论新医改形势下大型公立医院可持续发展战略

新医改形势下大型公立医院要在保持公益性的前提下,实现自身的发展壮大,面临前所未有的压力和挑战。从科学发展观的视角,围绕机制创新、技术创新、管理创新、服务创新进行思考,提出实现机制、技术、学科、管理、服务五力合一的医院战略管理路径,以促进公立医院长期的、差异性的、可持续的发展。     

关于我国医疗质量监管体系的探讨

通过文献研究和典型现场调查,对国内外医疗质量监管体系进行比较研究,进而提出我国医疗质量监管体系的框架：以政府为主导,政府授权的专业监管机构、医疗保险机构和社会监督力量共同参与的多元化的监管体系。     

基于物联网技术的医疗设备管理

医疗设备管理是医院内部管理的重点之一,影响着整个医院的综合管理水平。传统的医疗设备管理方法在越来越多的设备和越来越大的资产金额面前容易造成管理工作量大、设备利用率低下、资产盘点困难甚至设备流失等问题。对医疗设备管理现状进行了探讨,在考虑成本的前提下设计了一个新型的基于物联网技术的设备管理系统。此系统根据设备的价值高低分为高值设备管理系统、中高值设备管理系统和低值设备管理系统3个子系统和一个控制中心。3个子系统拥有同一个控制中心,统一对设备的出入库、维修、调配等进行管理。系统正在深圳市人民医院进行实施部署,将有效提升医院设备管理效率。     

Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

To simplify and facilitate beating heart (i.e., off-pump), minimally invasive coronary artery bypass surgery, a new coronary anastomotic connector, the Trinity Clip, is developed based on the excimer laser-assisted nonocclusive anastomosis technique. The Trinity Clip connector enables simplified, sutureless, and nonocclusive connection of the graft to the coronary artery, and an excimer laser catheter laser-punches the opening of the anastomosis. Consequently, owing to the complete nonocclusive anastomosis construction, coronary conditioning (i.e., occluding or shunting) is not necessary, in contrast to the conventional anastomotic technique, hence simplifying the off-pump bypass procedure. Prior to clinical application in coronary artery bypass grafting, the safety and quality of this novel connector will be evaluated in a long-term experimental porcine off-pump coronary artery bypass (OPCAB) study. In this paper, we describe how to evaluate the coronary anastomosis in the porcine OPCAB model using various techniques to assess its quality. Representative results are summarized and visually demonstrated.     

Responsibility and vaccine nationalism in the Israeli-Palestinian conflict

In this article we articulate a case from moral responsibility to assist Palestinians living in the Occupied Palestinian Territory (OPT). We contextualize this responsibility by focusing on access to healthcare and the provision of vaccines against COVID-19. We specifically present two arguments from responsibility, one that is global or cosmopolitan, and one that is country-specific. For the latter, we focus on Israel.     

Environmental footprinting of hospitals: Organizational life cycle assessment of a Canadian hospital

Healthcare is a critical and complex service sector with direct and indirect greenhouse gas (GHG) emissions amounting to 5%–10% of the national total in developed economies like Canada and the United States. Along with a growing, albeit sporadic, set of life cycle assessment (LCA) (and “carbon footprinting”) studies of specific medical products and procedures, there is growing interest in “environmental footprinting” of hospitals. In this article, we advance this rapidly evolving area through a comprehensive organizational LCA of a 40-bed hospital in British Columbia, Canada, in its 2019 fiscal year. Our results indicate that the total environmental footprint of the hospital includes, among other things, global warming potential of 3500–5000 t CO₂ eq. (with 95% confidence). “Hotspots” in this footprint are attributable to energy and water use (and wastewater released), releases of anesthetic gases (which are potent GHGs), and the upstream production of the thousands of materials, chemicals, pharmaceuticals, and other products used in the hospital. The generalizability and comparability of these results are limited by inconsistencies across the few environmental footprinting studies of hospitals conducted to date. Nonetheless, our novel methodological approach, in which we compiled new LCA data for 200 goods and services used in healthcare—strategically selected to statistically represent the 2927 unique products in the hospital's “supply-chains”—has broad applicability in healthcare and beyond.     

探索病理学教学改革,培养高素质医学人才

病理学是医学院校的重要基础课,高质量的病理学教学是培养高素质医学人才的必要基础。从更新教学内容,科学运用新的教学方法及多种现代化教学手段等方面探讨了当代病理学教学改革。     

Quality control of a medicinal larval (Lucilia sericata) debridement device based on released gelatinase activity

Lucilia sericata Meigen (Diptera: Calliphoridae) larvae are manufactured worldwide for the treatment of chronic wounds. Published research has confirmed that the primary clinical effect of the product, debridement (the degradation of non‐viable wound tissue), is accomplished by a range of enzymes released by larvae during feeding. The quality assessment of larval activity is currently achieved during production using meat‐based assays, which monitor insect growth and/or the reduction in substrate mass. To support this, the present authors developed a complementary radial diffusion enzymatic assay to produce a visual and measureable indication of the activity of larval alimentary products (LAP) collected under standardized conditions, against a gelatin substrate. Using basic laboratory equipment and reagents, the assay is rapid and suited to high throughput. Assay reproducibility is high (standard deviation: 0.06–0.27; coefficient of variation: 0.75–4.31%) and the LAP collection procedure does not adversely affect larval survival (mortality: < 2%). Because it is both cost‐ and time‐effective, this method is suited to both academic and industrial use and supports good manufacturing and laboratory practice as a quality control assay.