输血内涵质量评价机制的建立与应用

目的 建立输血内涵质量评价机制,提高临床科学合理用血水平。方法 制定系统的评价方案,确定专项的评价标准,成立评审专家团队,依托数字化病案管理系统平台,分季度有重点地开展输血内涵质量评价。结果 输血评价平均成绩2014年143分,2013年139分,t小于0.01,差异有统计学意义;输血评价缺陷数,手术、非手术科室2014年比2013年分别下降了37.8%和14%;2012—2014年输血比例和人均用血量逐年下降;2013-2014年24小时大量用血人数和用血量分别下降40.9%、37.3%;二次手术用血人数持平,用血量下降14.1%。结论 建立输血内涵质量评价机制,实现全过程输血质量监控,提高了临床合理用血水平,保护稀缺血源,保障临床用血安全。

     

住院总护士岗位设置的实践与效果

目的 提高夜间护理工作质量;催化临床高年资护师（取得护师资格≥3年）综合能力提升;帮助低年资护士（工龄1～3年）应急能力的提高。方法 设置住院总护士岗位,制定岗位管理制度,在高年资护师中遴选6位护士夜间履行住院总护士岗位职责。结果 住院总护士制实施半年来,为临床解决各种护理事件255 起;住院总护士在管理能力、协调能力、沟通能力以及专业技能方面得到了全面提升;住院总护士能缓解护士长的压力,为夜间低年资值班护士在心理、体力、技术上提供支持和帮助,并且有力地促进低年资护士应急能力的提高。结论 住院总护士岗位设置,对夜间护理服务不足进行了有效补充,保障了夜间护理安全,提高了护理质量。

     

基于闭环医嘱的患者临床安全信息保障研究与实践

目的 对医院临床信息系统进行改造和完善,进行患者临床安全信息保障体系理论研究。方法 结合医院信息化实际,针对药品、护理、手术、检查、检验、输血六大类医嘱,分析其流转环节关键节点,进行信息闭环,研究护理执行文档、手术医疗器械以及消毒供应包管理追溯、医技报告危急值报警等信息标准化,建立数据集,实现病人临床安全的信息化支撑。结果 实现了护理文档数据标准化和移动护理数据采集的全面应用,探索了医嘱闭环信息的工程化建设方法,研发了移动护理软件,形成了护理工作绩效评价的新模式。结论 通过项目研究,在国内率先进行了护理文档标准化研究,形成了医嘱闭环执行与护士工作量评价新方法,并在患者临床安全的一系列关键环节进行了信息保障的全面应用。     

以内部审核促进医院质量管理持续改进

目的 分析医院质量管理体系运行情况,促进医院质量管理持续改进。方法 通过内部审核,发现不合格项并对其进行统计分析,找出影响医院质量管理的主要问题,采取相应的改进措施。结果 2003—2008年医院共组织内部审核7次,发出不合格项118项,通过采取纠正措施和预防措施,并制定医院质量管理工作重点,不合格项目逐年减少。 结论 医院质量管理体系的运行符合ISO9001标准的要求,是适宜的、有效的。内部审核促进了医院质量管理持续改进。     

护士组织职业生涯管理对工作满意度影响的调查

目的 探讨医院实施组织职业生涯管理对护士工作满意度的影响。方法 随机选取我市3所已实施护士组织职业生涯管理的医院中80名护士进行调查分析,比较实施护士组织职业生涯管理的效果以及管理后护士工作满意度改善情况。结果 实验组护士的晋升公平评分、注重培训评分、提供职业信息、促进职业自我发展及总评分均显著高于对照组,差异具有有统计学意义(P＜0.05);实验组护士内在满意度评分、外在满意度评分及总满意度评分均显著高于对照组,差异具有有统计学意义(P＜0.05)。结论 实施护士组织职业生涯管理能有效提高护士的工作满意度,有利于促进护士的职业生涯发展及提高护理管理质量。     

临床路径在神经根型颈椎病保守治疗中的应用与变异管理

目的 评价临床路径在神经根型颈椎病保守治疗中的应用效果。方法 通过制订临床路径,将实施临床路径前后病人的住院天数、医疗费用、健康知识评分、满意度进行比较并对出现的变异进行管理。结果 实施临床路径提高了医务人员工作的主动性,加强了医患沟通,使患者住院天数、医疗费用有所下降,健康知识掌握情况、满意度有所提高。统计学分析差异有显著性。结论 临床路径作为一种新型的医疗质量管理模式,值得在临床推广应用。临床执行过程中应注意对变异的管理。     

前馈控制在ICU护理质量控制中的应用

目的 探讨ICU实施前馈控制的方法和效果,以提高护理质量。方法 在ICU病区建立质量控制架构（三级质控网）,采用前馈质控方法,对ICU护理工作进行全面质量控制管理。结果 实施前馈质控后,病房护理管理质量、消毒隔离质量、护理文件书写质量、教学质量、家属满意度、护士工作满意度等各项指标评分都有明显提高,不良事件发生率明显下降,差异有统计学意义(P<0.01)。结论 前馈控制方法整体上提高了ICU风险管理能力、护理管理效率和护理质量。     

护士工作压力与生活质量的相关性研究

??????? 目的 研究护士的工作压力及生活质量状况,探讨工作压力与生活质量之间的相关性。方法 对138名护士进行问卷调查。采用李小妹修订的护士工作压力源量表测定护士工作压力,用世界卫生组织的生活质量评定量表（WHOQOL-BREF）测定护士的生活质量。结果 护士工作压力总均分为（15.11±2.18）分,护士生活质量总得分为（58.07±8.43）分,护士工作压力各维度与生活质量各维度之间大多呈负相关。结论 护士工作压力为重度压力水平。护士生活质量得分明显低于常模,其生活质量较差。护士工作压力与生活质量之间关系呈显著负相关,工作压力大的护士其生活质量差。     

中西医结合医院临床科室医疗质量评价体系的构建与实施

目的 探索提高中西医结合医院医疗质量的有效途径。方法 建立并实施中西医结合医院临床科室医疗质量评价体系。结果 对医院业务发展以及质量改善起到积极的推动作用。结论 实施临床科室医疗质量评价体系是提高中西医结合医院医疗质量的较好方法。     

PDCA循环降低非计划再次手术发生率的效果评价

目的 探讨降低非计划再次手术发生率的有效方式,为医疗质量改进提供参考。方法 运用PDCA循环原理,对非计划再次手术的发生情况进行分析,找出影响非计划再次手术的主要原因,制定针对性措施实施过程改进。结果 实施改进措施后,非计划再次手术发生率由1.2%降低至0.9%。结论 PDCA循环的应用降低了非计划再次手术发生率,有利于提高手术质量,以实现医疗质量的持续性改进。     

Ectogenesis and the case against the right to the death of the foetus

Ectogenesis, or the use of an artificial womb to allow a foetus to develop, will likely become a reality within a few decades, and could significantly affect the abortion debate. We first examine the implications for Judith Jarvis Thomson’s violinist analogy, which argues for a woman’s right to withdraw life support from the foetus and so terminate her pregnancy, even if the foetus is granted full moral status. We show that on Thomson’s reasoning, there is no right to the death of the foetus, and abortion is not permissible if ectogenesis is available, provided it is safe and inexpensive. This raises the question of whether there are persuasive reasons for the right to the death of the foetus that could be exercised in the context of ectogenesis. Eric Mathison and Jeremy Davis have examined several arguments for this right, doubting that it exists, while Joona Räsänen has recently criticized their reasoning. We respond to Räsänen’s analysis, concluding that his arguments are unsuccessful, and that there is no right to the death of the foetus in these circumstances.     

On the diversity of the Cladocera in the tropics

The mythical concept of an impoverished tropical cladoceran fauna is refuted. On a planetary scale, around half of the cladoceran species presently known occur exclusively in the tropics-subtropics, often with considerable restriction to particular geographical subzones. On a regional (political) scale, the situation is often unclear because of the continued fragmentary nature of studies, and because political units are not a good basis for biogeographical comparisons. At the finest level of resolution (lake-perlake comparisons), there appears to be an upper limit of c. 50 cladoceran species per individual lake. No significant difference between lakes in the temperate zone and in the tropics could be established here. Daphnia is largely absent from the tropics, but is replaced by more Sidids, Moinids, and Bosminids, such that the average cladoceran community in the limnetic zone of a tropical lake is not characterized by less species but rather by lower population densities. This, in turn, is considered a consequence of higher prevalent predation levels in the tropics.     

Tubular networks in the terminal endings of the visual receptor cells in the human,the monkey,the cat and the dog

Summary A tubular network was found in the terminal endings of the visual receptor cells in the human, the monkey (Macaca mulatta), the cat and the dog. These tubules are arranged in close groups in the vicinity of the synaptic lamellae and the invaginated dendrites. According to the form, diameter, density of the tubules and to the consistence of the network formed by them one can distinguish at these places an initial type (type I), a transitory (type II) and a vesicular one (type III). In the the type III branching, bizarre forms are frequent. The diameter of all the tubules reaches 500–600 Å, their density and walls being the same as in the synaptic vesicles.Similar networks also occur in the axons of the visual receptor cells of the monkey.

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Zusammenfassung In den Endigungen der Photorezeptorzellen von Mensch, Affe (Macaca mulatta), Katze und Hund kommen aus Tubuli bestehende Komplexe vor. Organellenartig in geschlossenen Gruppen angeordnet, liegen sie in Nähe der synaptischen Lamellen und der invaginierten Dendriten. An diesen Stellen kann man nach Form, Durchmesser, Dichte und Konsistenz der von den Tubuli gebildeten Komplexe drei Typen unterscheiden: 1. einen initialen (Typus I), 2. einen Übergangstypus (Typus II) und 3. einen vesiculären Typus (Typus III). In letzterem kommen häufig verzweigte, bizarre Formen vor. Der Durchmesser sämtlicher Tubuli erreicht 500–600 Å. Ihre Dichte und ihre Wand gleicht denen der synaptischen Vesikel.Ähnliche Komplexe fanden wir auch in den Axonen der Photorezeptorzellen vom Affen.

     

Assessing the Physiological State of the Fucoids from the Barents Sea Littoral by the End of the Polar Night

Methods of amperometry and potentiometric titration were used to follow dark respiration (DR) and apparent photosynthesis (AP) in the fucoids Ascophyllum nodosum (L.) Le Jol, Fucus vesiculosus L., and F. serratus L. from the Barents Sea littoral by the end of the 40-day-long polar night. The macroalgae were shown to manifest species-specific low rates of photosynthesis and respiration. However, in spite of their low photosynthetic status due to the effects of subzero temperature and prolonged low or zero illumination, the macroalgae have been able to restore DR and AP to the initial level already by the day 9; the ability to restore AP depended on the level of illumination. The study of the changes in the carbonate–bicarbonate system in the light and darkness demonstrated that the macroalgae grown in darkness, in contrast to those grown in twilight, could absorb bicarbonate in darkness; however, they lost this capacity after two-day-long illumination at an irradiance of 7 mol/(m² s). Bicarbonate uptake in darkness and the capacity to restore the systems of photosynthesis and respiration in fucoid cells are discussed in the context of algal energy metabolism under the polar night conditions.     

Arranging the elements of the potassium channel: the T1 domain occludes the cytoplasmic face of the channel

The voltage-gated potassium channel is currently one of the few membrane proteins where functional roles have been mapped onto specific segments of sequence. Although high-resolution structures of the transmembrane portions of three bacterial potassium channels, the tetramerization domain and the cytoplasmic ball are available, their relative spatial arrangement in mammalian channels remains a matter of ongoing debate. Cryo-electron microscopic images of the six transmembrane voltage-gated Kv channel have been reconstructed at up to 18 Å resolution, revealing that the T1 domain tetramerizes and is suspended below the transmembrane segments. However, the resolution of these images is insufficient to reveal the location of the third piece of the puzzle, the inactivating ball domain. We have used the aberrant interactions observed in a series of chimæric channels to establish that an assembled T1 domain restricts access to the cytoplasmic face of the channel, suggesting that the N-terminal ball and chain may be confined in the space between the T1 domain and the transmembrane portion of the channel.     

Separation of the pineal vesicle from the wall of the third ventricle during the post-hatching development of the chicken

Summary According to light- and electron-microscopic observations the pineal organ of the 3-day-old chicken consists of a prominent end vesicle and a tapering parenchymal stalk. During this stage the pineal lumen is in open communication with the third ventricle. However, in the 40-day-old chicken, which still possesses a well-developed end vesicle, the proximal portion of the pineal stalk displays regressive changes leading to local fragmentation. At this stage the pineal stalk is reduced, and the pineal lumen is missing. In 1-year-old chickens the parenchyma of the proximal portion of the stalk is further diminished, and in 3-year-old domestic fowl is completely displaced by bundles of collagenous fibers, only some nerve fibers being present. This post-hatching pineal development may reflect the sequence of changes leading from pineal sense organs to pineal glands.This work was supported by a grant-in-aid for Scientific Research from the Ministry of Education, Science and Culture of Japan     

On the Dependence of the Quadratic Risk of the Classical Predictor and the Prediction-Horizon

When constructing predictors on the basis of the linear model of time series of various indicators often the question arises on the dependence of forecasting accuracy and the changing prediction horizon. The dependency of the quadratic risk of the classical predictor and the time horizon is considered.     

中国植物区系与其它地区区系的联系及其在世界区系中的地位和作用

基于吴征镒将中国全部种子植物３２３８个属的分布区划分为１５个大类型和３４个变型的基础上,简要地讨论了中国植物区系与其它地区区系的联系,以及它在被子植物起源方面的作用。主要论点如下：（１）与热带亚洲区系的联系。这种联系主要通过第７类型（热带亚洲分布）及其５个变型来体现的。本文列举了１０个科,龙脑香料、狭义隐翼科、交让木科、五隔草科、五列木科、肉实树科、心翼果科、八宝树科、兰花蕉科和四数木科,来说明这