潍坊市乡镇卫生院人力资源现状分析

目的 了解潍坊市乡镇卫生院人力资源情况,为政府部门合理配置卫生人力资源和基层医疗机构综合改革提供参考。方法 对2010年潍坊市148个乡镇卫生院进行问卷调查。从整体上对乡镇卫生院的整体情况、年龄结构、学历结构、职称构成和专业构成情况进行分析。结果 潍坊市乡镇卫生院人员实有编制数及人员素质总体偏低。结论 应采取有效措施培训和引进人才,提高卫生技术人员的素质和能力。     

广西新生儿专科护士的现况调查

目的了解并分析广西新生儿专科护士的现况,为广西新生儿专科护士的培训提供客观依据。方法通过查阅文献,结合广西新生儿专科护士培训方案及培训计划,采用自制调查表及自评式问卷对3期共163名广西新生儿专科护士进行培训技能需求调查,并对培训前、培训后的专科技能掌握现况进行自评。结果基本技能需求构成比为80.98%,重症护理需求构成比为93.25,外科护理需求构成比为51.53%,科研指导需求构成比为41.72%。培训前后新生儿专科基本技能和科研能力掌握评分比较,差异有统计学意义(P<0.05);新生儿重症护理技术和新生儿外科护理技术培训前后的评分比较,差异无统计学意义(P>0.05)。结论广西新生儿专科护士在重症护理技术和外科护理技术能力较低,系统、全面、规范的人才培养及培训有助于提高专科护士的专业技术水平。     

基层医院管理人员继续教育培训课程设置的需求研究

目的 分析基层医院管理人员对大型公立医院管理培训课程设置的需求,为改进培训课程提供依据。方法 进行现场问卷调查,对数据进行描述性统计分析。结果 调查对象对人力资源管理、人文管理、医疗管理课程内容需求最大,需求最大的课程组织形式是互动式交流座谈,最感兴趣的现场参观内容是制度流程及规范性文件,希望培训时长为15天,希望能建立长期联系获取后续学习服务。结论 大型公立医院作为培训基层医院管理人员的有效平台,应以需求为导向突出课程内容实用性,系统化整合个性化、多样化的课程形式,构建长效评价支持体系。     

论全面有效地培训新生代农民工

简述了农民工现状及存在的问题,分析培训新农民工的现实需求,指出企业是培训的落实者,培训新农民工是企业的社会责任,政府应该给与企业适当的补贴,并提出培训的基本思路、方向和内容。     

北京市乡镇卫生院经济运行状况分析

采取部分财务评价指标，通过对北京市两区一县的现场调查，分析了乡镇卫生院的经济运行情况，结果表明，乡镇卫生院运营状况堪忧。政府制定药品政策要结合卫生院经营的实际情况，为评价投资效果提供参考数据。     

医院行政管理人员培训需求的调查研究

目的 明确医院行政管理队伍培训需求,为建立规范化培训体系,提高医院管理水平奠定基础。方法 采用问卷调查法,面向医院行政管理人员开展个人培训需求意愿、医院内部管理体系运行现状及个人岗位胜任能力调查,在此基础上进行组织、岗位及个人层面的培训需求分析。结果 医院行政管理人员接受培训的意愿较为突出,而不同层级之间对培训内容、时间及方式的需求存在明显差异。结论 医院行政管理人员具有较为强烈的培训需求,建立一套科学实用的长效培训机制是建设高素质医院管理队伍的基础性工程。     

重视医学非护理专业学生学习护理技术

通过对370名非护理专业的实习返校学生调查,总结归纳了医学非护理专业学生学习常用护理技术的重要性、必要性和长期性,为基层、社区、个体诊所、乡村卫生院培养一线医务工作者打下了坚实的基础。     

论首都农村卫生室乡村医生的未来??????? ——以政策与法律变迁为研究主线

???? 未来,随着国家乡村卫生服务一体化管理的推进,在首都农村卫生室执业的执业（助理）医师将最终汇入乡镇卫生院的体制之内,无论是合同聘用,还是正式编制,均将改变其现在以及之前的农民身份,从而进入公职人员的行列;其后续人员的选拔在当前遇到了一定的困难,需要作出针对性的改革;其培训将主要通过网络平台同时辅助于一部分面授等方式来完成,其待遇将与卫生院医务人员趋同,其向村民提供的服务将在现有基础上增加一部分卫生院的服务项目。

     

四川省凉山州部分乡镇卫生院基本情况影响农民就诊情况的调查

乡镇卫生院负责本乡镇的医疗,预防和妇幼卫生等综合卫生服务,并指导村级医生,向居民提供方便、快捷的基本医疗服务。凉山彝族自治州地处四川西南部,农村人口占绝大多数,了解农民于乡镇卫生院的就诊情况与农民关注自己的健康状况有着必然的联系。而乡镇卫生院医务人员的学历、职称、医疗设施情况、医院的收费情况等与农民的就诊情况息息相关。本文通过对四川省凉山州部分乡镇卫生院的基本条件和农民的就诊情况分别进行调查,并分析其形成的原因。     

案例教学法(CBM)在康复治疗师培训中的应用和评价

目的:探讨案例教学法在康复治疗师培训中的应用。方法:100名康复治疗师志愿者按从业时间分为低、中、高级治疗师,随后将不同资格的志愿者平均分配到传统教学法教学组(对照组)和案例教学法教学组(实验组),以脑性瘫痪的康复为主要内容开展培训。培训结束后,针对学员对基础知识的掌握和病例的分析进行考核。结果:实验组的学员基础知识的平均分高于对照组(P0.05),并且对病例的分析能力也显著高于对照组(P0.01)。调查问卷结果显示,多数实验组学员认为案例教学法能够调动学习积极性,并提高独立思考、分析问题的能力。结论:在康复医学教学中,案例教学法在激发学习兴趣、提高学习效率和学生综合素质方面优于传统的教学方法。     

以利益均衡构筑权利保障——浅析侵权责任法立法价值取向及其对医疗机构的几点启示

利益均衡旨在于利益关系主体之间寻找平衡点,尽可能将内部矛盾冲突降低到最低限度,保持利益体系和利益格局的稳定,其最终目的是实现权利保障,而法律制度的确立则是最有公信力的长效调整机制和保障机制。从侵权责任法医疗损害侵权行为构成要件和归责原则的确认、“举证责任倒置”的改变、医用产品连带责任和不必要检查侵权的规定等几个方面,体现出其以医患双方利益均衡为前提、确保双方权利充分保障的立法价值取向。立足于此,医疗机构应树立对医方权利和患方权利给予同等重视、理解患者合法权利内容、界定合理的医患双方权利义务界限、增强权利自我维护意识的发展观念。     

公立医院医疗服务成本及效率分析

随着医院卫生体制改革的不断深入,医院靠高收费、高要价维持的现状将被改变。目前公立医院的医疗服务成本居高不下,医疗资源紧张,如何有效控制成本、提高资源使用效率是公立医院的管理重点与难点。以某三甲公立医院4个科室2008年的相关数据为基础,分析了各科室成本构成及效率。结果表明,人员支出在成本中占据较大比重,奖金大大超过工资,奖金制度不尽合理,医师人数严重不足,病床使用率超过100%,病床周转次数较低。针对这些问题提出建立全面的绩效考核指标、控制材料费用、建立术前评估制度等建议。     

我国影像临床试验注册情况及其对科研管理的启示

???? 目的 分析和探讨我国影像医学临床试验注册现状及存在的问题。方法 收集中国临床试验注册中心2008—2012年的临床试验注册数据,使用SPSS16.0软件进行统计分析,组间构成比比较采用Pearson χ²检验。结果 5年间我国影像医学临床试验注册数呈明显上升趋势。2011—2012年注册试验的影像手段构成与2008—2010年注册试验不同, P=0.037,MRI（从18.18%到32.73%）、CT（从9.09%到18.18%）试验所占比例明显升高。影像医学临床试验采用诊断试验设计的比例最高,占37.98%,明显高于平均水平3.45%,P<0.001。结论 我国影像临床试验的管理逐渐规范,临床试验的科学性和可信度随之提高。加强临床试验预注册、完善试验设计是提高影像医学试验管理水平的重要措施。     

临床科研管理系统在医院临床研究中的价值分析

目的 探讨临床科研管理系统在临床科室科研管理工作中的重要作用及推广价值。方法 使用SPSS15.0软件对数据进行统计分析,入组率比较采用χ²检验。结果 采用临床科研管理系统后,前3个月入组率不断升高,然后持续稳定在较高水平,前3个月的入组率（18.83%）明显低于后12个月的入组率（28.22%）,差异有统计学意义（P = 0.006）。目前已经有15项在研课题登记在案,科室科研氛围良好。结论 推行临床科研管理体系后,科研工作在数量和质量上均有了长足的发展和进步,在医院中具有推广价值。     

Modeling species-specific diacylglycerol dynamics in the RAW 264.7 macrophage

A mathematical model of the G protein signaling pathway in RAW 264.7 macrophages downstream of P2Y₆ receptors activated by the ubiquitous signaling nucleotide uridine 5’-diphosphate is developed. The model, which is based on time-course measurements of inositol trisphosphate, cytosolic calcium, and diacylglycerol, focuses particularly on differential dynamics of multiple chemical species of diacylglycerol. When using the canonical pathway representation, the model predicted that key interactions were missing from the current network structure. Indeed, the model suggested that accurate depiction of experimental observations required an additional branch to the signaling pathway. An intracellular pool of diacylglycerol is immediately phosphorylated upon stimulation of an extracellular receptor for uridine 5’-diphosphate and subsequently used to aid replenishment of phosphatidylinositol. As a result of sensitivity analysis of the model parameters, key predictions can be made regarding which of these parameters are the most sensitive to perturbations and are therefore most responsible for output uncertainty.     

Molecular characterization of β1,4-galactosyltransferase 7 genetic mutations linked to the progeroid form of Ehlers-Danlos syndrome (EDS)

β1,4-Galactosyltransferase 7 (β4GalT7) is a key enzyme initiating glycosaminoglycan (GAG) synthesis. Based on in vitro and ex vivo kinetics studies and structure-based modelling, we molecularly characterized β4GalT7 mutants linked to the progeroid form of Ehlers-Danlos syndrome (EDS), a severe connective tissue disorder. Our results revealed that loss of activity upon L206P substitution due to altered protein folding is the primary cause for the GAG synthesis defect in patients carrying the compound A186D and L206P mutations. We showed that R270C substitution strongly reduced β4GalT7 affinity towards xyloside acceptor, thus affecting GAG chains formation. This study establishes the molecular basis for β4GalT7 defects associated with altered GAG synthesis in EDS.     

Self-organization at the origin of life

The concept of an (M,R) system with organizational invariance allows one to understand how a system may be able to maintain itself indefinitely if it is coupled to an external source of energy and materials. However, although this constitutes an important step towards understanding the difference between a living and a non-living system, it is not clear that an (M,R) system with organizational invariance is sufficient to define a living system. To take a further step towards defining what it means to be alive it is necessary to add to a simple (M,R) system some property that represents its identity, and which can be maintained and modified in subsequent generations.     

Topology is the Principal Determinant in the Folding of a Complex All-alpha Greek Key Death Domain from Human FADD

In order to elucidate the relative importance of secondary structure and topology in determining folding mechanism, we have carried out a phi-value analysis of the death domain (DD) from human FADD. FADD DD is a 100 amino acid domain consisting of six anti-parallel alpha helices arranged in a Greek key structure. We asked how does the folding of this domain compare with that of (a) other all-alpha-helical proteins and (b) other Greek key proteins? Is the folding pathway determined mainly by secondary structure or is topology the principal determinant? Our Φ-value analysis reveals a striking resemblance to the all-beta Greek key immunoglobulin-like domains. Both fold via diffuse transition states and, importantly, long-range interactions between the four central elements of secondary structure are established in the transition state. The elements of secondary structure that are less tightly associated with the central core are less well packed in both cases. Topology appears to be the dominant factor in determining the pathway of folding in all Greek key domains.     

Uncovering operational interactions in genetic networks using asynchronous Boolean dynamics

Biological networks of large dimensions, with their diagram of interactions, are often well represented by a Boolean model with a family of logical rules. The state space of a Boolean model is finite, and its asynchronous dynamics are fully described by a transition graph in the state space. In this context, a model reduction method will be developed for identifying the active or operational interactions responsible for a given dynamic behaviour. The first step in this procedure is the decomposition of the asynchronous transition graph into its strongly connected components, to obtain a “reduced” and hierarchically organized graph of transitions. The second step consists of the identification of a partial graph of interactions and a sub-family of logical rules that remain operational in a given region of the state space. This model reduction method and its usefulness are illustrated by an application to a model of programmed cell death. The method identifies two mechanisms used by the cell to respond to death-receptor stimulation and decide between the survival and apoptotic pathways.     

The role of low avidity T cells in the protection against type 1 diabetes: a modeling investigation

Cytotoxic T lymphocytes (CTLs) play a dominant role in the pathogenesis of autoimmune diabetes, commonly denoted Type 1 Diabetes (T1D). These CTLs (notably CD8⁺ T cells) recognize and kill insulin-secreting pancreatic β cells, reducing their number by ∼90%. The resulting reduction of insulin secretion causes the defective regulation of glucose metabolism, leading to the characteristic symptoms of diabetes. Recognition of β cells as targets by CTLs depends on the interactions between MHC-peptide complexes on the surface of β cells and receptors (TCRs) on T cells. Those CTLs with high affinity TCRs (also called high avidity T cells) cause most of the harm, while those with low affinity TCRs (also called low avidity T cells) play a more mysterious role. Recent experimental evidence suggests that low avidity T cells accumulate as memory T cells during the disease and may be protective in NOD mice (a strain prone to developing T1D), delaying disease progression. It has been hypothesized that such low avidity T cells afford disease protection either by crowding the islets of Langerhans, where β cells reside, or by killing antigen presenting cells (APCs).In this paper, we explore the hypothesized mechanisms for this protective effect in the context of a series of models for (1) the interactions of low and high avidity T cells, (2) the effect of APCs and (3) the feedback from β cell killing to autoantigen-induced T cell proliferation. We analyze properties of these models, noting consistency of predictions with observed behaviour. We then use the models to examine the influence of various treatment strategies on the progression of the disease. The model reveals that progressive accumulation of memory low avidity autoreactive T cells during disease progression makes treatments aimed at expanding these protective T cell types more effective close to, or at the onset of clinical disease. It also provides evidence for the hypothesis that low avidity T cells kill APCs (rather than the alternate hypothesis that they crowd the islets).