公立医院医疗集团运行模式的探索与思考 ——以上海某医疗集团为例

目的 探寻一种适合我国国情,符合新医改要求的医疗集团的运行模式。方法 采用案例研究的方式,以上海某医院集团为例,就其医疗集团的合作模式、变革前后医疗机构集团化各项指标的变化以及集团化进程中取得的成果结合相关文献予以分析,对出现的问题和未来发展提出建议。结果 上海某医院医疗集团根据各成员单位的区域、发展现状、各取所需,通过不同协作运行模式,建立切实可行的运行机制,均可实现多方共赢。结论 一家医疗集团多种运行模式共存是行之有效的。紧密型联动模式对隶属同一行政部门较易实现,在区域范围内的成员单位以半紧密型联动模式的医院托管为优,可较好实现资源整合、分级诊疗、双向转诊,更加符合新医改要求;区域外的成员单位以松散型的学科托管或学科联盟等为佳,可促进学科发展,加强人才培养。     

区域性医疗集团运行模式的改革实践

地级市公立医院改革是值得探讨的重要课题。以福建省宁德市闽东医院医疗集团为例,在总结周宁、寿宁医疗联合体合作经验的基础上,不断完善集团的体制机制,通过完善法人治理结构、六个一体化建设、双向转诊机制和信息化建设等改革举措,构建区域内目标明确、布局合理、结构优化、功能完善的公立医院服务体系,努力打造区域性医疗集团的品牌效应和影响力。     

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。     

医联体内医疗质量同质化管理方法探析

我国医联体在促进区域医疗资源整合、理顺患者就医秩序等方面进行了许多有益的尝试和实践探索。但是,患者对医联体中基层医疗机构医疗水平的信任缺失,导致三甲医院依旧人满为患。因此,在医联体内进行医疗质量同质化管理对于提高成员医疗机构的医疗服务水平,真正实现医联体的宗旨和使命具有至关重要的意义。文章介绍了目前国内最大的全国范围的专科医联体——北京儿童医院集团在集团各家医院间实施医疗质量同质化管理的思路和具体措施,希望能为我国医联体如何实现医疗质量同质化管理提供借鉴。     

基于远程网络平台的医疗联合体建设探讨

组建医疗联合体、推进医疗资源纵向整合是落实国家新医改方案、推进公立医院改革、构建新型城市医疗服务体系的一项探索性举措。为了缓解区域医疗资源分布不均衡的问题,新疆医科大学第一附属医院依托网络平台,构建基于远程医疗的医疗联合体模式,通过该模式下的医院集团模式、协作发展模式、重点帮扶模式、三级医疗一体模式以及其他业态模式五大方向的运作,整合推进区域医疗资源的共享。     

立足中国 服务全球——GE医疗集团亚洲最大科学生产基地正式落户杭州

2009年9月28日,通用电气医疗集团（以下简称GE医疗集团）在亚洲兴建的第一家滤纸生产基地——杭州沃华滤纸有限公司正式开业。作为通用电气医疗集团在整个亚太地区投资兴建的规模最大的生产基地,该工厂拥有全球领先的工艺生产技术,对于通用电气医疗集团在全球供应链的部署具有重要的战略意义。杭州市副市长沈坚,桐庐县委书记戚哮虎,通用电气医疗集团生命科学总裁兼首席执行官Peter Ehrenheim,杭州沃华滤纸有限公司总经理刘海涛及各界领导、嘉宾出席了开业典礼并讲话。     

干细胞科技引领 药物开发新变革——GE医疗集团干细胞技术媒体见面会

GE医疗集团细胞技术研发负责人Stephen Minger博士于2010年6月28日在北京会见中国医疗健康领域的媒体先锋，共同探讨干细胞技术——这一尖端的、并对人类产生深远影响的科学。Stephen Minger博士于2009年加入GE医疗集团．现任GE医疗集团细胞技术研发负责人。     

区域医疗卫生服务体系评价的重要性及建议

区域医疗卫生服务体系评价对指导区域医疗资源规划,提高国家宏观调控和监管能力,实现医疗资源优化配置有重要意义。我国目前尚未建立一套科学全面的评价方法和指标体系。通过介绍区域医疗服务体系评价的重要性和影响因素,以及美国在评价区域医疗服务体系的做法,为建立完善我国区域卫生服务体系评价制度提供建议。     

基于区域协同医疗的检测技术需求分析与解决方案

在分析县级医院及基层医疗机构医疗服务能力基础上,为提出提升基层医疗机构检测水平的方法,探讨通过区域医疗信息化手段建立面向三级医疗机构的区域协同医疗共享平台及系列信息化系统,提升基层医疗机构检测水平,推动多级医疗协同服务模式的实现,提升区域协同医疗业务能力。     

北京市区域医疗联合体系建设问题探究

为解决城乡和区域间医疗资源配置不均衡、不合理,基层医疗机构服务能力薄弱等问题,北京市2013年开展了区域医疗联合体系建设工作,虽然取得了一定的成绩,但从实践情况看来,政策实施的效果与预期还存在一定差距。以北京市区域医疗联合体系为研究对象,通过理论、实例相结合的方式,分析其在运行过程中出现的问题及造成这些问题的原因,为北京市区域医疗联合体系更好地发挥作用提供政策建议。     

Group communication support for distributed collaboration systems

The Collaborative Computing Transport Layer (CCTL) is a communication substrate consisting of a suite of group communication protocols. The design of CCTL supports the needs of distributed collaborative applications. CCTL is based on a two-level group hierarchy that naturally matches the structure of many collaborative applications and that allows several implementation optimizations. Logical interconnections among processes, called channels, define an efficient, light-weight group mechanism, providing a variety of communication services such as reliability and message ordering. Related channels are associated with a heavy-weight group, called a session, that provides group management services, such as membership, for its associated channels. Sessions and channels run different protocol stacks, allowing a flexible and useful separation of group management semantics and communication service quality. This also allows the efficient reuse of existing group management services when introducing new communication services. This revised version was published online in July 2006 with corrections to the Cover Date.     

Problems of Distant Communication of Isolated Small Groups

A new psychological phenomenon, distant communication of an isolated small group, is described. Factors affecting distant communication and mechanisms determining the patterns of its development during a long-term spaceflight and model isolation are analyzed. On the basis of the patterns described, the possible development of communication in the spacecraft–Earth loop during a mission to Mars is predicted and methods of its optimization are suggested.     

The evolution of social communication systems in a subdivided population

Evolution of social communication systems is modeled with a quantitative genetic model. The mathematical model describes the coevolutionary process of a social signal (a social character) and responsiveness (a social preference) to the signal. The responsiveness is postulated to influence fitness of senders of the signal. Considerations are extended to subdivided population structure by combining the social selection model with a group selection model. The numerical results derived from the models indicate that the evolutionary rate of social communication systems depends largely on genetic correlation between the signal and the responsiveness. Group selection can reinforce the evolutionary rate and relax its dependence on genetic correlation. The origin of genetic correlation is discussed in relation to group selection.     

提高规范化培训住院医师在CCU沟通能力的探讨

摘要：随着生物医学模式向生物．心理．社会医学模式的转变,构建和谐的医患关系成为当今医学发展和进步的时代新要求,构建和谐的医患关系,有效的医患沟通是获得良好医疗效果的基本保证,本文总结了目前参加规范化培训的住院医师在心脏科重症监护室培训轮转期间医患沟通中存在的问题,分析了沟通障碍的主要影响因素,包括住院医师对医患关系的沟通认识不够充分,沟通技巧不够,工作负担增加,患方经济负担增加,治疗效果心理预期增加,医患双方认知差异增加,失信增加,健康和维权意识增加等都影响了医患关系的和谐构建;心脏重症监护室是心血管系统中常见病,多发病发展到终末期或急重期间的治疗场所,特点是病情急,危,重,死亡率高,结合其医患关系的实际特点,提出了提高住院医师沟通能力的可行性措施,主要包括：沟通的内容务必真实可信,形式力求形象,换位思考,注重诚信待人,加强非语言沟通,注重沟通分寸,尊重患者或家属的知情同意权,加强心脏监护室的细节规范化管理等。     

医患沟通技能培养在生殖医学教育中的实践及体会

目的：探讨医患沟通技能培养对生殖医学教育的作用及效果。方法：选择2010 级临床本科专业两个班级共30 人作为观察 组，进行医患沟通技能培养；另选取同年级的两个班级共28 人作为对照组，进行传统生殖医学教学模式培养。运用自行编制的教 学效果调查问卷及SEGUE 量表对两组学生的教学效果及医患沟通技能进行评价及比较。结果：与对照组相比，观察组的教学效 果有明显优势，学生对生殖医学更感兴趣，使生殖医学的教学更富有启发性，学生处理问题的能力显著增强，学生对生殖医学的 知识掌握程度及综合应用能力显著提高，差异具有统计学意义（P<0.05）；与对照组相比，观察组学生在信息收集、信息给予、理解 病人及沟通结束等四个维度的医患沟通能力显著增强，差异具有统计学意义（P<0.05）。结论：在生殖医学教育中加强医患沟通技 能的培养是一种行之有效的教学方法，值得推广。     

Information-statistical analysis of factors determining ongoing behaviour and social interaction in Java monkeys (Macaca fascicularis)

Behavioural data from triads of Java monkeys (Macaca fascicularis) are used to compare several information-statistical models for the analysis of social interaction and communication. An analysis-of-variance (ANOVA) model relating the variability of the ongoing behaviour of a reference subject to both its own preceding behaviour and that of its partners fits the data best. The same data are also used to investigate certain formal aspects of communication by means of the ANOVA model; in particular, the role of observable orientation in behaviour as reflecting intention to communicate. Finally, behavioural data from observing a group of six Java monkeys are presented to show that the ANOVA model can provide parameters for describing group structure and dominance relations.     

How the Spatial Position of Individuals Affects Their Influence on Swarms: A Numerical Comparison of Two Popular Swarm Dynamics Models

Schools of fish and flocks of birds are examples of self-organized animal groups that arise through social interactions among individuals. We numerically study two individual-based models, which recent empirical studies have suggested to explain self-organized group animal behavior: (i) a zone-based model where the group communication topology is determined by finite interacting zones of repulsion, attraction, and orientation among individuals; and (ii) a model where the communication topology is described by Delaunay triangulation, which is defined by each individual''s Voronoi neighbors. The models include a tunable parameter that controls an individual''s relative weighting of attraction and alignment. We perform computational experiments to investigate how effectively simulated groups transfer information in the form of velocity when an individual is perturbed. A cross-correlation function is used to measure the sensitivity of groups to sudden perturbations in the heading of individual members. The results show how relative weighting of attraction and alignment, location of the perturbed individual, population size, and the communication topology affect group structure and response to perturbation. We find that in the Delaunay-based model an individual who is perturbed is capable of triggering a cascade of responses, ultimately leading to the group changing direction. This phenomenon has been seen in self-organized animal groups in both experiments and nature.     

Environmental Risk Management Decision-Making in a Societal Context

Recent studies point to the need for improved understanding of environmental management frameworks designed to combine qualitative public and quantitative technical inputs in decision-making processes. Flux in public perception and concern about risks imply frameworks must be iterative in nature and incorporate a variety of assessment triggers in the form of decision points. A conceptual model is proposed here to explain the de facto operation of standard risk analytic frameworks within the broader sociopolitical milieu of public policy. The model is presented as a decision flow diagram that emphasizes setting environmental management goals based on societal input and the formulation of decision criteria for selecting management actions to achieve those goals. Prospective and retrospective decision control points operate to select management options that, respectively, avoid or reduce actual or predicted effects. Feedback loops that modify risk management outcomes are identified. Technical and scientific inputs (i.e., risk analysis) are assigned an essential information role within the framework and are responsible for informing the management process with the results of appropriately conducted and reviewed investigations. The proposed model is intended primarily to indicate how environmental risk management decision-making and associated technical assessments may be influenced by social pressures. It is hoped this understanding will lead to analytical transparency and better public communication of the environmental implications of policy options.     

Evolving communicative complexity: insights from rodents and beyond

Social living goes hand in hand with communication, but the details of this relationship are rarely simple. Complex communication may be described by attributes as diverse as a species' entire repertoire, signallers' individualistic signatures, or complex acoustic phenomena within single calls. Similarly, attributes of social complexity are diverse and may include group size, social role diversity, or networks of interactions and relationships. How these different attributes of social and communicative complexity co-evolve is an active question in behavioural ecology. Sciurid rodents (ground squirrels, prairie dogs and marmots) provide an excellent model system for studying these questions. Sciurid studies have found that demographic role complexity predicts alarm call repertoire size, while social group size predicts alarm call individuality. Along with other taxa, sciurids reveal an important insight: different attributes of sociality are linked to different attributes of communication. By breaking social and communicative complexity down to different attributes, focused studies can better untangle the underlying evolutionary relationships and move us closer to a comprehensive theory of how sociality and communication evolve.     

Forestry Matters: Decline of Oaks Will Impact Wildlife in Hardwood Forests

Abstract: Acom production by oaks (Quercus spp.) is an important food resource for wildlife in many deciduous forests. Its role as a hard mast crop that can be either stored or used to build fat reserves for winter survival cannot be replaced by most other potential foods. Changes in forest management, introduced pests and pathogens, and increased deer populations have resulted in significant changes in the demography of oaks in eastern North America, as evident in Forest Inventory and Analysis data. Specifically, maples (Acer spp.) are replacing oaks in many forests through dominance of the younger age classes. These changes are not yet obvious in mast production but will take decades to reverse. Effective forest management for mast production is arguably one of the more important tasks facing wildlife professionals, yet receives scant attention by both public and private land managers. Public forests need to explicitly include mast production in their forest planning and reduce adversarial relationships over forest management. Market forces are driving commercial forests toward forest certification. Private forests compose 80% of our oak forests and are the hardest group to influence. States have not been able to effectively market forest plans and we recommend joining with advocacy groups more adept at motivating the public. Increased communication between wildlife and forestry professionals is needed through agency restructuring and joint meetings of professional agencies at the state level. Professional wildlife and forest managers are encouraged to make increased use of monitoring data and form a multiagency cooperative using a joint venture model, which has been successful for other organizations.