北京市公立医院管理行为现状调查

???????? 目的 调查北京市公立医院管理行为的现状,为公立医院法人治理结构改革政策的完善和评价提供依据。方法 以北京市500张床以上的三级公立医院以及区县级综合医院作为调查对象,根据研究框架设计调查问卷对51家医院高层管理者进行调查。结果 北京市大型公立医院管理者对财务指标的熟悉程度较低,对医院收入支出、医院发展目标、患者满意度、医疗事故差错发生率等指标利用率较高,但对于成本相关指标特别是不同支付方式下成本核算方法,以及效率、效果相关指标的熟悉程度和使用程度均较低。结论 目前公立医院的治理结构未能激励医院管理者从医院长远发展角度考虑医院的管理,以及关注公立医院资源的效率和效果。     

医生与管理者对医院核心人力资源管理制度评价研究

目的 了解公立医院医生和管理者对薪酬、晋升与学习成长这医院3大核心人事制度的认知与评价。方法运用自行设计的人事制度管理状况调查表对我国东、中、西3省、直辖市9个地区的128所公立医院进行调查。结果 医院核心人事制度3个因子中,被调查者不清楚率最高的是“晋升”（5.21%）,不认同率最高的是“薪酬”（25.02%）。多元logistic分析显示,是否是管理者、院内工龄等与被调查者对3大医院核心人事制度的评价有显著关联（P<0.05）。结论 普通医生与管理者对医院核心人事制度的知晓度尚可,医院管理者对医院核心人事制度的评价均显著优于普通医生。     

六城市医院ICU病人安全现状及影响因素研究

目的 了解中国医院ICU病人安全现况及影响因素。方法 运用问卷调查法及个人深入访谈法进行调查,采用因子分析的方法进行影响因素分析。结果 目标调查的两级医院存在的主要问题有：规章制度不完善,设备配置不足,医护人员培训效果不佳,关键流程病人辨识有待加强;影响ICU病人安全的主要因素为:人力配备及人员素质、人员准入、布局流程、监督管理、财力物力投入、规章制度、沟通与协作和工作强度。结论 ICU管理存在薄弱环节,应加强管理以保障病人安全。     

公立医院院长职业化：中层管理者的看法与启示

??????? 目的 通过对公立医院中层管理者问卷调查,分析当前我国医院院长职业化建设的问题与原因。方法 定量与定性相结合,抽样调查和统计武汉市173名医院中层管理者对院长职业化认知情况,通过文献分析深入挖掘深层次问题与原因。结果 多数中层医院管理者了解并支持院长职业化但认为难度较大;倾向于临床与管理复合型院长,主张通过医院自主公开招聘选拔院长,不愿意放弃临床工作。结论 改革公立医院管理体制,对现任院长职业化再造,改革院长管理绩效考核和薪酬分配制度。     

基于TOPSIS法的病人安全文化多维度综合评价

目的 探索病人安全文化的重要维度，以期为病人安全文化建设提供依据。方法 采用TOPSIS综合评价法，对病人安全文化态度量表中的6个一级维度从重要性和可行性的角度进行综合评价。结果 病人安全文化态度量表中排序前3位的维度依次为团队合作、安全氛围、工作条件。结论 在提高医院病人安全文化时应重点注重这3个方面内容。     

北京市公立医院治理结构现状调查

??????? 目的 调查北京市公立医院治理结构的现状,为公立医院法人治理结构改革政策的完善提供依据。方法 以北京市500张床以上的三级公立医院以及区县级综合医院作为调查对象,根据研究框架设计调查问卷对医院高层管理者进行调查,共调查公立医院51家。 结果 公立医院具有较高的决策权和剩余索取权,较低程度的市场开放度、问责机制,政府对公立医院的社会功能缺乏明晰的规定和相应的补助。结论 目前治理结构中公立医院的激励机制和监督机制的不匹配,可能是导致公立医院偏离公益性的关键原因。     

医院员工对医院组织文化认知现状的调查与分析

目的 了解员工对医院组织文化认知现状,并分析相关因素,提出对策措施,为医院今后制定合理有效的医院文化发展战略计划提供依据。方法 采用配额抽样的方法抽取乌鲁木齐市3家医院的743名员工进行问卷调查。结果 制度规范、竞争意识、持续发展和社会责任4个维度的得分最高,授权、组织协调、患者导向和成本控制4个维度的得分最低,职称、工作性质、本院工作年限的职工医院组织文化存在显著差异（P<0.05）。结论 针对存在的问题给出了相应的意见及建议, 如加强社会责任,树立以病人为中心的理念是医院文化建设的共同点;医院管理者应该注意激励员工将医院发展的大目标内化为自身发展的小目标,坚持“病人利益至上”,充分考虑患者的需求并积极听取患者的建议来改进自己的工作;在进行文化建设时要注重对不同岗位的员工群体采取不同的激励方式。     

青岛市部分三级医院员工HPWS相关职业体验调查分析

目的 采用高绩效工作体系调查表评估青岛市2家三级医院人力资源管理实践,分析员工作满意度之间的关系。方法 运用HPWS相关员工职业体验调查问卷收集2家医院员工职业体验相关统计数据。结果 样本医院团队合作与回报得分最高,在就业安全感、授权、组织承诺、自主性、员工间关系、信任、平等等方面得分较高;晋升、情绪完好状态和绩效管理等方面得分较低;团队合作、授权、信息支持与员工工作满意度和员工感受的病人服务正相关。结论 我国医院管理实践中包含了大量HPWS的内容,HPWS与员工工作满意度呈正向关系,因此也适用于我国。     

我国公立医院自下而上声誉测评机制探讨

目的 探索我国公立医院的声誉测评体系,最终为个人就医和宏观医疗改革提供参考。方法 从声誉理论出发,借鉴美国医院声誉评价成果,探索我国自下而上声誉评价体系。结果 我国公立医院有其特殊性,但基于不完全契约和医院治理委托代理的现实相同,声誉研究方法依旧契合。结论 基于公立医院公益性,综合医疗质量和医疗资源利用效率等构建评价体系。     

我国公立医院病人安全文化的现状研究

目的 构建适合我国公立医院的病人安全文化测评量表,并分析我国公立医院病人安全文化现状。方法 对我国东、中、西部3省（直辖市）54所公立医院员工进行问卷调查。结果 中国版医疗机构病人安全文化调查量表信、效度可以接受;我国公立医院病人安全文化处于中上水平（总体平均分为3.80分）;在“害怕受责备与惩罚”“害怕受羞辱”“提供安全的医疗保健”和“组织安全资源”的维度上,评分相对较低;不同地区、等级公立医院病人安全文化存在一定差异。结论 我国公立医院病人安全文化尚未达到令人满意的程度,政府卫生主管部门和医院管理者需要营造更好的病人安全文化,尤其应加强西部地区医院和二级医院的病人安全文化建设。     

Changes in lactate dehydrogenase activity in chicken tissues in hyperthyreosis in ontogenesis

The lactate dehydrogenase activity in reactions of lactate oxidation and synthesis was studied in subfractions of the chicken brain, heart and liver at the embryonal, early postembryonal and adult stages of development after thyroxine administration. It has been shown that during embryogenesis thyroxine predominantly enhanced the rate of lactate oxidation in the mitochondrial tissues. A marked increase in the lactate synthesis was found in cytoplasm of the adult chicken tissues. Specificity of enzyme activity alterations was detected in the chicken brain during ontogenesis after thyroxine administration.     

Role for dopamine in malonate-induced damage in vivo in striatum and in vitro in mesencephalic cultures

Defects in mitochondrial energy metabolism have been implicated in the pathology of several neurodegenerative disorders. In addition, the reactive metabolites generated from the metabolism and oxidation of the neurotransmitter dopamine (DA) are thought to contribute to the damage to neurons of the basal ganglia. We have previously demonstrated that infusions of the metabolic inhibitor malonate into the striata of mice or rats produce degeneration of DA nerve terminals. In the present studies, we demonstrate that an intrastriatal infusion of malonate induces a substantial increase in DA efflux in awake, behaving mice as measured by in vivo microdialysis. Furthermore, pretreatment of mice with tetrabenazine (TBZ) or the TBZ analogue Ro 4-1284 (Ro-4), compounds that reversibly inhibit the vesicular storage of DA, attenuates the malonate-induced DA efflux as well as the damage to DA nerve terminals. Consistent with these findings, the damage to both DA and GABA neurons in mesencephalic cultures by malonate exposure was attenuated by pretreatment with TBZ or Ro-4. Treatment with these compounds did not affect the formation of free radicals or the inhibition of oxidative phosphorylation resulting from malonate exposure alone. Our data suggest that DA plays an important role in the neurotoxicity produced by malonate. These findings provide direct evidence that inhibition of succinate dehydrogenase causes an increase in extracellular DA levels and indicate that bioenergetic defects may contribute to the pathogenesis of chronic neurodegenerative diseases through a mechanism involving DA.     

Scurvy in capybaras bred in captivity in Argentine

In order to determine if the absence of vitamin C in the diet of capybaras (Hydrochoerus hydrochaeris) causes scurvy, a group of seven young individuals were fed food pellets without ascorbic acid, while another group of eight individuals received the same food with 1 g of ascorbic acid per animal per day. Animals in the first group developed signs of scurvy-like gingivitis, breaking of the incisors and death of one animal. Clinical signs appeared between 25 and 104 days from the beginning of the trial in all individuals. Growth rates of individuals deprived of vitamin C was considerably less than those observed in the control group. Deficiency of ascorbic acid had a severe effect on reproduction of another population of captive capybaras. We found that the decrease in ascorbic acid content in the diet affected pregnancy, especially during the first stages. The results obtained suggest that it is necessary to supply a suitable quantity of vitamin C in the diet of this species in captivity.     

SSTR5 ablation in islet results in alterations in glucose homeostasis in mice

Somatostatin (SST) peptide is a potent inhibitor of insulin secretion and its effect is mediated via somatostatin receptor 5 (SSTR5) in the endocrine pancreas. To investigate the consequences of gene ablation of SSTR5 in the mouse pancreas, we have generated a mouse model in which the SSTR5 gene was specifically knocked down in the pancreatic beta cells (betaSSTR5Kd) using the Cre-lox system. Immunohistochemistry analysis showed that SSTR5 gene expression was absent in beta cells at three months of age. At the time of gene ablation, betaSSTR5Kd mice demonstrated glucose intolerance with lack of insulin response and significantly reduced serum insulin levels. Insulin tolerance test demonstrated a significant increase of insulin clearance in vivo at the same age. In vitro studies demonstrated an absence of response to SST-28 stimulation in the betaSSTR5Kd mouse islet, which was associated with a significantly reduced SST expression level in betaSSTR5Kd mice pancreata. In addition, betaSSTR5Kd mice had significantly reduced serum glucose levels and increased serum insulin levels at 12 months of age. Glucose tolerance test at an older age also indicated a persistently higher insulin level in betaSSTR5Kd mice. Further studies of betaSSTR5Kd mice had revealed elevated serum C-peptide levels at both 3 and 12 months of age, suggesting that these mice are capable of producing and releasing insulin to the periphery. These results support the hypothesis that SSTR5 plays a pivotal role in the regulation of insulin secretion in the mouse pancreas.