新形势下加强医疗服务质量监管的路径选择

卫生服务质量包括公共卫生服务质量和医疗服务质量。其中,医疗服务质量直接关系到患者的生命与健康,是卫生服务的核心工作。目前,医疗服务市场”信息不对称”,因此,如何有效的监管医疗机构的服务质量成为政府的重要职责之一。本文在明确医疗服务质量监管内涵的基础上,结合我国监管现状,指出我国医疗服务领域所存在的监管主体单一、监管力量薄弱、监管法规有待完善、监管过程缺乏常态化、监管结果未能及时公开等方面的不足,并针对上述不足之处,提出四点政策建议：一是以政府为核心,培育多元监管主体;二是以信息化建设为平台,创新监管手段;三是以法规建设为重点,完善监管体系;四是加强监管结果的运用。     

我国县级公立医院改革关键问题与路径选择

自县级公立医院改革试点以来,在各领域都有所探索并形成初步的改革思路。但是,在改革中仍有不少关键问题未得到解决,诸如：改革的多元顶层设计思路、补偿机制的持续性与稳定性、地方政府财政压力加重、医院管理体制机制改革未能协同进行、调动和保障医务人员积极性的机制亟待完善、医疗服务定价无法体现医疗服务价值、人才队伍建设滞后、医保基金的使用等。建议下一步县级公立医院改革应在多元化、多层次的顶层设计指导下,坚持公益性与医院经营效益相结合,建立县级公立医院的现代医院管理制度。改革要从创新人力资本管理机制、完善破除“以药补医”后的补偿机制和配套措施、推进法人治理和政事分开、加强医保基金对居民医疗需求的引导、加快医院信息化建设等方向上寻求突破。     

医疗服务分档评估指标体系的测试

医疗机构医疗服务具有差别性,原有的医疗服务定价方式已不能完全体现不同级别医疗机构医疗服务价值。医疗服务分档定价方式拉开了不同级别医院的差距,体现了医务人员的技术劳务价值,减少医疗资源的浪费,与以往的医疗服务价格定价方式相比,具有明显的优越性。前期课题组初步建立了医疗服务分档评估指标体系,为了解医疗服务分档评估指标体系在非营利性医疗机构中的运用情况,分别选取三级、二级、一级医院共4家非营利性医疗机构进行测试。测试结果与课题前期研究设想基本吻合。     

政府实施公立医院医疗服务价格监管的动机溯源

为实现公立医院改革目标,必须完善科学的公立医院补偿机制,其中针对医疗服务价格实施调整是重要的改革举措。在改革中既要调整医疗服务价格,同时又需要对其实施有效监管。政府监管行为动机可由公共利益理论、利益集团“俘获”理论和激励相容理论等理论得到学理诠释,也可从公众、公立医院与医务人员等多元主体的利益诉求中探寻到实践印记,因此强化政府医疗服务价格监管也是新一轮医药卫生体制改革成效显现的重要基础要件。

     

N末端脑钠肽前体检测主流方法学定价研究

根据原卫生部、国家中医药管理局、国家发展和改革委员会联合下发的《2012版全国医疗服务价格项目规范》的要求,实验室诊断项目要按照不同级别医院使用的主流检验方法进行参考定价。通过对目前检测N末端脑钠肽前体的几种主要检测方法进行比较,发现了在实验室检测项目中采取主流方法学定价的利弊,为政府确定主流方法和科学定价提供参考。     

构建公立医院有效监管体系策略探讨

通过对公立医院监管乏力、趋利行为失控、医疗服务失范等现象产生原因分析,提出应着力建立有效的公立医院监控体系框架,充分发挥政府的监管职能,建立和完善社会和行业监管职能,实施有效的监控措施,促进公立医院公益性回归,保证公立医院健康发展。     

依托六大平台 实施医疗质量与安全精准化监管

运用信息化手段实施精准化的医疗质量与安全监管正在被越来越多的医院管理者所重视和接受。通过建立授权管理平台、环节质控平台、指标监测平台、医疗安全管理平台、电子病历质控平台和信息交互平台,对临床信息进行收集、统计、分析,为医院决策和医疗管理提供数据支撑,并及时反馈应用到临床医疗服务中,形成戴明环（PDCA循环）管理机制,切实打造医疗质量和安全精准化监管系统。     

德国医疗质量监管体系述评

德国非常重视以成文法的方式推动医疗质量监管的发展,这一点与其他国家有着很大的区别。在医疗质量监管主体方面,医疗职业共同体发挥着较大的作用。目前,德国试图整合各利益相关方的力量和优势,建立联邦联合委员会这样相对集中的监管平台。在医疗服务准入方面,德国大力推行各种认证制度;在卫生技术监管方面,加强了卫生技术评估的研究和推广;在医疗服务评价方面,力图建立可用于不同医院之间相互比较的医院质量监管指标体系;在医疗差错预防方面,则主要致力于建立基于互联网的非惩罚性的医疗差错匿名报告与讨论平台。     

公立医院质量规制现况、问题及其影响因素研究

?????? 目的 了解公立医院质量规制的现状,发现问题,研究影响因素,为建立有效的医院规制体系提供依据。方法 通过文献研究、现场调查、专家小组法收集相关数据,运用多元逻辑回归法进行影响因素分析。 结果 医院组织结构保障、医疗机构质量责任意识 、医院管理者的自身素质和管理水平、医院激励机制设计、政府对医院的补偿、有效的监督和真正严厉的惩处制度这6个因素是医院质量规制制度的影响因素。政府财政补偿不足以及医生工资待遇偏低是导致医疗机构忽视医疗服务质量的首要原因,其次依次为缺乏有效的质量监管手段,医院、医生激励机制设计不合理等。结论 政府对医院的补偿不足是影响医院质量规制制度的危险因素,其余为保护性因素。应适当加大政府对医院的财政投入,提高医生的工资待遇,加强对医疗质量的监管,完善医院激励机制。     

我国公立医院补偿机制现状浅析

通过对不同国家、不同地区、不同级别公立医院补偿机制现状进行比较分析,探讨进一步完善公立医院补偿机制的政策和措施,为政府部门制定补偿政策提供依据。医院发展离不开资金,因此对医院资金必须集中管理、统一调配、有效监督,加强资金收支的监督管理。健全医疗服务成本及价格监测体系,加强对医疗服务价格及成本构成要素的监测,为制定合理的医疗服务指导价格、建立灵活的价格调整机制提供依据。在医疗这一重要的社会消费领域,需要给公众真实客观的信息,加强宣传和沟通也极为重要。总之,完善公立医院补偿机制,是建立规范高效公立医院运行机制的重要保证,也是充分体现公立医院公益性的必然要求。当前我们应该积极探索,加快完善公立医院补偿机制。     

Effects of Temperature on Pratylenchus neglectus and on Its Pathogenicity to Barley

In a petri-dish study, development of the nematode Pratylenchus neglectus was observed every 4 days, and stage-specific development times were estimated, using a parameter estimation algorithm for a distributed-delay population model. The lower threshold temperature for development of a population of P. neglectus was 7.75 C. Temperatures above 25 C were unfavorable for this population on barley. Total numbers of P. neglectus in barley roots and associated soil in pots were greatest at 25 C and lower at temperatures above and below that level. There was no change in nematode numbers per gram of root as temperature increased between 24 C and 32 C because root weights decreased at higher temperatures. Restricted root mass may contribute to the lower total nematode population levels at higher temperature. Maximum number of nematodes moved through a 2-cm layer of sand on a Baermann funnel at about 20 C; lowest number of nematodes moved at 10 C and 30 C.     

Defence on demand: mechanisms behind optimal defence patterns

Background

The optimal defence hypothesis (ODH) predicts that tissues that contribute most to a plant''s fitness and have the highest probability of being attacked will be the parts best defended against biotic threats, including herbivores. In general, young sink tissues and reproductive structures show stronger induced defence responses after attack from pathogens and herbivores and contain higher basal levels of specialized defensive metabolites than other plant parts. However, the underlying physiological mechanisms responsible for these developmentally regulated defence patterns remain unknown.

Scope

This review summarizes current knowledge about optimal defence patterns in above- and below-ground plant tissues, including information on basal and induced defence metabolite accumulation, defensive structures and their regulation by jasmonic acid (JA). Physiological regulations underlying developmental differences of tissues with contrasting defence patterns are highlighted, with a special focus on the role of classical plant growth hormones, including auxins, cytokinins, gibberellins and brassinosteroids, and their interactions with the JA pathway. By synthesizing recent findings about the dual roles of these growth hormones in plant development and defence responses, this review aims to provide a framework for new discoveries on the molecular basis of patterns predicted by the ODH.

Conclusions

Almost four decades after its formulation, we are just beginning to understand the underlying molecular mechanisms responsible for the patterns of defence allocation predicted by the ODH. A requirement for future advances will be to understand how developmental and defence processes are integrated.     

A phylogenetic analysis of 100+ genera and 50+ families of euasterids based on morphological and molecular data with notes on possible higher level morphological synapomorphies

 A data matrix of 143 morphological and chemical characters for 142 genera of euasterids according to the APG system was compiled and complemented with rbcL and ndhF sequences for most of the genera. The data were subjected to parsimony analysis and support was assessed by bootstrapping. Strict consensus trees from analyses of morphology alone and morphology + rbcL + ndhF are presented. The morphological data recover several groups supported by molecular data but at the level of orders and above relationships are only superficially in agreement with molecular studies. The analyses provide support for monophyly of Gentianales, Aquifoliales, Apiales, Asterales, and Dipsacales. All data indicate that Adoxaceae are closely related to Dipsacales and hence they should be included in that order. The trees were used to assess some possible morphological synapomorphies for euasterids I and II and for the orders of the APG system. Euasterids I are generally characterised by opposite leaves, entire leaf margins, hypogynous flowers, “early sympetaly” with a ring-shaped corolla primordium, fusion of stamen filaments with the corolla tube, and capsular fruits. Euasterids II often have alternate leaves, serrate-dentate leaf margins, epigynous flowers, “late sympetaly” with distinct petal primordia, free stamen filaments, and indehiscent fruits. It is unclear which of these characters represent synapomorphies and symplesiomorphies for the two groups, respectively, and there are numerous expections to be interpreted as reversals and parallelisms. Received August 28, 2000 Accepted August 7, 2001     

Diversity Among a Heterodera glycines Field Isolate and Derived Inbreds Based on RAPD Analysis and Reproduction on Soybean Genotypes

A field population of Heterodera glycines was inbred by a combination of controlled male-female matings and inoculation of soybean with second-stage juveniles (J2) from single cysts. The initial and four F₆ inbred populations were subjected to random amplified polymorphic DNA analysis and were also tested for their ability to reproduce on race differentials. The RAPD patterns of the inbred populations had a lower number of total bands and a lower percentage of polymorphic bands among individual cysts than the initial population. The estimated number of polymorphic loci detected by RAPD analysis was about 25% for the initial population and 4% to 7% for the inbred lines. Reproduction of H. glycines decreased for 6 of 24 inbred-soybean combinations. In particular, reproduction of three inbred populations on PI 90763 was greatly reduced. Inbreeding did not decrease variance of cyst number on soybean genotypes. The inbreeding coefficient calculated from RAPD data was greater than that derived from the known inbreeding pedigree.     

大花美人蕉茎尖组织培养技术研究

以大花美人蕉(Canna×generalis)根茎茎尖为外植体进行组织培养技术研究,筛选出芽诱导适宜的培养基为MS+6-BA 8.0mg/L (单位下同)+TDZ 0.03;MS+6-BA 8.0+TDZ 0.03+NAA 0.1培养基能较好地诱导分化出丛生芽,继代增殖培养中与MS+6-BA 3.0+TDZ 0.03+NAA 0.1培养基交替使用可减少畸形芽,增殖系数达1.67;适宜的生根培养基为MS+6-BA 1.0+NAA 0.5,生根率达66.67%,且植株生长健壮,移栽易成活。     

热休克蛋白调控机制

热休克蛋白是生物体体应对温度、pH、渗透压等不利环境刺激时合成的一种保护蛋白。在环境应激时,调控因子可以在转录水平上调控热休克基因的表达,恢复或加速清除细胞内已经变性的蛋白质,使细胞处于稳态并产生耐受性。大量研究发现,热休克调控因子对微生物应激耐受性发挥重要作用,具有广阔的应用前景。综述了6类热休克调控因子的调控机制以及相互作用,对调控因子HrcA、σ^B和CtsR进行了重点阐述,旨在为进一步构建热休克调控网络提供有价值的参考。     

Influence of age on stem cells depends on the sex of the bone marrow donor

Ageing is often accompanied by an increase in bone marrow fat together with reduced bone volume and diseases of the bone such as osteoporosis. As mesenchymal stem cells (MSCs) are capable of forming bone, cartilage and fat tissue, studying these cells is of great importance to understand the underlying mechanisms behind age‐related bone diseases. However, inter‐donor variation has been found when handling MSCs. Therefore, the aim of this study was to investigate the effects of donor age and sex by comparing in vitro characteristics of human bone marrow‐derived MSCs (hBMSCs) from a large donor cohort (n = 175). For this, hBMSCs were analysed for CFU‐F capacity, proliferation, differentiation capacity and surface antigen expression under standardized culture conditions. The results demonstrated a significantly reduced CFU‐F number for hBMSCs of female compared to male donors. Furthermore, there was a significant decrease in the proliferation rate, adipogenic differentiation potential and cell surface expression of SSEA‐4, CD146 and CD274 of hBMSCs with an increase in donor age. Interestingly, all these findings were exclusive to hBMSCs from female donors. Further research should focus on postmenopausal‐related effects on hBMSCs, as the results imply a functional loss and immunophenotypic change of hBMSCs particularly in aged women.     

Study on the Change and Judgment of Tobacco Seed Maturity

Study and judgment of tobacco seed maturity, and then chose the optimum harvest time have important significance to some agriculture production problems, such as: high quality germplasm resource conservation, utilization, development and improve seed quality and production. This study research the changes during tobacco seed maturity, including morphological changes (seed color), physiological changes within the seeds (water content, germination) and chlorophyll fluorescence (CF) in seed coat changes; and presented the application of these metric to judge the tobacco seed maturity; further studies in this fields and issues that be occurred are also addressed in the paper.     

嗜热β-甘露聚糖酶的研究进展

β-甘露聚糖酶在生物能源、饲料、食品和纺织等工业中均有着重要的应用前景。其属于半纤维素酶类,广泛存在于动植物和微生物中,微生物来源尤为广泛。随着极端微生物和极端酶的广泛研究,嗜热甘露聚糖酶因其在高温环境中具有较高酶活性和稳定性而倍受关注,并取得了较大的研究进展。本文综述了β-甘露聚糖酶的来源、分类和水解催化方式,以及嗜热甘露聚糖酶的优势和其在基因资源挖掘、重组表达以及分子改良方面的研究进展,展望了嗜热β-甘露聚糖酶未来可能的研究方向和发展前景。     

Host-Parasite Relationship of Meloidogyne chitwoodi on Potato

The soil fumigant 1,3-dichloropropene gave good to excellent control of the Columbia root-knot nematode, Meloidogyne chitwoodi, on potato, Solanum tuberosum L. Nonfumigant nematicides (aldicarb, fensulfothion, carbofuran, ethoprop, and phenamiphos) were less effective in controlling M. chitwoodi, since the nematode affects tuber quality more than quantity. Soil temperature during the growing season affected parasitism of M. chitwoodi on potato more than did the initial nematode population. There were positive linear correlations between degree-days and infected and galled tubers (r = 0.92), degree-days and nematode generations (r = 1.00), and infected and galled tubers and nematode generations (r = 0.91). Differences in degree-days and resultant nematode reproduction caused great variability in infection and galling of potato tubers during four growing seasons: 89% for 1979, 0% for 1980, 13% for 1981, and 18% for 1982, giving positive linear correlation (r = 0.99) between final nematode soil population (Pf) and percentage of infected and galled tubers. Corresponding increases in the soil populations of second-stage juveniles (J2) during the growing season were 9,700% in 1979, 170% in 1980,552% in 1981, and 326% in 1982. There was a negative linear correlation (r = -0.87) between initial soil J2 populations (Pi) and the degree of parasitism (infection and galling) of potato tubers, Pi being of secondary importance to degree-days.