以考核准入为基础的三级医院临床实验室生物安全管理模式探讨

目的 探讨医务处在医院临床实验室生物安全管理的模式和作用。方法 建立以考核准入为基础的三级医院临床实验室生物安全管理模式,结合加强实验室生物安全管理委员会作用,完善硬件建设、加强日常监管、定期组织培训讲座、建立健全生物安全应急流程等其他管理措施。结果 以考核准入为基础的三级医院临床实验室生物安全管理模式在实践中运行良好,起到了保障医院实验室生物安全的作用。结论 医务处等医政管理部门通过建立并运行合理的临床实验室生物安全管理模式, 可以有效监督规范医院实验室生物安全工作, 防止和避免生物安全事故的发生。     

基于DRGs的军队医院临床绩效分类对比研究

目的 了解不同分类属性下军队综合医院临床医疗服务能力、服务效率、医疗安全及综合绩效水平。方法 采用疾病诊断相关组作为基本风险调整工具,建立临床绩效评价模型,分析研究各类军队医院临床服务绩效。结果 不同类型、不同等级医院间临床绩效指数差异均有显著统计学意义,不同地区、不同经济发展水平城市的军队医院间差异不明显,各单项指标在不同分类维度上的差异情况各不相同。结论 通过基本风险调整可较为客观地评价不同类型医院的临床医疗服务绩效水平,为明确各类医院临床管理目标导向、提升医院核心竞争力提供参考依据。     

我国临床实验室开展医护人员满意度调查现状分析

目的 了解我国临床实验室开展顾客满意度调查的现状。方法 向定期参加卫生部临床检验中心（室间质评计划的2 299家综合性医院的临床实验室发放网络调查表，收集顾客满意度调查开展情况的相关信息。使用Pearson相关分析和K-W检验分析组间差异。结果 调查表回报率是34.54%，其中92.19%的实验室进行过满意度调查。Pearson相关分析和K-W检验结果显示，不同等级医院临床实验室的调查百分率和调查频率存在差异。结论 我国临床实验室对顾客满意度的概念和涵意不甚了解，应该进行更多的临床实验室顾客满意度的研究。     

探索非营利性医院专业技术人才管理新模式：把医生还给患者

目的 分析我国非营利性医院行政管理模式的弊端,提出人才管理新模式,以促进提高全体医疗质量水平。方法 通过调查问卷收集数据并做回归模型,以检验非营利性医院现有行政管理模式对医务人员基础工作的影响以及由这种影响所造成的医疗质量变化和患者满意度水平的变动。结果 传统的医院管理模式引致的医务人员工作表现指标与患者满意度水平呈负相关。结论 传统的医院管理模式严重制约医疗质量水平的提高,应转变传统的官本位管理模式,行政部门以医务人员为中心,医务人员以患者为中心,把医生还给患者。     

医院电梯安全管理中需要注意的问题

目的 探讨医院电梯安全管理要注意的问题。方法 回顾性分析医院电梯管理现状,并给出具体的改善措施。 结果 医院电梯安全管理中工作人员起着非常重要的作用,其技术水平直接影响到管理效果。 结论 医院电梯安全管理质量直接影响到患者就诊,需要得到院方重视。     

基于系统论的护理不良事件管理模式构建与探讨

目的 以贝塔朗菲系统论为依据,构建新的医院护理不良事件管理模式,杜绝或减少各类不良事件的发生,保证患者安全。方法 通过一线护士将临床工作中的安全隐患上报护理部,护理部与相关处室沟通,医院各处室管理层及时解决存在的问题。结果 通过扩大隐患事件上报范围,护理隐患事件上报率较未扩大前增加275.7%;同类护理隐患事件未再发生或明显减少。结论 “护理部首接,多职能科（处）合作”的不良事件管理模式,促进了医院服务效率与质量的提高,保障了患者的就医安全。     

北京市三级医院手术安全核查管理现况调查

目的 调查不同医院的手术安全核查管理情况,以期建立手术安全核查标准作业流程。方法 以中国医院协会患者安全协作网北京组成员单位为研究对象,通过问卷调查方法分析手术安全核查制度和工作流程。结果 填写问卷的10家医院手术安全核查的工作流程不同,70%的医院核查督导结果未纳入科室绩效考核, 对于日常监管困难等管理不足表示认同。结论 手术安全核查管理中存在的问题主要有：缺乏统一的标准操作流程, 日常监管困难等,可以针对这些问题进行相应干预。     

不同管理模式在日间手术中的应用实践

目的 深入分析探究“日间手术”临床实践中管理模式。方法 通过回顾总结我院南北部采用不同的（集中化与分散化）管理模式开展“日间手术”实践经验,对服务的效率、病人满意度等样本数据进行客观的进行类比分析。结果 统计数据及分析结果表明“日间手术”采用集中化管理模式的南部在服务效率比、病人满意度方面大幅提升。结论 “日间手术”集中化管理模式可以大大提高医疗服务的效率比、医疗质量与安全得以最大保障。     

基于病种的精细化医疗管理模式研究与实践

目的 以肺部专科疾病为主要研究内容,探索基于病种的精细化医疗管理模式。方法 借鉴澳洲版DRGs体系,建立医院病种分类目录,并按病种目录进行绩效评价与考核。结果 实施病种管理以来,病例组合指数（CMI）呈明显升高趋势,从2013年0.94提高到2016年的1.04;医疗费用指标基本保持稳定;6个医疗质量指标有明显提高。结论 按病种管理有利于优化医院病种结构调整、控制医疗费用以及保证医疗质量。     

医院安全绩效影响因素及提升策略研究

目的 通过调查医院安全绩效的现状,了解和探究医院安全绩效的影响因素,并提出医院安全绩效的提升策略。方法 采用随机抽样的方法选取10家三级甲等医院的医务人员作为研究对象,通过简单回归分析和多元回归分析等方法对医院安全绩效影响因素进行分析。结果（1）安全训练和事故分析两个维度的积极反应率均低于75%;（2）医院安全文化与病人安全行为均对安全绩效具有影响作用。结论 医院安全绩效管理水平提升需加强医务人员的素质培养,同时营造良好的安全文化氛围,规范医务人员的安全行为。     

临床决策支持知识库研究

目的 运用知识管理的理念和方法,探讨切合实际应用的临床决策支持知识库概念模型,使医院能够通过知识管理提升其核心竞争力。方法 收集国内外相关资料,系统化研究及分析具有人工智能的临床决策支持知识库的框架。结果 实施医院知识管理的关键就是必须建立一个动态的,并具有自我学习能力的临床决策支持知识库,该知识库不仅需要通过医院信息系统收集传统的医学知识,而且需要建立用于临床指南等的标准医学知识收集的引擎和隐性知识转化模型,并嵌入智能化工具,通过知识库的自我学习功能,保证其动态更新和智能化的临床决策支持能力。结论 医院知识库创建过程实质也是医院价值的创造过程,智能化的临床决策支持知识库开发不仅涉及知识的收集和处理, 还包括知识的表达,人工智能技术的嵌入和各种规则、条件及分类方法等的应用,有待进一步研究。     

临床科室医疗设备监督管理体系的建立与实施

????? 目的 设计一套医院医疗设备监督管理体系,实现对医院临床科室医疗设备的标准化、规范化、统一化管理。方法 结合企业最新、最实用的管理方法,提出医院医学工程科有效开展临床科室医疗设备管理的新方法。结果 制订并实施医院临床科室医疗设备监督管理体系。结论 体系的引入,可以有效改善医疗设备的质量管理,确保医疗器械使用的安全性、可靠性、合法性,使医患双方的合法利益都得到保护,从而提高医院医学工程科管理效能。     

湖北省公立医院医护人员薪酬制度调查分析

目的 分析湖北省公立医院医护人员薪酬制度问题,提出解决策略。方法 以湖北省12家公立医院的1 155名医护人员为调查对象,利用描述性统计与χ²检验等方法对数据进行统计分析。结果 湖北省公立医院医护人员薪酬与市场价值背离;半数左右的医护人员认为薪酬制度不科学、不满意当前收入。结论 当前湖北省公立医院医护人员薪酬制度在一定程度上并不科学。     

Design,synthesis and molecular modeling studies on novel moxifloxacin derivatives as potential antibacterial and antituberculosis agents

Twenty-one novel alkyl/acyl/sulfonyl substituted fluoroquinolone derivatives were designed, synthesized and evaluated for their anti-tuberculosis and antibacterial activity. The targeted compounds were synthesized by the introduction of alkyl, acyl or sulfonyl moieties to the basic secondary amine moiety of moxifloxacin. Structures of the compounds were enlightened by FT-IR, ¹H NMR, ¹³C NMR and HRMS data besides elemental analysis. Compounds were initially tested in vitro for their anti-mycobacterial activity against Mycobacterium tuberculosis H37Rv using microplate alamar blue assay. Minimal inhibitory concentration (MIC) values of all compounds were found between > 25.00–0.39 µg/mL while compounds 1, 2 and 13 revealed an outstanding activity against M. tuberculosis H37Rv with MIC values of 0.39 µg/mL. Activities of compounds 1–21 against to a number of Gram-positive and Gram-negative bacteria and fast growing mycobacterium strain were also investigated by agar well diffusion and microdilution methods. According to antimicrobial activity results, compound 13 was found the most potent derivative with a IC₅₀ value of <1.23 μg/mL against Staphylococcus aureus and clinical strain of methicillin-resistant clinical strain of S. aureus.     

JCI标准下的中药管理信息化

?????? 目的 改进医院中药管理,提升医院中药服务质量。方法 参照JCI标准,结合医院实际,通过信息化技术将中药药事服务的各方面进行改进,如建立电子处方系统、电子医嘱审核系统、中药电子发药系统以及进行煎药房的信息化改革,实行条码化管理和单剂量发药等,构建信息化的医院中药管理模式。结论 JCI标准下中药信息化管理提高了工作效率和服务质量,建立了中药药事服务方便快捷、准确合理的管理、服务机制,在提高整体药学服务水平与质量的同时也为整个医院的信息化建设和管理贡献了力量。     

Discovery of aromatic amides with triazole-core as potent reversal agents against P-glycoprotein-mediated multidrug resistance

P-glycoprotein (P-gp)-mediated multidrug resistance (MDR) is a major impediment for clinical cancer therapy. 19 novel aromatic amides with triazole-core as MDR reversal agents were designed and synthesized via click chemistry to reverse MDR. Among them, compound 42 was identified as the most promising candidate with high potency (EC₅₀ = 78.1 ± 5.4 nM), low cytotoxity (SI > 1282) and persistent duration in reversing doxorubicin (DOX) resistance in K562/A02 cells. 42 also enhanced the potency of other P-gp associated cytotoxic agents with different structures. In further study, remarkably increased intracellular accumulation of Rh123 and DOX in K562/A02 cells was achieved by compound 42, while CYP3A4 activity had no change by compound 42. These results indicate that compound 42 as a relatively safe modulator of P-gp-mediated MDR has good potential for further development.     

对现行医院准入规制实施效果的评价

??????? 目的　通过对现行医院准入规制各项措施的重要性、失效程度等四方面进行综合评价,筛选优先干预措施,为建立有效的医院规制体系提供依据。方法 运用文献研究、现场调查及TOPSIS法对我国医院准入各项措施进行综合比较和评价,筛选优先干预措施。结果 我国医院准入规制改革的优先策略应以强化对公立医院规模、数量、布局管控为重要突破口,辅以对医院人员编制的准入以及对医保定点机构的强化管理手段为支撑。结论 TOPSIS法适宜应用于医院规制优先干预关键点的筛选,我国现行医院准入规制措施亟待改革调整。     

Steroids from Ganoderma sinense as new natural inhibitors of cancer-associated mutant IDH1

Isocitrate dehydrogenase (IDH) is one of the key enzymes in the tricarboxylic acid cycle, and IDH mutations have been associated with many cancers, including glioblastoma, sarcoma, acute myeloid leukemia, etc. Three natural steroids 1–3 from Ganoderma sinense, a unique and rare edible-medicinal fungi in China, were found as potential IDH1 inhibitors by virtual ligand screening method. Among the three compounds, 3 showed the highest binding affinity to IDH1 with significant calculated binding free energy. Enzymatic kinetics demonstrated that 3 inhibited mutant enzyme in a noncompetitive manner. The half effective concentration of 3 for reducing the concentration of D-2HG in HT1080 cells was 35.97 μM. The levels of histone H3K9me3 methylation in HT1080 cells were reduced by treating with 3. Furthermore, knockdown of mutant IDH1 in HT1080 cells decreased the anti-proliferative sensitivity to 3. In short, our findings highlight that compound 3 may have clinical potential in tumor therapies as an effective inhibitor of mutant IDH1.     

The development of 2-acetylphenol-donepezil hybrids as multifunctional agents for the treatment of Alzheimer’s disease

A series of 2-acetylphenol-donepezil hybrids was designed and synthesized based on multi-target-directed ligands strategy. The biological activities were evaluated by AChE/BChE inhibition and MAO-A/MAO-B inhibition. The results revealed that the tertiary amines and methylene chain length significantly affected the eeAChE inhibitory potency, in particular, compound TM-14 showed the best eeAChE inhibitory activity with IC₅₀ value of 2.9 μM, in addition, both kinetic analysis of AChE inhibition and docking study displayed that TM-14 could simultaneously bind to the catalytic active site and peripheral anionic site of AChE. Moreover, compound TM-14 was a selective metal chelator and could form 1:1 TM-14-Cu²⁺ complex. The structure-active-relationship also indicated that the O-alkylamine fragment remarkably decreased hMAO-B inhibitory activity, compound TM-2 exhibited potent hMAO-B inhibitory activity (IC₅₀ = 6.8 μM), which was supported by the molecular docking study. More interestingly, compounds TM-14 and TM-2 could cross the blood-brain barrier in vitro. Therefore, the structure-active-relationship of 2-acetylphenol-donepezil hybrids could encourage the development of multifunction agents with selective AChE inhibition or selective MAO-B inhibition for the treatment of Alzheimer’s disease.     

Integrated modeling of protein-coding genes in the Manduca sexta genome using RNA-Seq data from the biochemical model insect

The genome sequence of Manduca sexta was recently determined using 454 technology. Cufflinks and MAKER2 were used to establish gene models in the genome assembly based on the RNA-Seq data and other species' sequences. Aided by the extensive RNA-Seq data from 50 tissue samples at various life stages, annotators over the world (including the present authors) have manually confirmed and improved a small percentage of the models after spending months of effort. While such collaborative efforts are highly commendable, many of the predicted genes still have problems which may hamper future research on this insect species. As a biochemical model representing lepidopteran pests, M. sexta has been used extensively to study insect physiological processes for over five decades. In this work, we assembled Manduca datasets Cufflinks 3.0, Trinity 4.0, and Oases 4.0 to assist the manual annotation efforts and development of Official Gene Set (OGS) 2.0. To further improve annotation quality, we developed methods to evaluate gene models in the MAKER2, Cufflinks, Oases and Trinity assemblies and selected the best ones to constitute MCOT 1.0 after thorough crosschecking. MCOT 1.0 has 18,089 genes encoding 31,666 proteins: 32.8% match OGS 2.0 models perfectly or near perfectly, 11,747 differ considerably, and 29.5% are absent in OGS 2.0. Future automation of this process is anticipated to greatly reduce human efforts in generating comprehensive, reliable models of structural genes in other genome projects where extensive RNA-Seq data are available.