论医院绩效管理的人性化管理及其柔性化操作

医院绩效管理中存在倾向于刚性管理并热衷于惩罚方式的现象,其结果是无意中起了引导员工为逃避惩罚而隐瞒相关信息的作用,从而使医院员工不能共同分享与讨论各种经验教训,不利于医院进行持续质量改进。而有效预防与解决这一问题的主要策略是在绩效管理中进行人性化管理,并以柔性化操作处理那些不易进行刚性考核或易在刚性考核中产生消极后果的问题。     

Immunoassay Using Microfluid Filters Constructed by Deep X-Ray Lithography

Microfluid filters were fabricated, which possessed 2,100 cylindrical through-bores (φ40 μm) in 200 μm-thickness polymethylmethacrylate (PMMA) sheets (φ3 mm), by deep X-ray lithography using synchrotron radiation. To evaluate the microfluid filters as a device for an immunoassay, we bound the goat anti-mouse immunogloblin G (IgG) antibody to the surface of the filters, and set the filters between reaction vessels stacked vertically in a microreactor. An enzyme-linked immunosorbent assay (ELISA) of mouse IgG using the goat anti-mouse IgG/horseradish-peroxidase (HRP) conjugate indicated that mouse IgG could be quantitatively detected in the range of 0–100 ng/ml, demonstrating the applicability of vertical microfluidic operation to the immunoassay.     

妇科恶性肿瘤术后阴道微生态状况分析

目的了解妇科恶性肿瘤术后患者阴道微生态的状况,探讨妇科恶性肿瘤术后阴道微生态评价的临床意义。方法选取100例妇科恶性肿瘤术后复查的患者,取阴道分泌物进行微生态评价,以同期30例绝经体检妇女作为对照。结果妇科恶性肿瘤术后阴道优势菌以乳酸杆菌为主的,占41%;菌群密集度多在＋ ＋ ～＋ ＋ ＋,占52%;菌群多样性多在＋ ＋ ～＋ ＋ ＋,44% ;PH^4.5,占35% ;VVC阳性率为4% ;阴道毛滴虫阳性率为7% ;BV阳性率为5% ;微生态失调的发生率占69%。结论（1）妇科恶性肿瘤术后,阴道微生态失调发生率明显增高;（2）妇科恶性肿瘤术后阴道微生态的失调与肿瘤的种类、恶性程度、手术范围、卵巢去留等无关,但术后时间越长,阴道微生态失调率越高;（3）评价妇科恶性肿瘤术后阴道微生态环境的状况,对预防与治疗术后生殖道感染具有重要指导意义。     

腔内大量盐水灌洗辅助取出乳房内聚丙烯酰胺水凝胶临床应用

目的：探讨聚丙烯酰胺水凝胶注射隆胸后取出新方法.方法：对48例注射聚丙烯酰胺水凝胶隆胸患者术前行双乳MRI或彩超检查结合触诊准确定位.全麻小切口开放直视下吸出水凝胶,再用大量生理盐水反复灌洗所有腔隙,直至手感探测不到硬结,盐水中无水凝胶为止.结果：48例患者术后无继发感染和出血等并发症.术前诸症状体征消失,无明显乳房变形,乳房形态术后恢复满意.术后双乳MRI复查未见明显异物残留.术后1 ～12月（6.2±0.3月）45例随访复查MRI亦未见异物残留,乳房修复完好.结论：注射隆乳后腔内大量盐水灌洗辅助取出水凝胶具有创伤小、出血少、操作简单、费用低廉的优点,是一种较好的、值得推广的凝胶取出术式.     

Process model comparison and transferability across bioreactor scales and modes of operation for a mammalian cell bioprocess

A Monod kinetic model, logistic equation model, and statistical regression model were developed for a Chinese hamster ovary cell bioprocess operated under three different modes of operation (batch, bolus fed‐batch, and continuous fed‐batch) and grown on two different bioreactor scales (3 L bench‐top and 15 L pilot‐scale). The Monod kinetic model was developed for all modes of operation under study and predicted cell density, glucose glutamine, lactate, and ammonia concentrations well for the bioprocess. However, it was computationally demanding due to the large number of parameters necessary to produce a good model fit. The transferability of the Monod kinetic model structure and parameter set across bioreactor scales and modes of operation was investigated and a parameter sensitivity analysis performed. The experimentally determined parameters had the greatest influence on model performance. They changed with scale and mode of operation, but were easily calculated. The remaining parameters, which were fitted using a differential evolutionary algorithm, were not as crucial. Logistic equation and statistical regression models were investigated as alternatives to the Monod kinetic model. They were less computationally intensive to develop due to the absence of a large parameter set. However, modeling of the nutrient and metabolite concentrations proved to be troublesome due to the logistic equation model structure and the inability of both models to incorporate a feed. The complexity, computational load, and effort required for model development has to be balanced with the necessary level of model sophistication when choosing which model type to develop for a particular application. © 2012 American Institute of Chemical Engineers Biotechnol. Prog., 2013     

胸腔镜与传统手术方法对非小细胞肺癌患者的临床疗效

目的:比较电视胸腔镜手术与传统手术方法对非小细胞肺癌治疗的临床效果.方法:选择2010年5月至2012年6月本院收治的非小细胞肺癌患者84例,随机分为VATS组和OT组,各42例,VATS组行全胸腔镜肺叶切除术;OT组行传统开胸肺叶切除术.比较两组患者手术时间、淋巴结清扫数、术中出血量、术后引流时间、住院天数、术后疼痛和并发症发生情况,观察并比较两组患者术后3d血清CRP、TNF-α、IL-6、IL-10水平.结果:VATS组术后引流时间、住院时间明显短于OT组(P＜0.05);两组手术时间、淋巴结清扫数、术中出血量及并发症发生率比较无统计学差异(P＞0.05);VATS组术后1d、3d疼痛评分明显低于OT组(P＜0.05);VATS组术后3d血清CRP、TNF-α、IL-6、IL-10水平明显低于OT组(P＜0.05).结论:与传统手术相比,电视胸腔镜手术对患者创伤较小,患者术后炎症反应较低,痛苦较小,可作为非小细胞肺癌的推荐手术方式.     

妇科针对性护理对保守治疗、开腹手术治疗、腹腔镜微创手术治疗宫外孕患者机体恢复的影响

目的:目前宫外孕的发病率日趋增多,发病年龄也趋向年轻化,为减轻患者痛苦,促进其早日康复,本文旨在回顾性分析妇科护理工作在三种方式治疗宫外孕治疗中的作用.方法:选取2010年10月至2011年9月间,于我院妇科进行宫外孕手术的患者172例,针对172例患者所采取的保守治疗、开腹手术治疗、腹腔镜微创手术三种不同治疗方法,根据不同情况,实施多种妇科针对性护理措施,并对结果进行回顾性分析和总结.结果:172例宫外孕患者经腹腔镜微创手术治疗治愈126例,经过针对性妇科护理,平均住院6.56天;开腹手术治愈26例,经过针对性妇科护理,平均住院9.85天;保守治疗20例,保守治疗失败转为手术治疗3例,平均住院17.87天.经过对所有患者采取有效的针对性精心护理,护理效果较为满意,预后情况良好.结论:腹腔镜微创手术治疗因其创伤小、恢复快,且兼具明确诊断和治疗的作用,是目前临床治疗宫外孕的主要方法;对选择不同治疗方式的患者采取有效的针对性护理,可以提高护理质量和治疗效果,减轻患者痛苦、减少并发症的发生,确保患者早日康复出院.     

胸腔镜食管癌切除术后肺部感染患者肺功能和炎症因子水平的关系研究

目的:研究胸腔镜食管癌切除术后肺部感染患者肺功能和炎症因子水平的关系。方法:选取2015年3月～2018年7月我院收治的食管癌患者120例为研究对象,将其以随机数字表法分成对照组和观察组。对照组予以传统开胸手术治疗,观察组则予以胸腔镜食管切除术治疗。分别比较两组术后肺部感染发生情况、手术前后肺功能以及炎症因子水平变化情况,并分析胸腔镜食管癌切除术后肺部感染患者肺功能与炎症因子的关系。结果:观察组患者术后肺部感染发生率为13.33%(8/60),低于对照组的36.67%(22/60),差异有统计学意义(P0.05)。术后观察组用力肺活量(FVC)、第1秒用力呼气量(FEV1)、FEV1/FVC均高于对照组,差异均有统计学意义(均P0.05)。术后1 d、术后5 d观察组白细胞介素-6(IL-6)、白细胞介素-10(IL-10)以及C反应蛋白(CRP)水平均低于对照组,差异均有统计学意义(均P0.05)。经Pearson相关性分析可得:胸腔镜食管癌切除术后肺部感染患者FVC、FEV1、FEV1/FVC与IL-6、IL-10、CRP均呈负相关性(均P0.05)。结论:胸腔镜食管癌切除术可显著降低患者肺部感染发生风险,且术后肺部感染患者肺功能与炎症反应存在密切相关,降低术后肺部感染发生率的机制可能与减轻机体炎症反应有关。     

An Ultra‐Mechanosensitive Visco‐Poroelastic Polymer Ion Pump for Continuous Self‐Powering Kinematic Triboelectric Nanogenerators

A mechanosensitive, visco‐poroelastic polymer ion pump that can rapidly establish a dense electrical double layer via mechanical pressure, thereby significantly enhancing output performance of an ionic triboelectric nanogenerator (iTENG), is described. A working mechanism of an iTENG using a highly mechanosensitive, visco‐poroelastic ion pump is suggested and the optimal characteristics of the polymer ion pump are reported by investigating optical, mechanical, electrical, and electrochemical properties. Surprisingly, the pressure sensitivity of the iTENG reaches 23.3 V kPa^?1, which is tens of times the record value. To achieve controlled high‐frequency pulses from an iTENG, kinematic systems using a gear train and a cam are integrated with a single grounded iTENG, which produces a maximum of 600 V and 22 mA (≈2.2 W cm^?2) at an input frequency of 1.67 Hz; after power transforming, those values are converted to 1.42 V and 225 mA. A capacitor of 1 mF can be fully charged to 2 V in only 60 s, making it possible to continuously operate a wireless‐communicating self‐powered humidity sensor. Also, due to the high transparency and deformability of the polymer ion pump, a self‐powered transparent tactile sensor is successfully assembled using a 5 × 5 iTENG array.     

单孔与两孔胸腔镜下肺大疱切除手术治疗气胸的效果对比

目的:对比单孔与两孔胸腔镜下肺大疱切除手术治疗气胸的效果。方法:选取2015年9月～2018年10月我院收治的自发性气胸患者81例,采用随机数字表法将患者分为两组,观察组行单孔胸腔镜下肺大疱切除术,对照组行两孔胸腔镜下肺大疱切除术。比较两组患者的手术相关指标、术后疼痛评分、手术前后血清肿瘤坏死因子-α(Tumor necrosis factor-α, TNF-α)、白细胞介素1β(Interleukin-1β,IL-1β)和C反应蛋白(C-reactive protein,CRP)水平的变化及并发症的发生情况。结果:两组患者的手术时间比较无统计学差异(P0.05),观察组患者的术中出血量、术后引流量、引流管留置时间和切口长度均显著少于或短于对照组(P0.05);观察组患者术后3d和术后3个月的视觉模拟评分(Visual analogue scale,VAS)显著低于对照组(P0.05),两组术后1年VAS评分比较无统计学差异(P0.05)。术后7d,两组患者的血清TNF-α、IL-1β和CRP水平均较术前显著降低,且观察组显著低于对照组(P0.05)。两组患者并发症的发生率比较无统计学差异(P0.05)。结论:与两孔胸腔镜下肺大疱切除术相比,单孔胸腔镜下肺大疱切除术用于气胸患者的创伤更小,更有利于患者术后恢复,且安全性更高。