Objective:To analyze research status and development trends in the field of health management in China from 2011 to 2020.Methods:“CNKI” was chosen as the data source, and “health management（precise）” was used as the search term, and a total of 13, 686 valid data were finally obtained. Frequency counts were used to tabulate the number of articles published in the field of health management from 2011 to 2020. CiteSpace software was used to analyze the cooperation of institutions, and to explore the research hotspots and development trends in the field of health management by institutions co-occurrence, keyword co-occurrence and clustering timeline map. Bicomb software and SPSS 26.0 software were used for multi-dimensional scale analysis of keywords to comprehensively reflect the core degree and maturity of research topics.Results:The amount of domestic health management research literature had shown an increasing trend from 2011 (804) to 2020 (2 044). The top 5 keywords in terms of frequency were “hypertension（611）” “diabetes（577）” “health education（485）” “community（460）” and “chronic diseases（457）”. “Elderly” “Traditional Chinese Medicine（TCM health management）” and “Health management model” were the hot keywords and research trends of health management. There were 7 themes in the field of health management, namely “Construction and application of chronic diseases health management model” “Community health service and health management” “Health management in essential public health service” “Health management of the elderly” “Health management of Traditional Chinese Medicine” “Health examination and health management organization” “Health management based on big data and modern information technology”.Conclusions:A relatively close network of cooperation has been formed in the field of health management research and the number of articles has increased. The elderly, chronic disease and Traditional Chinese Medicine health management are the research trend. The construction and implementation of health management models, the integration of artificial intelligence and health management are the development trends in this field.

[目的]评价县域医共体分级诊疗建设中医疗服务情况和公共卫生服务情况,探讨依托医共体建设分级诊疗的效果及存在问题.[方法]通过广东省粤西地区某县域医共体分级诊疗建设项目访谈和调查数据,对2018-2019年调查医共体内3家县直医院和8家镇卫生院的门诊、急诊、住院、双向转诊、健康档案、家庭医生签约和医务人员交流学习等,进行比较分析.[结果]医共体内门诊、急诊和住院量明显增加,县直医院住院服务的年增长率14.1％较同类型机构门、急诊高,镇卫生院急诊年增长率33.8％则远高于县直医院,辖区居民县域内住院量增加12.2％,县域内住院率净增长2.8％,双向转诊行为年增长25.3％,下转人次高于上转人次,健康档案建档人数增加3.7％,家庭医生签约人数增加6.7％,县直医院与镇卫生院交流学习活动频繁.[结论]通过高位推动、融合资源、破除壁垒、错位发展、上下联动等措施开展县域医共体建设,能够提高基层诊疗水平,助力分级诊疗制度构建,有待从政策制定者、成员单位及辖区居民三方面进一步深化与强化.

高校在落实立德树人根本任务的过程中需将各类课程与思想政治理论课同向同行,形成协同效应,构建三全育人"大思政"格局.本文在理解课程思政内涵的基础上,结合高等院校课程思政改革工作面临的问题,从领导机制、工作机制、评价机制等方面提出几点思考,以期为着力有效推进课程思政改革提出对策建议.

2020年初新型冠状病毒肺炎疫情暴发,这次疫情是新中国成立以来在我国发生的传播速度最快、感染范围最广、防控难度最大的一次重大突发公共卫生事件,全国上下均大力开展疫情防控工作.佛山市里水镇位于广东省佛山市南海区东北部,紧邻广州,辖区面积148.28 km2,虽然行政区划是镇,但地处珠江三角洲,且是工业重镇,辖区内中小企业多,流动人口密集,湖北籍人员超过2万人.随着春节结束,不少企业复工复产,许多外来人员返回里水,在楼盘、工厂、企业等地聚集,疫情防控压力巨大.然而截止2020年3月5日,佛山市里水镇仅有10例输入性病例,实现本地"人传人"新冠肺炎"零记录".成功阻断病毒在社区的传播,得益于里水镇布局多时的基于"全科医学+"医共体的区域网格化管理模式,该模式以南方医科大学和当地政府的支持与资源配置为基础,通过大力发展全科医学,按照"医防融合"的目标统筹社会行业力量,旨在为社区居民提供全方位、全生命周期健康服务.在此次疫情时期构建全覆盖的新冠病毒肺炎社区防控体系,充分发挥基层全科医生的积极作用,有序有效开展社区疫情防控,主动高效加强重点人群管理,减轻政府防控压力,提高疫情防控效率,并为区域经济正常运行提供必要医疗卫生保障,值得推广与应用.

在新型冠状病毒肺炎疫情的背景下,为健全国家公共卫生应急管理体系,本研究从供应链整体管理的角度,归纳形成“两端三点”医疗物资供应链理论模型,并基于该模型分析疫情中应急医疗物资紧缺的原因,提出相应的政策建议.物资供给端产能不足,应充分激活、扩大产能,推动应急物资生产;物资需求端形势失衡,应保证需求信息的有效沟通;调度指挥点职能缺位,应科学策划、合理调配,集中统一管理;物资分配点运作混乱,应加强监督、保障发放,确保应急物资有序分配;物资储存点缓冲失效,应重视战略储备,提高管理意识;供应链整体协作不良,需促进政府社会联动,共抗疫情.

目的 采用卫生费用核算体系2011版(SHA 2011)分析2017年广东省糖尿病治疗费用及其资金来源、流向情况,从经济角度分析糖尿病对广东省造成的负担,为加强指导糖尿病费用管理提供政策依据.方法 治疗费用总量通过《2017年广东省卫生统计年鉴》、《2017年广东省卫生财务统计年报》、《2017年广东省社会保险基金决算表》获得.每种疾病的治疗费用根据国家卫健委制定的抽样方案由广东省卫健委向全省医疗卫生机构进行问卷调查获得.基于SHA 2011对糖尿病治疗费用进行分析.结果 2017年广东省全省治疗费用中内分泌、营养代谢疾病治疗费用总量为116.80亿元,其中糖尿病治疗费用总量为71.40亿元,占内分泌、营养代谢疾病治疗总费用的61.13％.门诊费用为51.75亿元,占总治疗费用的72.48％,住院费用为19.65亿元,占27.52％.糖尿病患者治疗总费用以45～74岁为主,占65.26％,男女性分别占51.48％、48.52％.65.16％的费用产生在综合医院,基层医疗卫生机构所占比例为13.18％.结论 广东省糖尿病治疗经济负担沉重,费用机构流向不合理,应提高卫生筹资公平合理性,强化基层医疗机构服务力,加强对重点人群的健康教育.

尊敬的各位读者、作者、编委: 硕果盈枝辞旧岁,壮志满怀迎新年!值此新春来临之际,南方医科大学学报编辑部全体同仁向关心支持我们的各界朋友表示衷心的感谢!恭祝大家在新的一年健康快乐!幸福吉祥!万事如意!

目的 本文旨在探索基层医共体建设与可持续发展的新路径,为医共体的建设提供可复制的参考经验.方法 通过文献分析、理论研究的方法,结合实地调研、专家论证对问题解析,同时进行面向区域基层的实践,探索构建新型医共体.结果 对国内部分城市医共体运行现状与发展进行了深入的分析,经过一年多的实践,首次提出并建立了医科大学与政府协同下的以三级医院为区域龙头医院,以省级公共卫生研究机构、乡镇社区卫生服务机构、功能社区紧密联合,以全科医学为抓手的医防融合型“全科医学+”医共体.该医共体以校政协同解决优质医疗资源缺乏和资源合理利用问题;以“五个统一”解决深层次体制机制矛盾问题;以全科医学为抓手推进区域医共体建设,解决基层服务能力不足的问题.通过“全科医学+”为实现普及健康生活、优化健康服务、完善健康保障、建设健康环境、发展健康产业的战略目标探索一条可实施、可持续的改革新路径.结论 “全科医学+”医共体在多方协同下为医药卫生体制改革提供新思路,为我国其他县级公立医院改革和医共体试点工作提供参考.

目的:了解乡镇居民对家庭医生签约服务的认知与需求,为因地制宜地推进该服务提供参考依据.方法:采用自编调查问卷,随机抽取佛山市某镇10个村共300位居民,进行家庭医生签约服务的认知及服务需求调查.结果:居民对家庭医生签约服务的知晓率为56.1%,不同性别、户籍的居民对服务的知晓有显著性差异. 74.1%的居民表示愿意签约家庭医生.不愿签约的原因主要是对医疗水平的不信任( 35.5%);知晓服务的居民签约意愿较高;服务方式需求以网络(46.3%)和电话(25.9%)为主;服务需求前三位依次是健康问题咨询(79.6%)、建立健康档案(76.5%)、常见病/多发病诊治(75.2%).结论:乡镇居民对家庭医生签约服务的知晓率不高,有待加大宣传力度;居民是否签约看重基层卫生服务水平;服务需求呈多样化,应丰富服务方式与内容,提供有针对性的服务.

在对大学第三方评价进行综合研究和比较分析的基础上,提出大学第三方指数的概念构想,通过指数理论建立计算模型与规则对入选的大学第三方评价信息进行整合和运算,构建了大学第三方指数.大学第三方指数用以综合反映多个大学第三方评价同时作用于一所大学的情况,为总体分析大学在第三方评价中的状态与趋势提供了一个新的角度和方法.通过多角度地挖掘与分析数据,大学第三方指数的综合指数、专项指数可以用于计算生成大学发展竞争力报告、基于区域内大学表现的高等教育竞争力报告等,为大学改革发展规划、区域高等教育发展战略等提供第三方评价的大数据分析和比较.

医改不仅需要“三医”联动,还需要代表医疗行业未来的医学生参与,即医教协同.志愿服务是医学院校人才德育培养和人文素质提升的重要抓手,有利于在新时代背景下落实“健康中国”战略,充分发挥医学生特点和职业发展优势.南方医科大学通过顶层设计,从专业性、创新性、医教研日常化及共赢性4个方面综合开展志愿活动,以多种专业志愿形式服务社会,建立了医学生志愿服务机制,可以有效增加人民群众的幸福感和获得感,实现多方共赢.

To introduce"Danshari"into the training of general practitioners,this article analyzes five parties that are closely related to the general practitioners' training process and draws the following conclusions.The government should cut off the inefficient supply,discard the disconnected or invalid policies,and stay away from the exercise of the initiative.The institutions that conduct the education of general practitioners should break the same training path as the specialist,discard the curriculum that does not meet the requirements,and keep away from the concept of quantity.Community health centers that provide practice for general practitioners should abandon models that focus on disease management,remove the extra service function,and be out of the all-round development concept.The public should reduce the hypothetical demand for medical resources,abandon the traditional misreading of the general practitioner,be away from the consumption view that patient is god.The general practitioner should refuse to do something that is not worth it,abandon the goal of multifaceted development,and get rid of the conformist mentality.

For the public hospital,the biggest advantage is the human resources,the biggest challenge is how to correctly attract,training and retain talent under the environment of private capital investing healthcare institute.Facing the challenges of encouraging private capital investing healthcare institute,abolishing government employee quota,the advantages of mechanism of private and the solidified personnel management in public hospital,suggestions such as constructing human resources centered hospital group,improving advanced discipline to promote human resource coordination development in the circle of product,teaching and research,building incentive mechanism to develop discipline team expanding the functions of human resources department and highlighting on hospital culture are presented to give reference for personnel management reform in public hospital.

Medical practitioner,patient and media are all over sensitive,which can not be a neglected factor of the tense doctor-patient relationship.Excessive sensitivity not only increases the additional cost,hut also weakens the relations between each other.Sometimes,there will be conflicts due to the dislocation of sensitivity.Therefore,the authors claimed that the insensitivity should be cultivated to make a balance with excessive sensitivity.All the parties should increase their sensitivity in crisis identification and health consciousness,but cultivate insensitivity in using technology and sensationalizing negative news.Only by building up a mutual trust will the doctor-patient relationship be harmonious.

党的十八大报告明确指出,要"把立德树人作为教育的根本任务,培养德智体美全面发展的社会主义建设者和接班人"."立德树人"鲜明地回答了当代教育工作"培养什么样的人、怎样培养人"的问题,同时指明了当代大学生思想政治教育工作的价值旨归.基于对立德树人价值命题的解析,找寻其价值实践路径,是促进高校大学生思想政治教育工作实践发展的迫切需要.

Based on the review of the existing evidence of the research on the hospital management institutional ethics , this paper found researches in this area in the last two decades focused on the concept and level definition of hospital management institutional ethics;the construction of hospital management institutional ethics;the value and function of hospital management institutional ethics, and the reason and result of lack of hospital management insti-tutional ethics. On this basis, it pointed out the deficiency of the current researches and outlook the prospects.

目的：评价替格瑞洛对ST段抬高型急性冠脉综合征合并糖尿病患者的心肌保护作用。方法选择ST段抬高型急性冠脉综合征合并糖尿病患者157例，随机分为对照组（78例）和观察组（79例）。在经皮冠脉介入治疗（ PCI）和常规治疗基础上，对照组给予氯吡格雷，观察组给予替格瑞洛，维持治疗6个月。比较两组患者血清肌酸激酶同工酶（ CK－MB）和心肌肌钙蛋白（ cTnI）水平，左心室舒张末内径（ LVDD）、左心室射血分数（ LVEF）等功能指标，以及主要不良心血管事件（ MACE）的发生率和治疗期间出血等不良反应。结果治疗前两组患者的基线资料差异无统计学意义。 PCI术后24 h，两组患者的CK－MB、cTnI水平差异无统计学意义但维持在较高水平；术后72 h，两项指标逐渐降低，且观察组显著低于对照组。 PCI术后1周和6个月，两组患者的血小板聚集率（ADP）、心脏功能指标LVEF和LVDD较治疗前有显著改善（P＜0.05），且观察组显著低于对照组。 PCI术后6个月，观察组不良心血管事件显著低于对照组（ P＜0.05）。治疗期间，除观察组呼吸困难患者高于对照组外，其他不良反应的发生率差异无统计学意义。结论对于糖尿病合并ST段抬高型急性冠脉综合征患者，替格瑞洛能有效地改善心肌损伤，降低不良心血管事件发生率，且不增加出血风险。

目的:探讨在TGF-β1及AngⅡ分别诱导的大鼠心肌细胞肥大中Smad信号途径中Smad2蛋白的表达.方法:分别建立TGF-β1及AngⅡ诱导的大鼠心肌细胞肥大模型,分为正常对照组、TGF-β1组以及AngⅡ组.以碘化丙啶(PI)染色标记法检测心肌细胞中RNA的表达量以间接反映心肌细胞肥大.以实时荧光定量PCR检测心肌细胞肥大相关肌球蛋白重链β亚型(β-MHC)的表达.以Western blot检测心肌细胞中磷酸化Smad2信号蛋白的表达.结果:TGF-β1及AngⅡ诱导的培养心肌细胞中肥大相关蛋白β-MHC的表达均明显高于对照组(P＜0.01).PI染色检测表明,TGF-β1组及AngⅡ组PI的含量明显增高(P＜0.01).与对照组相比,TGF-β1及AngⅡ均可明显上调磷酸化Smadz(p-Smad2)的表达(P＜0.01).TGF-β1组与AngⅡ组p-Smad2表达峰值相比无明显差异,但达峰的时间有所不同.结论:TGF-β1及AngⅡ单独均可诱导心肌细胞肥大,在此过程中p-Smad2蛋白的表达明显增加,TGF-β1与AngⅡ促进p-Smad2蛋白表达作用无明显差异.

With the change of the modern medical model and the medical environment,there are various challenges that medical education confronts.Although medical education is focusing on professional medical knowledge,how to enhance the general education and make it blend into the professional medical education becomes an important issue nowadays.Recently,a series of active explorations and measures have been applied in Guangzhou Medical College to push forward the general education reform,which will give benefits to others.

高等医学院校作为高校协同创新的重要方面军,在高层次人才培养,满足国家和社会需求,解决重大医药卫生课题,传承和创新医学文化方面担负着协同创新主体的角色,应该在充分认识协同创新意义的基础上,明确协同创新的目标和内容,建构协同创新的机制,制订切实可行的协同创新措施,在协同创新的大势中抓住机遇,迎接挑战,为发展医疗卫生事业和建设创新型国家作出应有的贡献。