北京市42所医院门诊预约挂号现状调查

目的 通过调查医院门诊预约挂号服务的内容、形式、管理模式等情况,为提高医院门诊预约挂号服务质量提供建议。方法 通过对2011—2013年北京市共计42所医院门诊预约挂号服务进行全面统计分析,了解其门诊预约挂号服务现状。 结果 目前北京市预约挂号工作呈现覆盖范围广泛、形式多样的特点;患者预约挂号使用率提高,就医习惯逐渐改变。结论医院应多部门协作,提供完善的配套制度、足够的人力资源等作为保障,推动预约挂号工作进一步发展。     

门诊退号原因调查分析及管理对策

通过对2007—2010年挂号、退号数据的分析研究,得出导致退号的原因中,医疗资源不足、病患家长不愿意长时间等候是首要原因,其他原因既有病患方面的,也有医院管理方面的。通过对各种原因的综合分析,提出改进医院门诊挂号管理的建议：预约挂号——按时间段实名制预约挂号,错峰门诊,以此促进医疗效率的提高。     

专家门诊预约挂号影响因素分析

??????? 目的 初步探讨影响专家预约挂号率的原因及相应对策。方法 以SPSS 13.0软件分析2012年4月—2013年1月专家门诊情况与预约挂号率的关系。结果 不同门诊时间（季度、周别、午别）、不同专科、不同专家、不同门诊级别以及挂号率与号源使用率对我院专家门诊预约挂号率均有影响。结论 影响专家门诊预约挂号率的因素是多方面的，需采取综合措施，加强医院核心竞争力才是根本。     

非急诊挂号全面预约模式的探索与实践

为优化门诊流程，北京同仁医院开展非急诊挂号全面预约工作，拓展了多种预约途径，利用信息系统进行门诊流程的改造。改革实施6个月，每日利用各种途径预约挂号量显著提高，同时诊间复诊预约量持续增加。     

“互联网+”背景下医院挂号缴费模式的机遇与挑战

随着“互联网+”的推广及普遍应用,基于互联网的信息技术在医疗服务行业迅速发展。网络预约挂号和移动支付等挂号缴费新模式的推行为解决医院“三长一短”的问题带来了新的契机。通过对“互联网+”背景下医院在挂号、缴费等方面的现状研究,提出了新模式下可能存在的问题及改进建议。

     

预约挂号平台出票客户端的设计与应用

目的 为预约挂号患者提供出票服务,分流挂号窗口排队人群。方法 设计预约挂号出票客户端,自助服务与人工服务相结合,合理规划业务流程。结果 预约挂号患者不需在挂号窗口排队,可为预约挂号患者提供24小时多地点自助出票服务,同时实现医院对预约挂号第三方支付的财务监管。结论 预约挂号出票客户端极大地方便了患者及医院,具有较好的可行性。     

北京某三甲医院预约挂号满意度及影响因素调查

目的 改进医院预约挂号服务工作,完善预约挂号流程,进一步满足患者需求。方法 以2011年6月对通过网络、电话预约挂号的方式成功挂号的患者为调查对象,采用问卷调查方法,由经过培训的调查员进行调查,采用Epidata3.0软件进行数据录入,采用SPSS13.0进行统计分析。结果 对网络、电话预约挂号不满意的有57.4%,不满意的原因主要集中在取号环节上,80%多的患者是通过媒体和医院的宣传知道预约挂号的,但外地患者不足10%。结论 医院试行的网络、电话预约挂号方式具有一定的现实可行性,但是在取号环节及宣传预约挂号的方面,具有一定的欠缺,需要进一步完善和优化。     

我院非急诊全面预约挂号改革的实践探索

按照北京市医院管理局工作的要求,我院推进实行非急诊全面预约挂号,在多渠道预约挂号、号源梳理、流程再造、便民措施方面重点展开工作,有效改善了既往门诊服务中“三长一短”的现状,提升了患者满意度及一定的社会效益。     

北京某三甲医院预约挂号对患者候诊时间的影响分析

目的 分析预约挂号是否缩短门诊患者的等候时间。方法抽取医院某一周全部患者挂号记录49 147条,通过秩和检验方法,分析预约挂号与非预约挂号患者的候诊时间的差异,比较不同预约方式对患者候诊时间是否存在影响。结果 预约挂号平均候诊时间为50分钟,非预约挂号患者平均候诊时间为111分钟,不同预约方式的患者候诊时间存在统计学上的差异。结论 预约挂号能够有效缩短门诊患者的候诊时间,其中复诊预约患者候诊时间最短,应鼓励患者预约就诊,复诊患者应鼓励进行复诊预约。     

某专科医院普通门诊分时段预约挂号的探讨

目的 了解某专科医院普通门诊分时段预约的特点和效果,探索适宜的评价指标、评价方式及提升预约服务的有效手段。方法 通过HIS系统提取2015年7月至2016年3月复旦大学附属妇产科医院杨浦院区4个普通门诊参与预约的12 889人次患者的预约信息及挂号就诊的181 447人次患者的相关数据,比较不同门诊的预约情况、流量分布及预约与非预约患者平均候诊时间等的差异。结果 普通门诊预约率仅7.24%,而爽约率高达25.90%;诊间预约不到全部预约的1%,普通门诊预约患者的平均候诊时间普遍短于非预约患者,无论预约率还是预约效果各科室间都存在明显差异。结论 评价普通门诊的预约情况应对各科室设置不同的基线和目标;结合专科医院的特点推动诊间预约;可将门诊流量监控引入门诊预约管理中。     

应用移动医疗App推进门诊预约挂号工作初探

介绍了北京协和医院应用移动医疗APP推进预约挂号工作的整体情况。结合实际经验,本文指出APP预约挂号功能在开发中应注意“一老一小”人群的使用,提高患者预约的准确性,严格遏制倒号行为,并提出可供借鉴的应对措施。     

Connecting the Dots: The Effects of Macromolecular Crowding on Cell Physiology

The physicochemical properties of cellular environments with a high macromolecular content have been systematically characterized to explain differences observed in the diffusion coefficients, kinetics parameters, and thermodynamic properties of proteins inside and outside of cells. However, much less attention has been given to the effects of macromolecular crowding on cell physiology. Here, we review recent findings that shed some light on the role of crowding in various cellular processes, such as reduction of biochemical activities, structural reorganization of the cytoplasm, cytoplasm fluidity, and cellular dormancy. We conclude by presenting some unresolved problems that require the attention of biophysicists, biochemists, and cell physiologists. Although it is still underappreciated, macromolecular crowding plays a critical role in life as we know it.     

The contrasting effect of macromolecular crowding on amyloid fibril formation

Background

Amyloid fibrils associated with neurodegenerative diseases can be considered biologically relevant failures of cellular quality control mechanisms. It is known that in vivo human Tau protein, human prion protein, and human copper, zinc superoxide dismutase (SOD1) have the tendency to form fibril deposits in a variety of tissues and they are associated with different neurodegenerative diseases, while rabbit prion protein and hen egg white lysozyme do not readily form fibrils and are unlikely to cause neurodegenerative diseases. In this study, we have investigated the contrasting effect of macromolecular crowding on fibril formation of different proteins.

Methodology/Principal Findings

As revealed by assays based on thioflavin T binding and turbidity, human Tau fragments, when phosphorylated by glycogen synthase kinase-3β, do not form filaments in the absence of a crowding agent but do form fibrils in the presence of a crowding agent, and the presence of a strong crowding agent dramatically promotes amyloid fibril formation of human prion protein and its two pathogenic mutants E196K and D178N. Such an enhancing effect of macromolecular crowding on fibril formation is also observed for a pathological human SOD1 mutant A4V. On the other hand, rabbit prion protein and hen lysozyme do not form amyloid fibrils when a crowding agent at 300 g/l is used but do form fibrils in the absence of a crowding agent. Furthermore, aggregation of these two proteins is remarkably inhibited by Ficoll 70 and dextran 70 at 200 g/l.

Conclusions/Significance

We suggest that proteins associated with neurodegenerative diseases are more likely to form amyloid fibrils under crowded conditions than in dilute solutions. By contrast, some of the proteins that are not neurodegenerative disease-associated are unlikely to misfold in crowded physiological environments. A possible explanation for the contrasting effect of macromolecular crowding on these two sets of proteins (amyloidogenic proteins and non-amyloidogenic proteins) has been proposed.     

The quality of registration of clinical trials

Background

Lack of transparency in clinical trial conduct, publication bias and selective reporting bias are still important problems in medical research. Through clinical trials registration, it should be possible to take steps towards resolving some of these problems. However, previous evaluations of registered records of clinical trials have shown that registered information is often incomplete and non-meaningful. If these studies are accurate, this negates the possible benefits of registration of clinical trials.

Methods and Findings

A 5% sample of records of clinical trials that were registered between 17 June 2008 and 17 June 2009 was taken from the International Clinical Trials Registry Platform (ICTRP) database and assessed for the presence of contact information, the presence of intervention specifics in drug trials and the quality of primary and secondary outcome reporting. 731 records were included. More than half of the records were registered after recruitment of the first participant. The name of a contact person was available in 94.4% of records from non-industry funded trials and 53.7% of records from industry funded trials. Either an email address or a phone number was present in 76.5% of non-industry funded trial records and in 56.5% of industry funded trial records. Although a drug name or company serial number was almost always provided, other drug intervention specifics were often omitted from registration. Of 3643 reported outcomes, 34.9% were specific measures with a meaningful time frame.

Conclusions

Clinical trials registration has the potential to contribute substantially to improving clinical trial transparency and reducing publication bias and selective reporting. These potential benefits are currently undermined by deficiencies in the provision of information in key areas of registered records.     

The influence of macromolecular crowding on thermodynamic activity: solubility and dimerization constants for spherical and dumbbell-shaped molecules in a hard-sphere mixture

Macromolecules in solution can have large effects on the properties of other solutes through nonideal excluded-volume (crowding) interactions. Minton has calculated such effects by treating the macromolecules as a hard-sphere fluid in a background of an inert structureless solvent. In the present paper these calculations are extended by including the primary solvent as a separate component in a hard-sphere mixture. The results are in good agreement with experimental data. However, some predictions of this model differ drastically from those based on Minton's approach. Thus, much smaller effects from macromolecular crowding, particularly by smaller molecules, are expected. The present results also predict a much larger dependence on the shape of the molecules under study; notably for a dimerization reaction, it is found that the excluded-volume effects actually can destabilize side-by-side binding of two spherical molecules, while a dimerization to a spherical complex is stabilized. Therefore there will exist intermediate shapes of complexes whose stability is insensitive to crowded-volume effects. The consequences for crowding effects inside the living cell are also discussed.     

Regulation of DNA nucleases by molecular crowding

Here, we examined the effects of molecular crowding on the function, structure and stability of nucleases. We found that the hydrolysis of a 29-mer double-stranded DNA by the endonucleases DNase I and S1 nuclease was substantially enhanced by molecular crowding using polyethylene glycol (PEG); however, molecular crowding had little effect on hydrolysis by exo III and exo I exonucleases. Moreover, kinetic analysis showed that the maximum velocity for the reaction of DNase I at 25°C was increased from 0.1 to 2.7μM/min by molecular crowding with 20% (w/v) PEG, whereas that of exonuclease I at 37°C decreased from 2.2 to 0.4μM/min. In contrast, molecular crowding did not significantly affect the Michaelis constant of DNase I or exonuclease I. These results indicate that molecular crowding has different effects on the catalytic activities of exonucleases and endonucleases.     

视觉拥挤效应的神经机制

当出现在边缘视野的一个物体被周围其他物体包围时,视觉系统对它的识别会很困难,这种现象叫做视觉拥挤效应.研究拥挤效应既有利于理解人类进行客体识别的过程,也对治疗黄斑变性、弱视和阅读障碍等视觉病变有显著的临床意义.自拥挤效应被提出以来,对拥挤效应的特性、神经机制和影响因素等都做了深入地研究.本文将系统地综述拥挤效应的研究进展,包括其特性、现有的理论假设、计算模型、可能涉及的大脑区域以及近年来利用知觉学习消除拥挤效应的一些工作,最后对该领域的未来发展给出建议.尽管在这个领域已经获得了丰富的成果,但在许多问题上仍有争议,未来还需要更为巧妙的设计和精确的技术进一步解决这些问题.