临床医师对电子病历相关知识认知的调查研究

目的:了解临床医师对电子病历书写的态度和行为现状以及电子病历管理和对医疗质量的认知等情况,为制定科学的电子病历管理方案提供借鉴。方法:选取两所2所三级甲等和2所三级乙等医院临床医师共计450名进行调查,采用问卷调查医师对电子病例相关知识(如临床医师对电子病例相关法规认知、电子病例监控对电子病历影响及电子病历优点等)的认知和需求。结果:临床医师电子病历总体书写现状调查显示,对于书写电子病历中相似的部分,48.7%(219例)的医师直接复制粘贴再修改;复制粘贴使用比率≥40%占76.7%(345例);电子病历书写出错原因主要为认为责任心不强(38.2%)和病历系统掌握不到位(29.6%);促进临床医师按要求写好病历的主要动力为法律证据(32.9%)和培养临床思维(49.1%);54.9%(247例)医师能对自己的病历进行经常检查;科室负责人对电子病历经常检查的占33.1%(149例);50%左右人员对电子病历系统操作掌握情况一般;79.33%的临床医师认为电子病历的使用有助于提高医疗质量;临床医师认为电子病历对医疗质量的影响主要是提高病历书写速率、病历完成及时性、管理系统性、病历安全性和患者满意度。结论:临床医师在电子病历书写中复制粘贴比例较高,且对相关的法律法规认识一般,对医院电子病历系统掌握不熟悉,应加大相关内容的培训,更有利于医院电子病历的管理。     

基于EMR数据挖掘的临床路径构建中EMR数据采集

在基于电子病历数据挖掘构建临床路径中，并非所有的电子病历都符合要求，也并非所有的电子病历所记录的内容都是必须的，因此，在采用基于电子病历数据挖掘技术构建临床路径过程中，需要对电子病历及电子病历中的具体内容进行筛选。文章即从该两个方面进行了探讨。     

浅谈电子病历应用中的患者知情权保护

患者知情权是患者的基本权利,目前医患信息的不对称凸显出患者知情权的重要性,电子病历作为医疗信息化产物被广泛应用,为患者实现知情权提供了捷径。但目前我国在电子病历应用中对患者知情权的保护尚有欠缺,主要体现在病历质量管理和病历公开两方面。因此,应推动相关法律法规的细化和落实,全面实现电子病历质控,并推进病历公开进程,改善患者知情权保护现状。     

电子病历系统在医院信息管理系统中应用初探

电子病历系统是通过计算机等电子设备为载体,对医院患者的诊疗活动进行数字化记录的软件。电子病历中详细记录了医嘱、病程、过敏史、影像检查结果、出院记录等多项医疗数据。电子病历完整、系统、科学地记录了患者身体健康情况以及历次就诊记录,通过一个维度将患者内部不同层次的信息有机的联系在一起。与传统的纸张病历相比,电子病历可以迅速实现不同时间、不同医院医疗信息的高效整合以及信息共享,为临床诊疗提供大量科学准确的信息,大大提高医院的服务效率。本文通过电子病历系统在医院信息管理系统中的应用情况进行简要分析,以期提高电子病历系统在临床中解决实际医疗问题的能力。     

电子病历应用中存在的问题与对策

结合电子病历在北京天坛医院应用过程中存在的问题，包括对电子病历内涵认识不清、过度强调预防差错而影响计算机的便捷优势、缺乏自我保护意识与法律责任等，提出相关的解决方案及对策，借此推动电子病历在我院的进一步发展，并对未来我国的电子病历的发展进行展望。     

《医疗机构病历管理规定（2013年版）》立法技术缺陷初探

通过以立法技术角度对《医疗机构病历管理规定（2013年版）》进行分析,与2002年下发的《医疗机构病历管理规定》进行对比,从立法依据、适当的立法技术、条与款的关系、法律责任、与上位法的关系等方面入手,结合其他法律的规定和学者的研究成果,在对该规定给与充分肯定的基础上,深入探讨其在立法技术方面存在的缺陷,以期对其有更加深入全面的认识;同时也希望促使立法者对立法技术给予应有的重视,在立法技术方面少犯错误,以利于立法工作更加完善。     

二级及以上公立医疗机构公共卫生相关科室设置分析

目的 摸底二级以上医疗机构公共卫生工作的组织方式,并对其设置公共卫生职能科室的必要性进行讨论。方法 检索北大法律信息数据库查找相关政府文件,梳理医疗机构设置公共卫生相关科室的要求。对发文要求设立公共卫生科室的省份和对比省份的163家医疗机构进行问卷调查。结果 原卫生部要求500张床位以上的医疗机构设立预防保健科,2003年以后部分省份发文要求二级以上医疗机构设立疾病预防控制或公共卫生科。72.5%的发文地区医疗机构和39.8%的未发文地区医疗机构设立了公共卫生相关科室,二级以上公立医疗机构设置公共卫生科室对公共卫生职责的承担有促进作用。结论 二级以上医疗机构应当设置公共卫生职能科室,以促进公共卫生职责的落实。     

关于新形势下病案管理的几点法律思考

病案是处理医疗纠纷的重要法律依据。2002年开始实施的《医院事故处理条例》和《医疗机构病历管理规范》,对依法治档、规范病案管理工作提供了重要保障。但是,面对医疗纠纷的“举证责任倒置”原则,医护人员应增强病案管理的法律意识。本文探讨了病案管理中法律观念与行为的内涵,分析了病案管理中法律问题表现形态和病案管理的内在需求,提出了病案管理法律观念与行为的培育途径。     

超说明书用药法律评价标准探讨

目前超说明书用药存在一定必要性与合理性，但从患者安全和医生执业角度都存在一定风险。通过对常见规避超说明书用药风险方法的法律属性及效力进行分析，区分超说明书用药的不同情况，提出超说明书用药法律评价标准，以期对司法审判及医疗机构的临床应用提供帮助。     

关于新形势下病案管理的几点法律思考

病案是处理医疗纠纷的重要法律依据。2002年开始实施的《医院事故处理条例》和《医疗机构病历管理规范》,对依法治档、规范病案管理工作提供了重要保障。但是,面对医疗纠纷的“举证责任倒置”原则,医护人员应增强病案管理的法律意识。本探讨了病案管理中法律观念与行为的内涵,分析了病案管理中法律问题表现形态和病案管理的内在需求,提出了病案管理法律观念与行为的培育途径。     

Studies on the energy coupling sites of photophosphorylation IV. The relation of proton fluxes to the electron transport and ATP formation associated with Photosystem II

1. By using dibromothymoquinone as the electron acceptor, it is possible to isolate functionally that segment of the chloroplast electron transport chain which includes only Photosystem II and only one of the two energy conservation sites coupled to the complete chain (Coupling Site II, observed P/e₂ = 0.3–0.4). A light-dependent, reversible proton translocation reaction is associated with the electron transport pathway: H₂O → Photosystem II → dibromothymoquinone. We have studied the characteristics of this proton uptake reaction and its relationship to the electron transport and ATP formation associated with Coupling Site II.

2. The initial phase of H⁺ uptake, analyzed by a flash-yield technique, exhibits linear kinetics (0–3 s) with no sign of transient phenomena such as the very rapid initial uptake (“pH gush”) encountered in the overall Hill reaction with methylviologen. Thus the initial rate of H⁺ uptake obtained by the flash-yield method is in good agreement with the initial rate estimated from a pH change tracing obtained under continuous illumination.

3. Dibromothymoquinone reduction, observed as O₂ evolution by a similar flash-yield technique, is also linear for at least the first 5 s, the rate of O₂ evolution agreeing well with the steady-state rate observed under continuous illumination.

4. Such measurements of the initial rates of O₂ evolution and H⁺ uptake yield an H⁺/e⁻ ratio close to 0.5 for the Photosystem II partial reaction regardless of pH from 6 to 8. (Parallel experiments for the methylviologen Hill reaction yield an H⁺/e⁻ ratio of 1.7 at pH 7.6.)

5. When dibromothymoquinone is being reduced, concurrent phosphorylation (or arsenylation) markedly lowers the extent of H⁺ uptake (by 40–60%). These data, unlike earlier data obtained using the overall Hill reaction, lend themselves to an unequivocal interpretation since phosphorylation does not alter the rate of electron transport in the Photosystem II partial reaction. ADP, P_i and hexokinase, when added individually, have no effect on proton uptake in this system.

6. The involvement of a proton uptake reaction with an H⁺/e⁻ ratio of 0.5 in the Photosystem II partial reaction H₂O → Photosystem II → dibromothymoquinone strongly suggests that at least 50% of the protons produced by the oxidation of water are released to the inside of the thylakoid, thereby leading to an internal acidification. It is pointed out that the observed efficiencies for ATP formation (P/e₂) and proton uptake (H⁺/e⁻) associated with Coupling Site II can be most easily explained by the chemiosmotic hypothesis of energy coupling.     

Evidence that the C-terminus of OprM is involved in the assembly of the VceAB-OprM efflux pump

Although the architecture of tripartite multiple drug resistance (MDR) efflux pumps of Gram-negative bacteria has been well characterized, the means by which the components recognize each other and assemble into a functional pump remains obscure. In this study we present evidence that the C-terminal domain of the Pseudomonas aeruginosa OprM and the α-helical hairpin domain of Vibrio cholerae VceA play an important role in the recognition/specificity/recruitment step in the assembly of a functional, VceAB-OprM chimeric efflux pump. To our knowledge, this is the first evidence directly linking the C-terminal domain of an outer membrane efflux protein to its recruitment during the assembly of a tripartite efflux pump.     

心脑血管疾病大额住院消费统计分析

通过对医院2004-2006年心脑血管疾病大额住院消费(消费大于50000元,以下简称大额消费)病例发病率高的前五种疾病的构成情况、药费、材料费消耗情况进行分析,认为加强大额病例中发病率高的病种的重点管理,是降低医疗费用的有效途径。建议制定常见病大额病种预定额付费方案和审查报销制度;采用适宜技术;控制药费,防止过度医疗,有效地遏制医疗费用的过快增长。     

Partial purification and properties of Galleria mellonella larvae proteolytic inhibitors acting on Metarhizium anisopliae toxic protease

Gel permeation, preparative isoelectric focusing, and affinity chromatography were used to purify three inhibitors of proteolytic activity from perchloric acid extracts of last instar Galleria mellonella larvae. Electrofocusing experiments revealed three isoinhibitors with different isoelectric points: inhibitor I-1 with p1 of pH 5.6, inhibitor I-2, pH 7.7, and inhibitor I-3 (of small inhibitory activity), pH 8.6. By affinity chromatography on trypsin-Sepharose 4B the I-1 was purified 9.7 ×, but 71.1% of inhibitory activity was lost. Molecular mass of the inhibitory complex was 12,600 Da. I-1 and I-2 are relatively stable to heat at several pHs with minor stability at pH 10. I-1 and I-2 inhibit serine proteases about 2.5 times as much as sulfhydryl proteases. In the same ratio protease P-1 and protease P-2 from Metarhizium anisopliae are inhibited.     

Strategy for Stabilizing Enzymes Part Two: Increasing Enzyme Stability by Selective Chemical Modification

The molecular mechanisms of change in the thermal stability of proteins modified with low molecular weight reagents are discussed. The choice of stabilization mechanisms to be used as a general strategy for increasing enzyme stability by chemical modification is addressed. Hydrophilization of nonpolar surface areas is the most simple and reliable approach to artificial stabilization of enzymes for use in applied biochemistry and biotechnology.     

THE DEATH OF BIOETHICS (AS WE ONCE KNEW IT)

Fast forward 50 years into the future. A look back at what occurred in the field of bioethics since 2010 reveals that a conference in 2050 commemorated the death of bioethics. In a steady progression over the years, the field became increasingly fragmented and bureaucratized. Disagreement and dissension were rife, and this once flourishing, multidisciplinary field began to splinter in multiple ways. Prominent journals folded, one by one, and were replaced with specialized publications dealing with genethics, reproethics, nanoethics, and necroethics. Mainstream bioethics organizations also collapsed, giving way to new associations along disciplinary and sub‐disciplinary lines. Physicians established their own journals, and specialty groups broke away from more general associations of medical ethics. Lawyers also split into three separate factions, and philosophers rejected all but the most rigorous, analytic articles into their newly established journal. Matters finally came to a head with global warming, the world‐wide spread of malaria and dengue, and the cost of medical treatments out of reach for almost everyone. The result was the need to develop plans for strict rationing of medical care. At the same time, recognition emerged of the importance of the right to health and the need for global justice in health. By 2060, a spark of hope was ignited, opening the door to the resuscitation of bioethics and involvement of the global community.     

Survival and metabolism of the harpacticoid copepod Thompsonula hyaenae (Thompson) fed on different diatoms

Survival times and oxygen consumption rates have been determined for a benthic harpacticoid copepod, Thompsonula hyaenae (Thompson), when fed different algal diets. Nauplii and adults lived slightly longer on a diet of Navicula sp. than did those fed N. pelliculosa or a mixture of both naviculoid species. Mean numbers of harpacticoids hatched were significantly higher in cultures of N. pelliculosa. Metabolic rates of non-gravid females fed for one week on N. sp. were significantly lower than those fed N. pelliculosa or the mixture. There was no significant difference in oxygen uptake between animals fed N. pelliculosa and those fed the mixed culture. The smaller size and lower food energy content of N. pelliculosa are reflected in the higher respiratory rates of animals led this diatom species.Based on a thesis submitted in partial fulfillment of the M.S. degree in Marine Science at the University of South Carolina. Belle W. Baruch Institute for Marine Biology and Coastal Research Contribution No. 114. Research supported by the Oceanography Section, National Science Foundation, NSF Grant DES72-01573 A01.     

贵州疣螈繁殖生态的研究

贵州疣螈（Tylototritonkweichowensis）是一年繁殖一次的有尾两栖动物。繁殖期肥满度、肝脏系数、脂肪系数、性腺成熟系数、性腺体积均具一定的生物学意义。繁殖期一般为5月上旬至7月上旬,窝卵数平均121．5±7．81枚,孵化期21．6天,孵化率44．33％。每窝印数与雌体头体长成正相关。幼体不同日龄的形态特征变化明显。其全长的Logistic生长方程为：     

Primeval cells: Possible energy-generating and cell-division mechanisms

Summary It is proposed that the first entity capable of adaptive Darwinian evolution consisted of a liposome vesicle formed of (1) abiotically produced phospholipidlike molecules; (2) a very few informational macromolecules; and (3) some abiogenic, lipid-soluble, organic molecule serving as a symporter for phosphate and protons and as a means of high-energy-bond generation. The genetic material had functions that led to the production of phospholipidlike materials (leading to growth and division of the primitive cells) and of the carrier needed for energy transduction. It is suggested that the most primitive exploitable energy source was the donation of 2H⁺+2e^– at the external face of the primitive cell. The electrons were transferred (by metal impurities) to internal sinks of organic material, thus creating, via a deficit, a protonmotive force that could drive both the active transport of phosphate and high-energy-bond formation.This model implies that proton translocation in a closed-membrane system preceded photochemical or electron transport mechanisms and that chemically transferable metabolic energy was needed at a much earlier stage in the development of life than has usually been assumed. It provides a plausible mechanism whereby cell division of the earliest protocells could have been a spontaneous process powered by the internal development of phospholipids. The stimulus for developing this evolutionary sequence was the realization that cellular life was essential if Darwinian survival of the fittest was to direct evolution toward adaptation to the external environment.     

用离散量的方法识别蛋白质的超二级结构

用离散量的方法,对2208个分辨率在2.5I以上的高精度的蛋白质结构中四类超二级结构进行了识别。从蛋白质一级序列出发,以氨基酸(20种氨基酸加一个空位)和其紧邻关联共同为参数,当序列模式固定长取8个氨基酸残基时,对“822”序列模式3交叉检验的平均预测精度达到78.1%,jack-knife检验的平均预测精度达到76.7%;当序列模式固定长取10个氨基酸残基时,对“1041”序列模式3交叉检验的平均预测精度达到83.1%,jack-knife检验的平均预测精度达到79.8%。