肿瘤死因乡镇培训教材

肿瘤死因乡镇培训教材 死因监测工作 规范 编程规范下载gsp规范下载钢格栅规范下载警徽规范下载建设厅规范下载 目的 ,通过在全县开展死因监测工作，掌握我县居民死亡的流行状况及其变化趋势; ,从而了解人群健康与死亡水平、死亡原因、死亡顺位、预期寿命和死亡率变化趋势等指标; ,为评估我国卫生及相关政策提供信息，为政府保障公民健康决策提供科学依据。 ,监测范围 监测覆盖全县100%的乡、镇、村。 ,监测对象 为发生在辖区内的所有户籍死亡个案。 ,监测工作周期 每年1月1日至12月31日。 工作内容 ,开展死因监测常规工作。各级各类医院和基层医疗卫生机构均为死因监测工作的责任报告单位。 ,(1)院内死亡，由临床医生填写死亡医学证明书，并由专人通过网络直报系统填报死亡个案信息。 ,(2)院外死亡，应建立村(居)委会、乡镇(街道)、县(区)逐级死因数据报告网络，由村医或社区卫生服务站医生向乡镇 卫生院或社区卫生服务中心防保人员报告死亡数，防保人员和临床医生负责开展死因流行病学调查，填写死亡医学证明书，并通过网络直报系统填报死亡个案信息。 工作职责,,医院 ,依据死因监测规范，建立院内死因登记报告流程和步骤，规范填写死亡医学证明书。 ,定期进行院内考核和 评价 LEC评价法下载LEC评价法下载评价量规免费下载学院评价表文档下载学院评价表文档下载 。 ,指定专门人员定期收集、审核本医院出具的死亡医学证明书，审核合格后通过网络进行直报，并及时复核辖区疾控机构反馈的信息。 ,定期对村级卫生所进行漏报调查，对其报告工作进行检查评估。 工作职责,,基层医疗卫生机构 ,(1)社区卫生服务中心和乡镇卫生院 ,指定专门人员负责所辖街道的死因监测管理工作;收集所辖服务站、卫生室的死因登记信息，统一上报; ,对死因明确的个案进行网络直报;对死亡原因不明的个案，开 ,展死因推断并进行网络直报; ,及时复核辖区疾控机构反馈的有关死亡原因不明的个案;配合收集所辖街道、乡镇上一年度分年龄和性别的人口等资料，并提供给辖区疾控机构。 ,(2)社区卫生服务站和村卫生室 ,指定专门人员负责出具死亡证明，按照要求定期上报到所属社区卫生服务中心、乡镇卫生院;及时复核上级反馈的信息或死因不明的个案。 信息收集 ,《死亡医学证明书》 ,一般项目 ,致死的主要疾病诊断 ,其他项目 死亡医学证明书各联流向 网络报告 1.死因信息报告方式 ,《死亡医学证明书》及副卡通过《中国疾病预防控制信息系统》平台上的《全国死因登记报告信息系统》进行网络直报。 ,)5 岁以下儿童死因登记报告副卡。 ,孕产妇死因登记报告副卡。 2. 报告程序、时限 ,县及县级以上医疗机构 to comply with the requirements. (6) pressure pipes are installed according to the design requirements of the system pressure test, segmented tiered when pressure testing to be carried out in sequence, drainage, stormwater pipes to do water testing, and recording, pressure test failed or untested pipeline may not be concealed. Test pressure is the pressure piping installation one stops. (7) the control interface of pipeline leakage from the processing begins. Thread processing to tight fit, length should comply with the requirements. Flange after welding to check end verticality, checking the welding quality. (8) electrical engineering should control the grounding line of weld quality and laying of pipeline quality, timely measurement of grounding resistance, and completes the record. (9) the phase and neutral and ground wire to strictly control the installation location may not be wrong, to multi color lines as required. (10) the distribution box, distribution bottle Shell to a separate ground line, shell transitions can not be used. (C) the pipeline installation engineering 1. construction sequence (1) be familiar with design drawings and related technical information; (2) construction survey and setting out; (3) cooperate with the reserved, embedded civil work; (4) pipe and tube processing (5) support (hanging) production; (6) the pipe prefabrication and Assembly; (7) the pipe laying and installation; (8) the pipes connected to the device; (9), instrumentation and piping installed; (10) pressure test and cleaning (blowing) washing; (11), anti-corrosion and thermal insulation; (12) acceptance. 2. construction conditions (1) the design drawings, specifications and other technical documentation is complete, and after a trial. (2) construction project ,由病案室或防保科在7天内完成对卡片的审核和网络报告。(将《死亡医学证明书》死因链、调查记录等原始信息如实录入，并进行根本死因确定及编码。) ,不具备网络报告条件的医疗机构，收到《死亡医学证明书》7天内向属地的县(区)级疾病预防控制机构报出。 ,县(区)级疾病预防控制机构收到报告卡后，应在5个工作日内代为完成网络报告。 2. 报告程序、时限 ,县级以下医疗机构 ,乡镇卫生院(社区卫生服务中心)防保医生将收集到的《死亡医学证明书》，在30天内完成审核及网络报告;(将《死亡医学证明书》死因链、调查记录等原始信息如实录入。) ,不具备网络报告条件的医疗机构，收到《死亡医学证明书》后向属地的县(区)级疾病预防控制机构报出。 ,县(区)级疾病预防控制机构收到报告卡后，应在5个工作日内代为完成网络报告。 ,其他医疗卫生机构 ,其他系统(军队、司法、农垦等)的医疗卫生机构应按照本 规定 关于下班后关闭电源的规定党章中关于入党时间的规定公务员考核规定下载规定办法文件下载宁波关于闷顶的规定 进行死因登记报告。 信息管理 1、死亡信息的审核 ,医疗机构的死亡报告管理人员对填报的《死亡医学证明书》自查; ,县(区)级疾控中心、妇幼保健机构的死亡报告管理人员网络审核报告信息 ,每个工作日需上网对辖区内报出的死亡信息、孕产妇和5岁以下儿童死亡信息进行审核 ,对于核实无误的《死亡医学证明书》及副卡，应于7天内通过网络进行审核确认。 ,县(区)疾控中心负责县级以下医疗机构报告死亡病例的根本死因确定和死因编码(具备条件的县级以下医疗机构也可承担根本死因确定和死因编码工作。) 信息管理 2、死亡信息的订正 县(区)级疾控中心负责订正; 3、死亡信息的补报 在质控过程中发现了漏报的死亡病例，应及时补报; 4、死亡信息的查重 每周对报告信息进行查重，对重复报告信息进行确认后删除; 资料保存与管理 1.报告单位和县(区)疾控中心应妥善保存死因登记信息原始资料; 2. 报告单位和县(区)疾控中心应定期下载个案数据和储存本单位网络上报的原始数据库，并采取有效方式进行数据的长期备份。 各级各类医疗机构 ,县及县以上各级各类医疗机构 :填写、收集和报告《死亡医学证明书》，专人负责网络报告。 ,乡镇卫生院(防保站)、社区卫生服务中心:收集死亡信息，填报死亡医学证明书、核对补漏，开展质量控制，专人负责网络报告。 ,村级卫生所及其他医疗机构:收集死亡信息，协助入户调查工作。 考核与评估 ,一般采取网络报告资料考评与现场考评相结合的方式， ,上级疾病预防控制中心对下级疾病预防控制中心至少每年考评一次，县(区)疾病预防控制机构对辖区全部报告单位的考评至少半年一次， 医疗机构内部至少每季度考评一次。 ,主要包括组织管理、网络建设、培训情况、报告质量、资料分析与利用等综合评价指标。 ,粗死亡率6‰以上;死因及时报告率95%以上;及时审核率95%以上;漏报率小于5% 。 死亡个案漏报 ,对医疗机构死亡个案，重点是健全医院内登记报告和定期核查 制度 关于办公室下班关闭电源制度矿山事故隐患举报和奖励制度制度下载人事管理制度doc盘点制度下载 ，对急诊科、儿科的死亡记录、抢救记录等进行定期核对; ,对医院外(在家、途中或外地等)死亡个案，应发挥村医(社区医生)的作用，尽可能及时上报死亡个案; 县区疾控中心重点要加强对医疗及基层卫生机构的管理和技术指导，包括:落实例会制度;及时反馈审核及督导意见，并限期落实;针对死亡证填写、死因编码等存在问题进行重点培训，等等。 ,通过与公安、民政、妇幼等部门建立定期核查制度，及时补充; ,定期开展漏报调查。 目前死因监测工作中的重点技术问题 to comply with the requirements. (6) pressure pipes are installed according to the design requirements of the system pressure test, segmented tiered when pressure testing to be carried out in sequence, drainage, stormwater pipes to do water testing, and recording, pressure test failed or untested pipeline may not be concealed. Test pressure is the pressure piping installation one stops. (7) the control interface of pipeline leakage from the processing begins. Thread processing to tight fit, length should comply with the requirements. Flange after welding to check end verticality, checking the welding quality. (8) electrical engineering should control the grounding line of weld quality and laying of pipeline quality, timely measurement of grounding resistance, and completes the record. (9) the phase and neutral and ground wire to strictly control the installation location may not be wrong, to multi color lines as required. (10) the distribution box, distribution bottle Shell to a separate ground line, shell transitions can not be used. (C) the pipeline installation engineering 1. construction sequence (1) be familiar with design drawings and related technical information; (2) construction survey and setting out; (3) cooperate with the reserved, embedded civil work; (4) pipe and tube processing (5) support (hanging) production; (6) the pipe prefabrication and Assembly; (7) the pipe laying and installation; (8) the pipes connected to the device; (9), instrumentation and piping installed; (10) pressure test and cleaning (blowing) washing; (11), anti-corrosion and thermal insulation; (12) acceptance. 2. construction conditions (1) the design drawings, specifications and other technical documentation is complete, and after a trial. (2) construction project 出生及人口信息的准确性 ,与妇幼、计生部门的合作; (出生资料中能产出0岁组死亡率或婴儿死亡率的分母。) ,通过户籍部门等途径及时掌握监测区域人口流动比例，掌握实际常住人口比例。 目前死因监测工作中的重点技术问题 死亡信息填写的完整性 ,发现死亡个案后应及时登记、追踪，定期上报; ,填写死亡证的医生应了解填写死亡证的目的和填写死因相关内容的基本原则; ,对在家死亡者、到达医院时已经死亡或院前急救过程中死亡者，应根据相关知情人提供的情况尽可能详细地填写调查记录和进行死因推断; ,死亡信息中，各种疾病诊断的间隔时间以及其他重要疾病情况也应尽可能填写详细，以能为根本死因的确定和推断提供尽可能多的原始信息。 总结 ,死因数据属基础性资料。 ,死因工作网络的正常运行不仅为提供死因数据服务，还是众多其他疾控工作的基础。 ,加强基层人员培训、督导和日常数据质量控制，才能够从根本上减少漏报，逐步提高数据质量。 ,ICD体现了预防的思想，需要加强预防与临床部门的合作。 ,应及时分析、利用数据和向各方反馈结果，并加强横向和纵向交流。 ,认真、责任心。死因工作中，相当一部分是责任心问题(以及部门协作问题)，而非技术问题。 临床医生如何正确填写《死亡医学证明书》 一、死亡医学证明书的用途 死亡医学证明书是由医务人员对死亡者填写的一种具有法律效力的证明文件，其用途主要包括: 1、是居民死亡的法定记录文件，属于法律凭证。 2、居民死亡医学证明，记载死者各项基本情况及死亡原因，有关部门据此注销户口，办理殡葬火化等手续。 3、是死亡原因的原始资料，卫生部门利用它可以进行居民健康状况的专题研究，提出优先解决的公共卫生问题，为制定卫生工作方针，采取防病措施，提供科学依据。 4、用于保险、遗产等群众性、社会性凭证及公证，成为其必备的文件。 二、基本概念 死亡原因:1967年，第二十届世界卫生大会对将记入死亡原因医学证明书中的死亡原因做如下定义:“所有导致或促进死亡的疾病、病态情况或损伤以及造成任何这类损伤的事故或暴力的情况”。定义的目的在于保证所有有关信息得以记录，而证明人不得自行选入某些情况而摒弃其他情况。这个定义不包括症状、体征和临死方式，如心力衰竭或呼吸衰竭。 根本死亡原因:从防止死亡的观点出发，有必要去中断可能致死事件的链条或某个环节治愈病人。最有效的to comply with the requirements. (6) pressure pipes are installed according to the design requirements of the system pressure test, segmented tiered when pressure testing to be carried out in sequence, drainage, stormwater pipes to do water testing, and recording, pressure test failed or untested pipeline may not be concealed. Test pressure is the pressure piping installation one stops. (7) the control interface of pipeline leakage from the processing begins. Thread processing to tight fit, length should comply with the requirements. Flange after welding to check end verticality, checking the welding quality. (8) electrical engineering should control the grounding line of weld quality and laying of pipeline quality, timely measurement of grounding resistance, and completes the record. (9) the phase and neutral and ground wire to strictly control the installation location may not be wrong, to multi color lines as required. (10) the distribution box, distribution bottle Shell to a separate ground line, shell transitions can not be used. (C) the pipeline installation engineering 1. construction sequence (1) be familiar with design drawings and related technical information; (2) construction survey and setting out; (3) cooperate with the reserved, embedded civil work; (4) pipe and tube processing (5) support (hanging) production; (6) the pipe prefabrication and Assembly; (7) the pipe laying and installation; (8) the pipes connected to the device; (9), instrumentation and piping installed; (10) pressure test and cleaning (blowing) washing; (11), anti-corrosion and thermal insulation; (12) acceptance. 2. construction conditions (1) the design drawings, specifications and other technical documentation is complete, and after a trial. (2) construction project 公共卫生目的是阻止加速死亡原因起作用。为此目的，WHO把根本死亡原因定义为:“(a)直接导致死亡的一系列病态事件中最早的那个疾病或损伤，或者(b)造成致命损伤的那个事故或暴力的情况”。 最早发生的病引起其他疾病有因果关系的，那个最早的病就是根本死亡原因。就是一种起主导作用的，带有根本性的疾病或损伤，由于它的存在，发生及发展，逐渐形成一连串的病态事件，并最终导致死亡。 死因链的确定: 疾病:疾病1?疾病2?疾病3„?死亡 举例:某人因30年前患慢性支气管炎，10年前引起肺气肿， 5年前引起肺心病并逐渐加重并最终导致 死亡。 本例的死因链确定为:慢支?肺气肿?肺心病?死亡， 最早的“引起一系列直接导致死亡事件的那个疾病”就是“慢性支气管炎”。 损伤/中毒:外部原因?临床表现?死亡 举例:某人因在道路上行走时意外被卡车撞倒引起颅骨骨折、颅内损伤并最终导致死亡。本例的死因链确定为:意外被撞?颅骨骨折?颅内损伤?死亡，最早的“引起一系列直接导致死亡事件的那个损伤”就是“颅骨骨折”，而造成“颅骨骨折”的外部原因是 “在道路上行走时意外被卡车撞倒”。 三、死亡医学证明书的基本格式 1992年卫生部、公安部、民政部根据世界卫生组织制定的统一的“国际死亡原因医学证明”，颁发了我国的“死亡医学证明书”，供各地统一使用。基本格式见附件。 居民死亡医学证明书 省 市 区(县) 街道(乡) 编号: 死者 性 1.男 民 主要职业 身份证常住户 姓名 别 2.女 族 及工种 编 号 口住址 婚姻1.未2.已3.丧4.离9.不 文化1.文盲或 2.小 3.中 4.大 9.不 生前工 状况 婚 婚 偶 婚 详 程度 半文盲 学 学 学 详 作单位 出生 死亡 实足 死亡地点1.医院 2.急诊室3.家中或 日期 年 月 日 日期 年 月 日 年龄 赴医院途中 4.外地及其他 9.不详 可以联系的 住址或 家属姓名 工作单位 to comply with the requirements. (6) pressure pipes are installed according to the design requirements of the system pressure test, segmented tiered when pressure testing to be carried out in sequence, drainage, stormwater pipes to do water testing, and recording, pressure test failed or untested pipeline may not be concealed. Test pressure is the pressure piping installation one stops. (7) the control interface of pipeline leakage from the processing begins. Thread processing to tight fit, length should comply with the requirements. Flange after welding to check end verticality, checking the welding quality. (8) electrical engineering should control the grounding line of weld quality and laying of pipeline quality, timely measurement of grounding resistance, and completes the record. (9) the phase and neutral and ground wire to strictly control the installation location may not be wrong, to multi color lines as required. (10) the distribution box, distribution bottle Shell to a separate ground line, shell transitions can not be used. (C) the pipeline installation engineering 1. construction sequence (1) be familiar with design drawings and related technical information; (2) construction survey and setting out; (3) cooperate with the reserved, embedded civil work; (4) pipe and tube processing (5) support (hanging) production; (6) the pipe prefabrication and Assembly; (7) the pipe laying and installation; (8) the pipes connected to the device; (9), instrumentation and piping installed; (10) pressure test and cleaning (blowing) washing; (11), anti-corrosion and thermal insulation; (12) acceptance. 2. construction conditions (1) the design drawings, specifications and other technical documentation is complete, and after a trial. (2) construction project 致死的主要疾病诊断(请填写具体的病名，勿填症发病到死亡的大概时间隔 状体征) ?.(a)直接导致死亡的疾病或情况: (b)引起(a)的疾病或情况: 第(c)引起(b)的疾病或情况: 二 联 ?.其他疾病诊断(促进死亡，但与导致死亡无关的 其他重要情况) 死者生前上述疾病的 1.省级(市)医院 2.地区级(市)医院 3.县级(区)医院 最高诊断单位: 4.乡级卫生院 5.乡村医生 6.未就诊 9.其他及不详 死者生前上述疾病1.尸检 2.病理 3.手术 4.临床+理化 5.临床 6.死后推断 9.不详 的最高诊断依据: 住院号: 医师签名: 单位盖章: 填报日期: 年 月 日 (以下由统计人员填写)根本死亡原因: ICD编码: 统计分类号: 损伤中毒的外部原由: E编码: 统计分类号: 我国的《死亡医学证明书》简称《死亡证》，共分四联。第一联:为出证单位存根;第二联:用于计算机录入,由出证单位直接报送至所在县(区)疾控机构;第三联:为户籍管理部门注销户口凭据;第四联:为殡葬火化凭据 四、死亡医学证明书的填写方法 必须由熟悉死者情况的医生填写 一般填写要求 按照实际情况填写每一项目，字迹清晰，不缺项，不错项。如为婴儿，可同时填 “某某之子”或“某某之女”。身份证:填写15位或18位身份证号码，注意与出生日期保持一致。 死亡原因的填写分三部分，第一部分-直接导致死亡的原因，第二部分-促进死亡的原因，第三部分-发病至死亡之间大概的时间间隔 1、第I部分死亡原因:填写导致死亡的疾病、损伤或并发症。 ?按照导致死亡的顺序填写，由(a)到(d)共4行，各行的逻辑关系是(d) ,(c) ,(b) , (a) ,死亡。直接致死疾病或情况填入a行，引起a行的疾病填入b行，依次类推填写c行、 d行。最早的疾病或情况填入第?部分的最低一行，各行并不一定非要填满。如果在一系列事件中只有一个步骤，则在I (a)行上记入一条就足够了。 如果存在多于一个步骤，则直接原因记(a)行，而起始前因记在最后一行，任何中介原因则要记在(b)行或(b)行和(c)行。 to comply with the requirements. (6) pressure pipes are installed according to the design requirements of the system pressure test, segmented tiered when pressure testing to be carried out in sequence, drainage, stormwater pipes to do water testing, and recording, pressure test failed or untested pipeline may not be concealed. Test pressure is the pressure piping installation one stops. (7) the control interface of pipeline leakage from the processing begins. Thread processing to tight fit, length should comply with the requirements. Flange after welding to check end verticality, checking the welding quality. (8) electrical engineering should control the grounding line of weld quality and laying of pipeline quality, timely measurement of grounding resistance, and completes the record. (9) the phase and neutral and ground wire to strictly control the installation location may not be wrong, to multi color lines as required. (10) the distribution box, distribution bottle Shell to a separate ground line, shell transitions can not be used. (C) the pipeline installation engineering 1. construction sequence (1) be familiar with design drawings and related technical information; (2) construction survey and setting out; (3) cooperate with the reserved, embedded civil work; (4) pipe and tube processing (5) support (hanging) production; (6) the pipe prefabrication and Assembly; (7) the pipe laying and installation; (8) the pipes connected to the device; (9), instrumentation and piping installed; (10) pressure test and cleaning (blowing) washing; (11), anti-corrosion and thermal insulation; (12) acceptance. 2. construction conditions (1) the design drawings, specifications and other technical documentation is complete, and after a trial. (2) construction project ?每行只能填写一个疾病; ? (a)行至少要填写一个疾病; ?发病距死亡的时间间隔应尽量填写，(a)到(d)的时间长度一定是从短到长。 ?填写的行数是不限定的，根据情况可增加填写(e)、(f)等行。 ?不要只填写临死方式/情形，例如“呼吸衰竭”、“循环衰竭”、“全身衰”等。 例1 I (a) 食道静脉曲张出血 (b) 门静脉高压 (c) 肝硬变 (d) 乙型肝炎 第 I 部分(a)、(b)、(c)三栏，其相互之间的逻辑关系是: (C) 病(根本死因)发展 (b)病(中介原因发展 (a)病(直接死因)导致 死亡。 2、第?部分 是对第?部分的补充，填写促进死亡但与导致死亡无关的疾病或情况，应根据具体情况填写。 ?填写所有促进死亡、但与第I部分死亡原因顺序无关的疾病; ?按照严重程度依次填写，无数目限制 ?没有也可以不填。 3、发病到死亡的大概时间间隔:指第?部分报告的疾病从发病到死亡之间的间隔时间(时间单位为:分、 时、天、周、月或年)，如询问不清，可以不填。一般情况是(d)病最长，(c)病次之，(a)病最短 小 例:慢支,肺气肿,肺心病,死亡 例:意外被撞,颅骨骨折,颅内损伤? (a) 肺心病 5年 ,死亡 (b) 肺气肿 10年 ? (a)颅内损伤 1小时 (c) 慢支 30年 (b)颅骨骨折 1小时 ? 糖尿病，高血压 (c)行走被撞 1小时 死亡原因的填写举例 a、有明确的死因链应按顺序报告 例1:I a 心源性休克 例2:I a 上消化道出血休克 b 急性心肌梗死 3 天 b肝、胰转移癌 半年 c 高血压 2 年 c直肠癌 3 年 b、没有明确死因链按严重程度报告 例3: I a 低心排综合征 例4: I a 慢性阻塞性肺气肿 ? 胰岛素依赖型糖尿病 ? 硬皮病 c、应尽可能报告特异性的诊断 例5:Ia 心衰 例6:Ia 铜绿假单胞菌败血症 b 二尖瓣主动脉瓣狭窄合并 b 急性粒细胞性白血病M4型 关闭不全 复发 to comply with the requirements. (6) pressure pipes are installed according to the design requirements of the system pressure test, segmented tiered when pressure testing to be carried out in sequence, drainage, stormwater pipes to do water testing, and recording, pressure test failed or untested pipeline may not be concealed. Test pressure is the pressure piping installation one stops. (7) the control interface of pipeline leakage from the processing begins. Thread processing to tight fit, length should comply with the requirements. Flange after welding to check end verticality, checking the welding quality. (8) electrical engineering should control the grounding line of weld quality and laying of pipeline quality, timely measurement of grounding resistance, and completes the record. (9) the phase and neutral and ground wire to strictly control the installation location may not be wrong, to multi color lines as required. (10) the distribution box, distribution bottle Shell to a separate ground line, shell transitions can not be used. (C) the pipeline installation engineering 1. construction sequence (1) be familiar with design drawings and related technical information; (2) construction survey and setting out; (3) cooperate with the reserved, embedded civil work; (4) pipe and tube processing (5) support (hanging) production; (6) the pipe prefabrication and Assembly; (7) the pipe laying and installation; (8) the pipes connected to the device; (9), instrumentation and piping installed; (10) pressure test and cleaning (blowing) washing; (11), anti-corrosion and thermal insulation; (12) acceptance. 2. construction conditions (1) the design drawings, specifications and other technical documentation is complete, and after a trial. (2) construction project d、对肿瘤致死者应明确报告肿瘤的原发部位及形态学情况 例7:I a 多发脑转移癌 例8:I a 肠梗阻伴消化道出血 b 多发骨转移 b 升结肠肝脾转移癌 c 左下肺高中分化鳞癌 c 胃印戒细胞癌 e、对后遗症情况致死者应明确报告时间间隔 例9: I a 脑梗死 2 年 例10:I a 股骨骨折 3 年 b 高血压 4 年 b 在家意外跌倒 3 年 f、对先天异常致死者，应优先报告严重的先天异常 例11:I a 左室右房异常通道 例12:I a 癫癎持续状态 b 先天性脑发育不良 g、对围生儿死亡，应优先报告围生儿本身严重的疾病 例13:I a 败血症 例14:I a 感染性休克 b 化脓性脐炎 5 天 b 新生儿感染性腹泻 、对损伤/中毒致死者，应同时报告损伤/中毒的临床表现及外部原因。为避免司法纠纷， 可以写明提供外h 部原因者的情况。 例15:I a 颅脑损伤 b 据家属xxx提供系高楼意外坠落 例16:I a 内脏广泛出血，创伤性 b 据随行人xxx提供系驾驶小汽车意外与卡车相撞 死因监测报告程序与时限 1、患者死亡后，由诊治医生填写《死亡医学证明书》; 2、医疗机构指定相关部门专业人员按照ICD,10要求统一进行死因编码; 3、医疗机构应在开具死亡证明书后7天内完成死因编码及网络直报; 4、不具备网络直报条件的医疗机构,应于7天内完成死因编码,将《死亡医学证明书》送疾控机构。 肿瘤登记报告技术 应收集什么样的信息? 个人信息(姓名、出生日期、性别、种族 婚姻状况、职业、籍贯、住址) 肿瘤情况(部位、形态学、生物学行为、病理 及临床分期) 诊断发现(诊断日期、方法) to comply with the requirements. (6) pressure pipes are installed according to the design requirements of the system pressure test, segmented tiered when pressure testing to be carried out in sequence, drainage, stormwater pipes to do water testing, and recording, pressure test failed or untested pipeline may not be concealed. Test pressure is the pressure piping installation one stops. (7) the control interface of pipeline leakage from the processing begins. Thread processing to tight fit, length should comply with the requirements. Flange after welding to check end verticality, checking the welding quality. (8) electrical engineering should control the grounding line of weld quality and laying of pipeline quality, timely measurement of grounding resistance, and completes the record. (9) the phase and neutral and ground wire to strictly control the installation location may not be wrong, to multi color lines as required. (10) the distribution box, distribution bottle Shell to a separate ground line, shell transitions can not be used. (C) the pipeline installation engineering 1. construction sequence (1) be familiar with design drawings and related technical information; (2) construction survey and setting out; (3) cooperate with the reserved, embedded civil work; (4) pipe and tube processing (5) support (hanging) production; (6) the pipe prefabrication and Assembly; (7) the pipe laying and installation; (8) the pipes connected to the device; (9), instrumentation and piping installed; (10) pressure test and cleaning (blowing) washing; (11), anti-corrosion and thermal insulation; (12) acceptance. 2. construction conditions (1) the design drawings, specifications and other technical documentation is complete, and after a trial. (2) construction project 治疗情况(治疗 方案 气瓶 现场处置方案 .pdf气瓶 现场处置方案 .doc见习基地管理方案.doc关于群访事件的化解方案建筑工地扬尘治理专项方案下载 、结果) 死亡情况 “发病”的定义 IARC (国际癌症研究机构)建议的发病(日期)定义为: (1) 到医院、诊所或研究机构因怀疑癌症问题 而首先就诊或入院的日期; 或者: (2) 由临床医生首先诊断或首先由病理学家报告(提及癌症)的日期;或者: (3) 死亡日期(首先由尸检等诊断的病例，其在存活时未怀疑过癌症)。 -DCO 从我国的实际情况考虑:发病(日期)的定义 就诊/入院日期、 医生/病理报告日期、 死亡日期 肿瘤登记报告 (一)报告单位 具备诊断和收住恶性肿瘤病例条件的医疗机构(二级及以上的综合性医院和肿瘤专科医院)为责任报告单位;基层卫生服务机构均有上报肿瘤发病与死亡病例的义务 (二)报告内容 按照国际疾病分类(ICD,10)，对新发的恶性肿瘤(C00.0-C97)和中枢神经系统良性肿瘤(D32.0-D33.9)进行登记报告。按照“肿瘤病例报告卡”(以下简称“报告卡”)填报患者的一般情况和肿瘤诊治的相关信息 肿瘤登记资料收集途径 建立网络: 三级机构 村-镇-县三级登记报告网络以开展肿瘤登记工作 建立网络:三级机构 村卫生室(服务站):所有乡村医生均有及时报告肿瘤新病例和死亡病例的义务。凡属所在村的肿瘤病例，经核实患者的基本情况后，填写于所在村的“肿瘤登记簿”中，并于每月5号前将报告卡和月报表上报告给所在的乡(镇)卫生院当月报告卡和“肿瘤月报表” 的上报时间规定为次月5日前 建立网络:三级机构 乡(镇)卫生院/县级医疗机构:有专职(兼职)人员负责具体工作，收集本地门诊、病房或随访中接受诊断和治疗的肿瘤病例，接受辖区基层医生的报告，填写“肿瘤登记簿”。同时常与本乡镇医院及附近地区医院的内、外、妇科、病理科及辅检科室取得联系，及时掌握本乡镇居民肿瘤发生死亡情况各肿瘤登记处还应定期到新农合、医保、社保等机构获取肿瘤发病病人的信息,做好发病病例的补充、剔重,尽可能减少发病病例的漏报，保持资料完整可靠。 乡(镇)卫生院/ 县级医疗机构的肿瘤月报表和报告卡的上报时间建议规定为次月的10日前 建立网络:三级机构 县肿瘤登记处:配备专人直接负责资料的收集、整理、计算机录入。肿瘤登记处应对下级机构(乡镇)人员进行经常性的指导、检查及业务培训; 接受各医疗机构防保科/病案室等按月报告卡，或主动收集县(市)各医疗机构中病案室中的记录资料,经归类整理后,有疑问的病例及时反馈给病例户籍所在乡镇进行核对,并补充填写到肿瘤登记的??台帐??(肿瘤登记簿)中 各肿瘤登记处还应定期到新农合、医保、社保等机构获取肿瘤发病病人的信息,做好发病病例的补充、剔重,尽可能减少发病病例的漏报，保持资料完整可靠。 县肿瘤登记处:对于死亡病例，各登记处每月上旬前定期主动将上月因肿瘤死亡病例的内容过录至肿瘤死亡报告卡上，对肿瘤发病日期及病理等信息不详的，及时与死亡证明书上报医院、家属或死者生前工作单位联系，搜集补充信息，并与各医疗机构定期上报的肿瘤死亡报告卡核对，补填漏报病例卡片,保持病例数据库资料的完整性。此外,还应定期到派出所、殡仪火化等机构调查,补报漏报病例,做好信息的收集与补充 肿瘤登记处的当月收集的数据(电子版)上报时间建议规定为次月的15日前;年度数据经登记处更新/补充信息，并清理后于次年1月中旬前上报至省疾控中心。 肿瘤死亡病例的登记 ,完善的全死因登记报告系统在肿瘤发病登记中的用途有以下三个方面 ,肿瘤新发病例的补充来源(死亡补发病) ,死亡结局的主要信息来源 ,提高数据质量——补充和修正患者信息 ,为避免漏报肿瘤病例，应加强死因相关监测工作 to comply with the requirements. (6) pressure pipes are installed according to the design requirements of the system pressure test, segmented tiered when pressure testing to be carried out in sequence, drainage, stormwater pipes to do water testing, and recording, pressure test failed or untested pipeline may not be concealed. Test pressure is the pressure piping installation one stops. (7) the control interface of pipeline leakage from the processing begins. Thread processing to tight fit, length should comply with the requirements. Flange after welding to check end verticality, checking the welding quality. (8) electrical engineering should control the grounding line of weld quality and laying of pipeline quality, timely measurement of grounding resistance, and completes the record. (9) the phase and neutral and ground wire to strictly control the installation location may not be wrong, to multi color lines as required. (10) the distribution box, distribution bottle Shell to a separate ground line, shell transitions can not be used. (C) the pipeline installation engineering 1. construction sequence (1) be familiar with design drawings and related technical information; (2) construction survey and setting out; (3) cooperate with the reserved, embedded civil work; (4) pipe and tube processing (5) support (hanging) production; (6) the pipe prefabrication and Assembly; (7) the pipe laying and installation; (8) the pipes connected to the device; (9), instrumentation and piping installed; (10) pressure test and cleaning (blowing) washing; (11), anti-corrosion and thermal insulation; (12) acceptance. 2. construction conditions (1) the design drawings, specifications and other technical documentation is complete, and after a trial. (2) construction project ,国家疾病监测点----DSP ,国家卫生统计信息系统 ,地方疾病监测工作:CDC死因统计 肿瘤死亡病例收集途径 ,死于医院:通过死因监测系统报县疾控中心，根据全死因库检出死于肿瘤的病例 ,有肿瘤病史，但死于其他疾病或外部原因 ,死于家中:社区报告 ,意外死亡:公安系统 补充漏报的途径 ,死亡补发病 ,社区补报、医保、新农合数据比对 ,外地就诊病例的补充 ,本省或外省 ,大型综合医院/肿瘤专科医院 ,接诊的户籍为当地的患者 ,专项流行病学调查收集的肿瘤病例 肿瘤病例的随访 全部登记处都要做到被动随访(通过与死因登记部门的肿瘤死亡报告资料与发病资料进行查对，掌握肿瘤病例的生存情况)。 在肿瘤防治(或疾病防治)网络完善的地区，推荐主动随访，即通过基层卫生服务机构人员或派专人进行访视，了解肿瘤病例的生存情况。访视的方式一般为上门访视，时间间隔可根据病人的生存状况确定(至少1年一次)。通过访视可了解病人的生存状况、居住地址和户口地址变迁等状况，还可收集病人进一步诊断、治疗、转移、复发等情况，并可为病人提供生活起居指导、定期医学监护提醒等基本卫生服务 需注意的问题 社区卫生服务中心、村卫生室和部分乡镇卫生院等基层医院一般不具备诊治肿瘤患者的能力，但有义务报告肿瘤病例的报卡相关信息。上述基层医院主要还是负责报卡有关内容的核实和死亡补充发病工作(可通过电话、上门访视，随访肿瘤患者的发病、肿瘤病理、死亡信息，以及当地肿瘤登记处反馈的认为需要核实的其它信息)，并将搜集的信息及时上报肿瘤登记处。 建立网络: “两本帐”与“一张表” 肿瘤登记簿:村级卫生站登记所在地的肿瘤发生与死亡病例;乡镇机构也同时按肿瘤部位或村别登记所在地的肿瘤发生与死亡病例。村、乡(镇)两级机构的肿瘤登记台帐必须保持动态的一致;登记簿所登记内容必须与月报表(报告卡)完全一致，并作妥善保存。 肿瘤月报表:月报表应一式两份，一份随报告卡一起上报，一份留底保存。 “发病”与“死亡”登记 模拟 登记处对新发病例核对/确认流程 死亡证明书中肿瘤病例的确认流程 to comply with the requirements. (6) pressure pipes are installed according to the design requirements of the system pressure test, segmented tiered when pressure testing to be carried out in sequence, drainage, stormwater pipes to do water testing, and recording, pressure test failed or untested pipeline may not be concealed. Test pressure is the pressure piping installation one stops. (7) the control interface of pipeline leakage from the processing begins. Thread processing to tight fit, length should comply with the requirements. Flange after welding to check end verticality, checking the welding quality. (8) electrical engineering should control the grounding line of weld quality and laying of pipeline quality, timely measurement of grounding resistance, and completes the record. (9) the phase and neutral and ground wire to strictly control the installation location may not be wrong, to multi color lines as required. (10) the distribution box, distribution bottle Shell to a separate ground line, shell transitions can not be used. (C) the pipeline installation engineering 1. construction sequence (1) be familiar with design drawings and related technical information; (2) construction survey and setting out; (3) cooperate with the reserved, embedded civil work; (4) pipe and tube processing (5) support (hanging) production; (6) the pipe prefabrication and Assembly; (7) the pipe laying and installation; (8) the pipes connected to the device; (9), instrumentation and piping installed; (10) pressure test and cleaning (blowing) washing; (11), anti-corrosion and thermal insulation; (12) acceptance. 2. construction conditions (1) the design drawings, specifications and other technical documentation is complete, and after a trial. (2) construction project 肿瘤登记月报表 市(县) 报告机构名称: 登记年月: 年 月 登记人: 页编码 发病例数: 例 死亡例数: 例 婚姻状诊断 肿瘤形态肿瘤行为(动诊断依死亡 姓 名 性别 年龄 职业 居住地址 肿瘤部位 诊断单位 死亡原因 备注 况 日期 学 态) 据 日期 to comply with the requirements. (6) pressure pipes are installed according to the design requirements of the system pressure test, segmented tiered when pressure testing to be carried out in sequence, drainage, stormwater pipes to do water testing, and recording, pressure test failed or untested pipeline may not be concealed. Test pressure is the pressure piping installation one stops. (7) the control interface of pipeline leakage from the processing begins. Thread processing to tight fit, length should comply with the requirements. Flange after welding to check end verticality, checking the welding quality. (8) electrical engineering should control the grounding line of weld quality and laying of pipeline quality, timely measurement of grounding resistance, and completes the record. (9) the phase and neutral and ground wire to strictly control the installation location may not be wrong, to multi color lines as required. (10) the distribution box, distribution bottle Shell to a separate ground line, shell transitions can not be used. (C) the pipeline installation engineering 1. construction sequence (1) be familiar with design drawings and related technical information; (2) construction survey and setting out; (3) cooperate with the reserved, embedded civil work; (4) pipe and tube processing (5) support (hanging) production; (6) the pipe prefabrication and Assembly; (7) the pipe laying and installation; (8) the pipes connected to the device; (9), instrumentation and piping installed; (10) pressure test and cleaning (blowing) washing; (11), anti-corrosion and thermal insulation; (12) acceptance. 2. construction conditions (1) the design drawings, specifications and other technical documentation is complete, and after a trial. (2) construction project 修水县卫生局 印 市(县) 报告机构名称: 登记年月: 年 月 登记人: 页编码 to comply with the requirements. (6) pressure pipes are installed according to the design requirements of the system pressure test, segmented tiered when pressure testing to be carried out in sequence, drainage, stormwater pipes to do water testing, and recording, pressure test failed or untested pipeline may not be concealed. Test pressure is the pressure piping installation one stops. (7) the control interface of pipeline leakage from the processing begins. Thread processing to tight fit, length should comply with the requirements. Flange after welding to check end verticality, checking the welding quality. (8) electrical engineering should control the grounding line of weld quality and laying of pipeline quality, timely measurement of grounding resistance, and completes the record. (9) the phase and neutral and ground wire to strictly control the installation location may not be wrong, to multi color lines as required. (10) the distribution box, distribution bottle Shell to a separate ground line, shell transitions can not be used. (C) the pipeline installation engineering 1. construction sequence (1) be familiar with design drawings and related technical information; (2) construction survey and setting out; (3) cooperate with the reserved, embedded civil work; (4) pipe and tube processing (5) support (hanging) production; (6) the pipe prefabrication and Assembly; (7) the pipe laying and installation; (8) the pipes connected to the device; (9), instrumentation and piping installed; (10) pressure test and cleaning (blowing) washing; (11), anti-corrosion and thermal insulation; (12) acceptance. 2. construction conditions (1) the design drawings, specifications and other technical documentation is complete, and after a trial. (2) construction project 具体居 诊断 确诊 最高诊 随访 随访 死亡 编号 姓 名 性别 年龄 职业 工作单位 死亡原因 备注 住地址 分类 日期 断单位 时间 情况 日期 说明:1 本表供各级医疗机构登记肿瘤病例，请详细填写姓名、地址、工作单位等项目，以便核对及随访病人 2 性别: ? 男;? 女 3诊断分类要填写具体，明确解剖部位及组织学类型 4诊断单位:? 省级医院;? 市级医院;? 县(区)级医院;? 乡(镇)卫生院;? 其它;? 不详 5 随访时间、随访情况:主要为随访人员(乡镇/社区防保人员等)填写。随访情况填写项目为:? 生存;? 户口迁出;? 死亡;? 失访 6 死亡原因:不一定为肿瘤 to comply with the requirements. (6) pressure pipes are installed according to the design requirements of the system pressure test, segmented tiered when pressure testing to be carried out in sequence, drainage, stormwater pipes to do water testing, and recording, pressure test failed or untested pipeline may not be concealed. Test pressure is the pressure piping installation one stops. (7) the control interface of pipeline leakage from the processing begins. Thread processing to tight fit, length should comply with the requirements. Flange after welding to check end verticality, checking the welding quality. (8) electrical engineering should control the grounding line of weld quality and laying of pipeline quality, timely measurement of grounding resistance, and completes the record. (9) the phase and neutral and ground wire to strictly control the installation location may not be wrong, to multi color lines as required. (10) the distribution box, distribution bottle Shell to a separate ground line, shell transitions can not be used. (C) the pipeline installation engineering 1. construction sequence (1) be familiar with design drawings and related technical information; (2) construction survey and setting out; (3) cooperate with the reserved, embedded civil work; (4) pipe and tube processing (5) support (hanging) production; (6) the pipe prefabrication and Assembly; (7) the pipe laying and installation; (8) the pipes connected to the device; (9), instrumentation and piping installed; (10) pressure test and cleaning (blowing) washing; (11), anti-corrosion and thermal insulation; (12) acceptance. 2. construction conditions (1) the design drawings, specifications and other technical documentation is complete, and after a trial. (2) construction project 修水县卫生局 印 市(县) 报告机构名称: 登记年月: 年 月 登记人: 页编码 出生 文化婚姻状职 业肿瘤名称 诊断诊断 死亡 编号 姓 名 住 址 性别 年龄 死亡地点 备注 日期 程度 况 (工种) (部位，病理组织类型) 依据 日期 时间 to comply with the requirements. (6) pressure pipes are installed according to the design requirements of the system pressure test, segmented tiered when pressure testing to be carried out in sequence, drainage, stormwater pipes to do water testing, and recording, pressure test failed or untested pipeline may not be concealed. Test pressure is the pressure piping installation one stops. (7) the control interface of pipeline leakage from the processing begins. Thread processing to tight fit, length should comply with the requirements. Flange after welding to check end verticality, checking the welding quality. (8) electrical engineering should control the grounding line of weld quality and laying of pipeline quality, timely measurement of grounding resistance, and completes the record. (9) the phase and neutral and ground wire to strictly control the installation location may not be wrong, to multi color lines as required. (10) the distribution box, distribution bottle Shell to a separate ground line, shell transitions can not be used. (C) the pipeline installation engineering 1. construction sequence (1) be familiar with design drawings and related technical information; (2) construction survey and setting out; (3) cooperate with the reserved, embedded civil work; (4) pipe and tube processing (5) support (hanging) production; (6) the pipe prefabrication and Assembly; (7) the pipe laying and installation; (8) the pipes connected to the device; (9), instrumentation and piping installed; (10) pressure test and cleaning (blowing) washing; (11), anti-corrosion and thermal insulation; (12) acceptance. 2. construction conditions (1) the design drawings, specifications and other technical documentation is complete, and after a trial. (2) construction project 说明 1 本表供各级医疗机构登记肿瘤病例 2 性别:? 男;? 女 3 文化程度:? 文盲;? 小学;? 初中;? 高中;? 大学及以上 4 婚姻状况:? 未婚;? 已婚;? 离异或丧偶 5 诊断依据:? 尸检;? 病理;? 手术;? 临床+生化;? 临床;? 死后推断;? 不详;? 肿瘤病例报告卡 to comply with the requirements. (6) pressure pipes are installed according to the design requirements of the system pressure test, segmented tiered when pressure testing to be carried out in sequence, drainage, stormwater pipes to do water testing, and recording, pressure test failed or untested pipeline may not be concealed. Test pressure is the pressure piping installation one stops. (7) the control interface of pipeline leakage from the processing begins. Thread processing to tight fit, length should comply with the requirements. Flange after welding to check end verticality, checking the welding quality. (8) electrical engineering should control the grounding line of weld quality and laying of pipeline quality, timely measurement of grounding resistance, and completes the record. (9) the phase and neutral and ground wire to strictly control the installation location may not be wrong, to multi color lines as required. (10) the distribution box, distribution bottle Shell to a separate ground line, shell transitions can not be used. (C) the pipeline installation engineering 1. construction sequence (1) be familiar with design drawings and related technical information; (2) construction survey and setting out; (3) cooperate with the reserved, embedded civil work; (4) pipe and tube processing (5) support (hanging) production; (6) the pipe prefabrication and Assembly; (7) the pipe laying and installation; (8) the pipes connected to the device; (9), instrumentation and piping installed; (10) pressure test and cleaning (blowing) washing; (11), anti-corrosion and thermal insulation; (12) acceptance. 2. construction conditions (1) the design drawings, specifications and other technical documentation is complete, and after a trial. (2) construction project