DRGs付费试点与临床路径实施情况初步观察

疾病诊断相关组付费试点是继临床路径管理试点之后的又一项医药卫生体制改革内容。通过对北京地区某三级甲等医院开展DRGs付费试点工作前后的临床路径相关指标进行统计分析,得到结论为DRGs付费制度对临床路径在医院管理方面的应用起到有效的推动作用,有利于进一步提高医疗效率、保障医疗安全。     

医院实施临床路径的难点与突破口探讨

?????? 目的 探讨现阶段临床路径实施的运行模式。方法 通过分析临床路径实施过程中遇到的问题及解决对策,总结临床路径实施的运行模式。结果 以疾病诊断相关组管理理念为导向,基于医院信息化建设的临床路径管理应用模式能够让临床路径工作广泛开展。结论 临床路径的实施是医院医疗质量管理的一部分,临床路径的应用与管理要与医院医疗质量管理的整体构思一致。     

临床医师临床路径应用和实施效果评价影响因素分析

目的 探索我国公立医院临床医师临床路径应用和实施效果评价的影响因素。方法 对我国东、中、西3省（直辖市）1 638名临床医师进行问卷调查;对54所公立医院进行机构问卷调查。结果 甘肃省医院和二级医院临床医师临床路径执行率较高, 但临床路径实施病种数较少医院的临床医师临床路径执行率较低。临床路径相关培训可提高临床医师临床路径应用和实施效果的正向评价。结论 医院所处地区和级别对临床医师临床路径执行率影响大,医院临床路径实施推广和培训能推动临床医师临床路径应用和正向效果评价。     

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。     

临床管理信息化阶段医疗收费管理流程现状分析与展望

医院信息化是医院管理水平的重要标志,而临床管理信息化阶段是整个医院信息化管理中非常重要的环节,分析临床管理信息化阶段医疗收费信息化管理流程现状,对其所存在的问题进行剖析和改进设想,以探索更加适合于临床管理信息化阶段的医疗收费管理流程。     

我院优化临床路径环节质控的策略和实践

临床路径作为一项有效的管理方法,在保障医疗安全和提高医疗效率中发挥了重要作用。以医院开展临床路径工作的实践经验为基础,从组织管理和执行实施两个方面,介绍了以加强环节质量控制及提高执行效率为目的的临床路径建设及持续优化策略,探讨完善临床路径管理的有效方法。     

临床路径医疗管理模式的应用研究

对临床路径管理的现实需求、实施途径、问题与挑战等方面进行了论述。通过采用套餐的方式进行部署,以信息化平台作为实现手段是最为可行有效的办法。临床路径管理系统是多系统的集成平台,将会大大减少临床开医嘱时间;提高医务工作人员的工作效率;系统的预警功能将降低医疗差错的风险,确保医疗质量。在我国医药卫生体制改革和医疗保险制度逐步完善的背景下,临床路径具有巨大的实现价值和发展潜力。     

我院临床路径实施效果的评价与分析

作为首批原卫生部临床路径试点医院,自2009年10月开展临床路径。比较临床路径实施前后,声带息肉或囊肿、结节性甲状腺肿、社区获得性肺炎（非重症）3个病种患者的平均住院日、平均医药费用、医疗质量与安全目标变化情况。结果表明,入径组平均住院日、平均医药费用均下降,医疗安全与质量指标显著上升。     

统计软件系统在医院信息化建设中的应用

医疗统计信息系统是国家八五重点攻关课题一中国医院信息系统（CHIS）中一个重要的应用系统。随着医疗信息技术的快速发展以及新医疗保险制度的实施,越来越多的医院实行了计算机网络化管理,这给传统模式的医院统计工作带来巨大冲击。医院在全面建设信息化的过程中,统计软件系统能更好地满足当前数字化医院发展的需要。     

疾病诊断相关组—预付费制度在我院的探索与实践

疾病诊断相关组是一种较为先进的付费方式。作为北京市的付费方式试点医院,医院从试点工作的管理模式、培训动员、病案首页的正确填写、临床路径的管理等与之相关工作进行了探索与实践。     

中国遗传学会会讯

中国遗传学会常务理事会扩大会于1981年12月 6日在京召开。会议讨论了“中国遗传学会第二届代 表大会暨学术讨论会”的具体事项。     

Thermo-responsive non-woven scaffolds for "smart" 3D cell culture

The thermo‐responsive polymer poly(N‐isopropylacrylamide) has received widespread attention for its in vitro application in the non‐invasive, non‐destructive release of adherent cells on two dimensional surfaces. In this study, 3D non‐woven scaffolds fabricated from poly(propylene) (PP), poly(ethylene terephthalate) (PET), and nylon that had been grafted with PNIPAAm were tested for their ability to support the proliferation and subsequent thermal release of HC04 and HepG2 hepatocytes. Hepatocyte viability and proliferation were estimated using the Alamar Blue assay and Hoechst 33258 total DNA quantification. The assays revealed that the pure and grafted non‐woven scaffolds maintained the hepatocytes within the matrix and promoted 3D proliferation comparable to that of the commercially available Algimatrix? alginate scaffold. Albumin production and selected cytochrome P450 genes expression was found to be superior in cells growing on pure and grafted non‐woven PP scaffolds as compared to cells grown as a 2D monolayer. Two scaffolds, namely, PP‐g‐PNIPAAm‐A and PP‐g‐PNIPAAm‐B were identified as having far superior thermal release capabilities; releasing the majority of the cells from the matrices within 2 h. This is the first report for the development of 3D non‐woven, thermo‐responsive scaffolds able to release cells from the matrix without the use of any enzymatic assistance or scaffold degradation. Biotechnol. Bioeng. 2012; 109:2147–2158. © 2012 Wiley Periodicals, Inc.     

Re-examination of the "3/4-law" of metabolism

We examine the scaling law B is proportional to M(alpha)which connects organismal resting metabolic rate B with organismal mass M, where alpha is commonly held to be 3/4. Since simple dimensional analysis suggests alpha = 2/3, we consider this to be a null hypothesis testable by empirical studies. We re-analyse data sets for mammals and birds compiled by Heusner, Bennett and Harvey, Bartels, Hemmingsen, Brody, and Kleiber, and find little evidence for rejecting alpha = 2/3 in favor of alpha = 3/4. For mammals, we find a possible breakdown in scaling for larger masses reflected in a systematic increase in alpha. We also review theoretical justifications of alpha = 3/4 based on dimensional analysis, nutrient-supply networks, and four-dimensional biology. We find that present theories for alpha = 3/4 require assumptions that render them unconvincing for rejecting the null hypothesis that alpha = 2/3.     

Molecular characterization of "inverted" pericentromeric heterochromatin of chromosome 3.

Inversion of the pericentromeric region of human chromosome 3 [inv (3) (p11q11.2)] is a rare event. Initially, this inversion was identified with staining for Q-bands by fluorescence using quinacrine (QFQ) and later characterized with staining for C-bands by CBG technique. The molecular methods of fluorescence in situ hybridization (FISH) and AluI/Giemsa and TaqI/Giemsa techniques were utilized. The findings suggest that the variable band q11.2 on chromosome 3 contains alphoid DNA sequences, which appear to be similar to those identified by conventional methods in the centromeric region (band p11).     

Bergerac-SH3: "frustation" induced by stabilizing the folding nucleus

The influence of an inserted exogenous independent folding element on the thermodynamics and folding properties of SH3 domain from alpha-spectrin has been investigated by creating a fused form between this small all-beta domain and a stable beta-hairpin (BH19). NMR analysis of synthetic peptides shows that insertion of BH19 nucleates formation of the original natural beta-hairpin (distal loop) that is part of the SH3 folding nucleus. The resulting protein (Bergerac-SHH) is more stable, folds faster and contains an elongated hairpin protruding from the globular domain as determined by 2D-NMR. "Protein engineering" analysis of the inserted region shows that it is folded in the transition state. Interestingly, stabilisation by insertion of the distal loop region results in the appearance of a compact intermediate revealed by a curved chevron plot at low denaturant concentration. This effect is eliminated at low salt concentrations by a single mutation of a hydrophobic residue within BH19 sequence, which is most probably involved in non-native interactions. Local stabilisation by enlargement and reinforcement of the folding nucleus, global compaction by the addition of salt and non-native interactions are shown to contribute to the observed deviation from the two-state behaviour.