部分国家和地区分级诊疗特点及启示

通过剖析部分国家和地区分级诊疗的特点,即分级诊疗是医疗卫生服务体系健全的自然结果,分级诊疗的实质在于服务整合,合理的支付制度是分级诊疗的重要促进因素;提出以强基层、建机制的原则发展分级诊疗,将医疗机构分工合作、服务功能整合作为分级诊疗的重要路径,增强医保对医疗服务体系的影响力以促进分级诊疗等建议。     

我国分级诊疗发展历程及政策演变研究

分级诊疗已成为“健康中国”战略的核心制度体系,并作为重塑我国医疗服务体系的重要内容。通过对我国分级诊疗发展历程和相关政策的梳理,总结分析了不同阶段分级诊疗发展的经验与教训,为分级诊疗制度的理论研究和政策制定提供制度的分析视角和历史资料的参考。     

德国分级诊疗实践和经验及对我国的启示

通过介绍德国医疗服务制度,总结并分析了德国分级诊疗的优势,并借鉴德国的经验,从构建新型分级诊疗体系、提升基层机构人员素质、规范医保报销和加大政府投入方面,提出我国构建分级诊疗服务体系的思路。

     

基于电子文件的分级诊疗模式研究

目的 了解我国分级诊疗现状和业务流程，提出基于电子文件的分级诊疗服务模式。方法 采用描述分析法对当前分级诊疗业务及所产生的电子文件进行研究，结合电子文件的特性，探索分级诊疗服务模式。结果 从电子文件中心构建、双向转诊、远程医疗、慢性病管理等方面构建了基于电子文件的分级诊疗模式。结论 基于电子文件开展分级诊疗服务能优化现有的业务流程，为分级诊疗进程的不断推进提供信息化支撑。     

我国分级医疗服务体系建设的关键问题

我国医疗服务体系存在卫生资源布局和利用不合理、缺乏分工协作、基层医疗服务能力薄弱等问题,分级医疗是优化与重构医疗卫生服务体系的有效途径。通过梳理分级医疗的基本内涵、关键问题及其困境,结合我国国情特点和社会分工理论,从系统层面（宏观）、组织层面（中观）、个体层面（微观）以及保障层面对我国分级医疗服务体系建设提出相应路径选择。     

我国县域分级医疗服务体系构建现状研究

目的 调查分析县域地区分级医疗服务体系构建及运行现状，挖掘影响分级医疗的不利因素，提出推进对策。方法 抽样调查全国11个国家级公立医院改革试点县县域内医疗资源和服务量的布局、患者就诊流向、医药费用及医保支出等情况，采用描述性统计方法、文献分析等方法对现况进行剖析。结果 县域地区分级医疗体系基本构建，但基层医疗机构人力资源配置待优化，医疗资源利用效率、服务能力不高，医保控费效果不显著，群众就医理念待更新，基层首诊、双向转诊、分级医疗运行状况不佳。结论 实现分级医疗应从优化县域医疗服务体系结构着手，优化县域资源配置，制订双向转诊标准，提升基层医疗机构服务能力，加强健康教育，构建高效运转的县域分级医疗服务体系。     

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。     

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。     

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。     

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。     

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.     

热带气旋对红树林的影响研究进展——基于文献计量分析

红树林在防风消浪、促淤保滩、固岸护堤等方面发挥重要的作用,是抵御台风、风暴潮、海岸侵蚀等自然灾害的重要天然屏障。热带气旋是红树林面临的最主要自然威胁之一,削弱了红树林对自然灾害的抵御及生物多性维持等功能发挥。然而,尽管热带气旋对红树林的影响日益受到全球的广泛关注,但缺乏对该领域研究进展的系统分析和总结。以Web of science核心集数据库为数据源,利用CiteSpace软件对1995—2021年间热带气旋对红树林影响研究进行文献计量分析和可视化图谱绘制,以厘清该领域研究的现状、趋势和热点,并揭示未来的发展方向。研究表明：（1）该领域研究年发文量随时间处于波动上升的趋势,尤其2013年后迅速增加,表明该领域的研究日益受到重视;（2）美国、澳大利亚和印度等国家在该领域的研究走在前列,美国的中介中心性最高,其次是德国,美国广泛地与德国、法国、日本等许多国家有密切合作;（3）美国佛罗里达、加勒比地区、澳大利亚北部和印度南部等是当前研究的热点区域;（4）研究热点随时间推移而不断发展,从红树林植被的干扰损害逐渐发展到固碳储碳、海岸防护等功能的影响。全球变化背景下热带气旋对红树林的影响、红树林对热带气旋干扰的弹性、基于遥感和大数据处理的模型模拟等日益受到关注,量化热带气旋对红树林功能的影响、探明热带气旋与海平面上升的关系及对红树林影响、构建完善的观测体系数据集等将是未来研究的重要方向。研究对长期关于热带气旋对红树林影响的研究进展进行定量和可视化分析,可为预测热带气旋对红树林的影响和风险、及减缓和应对其风险等研究提供借鉴参考。     

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.