基于持续改进的医疗质量控制体系构建

以等级医院评审为契机,借助《三级综合医院评审实施细则（2011版）》,设立院级、科级质控员岗位, 构建了“三级质控、四级网络”质控体系,并出台配套政策,完善岗位职责,严格业绩考评。通过持续改进医疗质量,推动质控体系的建立健全,提升了医院质量管理和质量控制内涵,为医院质量与安全提供基础保障。     

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。     

北京市属三级医院单病种质量管理现况研究

目的 调查北京市市属22家三级医院在单病种质量管理工作的开展现况,评估单病种质量管理水平。方法 采用调查问卷和深入访谈法对22家北京市市属三级医院单病种质量管理的开展数量、管理模式进行调查。结果 北京市市属22家三级医院开展单病种质量管理的占54.5%,单病种开展率为57.5%。实现实时监测单病种质控管理模式的仅4家医院。结论 单病种质控管理需要提升电子病历系统建设水平,结构化的电子病历对于质控数据的提取至关重要。     

对贵州省县级医院医疗帮扶需求的初步调查分析

目的 调查县级医院医疗帮扶需求现状,为县级医院对口帮扶政策制定提供基础依据。方法 以贵州省县级医院决策者为调查对象,按照研究主题设计调查表,实施调查,获取数据进行分类整理、分析。结果 （1）目前帮扶模式对医疗技术及管理有一定帮助（75.73%和63.43%）,帮助很大（16.02%和15.28%）,对医疗技术无帮助（8.25%）,医院管理能力无帮助（21.29%）。（2）目前最受欢迎的帮扶为医疗技术（74.89%）、人才培养（83.12%）及管理（61.04%）。（3）人才培养以选择住院医师或主治医生到帮扶医院进修学习（57.14%）,攻读本科学历（45.95%）及在职硕士（39.19%）为主。结论 当前医疗帮扶对县级医院医疗技术及管理具有一定的帮扶效果,但尚有待改进。     

检验全流程数字化管理及质量控制体系的构建

通过对检验工作各环节流程、质控情况的分析,制定了新的检验业务管理及质量控制流程,并利用数字化技术对流程各环节进行系统实现。检验全流程数字化管理及质量控制体系的构建,有效提高了检验工作的效率与质量安全,进一步促进了医院医疗质量管理水平的提高。     

实施首席质控师制度 加强医院质量内涵建设

为探索持续改进医疗质量的长效管理机制,实施了首席质控师制度。文章介绍了首席质控师的概念与资质认定、职责与管理模式,结合首席质控师制度的实践经验,对其在医院质量管理中的重要作用进行了探讨。     

电子病历环节质控点的设置及其在质量控制中的作用研究

电子病历的实施为医疗质量控制提供了手段,尤其电子病历多个环节质控点的设置使传统质控模式变为动态全程质控,提高了全员的质控意识,使质控指标考核依据更加科学、充分。因此,电子病历多个环节质控点的设置在质量控制中发挥了重要的作用。通过开发系列电子病历环节质控点,取得较好的质控效果。     

医院质量监测系统在医院管理及临床服务中的应用

医院质量监测系统（HQMS）作为医疗服务监管信息网络直报平台,对建立全国性医疗服务质量与效率资料库,提供医院评审评价数据支持,促进医院内部持续改进具有重要作用。文章将医院应用HQMS进行医疗质量管理和持续改进的具体实践以及取得的成效进行了总结,可以为各医院医疗质量管理提供有益参考。     

贵州省县级医院决策者的管理培训现状及需求调查

目的 为制订县级医院决策者培训计划提供依据,对贵州省县级医院决策者的管理培训现状及需求进行调查。方法 以贵州省县级医院决策者为调查对象,按照研究主题设计调查表,实施调查,获取数据进行分类整理、分析。结果 （1）医院决策者以中青年为主,分布于40～50岁;大学本科、副高及中级职称为主;（2）岗位前所学专业主要为临床医疗,专业管理人员少;从事管理5～15年占总体的59.31%;65.24%为兼职管理人员。（3）接受3个月以内的培训（65.80%）,3个月以上培训（9.52%）,未接受过培训（24.67%）;大部分人员接受过管理知识培训（21.21%～64.50%）,就培训内容而言,仅有接受医疗法律法规的决策者超过50%,绝大部分调查培训内容均未超过50%。（4）最需要的培训知识为战略管理（49.78%）、经营管理（53.25%）、人力资源管理（51.56%）、医院信息系统管理（45.89%）、领导科学（51.52%）。结论 县级医院决策者其培养时间及培养内容不足,医院决策者管理能力尚需加强。     

北京市心血管介入质量控制和改进中心管理模式探讨

通过对北京市心血管介入质量控制和改进中心成立1年来的运行状况进行分析,总结了质控中心在管理方面取得的经验和存在的问题,认为医疗专业质控中心应该着眼于本专业特点,制定有效、合理的质控管理模式,以质控管理促进专业的长期发展和技术进步。     

β-Alanine containing peptides: γ-Turns in cyclotetrapeptides

In the present paper we describe the synthesis, purification, single-crystal x-ray analysis, solution conformational characterization, and conformational energy calculations of the cyclic tetrapeptide cyclo- (β-Ala-L -Pro-β-Ala-L -Val). The peptide was synthesized by classical solution methods and the cyclization of the free tetrapeptide was accomplished in good yields in diluted methylene chloride solution using N,N-dicyclohexyl-carbodiimide. The compound crystallizes in the monoclinic space group P2₁ from ethanol with two independent molecules in the unit cell. All peptide bonds are trans. The nmr molecular conformation in the acetonitrile solution as well as that derived from the molecular dynamic simulation in vacuo is quite different from those observed in the solid state and is very similar to that previously observed for the parent compound cyclo-(β-Ala-L -Pro-β-Ala-L -Pro). © 1993 John Wiley & Sons, Inc.     

Solution properties of γ‐crystallins: Hydration of fish and mammal γ‐crystallins

Lens γ crystallins are found at the highest protein concentration of any tissue, ranging from 300 mg/mL in some mammals to over 1000 mg/mL in fish. Such high concentrations are necessary for the refraction of light, but impose extreme requirements for protein stability and solubility. γ‐crystallins, small stable monomeric proteins, are particularly associated with the lowest hydration regions of the lens. Here, we examine the solvation of selected γ‐crystallins from mammals (human γD and mouse γS) and fish (zebrafish γM2b and γM7). The thermodynamic water binding coefficient B₁ could be probed by sucrose expulsion, and the hydrodynamic hydration shell of tightly bound water was probed by translational diffusion and structure‐based hydrodynamic boundary element modeling. While the amount of tightly bound water of human γD was consistent with that of average proteins, the water binding of mouse γS was found to be relatively low. γM2b and γM7 crystallins were found to exhibit extremely low degrees hydration, consistent with their role in the fish lens. γM crystallins have a very high methionine content, in some species up to 15%. Structure‐based modeling of hydration in γM7 crystallin suggests low hydration is associated with the large number of surface methionine residues, likely in adaptation to the extremely high concentration and low hydration environment in fish lenses. Overall, the degree of hydration appears to balance stability and tissue density requirements required to produce and maintain the optical properties of the lens in different vertebrate species.     

Anti‐cancer therapy with TNFα and IFNγ: A comprehensive review

Tumour necrosis factor alpha (TNFα) and interferon gamma (IFNγ) were originally found to be produced by inflammatory cells and play important roles in the immune system and surveillance of tumour growth. By activating distinct signalling pathways of nuclear factor‐κB (NF‐κB), mitogen‐activated protein kinase (MAPK), and JAK/STAT, TNFα and IFNγ were reported to effectively trigger cell death and perform powerful anti‐cancer effects. In this review, we will discuss the new advancements of TNFα and IFNγ in anti‐cancer therapy.     

TGF-β3 and cancer: A review

With the development of growth factors and growth factor modulators as therapeutics for a range of disorders, it is prudent to consider whether modulating the growth factor profile in a tissue can influence tumour initiation or progression. As recombinant human TGF-β3 (avotermin) is being developed for the improvement of scarring in the skin it is important to understand the role, if any, of this cytokine in tumour progression.Elevated levels of TGF-β3 expression detected in late-stage tumours have linked this cytokine with tumourigenesis, although functional data to support a causative role are lacking. While it has proved tempting for researchers to interpret a ‘correlation’ as a ‘cause’ of disease, what has often been overlooked is the normal biological role of TGF-β3 in processes that are often subverted in tumourigenesis. Clarifying the role of this cytokine is complicated by inappropriate extrapolation of the data relating to TGF-β1 in tumourigenesis, despite marked differences in biology between the TGF-β isoforms. Indeed, published studies have indicated that TGF-β3 may actually play a protective role against tumourigenesis in a range of tissues including the skin, breast, oral and gastric mucosa. Based on currently available data it is reasonable to hypothesize that administration of acute low doses of exogenous TGF-β3 is unlikely to influence tumour initiation or progression.     

Ecosystem stability in space: α, β and γ variability

The past two decades have seen great progress in understanding the mechanisms of ecosystem stability in local ecological systems. There is, however, an urgent need to extend existing knowledge to larger spatial scales to match the scale of management and conservation. Here, we develop a general theoretical framework to study the stability and variability of ecosystems at multiple scales. Analogously to the partitioning of biodiversity, we propose the concepts of alpha, beta and gamma variability. Gamma variability at regional (metacommunity) scale can be partitioned into local alpha variability and spatial beta variability, either multiplicatively or additively. On average, variability decreases from local to regional scales, which creates a negative variability–area relationship. Our partitioning framework suggests that mechanisms of regional ecosystem stability can be understood by investigating the influence of ecological factors on alpha and beta variability. Diversity can provide insurance effects at the various levels of variability, thus generating alpha, beta and gamma diversity–stability relationships. As a consequence, the loss of biodiversity and habitat impairs ecosystem stability at the regional scale. Overall, our framework enables a synthetic understanding of ecosystem stability at multiple scales and has practical implications for landscape management.     

Identification of new Presenilin‐1 phosphosites: implication for γ‐secretase activity and Aβ production

An important pathological hallmark of Alzheimer's disease (AD) is the deposition of amyloid‐beta (Aβ) peptides in the brain parenchyma, leading to neuronal death and impaired learning and memory. The protease γ‐secretase is responsible for the intramembrane proteolysis of the amyloid‐β precursor protein (APP), which leads to the production of the toxic Aβ peptides. Thus, an attractive therapeutic strategy to treat AD is the modulation of the γ‐secretase activity, to reduce Aβ42 production. Because phosphorylation of proteins is a post‐translational modification known to modulate the activity of many different enzymes, we used electrospray (LC‐MS/MS) mass spectrometry to identify new phosphosites on highly purified human γ‐secretase. We identified 11 new single or double phosphosites in two well‐defined domains of Presenilin‐1 (PS1), the catalytic subunit of the γ‐secretase complex. Next, mutagenesis and biochemical approaches were used to investigate the role of each phosphosite in the maturation and activity of γ‐secretase. Together, our results suggest that the newly identified phosphorylation sites in PS1 do not modulate γ‐secretase activity and the production of the Alzheimer's Aβ peptides. Individual PS1 phosphosites shall probably not be considered therapeutic targets for reducing cerebral Aβ plaque formation in AD.