“互联网+”对病理学科发展推动作用的探讨

互联网为医学发展提供了丰富的网络资源,尤其是在远程医疗、康复保健、教学、科学研究方面展现了突出的优势。在病理学科发展方面,互联网+主要在推动区域性病理中心建设、多学科诊疗、病理远程会诊、住院医师规范化培训及病理教学方面发挥了极大的促动作用。

     

中医医院多学科一体化诊疗服务探讨

多学科一体化诊疗服务模式是新医改形势下中医医院坚持以病人为中心、顺应医学模式的转变、遵循中医思维模式而实施的医疗服务管理的改革。通过诊疗理念的革新和服务流程的再造,开展以病种为主线、以创建多专业服务平台为主要形式的一体化诊疗服务,突出中医药特色优势,强化了综合诊疗服务,推动中医医院服务能力的提升和整体医疗的发展。     

远程会诊系统诊断皮肤真菌病

远程医疗会诊作为一种新的医学服务模式,与传统的医疗手段相比较,发展迅速,在医学领域中已充分显示出优越性.我国地域辽阔,医疗资源分布非常不平均,边远地区极其缺乏高端医疗人才和器材.皮肤病有发病率高、直观性强等特点,非常适合开展远程会诊.现通过医院在建设皮肤病远程会诊系统过程中产生的问题,对皮肤病远程会诊进行一些讨论.     

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。     

虚拟现实技术在健康医疗领域的应用

介绍虚拟现实技术的发展历程及基本概况,综述VR/AR技术在临床技能培训与教育、康复治疗、心理治疗及远程医疗等方面的应用研究,提出健康医疗领域虚拟技术的应用还处于起步阶段,未来将在疾病诊疗、手术模拟、远程医疗、健康管理监测等方面不断发展,对提高医护工作人员的服务水平、改善患者就医体验有重大的意义。     

基于视联网的远程门诊系统应用探讨

远程门诊可拓展远程医疗服务范围和服务内容,将成为未来远程医疗发展的一种新型服务模式。文章介绍了远程门诊的概念和发展现状,分析了基于视联网技术的远程门诊系统框架和业务流程,探讨了基于视联网的远程门诊系统在远程门诊诊疗、门诊检查和门诊咨询等方面的应用及未来发展前景。     

网络环境下医学图书馆服务模式的演变发展探讨

随着网络化技术的发展,医学图书馆的信息服务模式也在进行着不断的转变.本文分析了医学图书馆的多元化发展趋势:医学图书馆馆藏媒介的多元化医学图书馆读者信息需求的多元化、医学图书馆信息服务方式的多元化,探讨了在运用新的技术手段和技术方法下医学图书馆服务模式的演变及新模式下的图书馆人员结构问题.     

区域远程影像信息系统建设与实践

在基层医疗机构,医学影像学检查存在检测技术水平有限,缺乏人才培养机制等问题。本文基于远程会诊应用模式,针对我市沙坪坝区的医疗资源分布不均的现状,构建区域远程影像信息系统,有效提高了资源利用率,为患者提供了更便捷的区域化医疗服务。     

基于整合医学搭建无边界医院的探索与实践

为贯彻落实“基层首诊、双向转诊、急慢分治、上下联动”的分级诊疗要求,太和医院基于整合医学理念搭建了远程无边界医院。以太和医院为区域中心,借助“互联网+”,上联国际、国内知名医院,下联县、乡、村四级网络医院,跨学科、跨区域实现了对医院整合和人员整合,构建综合诊疗大平台。这不仅促进了医院内涵建设,还为我院医联体发展添砖加瓦,在创新实践中取得了良好效果,其应用经验值得积极推广。

     

基于医疗联合体的区域医疗信息平台建设

以医疗联合体为依托,建立区域医疗信息平台。其平台系统集成并共享各医疗机构的诊疗信息,对居民在各医疗机构的诊疗信息进行系统、连贯的有机整合;系统制定规范的分级诊疗流程、上转诊间预约、下转自动推送机制;在区域医疗联合体内部层级医疗机构内,提供远程会诊、在线医学教育、病患健康宣教、区域临床统一知识库、居民电子健康档案、诊疗预约、信息共享服务。     

Cognition problems during rehabilitation of stroke patients in a nursing home

In many regions in the Netherlands the care for stroke patients is organised in a coordinated stroke service. Within these stroke services, each year more patients are referred to nursing homes for a period of rehabilitation. A stroke leads to lasting cognitive and emotional consequences in more than half of the stroke patients. These consequences interfere with the daily life of the patients and their caregivers. Due to the nature and severity of these problems specific care is needed in the nursing home. In the present article a procedure for cognitive screening in a nursing home is described and data of a large group of patients are presented. These data clearly show the magnitude of the cognitive problems: high percentages of impairments are found in many cognitive domains. In the discussion therefore arguments are given for specialised care - assessment as well as treatment - in the nursing home for stroke patients with cognitive deficits.     

Cognitieve problematiek bij revalidatie van CVA-patiënten in het verpleeghuis

In many regions in the Netherlands the care for stroke patients is organised in a coordinated stroke service. Within these stroke services, each year more patients are referred to nursing homes for a period of rehabilitation. A stroke leads to lasting cognitive and emotional consequences in more than half of the stroke patients. These consequences interfere with the daily life of the patients and their caregivers. Due to the nature and severity of these problems specific care is needed in the nursing home. In the present article a procedure for cognitive screening in a nursing home is described and data of a large group of patients are presented. These data clearly show the magnitude of the cognitive problems: high percentages of impairments are found in many cognitive domains. In the discussion therefore arguments are given for specialised care – assessment as well as treatment - in the nursing home for stroke patients with cognitive deficits.Tijdschr Gerontol Geriatr 2007; 38: 174-185     

Witness response at acute onset of stroke: a qualitative theory-guided study

Background

Delay in calling emergency medical services following stroke limits access to early treatment that can reduce disability. Emergency medical services contact is mostly initiated by stroke witnesses (often relatives), rather than stroke patients. This study explored appraisal and behavioural factors that are potentially important in influencing witness behaviour in response to stroke.

Methods and Findings

Semi-structured interviews with 26 stroke witnesses were transcribed and theory-guided content analysed was undertaken based on the Common Sense Self-Regulation Model (appraisal processes) and Theory Domains Framework (behavioural determinants). Response behaviours were often influenced by heuristics-guided appraisal (i.e. mental rules of thumb). Some witnesses described their responses to the situation as ‘automatic’ and ‘instinctive’, rather than products of deliberation. Potential behavioural influences included: environmental context and resources (e.g. time of day), social influence (e.g. prompts from patients) and beliefs about consequences (e.g. 999 accesses rapid help). Findings are based on retrospective accounts and need further verification in prospective studies.

Conclusions

Witnesses play a key role in patient access to emergency medical services. Factors that potentially influence witnesses’ responses to stroke were identified and could inform behavioural interventions and future research. Interventions might benefit from linking automatic/instinctive threat perceptions with deliberate appraisal of stroke symptoms, prompting action to call emergency medical services.     

Advanced high resolution three-dimensional imaging to visualize the cerebral neurovascular network in stroke

As an important method to accurately and timely diagnose stroke and study physiological characteristics and pathological mechanism in it, imaging technology has gone through more than a century of iteration. The interaction of cells densely packed in the brain is three-dimensional (3D), but the flat images brought by traditional visualization methods show only a few cells and ignore connections outside the slices. The increased resolution allows for a more microscopic and underlying view. Today''s intuitive 3D imagings of micron or even nanometer scale are showing its essentiality in stroke. In recent years, 3D imaging technology has gained rapid development. With the overhaul of imaging mediums and the innovation of imaging mode, the resolution has been significantly improved, endowing researchers with the capability of holistic observation of a large volume, real-time monitoring of tiny voxels, and quantitative measurement of spatial parameters. In this review, we will summarize the current methods of high-resolution 3D imaging applied in stroke.     

Serendipitous findings while researching oxygen free radicals

This review is based on the honor of receiving the Discovery Award from the Society of Free Radical Biology and Medicine. The review is reflective and presents our thinking that led to experiments that yielded novel observations. Critical questioning of our understanding of oxygen free radicals in biomedical problems led us to use and develop more direct and extremely sensitive methods. This included nitrone free radical spin trapping and HPLC–electrochemical detection. This technology led to the pioneering use of salicylate to trap hydroxyl free radicals and show increased flux in ischemia/reperfused brain regions and also to first sensitively detect 8-hydroxyl-2-deoxyguanosine in oxidatively damaged DNA and help assess its role in cancer development. We demonstrated that methylene blue (MB) photoinduces formation of 8-hydroxyguanine in DNA and RNA and discovered that MB sensitively photoinactivates RNA viruses, including HIV and the West Nile virus. Studies in experimental stroke led us serendipitously to discover that α-phenyl-tert-butylnitrone (PBN) was neuroprotective if given after the stroke. This led to extensive commercial development of NXY-059, a PBN derivative, for the treatment of stroke. More recently we discovered that PBN nitrones have potent anti-cancer activity and are active in preventing hearing loss caused by acute acoustical trauma.     

Cerebral small vessel disease: genetic risk assessment for prevention and treatment

Cerebrovascular disease is a major burden to individuals and their communities worldwide. Stroke is one of the leading causes of death and disability, and the prevention and treatment of stroke can be improved with a better understanding of its causation. Cerebral small vessel disease (SVD) is a subset of cerebrovascular disease, and has an equally large impact on an individual's quality of life. Although many risk factors are involved, we propose that genetics has a significant role in the pathogenesis of SVD through a complex interplay of environmental and multigenetic factors. Advances in molecular technology have enabled the human genome to be investigated both at a population and, more recently, an individual level. A better understanding of the molecular basis of SVD will enable the development of therapies to help in its prevention and treatment. This review assesses the molecular genetics underlying cerebral SVD.     

Evaluation of a stroke family care worker: results of a randomised controlled trial.

OBJECTIVE: To examine the effect of contact with a stroke family care worker on the physical, social, and psychological status of stroke patients and their carers. DESIGN: Randomised controlled trial with broad entry criteria and blinded outcome assessment six months after randomisation. SETTING: A well organised stroke service in an Edinburgh teaching hospital. SUBJECTS: 417 patients with an acute stroke in the previous 30 days randomly allocated to be contacted by a stroke family care worker (210) or to receive standard care (207). The patients represented 67% of all stroke patients assessed at the hospital during the study period. MAIN OUTCOME MEASURES: Patient completed Barthel index, Frenchay activities index, general health questionnaire, hospital anxiety and depression scale, social adjustment scale, mental adjustment to stroke scale, and patient satisfaction questionnaire; carer completed Frenchay activities index, general health questionnaire, hospital anxiety and depression scale, social adjustment scale, caregiving bassles scale, and carer satisfaction questionnaire. RESULTS: The groups were balanced for all important baseline variables. There were no significant differences in physical outcomes in patients or carers, though patients in the treatment group were possibly more helpless less well adjusted socially, and more depressed, whereas carers in the treatment group were possibly less hassled and anxious. However, both patients and carers in the group contacted by the stroke family care worker expressed significantly greater satisfaction with certain aspects of their care, in particular those related to communication and support. CONCLUSIONS: The introduction of a stroke family care worker improved patients'' and their carers'' satisfaction with services and may have had some effect on psychological and social outcomes but did not improve measures of patients'' physical wellbeing.     

青藏高原生态屏障区环境基本公共服务的非均衡性及其成因——基于青海村镇居民点的实证分析

环境基本公共服务是青藏高原生态屏障区生态环境治理及农牧民人居环境品质提升的关键环节,揭示其配置均衡状态及失效原因,对提升青藏高原环境基本公共服务均等化水平、降低生态屏障区内人类活动的生态环境胁迫风险具有重要意义。以青海省4315个村镇居民点为对象,选取生活垃圾处理、生活污水处理、卫生户厕改造3项特征指标,定量测度村镇环境基本公共服务配置非均衡性,运用有序多分类及二元逻辑斯蒂回归模型解析非均衡性的生成原因。结果显示：青海环境基本公共服务水平总体偏低,处于低和极低等级的村镇居民点占37.13%和37.84%;环境基本公共服务非均衡性受配置成本、人口社会、经济收入和基层管理因素的多重影响,自然地理的高寒性和交通区位的偏远性是生成非均衡性的重要因素;人口社会因素的规模报酬递增效应使非均衡性加剧,大分散、小聚居的农牧民定居点通常是服务配置的弱势区域,经济收入和基层管理因素分别是非均衡性加剧的内因和外因。建议在青藏高原生态屏障区实施递进式均衡配置模式及适应性管理,建立就地消纳与跨区处理结合的弹性生活垃圾处置体系,推广耐低温分散化污水处置模式和生态化处置技术体系,适应高寒环境的户厕改造技术研发和农牧...     

Interventional neuroradiology.

A wide variety of diseases affecting the central nervous system and head and neck can be treated using interventional neuroradiologic techniques. These new treatments have depended on advances in radiologic imaging, catheter technology, and the development of new embolic agents. These procedures may be an adjunct to other therapy, palliative or curative. Diseases for which interventional neuroradiologic techniques have been major advances in treatment include cerebral aneurysms, vasospasm after subarachnoid hemorrhage, cerebral arteriovenous malformations, dural arteriovenous fistulas, dural sinus thrombosis, atherosclerosis, scalp arteriovenous fistulas, carotid-cavernous fistulas, and stroke. This field is rapidly evolving as advances are made in catheter technology and new embolic agents are developed.     

脑血管疾病发生和防治的基础研究

以脑卒中为代表的脑血管疾病是非常严重的健康和社会问题。本项目结合我国国情,遵循优势互补、强强联合的方针,整合我国现有的优势和已建立起来的研究队伍,进行以下四个方面的研究：（1）遗传学研究,探讨脑卒中和颅内动脉狭窄的易感基因;（2）脑卒中发生的新的决定因素研究,探讨预防脑卒中的新靶点;（3）神经血管单元研究,探索脑卒中治疗的新策略;（4）转基因技术平台和化学生物学小分子探针技术平台研究,探讨脑卒中发生发展过程中涉及的各种信号转导通路。