HL7标准在医疗仪器通讯中的应用

介绍通过编程实现以HL7标准的检验数据在检验仪器与临床检验信息系统(clinical labora-tory information system,CLIS)之间的数据格式转换,从而解决各种检验仪器的接口软件重用性问题,并保证数据交换的准确性.国内外检验仪器的生产厂家应尽快应用HL7标准,规范仪器通讯接口的数据通讯.     

论动物福利法的基本理念

“承认和维护动物福利,认可和维护动物的自然权利,尊重生命、善待动物、不虐待动物,保护动物福利也是保护人的利益,人与动物和谐相处,将科学精神与人文精神相结合”,这些是动物福利法的基本理念。动物福利法确认的是“动物的权利”,而不是“动物的人权”,更不是法律确认了动物是人。尊重生命是善待动物、不虐待动物的思想基础,不虐待动物是尊重生命的起码要求。科学精神是动物福利法的基础,人文精神是动物福利法的灵魂。只有形成并贯彻科学精神与人文精神相结合的理念,才能在一个汇集多种文明、多种主义、多种观念的多元化的当代社会,启动和推进动物福利立法。     

新型农村合作医疗的经济学思考——山东省茌平县个案

随着市场经济的不断深化发展,目前农业和农村经济面临许多新情况、新问题。据统计茌平县70％以上的贫困人口是因病致贫或因病返贫。农民群众医疗保健得不到有效保障,已成为直接制约农村经济发展、农民生活水平提高的重要因素。前不久召开的山东省新型农村合作医疗试点工作会议上,确定茌平县为全省建立新型农村合作医疗制度试点县。由于刚刚兴起,对于其经济学以及管理学思考是由切实必要的。通过下文的一系列论述,提出了一些对于合作医疗的实施切实可行的意见以及建议。     

基于二阶段随机规划的城市医疗废弃物回收网络设计

城市医疗废弃物日益增加,且回收需求量受诸多因素的影响,难以准确预测,假定回收需求为确定值的医疗废弃物网络优化设计不能与实际需求相匹配。本文考虑了离散随机参数环境下,医疗回收网络设计中选址规划、分配计划及运输规划的协同优化问题,建立了以选址成本、运输成本最小为目标,设施与车辆能力限制为约束的二阶段随机规划模型。根据模型特点,设计了基于Benders decomposition的求解算法,同时,设计了一系列加速技术用于提高算法的求解效率。最后,以国内某城市医疗回收网络为背景设计算例,检验本文模型和求解策略的可行性和有效性。结果表明：相比确定性规划,随机规划的解能够节约总成本,结合一系列加速技术的Benders decomposition方法比CPLEX与纯的Benders decomposition更有优势。     

我国婴幼儿托育服务标准规范体系的现状及其优化研究

近年来,我国婴幼儿托育服务标准规范建设进程较快,当前体系框架已初步建立。但由于长期以来标准规范建设比较缓 慢、推进机制不健全等客观因素制约,当前婴幼儿托育服务在通用基础标准规范方面整体滞后,婴幼儿安全照护和权益保障标准 规范方面仍存短板,监管和人员标准规范方面较弱等问题。根据托育标准规范体系现状,结合托育服务发展需求,当前亟需建立 托育服务标准规范体系的协同推进工作机制,加快通用基础标准规范研制,促进服务提供标准规范的健全,补足支持保障标准规 范的短板,进而完善标准规范框架体系,推动各类标准规范的兼容,进而为婴幼儿托育服务高质量发展提供支持和保障。     

安徽省长期护理保险筹资水平精算研究

老龄化程度加剧,失能人数增加,是我国社会面临的一大难题,长期护理保险制度在该问题的解决中发挥着重要的作用。我国长期护理保险筹资机制存在参保主体覆盖面不足、筹资渠道单一、筹资水平高低不等、筹资激励措施缺乏等问题。文章将安徽省参保对象分为城镇职工和城乡居民,并将失能人群分为轻度、中度、重度三个等级,运用国际劳工组织(International Labour Organization,ILO)精算模型中的人口、收入、成本、结果等子模型测算安徽省长期护理保险筹资水平。结果显示,2019年安徽省城镇职工医疗保险参保人群的缴费率为0.14%,城乡居民每年需要缴纳96.77元。结合安徽省长期护理保险筹资水平与我国筹资机制实践存在的不足进行讨论,为安徽省长期护理保险筹资机制的设计提出优化建议。     

Institutional Ethnography and Experience as Data

Experience, as concept, is contested among feminists as to its epistemological status, thus its usefulness in knowledge claims. Institutional ethnography (Smith 1987) is a feminist methodology that nonetheless relies fundamentally on people's experience. Not as Truth, nor the object of inquiry, but as thepoint d'appui for sociological inquiry. This article offers a demonstration of institutional enthnography using observational and interview data that show experience as methodologically central to a trustworthy analysis. A moment in the work lives of nursing assistants in a long-term care setting is captured by a participant observer. The analysis produces two lines of argument. One is methodological; it is argued that nursing assistants' experiences are an entry into the social relations of the setting that, when mapped and disclosed, make those experiences understandable in terms of the ruling arrangements permeating both the organization and their own experiences. The other argument is substantive; the inquiry uncovers how a quality improvement' strategy in a long term care hospital in Canada is reorganizing caregivers' values and practices toward a market orientation in which care appears to be compromised. Use of experience as data in this approach holds the analysis accountable to everyday/everynight actualities in a lived world.     

Homework and domestic work

This study assesses two competing theories about the extent to which homework—paid work in the home—helps integrate work and domestic roles for men and women. Contrasting male and female homeworkers with their counterparts working outside the home, it supports some aspects of both the resource and role overload theories, but predominantly the role overload perspective. Homeworkers, especially in the working class, experience less interference between job and family life, but perform more housework and child care. They have no more leisure time nor greater marital satisfaction than those working outside the home, but receive more family assistance with their paid jobs, suggesting that they combine tasks from their first and second shifts. Working at home does not break down gender roles in domestic life. Despite time saved from commuting, male homeworkers perform no more housework than comparable men working outside the home. Thus, the gender division of unpaid household labor is not simply a matter of resources or spatial logistics.An earlier version was presented at the meetings of the Eastern Sociological Society, Providence, Rhode Island, April 1991.     

基于医疗质量的公立医院绩效体系构建研究

目的：运用德尔菲法构建一套科学、可操作的公立医院绩效评价体系。方法：采用文献法研究国内外绩效评价理论,结合问卷结果形成初始量表。通过德尔菲法对指标进行两轮筛选及优化。结果：初步形成由“社会效益”、“质量安全”、“运行效益与效率”为基本结构的指标体系,包括3个一级指标、13个二级指标和72个三级指标。结论：该指标体系重点关注医院公益性及内涵质量,对公立医院绩效评价具有一定参考意义。     

江苏省综合性医院临床医生对新医改认知研究

为了解江苏省综合性医院临床医生对新医改现状的看法,评价新医改在江苏省内的实施进展和效果,该研究选取了新医改部分重点问题,采用自设计问卷,调查江苏省内7家三级综合性医院和7家二级综合性医院临床医生,运用描述性分析和卡方检验辅助分析研究结果。发现66.5%的医生更希望政府医改经费投入能侧重于医务人员劳动收入;对家庭医生签约服务的认知度及成效评价低于分级诊疗及医联体建设;认为医患关系和看病难、看病贵问题略有改善的医生分别占20.3%、24.9%、27.9%。需正确认识医务人员认知差异及原因;重视医务人员权益、优化薪酬管理制度;加强家庭医生签约服务的宣传和推广;丰富医联体间活动形式;建立及时有效的临床医生反馈机制。