中美社区卫生服务机构法人治理结构比较研究

美国以社区卫生服务中心董事会为核心的法人治理结构,其在构建基础和背景、社区居民的参与程度、组织运行有效性的保障机制、举办主体的类型等方面与我国的社区卫生服务机构的治理结构存在明显的不同.我国应明确社区卫生服务机构法人治理结构的具体标准,让社区居民参与到社区卫生服务机构的决策与监督程序中,协调举办主体与社区之间的关系.     

中外老年人口社区卫生服务场所与内容比较研究

严峻的人口老龄化趋势带来了庞大的老年人口卫生服务需求,社区卫生服务成为满足这一需求的有效途径.很多较早进入老龄化社会的发达国家比我国拥有更成熟的老年人口社区卫生服务经验和体制.比较了中国和发达国家的老年人口社区卫生服务场所与内容,分析存在的差异,总结发达国家模式对我国的有益启示.     

贵州省城市社区卫生服务现状调查与分析

动态调查城市社区卫生服务的发展、存在的主要问题,并对社区卫生服务的发展提出对策和建议.自查和典型现场调查相结合.调查分析发现,目前社区卫生服务运作现状较好,国家在社区卫生方面的既定目标已基本达到;但仍存在社区卫生服务管理体制不顺;全科医学人才匮乏等问题.应继续加强领导,改革体制,引入竞争,积极创新,完善和深化服务,保证社区卫生服务的质量,使其健康发展.     

政策网络视角下社区卫生服务政策的网络浅析

社区卫生服务政策于1997年提出经过20余年的沉浮,在世纪转换中日臻完善.尝试以政策网络的分析途径,探究我国的社区卫生服务政策的制定和执行过程,并分析政策过程中各参与行动者的互动网络关系.据此找出政策发展的线索和剖析政策实施过程中存在的问题,并以此作为中国社区卫生服务政策以及公共政策过程科学化、民主化的参考,为将来的相关政策制定提供参考.     

社区卫生服务的"管理模式"与"治理模式"比较

依据社区卫生服务的提供方与消费方之间的权力关系,社区卫生服务模式可以划分为管理模式和治理模式.在管理模式中,社区卫生服务提供方与消费方之间是建立在行政和技术权威基础上的管理与被管理关系.在治理模式中,社区卫生服务的提供方与消费方则是建立在沟通基础上的合作关系.我国社区卫生服务模式的发展趋势是从管理向治理的转变.     

城市社区卫生服务管理立法的迫切性与可行性

政策的因应管理与法律的常态管理上的差异性,构成了我国城市社区卫生服务管理以政策为主法律为辅、既协调又矛盾的基本政策法律生态.顺应城市社区卫生服务的趋势和要求,立法管理社区卫生服务工作是十分必要和紧迫的任务.提出了推进城市社区卫生服务政策法律化的可行性措施.     

贵州省社区卫生服务机构准入抽查报告

深入了解我省社区卫生服务发展中存在的问题,随机抽样,现场调查.调查分析发现,社区卫生工作在我省呈现出蓬勃发展的趋势,但也暴露出了许多新的问题.应继续加强人才队伍建设,加强对社区卫生服务机构的监管,依法严格社区卫生服务机构、从业人员和技术的准入管理,制定细化的技术规范、操作规程,建立系统的考核标准、评价体系.     

美国社区卫生服务运行机制和管理模式研究

美国的卫生服务系统由社区卫生服务和医院服务两大部分组成.通过从组织形式、筹资机制、人力资源、动力与约束机制以及管理几个方面,对美国社区卫生服务的运行机制与管理模式进行分析,以期对我国社区卫生的发展有所借鉴与帮助.     

贵州省城市社区卫生服务现状调查与分析

动态调查城市社区卫生服务的发展、存在的主要问题,并对社区卫生服务的发展提出对策和建议。自查和典型现场调查相结合。调查分析发现,目前社区卫生服务运作现状较好,国家在社区卫生方面的既定目标已基本达到;但仍存在社区卫生服务管理体制不顺;全科医学人才匮乏等问题。应继续加强领导,改革体制,引入竞争,积极创新,完善和深化服务,保证社区卫生服务的质量,使其健康发展。     

在社区卫生服务中引入第三方介入机制的探索

社区卫生服务是我国卫生体系的重要组成部分。从目前社区卫生服务中公共卫生服务发展缓慢、监督管理体制不健全等问题入手,通过借鉴国外适宜经验,提出在社区卫生服务中引入第三方机制的设想,以此推动社区卫生服务的可持续发展。     

Intraoperative conversion to open technique: is informed consent implied?

This case raises issues regarding the anesthesia and surgical components of preoperative informed consent and the differing views of anesthesiologists and surgeons with regards to informed consent, in the context of conversion to open surgery from a minimally invasive approach.     

达芬奇手术机器人系统在普通外科的应用

20世纪80年代腹腔镜的出现使微创技术的发展取得了长足的进步,在此基础上,手术机器人的研发和应用开启了微创外科新纪元。本文通过达芬奇手术机器人系统在普通外科各类手术中的具体运用,分析了手术机器人对比传统腔镜技术的技术优势,及当前临床应用的瓶颈,并对高新技术的发展进行了点滴思考。     

腹腔镜与开腹肝包虫内囊摘除术的临床对照研究

对腹腔镜和开腹肝包虫内囊摘除术的治疗效果进行比较。选择腹腔镜肝包虫内囊摘除术病例26例及行开腹肝包虫内囊摘除术病例50例,比较其手术时间、术中出血量、胃肠功能恢复时间、术后禁食时间、镇痛药物使用例数、镇痛药物使用时间、并发症发生率及术后住院时间的比较。腹腔镜和开腹组均无手术死亡病例;腹腔镜组术中出血量明显少于开腹组;术后胃肠功能恢复时间、术后禁食时间、镇痛药使用例数及时间、住院天数显著短于开腹组;两组并发症发生率差异无统计学意义。腹腔镜下肝包虫内囊摘除术可以达到与开腹肝包虫内囊摘除术同样的效果,且手术创伤小,恢复快。     

丁文江与中医——对张起钧与伊广谦关于丁文江之死两文的批评

1丁文江其人丁文江(1887-1936),字在君,江苏泰兴人。1902年,16岁东渡日本,过“谈革命,写文章”的生活。1904年转赴英国,先在东部一个斯堡尔丁镇的中学就读二年。1906年考入剑桥大学,由于财力不济,上了半年便赴欧洲大陆游历。1907年夏去英国格拉斯哥,在一所工科学院(Technical College)选课一年。翌年报考伦敦大学医科,应试未能遂愿,于是改入格拉斯哥大学,主修动物学,副科为地质学,最后一年又将地质学列入主科,地理学为副科。1911年从该校“动物学和地质学双科毕业”,4月回国[1]。1913年,丁文江就任民国政府工商部矿政司地质科科长。次年,北…     

A hidden markov model-based analysis framework using eye-tracking data to characterise re-orientation strategies in minimally invasive surgery

Natural Orifice Translumenal Endoscopic Surgery (NOTES) represents a new paradigm in minimally invasive surgery whereby an operator uses a flexible instrument to navigate within an anatomical space. The flexible instrument is introduced via a natural body orifice such as the mouth to perform an operative intervention controlled by the surgeon without making incisions in the anterior abdominal wall. It differs from laparoscopic (traditional keyhole) surgery in two main ways: (1) the instruments used in NOTES are not rigid as in laparoscopic surgery and not specifically designed for this application; and (2) there are no incisions in the anterior abdominal wall. Disorientation during NOTES is a significant problem because as in laparoscopic surgery the operator typically uses a 2D camera-monitor interface for visualisation by the camera at the site of the operation. Furthermore, the positional cue offered by the external component (outside the body) of the camera is absent, and camera navigation is more cumbersome. When the operator is disorientated, it is important to be able to re-orientate quickly to minimise potential surgical errors. It is hypothesised that when surgeons become disorientated, there exist discrete patterns in psychophysical behaviour which are associated with effective re-orientation, and that these patterns are recognisable. In this study, we examine visual re-orientation behaviour in 18 subjects using eye-tracker data in a model comprised of selective image manipulation of everyday objects in a box trainer. We characterise effective behaviour using a fixation sequence similarity-based hidden Markov model. We show that the output of this algorithm is reliable in differentiating visual behavioural sequences, and that there are specific behavioural patterns and strategies associated with successful re-orientation in this model. Good re-orientation strategy appears to rely on identification and focus on a central object within the scene and judging position of its surrounding peripheral objects, suggesting integration of both geometric and feature information in a systematic way. Using selective, inconsistent feature cues for re-orientation were associated with less effective performance.     

浅谈妇外科医生手术操作的四个层次

手术是处理妇科疾病的主要手段之一。本文从作者的经历和感触出发,就妇外科医师的成长过程中的共性规律进行总结。对于住院医师,熟悉解剖结构、练习基本操作是主要目标;对于主治医师,归纳手术套路、学会独立操作是主要任务;对于主任医师,承担常规工作的同时,条件和能力许可应有所创新。只有将手术从工作变为创作,将技术升华为艺术时,才能完成从“手术匠”到“大师”的飞跃。     

Mental rotation: cross-task training and generalization

It is well established that performance on standard mental rotation tasks improves with training (Peters et al., 1995), but thus far there is little consensus regarding the degree of transfer to other tasks which also involve mental rotation. In Experiment 1, we assessed the effect of mental rotation training on participants' Mental Rotation Test (MRT) scores. Twenty-eight participants were randomly assigned to one of three groups: a "One-Day Training," "Spaced Training," or "No Training" group. Participants who received training achieved higher scores on the MRT, an advantage that was still evident after 1 week. Distribution of training did not affect performance. Experiment 2 assessed generalization of mental rotation training to a more complex mental rotation task, laparoscopic surgery. Laparoscopic surgical skills were assessed using Fundamentals of Laparoscopic Surgery (FLS) tasks. Thirty-four participants were randomly assigned to a "Full Mental Rotation Training, MRT and FLS," "MRT and FLS," or "FLS-only" group. MRT results from Experiment 1 were replicated and mental rotation training was found to elicit higher scores on the MRT. Further, mental rotation training was found to generalize to certain laparoscopic surgical tasks. Participants who obtained mental rotation training performed significantly better on mental-rotation dependent surgical tasks than participants who did not receive training. Therefore, surgical training programs can use simple computer or paper-based mental rotation training instead of more expensive materials to enhance certain aspects of surgical performance of trainees.     

Learning a spatial skill for surgery: how the contributions of abilities change with practice

We examined changes in performance as people learned to use an angled laparoscope, a challenging spatial skill that must be mastered by surgeons who perform minimally invasive techniques. In Experiment 1, novices took tests of spatial and general reasoning ability, and then learned to operate an angled laparoscope, simulated in a virtual environment, over 12 learning sessions. Initial performance showed considerable variability among learners, with performance related to general and spatial abilities. As learning progressed, interindividual variability diminished and all learners attained proficiency; the correlation with general ability diminished but the correlation with spatial ability remained significant. In Experiment 2, performance by highly experienced surgeons on the simulation was excellent from the first session, confirming its ecological validity. The findings contribute to theories of skill acquisition. They also have practical implications for the selection of surgeons and for the potential use of virtual environments in surgical training. Copyright © 2006 John Wiley & Sons, Ltd.     

腹腔镜在结直肠肿瘤手术中应用的回顾与思考

以腹腔镜为代表的微创外科技术迅速发展并取得了良好的临床效果。腹腔镜手术治疗结直肠癌存在较大争议,全盘否定或盲目应用都会影响腹部外科的发展。腹腔镜结直肠癌切除术都有其适应证并且对医生提出了更高的技术要求。随着腹腔镜技术的不断发展和完善,腹腔镜在结直肠癌手术的应用有广阔的发展空间。     

A multi-modal approach to cognitive training and assistance in minimally invasive surgery

Minimally-invasive surgery (MIS) offers many benefits to patients, but is considerably more difficult to learn and perform than is open surgery. One main reason for the observed difficulty is attributable to the visuo-spatial challenges that arise in MIS, taxing the surgeons’ cognitive skills. In this contribution, we present a new approach that combines training and assistance as well as the visual and the auditory modality to help surgeons to overcome these challenges. To achieve this, our approach assumes two main components: An adaptive, individualized training component as well as a component that conveys spatial information through sound. The training component (a) specifically targets the visuo-spatial processes crucial for successful MIS performance and (b) trains surgeons in the use of the sound component. The second component is an auditory display based on a psychoacoustic sonification, which reduces and avoids some of the commonly experienced MIS challenges. Implementations of both components are described and their integration is discussed. Our approach and both of its components go beyond the current state of the art in important ways. The training component has been explicitly designed to target MIS-specific visuo-spatial skills and to allow for adaptive testing, promoting individualized learning. The auditory display is conveying spatial information in 3-D space. Our approach is the first that encompasses both training for improved mastery and reduction of cognitive challenges in MIS. This promises better tailoring of surgical skills and assistance to the needs and the capabilities of the surgeons and, thus, ultimately, increased patient safety and health.