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。     

医疗机构分工协作研究综述

尽管政策鼓励医疗机构开展分工协作,但关于分工协作的内容、必要性缺乏研究,没有厘清整合与分工协作的关系,部分效果评价存在一些问题,更缺乏从宏观层面介绍国外开展医疗机构分工协作的情况。文章从医疗机构分工协作定义、分工协作必要性、存在的问题和动力机制、模式效果评价以及国外医疗整合现况等5个方面予以分析,并提出了值得研究的问题。     

公立医院与基层医疗卫生机构分工协作的现状及策略

公立医院与基层医疗卫生机构分工协作有利于医疗卫生资源合理化配置,有效降低医疗费用,是我国卫生事业改革、发展的目标和方向。文章通过文献研究,总结当前分工协作主要模式,对其存在的难点进行分析,并在此基础上结合实践提出政策建议。     

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。     

论新形势下政府基本医疗服务补偿责任定位

医疗服务补偿机制决定基本医疗服务供给模式,因此,建立合理补偿机制始终是医改的核心任务。在新医改实践中,明确政府基本医疗服务补偿责任定位,设计、实施合理的符合国情实际的城市基本医疗服务补偿机制是实现改革总体目标的客观需要,也是对政府坚持依法治国方略、切实转变管理职能、科学履行公共管理职责的必然要求。同时,还必须厘清政府补偿责任边界、明晰政府补偿责任内涵和实现政府补偿责任法治。     

我国公立医院补偿机制现状浅析

通过对不同国家、不同地区、不同级别公立医院补偿机制现状进行比较分析,探讨进一步完善公立医院补偿机制的政策和措施,为政府部门制定补偿政策提供依据。医院发展离不开资金,因此对医院资金必须集中管理、统一调配、有效监督,加强资金收支的监督管理。健全医疗服务成本及价格监测体系,加强对医疗服务价格及成本构成要素的监测,为制定合理的医疗服务指导价格、建立灵活的价格调整机制提供依据。在医疗这一重要的社会消费领域,需要给公众真实客观的信息,加强宣传和沟通也极为重要。总之,完善公立医院补偿机制,是建立规范高效公立医院运行机制的重要保证,也是充分体现公立医院公益性的必然要求。当前我们应该积极探索,加快完善公立医院补偿机制。     

基于博弈论的我国分级医疗服务体系构建策略分析

医疗服务体系是一个由多个利益相关集团组成的复杂系统,分级医疗模式即是要建立在不同层级、不同类别医疗机构之间有效分工协作的前提下。文章运用博弈论,在我国医疗行业各个利益集团纵向战略互动模型的理论基础上,基于激励相容理论,对上级医院与基层医疗机构垂直战略互动博弈行为进行分析,从理论层面探讨分级医疗服务体系中各利益相关方的博弈关系及行为选择。     

实行药品零差率后公立医院的补偿机制研究

对我国公立医院实施药品零差率后的补偿机制进行阐述和分析。通过现场调研和查阅文献的形式,对各地不同试点公立医院补偿机制现状进行分析总结。补偿机制在实际推行中出现障碍,出现财政投入落实不到位、医疗服务价格调整缓慢、医保支付方式不合理等问题。抓住补偿机制的三个关键要素,才能有效弥补医院的资金缺口,即保证政府资金的有效性,找出医疗服务价格的均衡点以及探索合理的医保支付方式。     

公立医院医疗服务价格调整难点及推进策略

从政策角度分析医疗服务价格的演变过程、形成机制,研究新医改以来公立医院医疗服务价格调整的进展和问题,以34家国家级试点为例,探讨调整医疗服务价格的解决策略和路径,提出推进策略。文章认为,对于医疗服务价格调整,要深刻认识价格改革在公立医院改革中的地位和作用,坚持基本原则,处理好几个方面关系,并把握好几个技术难点。     

关于公立医院补偿机制改革的思考

从理论上分析了公立医院补偿模式的特点,以及政府卫生投入和医疗服务收费之间的关系;梳理了公立医院补偿机制存在的问题;提出了改革补偿机制的建议,即在政府按照医改要求足额投入,调整医疗服务价格的基础上,改革政府投入机制、医疗服务收入分配机制和医保支付方式,并建立有效的监管和奖惩体系。     

The necessity of strengthening the cooperation between tissue banks and organ transplant organizations at national, regional, and international levels

The donation of tissues and organs increases significantly when tissue banks and organ transplant organizations work together in the procurement of organs and tissues at donor sources (hospitals, coroners system, organ procurement agencies, and funeral homes, among others). To achieve this important goal, national competent health authorities should considered the establishment of a mechanism that promote the widest possible cooperation between tissue banks and organ transplant organizations with hospitals, research medical institutions, universities, and other medical institutions and facilities. One of the issues that can facilitate this cooperation is the establishment of a coding and traceability system that could identify all tissues and organs used in transplant activities carried out in any country. The promotion of national, regional, and international cooperation between tissue banks and organ transplant organizations would enable the sharing of relevant information that could be important for medical practice and scientific studies carried out by many countries, particularly for those countries with a weak health care system.     

1997—2009年《生命科学研究》载文、作者、基金资助论文和影响因子统计分析

对<生命科学研究)1997-2009年的载文、作者、基金支持论文和影响因子情况进行了统计分析,得出该刊13年来发展的一些规律,为进一步提高该刊的学术水平和影响力提供依据.利用维普(VIP)资讯系统(中文科技期刊数据库),采用文献计量法,分析<生命科学研究>1997-2009年的载文量、作者合作度、合作率、以及地域分布、基金支持、影响因子等指标和内容.13年共检出886篇文献,作者3 544人次,合作度为4,合著率为94.92%.作者分布在全国29个省、自治区和直辖市,高等医药院校作者最多.占作者总数的84.76%.13年<生命科学研究>共发表各类基金资助论文734篇.影响因子和总被引频次逐年提升.该刊因其著者整体学术水平高,在生命科学研究领域有较大的影响.已成为我国生命科学研究领域具有普遍的指导意义、影响深远的重要学术性期刊和中文核心期刊.     

医学图书馆馆藏建设的调查分析

探讨了目前医学图书馆馆藏结构的现状和馆藏建设策略的转变,在资金短缺的情况下,医学图书馆要确定有效的采购方案,保质保量,突出重点,加强网络协作,实现资源共享,以满足临床和科研的需要。     

我国二级及以上医疗机构开展公共卫生工作现况分析

目的 对二级以上医疗机构疾病预防控制等公共卫生工作现况进行评估。方法 对全国10个省163家医院进行二级以上医疗机构公共卫生工作开展基本情况调查和人员基本情况调查的问卷调查;对全国34个省、自治区、直辖市和新疆生产建设兵团进行函调以及对浙江、河南、辽宁和甘肃4个省进行实地调研。结果（1）医疗机构应承担的公共卫生职能与落实情况相差甚远。（2）医疗机构从事公共卫生工作积极性不高。（3）医疗机构在公共卫生工作中接受多个部门管理,但在工作中缺乏协调。结论（1）弥合临床医疗服务体系与公共卫生体系的割裂状态。（2）增强医疗机构从事公共卫生工作积极性。（3）加强督察考核,促进公共卫生工作的落实。     

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。     

Occupational medicine programs for animal research facilities

Occupational medicine is a key component of a comprehensive occupational health and safety program in support of laboratory animal research and production facilities. The mission of the department is to maximize employee health and productivity utilizing a population health management approach, which includes measurement and analysis of health benefits utilization. The department works in close cooperation with other institutional health and safety professionals to identify potential risks from exposure to physical, chemical, and biological hazards in the workplace. As soon as exposures are identified, the department is responsible for formulating and providing appropriate medical surveillance programs. Occupational medicine is also responsible for targeted delivery of preventive and wellness services; management of injury, disease, and disability; maintenance of medical information; and other clinic services required by the institution. Recommendations are provided for the organization and content of occupational medicine programs for animal research facilities.     

Two types of division of labour in clonal plants: benefits, costs and constraints

Clonal plants spread vegetatively within their habitats by forming rooted ramets on stolons or rhizomes. Each of these ramets is capable of an independent existence after establishment. Nevertheless, ramets remain physically connected by stolon or rhizome internodes for variable periods of time, thereby allowing for resource movement and signal transduction within clones.Interconnected ramets of clonal plants, though potentially independent and totipotent, can specialize functionally in the performance of limited numbers of tasks such as the uptake of resources from above- vs below-ground sources, carbohydrate storage, vegetative spread and sexual reproduction. Such specialization and cooperation is comparable to a division of labour in economic systems or in colonies of social animals. The ecological significance of division of labour in clonal plants may be found in the increased efficiency of entire clones in exploiting their environments.Two different types of division of labour in clonal plants will be discussed in this review. The first type is an environmentally-induced specialization of ramets in the uptake of locally abundant resources (plastic division of labour), which can be found in several stoloniferous species. Evidence exists that this response increases resource uptake in spatially heterogeneous environments. The second type of division of labour, which occurs mainly in rhizomatous species, relates to a developmentally-programmed specialization and cooperation between interconnected ramets. This response pattern is thought to enhance plant performance by restricting the number of tasks for individual ramets and thereby significantly increasing the efficiency of task performance. In some plants, such an inherent division of labour is likely to contribute to nutrient extraction from poor and unpredictably variable sources.In this article not only benefits but also potential costs and constraints on division of labour in clonal plants are shown. The aim is to provide a review of existing knowledge and to develop concepts and hypotheses for future research.     

Aging and death in an organism that reproduces by morphologically symmetric division

In macroscopic organisms, aging is often obvious; in single-celled organisms, where there is the greatest potential to identify the molecular mechanisms involved, identifying and quantifying aging is harder. The primary results in this area have come from organisms that share the traits of a visibly asymmetric division and an identifiable juvenile phase. As reproductive aging must require a differential distribution of aged and young components between parent and offspring, it has been postulated that organisms without these traits do not age, thus exhibiting functional immortality. Through automated time-lapse microscopy, we followed repeated cycles of reproduction by individual cells of the model organism Escherichia coli, which reproduces without a juvenile phase and with an apparently symmetric division. We show that the cell that inherits the old pole exhibits a diminished growth rate, decreased offspring production, and an increased incidence of death. We conclude that the two supposedly identical cells produced during cell division are functionally asymmetric; the old pole cell should be considered an aging parent repeatedly producing rejuvenated offspring. These results suggest that no life strategy is immune to the effects of aging, and therefore immortality may be either too costly or mechanistically impossible in natural organisms.     

Evolution of equal division among unequal partners

One of the hallmarks of human fairness is its insensitivity to power: although strong individuals are often in a position to coerce weak individuals, fairness requires them to share the benefits of cooperation equally. The existence of such egalitarianism is poorly explained by current evolutionary models. We present a model based on cooperation and partner choice that can account for the emergence of a psychological disposition toward fairness, whatever the balance of power between the cooperative partners. We model the evolution of the division of a benefit in an interaction similar to an ultimatum game, in a population made up of individuals of variable strength. The model shows that strong individuals will not receive any advantage from their strength, instead having to share the benefits of cooperation equally with weak individuals at the evolutionary equilibrium, a result that is robust to variations in population size and the proportion of weak individuals. We discuss how this model suggests an explanation for why egalitarian behaviors toward everyone, including the weak, should be more likely to evolve in humans than in any other species.     

高效石油降解菌群的构建及对芳香烃化合物萘的协同降解性能

【背景】石油作为一类混杂有机化合物,一旦产生污染就会对人类和环境造成严重的危害。【目的】从新疆石油污染土壤中分离筛选石油降解菌,为石油污染土壤的生物修复提供数据支持及技术参考。【方法】以石油为唯一碳源,通过富集培养、筛选分离得到123株单菌,根据菌落形态挑选出30个不同形态菌株,通过16S rRNA基因序列确定其种属,构建系统发育树;通过原油降解实验筛选出高效石油降解菌,以芳香烃的标志化合物萘为唯一碳源筛选出高效降解菌株,并分别筛选可降解水杨酸、邻苯二酚的菌株。【结果】分离筛选出5株高效石油降解菌,降解率高于85%;萘、水杨酸和邻苯二酚降解菌株各获得一株,将3种菌株按照1:1:1的接种比例对萘进行降解,萘的降解率从单菌60.74%提升到89.40%,菌株间的分工协作可以提高有机物的降解效率。【结论】筛选得到的菌株丰富了石油降解微生物菌种库,不同微生物菌株之间的分工协作为石油污染物的降解提供了新思路,为进一步研究石油污染治理提供参考。