深圳社区健康服务中心医师日均担负诊疗人次为40.77人次，该数据明显高于医院，这是深圳市卫生统计简报（2011年上半年）显示的结果之一。
作为二级医疗网点组成，社区健康服务中心承担常见病、多发病诊疗任务，及时治疗、处置居民轻症。社区健康服务中心一旦发现及急、危、重症，在做好院前急救的同时，通过急救转运系统转往综合医院进行恰当医学处理。同时，综合医院配备良好的诊断设备，社区发现的复杂病例经过转介服务，在综合医院完成必要的确诊，实现医疗资源整合。
社区疾病谱以轻微疾病为主，外加医疗保险的付费调节政策，有利于居民主动选择社区健康服务中心。也体现了社区医疗机构的服务便利性。
在澳大利亚，类似的社区医疗机构称为 multi purpose health centre，general practice，或 practice surgery。名字不同，功能却同归殊途，降低病人在高级医疗资源上不必要的成本支出。
1996年，深圳开始发展社区健康服务，也称为社区卫生服务。
经过两个晚上努力，解决了一些 html 语法错误和 CSS 混乱，本地医生、护士使用的上网导航 （Health Care Navigator）终于挂到二级域名以下。
9月份浏览澳大利亚全科医生网页时受到启发，把卫生保健资源挂到网页上，这是澳大利亚信息化的一个做法。我想，在自己的博客上如此这般，一能够方便深圳的健康工作者快速找到网络办公、网络信息支持资源，无需加入浏览器长长一列收藏夹，也不用一时慌张四处寻找；二可以增加使用者对不同健康、健康服务网页的使用量。
第二点其实很多人都熟悉这两个术语：知晓率、使用率。
大家用了之后有任何意见，希望增减网页信息、优化排版，都可以告诉我。
无论是专科医生（specialist）还是毕业生（GP registra），如果要在澳大利亚从事全科医学服务（general practice）均要通过必要的入门考试，并且要通过全科医师培训，以达到 RACGP （皇家澳大利亚全科医学院）的认证系列条件。如此严格，是为了实现“以病人为中心”的理念，规范 GP 行为。John Murtagh 教授是 patient-centered care 的提出人。
Frank，塔斯马尼亚州一位全科医学培训师，从事全科医学服务30年，兼职新入门 GP 的理论培训、思维开发、行为训练。以下视频中，Frank 演示了作为一个普通全科医生应该如何聆听、关注病人的问题和体验，怎样抓住病人就诊的关键问题，和居民健康管理。
该视频节选自 General Practice Consultations DVD – Existing Patient of Practice/New Patient of Practice，适合医学院校、医学继续教育使用。GPTT 接受澳大利亚海外订购该培训光碟，联系方式为：
General Practice Training Tasmania
206 New Town Road
NEW TOWN
Tasmania 7008
T: +61 3 6278 1551
F: +61 3 6228 7452
Email: enquiries@gptt.com.au
Website: www.gptt.com.au
澳大利亚公民，无论是否有工作、住所，享受全民医疗保险覆盖。访问一次全科医生后，从 Medicare 支付 80AUD，而且必须提前向社区健康服务中心预约。
再次感谢 Frank 对我们深圳全科医生骨干考察团一行的培训。
Recently, Brain Stroke Health Centre is set up in Shenzhen Second People’s Hospital, which has been accredited by Ministry of Heath, according to local news media Shenzhen News Net.
@mryebin Hypertension is one of the risk factors to vascular diseases, and it causes some brain stroke, while heart attacks are popular in western countries.
The major duties of Shenzhen Brain Stroke Health Centre (BSHC Shenzhen) are screening, evaluation brain stroke cases, whilst disease controlling as well. Cerebrovascular accidents will lead to physical activity dysfunction in most cases, and decrease the victim’s qualities of life.
Besides Shenzhen City, Zhuhai, and Foshan also set up Brain Stroke Health Centres.
Mail to me if you have more details.
这次的英语视频更有挑战，我发现其中对话中一名男性的喉音很重，有若干处无法掌握。但是不影响信息沟通。就像听日本人说英语，整句话几乎都明白，但是不能指望掌握每一个单词。
GP: So eh, what brought you in today?
Client: Ah, I’ve got a really soar right foot. GP: mhm.
Client: Yes, it’s really a sort of pain foot. GP: Uh. Right. Client: Yep, yep.
GP: So, Just tell me a bit more about that and …
Client: Ah, I woke up in the morning bed two days ago. GP: Er huh.
Client: And I er did it too much of tap at that time, but then just increasingly worse.
GP: Er huh.
Client: You know as I were on, I haven’t been to work for last couple of days.
Client: I can’t put anything on it. So hence the kind of cover, you know, the big clothes on it when I am sleeping. So it’s …
GP: Right.
GP: Right. Yes. So what about the reason for is it?
Client: Uh, it’s just on my right big toe.
GP: Uhur. OK. Yeah.
GP: So come back to that at the moment. Client: Yep. GP: Is there anything else you come about today?
Client: Yeah. Ur, I pretty would like a skin check.
GP: Yeah.
Client: Yes, well. Just for, you know, ur cancer.
GP: Yep. Client: Yep.
Client: Ur, mind that I have ur a move the days, I thought it’s a good idea I come in and get that check too.
GP: Yes.
GP: Uha. Mhm.
Client: Yep. And a prostate check as well.
GP: OK. Client: Yes.
GP: So ur what’s the … propstate of the …
Client: I saw it on the television.
GP: Yeah.
Client: So I thought “Oh yeah … get that done as well”.
GP: Sure.
GP: It’s the check about postate cancer …
Client: Yeah, that’s right.
GP: a sort of thing.
GP: Sure, sure.
GP: Was there anyting you come for today?
Client: No, no that’s all why me in.
GP: Sure.
Client: Just thoses things.
GP: Sure, OK. Then, so I just clarify that we’ve got three things to deal today.
GP: Your uh fault on your toe, and we got postate check, and your skin check.
Client: Yep.
Client: Yep.
GP: Which is the most important for you today?
Client: Uh, it’ll be the toe right now.
GP: OK, right. So we can reshedule your another visit…
Client: Sure.
GP: and deal with the skin test and the postate next time. Is that OK?
Client: Yep.
GP: Sure.
脱离英语听说环境20天，感觉自己反应迟钝，找了一段视频来练习练习，力争听清楚每个词。
GP: John Masten?
Client: THX.
Client: [groaning] Huh…
GP: Hi, John.
Client: Hi.
GP: Come through.
Client: THX.
GP: Good. Warming up outside now?
Client: Yeah, it’s good a lot about now.
GP: Oh, it’s good.
GP: Have a seat in.
Client: THX.
GP: I’m Dr Jon Jaytons.
Client: Hi.
GP: Yes. So you’re new to this practice?
Client: Yeah, yeah.
GP: Right.
Total 24 seconds.
Tuesday, October 25, 2011 of local time , Australia Melbourne Monash University Research Fellow Mr Christopher Anderson visited Shenzhen Continuing Medical Education Centre ( CME Shenzhen ) and had a conversation with GP representatives. The GP representatives were from surgery practices of local city and rural areas, practicing in community health service in different medical fields such as gynecology, general surgery, or cardio@mryebinlogy.
Unlike medical system in Australia, Shenzhenese can visit any community health centres, clinics or a hospitals consulting room as they wish. Whilst the public health insurance have already set up programmes to encourage these health buyers who use the community practice only pay 70% for drugs in general dispensary catalogue.
CME Shenzhen hosted Christopher’s visit and he instroduced his research on gambling problems in Australia, which had already drew series trouble to gamblers themselves, their families and the communities as well. The research team in Medicine, Nursing and Health Science School of Monash University had been working with RACGP, The Royal Australian College of General Practitioners, and set up guideline for GPs to idendify gambling problems from client’s visiting.
Some gamblers suffer from depressions, stressess, human relationship conflicts and they commonly are covered by simple symptoms and complaints. A visitor to the surgery practice probably would not tell his gambling history to the GP. According to the new guideline, GPs may transfer gambling addiction cases to special consultants for further psychological and mental services.
Mr Christopher Anderson just finished a international problem gambling conference in Beijing before his arrival to Shenzhen. Local GP representatives showed their interest to gambling problems in Australia as a public health topic. They also invited Christopher to visit Shenzhen again to explore local GP systems.
Mr Anderson is currently the coordinator of the Primary Health Care Research Evaluation and Development Initiative.
以一篇题为Oral corticosteroids for stable chronic obstructive pulmonary disease 流行病学报告为对象，分析澳大利亚医学报告的结构，以了解这个国家可研报告格式，方便检索后的精读。
以上结构比起我见到的中文医学科研结构更精细，但是更好理解。
第一部分，说明研究背景，为进一步引出研究目的做铺垫。
第二部分，明确研究目的。这里 objectives 是复数形式，意味着个别情况下可以研究 2 个或以上的目标。当然这受到研究资金、人力、时间等医学科研资源影响。按照我自己经历过的流行病学研究，研究地区越大，资金耗费越多，有条件一次性了解多个问题。
第三部分，研究的时间范围，材料或工具。例如在 Oral corticosteroids for stable chronic obstructive pulmonary disease，研究者使用Cochrane Airways Group Specialised Register ，MEDLINE 两个数据库，实验过程从2003年12月开始，2004年12月结束。一旦其他研究人员怀疑本次科研可重复性，能够根据这些条件予以重复。此处或者可以提临床试验采用的医疗设备、诊断标准。
第四部分，研究对象的进入、离开。由于这是一个临床试验，必须排除不属于研究范畴的病人在外，例如普通的糖尿病人、普通的上呼吸道感染病人……，仅仅让 COPD 患者成为研究对象。实际执行中，研究对象有可能发生死亡、搬迁到其它城市，或者虽然签署了知情同意书、愿意参与研究，但是科研没有结束前个别研究对象后悔退出。这些情况都要提前设定好，限定统计学处理方案，以免真正碰到特殊情况无法处理，或直接影响到数据处理的结果。
第五部分，数据收集、整理、分析和反馈的工具，例如使用某种生物统计方法，使用哪一个统计软件。这里报告了两个独立的分析人员使用 Review Manager (version 4.2.7 @mryebin)独立、分别、重复输入研究得到的病人数据，进行分析。这在流行病学设计叫“盲法”，避免研究过程受到主观误导和干预。
第六部分，客观、中性陈列调查结果，结果是可以比较的数据、数字。而不是虚意的形容词“明显提高”、“得到改善”。
第七部分，结论。结论部分出现观点，“好”、“不好”，或者阴性的结果也可以提示研究得出一个假设。
以上说明我们的医学科研过程和报告结构和澳大利亚流行病研究大致相近，我期望这能为社区医生、全科医生带来启发。
