫生管理机构“信息孤岛”问题,建立起基层首诊、双向转诊、急慢分治、上下联动的分级诊疗模式,全面带动了陕西省医疗机构分级诊疗工作的开展。     

基于社会分工理论的分级诊疗服务体系研究

医疗卫生服务体系结构复杂，建立规划合理、分工明确的分级诊疗服务体系是保障医疗资源合理配置、提高医疗服务协调性和连续性的重要手段。通过探讨当前分级诊疗服务体系存在的问题，进而结合社会分工理论为形成适应我国国情的分级诊疗制度提出对策建议。     

我院实施双向转诊的实践与探讨

新医改方案中明确提出了健全基层医疗卫生服务体系,建立城市医院与社区卫生服务机构的分工协作机制,引导一般诊疗下沉到基层,逐步实现社区首诊、分级医疗和双向转诊,缓解目前“看病难、看病贵”的就医矛盾。双向转诊是实施医疗卫生体制改革的突破方略。对双向转诊模式进行实践和研究,以期最终实现医疗资源的节约和人民群众的就医方便。     

我国分级诊疗

实施分级诊疗制度是深化我国医药卫生体制改革的核心战略要求,其实质是在卫生、财政、医保、药品监督等多部门协同作用下,各层医疗机构之间实现诊疗服务的科学性和连续性,形成预防、治疗、康复等有机整体,达到合理有序的就医格局。当前的分级诊疗制度存在分级诊疗体系建设不完善,基层首诊实现程度低,缺乏利益激励机制以及信息化程度不高等问题,对此提出相应的建设性对策,以实现分级诊疗制度的可持续推进。     

台湾地区全民健保下分级诊疗制度之借鉴

借鉴我国台湾地区全民健保下分级诊疗制度,落实和完善现行分级诊疗制度以保证医疗资源的合理配置。利用文献分析,对比研究两岸不同卫生体制下分级诊疗制度实施现状,结合专家访谈的形式明确台湾分级诊疗制度的特点。通过建立短期医疗网计划、成立社区医疗群、改革医保补偿机制、构筑医联体等方式优化分级诊疗制度。     

新医改背景下我国分级诊疗实践及问题分析

分级诊疗是医改的重中之重,将为健康中国和基本医疗卫生制度建设提供坚实的体系基础和制度保障。系统总结了我国现阶段各地分级诊疗的实践,分析存在的主要问题,在此基础上提出相应的对策建议,为我国有序推进分级诊疗建设、深化医改提供参考依据。     

分级诊疗在县(市)级医院的探索

分级诊疗是在卫生部提倡"医联体"形式的背景下发展起来的,通过大型公立医院带动县市等基层医院及医疗卫生机构系统发展,共同进步,从而促进医疗资源的合理分配和效率提高。尽管我国在探索分级诊疗的道路上取得了较为显著的成效,但仍存在诸多不足,没有充分发挥该制度的优越性。通过对笔者所在地区的县医院进行分析,发现分级诊疗存在医疗资源利用率不高、支援收益不明显等问题,针对这些现状提出了几点完善我县县医院分级诊疗机制的举措。     

南充市高坪区居民关于分级诊疗制度知晓度调查及分析

目的:了解南充市高坪区居民分级诊疗制度的知晓程度,以及对该制度的实施提供进一步理论依据。方法:采取自制调查问卷进行面对面调查,并用统计学方法进行分析。结果:在接受调查居民中,对分级诊疗制度的知晓率为87.3%,然而分级诊疗制度实施结果并不理想。结论:居民对分级诊疗制度的知晓率与分级诊疗制度实施情况不相符,说明分级诊疗制度实施仍然面临许多阻碍。     

基于博弈论与激励相容理论的我国分级诊疗体系分析

目的 了解政府、大型综合医院、上级医疗机构与基层医疗机构在分级诊疗体系下的利益诉求,以推进分级诊疗体系的建立。方法 采用博弈论分析这些利益主体间的矛盾,利用激励相容理论提出建议。结果 政府投入不足,上级医疗机构不愿下沉医疗资源,基层医疗机构能力不足等问题阻碍了分级诊疗体系的推行。结论 发挥政府引领作用,加大政府投入;加强医疗机构的分工协作,合理配置医疗资源;提高基层医疗机构服务能力。     

基于博弈论的我国分级诊疗制度分析与政策建议

目的 研究我国建立分级诊疗制度的困境以及相关解决政策建议。方法 利用博弈论和帕累托改进理论分析促进分级诊疗制度的实施方法。结果 分级诊疗的难点在于未能实现拍累托改进,即患者和政府可以在分级诊疗制度中节约成本,但医生并未得到相应的激励,因此,缺乏下沉积极性。结论 若能够让政府和患者节省的一部分费用补贴给大医院医生,则这些医生就会下沉到基层医疗机构,即可以实现帕累托改进、建立分级诊疗就医秩序。

     

音乐治疗效应的动物实验研究

近年来国内外关于音乐治疗效应的动物实验研究认为：音乐能影响动物的情绪;音乐还对动物的免疫功能、学习及记忆能力、以及动物的神经系统结构和功能等均有一定影响。该领域的研究有利于深入探索音乐疗法的作用机理。     

Time on task effects on safety

Reviewing the literature on time on task effects on safety shows contradictory evidence, especially with regard to 12 h shifts. It is argued that this might depend on methodological problems associated with the analysis of accident data, e.g. selectivity of samples, validity of data bases and study designs, especially for analyses at the company level. Analyses of aggregated data seem to indicate an exponential increase of accident risk with time on task beyond the normal working day. This is supported by some recent studies based on data from the Federal Republic of Germany.     

Perspectives on hair evolution based on some comparative studies on vertebrate cornification

Hair evolution contributed to the biological success of mammals. Hair origin from synapsid scales is speculative and requires extensive modifications of the morphogenetic process transforming lens-shaped dermis of scales into small dermal papillae in hair. Hair evolution from glands is hypothetical but is supported from studies on the signaling control of hair vs. glandular morphogenesis. Based on immunocytochemical and comparative studies, it is hypothesized that the onion-like organization of hair derived from glandular pegs which central part produced lipids and some keratin. In a following stage, involucrin, trichohyalin, and keratins were produced in the central cells of the gland and formed a solid medulla surrounded by keratinocytes of the inner root sheath. The origin of this protohair was possibly related to increased concentration of beta-catenin and other signaling molecules in epithelial cells following the evolution of a dermal papilla. The latter activated the keratogenic genes, already utilized in cells of the claws, in concentric layers of cells of the glandular peg. Lipidogenic genes were depressed. As new genes evolved in the genome of synapsids, new circular layers of keratinocytes containing specialized hard keratins and keratin-associated proteins were formed around medullary cells. The new keratinocytes probably originated the cortex separating medulla from the external cells that became the inner root sheath. The hypothesis indicates that in a following stage, the medulla was obliterated or replaced by cortical cells while the external part of the cortex formed a cuticular surface due to the different growth rate with inner root sheath cells.     

Studies on Biosynthesis on Biotin by Microorganisms

The accumulation of biotin-vitamers in the culture media of a large number of microorganisms (about 700 strains) was studied. The contents of the biotin-vitamers were quantitatively determined by microbiological assays with Lactobacillus arabinosus and Saccharomyces cerevisiae.

It was found that large amounts of biotin-vitamers were accumulated by various microorganisms such as Streptomyces, molds and bacteria, and that the yield of biotin-vitamers was enhanced by the addition of pimelic acid or azelaic acid to the media. It was also found that the main portion of the vitamers accumulated by many microorganisms did not support the growth of Lactobacillus arabinosus, while it did support that of Saccharomyces cerevisiae. The small amounts of true biotin were observed in the culture media of various Streptomyces and molds, but hardly in the culture media of bacteria.

The identification of biotin-vitamers accumulated by various microorganisms is described, and the distribution of the vitamers in microorganisms is also described.

The results presented in this paper show that the main component of the vitamers accumulated by many microorganisms is identified as desthiobiotin by anion exchange column chromatography, paper chromatography and chemical analysis. Small amounts of fraction B (unidentified vitamers) and Fraction D (biotin) were also detected in the culture media of various molds and Streptomyces. However, these fractions were not observed in the culture media of any bacteria tested.

It was also found that large amounts of an unknown biotin-vitamer was accumulated by various bacteria. The vitamer was avidin-uncombinable, and, from the paper electrophoretic studies, it was assumed that the vitamer might be an analogue of pelargonic acid.