Medical emergency support for the snowboarding project during the Beijing Winter Olympics / 北京大学学报(医学版)

Objective:To analyze and summarize the medical security situation of the snowmobile,sled,and steel frame snowmobile tracks at the National Sliding Centre,and to provide experience for future event hosting and medical security work for mass ice and snow sports.Methods:Retrospective analysis of injuries and treatment of athletes participating in the International Training Week and World Cup for Ski,Sled,and Steel Frame Ski from October to November 2021(hereinafter referred to as"Inter-national Training Week"),as well as the Ski,Sled,and Steel Frame Ski events at the Beijing Winter Olympics in February 2022(hereinafter referred to as the"Beijing Winter Olympics").We referred to and drew on the"Medical Security Standards for Winter Snow Sports"to develop specific classification standards for analyzing injured areas,types of injuries,and accident locations.Results:A total of 743 athletes participated in the International Training Week and the Beijing Winter Olympics.During the com-petition,there were 58 incidents of overturning,prying,and collision,of which 28(28 athletes)were in-jured,accounting for 48.3％of the total accidents and 3.8％of the total number of athletes.Among them,there were 9 males(32.1％)and 19 females(67.9％),with an average age of(26.3±4.7)years.Among the 28 injured athletes,20 cases(71.4％)received on-site treatment for Class Ⅰ injuries,while 8 cases(28.6％)had more severe injuries,including Class Ⅱ injuries(7 cases)and Class Ⅲ injuries(1 case),which were referred to designated hospitals for further treatment.Among the 28 injured athletes,3 cases(10.7％)experienced multiple injuries,including 2 cases of 2 injuries and 1 case of 3 injuries.The most common injuries were in the ankle and toes(10/32,31.3％).Out of 28 injured athletes,one(3.6％)experienced two types of injuries simultaneously,with joint and/or ligament injuries being the most common(11/29,37.9％).The most accident prone point on the track was the ninth curve(18/58,31.0％).Conclusion:Through the analysis and summary of medical security work,it can provide better experience and reference for the future development of snowmobile,sled,and steel frame snowmobile sports in China,making the National Snowy and Ski Center truly a sustainable Olympic heritage.

Construction and operation of the multi-level medical security system of the West China Women and Children Alliance / 中华医院管理杂志

Medical mutual aid is an important component of multi-level medical security system. West China Second University Hospital of Sichuan University led the establishment of the pediatric specialty alliance " West China Women and Children Alliance". Based on customized and inclusive mutual insurance product " Family Doctor Mutual Aid Plan", the alliance implemented key links such as mutual aid product forms, patient risk protection, institutional financing and hematopoiesis, and distribution of benefits to all parties, explored innovative mutual aid funding, payment, and incentive mechanisms, forming a closed-loop pediatric tiered diagnosis and treatment service system with the Mutual Aid Plan as the core. This system operated continuously under the " Four-in-One" framework, stimulating the integration of medical insurance and service supply systems while enhancing the synergistic effect between mutual insurance and social security. It has formed a distinctive health-centered multi-level medical security system within the alliance, and could provide reference for the construction and exploration of hierarchical diagnosis and treatment system.

Design and practice of medical service for the main venue of the 19th Hangzhou Asian Games / 中华急诊医学杂志

Objective:To clarify the medical security plan and its practical effects at the main venue of the 19th Hangzhou Asian Games.Methods:The plan described the medical security implementation plan of the main venue of the 19th Asian Games in Hangzhou (organizational management and operation mechanism, medical security operation system, standardized training and support processes, application of Asian Games intelligent first aid security system, and so on). And through high-facticity simulation verify the operation effect of the main venue's medical support (team mode and response time). Finally, the feasibility and effectiveness of the medical security program verified through the effect of medical services (quantity, disease types, transfers, etc.) during the Asian Games and Asian Paralympic Games.Results:The medical security team of the main venue of the 19th Hangzhou Asian Games included the management team and the operation team, of which consisted of 44 medical staffs (22 doctors and 22 nurses); and were deployed to 16 different security positions. It was also accompanied with 16 volunteers to assist medical staff to transport patients. In addition, a total of 300 medical observers were enrolled in audience area to assist rapid identification, intervention, and collaborative diagnosis and treatment with the medical team. Medical security teams were arranged to cover all the audience areas who can arrive at the patient's area within 2 minutes after receiving orders, transfer the patient to the ambulance’s site in 8 minutes, and transport the patient to a designated hospital within 10-20 minutes. During the Asian Games and Asian Paralympic Games, the medical-care team treated a total of 3 742 patients, including 9 patients transported from medical service sites of the audience area to the stadium infirmary, as well as 83 patients referred to the designated hospital.Conclusions:The medical security implementation plan for the main venues of the Asian Games provides good medical security for the Asian Games and Asian Paralympic Games. It also provides theoretical and practical experience for the development of the medical security system for international events in future.

Knowledge graph and future prospects of medical security research:literature analysis based on CNKI(since 1998) / 现代医院

Objective To present a knowledge graph of over 20 years of research on medical security and predict future trends.Methods Based on 4818 Chinese core journal papers indexed by CNKI since 1998,CiteSpace 5.0 was used to present a knowledge graph of medical security research from three aspects:time zone distribution,force composition,and research con-tent.Results Medical security research has gone through three stages:the initial stage,the peak stage,and the adjustment and stability stage.At present,the development of research forces is uneven,and the cooperation network shows a trend of partial concentration and overall dispersion.The research topics focus on seven aspects such as the construction of medical security sys-tem,internal design of the system,external support system,and new rural cooperative medical care.Conclusion In the future,efforts should be made to build a research system for medical security governance and highlight the innovation and development of legal construction of medical security in five aspects.

Enlightenment of the DRG payment reform in the United States on the reform of China′s medical insurance payment methods / 中华医院管理杂志

In order to curb the excessive growth of medical expenses, the United States has initiated payment reform of diagnosis-related groups (DRG) since 1983, and developed a series of complementary measures to address issues such as overcoding and declining healthcare service quality which were exposed during the reform. The authors discussed the implementation of DRG payment reform in the United States, namely the case-mix specialization of medical institutions and the reduction of costs, as well as the relationship between the two. On this basis, the authors suggested that when implementing reforms to the medical insurance payment system in China, it is imperative to avoid such loopholes as overcoding by medical institutions and excessive pursuit of efficiency at the expense of quality control, as well as the decline of comprehensive rescue capability and quality of care incurred by the exacerbated specialization.

Investigation on medical security and quality of life of migrant workers with pneumoconiosis / 中华劳动卫生职业病杂志

Objective: To investigate and understand the medical security and quality of life of migrant workers with pneumoconiosis, so as to provide scientific basis for the prevention and control countermeasures of migrant workers with pneumoconiosis and targeted poverty alleviation. Methods: Using a stratified random sampling method, 200 migrant workers diagnosed with pneumoconiosis at the Shandong Academy of Occupational Health and Occupational Medicine from January 2016 to December 2021 were selected as the observation group, while 200 non migrant workers diagnosed with pneumoconiosis were selected as the control group. St. George's Respiratory Questionnaire (SGRQ) and Pneumoconiosis Questionnaire were used to collect and compare information on the age, working age of dust exposure, economic sources, employment status, income, medical security and quality of life of two groups of patients. Results: The age of migrant worker pneumoconiosis patients in the observation group was (58.1±8.1) years old, and the working age of dust exposure was (19.3±10.1) years. The main source of income was children support (85.5%, 171/200), employment status was mainly wait for employment or unemployed (69.0%, 138/200), personal monthly income was mainly non income (90.0%, 180/200), and family annual income was mainly less than 10000 yuan (48.0%, 96/200). The average personal annual medical expenditure of 5000-<10000 yuan accounted for 42.0% (84/200). The age of pneumoconiosis patients in the control group was (59.2±8.9) years old, and the working age of dust exposure was (20.2±10.5) years. The main source of income was retirement pension or salary (99.0%, 198/200), with retirement as the main employment status (66.0%, 132/200), the main personal monthly income was 2000-<4000 yuan (61.5%, 123/200), the main family annual income was 20000-<40000 yuan (44.0%, 88/200), and the average personal annual medical expenditure was mostly non-expenditure (92.0%, 184/200). There were statistically significant differences in the distribution of economic sources, employment status, personal monthly income, family annual income and average personal annual medical expenditure between the two groups (P<0.001). The main type of insurance for the observation group was rural cooperative medical care (68.5%, 137/200), and 87.0% (174/200) had no medical reimbursement and a proportion less than 50%. There were statistically significant differences in insurance type and medical reimbursement proportion between the two groups (P<0.001). The respiratory symptoms, activity ability, daily life influence and total quality of life scores of pneumoconiosis patients in the observation group were significantly higher than those in the control group, the differences were statistically significant (P<0.001) . Conclusion: Migrant workers with pneumoconiosis have low income, high medical expenditure, low medical reimbursement proportion and poor quality of life. Therefore, it is necessary to draw high attention from relevant departments and provide timely attention and assistance to improve the quality of life of migrant workers with pneumoconiosis.

Study on the strategy of medical security for rare diseases in China from the perspective of public concern and emotion：taking nosinasine as an example / 中国药房

OBJECTIVE To mine the focus and emotional attitude of the public on rare diseases， and to provide decision- making reference for relevant departments to formulate and implement relevant policies， systems and strategies for medical security of rare diseases. METHODS Latent Dirichlet allocation （LDA） topic model and sentiment analysis method were used to analyze the comment text of short videos related to the “nosinasine” medical insurance admission event on the Bilibili video website， mine the theme and sentiment tendency of the text， and put forward relevant strategy suggestions. RESULTS A total of 8 videos with tens of thousands of playback and 7 109 text data were obtained. According to the LDA analysis， online public paid attention to 9 topics related to rare diseases （the price of rare disease drugs， the inclusion of rare disease drugs in medical insurance， the status quo of research and development of rare disease drugs， the scope of medical insurance and the medical security system， the plight of rare disease patients， the prevention and screening of rare diseases， the value of rare disease drugs in medical insurance， the Chinese and western medical methods of rare diseases， and the supply and demand status of rare disease drugs）， which could be summarized into 4 categories according to the objects of concern （rare disease drugs， rare disease medical insurance， rare disease medical and health services and rare disease patient groups）. On the whole， the emotional tendency of the Internet public towards each topic showed a low positive and high negative tendency. CONCLUSIONS The public paid more attention to the price， research and development， supply and demand of rare disease drugs， and was deeply worried about the current medical status of rare diseases in China. To strengthen and improve the medical security for patients with rare diseases， such as actively carrying out public health services for rare diseases， strengthening cooperation in the diagnosis and treatment of rare diseases， and researching rare disease drugs， etc. Chinese medical and health departments can make concerted efforts in medical and health services， drug supply security， medical security and other social security.

Research on the social and commercial integration mode of Huimin Insurance from the perspective of holistic governance / 中华医院管理杂志

As an important part of China′s multi-level medical insurance system, commercial health insurance has developed rapidly in recent years, but its guarantee level is still limited, and its role in the multi-level medical insurance system is not fully played. Huimin Insurance, as a new public private partnership health insurance, takes into account the dual characteristics of commercial operation and inclusive protection, and provides an important supplement to meet the needs of the masses for multi-level protection, alleviate the economic burden of serious diseases, and promote the innovation and development of the pharmaceutical industry. The author systematically analyzed the characteristics of social and commercial integration in the development of Huimin Insurance in China from the aspects of value-oriented mechanism, policy complementary mechanism and operation support mechanism, and analyzed the problems of in the current development process of Huimin Insurance based on the holistic governance framework of multi-level medical security system in three dimensions of " hierarchy-institutional-tool". It is suggested that the functional positioning of multiple subjects should be clarified, the ability of information integration should be enhanced, and the product design and serviceshould be optimized, so as to fully enlarge the supplementary security efficiency of Huimin Insurance, and explore a new path for the formation of a multi-level medical insurance system with Chinese characteristics.

Practice and thinking of designated hospital medical emergency support for the 19th Hangzhou Asian Games / 中华急诊医学杂志

Objective:To analyze the construction and operation of the 19th Hangzhou Asian Games designated hospitals, and to discuss the medical emergency security work of large-scale sports events, so as to provide references for the planning of designated hospitals in future large-scale sports events.Methods:Retrospective analysis was made on the establishment principles, requirements, selection of medical support personnel, and training exercises of the designated hospitals, focusing on the key links such as organizational system, staffing, designated areas, and drug management.Results:Total of 40 designated hospitals have successfully completed the task of medical security by rebuilding the medical security area of the Asian Games, elevating the process, equipping facilities, and strengthening staff training. During the Asian Games, 349 people were transferred to designated hospitals by ambulance, 54 people were hospitalized, 19 people underwent surgery, and 1022 people went to designated hospitals by themselves.Conclusion:The construction of the designated hospitals during the 19th Hangzhou Asian Games was of high quality, efficient and smooth operation. It is suggested that efforts should be made in the reconstruction of the medical security area for the Asian Games to be "relatively independent". The treatment process of self-visiting patients should be fully considered and the flat urgent emergency response mechanism needs to be established.

The practice of the "three-dimensional closed-loop" emergency system in the guarantee of the Asian Games in Wenzhou / 中华急诊医学杂志

Objective:The regional emergency system needs to maintain normal operation in disasters and sudden public health events, ensuring the timely treatment of critically ill patients, and also bearing the responsibility of ensuring various large-scale sports events. This article explores the practice of the "three-dimensional closed-loop" emergency system in the guarantee of the Hangzhou Asian Games in Wenzhou.Methods:After analyzing and integrating existing medical resources, the First Hospital Affiliated to Wenzhou Medical University conducted a two-year medical emergency exercise in a simulated urban road and natural water environment, and improved and optimized the weak links in the medical security system.Results:The hospital established a "three-dimensional closed-loop" emergency system and completed the medical support tasks for the Asian Games. The "three-dimensional closed-loop" emergency rescue system adopted a three-dimensional management team that combined a decentralized organizational structure and a professional medical team, and also has a land-air-sea emergency rescue team. By combining manpower and information technology, the system could provide "4R" medical services: real-time perception of medical emergencies in venues, rapid assessment of the patient's condition, rapid transfer of patients and rapid deployment of medical forces within the hospital. In addition, closed-loop management of the hospital's diagnosis and treatment process improved patients' satisfaction during the treatment process.Conclusions:The the "three-dimensional closed-loop" emergency system provided a strong guarantee for the successful holding of the Hangzhou Asian Games in Wenzhou and also accumulates experience for future urban emergency rescue.

Research progress and trend analysis of medical insurance governance in China based on CNKI database / 中华医院管理杂志

Objective:To analyze the research hot topics, knowledge evolution context, potential frontier trends and future breakthrough directions in the field of medical security governance in China.Methods:Subject term retrieval was used to study the literatures related to medical security governance published by CNKI from January 2009 to December 2021. CiteSpace V software was used to draw the keyword co-occurrence network, time zone map, cluster map, and emergent word graph, and to visually analyze and predict the frontier hotspots and evolution trends in the field of medical security governance.Results:A total of 793 literatures were retrieved. The cooperation network among medical security governance research institutions in China needed to be strengthened; the mainstream of research focused on basic research on medical insurance system design, research on medical security governance paths and methods, and empirical research combined with the era background or policy hotspots.Conclusions:There are some problems in the current rerearch on medical security governance, such as imperfect theoretical construction, research content to be expanded, insufficient communication and cooperation, etc. Future research hotspots tend to be innovation of the goal, structure and path of medical security governance, application of big data in the field of medical security governance, and research on crisis response and challenges of medical security governance under public health emergencies. Future research should strengthen multi-cooperation to jointly tackle key problems, pay attention to the cross-integration of disciplines, develop localized medical security governance innovation systems and mechanisms, and enrich problem-oriented empirical research.

Analysis and practice on the " dual-channel" management mode of national medicare negotiated drugs in China / 中华医院管理杂志

" Dual-channel" management is an important management measure to solve the difficulty of national medicare negotiated drugs entering the hospital and improve the accessibility of the drugs. China clearly included some social pharmacies into the supply guarantee channel of national medicare negotiated drugs, and formed a " dual-channel" supply mode for negotiated drugs together with the hospital supply. By sorting out China′s national medicare negotiated drugs policy management documents and the management modes and specific measures in various regions and periods, this paper summarized and analyzed the progress of process management, multi-level medical security integration, remote handling, drug safety supervision, and information construction in various regions. Based on the relevant policy guidance and local practical experience, the authors explored and optimized the " dual-channel" landing management, so as to provide reference and suggestions for further improving the accessibility of national medicare negotiated drugs and giving full play to the effectiveness of medical security.

Practice and thinking of pre-hospital emergency support for the 2022 Beijing Winter Olympic Games / 中华医院管理杂志

Under the leadership of the Beijing Winter Olympic Organizing Committee and the Beijing Municipal Health Commission, the Beijing Emergency Center, as the designated medical institution for the 2022 Beijing Winter Olympic Games, has completed the first aid support task of this Winter Olympic Games with other medical institutions. The author systematically analyzed the development of each link in the pre-hospital emergency support for the 2022 Beijing Winter Olympic Games, summarizes the key links of the entire Winter Olympics cycle, such as the construction of the organizational system, the formulation of support plans, and the training of support personnel, and analyzed the results of related work, so as to provide reference for the pre-hospital emergency support for China to host large-scale international events in the future.

Research on medical insurance data sharing mode based on " City-customized Medical Insurance" / 中华医院管理杂志

With the explosive growth of " City-customized Medical Insurance" products, the voice of commercial health insurance needs medical insurance data support is increasing.The authors took " City-customized Medical Insurance" as the representative of commercial health insurance, analyzed the demands and motivations of stakeholders in medical insurance data sharing through the power-interest matrix model, and summarized the medical insurance data sharing path at the commercial insurance product design end and claim settlement end. It is suggested to strengthen the top-level design, build the implementation path of standardized sharing of medical insurance data and the operation mechanism of hospital data docking, to realize the value increment of all stakeholders.

Application Status, Problems and Suggestions of Commerical Health Insurance in Medical Security for Rare Dsieases in China / 罕见病研究

At present, the diagnosis, treatment, and social security of rare diseases have attracts social attention. As an important part of the multi-level health insurance system in China, commercial health insurance plays an increasingly important role in the supplement to basic medical insurance. Moreover, recently, the benefits of new healthcare reform policies have provided much room and great opportunities for the application of commercial health insurance for rare disease.This paper presents current medical insurance for patients with rare diseases and discuss the necessity and feasibility of bringing rare diseases into the coverage of commercial health insurance, and analyzes the current application and the potential problems of rare disease insurance in the commercial health insurance. This article also gives suggestions to the policies to make full use of the positive role of commercial insurance for the completion of multi-level health insurance system for rare disease.

New characteristics and countermeasures of first aid for astronauts on the Shenzhou 12 space station mission / 中华急诊医学杂志

Objective:Summarize the experience of the medical rescue team at the main landing site of China's manned space mission, analyze the new characteristics of the Shenzhou 12 space station mission, and take corresponding countermeasures and measures to ensure the strong medical rescue guarantee for astronauts.Methods:Search the publications about astronaut medical aid domestic and abroad, summarize the rescue and medical aid experiences from Shenzhou 5 to Shenzhou 11. In consideration of prolonged on-orbit time, Location adjustment of the landing site and the new characteristics of the complex terrain, new targeted strategies were presented.Results:The astronauts flew in orbit for 90 days, and the main landing site and launch site are in the same area. The medical security includes three parts: launch section, running section and return section. Desert rescue model were added. Ten injuries were simulated and each injury first-aid procedure was standardized.Conclusion:After targeted improvement and optimization, the Shenzhou 12 astronauts medical rescue support program ensures the safety of the whole process, all-weather and all-terrain emergency and rear delivery of the astronauts in the new mission environment and complex terrain.

Practice of medical care and rescue Amne Machin extreme cross-country challenge / 中华危重病急救医学

Objective:To share the practice of medical care and rescue in the 2017-2019 Amne Machin extreme cross-country challenge.Methods:At the invitation of the Organizing Committee of Amne Machin extreme cross-country challenge of Maqin County of Qinghai Province. More than 150 medical personnel were sent to make the rescue plan and implement the medical security for three consecutive years. The support was divided into leading command group, expert consulting group, on-site medical support group, rear medical support group, and medical material support group. The on-site medical support group was equipped with the ambulance, corresponding emergency medical equipments and medicines to provide medical support at eight medical stations from the starting point to the endpoint and along the route between each station.Results:There were no cardiac arrest and sudden death cases during the three competitions. A total of 56 patients (5 cases of combined injuries) were received, including 21 cases of mild altitude reaction, 8 cases of abrasions, 13 cases of muscle spasm and strain, 11 cases of hypoglycemia, and 3 cases of abdominal pain. All the injured were treated and observed in time. Each patient achieved a complete remission.Conclusions:To achieve the success of medical security of the highest average altitude cross-country race certified by International Trail Running Association (ITRA), we must formulate a scientific and perfect medical security work plan in the first place: pre competition physical examination, especially the application of sports cardiopulmonary function test, screen out athletes who may have medical accidents; during the competition, focus on monitoring and tracking the players who may have problems; each support point is closely connected with the support vehicle; do a good job of first aid training for all kinds of personnel, so that medical accidents can be found, aided, and transferred at the first time. The medical care and rescue of Amne Machin extreme cross-country challenge have played a good role in the security of the international plateau sports events, which provides a reference for the security of similar events.

The Enlightenment of Foreign Drug Security System for Rare Diseases to China / 中国药学杂志

OBJECTIVE: To explore the suggestions for the development of the medical security system and the medication for rare diseases (orphan drugs) in China and analyze the current progress of orphan drugs in China as well as other developed countries. METHODS: Based on literature search, the policies related with orphan drugs well as the medical security policies for patients with rare diseases in China and abroad were analyzed and summarized. RESULTS: Through analysis, it was found that the definition, regulation, and the research and development for orphan drugs started early in the developed countries and had made good progress. At the same time, they have relatively sound medical security system for rare diseases. At present,China has not established a complete policy, regulation and medical security system for rare disease, nor has an official definition of rare diseases. However, in recent years, China's policies on the research and approval of rare diseases and as well as medical serurity are improving day by day. CONCLUSION: Although China has not yet established a complete and perfect policy system for rare diseases, it has already made a series of policies according to our specific national conditions, which narrowed the gap between China and other developed countries. Our country should learn from foreign experience and consider the actual situation of our country, further complete the policies for rare diseases, and improve the diagnosis and treatment of patients with rare diseases.

First aid cardiopulmonary resuscitation at the exit of capsule and strategy coping with the "Shenzhou 11"spacecraft / 中华急诊医学杂志

Objective To summarize the medical security experience in first-aid and resuscitation for astronauts at the exit of capsule after the spacecraft returns to the main landing site in the process of human spaceflight in China,and thus to provide a powerful security measures for Chinese aerospace medicine.Methods The medical support experiences were summarized in human spaceflight from "Shenzhou V" to "Shenzhou X",relevant reports on emergency rescue and resuscitation were consulted in in-orbit process and after emergency return and landing for domestic and foreign astronauts,astronauts' physiological changes in cardiopulmonary resuscitation were analyzed during emergency return,and then,corresponding strategies were proposed and tested in practice (actual combat) by combining with the flight characteristics of the spacecraft "Shenzhou XI".Results On the basis of the original emergency treatment,the countermeasures for the cardiopulmonary resuscitation were proposed after the spacecraft returned to the main landing site in human spaceflight,the emergency equipment was adjusted,the emergency procedures were optimized,and anti-fog glidescopes were added,laryngeal masks were introduced to perform supraglottic ventilation as the quickest and most effective airway opening measure on site.In addition,ultrasound examination was applied in practice as an important treatment and assessment method for basic life support and advanced life support.All these could ensure the rescuing ability on cardiopulmonary resuscitation during their stay in space for the medium-term and after their return to the main landing site.Conclusions During the return of the astronauts of the spacecraft "Shenzhou XI" to the main landing site,the first aid and support program had been improved specifically and the process had been optimized to ensure the successful completion of medical security mission of China's human spaceflight.

Exploration of the transformation of medical insurance system to health security system under Healthy China / 中国卫生政策研究

The national strategy of Healthy China clearly establishes the health insurance system,which would control health risk factors and enhance hygiene factors to safeguard the citizens's; health. There are some difference in goals,forces,contents, and compensation mechanism between health insurance system and medical insurance sys-tem. The conversion from medical security system needs to take actions including of extending the security contents, health-centered medical insurance,a combination of medical treatment and endowment. Health-centered medical in-surance reform needs to start with extending health contents and payments reform,enhancing the controlling and guid-ing the health delivery system. This is also the inevitable direction for the development of medical insurance.