2022年上海本轮新型冠状病毒肺炎(以下简称"新冠肺炎")疫情发生以来,上海申康医院发展中心切实履行办医主体责任,加强市级医院救治能力建设,在原有上海市公共卫生临床中心和复旦大学附属儿科医院2家常态化定点医院基础上,指导7家市级综合医院和3家儿科类医院以最快速度将其中一个院区或独立区域整体转换为新冠肺炎定点医院.同时构建了市级定点医院新冠肺炎患者医疗救治体系,明确了医疗救治原则和运行机制,制定了多项特色核心制度,在全面组织协调市级定点医院开展医疗救治过程中,探索形成了一整套管理举措和工作方法,对做好重症患者救治、提高治愈率、降低病亡率、加快周转率等起到了至关重要的作用,为夺取大上海保卫战的最终胜利作出了贡献.

Objective To study the perceptions of the safetyeffectivenesseconomy and ethics of physicians and managers in Orthopedics on the application of 3D printings.Methods Questionnaire surveys were conducted among all orthopedic physicians and some related hospital administrators in 4 tertiary hospitals in Shanghaiand qualitative interviews were adopted in 4 orthopedic experts.Results 3 hospitals have applied 3D printing technology in Orthopedicsbut the number of operations is limited.The advantages perceived by the surveyed physicians and managers are 3D printing in Orthopedics has shorter operation durationmakes operation convenience and has higher operation success rate.While the disadvantages include high cost and pricelack of standards and professional normsand process complexity and time consuming.Conclusion Clinical evaluation on safety and effectiveness of 3D printing in Orthopedics needs long term follow up.The regulation needs to be built up for rational use of 3D printing in Orthopedics.

医疗卫生体制改革事关社会主义现代化建设的全局.中国正处于医疗卫生体制改革与和谐社会构建的关键时期,这同时也是医务社会工作制度建立的最佳时期.2015年,国家卫生和计划生育委员会联合国家中医药管理局发布的《进一步改善医疗服务行动计划》中提出用3年时间,创新方便群众就医的措施,让人民群众切实感受到医改成效.特别是该计划明确指出“注重医学人文关怀,促进社工志愿服务”,为医务社会工作和志愿服务的发展指明了道路.本文梳理了政策出台的背景、政策亮点等内容,从医务社会工作的视角进行解读,并认为该计划的实施对完善医务社会工作和志愿服务制度建设、人才培育和专业化水平提升等具有积极意义,有助于推动医疗卫生体制改革和实践中的医务社会工作者与志愿者联动发展.

Objectives: To investigate the impact of background characteristics of hospital presidents on hospital performance and to provide suggestions for producing hospital president. Methods: it used the upper echelons theory as the theoretical basis, examined the background characteristics of hospital presidents (e.g. demographic characteristics, educational background, professional background and academic background) on the hospital performance through comparing with two group hospitals of rapid progress and rapid regress. Results: there are no significant difference between the two groups in the aspect of demographic characteristics and academic background, but the proportion of presidents graduating from 985 and 211 universities is higher in rapid progress hospital than that in rapid regress hospital, but the study and work experience abroad are otherwise. Conclusion: promotion from their own hospital and graduation from famous university will promote hospital progress. Learning and work experiences abroad might not necessarily adapt to China’s current health care system. It did not affect the progress of hospitals. Qualification does not depend on the academic ability, but lie on its management and leadership skills.

Objective:To analyze the length of stay and fee composition in two tertiary hospitals of Shanghai. Methods:Descriptive statistical methods were used to analyze the patients’ pre-operation stay,average length of stay and fee component between 2010 and 2014.Results:There were significant differences among pre-operation stay,average length of stay and fee components. Hospital expense growth was mainly caused by the growth of surgery and material expense. Length of stay has a significant positive correlation with examination expense,bed care expense,and diagnosis and treatment expense.Conclusion:The two hospitals,especially hospital B,had a large space in shortening average length of stay and pre-operation stay,which helps to lower examination fee,bed care and medical treatment expense,improve bed turnover and create higher economic returns for hospitals and more benefits to the society.

Objective:To make clear health human resource allocation among 17 districts after health resource layout was adjusted in Shanghai. Methods:Lorenz Curve and the Gini Coefficient were applied to describe the inequality degree of the distribution of health human resources. Results:The health human resource in urban area was much higher than that in suburban area. After adjusting the health resource layout by the“5+3+1”project,the equality of health human resource distribution was improved. Conclusion:Disparities still persisted between urban and suburban areas. The amount of doctors was lagging behind population growth. The health human resource allocation in suburban areas needs to be further strengthened.

Thanks to the great success of“Stories in the ER”,large-scale documentary shows on medical science,great effects they have on health communications has been widely circulated. This paper endeavors to analyze how the TV reality shows is popularizing medical scientific knowledge in a way that is different from traditional way. It argues that such TVreality show has made great contribution to the popularization of medical science.

随着流动人口规模的不断扩大,异地就医即时结算问题日益突出.通过从不同险种、不同地区、不同结算方式3个方面总结异地就医结算现状,提出需要解决的问题和需要防范的风险,为促进异地就医即时结算提供借鉴.

This article discussed social work practice by analyzing“3+X”work pattern on how to deliver professional social work services for services users proposed by a comprehensive tertiary grade A hospital. Meanwhile, challenges and opportunities were also studied and some feasible suggestions were summarized for the future development of localized social work in health care hospitals.

目的：探讨小组干预对改善糖尿病患者焦虑水平、社会支持状况的效果。方法：52名糖尿病患者分为实验组24例，对照组28例。实验组接受医务社会工作中的小组工作干预，对照组观看健康教育片，对两组在干预前、后分别进行焦虑水平和社会支持的测量。结果：干预前，实验组和对照组在焦虑水平、社会支持上的测评结果无统计学意义（37.5±7.7/35.5±6.7，t=-1.91，P>0.05；39.4±6.0/37.6±5.8，t=1.510，P>0.05）。小组干预后，实验组的焦虑水平和社会支持相比干预前有显著差异（P<0.05）。结论：医务社会工作的小组干预可降低糖尿病患者的焦虑水平，提升社会支持水平。

As part of efforts throughout China to improve the outcomes of individuals with disabilities, the Shanghai government has launched a campaign to screen at least 95 percent of newborns. To assist in meeting this goal, the Ages & Stages Questionnaires (ASQ), Third Edition, was translated into Chinese and the feasibility of a screening system using the ASQ-Chinese translation (ASQ-C) was investigated in Shanghai. Twenty-nine primary children’s healthcare clinics and several district-wide children’s healthcare institutes participated. Validity and reliability of the ASQ-C were studied as well as utility in pediatric clinics as part of well child visits. Using a sample of more than 8000 caregivers and children from 3 to 66 months of age, screening cutoff scores for each of the 19 ASQ-C intervals were determined, based on two standard deviations below the mean domain score. Inter-rater agreement between ASQ-C completed by 519 parents and a professional assessor was .89. Test-retest reliability for 651 caregivers who completed two ASQ-C at a 1–4 week interval was .91. Cronbach’s coefficient alpha measuring internal consistency ranged from .37 to .79. Convergent validity, measuring agreement between Bayley Scales of Infant Development, 2nd edition, and Denver II outcome categories (i.e. risk, typical) and ASQ-C outcomes (i.e. risk, typical), ranged from .57 to .94. Results from this pilot study suggest the ASQ-C is a promising screening instrument for identification of developmental problems in the Shanghai region. Implementation of a universal screening system in pediatric clinics has the potential to assist in early identification of developmental delays, referral to rehabilitative services, and improvement of developmental outcomes for young children and their families.

OBJECTIVE:To introduce the Ages and Stages Questionnaire (ASQ) to China, we created ASQ-Chinese (ASQ-C) and carried out studies of its norm and the psychometrical properties in Shanghai children aged 3-66 months in collaboration with the author of the ASQ with the permissions from the publisher.METHOD:The 19 ASQ intervals were translated into Chinese, to make the ASQ-C culturally relevant, and back translated into English. The project used a stratified cluster sampling method and recruited children aged 3 - 66 months with respect to demographic characteristics that were representative of Shanghai census data, and excluded the children whose mother tongue was not Chinese and/or diagnosed with disabilities by the authoritative hospitals in Shanghai. Parents/caregivers of the 8472 children either independently completed the age-appropriate ASQ-Cs or completed with help from the researchers for the normative samples. Among them, professionals completed the age-appropriate ASQ-C again for 519 children within six days after the parents/caregivers completed the ASQ-C for inter-rater reliability. In terms of test-retest reliability, 651 parents completed another age-appropriate questionnaires within a 10- to 23-day interval. For concurrent validity, BSIDII were administered with 255 children from 6, 12, 18, 24, and 30-month ASQ-C age intervals. The cutoffs of the ASQ-C and the BSIDII were all set at the two standard deviations below the means. The statistical analysis was carried out using SPSS 13.0.RESULT:The ASQ-Cs were independently completed by 85.25% of the parents/caregivers; the percentage of gender, family income and region of residence were similar to the Shanghai population census conducted in the recent years. Two standard deviations below the means were used as the cutoff scores of the ASQ-Cs across the age intervals. In terms of internal consistency of the ASQ-C, Cronbach standardized alpha was 0.77. The Pearson correlation coefficient between the ASQ-C total scores of the two testers was 0.84 (P < 0.0001). The Pearson correlation coefficient between the ASQ-C total scores of the two tests was 0.82 (P < 0.0001). The percentage of the agreement between the ASQ-C and the BSID II was 84.31%, the sensitivity of ASQ-C was 85.00%, and the specificity of ASQ-C was 84.26%.CONCLUSION:It is practicable that the ASQ-C can be completed by the parents/caregivers of Shanghai children. ASQ-C has solid psychometric properties and is worthy of further research and introduction to China.

目的:分析需方对实施新生儿疾病筛查的态度和影响因素及其对于新生儿疾病筛查的影响.进一步寻找潜在的促进和阻碍新生儿PKU和CH筛查开展的各种因素.方法:采用问卷调查的方法对上海市4家接产机构的75例孕产妇进行了需方意向调查.结果:被调查孕产妇中80.6%曾听说过新生儿疾病筛查,86.6%认为新生儿疾病筛查是有必要的,95.5%的孕产妇同意给孩子做新生儿疾病筛查.多因素Logistic回归分析结果显示:家长的年龄、职业、文化程度、家庭月收入和医保状况都不是影响其对于新生儿疾病筛查的认知水平及需求的因素.结论:需方对于新生儿疾病筛查具有高接受度,经济不是影响家长认知水平及需求的因素,在筛查工作中应正确认识"新生儿疾病筛查中的知情同意权"问题,应加强对筛查服务提供者和接受者的教育,确保筛查的有效实施.

目的:评价上海市新生儿CH筛查实施的效果,分析是否达到了筛查的最终目的.方法:对召回的患儿进行现场体检和智力评测.依据上海市1995年儿童体格发育指标评价和1995年全国城市儿童体格发育评价指标为每例患儿的体重、身高、头围、胸围进行百分位数评分;对4岁以下患儿采用DST智测量表评测,大于4岁患儿采用PPVT量表评测.结果:CH患儿体格发育情况基本与正常同龄儿童相当,体格发育指标呈正态分布,多数CH患儿的生长发育水平集中在平均值的上下;19例MI测试平均值为100,最小值为70,最大值为117;另19例IQ测试平均值106,最小值88,最大值122.无一人有智力残疾.结论:干预治疗能确保CH患儿体格智力发育良好,新生儿疾病筛查工作得到CH患儿家长的广泛认可,具有很高的满意度.

目的:评价上海市新生儿PKU筛查实施的效果,分析是否达到了筛查的最终目的.方法:对患儿进行现场体检和智力评测.依据上海市1995年儿童体格发育指标评价和1995年全国城市儿童体格发育评价指标为每例患儿的体重、身高、头围、胸围进行百分位数评分;智测方面,对4岁以下患儿采用DST量表评测,大于4岁患儿采用PPVT量表评测.结果:大多数PKU患儿的生长发育指标、智能能够达到同龄人水平;PKU患儿平均智商(IQ)达到86,IQ最小值为40.最大值为122.结论:早期干预和坚持规范化治疗是影响治疗效果的关键因素.在今后的干预治疗工作中,还需加强对患儿的心理辅导与测评.

目的:在探索开展新生儿PKU和CH筛查的必要性和可行性基础上,研究开展普遍筛查的策略,构建一套适合国情的,在出生后能早期发现、早期诊断、早期治疗先天性代谢性疾病的方法和干预策略,避免患儿智力障碍的发生,提高人口素质和保护儿童健康。方法:综合运用文献分析、二级资料提取、焦点组访谈、现场调查、统计分析等方法,定性与定量相结合,对上海市新生儿疾病筛查干预策略及实施效果进行系统研究。结果:截至2004年,上海市筛查出CH患儿303例,PKU患儿87例,使200多名患儿得到了及时的治疗,避免了智力障碍的发生,取得了良好的社会和经济效益。结论:上海市人口与社会经济发展状况决定了有必要开展新生儿疾病筛查,筛查干预策略的逐步完善是保证筛查工作顺利开展的前提。目前,上海市通过筛查网络的干预治疗,确保了PKU和CH患儿体格智力的良好发育,得到了广大家长的认可。

目的:了解患儿家长对筛查的评价,从家长层面寻找影响筛查有效实施及最终目标实现的因素.方法:采用问卷调查和个别访谈的方法对cH患儿家长的心理状况及其对筛查工作的满意度等方面进行调查,采用excel 2003对问卷进行数据录入及归类整理,用SPSS 11.5对数据进行统计分析.结果:95.1%的家长从医院了解到新生儿疾病筛查,家长对筛查服务的满意程度普遍较高;多因素Logistic回归分析显示,父母文化程度、家庭月收入对筛查收费满意程度无显著性影响.结论:cH治疗方便,治疗效果好,家长较为满意.

目的:调查PKU患儿家长的心理状况及对筛查工作满意度等方面的意向,了解患儿家长对筛查的评价,从家长层面寻找影响筛查有效实施及筛查最终目标实现的影响因素.方法:采用现场询问、问卷调查和个别访谈的方法进行患儿家长意向调查.采用excel 2003对意向问卷进行数据录入及归类整理,用SPSS 11.5对数据进行统计分析.结果:66.7%的家长自愿给孩子做新生儿筛查;家长对PKU筛查的不满意主要集中在治疗费用上,仅3.7%的家长对治疗收费表示满意,7.4%的家长比较满意.18.5%的家长认为一般,对治疗收费不满意的家长占25.9%,很不满意的占44.4%.经多因素Logistic回归分析,父母的文化程度、家庭月收入对筛查收费满意程度均无显著性影响.结论:在筛查前告知家长筛查工作的重要性和内容是很有必要的,较高的治疗费用是影响PKU患儿家长满意度的最主要因素,也给家长带来了沉重的心理负担.构建更人性化和更有保障的干预支持系统是非常必要和重要的.

Objective To research trend in morbidity of childhood simple obesity and effect of intervention for children with simple obesity aged 0~6 years old in Shanghai so as to explore proper prevention for the disease.Methods Height and weight were measured,and the weight for height of NCHS/WHO was used as reference data to define overweight and obesity(overweight: weight for height≥110%~119.9% of the median,mild obesity: weight for height≥120%~129.9% of the median,moderate obesity: weight for height≥130%~149.9% of the median,severe obesity: weight for height≥150% of the median).The dynamic trend in occurrence and development of simple obesity of children was obtained by sample investigation,setting up monitoring spot,and reviewing conventional report forms.The data were analyzed by SPSS 10.0 software.Results The results of sampling investigation showed that in the old town areas of Shanghai the morbidity of simple obesity of children increased by 1 time in the year 2002(6.01%),as compared with that in the year 1996,and that in the new town areas in the year of 2002 was 3.87%,which was higher than that in the old town areas in 1996 too(2.62%).All of the children in eight nurseries were monitored from 1999 to 2001 and the morbidity of simple obesity of children among half of nurseries shown a continuously increasing tendency.The morbidity of simple obesity of children in those intensively monitored-spot nurseries during the period from 2002 to 2005 was controlled a few.Conclusion The morbidity of simple obesity of children aged 0~6 years old shows an increasing tendency and effective interventions could control morbidity of the disease.

Objective:To study the health status of temporal residents under 3-year-old in Shanghai and provide valid measures for children's health care.Methods:180 childern in Baoshan (90 boys and 90 girls) and 180 childern in Hongkou (98 boys and 82 girls) randomly selected were divided into three age groups: 0~, 1~, 2~3 years old. Data of regular physical examination, trophonosis, five sensory organs diseases and accidents were investigated by questionnaire.Results:The floating children had no recorded card was more than resident children (P<0.01), and more children aged over 1 year old had recorded card, accounting for 15.5%.Shanghai resident children with more than 50% of weight and height value were more than floating children. The rate of completing "4·2·1" examination in resident children were higher than that in floating children (84.3% vs 35.5%) (P<0.01).The rate of trophonosis in floating children was higher than that in resident ones, the attack of upper respiratory infection in floating children was higher than that in resident ones. Conclusion:An effective measures should be taken to improve the manegement of children temporal residents and more attention should be paid to these vulnerable children.