Psycho-medical aspects on migrants health of III? world pediatric surgical patients

The constantly expanding world wide mobility and globalization within the pediatric community puts new demands on pediatric surgical health care systems worldwide. Forcing carers to pay attention not only on their best surgical and medical performance like in the past. In contrary, they are forced to pay much more attention on psycho-medical aspects like finance, rehabilitation, socialization and integration, culture, management and logistics, health edu-cation and language skills. Then, according to our opinion these aspects should be considered as Post Traumatic Stress Disorder (PTSD)-like syndrome and treated accordingly. Then handling this problem succesfully, would be essential for the future survival of any health care system.

The development of patient education: Experiences of collaborative work between special and primary care in Finland

Evaluating care pathways, strengthening patient education, developing staff’s patient education skills, and improving collaboration between primary and special healthcare workers are all topical challenges. Successful patient education requires seamless cooperation across organizational boundaries throughout the whole nursing process. The aim of this study is to describe participants’ experiences of development work between primary and special health care units on patient education. In this qualitative descriptive study twenty four health care workers who took part in development work in a collaborative project of special and primary health care service in northern Finland were interviewed when they had nine months’ experience of the development work. The material was analysed using content analysis. Experiences of the nature of development work were described using the following categories: attachment to development work, delight in participation, factors supporting success and challenges of development work. Improvement of co-operation between special and primary health service is a topical challenge. Participation in development work offers occupational learning opportunities. Evaluation and development of own work strengthens staff members’ occupational know-how. The results of this research may be utilized in the planning and execution of development work in the field of health care.

Healed and Crippled： The Effect of Global Medicine on African Indigenous Treatment and Care Approaches

Whereas global medicine and health care practices have improved the quality of people＇s lives, especially in the developing countries data abounds that local communities have been crippled by the same medical practises. Some societies in developing countries have become sources of specimen for clinical trials of biomedicine which is unaffordable to their citizens. This paper explores the neglect of traditional African medicinal innovations and research in favour of imported Western medicine perpetuated by the developed countries. The paper argues that global medicine and health care have neither utilized nor recognized the African Traditional Medicine （ATM） fully, despite the fact that cultures in developed world used and continue to utilize the indigenous medical knowledge. The paper further argues that instead of neglecting African Traditional Medicine, ATM and biomedicine can be more beneficial by blending them into a single system, through what we would call in this paper High-Performance Medical Research （HPMR）. This would allow participation of communities to achieve both socio-eeonomic and medical knowledge growth rather than being a monopoly and preserve of developed organizations in the North. This paper proposes that HPMR should be a systematic and scientific approach for enhancing local people＇s participation in the development of medical ventures. This paper draws on secondary data on traditional African therapeutic practices by some local communities in East Africa combined with literature review on medical practice in Western societies.

Health Training Needs at Primary Care Level Health Facilities in Rural Western Uganda

Introduction: Continual education is recognized worldwide as a tool for the professional development of health care practitioners. It is however effective when the training targets the appropriate needs of the target beneficiaries. This study was therefore aimed at identifying priority training needs of Primary Care Level health professionals in rural Western Uganda. Methods: This was a descriptive cross-sectional survey among 35 rural community health facilities represented by their managers in rural Western Uganda. Participants were invited to Mbarara University of Science and Technology and responded to a self-administered questionnaire and also participated in qualitative group discussions guided by Facilitators from the Community Based Education and Research Services unit within the Community Health Department of Mbarara University of Science and Technology. Priority health training needs were determined based on the computed weighted scores. Results: The majority of managers of rural primary care level health facilities were medical officers by the level of training (51.43%) and male by gender (68.57%). Priority health training needs identified were child health and maternal health with total weighted scores of 12.0 and 10.9 respectively. Qualitatively, emerging themes included;leadership and management, and supervisory roles during student field attachments. Conclusion: Priority health training needs at rural Primary Care level health facilities were child health, maternal health, leadership and management, and supervisory skills. There is dire need to train rural primary care level, health professionals. In-service training based on identified needs should be offered by MUST in partnership with regional stakeholders. This is likely to enhance the quality of services provided by rural primary care level health facilities.

Medical Curriculum at KU Leuven-University of Leuven, Belgium

In this paper we reflect on the evolution of medical education, with the medical curriculum at the University of Leuven as a concrete example. Formally, the Leuven curriculum follows a bachelor's and master's structure that leads to the degree of Medical Doctor after which further advanced training is required to become a practising physician. The Leuven curriculum takes the CanMEDS model as its educational framework. Embedding the CanMEDs roles within the curriculum is achieved using four learning pathways(Knowledge and Fundamentals of Medicine; Scientific Training; The Physician in Society; Skills and Communication) that run across the bachelor's and master's programmes. A stepwise approach is adopted whereby students progressively acquire the required competences to translate medical knowledge into evidence-based clinical practice. The learning process initially takes place in a simple and controlled environment, e.g. lectures or demonstrations with(simulated) patients. As the programme progresses, learning and assessment occur in ever more authentic medical situations,e.g. during the clerkships. In the future it will be important to capture new developments in e.g. education technology, health care organisation and patient involvement, and incorporate them into the medical curriculum. In this way we may fulfil our ambition to train medical doctors that are ready to participate in the 21^(st) century health care system and take their responsibility towards both the individual patient and public health care.

Preliminary Discussion on Sand Therapy in Mongolian Medicine

Sand therapy of Mongolian medicine is one of traditional Mongolian medical treatments.It conducts heat energy to the human body through natural hot sand applied on the body,achieving the effect of preventing and curing disease.It is an external treatment method,characterized with easy operation,obvious curative effect and small side effects.Referring to the relevant literature of sand therapy in Mongolian medicine and combined with actual situation,the functions and use of sand therapy are summarized in this article,thereby providing theoretical basis and reference for research on sand therapy.

医学院校体医融合双主体协同发展路径研究

随着COVID-19在全球肆虐,健康中国建设的重要性和紧迫性进一步凸显。体医融合模式是实现健康中国的有效路径之一,医学院校作为健康中国的重要阵地,理应发挥作用。当前,我国医学院校存在体医融合模式主体不明、师资匮乏、学科融合不足以及融合机制尚未建立等问题亟待解决。本文基于健康中国框架,提出医学院校体医融合应以教学改革为切入点、以师资队伍建设为保障、以增设体医融合专业为依托、以改革成果验收和推广为目标,构建体医双主体互惠共生协同发展机制,为实现健康公平和健康中国提供支撑。

养老服务新体系下推进医养与康养衔接发展的思考

人口老龄化程度加剧带来了老年人健康需求的变化,医养与康养相融合成为当前养老服务体系建设的重要内容之一,因此要通过两者的有效衔接实现服务的均等化、可及性、延伸拓展、资源共享,但是由于管理体系不顺畅、资源配置不合理、服务项目不融合、保障措施不力、主动健康认识不足等因素造成了医养与康养衔接的现实障碍。文章提出了要将医养与康养有效衔接作为促进健康老龄化的积极行动、将管理协同和有效作为推动医养与康养衔接的重要力量、将政策推动和协同作为推动医养与康养衔接的保障基础、将资源整合和可及作为推动医养与康养衔接的关键动力、将医养与康养衔接作为高质量发展“银发经济”的有效途径等建议,为养老服务新体系下推进医养与康养衔接的发展提供政策依据。

医疗保健生态学模型在卫生服务研究中的应用现状及启示:一项概况性评价

背景近十年来,随着医疗保健生态学模型(ecology of medical care model)应用价值的突显,该模型得到了学者们的高度关注。医疗保健生态学理论模型构建的差异与变化在一定程度上可以反映医疗模式的转变,为了解我国人群健康需求和卫生服务利用情况提供证据基础。目的对运用医疗保健生态学模型的研究进行整合和对比,以描述使用医疗保健生态学模型建立的研究现状、对比研究方法和主要发现。方法于2022年6月,在PubMed、Ovid Medline、Web of Science、EmBase、中国生物医学文献服务系统、中国知网、万方数据知识服务平台中根据关键词、不限制语种开展检索,检索时限为1961-2022年。在Joanna Briggs Institute(JBI)概况性评价方法学手册的指导下,对文献进行筛选、信息提取,并开展描述性分析。结果共纳入符合要求的文献28篇,其中22篇(78.6%)发表于2010年以后。多数研究运用医疗保健生态学模型重点关注人群的健康需求、医疗资源利用模式,聚焦就医行为模式、疾病转诊等问题。在研究人群方面,多数研究覆盖全年龄段人群(11篇,39.3%),针对特定人群开展的研究有7篇(25.0%)。有4项研究在中国开展,均针对城市地区。相较于发达国家(地区),发展中国家(地区)研究中较少关注患者自我寻求帮助(非处方药、按摩等)情况,已有的医疗保健生态学模型反映出发展中国家(地区)具有较低的患者自报有健康问题(症状)比例,但具有更高的医院门诊就诊和急诊就诊比例。结论医疗保健生态学模型及其研究方法在过去20年间不断演进,仍然是帮助研究者和政策制定者了解医疗保健需求和医疗资源供需关系的重要工具。目前,中国对医疗保健生态学框架的应用程度不高,未来可更多地运用该模型反映卫生服务不平等和健康需求未被满足情况,并可开展群医学等领域的研究,为提高我国人群健康资源合理分配提供证据基础。

叙事医学在基层医疗中的实践:基于全科医生视角

全科医学提供的初级卫生保健是实现全民健康的重要保障。随着新医改的不断深入,我国基层医疗机构的数量、全科医生的数量及门诊人次数均较十年前大幅提升。全科医生作为全科医学的实施主体,在以患者为中心、同时关注患者的心理和社会因素方面与叙事医学理念不谋而合,叙事医学是由具有叙事能力的临床工作者所实践的医学,目前在我国存在理论强、实践弱的情况。本文在全科医生视角下,以平行病历的形式展现叙事医学在基层医疗中的实践对全科医生的积极影响。

社区嵌入式中医药特色医养结合服务绩效评价及障碍因子诊断研究

背景在“全面推进健康中国建设”和“积极应对人口老龄化国家战略”背景下,科学评价社区嵌入式中医药特色医养结合服务绩效是提升医养结合服务质量的关键。目的评价社区嵌入式中医药特色医养结合服务绩效并分析其主要障碍因子,为政府部门制定相关政策及开展社区嵌入式中医药特色医养结合服务绩效评价提供现实依据。方法于2022年11月,将构建的社区嵌入式中医药特色医养结合服务绩效评价指标体系转化为机构基本情况、工作人员满意度和老年人满意度三份调查问卷;于2022年11月—2023年1月,采用问卷调查法,深入10家样本机构收集机构基本数据、工作人员和老年人满意度数据;于2023年2—3月,使用TOPSIS法对社区嵌入式中医药特色医养结合服务绩效进行评价,并利用障碍度模型分析服务绩效的主要障碍因子。结果10家机构的嵌入性总体、结构嵌入、关系嵌入Cn值和嵌入绩效Cn值的排序一致,7家机构的认知嵌入Cn值和嵌入绩效Cn值排序一致,并且与各机构服务绩效的Cn值排序保持一致。社区嵌入式中医药特色医养结合服务绩效的主要障碍因子分别是C33(中医养生保健指导服务人次)、C44(老年人满意度)、C8(机构与合作伙伴坚持合作共赢)、C37(中医非药物疗法康复护理人次占比)、C39(服务的老年人数量)。结论社区嵌入式中医药特色医养结合的嵌入性、结构嵌入、关系嵌入对其嵌入绩效均有正向影响,认知嵌入对嵌入绩效基本有正向影响。政府部门应明确职能定位,强化政策支持,健全评价体系,注重动态评价,引导和促进社区嵌入式中医药特色医养结合高质量发展;机构应通过加强与合作伙伴的结构嵌入、关系嵌入和认知嵌入,从而不断提升其服务绩效,满足居家社区老年人多样化、多层次的健康养老服务需求,同时要把握好嵌入的度,以免产生嵌入性的负效应。

基于灰色系统理论GM(1,1)模型的全国异地就医发展趋势预测研究

目的分析GM(1,1)模型在我国异地就医领域中应用的可行性,并预测我国异地就医未来发展变化趋势,以期为医疗保障的政策制定与规划决策提供借鉴和参考。方法基于灰色系统理论GM(1,1)模型,对2023年—2030年我国异地就医人次和医疗费用变化趋势进行定量预测分析。结果异地就医人次2023年—2030年预测结果分别是11605.476万、12306.701万、13029.631万、13774.936万、14543.310万、15335.467万、16152.142万、16994.094万人次,其模型平均相对误差为6.103%;而异地就医医疗费用2023年—2030年预测结果分别是5402.736亿、5769.652亿、6149.246亿、6541.956亿、6948.235亿、7368.554亿、7803.395亿、8253.262亿元,其模型平均相对误差为4.385%。结论运用GM(1,1)模型对我国异地就医未来发展变化趋势进行预测分析是可行的,且预测精度等级优秀,预测值与实际值走势一致,模型拟合度较高,符合历史发展趋势,具有较为科学的预测效果。同时,从异地就医的风险管理、基金监管和疾病预防3个方面提出相应的对策建议,以促进异地就医健康良性发展。

初级卫生保健人员与专科医务人员在提供整合服务中的协作模式及效果:概况性评价

背景应对当前健康挑战需要为患者提供整合和连续性服务,初级卫生保健人员与全科医生外其他专科医务人员协作是最常见的实现途径,不同学科人员之间协作的模式及效果直接影响整合服务的提供质量,并对患者的健康结局改善至关重要。目的采用概况性评价的方法,对初级卫生保健人员与专科医务人员协作模式相关研究特征、协作模式内容、作者报告的协作模式效果进行系统梳理。方法于2022-09-03,系统检索PubMed、EmBase、Web of Science、中国知网、万方数据知识服务平台中与初级卫生保健人员和专科医务人员协作相关的文献,检索时限设定为建库至检索当日。提取纳入文献的基本特征、协作模式特征及效果。基于Mulave齿轮模型对团队协作模式进行元素分解,结合内容分析法对文献中的协作模式内容进行整合和展示。结果最终纳入与主题相关的文献420篇,其中214篇(51.0%)的研究目的为评价协作模式效果,但仅82篇(19.5%)能够提取出具体的协作方式内容。提取有限的协作模式细节信息发现,初级卫生保健人员和专科医务人员协作模式的突出特点是共同工作方式明确且正规、协作服务内容有循证指南/规范支持、在两类人员协作中有信息系统和专职协调人员的支持。82篇文献中,54篇(65.9%)文献报告了明确的效果指标,其中90.7%(49/54)的结论为协作对服务提供过程、服务利用和健康结果相关指标的改善有影响,但较高比例(90.7%,49/54)的研究报告正面效果不能排除发表偏倚的存在。结论整合型服务使用初级卫生保健人员和专科医务人员协作模式时,需要确保两类人员合作方式、工作内容的明确化,同时注重信息和协调人员的支持作用;卫生体系与政策相关干预研究应重视对干预设计细节和执行过程的描述,未来有必要对该主题研究开展方法学质量评价和Meta分析。

医防协同的国际经验与启示

目的:创新医防协同机制,为建设中国特色医防融合体系提供部分借鉴。方法:采用文献研究、政策对比、国际比较等方法分析典型国家医防融合模式与经验,并进行具体分析。结果:与部分发达国家相比,我国医防协同机制不完善,医防脱节问题突出,缺乏有效的信息共享与交流机制,人才和科学技术短缺,资源配置不平衡,难以完成连续、综合的健康服务。结论:推进医防协同机制,要统筹医保基金和公卫资金使用、创新医防融合服务、完善以价值为导向的医保支付政策、发挥医保在推动分级诊疗中的促进作用等。

基于SLICE模型的东台“三医”协同发展和治理实践分析

医疗、医保、医药协同发展和治理是实现卫生健康事业高质量发展和深化医药卫生体制改革的关键。剖析总结了江苏省东台市医疗、医保、医药协同发展和治理改革在战略设计(导航仪)、组织领导(引擎机)、资源统合(燃料箱)、协同工具(润滑剂)和评估反馈(晴雨表)全闭环方面的经验举措,提炼为“三医”协同发展和治理的SLICE模型,并提出在坚持以改革创新激发“三医”协同发展和治理活力的基础上,充分发挥各级党委、政府的主导作用,建立“三医”协同发展和治理跨部门议事协调机制,吸纳多元主体参与协同治理并强化协同治理措施的系统性,以确保“三医”协同发展和治理改革行稳致远。

社会医学视角下社区养老卫生服务保障体系的构建与优化研究

基于社会医学视角了解社区养老卫生服务现状,随机对曾在陕西省西安市碑林区社区卫生服务中心就诊的老年人进行问卷调查。结果表明,整体上,社区养老卫生服务质量处于中等偏上水平,医疗设施维度和养老环境维度相对薄弱,是受访老年人认为最需要优化的两个方面。由相关性分析可知,受访老年人的满意度与社区养老卫生服务的便捷性、服务态度、服务公平性、医疗设施情况及养老环境显著相关(P<0.05)。需改善社区养老卫生服务的医疗设施条件,优化服务环境,强化服务的便捷性,提高服务水平,定期对其服务质量进行评估和改进,有效促进医养结合养老服务的发展,才能使社区养老服务体系更加完备和健全,从而更好地满足老年人多样化的养老需求。

积极老龄化战略下体医养融合发展研究

推动体医养融合发展是提升老年人体质健康水平、贯彻落实“积极老龄化”战略的重要途径。运用文献资料法,对体医养融合发展的内涵特征、现实困境与推进思路进行研究。研究认为:体医养融合发展是通过有效整合体育、医疗、养老等公共服务资源,为老年群体提供医疗干预和非医疗干预相结合的养老服务新模式,呈现出融合理念科学化、服务内容综合化、保障对象细分化、参与主体多元化、组织管理协同化五大特征。并从制定支持政策、加大要素供给、协调组织利益、引导供需适配、完善法律规范五个方面来破解当前体医养融合发展中的融合机制难以形成、融合动力难以激发、合作关系难以维持、服务质量难以提升和保障体系难以构建等现实困境。

DRGs付费制度对医院绩效管理的影响及对策研究

在我国医疗改革的大背景下,基于疾病诊断相关分组(diagnosis related groups,DRGs)付费制度的推广与实施为医疗行业带来了新的挑战与机遇。这种付费方式不仅改变了医院传统的收入模式,还对医院的绩效管理产生了深远的影响。文章旨在深入探讨DRGs付费制度对医院绩效管理各个方面的影响,包括医院收入结构、医疗质量提升、医疗资源的有效利用以及医疗成本控制等。经过全面而系统的分析,阐明了DRGs付费制度对医院绩效管理所带来的多重挑战。这些挑战不仅涵盖了医院收入结构的调整、医疗服务质量的提升,还涉及医疗资源的有效利用以及医疗成本的控制等方面,对医院的运营和管理提出了更高的要求。针对这些问题,文章提出了一系列对策建议,旨在帮助医院在DRGs付费制度下优化绩效管理体系,实现科学、合理的绩效管理,从而提高医院的可持续发展能力。

公立医院高质量发展背景下的县域医共体建设

在公立医院高质量发展的脉络下,本研究以深入调研的方式探讨了县域医共体建设的做法、成效、经验问题思考及建议。在做法方面,通过推进“1+8”紧密型医共体建设,详细分析了工作目标、合作内容和双方权利的明确定义,以及在实践中的具体实施过程。成效方面,通过数据支持,凸显了医疗集团全面推进、一体化服务模式平台搭建、医共体内双向转诊渠道畅通等取得的显著成果。在经验问题思考方面,深刻总结了建设紧密型医共体降低“门住比”、提高“病例组合指数值”和提升“满意度”等方面的关键举措。最后,基于实证研究,提出了全面融合医共体建设与公立医院高质量发展的建议,加速信息平台互联互通、完善人事、薪酬考核制度等,为未来工作提供实质性的指导方向。

新晃侗苗医药康养资源发展路径研究

以新晃侗苗医药为研究对象,从民族医学的视角,探讨了“康养”的内涵和侗苗医药康养资源的分类、现状、问题和发展路径。康养是从健康、养生和养老3个维度对生命的长度、丰度和自由度三位一体的拓展,而民族医药富含“康养”元素。新晃侗苗医药康养资源包括药材、食材、其他自然资源、医疗和人文活动5大类,具有丰富的物质和非物质价值。新晃侗苗医药康养资源的开发利用已取得一定成效,但仍存在缺乏系统规划和开发、资源整合力度不够、产品科技创新能力不足、服务体系尚未完善、专门项目和人才支撑不够等问题。提出了加强顶层设计、推进资源整合、深化创新合作、扩大国际交流4个方面的发展路径,旨在为新晃侗苗医药康养资源的可持续发展提供参考和借鉴。