三级医院新护士职业价值观及离职意愿现状调查

目的 调查新护士的职业价值观及离职意愿现状, 为护理管理者培养社会需要的护理人才、稳定护理队伍提供借鉴。 方法 采用护士职业价值观量表和离职意愿量表对496名新护士进行调查, 并对结果作统计学分析。 结果 新护士职业价值观各条目的总均分为（3.579±0.681）分;不同学历的新护士,其职业价值观评分的差异有统计学意义（P＜0.05）;新护士离职意愿量表总平均分为（2.68±0.69）分;不同任职方式、学历、科室的新护士,其离职意愿总平均得分的差异均有统计学意义（P＜0.05）。 结论 大部分新护士的职业价值观较为积极,但离职意愿较高。护理管理者应加大对新护士的重视,协助其完成职业过渡。     

电子病历系统对临床路径管理的影响研究

目的 探讨电子病历系统对临床路径管理的影响。方法 入选河北北方学院附属第一医院2014年1月—2014年6月进入临床路径管理的512例患者（包括胆囊结石腹腔镜胆囊切除术、慢性鼻-鼻窦炎、2型糖尿病3个病种）作为观察对象,其中258例患者采用电子病历系统进行临床路径管理,254例患者采用纸质病历系统进行临床路径管理,比较两组病历质量、路径变异率、病种治疗费用及患者满意度。结果 观察组甲级率明显高于对照组、乙级率明显低于对照组,差异均具有统计学意义（均P<0.05）;观察组路径变异率为7.8%（20/258）,显著低于对照组15.0%（38/254）,差异具有统计学意义（P＜0.05）;观察组3个病种的治疗费用均显著低于对照组,差异均具有统计学意义（均P＜0.05）;观察组患者满意度为95.3%（246/258）,显著高于对照组的77.2%（196/254）,差异具有统计学意义（P＜0.05）。结论 电子病历系统与临床路径管理结合有助于降低路径变异率,提高医护人员工作效率,降低医疗费用,提高患者满意度。     

理论与实践交互渗透培养方案对实习护士的培训效果

目的 探究理论与实践交互渗透培养方案对普外科实习护士的培训效果。 方法 2013年4月—2014年4月期间60例普外科室实习护士进行培训,实验组采取理论与实践交互渗透培养方案,对照组采取常规培养方案。对两组学员培训前、培训后的理论成绩、操作成绩、患者对学员的满意度以及学员队培训方案满意度进行比较。 结果 培训后,实验组的理论成绩为（91.18±3.61） 分,对照组为（82.73±4.84） 分;实验组的操作成绩为（97.34±1.15） 分,对照组为（91.75±2.12） 分。患者对实验组的沟通能力、观察力、主动服务能力、职业操作规范性、职业道德的满意度均高于对照组。实验组学员对本次培训方案的满意度为100.00%,对照组学员的满意度为83.33%。经比较以上项目均具有显著差异,具有统计学意义（P<0.05）。 结论 理论与实践交互渗透培养方案更有利于提高普外科室实习护士的培训效果,学员的满意度更高,值得广泛推广。     

“以人为本”理念在产科护理质量持续性改进中的应用

目的 探析“以人文本”管理理念指导产科管理对护理质量持续性提高的促进作用。方法 随机选取“以人为本”管理模式实施前后半年收治的120例产妇为调查对象,分别归于对照组和研究组,对比分析两组产妇并发症发生情况及护理服务满意情况,同时随机选取本科室40名护理人员,对比分析实施前后职业工作紧张和职业倦怠情况、护理管理态度以及护理质量情况。结果 实施“以人为本”护理管理后,护理人员学习主动性、护理管理理解、护理管理接受、护理管理态度、护理工作价值观评分明显高于常规管理（P＜0.05）。结论 “以人为本”管理实施提高护理人员积极性和职业效能。     

职场正念对护士工作使命感影响及组织认同中介效应

目的 探讨职场正念对护士工作使命感的影响并检验组织认同的中介效应。方法 通过一个横断面式的网络问卷调查收集资料,采用阶层线性回归法验证变量间的作用关系。结果 职场正念能够显著正向预测组织认同（β=0.348,P＜0.01）和工作使命感（β=0.281,P＜0.01）;组织认同能够显著正向预测工作使命感（β=0.534,P＜0.01）;组织认同在职场正念与工作使命感的关系中扮演部分中介角色。结论 职场正念可以提升护士组织认同与依附,进而间接促进工作使命感。同时,职场正念可以通过提升核心自我评价、提高职业生涯韧性和维护护士职业适应进而直接提高她们的工作使命感。     

能级进阶的护士分层管理效果评价研究

目的 探讨能级进阶的护士分层管理效果。方法 将研究对象按能级进阶分层管理实施与否分为实施前组和实施后组,护士分别为251人和283人。比较两组护士实践能力及职业态度。结果 护士实践能力、护士职业态度及其各维度评分实施后组高于实施前组（P＜0.05）。结论 实施能级进阶护士分层管理可提高护理质量,有利于护士形成正向的职业态度,有助于培养护理人才。     

综合性医院癌痛患者管理模式探讨

目的 探讨综合性医院癌痛患者的管理模式。方法 成立“癌痛治疗小组”,小组成员由麻醉或疼痛医生、护士、精神科医生、药师、肿瘤科医生及相应专科医生构成,其职责是负责全院癌痛患者的管理与治疗。同时观察15例采用此模式管理的癌痛患者（观察组）,并与传统管理方式相比（对照组）。结果 观察组镇痛效果评分及病人满意度评分均显著高于对照组（P<0.01）。结论 在综合医院建立“癌痛治疗小组”可提高癌痛病人镇痛效果及满意度,有效利用医疗资源、提高医疗质量。     

院前急救病种导向单元组前出模式应用研究

目的 探讨病种导向单元组前出模式(DGPM)在院前急救(FA)中的应用效果。方法 以常规模式为对照组,观察研究组实施DGPM后FA反应速度、救治规范性、临床效果指标的变化,2组各随机抽取100例病例,调查满意度变化,并采用多元逐步Logistic回归探讨满意度影响因素。结果 研究组到达—处置时间、发病—离院天数明显缩短(P＜0.05)，现场处置率、处置规范性和病情缓解程度显著提高(P＜0.05)；满意度显著改善(P＜0.05)，满意度影响因素为到达—处置时间、处置规范性和病情缓解程度。结论 DGPM适应FA需求,效果明显,值得推广应用。     

品管圈在持续改进药事质量管理的实践效果评价

目的 完善医院药学品质监管体制的核心在于借助监管工具实现经验监管到科学监管的过渡,探讨质量管理工具对医院药事质量管理的影响。方法 对医院品管圈的理论基础、流程、运营环境等进行讲解,整理医院开展的QCC活动,对该项目最终取得的成果进行剖析。结果 活动改善后患者取药时间明显低于对照组(P＜0.05);药品账物相符率、患者用药依从性差异有统计学意义(P＜0.05)。结论 在医院对药学部质量管理实施品管圈模式,及时发现和改进药事管理中的不足,为全面提高医院药事服务质量提供可靠依据。     

住院医师/专科医师对规范化培训带教师资和培训管理的满意度调查分析

目的 调查参加规范化培训的住院/专科医师对带教师资综合职业能力和培训管理的满意度,进一步了解不同医院开展毕业后医学教育所面临的问题和进行毕业后医学教育规范化培训异同。方法 采用自制问卷对成都市4所三级甲等医院598名住院/专科医师进行问卷调查,对收集的数据进行因子分析和方差分析。结果 受调查的598名住院/专科医师对带教师资的综合职业能力的满意度评分在3.83～4.11之间﹝满分为5分﹞,而对培训管理的满意度评分在2.91～3.75之间,且不同医院住院/专科医师的满意度有差异性﹝P﹤0.05﹞。结论 无论教学医院还是非教学医院,都应加强带教师资建设和培训管理,才能提高住院/专科医师对规范化培训的满意度,以促进住院/专科医师规范化培训的顺利开展。     

A Unique Protease Cleavage Site Predicted in the Spike Protein of the Novel Pneumonia Coronavirus (2019-nCoV) Potentially Related to Viral Transmissibility

正Dear Editor,In December 2019, a novel human coronavirus caused an epidemic of severe pneumonia(Coronavirus Disease 2019,COVID-19) in Wuhan, Hubei, China(Wu et al. 2020; Zhu et al. 2020). So far, this virus has spread to all areas of China and even to other countries. The epidemic has caused 67,102 confirmed infections with 1526 fatal cases     

Curcuminoids as inhibitors of thioredoxin reductase: A receptor based pharmacophore study with distance mapping of the active site

Curcumin is the yellow pigment of turmeric that interacts irreversibly forming an adduct with thioredoxin reductase (TrxR), an enzyme responsible for redox control of cell and defence against oxidative stress. Docking at both the active sites of TrxR was performed to compare the potency of three naturally occurring curcuminoids, namely curcumin, demethoxy curcumin and bis-demethoxy curcumin. Results show that active sites of TrxR occur at the junction of E and F chains. Volume and area of both cavities is predicted. It has been concluded by distance mapping of the most active conformations that Se atom of catalytic residue SeCYS498, is at a distance of 3.56 from C13 of demethoxy curcumin at the E chain active site, whereas C13 carbon atom forms adduct with Se atom of SeCys 498. We report that at least one methoxy group in curcuminoids is necessary for interation with catalytic residues of thioredoxin. Pharmacophore of both active sites of the TrxR receptor for curcumin and demethoxy curcumin molecules has been drawn and proposed for design and synthesis of most probable potent antiproliferative synthetic drugs.     

Comparative morphology of the carpel in the Liliaceae: Hewardieae, Petrosavieae, and Tricyrteae

The young pistils in the melanthioid tribes, Hewardieae, Petrosavieae and Tricyrteae, are uniformly tricarpellate and syncarpous. They lack raphide idioblasts. All are multiovulate, with bitegmic ovules. The Petrosavieae are marked by the presence of septal glands and incomplete syncarpy. Tepals and stamens adhere to the ovary in the Hewardieae and the Petrosavieae but not in the Tricyrteae. Two vascular bundles occur in the stamens of the Hewartlieae and Tricyrtis latifolia. Ventral bundles in the upper part of the ovary of the Hewardieae are continuous with compound septal bundles and placental bundles in the lower part. Putative ventral bundles occur in the alternate position in the Tricyrteae and putative placental bundles in the opposite. position in the Petrosavieae. The dichtomously branched stigma in each carpel of the Tricyrteae is supplied by a bifurcated dorsal bundle.     

Selection with two alleles and complete dominance

For a plant selection model with frequency-independent viabilities, fertilities and selfing rates, it is shown that apart from global fixation, for certain parameter combinations a protected polymorphism and facultative fixation (either allele may become fixed according to initial frequencies) may both occur. Facultative fixation requires different selling rates for the dominant and recessive type. Protection of the polymorphism requires resource allocation for male and female function. In this connection the problem of purely genetically caused population extinction is discussed.
For general frequency dependence and regular segregation, the chances for establishment of a completely recessive gene are compared to those of a completely dominant gene. It is proven that the process of establishment of the recessive gene, despite a fitness advantage, may be considerably endangered by drift effects if random mating prevails. The recessive gene may reach the same effectivity in establishment as a dominant gene, only if the recessive homozygote mates exclusively with its own type during the period of establishment.     

Composition and diversity of bird communities in Swedish farmland–forest mosaic landscapes

CapsuleThe amount of forest (at local and landscape scales) and occurrence of residual habitats at the local scale are shown to be the major factors influencing bird community composition in farmland–forest landscapes in central Sweden.

Aims To investigate the importance of local habitat and landscape structure for breeding birds in farmland–forest landscapes in central Sweden.

Methods Breeding birds were censused at 292 points. A detailed habitat mapping was made within 300 m of the points. Within a 300–600 m radius only two major habitats (forests and arable fields) were identified.

Results Cluster analyses of bird communities identified three site types that also differed in habitat composition: (i) partially forested sites in forested landscapes; (ii) heterogeneous sites with residual habitats in mosaic landscapes; and (iii) field-dominated farmland sites in open landscapes. A total of 19 of 25 farmland bird species (restricted to farmland or using both farmland and forest) had the highest abundance in farmland sites with mosaics of forest and farmland, while only six farmland species had the highest abundance in field-dominated sites. The bird community changed from being dominated by farmland species to being dominated by forest species (common in forest landscapes without farmland) at small proportions (10–20%) of forest at the local scale. A major difference in habitat composition between heterogeneous and field-dominated sites was the occurrence of different residual habitats (e.g. shrubby areas and seminatural grasslands). These habitats seemed to influence bird community composition more than land-use, despite covering <10% of the area. Seminatural grasslands were important for bird community composition and species-richness, but grazing seemed to be less important. Among different land-use types, cereal crops were the least preferred fields. Set-asides with tall vegetation and short rotation coppices were positively associated with species-richness of farmland birds.

Conclusion In general, the composition of the landscape was important for bird community composition, although amount and distribution of forests, occurrence of residual habitats and land-use of fields at the local scale had the strongest influence on bird community composition. The possible implications of these patterns for managing farmland–forest landscapes are discussed.     

Chemical constituents from the fruits of Rhus typhina L. and their chemotaxonomic significance

This work describes the isolation and characterization of twenty-nine compounds from the fruits of Rhus typhina L., including eleven flavonoids (1–11), eleven phenols (12–22), two pentacyclic triterpenes (23–24), two organic acids (25–26), one lumichrome (27), one courmarin (28) and one pyrimidine (29) on the basis of their spectroscopic data. Compounds apigenin (1), daidzein (4), orobol (5), 3′, 5, 5′, 7-tetrahydroxyflavanone (6), naringenin (7), butein (8), (-)-catechin (9), quercetin-3-O-α-L-(3″-O-galloyl)-rhamnoside (11), 2-hydroxybenzoic acid (13), 4-hydroxybenzaldehyde (14), vanillin (15), methyl 3,4-dihydroxybenzoate (16), 3,5-dihydroxybenzamide (18), tyrosol (19), caffeic acid (20), 3-(2,4,6-trihydroxyphenyl)-1-(4-hydroxyphenyl)-propan-1-one (21), phlorizin (22), friedelin (23), oleanolic acid (24), 4,4-dimethyl-heptanedioic acid (25), anthranilic acid (26), lumichrome (27), scoparone (28) and uracil (29) have not been recorded before in this plant. This is the first report on the occurrence of compounds 4–7, 9, 11, 13–14, 16, 18–21, 25–29 from the genus Rhus. Moreover, the chemotaxonomic significance of these isolated compounds was also summarized.