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ABSTRACT BACKGROUND: In Latin America, liver cancer is one of the top causes of cancer mortality. It is the fifth most common cause of death among malignant tumors in Mexico and is the leading cause in Hidalgo State (43.8% of the population living in poverty). OBJECTIVE: To conduct a correlational analysis on the main risk factors for liver cancer in Hidalgo State, Mexico, including municipal disaggregation and comparison with the national level. DESIGN AND SETTING: Cross-sectional, correlational, descriptive and comparative epidemiological study using Mexican governmental databases covering 1990-2019. METHODS: A comprehensive review of the databases of the General Directorate of Health Information (DGIS) was performed to analyze official death figures, hospital discharges and national and municipal population projections, using specific search criteria defined in the Global Burden of Disease classification, based on the risk factors for liver cancer. RESULTS: Liver cancer rates showed an evident rise in Hidalgo (183%), moving from 21st place in Mexico in 1990 to 9th place in 2019. This increase was correlated with alcoholism. An increasing trend for liver cancer deaths, of 133.89%, is projected for 2030. Females and the population over 60 years of age are more affected. There are some critical regions with liver cancer death rates twice the national rate or more. CONCLUSION: Targeted effective public health strategies should be structured by identifying, characterizing and regionalizing critical marginalized municipalities that are vulnerable to alcoholism and other risk factors for liver cancer. This approach may be helpful for other states in Mexico or similar countries.
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The constrution of national regional medical centers has been included in the 14th Five-Year Plan. As a major project to build a high-quality and efficient medical health service system in China, it is imperative to expand such high quality medical resources and balance their regional distribution. The authors analyzed the dual resources integration attributes of regional medical centers—horizontal expansion and vertical extension—from the perspective of medical resources integration, and by means of literature methodology and content analysis methods. With both two work paths and progresses led by the National Development and Reform Commission and the National Health Care Commission, the authors identified setbacks in the construction of such medical centers in terms of building a synergy system, optimizing the cooperation modes, and enhancing the awareness of the entity bodies. On such basis, the authors suggested that government departments should hold on to the leadership in general, while in the construction process, output hospitals and input hospitals should respectively take their entity responsibilities in both operation management and cooperation.
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China national medical centers and national regional medical centers are the key entities to expand the availability of quality medical resources and ensure they are better distributed among regions. It is of great significance for the centers′ high-quality development to understand the key issues in the construction and progression of centers by evaluating the performance of their function fulfillment. The evaluation framework of this study was based on the " structure-process-outcome" model. The study was divided into three stages, including centers′ self-evaluation, data reporting, and on-site investigation and evaluation. The team conducted the evaluation on 15 entity hospitals supporting 6 national medical centers and 5 national regional medical centers that had been approved by October 2020. As the results showed, the funding and policy support for these centers from governments at all levels were increased, the internal and external management mechanism of the centers were preliminarily set up, the functions of the centers were executed properly, and the " radiation effect" of the centers was in place gradually. The key problems hindering the fulfillment of functions concern the mechanisms that were not sound and need to be further refined, which included the field of financial investment and policy guarantee for the entity hospitals, internal and external management of centers, introduction and cultivaton of the talented, and the innovation and transformation of scientific achievements which facilitates breakthroughs in core technologies. To promote the efficient implementation of functional tasks of the centers, the authors proposed four suggestions. First, the " commission and province co-construction" mechanism should be further improved to augment investment and policy guarantee from the government. Second, the internal organization and management mechanism of each centers should be optimized. Third, the reform and innovation in the training and management system of the talented medical personnel should be accelerated. Last, the health needs oriented mechanism for scientific research innovation and achievements transformation should be established.
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The authors took the management practice of " one hospital with multiple districts" in Children′s Hospital Affiliated of Zhengzhou University as the research object, analyzed the main problems and challenges faced by the multi-district hospital management under the new pattern of national regional medical center. Through coordinating the hospital′s strategic planning and the development of discipline layout, building an integrated management system, improving the level of homogeneous service and other key countermeasures, the hospital has significantly improved its management efficiency and operation efficiency, and the medical service capacity of each district has developed in a balanced way. It could give full play to the pilot value for the construction of national regional medical center, hoping to provide reference for hospital administrators.
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Medical science and technology innovation activities should meet the latest requirements of Opinions Issued to Strengthen Governance over Ethics in Science and Technology. Thus, attention should paid on the challenges facing medical science and technology ethics governance. This study discussed the necessity, responsibilities and operational guarantee elements of establishing an independent and professional regional medical science and technology ethics center. On the one hand, promote the innovation and development of medical science and technology and ensure the compliance with ethical norms, On the other hand, the government needs to carry out top-level design and build a science and technology ethics system with equal emphasis on supervision and technical services.
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Medical alliances constitute a vertical integration of regional medical resources, and an effective means to promote the tiered medical services. As one of the largest tertiary hospitals in Xinjiang, a hospital has gradually built a " 1+ 6+ N" medical alliance cooperative system fitting the geographical characteristics of Xinjiang since 2018. The system was based on the hospital, made county-level medical institutions as the hub, primary medical and health units as the focus, and telemedicine as the bridge. It turned a telemedicine service platform as the medium, integrating such service segments, as offline practices of experts like clinical teaching, ward rounds, surgical guidance and discipline construction, and as online practices like remote consultation, remote diagnosis, remote education, and remote new technology training among others. Then these segments were integrated into such cooperative models as the remote cooperative medical alliances, specialist-cooperative medical alliances, inter-department co-construction medical alliances, precision-based assistance medical alliances, urban medical group type of medical alliances, and " alliance-consortium" integrated development medical alliances. These practices enabled the expansion and primary support of high-quality medical resources. By June 2022, the hospital had established cooperation via medical alliances with 285 medical institutions at all levels. The implementation of this cooperation mechanism has effectively improved the medical service capacity, diagnosis and treatment capacity of difficult and critical diseases, diagnosis and treatment homogeneity and remote diagnosis capacity in the region, as well as the smooth and orderly progress of the tiered medical services and two-way referrals within a medical alliance.
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As guided by the policy of building national regional medical centers, it is imperative to advance the construction of the national regional medical centers for mental health to achieve the sustainable and balanced development of the mental health cause of the country. The authors summarized the current status of national regional medical centers, and analyzed challenges faced in management and operation mode, government investment and compensation mechanism, expansion of high-quality psychiatric medical resources, as well as research and innovation of mental diseases of these centers. On such basis, the authors put forward corresponding countermeasures and suggestions for the next stage of development.
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Objective:To explore the integration path of medical resources in regional medical consortium, find out the problems affecting the process of integration, and put forward relevant suggestions.Methods:Methods According to the purposive sampling and combined with grounded theoretical research methods, semi-structured interviews were conducted with 73 government officials, heads and backbones of medical institutions in different regions of a city from August to November 2019. The data obtained from semi-structured interviews were analyzed by using grounded theory, and the path framework of medical resource integration in regional medical consortium was constructed through open coding, spindle coding and selective coding.Results:Four key links of medical resource integration in the regional medical alliance were sorted out, namely, integration prerequisites, integration strategies, support conditions, and integration methods, which together constituted the main axis of the theoretical framework. In addition, integration methods were affected by integration prerequisites, integration strategies and support conditions. The four factors and integration willingness served as influencing factors to exert impact on the integration tendency.Conclusions:The integration of medical resources in the medical alliance is a systematic project, which emphasizes the organic and overall governance of each key link, and the interaction between various elements will affect the final effect of medical resource integration.
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Objective:To evaluate the operation effect of remote imaging network platform in a regional medical center.Methods:The workload data of remote imaging network in a regional medical center from 2017 to 2019 were analyzed.Results:137 medical institutions were connected to the remote imaging diagnosis network platform, and the number of imaging examinations in grass-roots medical institutions increased significantly. Part of the imaging examination in the superior medical center was gradually diverted to the subordinate medical institutions. However, limited by the ability of image diagnosis, grass-roots medical institutions relied on remote diagnosis of higher-level hospitals.Conclusions:Remote image diagnosis network is an important platform support for Internet plus medical health service, which can rapidly and effectively enhance the ability and level of imaging diagnosis in primary medical institutions.
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In Japan, the revised Immunization Law was enacted in December 2020, and municipalities have promoted a free vaccination project against COVID-19 with the aid of upper prefectural governments under the management of the Minister of Health, Labour and Welfare. To support prompt vaccination for residents over 65 years old, Kawachinagano City Pharmaceutical Association supplied a Prevaccination Screening Questionnaire to all pharmacies in Kawachinagano in cooperation with the local governments and medical associations. We conducted a questionnaire survey on the handling of questionnaire forms at pharmacies and the content of consultation by residents regarding vaccination, and investigated the significance of community pharmacy in regional medical activities by analyzing the responses. By the end of May 2021, the number of questionnaire forms provided to residents from pharmacies of the Kawachinagano City Pharmaceutical Association was approximately 3,000, which was attributable to the efforts of each pharmacist in almost all pharmacies to individually offer sincere consultation services to residents. In addition, residents were markedly concerned about pharmacotherapy, with the frequency of consultation by residents being higher about “treatment details, including drug use” and “adverse reactions of the vaccine.” Our study revealed that community pharmacies of the Kawachinagano City Pharmaceutical Association largely contributed to the smooth implementation of vaccination by performing routine work originally dealt to the local governments and medical institutions, which strongly suggests that community pharmacies fulfill their mission corresponding to social needs even during a pandemic.
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@#Objective To explore the efficacy of artificial intelligence (AI) detection on pulmonary nodule compared with multidisciplinary team (MDT) in regional medical center. Methods We retrospectively analyzed the clinical data of 102 patients with lung nodules in the Xiamen Fifth Hospital from April to December 2020. There were 57 males and 45 females at age of 36-90 (48.8±11.6) years. The preoperative chest CT was imported into AI system to record the detected lung nodules. The detection rate of pulmonary nodules by AI system was calculated, and the sensitivity, specificity of AI in the different diagnosis of benign and malignant pulmonary was calculated and compared with manual film reading by MDT. Results A total of 322 nodules were detected by AI software system, and 305 nodules were manually detected by physicians (P<0.05). Among them, 113 pulmonary nodules were diagnosed by pathologist. Thirty-eight of 40 lung cancer nodules were AI high-risk nodules, the sensitivity was 95.0%, and 25 of 73 benign nodules were AI high-risk nodules, the specificity was 65.8%. Lung cancer nodules were correctly diagnosed by MDT, but benign nodules were still considered as lung cancer at the first diagnosis in 10 patients. Conclusion AI assisted diagnosis system has strong performance in the detection of pulmonary nodules, but it can not content itself with clinical needs in the differentiation of benign and malignant pulmonary nodules. The artificial intelligence system can be used as an auxiliary tool for MDT to detect pulmonary nodules in regional medical center.
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Objective: To examine how doctors who work in outpatient clinics in depopulated areas in Hokkaido contribute to the provision of primary care to residents.Methods: The study adopted a qualitative research design. Six doctors, all of whom were men and in charge of medical clinics located in depopulated areas in Hokkaido, participated in a semi-structured interview. The interviews were recorded using a digital voice recorder. The data were transcribed and classified into codes, subcategories, and categories, and analyzed.Results: A qualitative analysis yielded the following five superordinate categories: (1) clinical praxis in accordance with residents’ lifestyles and life stages; (2) innovative care provision based on residents’ conditions; (3) provision of routine care in partnership with other healthcare providers and associated stakeholders; (4) beliefs and feelings of pride associated with working as doctors in clinics in depopulated areas; and (5) difficulties in guaranteeing reliable and continuous operation of clinics in depopulated areas.Conclusion: This study successfully identified the specific contributions of doctors working in outpatient clinics in depopulated areas to primary care, as well as the related challenges that they face. Moving forward, researchers should continue to examine how the issues faced by clinics in depopulated areas can be addressed using regional medical care plans.
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With the progress of the hierarchical medical system, the top-level design for building medical alliances is exhibiting a clearer picture. The Chinese government sets about trying to build a grid-based medical system layout, covering from national, provincial, municipal, county, township, all the way to village level. Based on the analysis of regional grid-based medical systems in the United States, Switzerland, Singapore and Canada, the authors reviewed the development of grid-based health service system in China, and found out key roadblocks for grid-based medical alliances. These problems include the organizational structure, service content, management mechanism, payment system and other aspects, and corresponding countermeasures and suggestions were proposed in the end.
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Introduction: Research was carried out using a mixed method approach in order to evaluate the educational effects of medical students' visit of an elderly home.Methods: Focus group interviews were conducted with 5 medical students and 5 elderlies. All interviewees had experienced the visitation program more than three times. Self-administrative questionnaires were built based on the results of the focus group interview. The questionnaire was then distributed to medical students and elderlies who participated in the program.Results: A total of 84 medical students and 30 elderlies provided informed consent to participate in the study and returned the questionnaire. Nearly 70 percent of the students answered that they had gotten to know about the life of elderly people and sixty percent of the elderlies answered they had experienced some favorable changes after joining the program. While ninety percent of the elderly were satisfied with the program, only half of the students showed positive comments toward it.Discussion: To help all students participate in this program more actively, more organized planning is necessary so that students can have more chances to build communication skills and clarify their own objectives when visiting the elderly.
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Objective Through analyzing and summarizing the experiences and reflections during the construction of regional medical scientific research alliance,to explore the ultimate goal and ideal model of such work.Methods Literature review,as well as working experience summary and analysis.Results The purpose of setting up regional medical scientific research alliance lies in shared regional medical scientific research data information,using the two-way transformation model of laboratory and clinical research to support the medical service of primary health care in local hospitals,at the same time,promoting the construction and development of regional medical alliance.The ideal model is to make good use of the regional clini cal scientific research data sharing platform and related information sharing platform to promote the collaborative development of regional medical scientific research.Conclusions The ultimate goal of collaborative development of scientific research is to establish "an information map of regional scientific research resources",the map can be used for scientific research project cooperation,resource allocation,integration of scientific research forces and training of talent echelon,thereby comprehensively improve the regional research capacity.
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OBJETIVO: Aplicar o modelo lógico ao Programa Mais Médicos e pré-avaliar o programa do Distrito Federal. MÉTODO: Aplicação do modelo lógico ao Programa mais médicos e análise quantitativa de dados do programa do Distrito Federal. Os indicadores foram acompanhados anualmente, para o Brasil e para o Distrito Federal, de 2013 a 2015 e as demais variáveis no período anterior (Janeiro/2011 a Julho/2013) e posterior (Agosto/2013 a Dezembro/2015) à adesão do Distrito Federal ao Programa Mais Médicos. RESULTADOS: Metas, atividades e produtos não foram identificados na construção do modelo lógico. As variáveis e indicadores analisados demonstraram, de forma geral, sugestão de ganhos positivos com a implantação do programa no Distrito Federal. Houve aumento em 32% da cobertura populacional por equipes da atenção básica, aumento do número de médicos e equipes na Estratégia Saúde da Família (p< 0,001), melhora da cobertura de pré-natal e de consultas aos maiores de 60 anos (p<0,001), além de aumento de visitas médicas domiciliares (p<0,005). CONCLUSÃO: Com relação a construção do Programa Mais médicos, faltam aspectos importantes do ponto de vista estrutural de um projeto, porém no Distrito Federal conseguimos observar resultados significativos.
AIM: Apply the logical model to Mais Médicos (More Doctors) program and evaluate the program of the Federal District. METHODS: Application of the logical model to Mais Médicos (More Doctors) Program and quantitative data analysis from the Federal District program. Annual indicators were extracted from Brazilian and Federal District data from 2013 to 2015 and the other variables in the first (January / 2011 to July / 2013) and the second (August / 2013 to December / 2015) periods to the accession of Federal District to the Mais Médicos Program. RESULTS: Goals, activities and products were not detected in the logical model performance. The evaluated variables and indicators suggested, in a general way, positive effects with the implementation of the program in the Federal District. Increasing population covered by basic health care teams (32%), increasing number of doctors and teams in the Family Health Strategy (p<0,001), higher prenatal coverage and consultations among patients over 60-y old (p<0,001) and also higher number of home visits (p<0,005) were detected. CONCLUSION: Concerning the Mais Médicos (More Doctors) Program implementation, important aspects from the main structural project are missing, but significant results were noticed in the Federal District Program.
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Humans , Regional Medical Programs , Physicians Distribution , Program EvaluationABSTRACT
Buscamos analisar a agenda política das principais entidades médicas nacionais brasileiras e suas lutas em torno do Programa Mais Médicos do Ministério da Saúde do Brasil. Trata-se de pesquisa de natureza qualitativa, de nível exploratório e de caráter analítico, baseada em diversas fontes que veicularam posições dessas entidades, de maio de 2010 a dezembro de 2014, e em publicações da imprensa, de junho de 2013 a dezembro de 2014, que foram sistematizadas segundo categorias elaboradas a partir da própria análise. Identificamos que as entidades médicas brasileiras realizaram intensa atuação conjunta, integrando interesses voltados aos setores público e privado. O apogeu se deu entre junho e outubro de 2013, nas mobilizações de resistência ao Programa Mais Médicos. Entretanto, registramos que divergências em torno das lutas contra este Programa fragilizaram as articulações políticas dessas entidades que haviam sido construídas nos últimos anos.
We sought to analyze the political agenda of the main Brazilian national medical entities and their struggles around the More Doctors Program implemented by the Brazilian Ministry of Health. It is a research of qualitative nature, of exploratory level and of analytical character, based on several sources presenting positions of these entities, from May 2010 to December 2014, and in press publications, from June 2013 to December 2014, systematized according to categories elaborated from the analysis itself. We identified that the Brazilian medical entities performed intense joint action integrating interests directed to the public and private sectors. The apogee took place between June and October of 2013, through mobilizations of resistance to the More Doctors Program. However, we note that divergences around the struggles against this Program have weakened the political links of these entities that had been built in recent years.
Nuestro objetivo fue analizar la agenda política de las principales entidades médicas nacionales brasileñas y sus luchas frente al programa Más Médicos del Ministerio de la Salud de Brasil. Se trata de investigación de naturaleza cualitativa, de nivel exploratorio y de carácter analítico con base en diversas fuentes que publicaron posiciones de esas entidades, desde mayo de 2010 a diciembre de 2014 y en publicaciones de la prensa, de junio de 2013 a diciembre de 2104, que han sido sistematizadas según categorías elaboradas a partir del propio análisis. Identificamos que las entidades médicas brasileñas realizaron una intensa actuación conjunta integrando intereses enfocados en los sectores público y privado. El apogeo fue entre junio y octubre de 2013 en las movilizaciones de resistencia al Programa Más Médicos. No obstante, registramos que las divergencias alrededor de las luchas contra este Programa fragilizaron las articulaciones políticas de esas entidades que se habían construido en los últimos años.
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Humans , Physicians/supply & distribution , Societies, Medical/history , Health Consortia , Unified Health System/organization & administration , Brazil , Government Programs/trendsABSTRACT
With the deepening of the national medical and health system reform,it is particularly important to establish the regional medical cooperative system with the large hospital as the core.The Affiliated Hospital of Xuzhou Medical University establishes interactive coordination relation with county-level hospitals through township hospitals in the cooperation model for collectivize operation,trusteeship and technical support,and it has accumulated some practical experience.The paper investigates and contrasts the core hospital and the member hospital development of the before and after the cooperative relationship,and sums up 6 key measures that the core hospital promoted the regional medical cooperative system construction,that is,improving the member hospital grade,strengthening talent development,support technology,specialty developments,hardware support and public project cooperation in order to provide references to promote the development of the regional medical cooperative system.
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Specific to the existing problems of uneven distribution of resources in the medical industry,especially the shortage of grass-root high-quality medical resources,the paper introduces the construction objective,overall architecture and construction contents of regional medical collaboration,and normalizes the medical service process through informationalized technological means,in order to promote standardized construction of the regional medical information system and information interconnection and intercommunication.
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Objective To explore the construction and application of cloud-based healthcare information system (CHIS).Methods The process of CHIS employment and implementation for primary-level medical and healthcare institutions was elaborated by the example of a city after the analysis and comparison of mode difference between traditional and cloud construction.Results CHIS integrated regional medical resources and realized integrated application of medical and public healthcare resources,mobile integration of regional operation and continuous innovation in construction mode,and facilitated uniformed management,high-efficiency running and maintenance as well as business development.Conclusion CHIS contributes to enhancing medical inforrnatization in primary institutions,promoting continuous medical innovation and innovating medical informatization mode.