The Brazilian public healthcare system and its participation in medical training

Introduction: In Brazil, in a joint initiative of the Ministries of Health and of Education and Culture, the Program for the Promotion of Changes in Medical School Curricula (PROMED) was created, in order to give financial support to medical schools for the development and implementation of curricular changes to the medicine courses. Objective: To ascertain the influence of PROMED on the interaction between the Brazilian public healthcare system (SUS) and the universities. Method: Using the qualitative method by way of content analysis of the Bardin, interviews with 19 coordinators of the medicine courses which received financial support from PROMED were carried out and analyzed. Results: Subcategories which express the current relation between SUS and the universities were found: the need to train SUS professionals and the teaching staff involved, the lines of research directed toward SUS and partnership relations as part of the student learning process, the strengthening of SUS and the internal problems. Conclusions: Observing the needs of the relationship between SUS and the curricular changes it was noted that the public health services are of extreme importance as part of the training process of the medical student. Besides favoring practice, it establishes student activities within the health services, the evaluation of the policies, planning and management of the health services in activities of training and social communication in healthcare, linked to community organizations or diverse social entities. Thus, problems associated with the healthcare service can be identified, as well as the health conditions and life style of the population.

An End-to-End Authentication Scheme for Healthcare IoT Systems Using WMSN

The healthcare internet of things(IoT)system has dramatically reshaped this important industry sector.This system employs the latest technology of IoT and wireless medical sensor networks to support the reliable connection of patients and healthcare providers.The goal is the remote monitoring of a patient’s physiological data by physicians.Moreover,this system can reduce the number and expenses of healthcare centers,make up for the shortage of healthcare centers in remote areas,enable consultation with expert physicians around the world,and increase the health awareness of communities.The major challenges that affect the rapid deployment and widespread acceptance of such a system are the weaknesses in the authentication process,which should maintain the privacy of patients,and the integrity of remote medical instructions.Current research results indicate the need of a flexible authentication scheme.This study proposes a scheme with enhanced security for healthcare IoT systems,called an end-to-end authentication scheme for healthcare IoT systems,that is,an E2EA.The proposed scheme supports security services such as a strong and flexible authentication process,simultaneous anonymity of the patient and physician,and perfect forward secrecy services.A security analysis based on formal and informal methods demonstrates that the proposed scheme can resist numerous security-related attacks.A comparison with related authentication schemes shows that the proposed scheme is efficient in terms of communication,computation,and storage,and therefore cannot only offer attractive security services but can reasonably be applied to healthcare IoT systems.

Revelation of Rural System of Medical Services in BRICS to China

In recent years, the great achievements of basic medical and healthcare services of BRICS have gained great attention and acknowledgement from the whole world. In their medical system reform, India, Brazil, Russia and South Africa have established their medical systems with their own characteristics. This provides valuable references for China in its critical stage of medical system reform. This paper explored the experience of BRICS＇ reform of medical system in order to offer some references and guidance for the establishment of basic medical and health services with Chinese characteristics and conforming to Chinese practice.

The Shortage of Local Anesthesia and Palliative Care Medications in Minor Postoperative Orthopedic Surgical Procedures in Ecuador

This white paper discusses the Ecuadorian healthcare system specifically the lack of proper anesthesia and post-operative pain medication and touches base with centralized hospitals. This paper articulates the specific problems inhibiting the usage of these proper medications, specifically looking at a hospital in Quito, Ecuador. Present day tribal situations are also discussed as they are a significant part of the population that is affected by the shortages of pain medication and anesthesia. Solutions are presented to solve the problems the country faces and how it is relevant today.

IoMT-Enabled Fusion-Based Model to Predict Posture for Smart Healthcare Systems

Smart healthcare applications depend on data from wearable sensors(WSs)mounted on a patient’s body for frequent monitoring information.Healthcare systems depend on multi-level data for detecting illnesses and consequently delivering correct diagnostic measures.The collection of WS data and integration of that data for diagnostic purposes is a difficult task.This paper proposes an Errorless Data Fusion(EDF)approach to increase posture recognition accuracy.The research is based on a case study in a health organization.With the rise in smart healthcare systems,WS data fusion necessitates careful attention to provide sensitive analysis of the recognized illness.As a result,it is dependent on WS inputs and performs group analysis at a similar rate to improve diagnostic efficiency.Sensor breakdowns,the constant time factor,aggregation,and analysis results all cause errors,resulting in rejected or incorrect suggestions.This paper resolves this problem by using EDF,which is related to patient situational discovery through healthcare surveillance systems.Features of WS data are examined extensively using active and iterative learning to identify errors in specific postures.This technology improves position detection accuracy,analysis duration,and error rate,regardless of user movements.Wearable devices play a critical role in the management and treatment of patients.They can ensure that patients are provided with a unique treatment for their medical needs.This paper discusses the EDF technique for optimizing posture identification accuracy through multi-feature analysis.At first,the patients’walking patterns are tracked at various time intervals.The characteristics are then evaluated in relation to the stored data using a random forest classifier.

Best Practices and Innovative Scenarios of Integrated Patient Data Management to Improve Continuity of Care and Scientific Research

Clinical data have strong features of complexity and multi-disciplinarity. Clinical data are generated both from the documentation of physicians＇ interactions with the patient and by diagnostic systems. During the care process, a number of different actors and roles （physicians, specialists, nurses, etc.） have the need to access patient data and document clinical activities in different moments and settings. Thus, data sharing and flexible aggregation based on different users＇ needs have become more and more important for supporting continuity of care at home, at hospitals, at outpatient clinics. In this paper, the authors identify and describe needs and challenges for patient data management at provider level and regional- （or inter-organizational-） level, because nowadays sharing patient data is needed to improve continuity and quality of care. For each level, the authors describe state-of-the-art Information and Communication Technology solutions to collect, manage, aggregate and share patient data. For each level some examples of best practices and solution scenarios being implemented in the Italian Healthcare setting are described as well.

“大、小、重、慢”疾病定义与全科医生“4善”定位的探讨

随着我国医药卫生体制的深度改革,特别是分级诊疗制度的推进,全科医生在基层医疗保健体系中的角色日益重要。全科医生不仅是居民健康的第一道防线,更是常见疾病预防、诊断、治疗及健康教育的关键执行者。国家对全科医生提出了“小病善治、大病善识、重病善转、慢病善管”的临床定位。本文通过问答形式,分析“小、大、重、慢”疾病的分类与全科医生的“4善”定位,探讨全科医生在新医改时代下的重要职能及挑战。访谈者认为虽然分级诊疗制度旨在优化医疗资源配置,但在实践中仍面临“大、小、重、慢”疾病分类的模糊性和基层医疗资源的不均衡分配等问题。全科医生在这个体系中扮演着至关重要的角色,其需要具备综合的临床诊疗能力,并与专科医生共同制定临床判断标准和诊疗标准。为了应对这些挑战并充分发挥全科医生在现代医疗体系中的作用,迫切需要对全科医学教育和实践进行进一步改革与优化,同时强化全科医生的角色定位,以确保在提升医疗服务质量和效率的同时,实现公平和可持续的健康保障体系。

Telemedicine System Based on Medical Consultation Assistance Integration

With the aging of the global population, how to provide effective telemedicine for the aging population has become a very important issue, especially for the elderly with limited mobility. If there is a complete telemedicine system, it will not only greatly improve medical efficiency. It can reduce the chance of contact between people and avoid the medical risks caused by severe special infectious pneumonia. This paper focuses on the development of a high-efficiency telemedicine system platform that conforms to international standard data exchange formats. This system platform can not only solve the problem of shortage of medical staff but also allow patients to be free from medical outpatient time constraints. Achieve the effect of telemedicine at any time, and digitize the medical process rules to establish a complete online telemedicine system platform.

Thinking on establishing regional diagnostic center

分析建立区域性医学诊断中心的必要性、可行性,总结了近年来独立医学诊断机构发展存在的瓶颈和 问题,提出通过合理界定区域性医学检验中心的定位、采用政策制定推广机构的建立、探索建设基于AI辅助 诊断团队、搭建第三方机构人才培养体系以及多渠道采集样本等举措实现区域诊断中心的建立和运行.

Patient Opinion网站对我国医患交互式网站建设的启示

目前,我国医药卫生网站缺少以患者作为信息发布者提供信息反馈的权威网站,而英国的Patient Opinion网站为我们提供了可资借鉴的模式和思路。文章通过介绍该网站的特色功能,分析其经营研究报告,促进国内基于Web2.0的医患交互式网站的开发和建设,并希望此类网站的创立与发展为我国医改带来新的思路与动力。

探索中国式医疗保障制度——三明医改实践

医疗卫生改革是各个国家的政治、经济和社会的焦点问题,政府如何选择正确的医疗保障模式至关重要。福建省三明市的医改是中国医改的成功典范。三明市敢为人先,通过系统综合改革,破除逐利创收的旧体制,建立保障公益性和符合人民健康需求的新制度。三明医改为探索中国式医疗保障制度提供了地方经验和可行路径,也为世界各国医改贡献了可供借鉴的中国经验。

人工智能视域下的医护科研人员知识服务

随着ChatGPT的兴起,如何将人工智能更好地运用于医护科研人员知识服务体系中,成为推进“健康中国”建设的重要举措。文章以医护科研人员为研究对象,以Wilson信息行为模型和信息搜寻行为的情境为理论基础,采用问卷调查法和因子分析法设计用户画像标签体系,构建医护科研人员用户画像。研究发现:医护科研人员可细分为科研成熟型、科研进阶型、科研起步型和科研潜在型四类群体;图书馆员可通过积极采纳AI服务理念进行用户特征的个性化与动态化识别,使用自然语言处理与机器学习实现医学资源自动化管理,以AI教学平台提升医护科研人员对新工具的掌握效率等途径,实现人工智能视域下医护科研人员知识服务效能的提升。

综合医疗制度改革对中国家庭财务脆弱性的影响

健康风险作为背景风险的重要组成部分,会给一般家庭造成明显的财务脆弱性。医疗制度作为重要的社会保障基础,可以为家庭提供关键的健康保障,从而有效缓解家庭财务脆弱性。引入2010—2020年中国家庭追踪调查数据(CFPS),构建准自然实验研究体系,采用双重差分法检验了综合医改政策对家庭财务脆弱性的影响特征及其作用机制。研究发现,综合医改政策的实施显著缓解了家庭财务脆弱性,并且这一效应在城镇家庭、有老年人的家庭、儿童健康风险高的家庭、弱社会网络家庭、使用互联网的家庭以及社会信任度高的家庭中表现更加明显。同时,综合医改政策可以通过降低家庭医疗负担、提升家庭劳动参与、改变家庭风险态度等途径缓解家庭财务脆弱性。本文为评估综合医改政策及其对家庭财务影响的有效性提供了新视角,为进一步从微观层面深化医疗卫生体制改革提供了重要的政策启示。

三级公立医院绩效考核背景下医院运营管理的研究

国家三级公立医院绩效考核开始于2019年,运营效率作为考核的一部分,相关的国家监测指标有9个,包含收支结构和费用控制。绩效考核是医改工作的有力抓手,也是加快现代医院管理制度建立的强劲推手。通过分析某三级甲等口腔专科医院在绩效考核背景下运营效率指标的得分情况,找出原因;并通过加强党建引领,做好医院运营管理体系架构顶层设计,加强医疗质量管理,落实医改相关政策,加强能耗管理,不断提高员工福利待遇,强化公立医院功能定位,提高医疗服务收入占比,绩效分配体现医务人员的劳动技术价值,提高运营管理能力,助推医院高质量发展。

医学课程在线教学学习效果评价体系研究

面对大数据时代的新要求以及不断变化的新型冠状病毒肺炎疫情挑战,线上教学成为高等教育中备受瞩目的新形式。依托教学平台进行在线教学,能够使优质教育资源共享,为学生带来全新的教学感受,以及个性化体验;同时,平台提供的学生学习行为与学习成绩数据更利于教师精准施教。因此,医学课程在线教学亦需要在多方面进行改进与优化,研究基于教学平台的医学课程在线教学学习效果评价体系将为进一步建设医学一流课程、一流专业提供有力支撑,具有重要的理论意义与实践价值。

健康中国背景下的“看病贵”与政府支出——基于资源配置结构性失衡视角的分析

“看病贵”意味着医疗卫生资源转化为医疗卫生服务的成本高,有限资源下医疗卫生服务供给的数量和质量难以满足公众健康需求,从而直接影响健康中国建设。同时,人口快速老龄化带来的医疗卫生需求爆发式增长,将形成医疗卫生体系的额外压力,加剧供求矛盾。基于医疗卫生资源配置结构性失衡视角研究“看病贵”与政府支出之间的关系发现:政府增加卫生支出会通过加剧人力资源配置的结构性失衡而加剧“看病贵”问题;只有将增加政府卫生支出与深化医疗卫生体制改革相结合,才能真正缓解全社会“看病贵”问题。因此,应深化公立医院改革,优化政府对医疗卫生资源的配置方式,加强基层医疗卫生体系建设,重塑医疗卫生服务治理模式,构建专业化治理模式,系统性重构中国医疗卫生领域人才建设。

新医改背景下医学本科生医德认知调查及医德教育对策研究

目的:探讨新医改背景下医学本科生医德认知水平及医德教育对策。方法:选取滨州医学院附属医院五年制临床医学专业见习阶段及实习阶段的本科生为研究对象,发放医德教育评价、医德认知调查问卷及以投诉医疗服务问题为主的医患冲突案例,分析调查结果。结果:大部分受访者认为以投诉医疗服务问题为主的医患冲突与医德水平有关,并且医德水平主要与自我价值观及是否接受医德教育有关。受访者均认为在见习实习阶段需要加强医德教育,并且大部分受访者认可医德教育导师制。结论:医学本科生基本具备正确的医德认知理论水平,医德教育需要与临床专业实践教学相融合,医德教育导师制是医学教育模式的有益探索。

某三甲医院继续医学教育减负政策的效果与思考

目的 评估北京某三级甲等医院继续医学教育(continuing medical education,CME)减负政策的实施效果。方法 选择北京某三级甲等医院的2016年11月—2022年10月接受医院CME 2 087名人员相关资料,应用资料分析方法分析相关CME情况。结果 国家级/市级项目方面,实施时间对CME得分有负面影响(P <0.001),职称对CME得分的影响不显著(P=0.641),专业对CME得分有正向影响(P <0.001);区级项目方面,实施时间、职称、专业对CME得分均有负面影响(均P <0.001);线上学分回归结果显示,实施时间为正面影响(P <0.001),职称和专业对得分影响不显著(P=0.889、0.058)。结论 减负政策对CME得分有正面影响,需要进一步完善政策以支持医务人员的学习。CME已经进入继续职业发展阶段,应重视自主学习,了解医务人员教育需求,提供多样化的学习方式,扩展线上教育,加强激励和约束机制。

基于虚拟教研室建设的课程思政教学模式探索

虚拟教研室是一种基于现代信息技术平台,打破传统的专业及院校壁垒,联合开展协同教学研究与改革实践的教师共同体。课程思政是把“立德树人”贯穿整个教学过程的一种综合教育理念。虚拟教研室能够有效地突破传统教研模式的局限,依托虚拟教研室建设进行多元化师资培训,深入挖掘教学中的思政元素,建立思政资源库,通过虚拟教研室分享交流并不断完善,使课程思政的实施更规范更合理。将数字化思政元素有机融入知识图谱,尝试引入生成式预训练Transformer模型(generative pre-trained transformer,GPT)等人工智能技术,形成智能+基础上的数字化教学体系,能够使课程思政元素更加立体和智能,从而更有利于课程思政经验的推广。构建科学的评价体系,评价课程思政的效果及虚拟教研室的优势,助推虚拟教研室的建设及课程思政的深度融入,能够逐步实现为党育人、为国育才的目标。

城镇职工基本医疗保险制度改革受益归宿分析

我国于2021年4月发布了关于城镇职工基本医疗保险制度改革的指导意见。为了探究此次改革的具体受益情况,在赋予城镇职工基本医疗保险的个人账户资金私人属性的基础上,采用模拟分析的方法,对不同收入阶层、参保群体在改革前后的自费负担和自费负担变化幅度进行测算。研究表明:城镇职工基本医疗保险制度改革增加了患病参保群体的受益程度,减轻了自费负担;在不同报销金额、起付线和报销比例的条件下,收入越低的参保群体,其受益增加程度越大;同一假设条件下的在职职工与退休人员,后者在改革中的受益略高于前者。基于结论提出完善城镇职工基本医疗保险缴费、报销环节设计、进一步扩大个账使用范围以及简化家庭共济流程等相关建议。