互联网＋乳腺日间手术的理论设计和关键技术研究

互联网＋临床实践是新型医疗资源管理方式和卫生服务业态。在互联网＋乳腺日间手术项目中,笔者对其理论设计及关键技术进行了系统研究。其中,理论设计包括多学科合作为基础的顶层系统设计、以问题为导向的新型工作模式设计、以患者参与为重点的人性化设计和以医疗规章制度及医学伦理原则为指导的论证设计。为了实现理论设计,形成和完善了7项关键技术,包括：统一语言环境技术、网络整合和拼接技术、病历自动生成技术、针对患者的一站式服务技术、实现患者主动参与的关键技术和网络安全及患者隐私保护技术。通过学科专项问题调研、应用定义、问题分析、服务定位、设计规划、临床体验、修改完善等线路框架的逐步推进,最终实现互联网＋乳腺日间手术临床应用。该模式省时快捷、应用方便、经济高效,患者参与度显著提高和安全性良好,具有明显的示范效应。     

不同医疗服务模式的经济学特征及我国医疗改革模式探讨

文章从经济学角度介绍了不同的医疗服务提供和筹资模式的特点,分析了不同医疗服务供给模式和医疗服务的筹资关系和各自的优缺点。市场化的医疗服务模式是政府通过市场的作用提供医疗服务和进行筹资。全民医疗服务模式的特点是通过国家税收的途径进行筹资而完成全民的医疗覆盖;而混合型筹资模式则以筹资途径的多样性为特点,医疗服务的供给是多种所有制的医疗实体来完成。全文并根据目前的国情,探讨我国医疗服务改革的选择模式。     

辽宁省肿瘤医院医疗联盟基本框架与发展思考

随着医改的深入,特别是卫生部提出“医联体”模式后,大型公立医院集团化的走向,将是公立医院改革的一个重要课题.辽宁省肿瘤医院作为辽宁省癌症中心、辽宁省肿瘤防治办公室的牵头单位,成立了辽宁省肿瘤医院联盟,迈出了专科医院集团化探索的第一步.实行医院集团化的目的是将城市优质医疗资源下沉,规范全省肿瘤诊疗,实现技术优化,扩大优质资源存量,实现各级医院的功能定位,重建基层首诊、分级医疗、双向转诊的医疗秩序,提高百姓技术利用的可及性,降低群众就医费用.在集团化的过程中,要结合实际分步推进,建立起统一的肿瘤防治自律维权体系,并最终向法人治理结构迈进.     

第一届“肿瘤个体化治疗临床应用与进展”征文启事

益善生物是由留学回国科学家团队于2006年创办的生物科技企业,专注于个体化医疗靶标检测产品的研发、生产及推广;是中国个体化医疗产业开拓者和领军企业、国际个体化医学联盟目前唯一中国成员。益善生物拥有入选国家"千人计划"的研发团队、领先的技术平台、现代化的研究实验室和生产服务设施。迄今申报个体化医疗领域的国际国内发明专利140余项。国际首创"肿瘤个体化治疗靶标检测系统方案",在     

国内甲状腺癌专病数据库单中心及多中心建设的探索及初步应用

甲状腺癌是最常见的内分泌系统恶性肿瘤。国内在甲状腺癌诊疗过程中缺乏系统性收集和整理标准化临床数据, 缺乏高级别的诊断准确性、治疗有效性、并发症发生率等相关的临床研究, 因此建立甲状腺癌专病数据库是一条必经之路。甲状腺癌单病种数据库需要保证数据的结构化、完整性、准确性及时效性。单中心甲状腺癌专病数据库的建设是多中心数据库建设的基础。通过基于区块链技术联盟协作开展多中心临床研究, 建立全国首个多中心、一体化、规范化的甲状腺癌专病数据库。多中心甲状腺癌专病数据库的建立难度主要在于数据标准及数据上传格式的统一, 需要有统一的监督管理组织及数据共享合作模式。     

精准医疗—肿瘤诊治的新模式

精准医疗（precision medicine）又称为个性化医疗,是根据个体基因特征、环境以及生活习惯,为病人量身设计出最佳治疗方案,以期达到治疗效果最大化和不良反应最小化的一种定制医疗模式。作为一种全新的医学概念与医疗模式,日益在恶性肿瘤临床治疗中显示出价值。人类基因组计划的完成和测序技术的飞速发展,极大地促进了肿瘤基因组测序研究,发现了大量与肿瘤相关的基因组改变,为肿瘤的个体化精准治疗提供理论和技术支撑。本文主要对精准医疗的概念、实施步骤以及在肿瘤治疗中的应用做一简要的概述。     

记录中国缓和医疗前进的脚步 ——《中国缓和医疗发展蓝皮书2019-2020》面世

每年十月份第二个周六的世界安宁缓和医疗日,世界安宁缓和医疗联盟(WHPCA)都会在活动前数月公布当年活动的主题.2020年世界安宁缓和医疗日的主题是"缓和医疗:我的舒适和照料(PalliativeCare:it'sMyCare,My Comfort)".可见,舒适和照料是安宁缓和医疗的核心.     

儿科内分泌学和糖尿病学欧洲地区的进修计划

自1996年以来,欧洲儿科学专科医师联盟承认了儿科内分泌学和糖尿病的亚专科化,自1999年以后很多欧洲国家均已认可这一亚专科化。 本文中所列计划纲要是由欧洲内分泌学协会与欧洲儿科学理事会合作所拟订编写的,并已经欧洲医学专科医师联盟儿科学组认可,且已在欧洲医学专科医师联盟的内分泌学和糖尿病学组登记。此外,此培训计划经过德国儿科学协会的儿科内分泌学工作联盟、德国内分泌学协会的儿科内分泌学组以及德     

推进肿瘤专科医院多学科综合诊治模式的体会

多学科综合诊治工作团队（MDT）是肿瘤治疗的理想模式。MDT模式有利于优化医疗资源,改善治疗效果,确保医疗安全。辽宁省肿瘤医院通过长期探索实践,逐步建立了覆盖常见恶性肿瘤的14个团队,实现了MDT的日常化运营并持续改进,取得了良好的社会效益。全文对肿瘤专科医院MDT工作的推进条件、推进方法,MDT模式诊疗的工作经验进行分析。     

第四届亚洲放疗联盟学术会议圆满结束

亚洲放射肿瘤联盟(FARO)成立于2014年,是由亚洲国家参与的国际性、专业性、学术性、非营利性社会组织。现共有14个成员国,原有中国、孟加拉国、印度、印度尼西亚、日本、韩国、马来西亚、菲律宾、新加坡、斯里兰卡、泰国、巴基斯坦共12个国家,本次会议通过缅甸及蒙古国成为新成员。FARO旨在加强亚洲地区放射肿瘤学组织的合作交流,自2016年起每年举办1次会议,同时开展相关教育培训、加强研究合作、制订亚洲共识。     

企业识别系统在医院文化建设中的设计与思考

医院文化是一个医院的精神和灵魂,是医院建设的重要组成部分和改革创新的强大动力,更是一个医院软实力的重要象征。全文通过对新疆医科大学附属肿瘤医院文化建设的现状调查、外部环境评估、内部环境分析,探索运用企业识别系统设计医院文化,对其他医院在医院文化建设上有一定的参考价值。     

Multiple cancer site comparison of adjusted survival by hospital of treatment: an East Anglian study

We performed a preliminary investigation into which hospitals would benefit from investment and development, and which should have services restricted, with respect to the implementation of the Calman-Hine strategy of specialist cancer care. A retrospective study approach was used implementing uniform definitions for colon, rectal, breast, melanoma, bladder and ovarian cancers. A total of 14 527 cases registered by the East Anglian cancer registry and diagnosed between 1989 and 1993 were included. The cases were analysed in two age groups (< 75, 75+ years) and two hospital groups: group 1, those treated at hospitals with radiotherapy and oncology departments; group 2, other district general hospitals. Adjusted hazard ratios derived from Cox's proportional hazards model and adjusted conditional survival curves were presented. We found that after adjustment for age, sex and tumour stage at diagnosis, survival up to 5 years after diagnosis was usually worse in group 2 hospitals and significantly so for patients aged < 75 years with breast, ovarian and rectal tumours. Hospital workload produced little significant effect independently from hospital group. Analysing the selected cancer sites using uniform definitions and consistent staging supports the view that the strategy proposed in the Calman-Hine report is likely to be beneficial, but particular priority for change should be given to younger patients with breast, ovarian and rectal tumours.     

Influence of hospital volume on local recurrence and survival in a population sample of rectal cancer patients.

AIMS: To investigate the role of hospital volume and individual hospitals on long term outcomes (local recurrence and survival) of rectal cancer patients. METHODS: One thousand thirty-eight patients with rectal cancer were diagnosed between 1996 and 1998. From these, we analysed 884 patients with a resected invasive primary rectal cancer. Median follow-up was 5.7 years. The impact of hospital volume (<10, 10-30 and >30 rectal cancer patients annually) on local recurrence and survival was examined in a Cox model. Differences between the four largest clinics in the high volume group were also investigated. RESULTS: In the multivariate model predicting survival the following variables were significant: UICC stage, grade, age, local recurrence, and (neo-) adjuvant therapy treatment. In the multivariate model predicting local recurrence UICC stage, tumour localisation, and neoadjuvant therapy treatment were significant variables. Hospital volume was not a significant factor for survival or local recurrence. Within the high volume category one hospital showed significantly worse local recurrence rates than all other hospitals, but no survival difference could be seen between the four largest hospitals of the high volume group. CONCLUSIONS: This analysis of a rectal cancer population found that hospital volume did not determine survival or local recurrence. Detailed clinical data with long term follow-up from cancer registries are vital to demonstrate the quality of routine care.     

Hospital racial composition and the treatment of localized prostate cancer

BACKGROUND:

Racial differences in the treatment of men with localized prostate cancer remain poorly understood. This study examines whether hospital racial composition is associated with the type of treatment black and white men receive.

METHODS:

The authors performed a retrospective cohort study of men in Surveillance, Epidemiology, and End Results‐Medicare diagnosed with localized prostate cancer from 1995 to 2005 linked to hospital and census data. A total of 134,291 men were assigned to the hospital where they received care. Generalized estimating equations were used to determine whether hospital racial composition was associated with the receipt of definitive therapy and type of treatment.

RESULTS:

Black men were less likely to receive radiation and/or prostatectomy compared with white men (55.5% vs 63.7%, P < .001) and, among those who received definitive therapy, were less likely to undergo prostatectomy (27.5% vs 31.9%, P < .001). The percentage of black men who received their care at hospitals with a high proportion of black patients was 48.0%, compared with only 5.2% of white patients who received care in this subset of hospitals. Men were significantly less likely to receive definitive treatment (odds ratio, 0.81; 95% confidence interval, 0.74‐0.90) in hospitals with a high proportion of black patients compared with men seen at hospitals with fewer black patients. The association between hospital racial composition and treatment did not significantly differ by patient race.

CONCLUSIONS:

Hospital racial composition is consistently associated with the care that men receive for localized prostate cancer. Better understanding of the factors that determine where men receive care is an important component in reducing variation in treatment. Cancer 2011;. © 2011 American Cancer Society.     

Hospital volume of percutaneous radiofrequency ablation is closely associated with treatment outcomes for patients with hepatocellular carcinoma

BACKGROUND:

Hospital volume for several major operations is associated with treatment outcomes. In this study, the authors explored the influence of hospital radiofrequency ablation (RFA) volume on the prognosis of patients who received RFA for hepatocellular carcinoma (HCC).

METHODS:

The authors searched for all patients who were diagnosed with stage I or stage II HCC from 2004 to 2006 and who received RFA as first‐line therapy in a population‐based cohort. Overall survival (OS) and liver cancer‐specific survival (CSS) were compared according to hospital volume. A Cox proportional hazards model was used for multivariate analysis.

RESULTS:

In total, 661 patients received first‐line RFA for stage I and II HCC in 28 hospitals. Among these, there were 480 patients (72.6%) in the high‐volume group (those who received RFA at hospitals that treated >10 first‐line patients per year), and there were 181 patients (27.4%) in the low‐volume group (those who received RFA at hospitals that treated ≤10 first‐line patients per year). The sex, age, stage, tumor size, and year of diagnosis for patients in the 2 groups did not differ significantly. Patients in the high‐volume group demonstrated significantly longer OS and CSS than those in the low‐volume group (5‐year OS rate, 58.7% vs 47.2%; P = .001; 5‐year CSS rate, 67.1% vs 57.1%; P = .009). After adjusting for covariates, high‐volume hospitals remained an independent predictor of longer OS (hazard ratio, 0.57; P < .001) and CSS (hazard ratio, 0.57; P = .003).

CONCLUSIONS:

Patients who received first‐line RFA for HCC in high‐volume hospitals demonstrated better survival outcomes. Cancer 2013. © 2012 American Cancer Society.     

Should Soft Tissue Sarcomas be Treated at a Specialist Centre?

Objective. We have investigated whether there is evidence that patients with soft tissue sarcomas do better if treated in a specialist centre compared with district general hospitals.Patients. All patients diagnosed with soft tissue sarcomas who were residents of WMRHA between 1994 and 1996, with minimum follow up of 5 years, excluding head and neck or retroperitoneal tumors.Methods. We reviewed data from the Royal Orthopaedic Hospital Oncology Service (ROHOS) database and the Cancer Intelligence Unit (CIU) Database, with medial record review where necessary. Main outcome measures were local recurrence and overall survival.Results. A total of 260 patients were diagnosed as having STS over the 3-year period (incidence=1.62per 100000 per year): 37% of patients had the majority of treatment at the specialist centre under the care of three surgeons, whilst the other 63% were treated at a total of 38 different hospitals. The rate of local recurrence was 39% at the district general hospitals compared with 19% at the specialist centre despite the fact that tumours treated at the district hospitals were smaller and of lower grade. The most significant factors affecting survival were grade (high versus low) and depth of the tumour. Patients treated at the specialist centre had a small survival advantage after multivariate testing.Conclusion. Soft tissue sarcomas are rare. Centralization of treatment improves local control in all patients and survival in some. Appropriate mechanisms for ensuring that patients with soft tissue sarcomas are seen and treated at specialist centres should be developed.     

Basal cell carcinoma of the vulva

BACKGROUND AND OBJECTIVES: Vulvar basal cell carcinoma (BCC) accounts for 7% of all vulvar cancers at two hospitals in the south of Israel. The purpose of this study was to investigate the clinical findings, treatment and outcome of patients with vulvar BCC treated at these institutions. METHODS: Data from the files of eight patients with vulvar BCC who were managed at two regional hospitals in the south of Israel (Soroka Medical Center, Beer-Sheva and Kaplan Hospital, Rehovot) between January 1961 and December 1997 were evaluated. RESULTS: Mean age at diagnosis was 70.5 years. A history of other primary cancers was encountered in two patients. Prevailing presenting symptoms were vulvar lump, ulcer, itching, and bleeding. The tumor was most often located on the labium major and its mean size was 2.25 cm. Six patients had wide local excision, one had excisional biopsy, and one had hemivulvectomy. Two patients developed local recurrence and were treated by wide local reexcision and hemivulvectomy, respectively. At follow-up, no patient developed regional and/or distant metastases, or died of BCC. CONCLUSIONS: Vulvar BCC is characterized by an indolent behavior with a very low propensity for metastatic spread. The treatment of choice is wide local excision. Because of a substantial risk of local recurrence and high frequency of other primary cancers, close long-term follow-up is essential.     

Outcome following surgery for colorectal cancer: analysis by hospital after adjustment for case-mix and deprivation

Outcome, adjusted for case-mix and deprivation, in 3200 patients undergoing resection for colorectal cancer in 11 hospitals in Central Scotland between 1991 and 1994 was studied. There were significant differences among individual hospitals in the proportion of elderly (P<0.001) and deprived (P<0.0001) patients, the mode (P=0.007) and stage (P<0.0001) at presentation, and the proportion of patients who underwent apparently curative resection (P<0.001). There were no significant differences in postoperative mortality. Cancer-specific survival at 5 years following apparently curative resection varied from 59 to 76%; cancer-specific survival at 2 years following palliative resection varied from 22 to 44%. The corresponding hazard ratios, adjusted for the above prognostic factors, for patients undergoing apparently curative resection varied among hospitals from 0.58 to 1.32; and the ratios for palliative resection varied from 0.73 to 1.26. This study demonstrates that, after adjustment for variations in case-mix and deprivation, significant differences in outcome among hospitals following resection for colorectal cancer persist.     

Disagreement of ICD-10 Codes Between a Local Hospital Information System and a Cancer Registry

Background: In the field of cancer, the ICD-10 coding convention is based on the site of a neoplasm in the bodyand usually ignores the morphology, thus the same code may be assigned to tumors of different morphologic typesin an organ. Nowadays, all general (provincial) and center hospitals in Thailand are equipped with the hospitalinformation system (HIS) database. Objective: This study aimed to find the characteristics and magnitude ofagreement represented by the positive predictive value (PPV) of provisional cancer diagnoses in the HIS databasein Pattani Hospital in Thailand in comparison with the final cancer diagnosis of the ICD-10 codes generatedfrom a well established cancer registry in Songklanagarind Hospital, the medical school hospital of Prince ofSongkla University. Materials and Methods: Data on cancer patients residing in Pattani province who visitedPattani Hospital from January 2007 to May 2011 were obtained from the HIS database. The ICD-10 codes ofthe HIS computer database of Pattani Hospital were compared against the ICD-10 codes of the same personrecorded in the hospital-based cancer registry of Songklanagarind Hospital. The degree of agreement or positivepredictive value (PPV) was calculated for each sex and for both sexes combined. Results: A total of 313 cases(15.9%) could be matched in the two databases. Some 222 cases, 109 males and 113 females, fulfilled the criteriaof referral from Pattani to Songklanagarind Hospitals. Of 109 male cancer cases, 76 had the same ICD-10 codesin both hospitals, thus, the PPV was 69.7% (95%CI: 60.2-78.2%). Agreement in 76 out of 113 females gave a PPVof 67.3% (95%CI: 57.8-75.8%). The two percentages were found non-significant with Fisher’s exact p-value of0.773. The PPV for combined cases of both sexes was 68.5% (95%CI: 61.9-74.5%). Conclusions: Changes in finaldiagnosis in the referral system are common, thus the summary statistics of a hospital without full investigationfacilities must be used with care, as the statistics are biased towards simple diseases able to be investigated byavailable facilities. A systematic feedback of patient information from a tertiary to a referring hospital shouldbe considered to increase the accuracy of statistics and to improve the comprehensive care of cancer patients.     

肿瘤专科医院核心竞争力分析

全文简要阐述了核心竞争力的概念及维度,重点就肿瘤专科医院核心竞争力进行深入而全面的分析.肿瘤专科医院核心竞争力主要体现在四个方面:一是肿瘤专科医院的核心价值观;二是肿瘤专科医院的专科人才和专科技术;三是肿瘤专科医院的组织结构和完备的专业设备:四是肿瘤专科医院特有的组织内良好的沟通、协调能力.