Chinese medical service and medical education in urgent need of reform in the context of public welfare-based medical reform

After six years＇medical reform,about 7.8 billion person-times of medical service has been achieved by2014,and the number of persons covered by basic medical insurance for urban employees,basic medical insurance for urban residents,and new rural cooperative medical insurance exceeded 1.3 billion,of which the coverage ratio reached as high as over 95%,establishing the largest basic medical security network in the world.

Implementation Strategy of“Eight in One”of Integrated Medical and Care Service System in China:A Case Study of Anshan City of Liaoning

With the gradual intensification of aging in China,the issue of elderly care has become the primary issue that needs to be urgently solved in society.The construction of a reasonable and scientific integrated medical and care service system can not only efficiently allocate medical resources and services,but also better meet the needs of the elderly.Due to the involvement of multiple disciplines such as architecture,sociology,psychology,and behavioral science in the construction of the system,as well as the restriction of various objective factors such as medical capacity,spatial scale,and operating costs,the government and elderly care institutions have always been unable to find the best solution for how to scientifically and reasonably construct an integrated medical and care service system.This paper is based on Anshan City,Liaoning Province,which has prominent aging issues and distinct characteristics of the elderly population.Through extensive field research in elderly care institutions,and face-to-face communication with personnel from relevant government departments such as the Municipal Commission on Aging,the Civil Affairs Bureau,the Health Commission,the Medical Insurance Bureau,and the Human Resources and Social Security Bureau,it truly understands the problems that arise in the construction of the urban integrated medical and care service system.From three aspects:urban situation,institutional situation and the needs of the elderly,it is proposed to establish a clear departmental linkage mechanism with clear rights and responsibilities,a policy guarantee mechanism tailored to local conditions,a multi-measure operation mechanism,a technology first intelligent response mechanism,a warm and efficient service mechanism for the people,an overall layout mechanism,an evaluation and supervision mechanism for full process control,and a talent supply mechanism of external introduction and internal training.It aims to provide reference for the construction of an integrated medical and care service system in similar cities.

Construction of a New Model of Contactless Medical Services for Outpatients Based on the Project-Achieving Quality Control Circle

Objective: To carry out empirical research on the role of project-achieving quality control circle (QCC) in constructing a new model of contactless medical service for outpatients. Methods: A QCC, consisting of information office members from a grade A tertiary hospital in Wenzhou, was established to conduct a research project with the theme “Constructing a new model of contactless medical service based on outpatients’ experience.” According to the ten steps and PDCA cycle, an analysis was carried out before and after the QCC activities, focusing on improving pre-consultation services, providing steward-like services, and facilitating post-consultation management. Results: After the QCC activities, the mobile appointment rate, missed appointment rate, the proportion of smart check-ins, and the average check-in time were 55.68%, 4.02%, 39.75%, and 8.24 ± 3.66 min, respectively;in contrast, before the activities, they were 32.00%, 7.88%, 0.00%, and 14.96 ± 4.98 min, respectively;the difference between the two groups was statistically significant (χ2 = 3480.112, 4994.496;Fisher’s exact probability = 963788.570;t = 5.323, P < 0.001). Many experts have also visited the hospital to learn about this system, thus rendering social and economic benefits. Conclusion: Project-achieving QCC activities are suitable for complex situations, such as constructing a new model of contactless medical service, and can significantly improve outpatient service quality, enhance patients’ experience, and improve the abilities of circle members.

Medical services for sports injuries and illnesses in the Beijing 2022 Olympic Winter Games

BACKGROUND:Beijing 2022 Olympic Winter Games was the second Games held amid the COVID-19 pandemic.To a certain extent,it has altered the way sporting activities operate.There is a lack of knowledge on injury risk and illness occurrence in elite winter sport athletes amid the COVID-19 pandemic.This study aimed to describe the incidence of injuries and illnesses sustained during the XXIV Olympic Winter Games in Beijing from February 4 to 20,2022.METHODS:We recorded the daily number of injuries and illnesses among athletes reported by Beijing 2022 medical staff in the polyclinic,medical venues,and ambulance.We calculated injury and illness incidence as the number of injuries or illnesses occurring during competition or training,respectively,with incidence presented as injuries/illnesses per 100 athlete-days.RESULTS:In total,2,897 athletes from 91 nations experienced injury or illness.Beijing 2022 medical staff reported 326 injuries and 80 illnesses,equaling 11.3 injuries and 2.8 illnesses per 100 athletes over the 17-day period.Altogether,11%of the athletes incurred at least one injury and nearly 3%incurred at least one illness.The number of injured athletes was highest in the skating sports(n=104),followed by alpine skiing(n=53),ice track(n=37),freestyle skiing(n=36),and ice hockey(n=35),and was the lowest in the Nordic skiing disciplines(n=20).Of the 326 injuries,14(4.3%)led to an estimated absence from training or competition of more than 1 week.A total of 52 injured athletes were transferred to hospitals for further care.The number of athletes with illness(n=80)was the highest for skating(n=33)and Nordic skiing(n=22).A total of 50 illnesses(62.5%)were admitted to the department of dentistry/ophthalmology/otolaryngology,and the most common cause of illness was other causes,including preexisting illness and medicine(n=52,65%).CONCLUSION:Overall,11%of athletes incurred at least one injury during the Games,which is similar to the findings during the Olympic Winter Games in 2014 and 2018.Regarding illness,2%of athletes were affected,which is approximately one-third of the number affected in the 2018 Olympic Winter Games.

An Evaluation Scale of Medical Services Quality Based on “Patients' Experience”

An evaluation scale of medical services quality was developed on the basis of ＂patients＇ experience＂. The questionnaires were developed by, among others, searching relevant literature, col- lecting well-established assessment scales, measuring patients＇ experience and satisfaction, brain-storming, literature analysis. Delphi method was adopted for expert consultation. Scale items were screened and revised. The key indexes were converted. Field surveys were conducted for testing the reliability and validity of the scale. Our modified evaluation scale for measuring medical services quality based on ＂patients＇ experience＂ included 6 dimensions （tangibility, reliability, responsiveness, assurance, empathy and continuity）, and 50 items. The novel scale based on ＂patients＇ experience＂ may better serve the purpose of assessin~ medical services quality.

Facilitators of and barriers to emergency medical service use by acute ischemic stroke patients: A retrospective survey

Objective: The objective of the study was to identify facilitators and barriers to emergency medical service use among acute ischemic stroke patients in Korea.Methods: This paper presents a secondary analysis of a retrospective survey that collected data from questionnaires and medical records.Among 233 acute ischemic stroke patients enrolled in a large-scale study,160 patients who had arrived at a hospital within 72 h after symptom onset were included in the data analysis.Results: Users of emergency medical services needed a shorter time than non-users to arrive at hospital (140 min vs.625 min.,p =0.001) and were more likely to arrive at hospital within 3 h of symptom onset (51.9% vs.31.5%,p =0.013).For those who first contacted emergency medical service,the facilitators of emergency medical service use were the presence of hemiparesis (p =0.003),bilateral paralysis (p =0.040),and loss of balance (p =0.021).The predominant barrier was the failure to recognize the urgency of symptoms (p 0.006).Conclusions: The use of emergency medical services reduced prehospital delay and increased the likelihood of patient arrival at hospital within 3 h.Given that experiencing typical stroke symptoms was a facilitator of emergency medical service use yet failure to recognize the urgency of symptoms was a barrier,public awareness should be raised as regards stroke symptoms and the benefits of using emergency medical services.

Association of post-traumatic stress disorder and work performance: A survey from an emergency medical service, Karachi, Pakistan

BACKGROUND: The purpose of the study was to explore the association between posttraumatic stress disorder(PTSD) and work performance of emergency medical services personnel in Karachi, Pakistan.METHODS: Emergency medical service personnel were screened for potential PTSD using Impact of Event Scale-Revised(IES-R). Work performance was assessed on the basis of fi ve variables: number of late arrivals to work, number of days absent, number of days sick, adherence to protocol, and patient satisfaction over a period of 3 months. In order to model outcomes like the number of late arrivals to work, days absent and days late, negative binomial regression was applied, whereas logistic regression was applied for adherence to protocol and linear for patient satisfaction scores.RESULTS: Mean scores of PTSD were 24.0±12.2. No association was found between PTSD and work performance measures: number of late arrivals to work(RRadj 0.99; 0.98–1.00), days absent(RRadj 0.98; 0.96–0.99), days sick(RRadj 0.99; 0.98–1.00), adherence to protocol(ORadj 1.01; 0.99–1.04) and patient satisfaction(β 0.001%–0.03%) after adjusting for years of formal schooling, living status, coping mechanism, social support, working hours, years of experience and anxiety or depression.CONCLUSION: No statistically significant association was found between PTSD and work performance amongst EMS personnel in Karachi, Pakistan.

Overview of the Shenzhen Emergency Medical Service Call Pattern

BACKGROUND:In Shenzhen,the Emergency Medical Service(EMS) system has been in service since 1997.This study aims to examine the operation of Shenzhen 120 EMS center and to identify the reasons of calling EMS.METHODS:In this retrospective quantitative descriptive study,the data from the Shenzhen 120 EMS registry in 2011 were analyzed.RESULTS:Shenzhen 120 EMS center is a communication command center.When the number of 120 are dialed,it is forwarded to the closest appropriate hospital for ambulance dispatch.In2011,the Shenzhen 120 EMS center received 153 160 ambulance calls,with an average of 420 calls per day.Calling emergency services was mainly due to traffic accidents.Trauma and other acute diseases constituted a majority of ambulance transports.The adult patients aged 15-60 years are the principal users of EMS.There are no recognized 'paramedic' doctors and nurses.The pre-hospital emergency service is under the operation of emergency departments of hospitals.Shenzhen at present does not have specialized pre-hospital training for doctors and nurses in posttrauma management.Moreover,specialized pre-hospital training,financial support,and public health education on proper use of EMS should be emphasized.CONCLUSION:The Shenzhen 120 EMS center has its own epidemiology characteristics.Traumatic injury and traffic accident are the main reasons for calling ambulance service.In-depth study emphasizing the distribution and characteristics of trauma patients is crucial to the future development of EMS.

Challenges and optimization strategies in medical imaging service delivery during COVID-19

In coronavirus disease 2019(COVID-19),medical imaging plays an essential role in the diagnosis,management and disease progression surveillance.Chest radiography and computed tomography are commonly used imaging techniques globally during this pandemic.As the pandemic continues to unfold,many healthcare systems worldwide struggle to balance the heavy strain due to overwhelming demand for healthcare resources.Changes are required across the entire healthcare system and medical imaging departments are no exception.The COVID-19 pandemic had a devastating impact on medical imaging practices.It is now time to pay further attention to the profound challenges of COVID-19 on medical imaging services and develop effective strategies to get ahead of the crisis.Additionally,preparation for operations and survival in the post-pandemic future are necessary considerations.This review aims to comprehensively examine the challenges and optimization of delivering medical imaging services in relation to the current COVID-19 global pandemic,including the role of medical imaging during these challenging times and potential future directions post-COVID-19.

Self-Reported Use of Personal Protective Equipment during the SARS-CoV-2 Pandemic in Emergency Medical Service Employees in Germany—A Survey

Background: Multicentric prospective cohort investigation survey conducted between 1st of March and 1st of April 2021on SARS-CoV-2 occupational risk for German Emergency Medical Services (EMS) personnel. Study Objectives: Primary: The objective is to take stock of the use and availability of Personal Protective Equipment (PPE) in German EMS, both at managerial and employee level, during the SARS-CoV-2 pandemic. Secondary: Generate additional data on individual perceptions of risk of infection and occurrence of infections at respective places of service. Methods: Multicentric prospective cohort investigation survey conducted online at two levels of German EMS personnel—EMS managers and EMS employees, both medical and paramedical—with questions adapted slightly to fit the respective study population. Results: A total of 34 responses were received in the managerial group;a total of 2389 responses were received in the group of employees. Self-reported PPE adherence of EMS employees for confirmed SARS-CoV-2 positive patients: use of gloves (99.8%), FFP2 or FFP3 masks (99.8%), gowns or coveralls (99.1%), goggles (89.7%), face shields (24.0%), surgical masks (0.0%). Self-reported PPE adherence of EMS employees for suspected SARS-CoV-2 positive patients: gloves (98.8%), FFP2 or FFP3 masks (total: 99.4%), gowns or coveralls (total: 95.9%), goggles (85.6%), face shields (19.2%), surgical masks (0.2%). Conclusions: Findings included an overall improved self-reported adherence to PPE compared to studies that were conducted before the pandemic. Self-reported general adherence to PPE recommendations when attending to confirmed SARS-CoV-2 positive patients was good, with the exception of goggles. Self-reported adherence to PPE recommendations dropped when attending to suspected SARS-CoV-2 positive patients.

Mobile EMR Use for Epidemiological Surveillance on a Medical Service Trip in Honduras: A Pilot Study

Rationale: Medical treatment on short-term primary care medical service trips (MSTs) is generally symptom-based and supplemented by point-of-care testing. This pilot study contributes to the effective planning for such austere settings based on predicted symptomology. Objective: We aimed to prospectively document the epidemiology of patients seen during two low-resource clinics on a MST in Honduras and apply predefined case definitions adapted from guidelines used by international healthcare organizations (e.g. World Health Organization). Methods: An observational design was used to track the epidemiology during two clinics on an MST in Limon, Honduras in March 2015. The QuickChart mobile electronic medical record (EMR) application was piloted to document diagnoses according to predefined case definitions. Results: The most commonly diagnosed syndromes were upper respiratory complaints (20.19%), nonspecific abdominal complaints (20.19%), general pain (15.38%), hypertension (9.62%), pruritus (6.73%), and asthma/ COPD (4.81%). The case definitions accounted for 94% of all complaints and diagnoses on the brigade. Discussion: The distribution of common patient diagnoses on this MST was similar to that which had been reported elsewhere. The use of broader symptom-based case definitions for epidemiologic surveillance could also facilitate the syndromic management of patients seen on MSTs, and improve the consistency of treatment offered. Conclusion: Case definitions for common syndromes on primary care MSTs may be a feasible method of standardizing patient management. Preliminary use of the QuickChart EMR was acceptable for documentation of epidemiology in the field. Further study is necessary to investigate the reliability of syndromic diagnostic criteria between different clinicians and in a variety of MST settings.

Do the Right Patients use the Ambulance Service in South-Eastern Finland?-A Prospective Descriptive Study of Ambulance Dispatching in Relation to the Ambulance Staff’s Assessment of Patients’Needs in a Subset in the South East of Finland

Background: Several Emergency Medical Systems use a criteria-based prioritization system for ambulance response. The emergency medical priority dispatching of ambulances was introduced in the 1980s. In a system of this kind, the operators at the medical emergency dispatch centers have to assess the patients’ symptoms and the need for ambulance response. The prioritization of the ambulance response is based on the seriousness of the patient’s symptoms, his/her current condition and, in the case of trauma, the trauma mechanism. The priority system is supposed to optimize the use of the ambulance service and to match and meet the patients’ needs with an adequate response from the ambulances. The aim of this study was to describe the dispatching and utilization of the ambulance service in a part of Finland. Results: There was a substantial divergence between the initial priority assigned and the patients’ medical status at the scene. The ambulance staff confirmed the need for ambulance transport for 65% of all the patients who were assigned an ambulance by the dispatch center. Conclusions: Using a criteria-based dispatch protocol, the dispatch operator works with a wider safety margin in the priority assessments for ambulance response than was actually confirmed by the ambulance personnel at the scene. In this sample, there may be some overuse of the ambulance service. According to the assessments made by the ambulance staff, 35% of the patients did not require ambulance transport. The emergency system has to accept and work with safety margins. At the same time, there must be a balance between a safety margin and a waste of limited resources.

Bring Affordable Medical Service to Farmers

Huo Yulan had suffered from hydrocephalus, a brain disease, for decades before she finally agreed to have an operation for it in the Beipiao County Hospital, Liaoning Province in Northeast China last March.

Quality Medical Services at Doorway——Beijing's community-based medical institutions

For years suffering from hypertension, Mrs. Zhang, now in her 60s, is a frequent visitor to Beijing Dewai Community Hospital in her neighborhood.＂I feel too painstaking to go to a ＇big hospital,＇＂ she says. ＂Buses are always overcrowded and slow, not suitable for people like me. Besides, community-based medical institutions charge less for treatment of the same diseases.＂

Current Rural Medical Service in China

In contrast to the great changes that have taken place in the Chi- nese economy, China is confronting with a rural health crisis. Statistics shows that about 40-60% of the people in rural areas fail to see a doctor when they get sick simply because they cannot afford it and 70% of the people impoverished due to diseases. In the western part of the country, 60-80% of the patient farmers have to die at home. Part of the Chinese farmers has been thrown into an endless cycle of disease-poverty-disease. Health has become a problem that the farmers are most concerned about.

40 Years of Rural Cooperative Medical Service

Our story dates from 40 years ago, on August 10, 1966, when China＇s first institution of rural medical service was inaugurated at a county called Changyang, Hubei Province, Central China, where people of Tujia, an ethnic minority group, live in compact communities. It was actually a clinic at a Dujia Village in the county, which charged itself with the task of making primary or basic medical care available and affordable-- to all the villagers. China has undergone tremendous changes since then, and now its economy becoming increasingly market-oriented. Despite that, rural cooperative medical service has kept expanding at Changyang though having experienced twists and turns over the past four decades. The county has been chosen by the central authorities to try out a new type of rural medical service, which in many ways is different from the old pioneered by Dujia in Changyang County.

HOME-BASED MEDICAL SERVICES GET POPULAR IN LHASA

Whenever anybody feels uncomfortable,a doctor,once called,will immediately come to provide his or her services.As part of the new wave of doctors providing their services to smaller communities,"homebased doctors"are gradually being introduced to common civilian homes.At present,Lhasa City has been positively promoted the home-

Exploration and Research on the Integrated Development of“Internet Plus Medical Treatment”

Objective To analyze the development of“internet plus medical treatment”and to explore advantages.Methods The literature of“internet plus medical treatment”was systematically combed and analyzed.Results and Conclusion After exploring the status quo of“internet plus hospitals”,smart pharmacy and web-assisted health management in China,we find that there are some problems in the medical service at present,such as the imperfect laws and regulations,the hidden dangers of information security and the obstacles of medical insurance payment.Therefore,we propose that the development of web-assisted medical service should be led by the government and relevant policies must be improved.Then,self-regulation should be strengthened,and industry standards should be enhanced.Three suggestions are made to improve medical insurance payment and benefit both hospitals and patients,which can provide reference for promoting the development of“internet plus medical treatment”in China.

Research on Rural Public Service System Based on the Data of "The Eleventh Five-Year Plan"

Rural public service is the services provided to rural residents to fulfill the needs of agricultural production, development of rural economy and improvement of peasant's living standard. Improving rural public service system is good for promoting the development of rural economy, enhancing the quality of peasant's living standard, narrowing the gap between rural and urban areas and constructing socialistic harmonious society. Currently, our rural power grid construction can meet the essential needs of economic and social development in rural areas. Rural water conservancy structure also fulfills the needs of agricultural production and peasant's life. Rural traffic condition has an obvious improvement. Education, culture, medical care and other public services all have a general enhancement. However, comparing to the city, rural public service system still exists some problems including imperfect infrastructures, low-quality education and medical treatment, low-level living environment and so on. Therefore, it is needed to establish a long-acting system of rural public service to boost the reform of rural basic education, improve the facilities of rural medical treatment, promote the reform of rural cooperative medical service, enhance the management of rural governance and improve the quality of rural life and environment.

Satisfaction at Work and Suffering in Professional Psychic Service Mobile Service Emergency (SAMU)

Background: This study aimed to evaluate the level of professional satisfaction, to identify the presence of psychic suffering and their correlations in Emergency Medical Services professionals. Methods: The study is of the exploratory, census, descriptive, transversal type, with quantitative approach. It used three instruments: A sociodemographic questionnaire;the Professional Satisfaction Index—PSI;and the Self Report Questionnaire—SRQ-20. 200 professionals took part in the research (doctors, nurses, nursing technicians and conductors). Results: The data show that the majority of professionals are aged between 40 and 49 years old and that the largest quantity of women belong to the group of nurses. As to the PSI, the majority of professionals pointed out remuneration as the most important for satisfaction. In the overall satisfaction result, the physicians were those who had the highest level of satisfaction. Regarding the SRQ-20 scores, the group of nursing technicians and nurses had the highest prevalence for psychic suffering, with 44.56% and 43.48%. In the statistical analyses between each of the components of the professional satisfaction with the SRQ-20 scores, we verified statistically significant correlations when adopting (p Conclusions: It was concluded that the discontent of workers with remuneration and managerial issues are predominant for total dissatisfaction with work and dissatisfaction exerts a strong influence on the presence of suffering in these professionals.