CN103942742A - Control and management method for tuberculosis on basis of disease control theory - Google Patents
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Abstract
The invention discloses a control and management method for tuberculosis on the basis of a disease control theory. The method accords with the objective law of occurring and developing of the tuberculosis. Through effect evaluation of the control and management of the tuberculosis, performance of the control and management of the tuberculosis is analyzed, new suggestions for improvement are proposed for control and management of the tuberculosis, disease control of the tuberculosis is achieved gradually, and the control and management of the tuberculosis tending to a perfect medical condition is achieved.
Description
Technical field
The invention belongs to medical condition control technology field, relate to a kind of based on the cybernatic control and management method lungy of disease.
Background technology
Tuberculosis is the chronic infectious disease of ancient, a serious harm human health., just there is literature record lungy in Egypt before 5000
[1].Enter 19th-century, tuberculosis spreads in many big cities, becomes the principal disease of society at that time, and owing to not having specific treatment way, the mortality ratio of tuberculosis patient is very high, has caused very large fear.After 1854-1859, people have set up for isolation and the sanatorium of " treatment " for tuberculosis patient
[2].This method has reduced mortality ratio lungy, but does not play the effect of essence.Nineteen twenty-three, G.Lissant Cox has carried out the rear discovery of following up a case by regular visits to of 5 years to the 4000 multidigit tuberculosis patients of England Lancashire County, and in the patient of " phlegm painting " feminine gender, the mortality ratio of living in sanatorium is 14%, and the mortality ratio of living is at home 38%; The patient that " phlegm painting " is positive, mortality ratio is respectively 61% and 81%
[1].Research is discovery also, and tuberculosis patient is mainly the poor and proletarian inside the city, and sanitary condition is badly one of important reason.
In very over a long time, tuberculosis is seriously threatening the mankind's life.Koch in 1882
[3]found and confirmed that Mycobacterium tuberculosis is pathogen lungy, after this, Study of Prevention Technology lungy has obtained fast development.Nineteen twenty-one, Calmette and Guerin develop tuberculosis vaccine---Bacille Calmette-Guerin; Between nineteen forty-four-1971 year, treat effective antibiotics lungy and SCC method and come out one after another and obtain remarkable result for the treatment of
[3].People once thought, conquer tuberculosis and point the day and await for it, but actual conditions are really not so.Due to the appearance of resistance and the bacterial strain of resistance to multiple medicines and popular, treatment cycle is long (6-12 month), the patient that carries disease germs lacks many-sided factors such as effective control [4], various countries' incidence of disease lungy is rise trend, tuberculosis epidemic situation worldwide sharply worsens, according to the World Health Organization (WHO) (WHO), estimate, existing nearly 2,000,000,000 people in the whole world are subject to tubercle bacillus affection, there are 2,000 ten thousand tuberculosis patients, annual neopathy case load is 800-1000 ten thousand people, death 2,000,000 people, the tidemark of the dead wound of nineteen ninety-five whole world tuberculosis since 1850, reaches 3,000,000.For this reason, in April, 1993, WHO proposes the whole world and enters the tuberculosis emergency circumstance and a new tuberculosis prevention and treatment strategy---DOTS (Direct Observation of Treatment, Short-course Chemotherapy)
[5], the government of numerous countries and regions, non-government institution have given to show great attention to and support to tuberculosis prevention and treatment
[4-7].However, (mortality ratio 1-2/10 ten thousand, are coated with positive morbidity rate 20,/10 ten thousand, AIR 10-20/10 ten thousand to reach the interior control of world wide tuberculosis
[8,9]), within 1999, the whole world only has 16% active tuberculosis disease to accept the standard chemotherapy of recommending
[10].At present, WHO, just strengthening tuberculosis to control, but the Future is still shouldered heavy responsibilities with countries in the world man together with area.
List of references
[1]Daniel?TM.The?history?of?tuberculosis[J].Respir?Med,2006,100:1862-1870.
[2] Philippe Adam, Claudine Herzlich, Francois de Singly. Wang Ji meeting. translate. disease and medical sociology [M]. the 1st edition. Tianjin: the Tianjin People's Press, 2005,10:5-7.
[3] Wan Kanglin. the popular new feature of Chinese tuberculosis and challenge [J]. diseases monitoring, 2008,23 (11): 667-670.
[4]Carter?A,Zwerling,Olson?S,et?al.Tuberlosis?and?the?city[J].Health&Place,2009,15:777-783.
[5]Ogden?J,Walt?G,Lush?L.The?politics?of‘branding’in?policy?transfer:the?case?of?DOTS?for?tuberculosis?control[J].Social?Science&Medicine,2003,57:179-188.
[6]Wei?Xiaolin,Walley?J,Zhao?J,et?al.Why?financial?incentives?did?not?reach?the?poor?tuberculosis?patients？A?qualitative?study?of?a?Fidelis?funded?project?in?Shanxi,China[J].Health?Policy,2009,90:206-213.
[7]Ahmad?K.MSF?tuberculosis?report?criticises?DOTS?strategy.Infectious?Diseases,2004,4:719.
[8] Feng Taichang. China's Tuberculosis Epidemic [M]. practical tuberculosis prevention and treatment. the 1st edition. Beijing: Chinese Medicine science and technology publishing house, 1991,10:4-8.
[9]WHO.Framework?for?effective?tuberculosis?control.WHO/TB/94.179,Geneva,1994.
[10] He Lixian. pulmonary tuberculosis [M]. Chen Haozhu. chief editor. practical clinical practice .11 version. Beijing: People's Health Publisher, 2001:497-517.
Summary of the invention
Defect in view of above-mentioned prior art exists, the object of the invention is to propose a kind of based on the cybernatic control and management method lungy of disease.
Object of the present invention will be achieved by the following technical programs:
Based on the cybernatic control and management method lungy of disease, comprise the following steps:
(1) set up tuberculosis control and management system, described tuberculosis control and management system comprises to be controlled infection sources module, raising herd immunity module, minimizing and elimination route of transmission module and improves medical service system module;
(2) gather described control infection sources module, improve herd immunity's module, minimizing and elimination route of transmission module and improve the medical service system module information content of corresponding item elements respectively, input in described tuberculosis control and management system and analyze;
(3) described tuberculosis control and management system according to perfect condition under tuberculosis control the state reaching and compare, draw the effect assessment to control and management lungy, analyze the performance of tuberculosis control and management, and propose new recommendation on improvement for control and management lungy.
Preferably, above-mentioned based on the cybernatic control and management method lungy of disease, wherein: the item elements of described control infection sources module comprises:
One, early find, early diagnose: training may be examined doctor by head, universal masses' disease general knowledge, uses quick diagnosis technology;
Two, standard diagnosis: professional institution's level is up to standard, and can effectively utilize;
Three, treatment tuberculosis patient: therapeutic scheme science, standard, medical expense is protected;
Four, treatment management: directly inspection;
Five, tuberculosis patient management: suitably control activity space, take necessary quarantine measures;
Six, other may infections sources management: to as the strick precaution of bacillus tuberculosis bovis etc., sterilization and quality inspection that must attention milk;
Seven, treatment results monitoring: medical further consultation, prevention supervision.
Preferably, above-mentioned based on the cybernatic control and management method lungy of disease, wherein: the item elements of described raising herd immunity module comprises:
One, population composition: the population strategy of science;
Two, nutrition condition: staple food supply fully can and, diet obtains scientific guidance;
Three, condition: the whole people take exercises, health is good;
Four, other diseases: good hygienic habit, in time Scientific Treatment disease;
Five, extraordinary immunity: vaccine inoculation.
Preferably, above-mentioned based on the cybernatic control and management method lungy of disease, wherein: described minimizing and the item elements of eliminating route of transmission module comprise:
One, infection sources open-assembly time: treat in time tuberculosis patient;
Two, infection sources exposed space: necessary control measures are taked in activity to tuberculosis patient;
Three, public environment health: note public place, as good in enhancement of environment, the circulation of air in the places such as station, market, bus, subway;
Four, domestic environment: sanitary condition is good, circulation of air is good;
Five, value and strengthen group is anti-: strengthen tissue and publicity, improve whole people's science prevention awareness.
Preferably, above-mentioned based on the cybernatic control and management method lungy of disease, wherein: the described item elements of improving medical service system module comprises:
Perfect medical condition: everybody enjoy basic medical, medical services meet various leveled demands, resource distribution rationally, manage brief efficient, medical personnel is stable, the incidence of disease is stable, the medical general knowledge of the common people is universal, Community health's consciousness is good.
Preferably, above-mentioned based on the cybernatic control and management method lungy of disease, wherein: the form of the information content gathering in described step (2) comprises: enumerable discrete selection, gageable data, and describable text.
Of the present invention a kind of based on the cybernatic control and management method lungy of disease, meet the objective law that tuberculosis occurs and develops, by the effect assessment to control and management lungy, analyze the performance of tuberculosis control and management, and for control and management lungy, new recommendation on improvement is proposed, progressively realize disease lungy and control, trend towards the control and management lungy under perfect medical condition.
Below just accompanying drawing in conjunction with the embodiments, is described in further detail the specific embodiment of the present invention, so that technical solution of the present invention is easier to understand, grasp.
Accompanying drawing explanation
Fig. 1 is tuberculosis diagnosis and treatment process mode figure;
Fig. 2 is the process flow diagram of the control and management method lungy of the embodiment of the present invention;
Fig. 3 is the tuberculosis system control flow of the embodiment of the present invention.
Embodiment
Propagation lungy and popularly comprise three links: the infection sources (origin of infection, OI), route of transmission (route of transmission, RT), people (crowd) immunity (immunizing power of person, IP), three links are expressed as O, R, I.
The infection sources is mainly discharge of bacteria patient, is the patient who carries tuberculosis germ.The communicable power of the infection sources depends on discharge of bacteria amount and CF.Discharge of bacteria amount is divided in a large number: phlegm smear-positive (smear-positive, SP); A small amount of: sputum smear negative but cultivate positive (swear-negative/culture-positive, SN/CP); Not discharge of bacteria or trace: phlegm smear and cultivate all negative (swear-negative/culture-negative, SN/CN).The patient (smear-positive pulmonary disease) who it is generally acknowledged phlegm smear-positive is only the main infection sources, but not evidence suggests that it is not the infection sources that other situations are carried tulase person.
Route of transmission is most importantly by respiratory infectious, and the patient that carries disease germs discharges tulase by cough, sneeze, laugh etc. with the spittle, and Healthy People is drawn into alveolar, can cause infection.Tuberculosis patient self is propagated can also be through propagation such as blood, urinary systems.
People (crowd) immunity is the 3rd link.Human body has suitable immunity to tulase, comprises specific immunity and nospecific immunity.Nospecific immunity and social factor, as living condition, sanitary condition, nutrition condition etc. have substantial connection; Sex, age, whether suffer from some other diseases etc. and also can weaken the resistibility of human body, with mathematical formulae, can be expressed as follows.
O＝{SP,SN/CP,SN/CN}， (5.1)
It is generally acknowledged, when O=SP, discharge of bacteria amount is large, has infectiousness, is the infection sources lungy.Tuberculosis patient or the tulase phlegm that carries disease germs is coated with positively, after chemotherapy, even if phlegm is coated with, does not turn out cloudy, and appeal also weakens greatly.
The R={ spittle, blood, alimentary canal, skin, urinary system ..., (5.2)
The spittle be by coughing, sneeze, the mode such as laugh is discharged in air, once cough approximately can spray 3500 spittle, forms droplet nuclel after moisture evaporation, its diameter is less than 5 microns, time floating in air is long, and Healthy People sucks alveolar by breathing, can cause infection.
f(O
n)＝k
nL
0， (5.4)
By formula (5.3), (5.4), obtained:
Set the immunity (I) of human body and with body, suffer from the possibility degree of certain disease
describe.κ
nfor self or extraneous factor of certain human body causes the immunity coefficient of human body to tubercle bacillus affection.How does immunity coefficient value express? the expression of can suing for peace of the immunity coefficient total value of various factors? set L
0for body is suffered from possibility degree critical value lungy.Healthy People sucks tuberculosis germ, might not suffer from disease.The concrete condition of human body, such as age, physique, sex, gene etc., and residing social status etc., affected it to suffer from possibility degree lungy, if possible property degree is lower than critical value L
0, body can not infect tuberculosis germ; If higher than L
0, PI tuberculosis germ.That is:
At present, according to sanitary conditions, living conditions, exposed population group etc., the annual PI 10-20 Healthy People of each infection sources, wherein 3-10% will become tuberculosis patient; In the patient of neopathy, approximately have again 50% will become the new infection sources.The infection sources has great role for propagation lungy, and controlling and eliminate the infection sources is to control the popular key link of tuberculosis.The basic goal that the infection sources is controlled is to reduce the incidence of disease, even eliminate this disease, control for the tuberculosis infection sources, comprise and find early tuberculosis patient and tuberculosis germ carrier, patient is carried out to standard treatment, remove its infectiousness and thoroughly cure, to tulase carrier, should carry out necessary monitoring and guidance, to avoid it to be converted into the infection sources.
For the ease of understanding formulation and the enforcement of tuberculosis infection sources control measure, first recall the diagnosis and treatment flow process of tuberculosis patient.From a Healthy People or the patient with certain respiratory symptom as starting point, by health examination or disease indagation, tentatively determine whether to suffer from tuberculosis, if be diagnosed as tuberculosis, need clear and definite whether just controlling? whether paralysis smear and cultivation positive? and clear and definite susceptibility and chemotherapy regimen; Then by DOTS, carry out standard treatment; After treatment, if fail to cure, enter and control again program, if clearly cured, treat successfully, as shown in Figure 1.
Realization will be accomplished 2 points to the control of the infection sources:
(1) cure in time the infection sources
The key of curing in time the infection sources is to make a definite diagnosis in time, avoids mistaken diagnosis, fails to pinpoint a disease in diagnosis.Tuberculosis clinical manifestation is varied, and the typical case of pulmonary tuberculosis heating shows as prolonged low grade fever, and every day, in the afternoon or start be at dusk down to normally morning next day, but be not all be all so typical performance; The respiratory symptoms such as cough and expectoration are also phthisical important symptoms; X-Ray checks it is phthisical indispensable inspection of diagnosis.First the doctors of lung section of medical examiner, community medicine center (station), health clinics in towns and townships, village's clinic, clinic, all kinds of hospitals etc., all can touch tuberculosis patient, lunger particularly, and we call these doctors may examine doctor by head.Possible head examines the grasp of doctor to tuberculosis genius morbi and rule, and to the understanding that tuberculosis prevention and treatment requires, for lungy, makes a definite diagnosis in time, avoids failing to pinpoint a disease in diagnosis, mistaken diagnosis plays conclusive effect.Possible head examines doctor should be by suspicious or make a definite diagnosis tuberculosis patient and proceed to rapidly special tuberculosis prevention and treatment mechanism and carry out further diagnosis and treatment.
Special tuberculosis prevention and treatment mechanism and medical worker thereof make a definite diagnosis and get rid of and must carry out according to the requirement of standard lungy, must carry out phlegm smear and phlegm and cultivate inspection, and further make determination of drug sensitivity to cultivating bacterial strain, to carry out standard treatment and registration to the case of making a definite diagnosis simultaneously, to carry out sick record and the monitoring of learning index of Major Epidemic, these indexs comprise: pulmonary tuberculosis morbidity rate and the positive morbidity rate of painting, pulmonary tuberculosis (year) incidence of disease and (year) are coated with the positive incidence of disease, tuberculosis case registration rate, tuberculosis mortality rate, erythema nodosum and AIR.
(2) the new infection sources occurs
The infection sources is the main source that the new infection sources occurs to non-tuberculosis crowd's infection.Infection sources open-assembly time in crowd is longer, and new infection sources odds is larger.Make a definite diagnosis early tuberculosis patient, the treatment of the professional etiquette of going forward side by side model can be shortened the open-assembly time of the infection sources preferably.The infection sources is through standard treatment, and still positive even if phlegm is coated with, infectiousness also significantly declines.The activity of tuberculosis patient is carried out to necessary control, can dwindle the exposed space of the infection sources, reduce the infection sources and contact with more crowds, particularly in densely populated supermarket, bus, subway, station, rally etc.Pay attention to that living environment is clean and with fresh air, personal hygiene, appropriate physical exercise, dietetic nutrition are good, avoid merging other diseases etc., can reduce and infect possibility lungy.
Be summed up, controlling the infection sources, cutting off route of transmission and improve body immunity is to prevent human infection tulase, also reduces three links that the new infection sources occurs.
Disease kybernetics to sum up, is followed disease rule exactly, usings and builds perfect medical treatment as dreamboat, and take systematology, kybernetics is theoretical direction, and the medical condition that moves forward steadily every aspect is to dreamboat infinite tendency separately.
Embodiment:
If the set of the tuberculosis state of a control of a country (TB State of National, TBSN) is:
TBSN＝{B
0,B
1,B
2,…,B
n-1,B
n}，
TBSN is by B
0→ B
nstate by optimum to running down, B
0state is the optimum state that the country tuberculosis that can reach is controlled, in this case, (1) (year) lungy incidence of disease is stable in minimum maintenance, and lungy other are controlled indexs and all in optimum condition, also kept stablizing; (2) herd immunity (I
q) in best condition, crowd is to resistivity lungy in the strongest state, this state should be by the above dietetic nutrition supply that can guarantee crowd etc. that acquires a certain degree of reasonable and stable population composition, social wealth; (3) factors that affect route of transmission (R) comprise: the time that environmental health, air regime, the infection sources expose and space etc. are in favo(u)red state; (4) the national health service system in social system in or approach perfect medical condition.
The present embodiment a kind of based on the cybernatic control and management method lungy of disease, as shown in Figure 2, comprises the following steps:
(1) set up tuberculosis control and management system, tuberculosis control and management system comprises to be controlled infection sources module, raising herd immunity module, minimizing and elimination route of transmission module and improves medical service system module; Wherein, the item elements of control infection sources module comprises:
One, early find, early diagnose: training may be examined doctor by head, universal masses' disease general knowledge, uses quick diagnosis technology;
Two, standard diagnosis: professional institution's level is up to standard, and can effectively utilize;
Three, treatment tuberculosis patient: therapeutic scheme science, standard, medical expense is protected;
Four, treatment management: directly inspection;
Five, tuberculosis patient management: suitably control activity space, take necessary quarantine measures;
Six, other may infections sources management: to as the strick precaution of bacillus tuberculosis bovis etc., sterilization and quality inspection that must attention milk;
Seven, treatment results monitoring: medical further consultation, prevention supervision.
The item elements that improves herd immunity's module comprises:
One, population composition: the population strategy of science;
Two, nutrition condition: staple food supply fully can and, diet obtains scientific guidance;
Three, condition: the whole people take exercises, health is good;
Four, other diseases: good hygienic habit, in time Scientific Treatment disease;
Five, extraordinary immunity: vaccine inoculation.
The item elements of minimizing and elimination route of transmission module comprises:
One, infection sources open-assembly time: treat in time tuberculosis patient;
Two, infection sources exposed space: necessary control measures are taked in activity to tuberculosis patient;
Three, public environment health: note public place, as good in enhancement of environment, the circulation of air in the places such as station, market, bus, subway;
Four, domestic environment: sanitary condition is good, circulation of air is good;
Five, value and strengthen group is anti-: strengthen tissue and publicity, improve whole people's science prevention awareness.
The item elements of improving medical service system module comprises:
Perfect medical condition: everybody enjoy basic medical, medical services meet various leveled demands, resource distribution rationally, manage brief efficient, medical personnel is stable, the incidence of disease is stable, the medical general knowledge of the common people is universal, Community health's consciousness is good.
(2) gather and control infection sources module, improve herd immunity's module, minimizing and elimination route of transmission module and improve the medical service system module information content of corresponding item elements respectively, input in tuberculosis control and management system and analyze; The form of the information content gathering comprises: enumerable discrete selection, gageable data, and describable text.
(3) tuberculosis control and management system according to perfect condition under tuberculosis control the state reach and compare, draw the effect assessment to control and management lungy, analyze the performance of tuberculosis control and management, and propose new recommendation on improvement for control and management lungy.
Use disease kybernetics theoretical, the process flow diagram building for control and management lungy, as shown in Figure 3.
The present embodiment a kind of based on the cybernatic control and management method lungy of disease, meet the objective law that tuberculosis occurs and develops, by the effect assessment to control and management lungy, analyze the performance of tuberculosis control and management, and for control and management lungy, new recommendation on improvement is proposed, progressively realize disease lungy and control, trend towards the control and management lungy under perfect medical condition.
The present invention still has numerous embodiments, and all employing equivalents or equivalent transformation and all technical schemes of forming, within all dropping on protection scope of the present invention.
Claims (6)
1. based on the cybernatic control and management method lungy of disease, it is characterized in that comprising the following steps:
(1) set up tuberculosis control and management system, described tuberculosis control and management system comprises to be controlled infection sources module, raising herd immunity module, minimizing and elimination route of transmission module and improves medical service system module;
(2) gather described control infection sources module, improve herd immunity's module, minimizing and elimination route of transmission module and improve the medical service system module information content of corresponding item elements respectively, input in described tuberculosis control and management system and analyze;
(3) described tuberculosis control and management system according to perfect condition under tuberculosis control the state reaching and compare, draw the effect assessment to control and management lungy, analyze the performance of tuberculosis control and management, and propose new recommendation on improvement for control and management lungy.
2. according to claim 1 based on the cybernatic control and management method lungy of disease, it is characterized in that: the item elements of described control infection sources module comprises:
One, early find, early diagnose: training may be examined doctor by head, universal masses' disease general knowledge, uses quick diagnosis technology;
Two, standard diagnosis: professional institution's level is up to standard, and can effectively utilize;
Three, treatment tuberculosis patient: therapeutic scheme science, standard, medical expense is protected;
Four, treatment management: directly inspection;
Five, tuberculosis patient management: suitably control activity space, take necessary quarantine measures;
Six, other may infections sources management: to as the strick precaution of bacillus tuberculosis bovis etc., sterilization and quality inspection that must attention milk;
Seven, treatment results monitoring: medical further consultation, prevention supervision.
3. according to claim 1 based on the cybernatic control and management method lungy of disease, it is characterized in that: the item elements of described raising herd immunity module comprises:
One, population composition: the population strategy of science;
Two, nutrition condition: staple food supply fully can and, diet obtains scientific guidance;
Three, condition: the whole people take exercises, health is good;
Four, other diseases: good hygienic habit, in time Scientific Treatment disease;
Five, extraordinary immunity: vaccine inoculation.
4. according to claim 1 based on the cybernatic control and management method lungy of disease, it is characterized in that: the item elements of described minimizing and elimination route of transmission module comprises:
One, infection sources open-assembly time: treat in time tuberculosis patient;
Two, infection sources exposed space: necessary control measures are taked in activity to tuberculosis patient;
Three, public environment health: note public place, as good in enhancement of environment, the circulation of air in the places such as station, market, bus, subway;
Four, domestic environment: sanitary condition is good, circulation of air is good;
Five, value and strengthen group is anti-: strengthen tissue and publicity, improve whole people's science prevention awareness.
5. according to claim 1 based on the cybernatic control and management method lungy of disease, it is characterized in that: the described item elements of improving medical service system module comprises:
Perfect medical condition: everybody enjoy basic medical, medical services meet various leveled demands, resource distribution rationally, manage brief efficient, medical personnel is stable, the incidence of disease is stable, the medical general knowledge of the common people is universal, Community health's consciousness is good.
6. according to claim 1 based on the cybernatic control and management method lungy of disease, it is characterized in that: the form of the information content gathering in described step (2) comprises: enumerable discrete selection, gageable data, and describable text.
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| US20020087358A1 (en) * | 1998-12-16 | 2002-07-04 | Gilbert Edward H. | System, method, and computer program product for processing diagnostic, treatment, costs, and outcomes information for effective analysis and health care guidance |
| CN101369339A (en) * | 2007-08-17 | 2009-02-18 | 上海市闵行区卫生局 | Community sanitation service information system |
| CN102737040A (en) * | 2011-04-08 | 2012-10-17 | 中国人民解放军第三〇二医院 | Method and system for infectious disease information query |
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2014
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| US20020087358A1 (en) * | 1998-12-16 | 2002-07-04 | Gilbert Edward H. | System, method, and computer program product for processing diagnostic, treatment, costs, and outcomes information for effective analysis and health care guidance |
| CN101369339A (en) * | 2007-08-17 | 2009-02-18 | 上海市闵行区卫生局 | Community sanitation service information system |
| CN102737040A (en) * | 2011-04-08 | 2012-10-17 | 中国人民解放军第三〇二医院 | Method and system for infectious disease information query |
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Application publication date: 20140723 |