JL-DRGs在综合医院管理中的应用探讨

目的 探讨JL-DRGs在综合医院管理中的应用。方法 对2012年和2013年运行JL-DRGs管理前后的全部出院病例进行统计分析。结果 2013年开始全面运行JL-DRGs后平均住院日下降17.74%,均次费用下降13.49%,医保超支年度累计减少1 866万元,平均每月医保超支额度下降39.23%,医疗质量、效率均显著提升。结论 JL-DRGs在大型综合医院管理中应用效果好,可以积极促进医院提质升效并降低运营成本。     

医院大数据应用影响因素分析与对策研究

目的 深入分析限制医院大数据应用普及的影响因素,研究促进医院大数据应用的对策与方法。方法 采用德尔菲法自制医院大数据应用影响因素调查问卷,随机抽取中国研究型医院学会医疗分会64家会员单位会员代表进行调查,获得有效问卷104份,有效回收率为94.55%。结果 应用推广（4.14±0.65）分,管理方式（4.07±0.60）分,数据基础（3.88±0.82）分。不同性别、年龄、职称、岗位组间对于影响因素的态度差异没有统计学意义（P > 0.05）。多元线性回归分析结果显示,管理方式（b= -0.381, P=0.019）和“缺乏大数据专业化人才”（b=-0.268, P=0.011）会对医院大数据应用普及程度产生显著的负向影响关系。结论 医院大数据应用水平未能有效满足医务人员需求,应从管理顶层设计入手,重点加强大数据专业化人才的培养,同时注重提升数据基础质量和应用推广力度。     

综合医院大数据应用需求调查与分析

目的 分析综合医院对于大数据应用的内在需求,为医院的大数据研发与应用提供导向和依据。方法 采用德尔菲法自制医院大数据应用需求调查问卷,随机抽取中国研究型医院学会医疗分会64家会员单位进行调查,获得有效问卷104份,有效回收率为94.55%。结果 精准医疗（4.31±0.42）分,精益管理（4.23±0.56）分,科学研究（4.19±0.52）分,健康管理（4.16±0.52）分,数字医疗（4.06±0.60）分,教育培训（3.69±0.69）分。不同性别、年龄、职称、岗位组间的需求差异有统计学意义（P＜0.05）。多元线性回归分析结果显示,医学人工智能（b=0.324,P=0.000）和互联网+医疗（b=0.161,P=0.047）的需求程度会对医院大数据应用前景态度产生显著的正向影响关系。结论 综合性医院对大数据具有较强的、多样化的应用需求,应以实际需求为导向,重点推进精准医疗、医学人工智能和互联网+医疗等相关应用的研发。     

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。     

Difficulties with anonymous shortlisting of medical school applications and its effects on candidates with non-European names: prospective cohort study

ObjectiveTo assess the feasibility of anonymous shortlisting of applications for medical school and its effect on those with non-European names.DesignProspective cohort study.SettingLeeds school of medicine, United Kingdom.Subjects2047 applications for 1998 entry from the United Kingdom and the European Union.InterventionDeletion of all references to name and nationality from the application form.ResultsDeleting names was cumbersome as some were repeated up to 15 times. Anonymising application forms was ineffective as one admissions tutor was able to identify nearly 50% of candidates classed as being from an ethnic minority group. Although scores were lower for applicants with non-European names, anonymity did not improve scores. Applicants with non-European names who were identified as such by tutors were significantly less likely to drop marks in one particular non-academic area (the career insight component) than their European counterparts.ConclusionsThere was no evidence of benefit to candidates with non-European names of attempting to blind assessment. Anonymising application forms cannot be recommended.

Key messages

• It is cumbersome to anonymise the current Universities and Colleges Admissions Service form as a candidate''s name may appear up to 15 times
• Anonymised application forms may still be identified as being from candidates from ethnic minority groups
• More thorough anonymising of application forms, such as deletion of cultural activities, would edit out some personal attributes and may disadvantage these candidates
• Anonymous assessment of applications cannot be recommended

     

α-Hydroxybenzylphosphonate Modified Oligonucleotides: Synthesis,Properties, and a Novel Route via Monomer Building Blocks

Abstract

In general, α-hydroxybenzylphosphonate modified 2′-deoxyadenosine-thymidine dimer building blocks 1, 2 are utilized for the incorporation into α-hydroxybenzylphosphonate pro-oligonucleotides. For a universal application of our pro-oligonucleotide concept on biologically relevant oligonucleotides a route for the synthesis of modified monomer building blocks 3 was developed and is presented herein.     

门诊信息化和医疗服务保障体系联合应用效果分析

?????? 目的 探讨门诊信息化和SAFE-CARE体系在提升门诊优质服务水平中的作用。方法 总结1年多来门诊信息化建设和SAFE-CARE体系在提升门诊医疗服务水平中的经验。结果 门诊信息化为医院门诊医疗服务提供了高效的作业工具,提高了就诊效率;SAFE-CARE体系保障了医疗安全和医疗质量,提升了医院管理水平。结论 门诊信息化和SAFE-CARE体系式联合应用是解决群众“看病难和看好病”的重要举措。     

卡氏德巴利酵母植酸酶在毕赤酵母中的异源表达及优化

【背景】植酸是一种能螯合金属离子和蛋白质的有机磷类化合物,广泛存在于植物组织中,影响动物对营养元素的吸收。在饲料中加入植酸酶可有效降解植酸。【目的】构建毕赤酵母异源表达卡氏德巴利酵母(Debaryomyces castellii,D. castellii)植酸酶的菌株,促进卡氏德巴利酵母植酸酶的研究及工业应用。【方法】将卡氏德巴利酵母植酸酶基因进行密码子优化后转入毕赤酵母GS115中,通过筛选多拷贝、敲除蛋白酶、过表达分子伴侣及转运蛋白的方法获取优势菌株。【结果】所得重组菌株GS115/DCphy(ΔPep4)(BFR2)的产酶酶活是低拷贝菌株的7倍。【结论】研究结果为卡氏德巴利酵母植酸酶的异源表达及潜在工业应用提供了一定的指导。     

Influence of Pak choi plant cultivation on Se distribution,speciation and bioavailability in soil

Background and aims

The combination of plant breeding and agronomic biofortification is the most reasonable approach to minimize zinc (Zn) deficiency-related problems in humans, but also in crop production. However, its efficiency and suitability under Mediterranean conditions and its effects on the grain yield and quality parameters are not well known.

Methods

Field experiments were conducted over two years in south-eastern Portugal, where soils are deficient in Zn. Ten advanced breeding lines and three commercial varieties of bread-making wheat were fertilized with four Zn treatments as following: i) control, ii) soil Zn application, iii) foliar Zn application and iv) both soil and foliar Zn application.

Results

Low rainfall produced 46 % more of grain Zn concentration but about 67 % less of grain yield. Grain Zn concentration varied greatly across treatments and cultivars with INIAV-1, INIAV-6, INIAV-9 and the commercial varieties being the most efficient. There were no significant increases in Zn concentrations due to soil Zn application, but gains higher than 20 mg kg^?1 were obtained both with foliar and soil+foliar Zn applications. Grain yield was not significantly higher in foliar application, but increased to about 10 % in soil, and about 7 % in soil+foliar applications, respectively.

Conclusions

In soils with low Zn availability, the best strategy to improve grain Zn concentrations has been to select the most efficient cultivars for Zn accumulation with the added application of Zn in soil+foliar form.

     

Effect of cycling exercise on lumbopelvic control performance in elite female cyclists

Objectives:The purpose of the present study is to assess the effects of an intense cycling training session on the stability of the lumbopelvic-hip complex through two dynamic exercise tests - the single-leg-deadlift (SLD) and a variation of the bird-modified dog (BD), via the OCTOcore application.Methods:Thirty-one elite female road cyclists were self-evaluated with their own smartphones, before and immediately after finishing their training sessions. Right, left and composite were measured for each exercise test.Results:There was a significant time effect on performance for both the SLB and BD tests (p<0.05; η²=0.137), and the SLD and BD tests were increased with respect to the pre-test at 15% and 17%, respectively.Conclusion:An intense cycling training session produced significant alterations in lumbopelvic behavior in the elite female cyclists. The OCTOcore application demonstrated that it was a sensitive tool in detecting these changes and it could easily be used by the cyclists themselves.     

脑卒中患者连续性护理的应用及效果评价

目的 探讨对脑卒中患者应用连续性护理的效果。方法 构建连续性护理模式,从入院开始进行连续性护理干预,通过患者住院天数、住院费用、再入院率、护理服务满意度、BI指数等指标评价应用效果。结果 连续性护理干预减少了患者住院天数、住院费用、再入院率（P<0.01,P<0.01,P<0.05）,提高了患者对护理服务的满意度及BI指数（P<0.05）。结论 连续性护理是脑卒中患者护理的有效途径,值得推广应用。     

基于Golden Gate技术的齐整小核菌转录单元高效组装系统

【目的】为齐整小核菌代谢工程研究建立高效的转录单元组装系统。【方法】通过应用Golden Gate技术,以mobius assembly为基础,分别设计并构建DNA元件标准化接口改造、单转录单元组装、应用质粒(多转录单元)组装等功能的载体,从而形成一套完整的多转录单元组装系统。【结果】构建了2个用于DNA元件标准化接口改造的Level 0载体,4个用于单转录单元组装的Level 1载体,4个用于应用质粒组装的Level 2载体和13个应用质粒组装的辅助质粒。然后应用此系统为齐整小核菌组装了若干经过标准化接口改造的DNA元件质粒、单转录单元质粒和硬葡聚糖相关基因的功能分析质粒。所构建的最终应用质粒可以同时适用于齐整小核菌的根癌农杆菌介导转化法、电穿孔转化法和原生质体转化法。【结论】此质粒系统具有强大的DNA设计、组装和容纳能力,为未来齐整小核菌代谢工程和功能基因组学研究提供了高效的质粒构建技术平台。     

基于CIS的医疗质量安全监管系统应用效果

?????? 目的 探讨以临床信息系统（CIS）为基础构建医疗质量安全监管系统的实际应用效果。方法 对照分析应用CIS及医疗质量信息化监管系统前后的医疗服务效率与质量安全指标变化。结果 实施CIS及信息化医疗质量安全监管系统后医疗效率和质量安全指标均有显著性提升。结论 基于临床信息系统建立健全医疗质量安全监管系统,是深入挖掘利用CIS、充分发挥其持续改进医疗质量、保障患者安全、提升服务效能的重要支持和保证。     

碱性蛋白酶SubC在枯草芽孢杆菌中的高效异源表达

【背景】碱性蛋白酶是工业用酶中占比最大的酶类,广泛应用于清洁、食品、医疗等行业。近期研究发现碱性蛋白酶在生产生物活性肽方面有巨大潜力,这将进一步拓宽其在保健食品领域中的应用。【目的】利用枯草芽孢杆菌异源表达地衣芽孢杆菌来源的碱性蛋白酶SubC。【方法】通过筛选3种枯草芽孢杆菌宿主菌株(Bacillus subtilis 1A751、MA07、MA08)和6种信号肽(AmyE、AprE、NprE、Pel、YddT、YoqM),同时优化诱导剂浓度、发酵培养基和发酵时长,最终得到最优重组菌株MA08-AmyE-subCopt。【结果】重组菌株MA08-AmyE-subCopt的胞外酶活力为3.33×103 AU/mL,胞外蛋白分泌量为胞内可溶蛋白表达量的4倍,与携带野生型信号肽的对照组菌株WT相比,酶活提高了73.4%。【结论】异源碱性蛋白酶SubC在枯草芽孢杆菌中成功表达,为碱性蛋白酶SubC的表达和在保健食品领域的工业化应用提供了理论基础。     

专项整治对综合医院抗菌药物使用强度的影响

??????? 目的 探讨抗菌药物临床应用专项整治活动对综合医院住院患者抗菌药物使用强度的影响。方法 以限定日剂量（DDD）为单位,对某综合性医院在实施专项整治前、后住院患者抗菌药物使用强度（AUD）进行统计、分析。结果 专项整治活动降低了住院患者累计AUD值,大环内酯类等药物AUD明显下降,第二代、第三代和第四代头孢菌素和不同管理级别抗菌药物AUD均下降。但还存在用药集中、注射用头孢哌酮钠舒巴坦钠AUD下降不明显等问题。结论 专项整治有效降低了综合医院住院患者AUD,但与卫生行政部门标准仍存在差距,应进一步加强管理。     

The involvement of TRPA1 channel activation in the inflammatory response evoked by topical application of cinnamaldehyde to mice

AimsIn the present work, we characterize the inflammatory process induced by the topical application of cinnamaldehyde on the skin of mice and verify the participation of transient receptor potential A1 TRPA1 receptors in this process.Main methodsWe measured mouse ear edema and sensitization/desensitization after topical application of cinnamaldehyde or/and capsaicin. We also quantified cellular infiltration through myeloperoxidase (MPO) activity and histological and immunohistochemical analyses and evaluated the expression of TRPV1 and TRPA1 by western blot.Key findingsCinnamaldehyde induced ear edema in mice (1–6 μg/ear) with a maximum effect of 4 μg/ear. Cinnamaldehyde promoted leukocyte infiltration as detected by increasing MPO activity and confirmed by histological analyses. The edema and cellular infiltration evoked by the application of 4 μg/ear of cinnamaldehyde were prevented by topical application of ruthenium red, a non-selective TRP antagonist as well as camphor and HC030031, two TRPA1 receptor antagonists. Cinnamaldehyde-induced edema, but not cellular infiltration, was prevented by topical application of the tachykinin NK1 antagonist, aprepitant, indicating a neuropeptide release phenomenon in this process. Additionally, we observed that repeated topical applications of cinnamaldehyde did not induce changes in sensitization or desensitization with respect to the edema response. Interestingly, repeated treatment with the TRPV1 agonist, capsaicin, abrogated it edematogenic response, confirming the desensitization process and partially decreasing the cinnamaldehyde-induced edema, suggesting the involvement of capsaicin-sensitive fibers.SignificanceOur data demonstrate that the topical application of cinnamaldehyde produces an inflammatory response that is dependent on TRPA1 receptor stimulation.     

皮肤病专科医院电子病历的设计与应用

???????目的 研究与开发具有皮肤病专科特色的电子病历系统,以实现皮肤科病人医疗信息的采集、加工、存储、传输和服务。方法 以windows sqlserver2005为后台数据库,以XML、C#为开发语言,建立皮肤病结构化病历。结果 该系统运行良好,安全稳定、易维护、通用性好。有效地提高了医生书写病历的速度和质量,并具有皮疹数码照片嵌入等功能。结论 本研究实现了具有皮肤病专科特色的电子病历系统,值得皮肤病医院推荐使用。     

Protein intrinsic disorder toolbox for comparative analysis of viral proteins

Motivation

BLAST programs are very efficient in finding similarities for sequences. However for large datasets such as ESTs, manual extraction of the information from the batch BLAST output is needed. This can be time consuming, insufficient, and inaccurate. Therefore implementation of a parser application would be extremely useful in extracting information from BLAST outputs.

Results

We have developed a java application, Batch Blast Extractor, with a user friendly graphical interface to extract information from BLAST output. The application generates a tab delimited text file that can be easily imported into any statistical package such as Excel or SPSS for further analysis. For each BLAST hit, the program obtains and saves the essential features from the BLAST output file that would allow further analysis. The program was written in Java and therefore is OS independent. It works on both Windows and Linux OS with java 1.4 and higher. It is freely available from: http://mcbc.usm.edu/BatchBlastExtractor/

     

Structures and energies of the radicals and anions generated from chlorpyrifos

The radicals and anions generated from chlorpyrifos by removing a hydrogen atom have been investigated using the hybrid density functional B3PW91 method. The results show that all the radicals have been classified as three groups and their stability order is methylene (radical 1, 3, 5, and 7) > methyl (radical 9, 11 and 13) > ring (15); the anions have the relative energetic order: methyl > methylene > ring. Moreover, some decomposition reactions are also reported. The large HOMO-LUMO gaps indicate that both radicals and anions are predicted to be high-kinetic stable molecules. We also find that radicals 9, 11 and 13 have the highest AEAs and anions 2, 4 and 6 have higher VDEs. Additionally, natural population analysis charges show that there is the lowest Δq (0.14) for the C7 and C9 atoms. We hope that our theoretical results may provide a reference for further experiment and practical application.