微型移动导管手术室的民用模式研究

微型移动导管手术室是为适应野战条件下心血管急重伤病的快速诊治而研制的新型医疗设备。本文主要研究探讨该微型移动导管手术室的民用模式,包括针对STEMI病人的人机一体化反送救治模式,突发事件中伤员的现场救治模式,重要活动的卫生安全保障模式以及对三线以下城市乡镇的医疗巡诊模式。     

“互联网+”背景下我国移动医疗监管模式的设想

近年来,随着互联网经济与移动通信技术的不断进步和迅猛发展,传统的医疗服务行为与模式正不断地发生改变。在政府将“互联网+”行动计划提高至国家战略的背景下,移动医疗,作为“互联网+”医疗所形成的一种新型的医疗健康模式应运而生,其发展势如破竹,使用快捷、有效且利于推广,得到了社会广泛的肯定与应用。但是在移动医疗快速发展的同时,移动医疗所面临的监管问题也日益突出。通过研究国内外移动医疗监管的现状,以电子商务的平台化治理为参考,分析和思考了我国移动医疗监管领域的五大问题,即5W（WHY,WHO,WHEN,WAY,WHAT）,并在此基础上提出关于移动医疗监管模式的设想以保证移动医疗用户的安全和健康,促进行业的有序发展。     

清除动脉血凝块的微型高压水枪

最近,英国医学科学家研制出一种微型高压水枪,可用来清洗病人动脉中的血凝块。在这一系统中,医生用一根橡皮导管将微型水管植入于病人体内,然后通过标准X线照射将水管定位在血块附近,通过6个小孔向血块喷射生理盐水,迫使血块进入橡皮导管,最后将血块从病人动脉中取出。 科学家们设计一个可以灵活移动的压力泵,以每平方英寸1万磅的压力将水压进微型水管。该系统非常小,医生可在直径2毫米的心脏动脉内清除血块,较小的血块可在两分钟内     

我国移动医疗应用服务监管刍议

通过阐述移动医疗应用服务的内涵和外延，介绍了其应用领域和优势特点，重点分析了目前我国移动医疗应用服务的发展困境，如应用软件准入门槛低、医生在线执业不合法、移动医疗引发安全风险等问题。同时借鉴美国移动医疗监管模式，从移动医疗立法、主体监管部门、分类管理制度等角度展开探讨，希冀推动移动医疗的蓬勃发展，让人人享有基本医疗卫生服务。     

再论医院整体医疗管理的理论基础与组织运作

整体医疗管理是在整体论和医学整体观启发下产生的医院医疗管理新理论。医院整体医疗管理弥补了传统医院医疗管理模式的不足,对促进医院服务由医疗救治模式向院前、院内、院后全程化,预防、医疗、保健、康复一体化的健康服务模式转化具有重要意义。文章论述了实行医院整体医疗管理的必要性,讨论了其思想基础、变革目标以及基本运作模式。     

整体护理模式的应用思考

手术室的安全防范是传统手术室护理的重中之重,手术室是整个医学感染防空的重要部门。随着时代的发展,医学的医疗水平不断进步,同时也带动了护理水平的大幅度提高。整体护理模式是将临床护理和护理管理的各个环节系统化的工作模式,是以人为中、以现代护理观为指导、以护理程序为基础框架,并且把护理序系统化地运用到临床护理和护理管理中去的指导思想。目前,整体护理模式已广泛应用临床。手术室护士对手术患者进行整体护理可以使其以最佳心理状态迎接手术治疗,提高病人对护理工作的满意度及手室护士的整体素质。     

微型血管探测器

英国伦敦一研究机构研制一种微型血管探测器,用以拍摄血管内部图像,为心血管手术提供有力的工具。 微型血管探测器长0.9毫米,形同子弹头,前部与一导管相连,由导管将其引入血管内部,探测器的中部安有64个特殊晶体以发出和接收超声波。晶体后面为4个微型芯片,以收集超声波数据。探测器后部也与导管相连,该导管内设有14条信号传输线,将超声波探测数据传回人体外部的计算机中,计算机根据这些数据绘制出血管内部的图像。     

锐珂医疗与华西医院合作搭建灾区远程医疗诊断系统

在5月12日地震发生的当晚,全球最大的医疗成像和信息技术公司之一锐珂医疗就开展了全方位的紧急救援方案,并第一时间通过中国红十字会向地震灾区捐献价值350万的医疗设备及相关技术服务,其中包括一台适用于野战作战的移动PoC CR系统,两台适用于急救的最新技术和设计的移动式CR ITX550系统。三台设备已分别运到绵竹市人民医院、成都第五人民医院、绵阳市中医院三个重点伤员救治医院。     

手术室常见职业危害及防护

随着医疗条件的不断改善,各种各样的医疗设备、消毒用品、化学物质在临床上的广泛应用以及各种手术的普遍开展及新型传染病的增多,手术室护士暴露在各种化学、物理、生物、机械性损伤危险的机会也增加,如何做好手术室护士的职业防护,保障手术室护士的心身健康,现就手术室护士职业危害的防护对策探讨如下。     

基于微信公众平台的医学微生物学微型移动课程资源的建设与实践

随着移动技术的发展和网络的普及,利用移动终端进行微课程的学习将成为新的学习方式。本文尝试利用微信公众平台进行医学微生物学微型移动课程的实践,利用碎片化时间进行移动教学,以弥补传统课堂教学的不足。对微信公众平台在医学微生物微课程教学中的教学效果、优势和存在的问题等进行评价。阐明了基于微信公众平台的医学微生物学微型移动课程在教学领域有着广阔的发展前景。     

急诊手术的职业暴露及防护对策

目的:通过对医务人员在急诊手术中职业暴露的情况调查,了解急诊手术中标准预防现状,提出合理化建议和措施。方法:对2007年6月-2010年5月手术患者乙肝、丙肝、梅毒、艾滋病的阳性率进行比较,现场调查急诊手术中防护用品的使用情况。结果:手术患者乙肝、丙肝、梅毒、艾滋病的阳性率逐年上升,职业暴露的危险性越来越大;急诊手术中医务人员防护用品使用率的高低取决于血液、体液、分泌物的污染程度。结论:对医务人员要加强职业安全教育,强化标准预防,提高医务人员的整体防护水平,避免或减少职业暴露的危害,在救死扶伤的同时,保护好自身安全。     

急诊手术的职业暴露及防护对策

目的：通过对医务人员在急诊手术中职业暴露的情况调查,了解急诊手术中标准预防现状,提出合理化建议和措施。方法：对2007年6月．2010年5月手术患者乙肝、丙肝、梅毒、艾滋病的阳性率进行比较,现场调查急诊手术中防护用品的使用情况。结果：手术患者乙肝、丙肝、梅毒、艾滋病的阳性率逐年上升,职业暴露的危险性越来越大;急诊手术中医务人员防护用品使用率的高低取决于血液、体液、分泌物的污染程度。结论：对医务人员要加强职业安全教育,强化标准预防,提高医务人员的整体防护水平,避免或减少职业暴露的危害,在救死扶伤的同时,保护好自身安全。     

Emergency calls in the Samu system

The French emergency medical system is public and medical. Named Samu, it is almost entirely managed by anesthesiologists specially trained for emergency medical assistance and advanced medical support. The system comprises a reception and dispatching center for emergency calls, directly connected to police and firemen, but assuring patient confidentiality. This fixed center is managing mobile units which are Medical Intensive Care Ambulances (MICA named Smur in France). The Samu's mission consists in performing urgent individual medical assistance and also medical services for treatment of mass casualties. It is also to find adequate hospital units for the patients, to perform medical transport and to be a consultant for general practitioners in emergency.     

Départ imprévu en CEC

The cardio pulmonary bypass (CPB) is used in heart surgery for circulatory and respiratory replacement. The effectiveness of this technique, as well circulatory as respiratory goes and will go to spread its use far beyond the strictly surgical field. The unexpected starts on CPB include not provided starts, anticipated stars, and renewed stars. The not provided starts concern going on CPB for a cardiac or respiratory failure, not reacting to the conventional techniques of cardiopulmonary resuscitation and rare cases of inability to access the airway in emergency. This could be an exceptional complement to external cardiac massage. The anticipated departures involve patients in the operating room for cardiac surgery for which the establishment of the CPB has to treat with emergency life threatening brutal cardiac failure on valvular or coronary artery disease. The renewed starts are being on CPB or after weaning of CPB. It is being CPB to change a failed oxygenator responsible for a tissue hypoxia or replace a piece of tube main circuit of the CPB. A new start on CPB after weaning is essentially for circulatory assistance made necessary by postcardiotomy heart failure, by side effects of protamine injection, excessive bleeding or intra cardiac thrombosis. The oxygenator replacement techniques in emergency are exposed. This techniques demand a well trained and mobile medical and para medical staff.     

左半结直肠癌并急性肠梗阻经内镜介入治疗后再限期手术 的临床应用探讨

目的:探讨左半结直肠癌并急性肠梗阻经内镜介入治疗后再限期行肿瘤根治切除及一期肠吻合术的临床应用价值.方法:回顾性分析2006年-2011年我院收治的87例左半结直肠癌并急性肠梗阻的临床资料.结果:本组87例中,71例经内镜置入支架或肠梗阻导管介入减压治疗成功并完成了肿瘤根治性切除及一期肠吻合术.16例介入治疗失败行了急诊手术治疗,其中支架或导管置入失败7例,堵塞5例,减压效果差4例,无穿孔、出血并发症,介入治疗有效率81.6％.限期手术后切口感染5例(7.0％);急诊手术后切口感染4例(25.0％);吻合口漏2例(2.8％);无死亡病例发生.结论:左半结直肠癌并急性肠梗阻经内镜介入治疗后,限期行肿瘤根治性切除及一期肠吻合术,可以最大限度降低术后切口感染、吻合口漏机率,值得临床推广应用.     

A mobile surgery for single homeless people in London.

Little is known about the social and medical characteristics of people who regularly sleep rough, or whether medical care can be targeted at these people. In 1987 a mobile surgery was used to provide primary health care at two sites in central London where many single homeless people sleep outdoors. One hundred and forty six patients were seen with illnesses ranging from scabies to osteomyelitis and tuberculosis. Sociodemographic data showed the patients to be generally an isolated group with deprived and unstable backgrounds, often compounded by alcohol abuse. Over a third of the patients from one site attended a drop in surgery for homeless people in Soho within a month after seeing a doctor in the mobile surgery. This suggests that the project can be a first step in integrating this isolated group with health care facilities.     

A procedure for intravenous injection using external jugular vein in Mongolian gerbil (Meriones unguiculatus)

The Mongolian gerbil is commonly used in medical research. Intravenous administration of compounds in gerbils is difficult as tail vein injection sites are not visible. The present study describes a method for intravenous administration into the jugular vein in Mongolian gerbil by using an 'over-the-needle' catheter under anaesthesia. The catheter penetrates the pectoral muscle and is easily inserted into the vein. The method is simple and avoids extensive surgery in the animals.     

Prehospital Thrombolysis: A Manual from Berlin

In acute ischemic stroke, time from symptom onset to intervention is a decisive prognostic factor. In order to reduce this time, prehospital thrombolysis at the emergency site would be preferable. However, apart from neurological expertise and laboratory investigations a computed tomography (CT) scan is necessary to exclude hemorrhagic stroke prior to thrombolysis. Therefore, a specialized ambulance equipped with a CT scanner and point-of-care laboratory was designed and constructed. Further, a new stroke identifying interview algorithm was developed and implemented in the Berlin emergency medical services. Since February 2011 the identification of suspected stroke in the dispatch center of the Berlin Fire Brigade prompts the deployment of this ambulance, a stroke emergency mobile (STEMO). On arrival, a neurologist, experienced in stroke care and with additional training in emergency medicine, takes a neurological examination. If stroke is suspected a CT scan excludes intracranial hemorrhage. The CT-scans are telemetrically transmitted to the neuroradiologist on-call. If coagulation status of the patient is normal and patient''s medical history reveals no contraindication, prehospital thrombolysis is applied according to current guidelines (intravenous recombinant tissue plasminogen activator, iv rtPA, alteplase, Actilyse).Thereafter patients are transported to the nearest hospital with a certified stroke unit for further treatment and assessment of strokeaetiology. After a pilot-phase, weeks were randomized into blocks either with or without STEMO care. Primary end-point of this study is time from alarm to the initiation of thrombolysis. We hypothesized that alarm-to-treatment time can be reduced by at least 20 min compared to regular care.     

北京某医院2007 —2008年急诊患者就诊及付费行为模式分析

目的 分析急诊患者就诊及付费行为模式。方法 定义内急诊就诊流程,计算急诊挂号人次数分布情况等。结果 医院急诊量大,患者缴费次数多。结论 预交金付费模式是改变传统就诊模式、优化医疗服务流程、减少患者排队拥堵现象的可行措施。