武汉市医院效率动态变化的Malmquist指数分析

目的 了解武汉市医院2006—2008年3年间运行效率变化的情况,找出引起其效率变化的原因,有针对性地采取措施,以提高医院的整体效率。方法 通过Malmquist指数法分析了武汉市23家医院3年间的全要素生产率、技术效率、技术变化等方面的变化趋势。结果 23家医院全要素生产率普遍下降主要是由于技术退步所致,医院的纯技术效率和规模效率趋于稳定,发挥的促进作用较小。结论 医院不但需要提高管理水平、引进先进的管理模式、控制合适的规模以保证技术效率的提高;更应引进人才,加强技术培训与进修,鼓励医务人员在诊疗技术、诊疗过程上有所创新,以此来提高医疗技术水平,进而提升医院的运行效率。

     

ABC分类法在医院感染管理绩效考核中的应用

目的 探讨ABC分类法在医院感染管理绩效考核中的作用。方法 根据管理特点和工作性质将科室分为A、B、C 3类,分别制定绩效考核方案进行考核。结果 除重症监护室（ICU）外,A类科室中其他科室以及B、C类科室主要考核指标均有所改善。结论 分类管理绩效考核方法提高了管理效率,实现了医院感染管理质量的持续改进。     

职场正念对公立医院护士心理韧性的影响研究

目的 探讨职场正念对护士心理韧性的影响及可能的机制。方法 通过一个横断面式的网络问卷调查收集资料,阶层线性回归法验证变量间的作用关系。结果 护士的职场正念均值水平为（4.74±0.63）,护士心理韧性均值水平为（3.44±0.89）;职场正念对护士心理韧性（β= 0.255,P＜0.01）具有正向预测作用。结论 职场正念可以有效提升护士的心理韧性水平,有助于护士抵御不良事件和负向情绪的侵袭,帮助她们快速从消极情绪中恢复。     

非医疗技术因素对门诊患者满意度的调查与分析

?????? 目的 了解门诊患者对于非医疗技术服务的满意度现状,探讨影响门诊患者满意度的非技术因素。方法 对广州市某三甲医院2012年3—6月就诊的208名门诊患者进行问卷调查。结果 与“等候时间”、“诊疗费用”相关的满意度水平显著低于“服务态度”、“环境设施”类,且满意度水平存在着社会人口学差异。结论 医院应注重非医疗技术服务的改进,可从营造舒适就诊环境、加强医患沟通、降低医疗费用及合理门诊布局等方面入手。同时,优化门诊预约服务可有效提高门诊患者满意度。     

实习前护理专科生的焦虑状况及影响因素分析

目的 了解 护理专科生实习前心理健康状况,探讨其实习前焦虑程度的影响因素。方法 收集2013级某中专院校护理专业10个班和某高等职业院校护理专业5个班的调查问卷,最终整理所得有效样本为578份。应用SPSS19软件进行统计分析。结 果 护生实习前心理健康问题除人际敏感和抑郁之外,均高于全国青年常模（P ＜0.05）;护生的焦虑水平与护生的人格特点、年龄有关;回归分析得出护生的学历、生源地、独生子女等对焦虑程度有明显影响,差异有统计学意义（P ＜0.05）。结论 掌握影响护生产生焦虑程度的因素,为护生护理教育提供依据。     

上海市医疗机构基因临床研究与应用的现状分析

?????? 目的 分析上海市基因临床研究与应用中存在或可能存在的伦理问题。方法 对上海市22所医疗机构进行问卷调查,并对相关人员进行关键知情者访谈。结果 被调查的上海市医疗机构中有7所开展基因工作,2011年公立医院基因检测平均服务量比2009年增长1.75倍;31%的公立医院从事基因工作的人员在近一年内参加过伦理培训,体检机构未向员工提供伦理培训;3所开展基因检测的机构未要求签署知情同意书。结论 上海市基因临床研究与应用发展较快但应用不广,应进一步促进基因检测技术的临床应用,完善基因临床应用的伦理规范。     

宁夏县级医院耳鼻咽喉科医疗服务能力分析

目的 通过对宁夏县级医院耳鼻咽喉科医疗服务现状的调查,了解其发展瓶颈与不足,提出提升宁夏县级医院耳鼻咽喉科医疗服务能力的建议。方法 采用整群抽样方法,对宁夏县级公立综合医院耳鼻咽喉科进行问卷调查,并抽样访谈部分医院耳鼻咽喉科主任,回收、整理、分析相关数据,定量定性分析调查医院耳鼻咽喉科医疗服务能力。结果 宁夏县级医院耳鼻咽喉科各项现状指标均低于县医院标准要求,科室人员与设备数量严重不足,可开展医疗技术项目少,门诊、出院人数逐年提高。结论 宁夏县级医院耳鼻咽喉科医疗服务能力不足,建议科室制定发展规划,创新发展方式;开发人力资源,提升技术水平;借助信息平台,共建学科联盟。     

应急小分队现场医学救援能力现状及其影响因素分析

??????? 目的 了解黑龙江省医疗机构应急小分队人员的突发事件现场医学救援能力现状,对影响救援能力的因素进行诊断,为提高突发事件现场医学救援能力建设提供参考依据。方法 采用分层整群抽样的方法,选取47个医疗机构,对807名医疗机构应急小分队人员进行问卷调查,并辅以定性访谈。结果 通过多因素Logistic回归分析,筛出影响医疗机构应急小分队现场医学救援能力的因素大小依次是实战经验、个人防护能力、培训、装备、医院级别和工作年限,且均呈正相关关系。结论 为提高医疗机构应急小分队现场救援能力,应进一步加强实战经验,提高个人防护能力,重视培训内容、方式与效果,合理储备利用装备等。     

医疗纠纷案例处理方式的Meta分析

目的 综合分析协商、调解、诉讼等医疗纠纷处理方式的使用情况,以期为完善医疗纠纷处理机制提供参考。方法 搜索近年研究医疗纠纷的相关文献,运用Meta分析方法对医疗纠纷案例研究中的数据进行统计和处理,分析各种医疗纠纷处理方式的使用分布情况。结果 在引入医疗纠纷人民调解之前,文献研究中各种处理方式所占比例分别为：双方协商解决65%、卫生行政调解23%、诉讼19%。而在引入医疗纠纷人民调解之后,文献研究中各种处理方式所占比例分别为双方协商解决75%、医疗纠纷人民调解17%、卫生行政调解1%、诉讼6%。结论 医患双方协商解决仍为目前医疗纠纷的主要处理方式,随着医疗纠纷人民调解的逐步发展,多元化的医疗纠纷处理机制将日趋完善。     

浙江省县级综合医院卫生人力资源配置公平性研究

目的 分析2013年浙江省县级综合医院卫生人力资源配置及按人口分布的公平性,为合理配置卫生人力资源提供依据。方法 采用自填问卷的方式,调查浙江省11个地级市137家县级综合医院,同时用Lorenz曲线和基尼系数从人口分布来判断其公平性。 结果 编制外人员所占比例较大,尤其护理人员无编制情况严重;医护比、护理人员数占卫生技术人员总数的比例、每千人口卫生人员,均与标准差距较大;各地级市之间差距较大;卫生技术人员、执业医师、护理人员数按人口分布公平性较高。结论 应科学核定编制数,优化人员配置结构,合理开展区域卫生规划。     

Role for dopamine in malonate-induced damage in vivo in striatum and in vitro in mesencephalic cultures

Defects in mitochondrial energy metabolism have been implicated in the pathology of several neurodegenerative disorders. In addition, the reactive metabolites generated from the metabolism and oxidation of the neurotransmitter dopamine (DA) are thought to contribute to the damage to neurons of the basal ganglia. We have previously demonstrated that infusions of the metabolic inhibitor malonate into the striata of mice or rats produce degeneration of DA nerve terminals. In the present studies, we demonstrate that an intrastriatal infusion of malonate induces a substantial increase in DA efflux in awake, behaving mice as measured by in vivo microdialysis. Furthermore, pretreatment of mice with tetrabenazine (TBZ) or the TBZ analogue Ro 4-1284 (Ro-4), compounds that reversibly inhibit the vesicular storage of DA, attenuates the malonate-induced DA efflux as well as the damage to DA nerve terminals. Consistent with these findings, the damage to both DA and GABA neurons in mesencephalic cultures by malonate exposure was attenuated by pretreatment with TBZ or Ro-4. Treatment with these compounds did not affect the formation of free radicals or the inhibition of oxidative phosphorylation resulting from malonate exposure alone. Our data suggest that DA plays an important role in the neurotoxicity produced by malonate. These findings provide direct evidence that inhibition of succinate dehydrogenase causes an increase in extracellular DA levels and indicate that bioenergetic defects may contribute to the pathogenesis of chronic neurodegenerative diseases through a mechanism involving DA.     

2018年中国植物科学若干领域重要研究进展

2018年中国植物科学继续呈现快速发展的态势, 我国科学家在国际植物科学主流学术刊物发表论文数量大幅增加, 取得了多项具有重要影响的成果。调控植物生长-代谢平衡实现可持续农业发展入选2018年度中国科学十大进展; 中国被子植物区系进化历史研究入选2018年度中国生命科学十大进展。以水稻为代表的农作物和果蔬等经济作物研究在国际上已呈现出明显的优势, 若干领域已从“追赶”状态跨越到“领跑”地位。该文对2018年中国科学家在植物科学若干领域取得的重要研究成果进行了概括性评述, 旨在全面追踪和报道当前中国植物科学领域的发展前沿和热点, 展示中国科学家所取得的杰出成就。     

2017年中国植物科学若干领域重要研究进展

2017年中国植物科学继续保持高速发展态势, 重大成果频出, 具体表现在中国植物学家在国际顶级学术期刊发表的文章数量平稳上升。中国植物科学领域的研究工作者成果精彩纷呈, 如新型广谱抗病机制的发现、水稻广谱抗病遗传基础及机制和疫霉菌诱发病害成灾机制研究等。2017年中国生命科学领域十大进展评选中, 有两项植物科学领域的研究成果入选。水稻生物学、进化与基因组学和激素生物学等领域学科发展突出。另外, 值得一提的是, 长期从事高等植物与代谢途径调控分子网络研究和水稻品种设计育种的李家洋院士的研究成果“水稻高产优质性状形成的分子机理及品种设计”荣获2017年国家自然科学一等奖。这一具有重大国际影响的开创性贡献标志着中国植物科学在该领域的国际科学前沿居于引领和卓越地位。该文对2017年中国本土科学家在植物科学若干领域取得的重要研究成果进行了系统梳理, 旨在全面追踪和报道当前中国植物科学领域发展的最新前沿动态, 与广大读者共同分享我国科学家所取得的辉煌成就。     

我国葫芦科植物离体培养研究进展

葫芦科植物包括多种瓜类蔬菜,对其进行离体培养研究具有重要的理论和实践意义。综述了国内在葫芦科植物器官培养、体细胞胚胎发生、花药培养、原生质体培养和体细胞杂交及离体遗传转化等方面取得的研究进展,并对葫芦科植物离体培养、遗传转化与育种的前景作了展望。     

SSTR5 ablation in islet results in alterations in glucose homeostasis in mice

Somatostatin (SST) peptide is a potent inhibitor of insulin secretion and its effect is mediated via somatostatin receptor 5 (SSTR5) in the endocrine pancreas. To investigate the consequences of gene ablation of SSTR5 in the mouse pancreas, we have generated a mouse model in which the SSTR5 gene was specifically knocked down in the pancreatic beta cells (betaSSTR5Kd) using the Cre-lox system. Immunohistochemistry analysis showed that SSTR5 gene expression was absent in beta cells at three months of age. At the time of gene ablation, betaSSTR5Kd mice demonstrated glucose intolerance with lack of insulin response and significantly reduced serum insulin levels. Insulin tolerance test demonstrated a significant increase of insulin clearance in vivo at the same age. In vitro studies demonstrated an absence of response to SST-28 stimulation in the betaSSTR5Kd mouse islet, which was associated with a significantly reduced SST expression level in betaSSTR5Kd mice pancreata. In addition, betaSSTR5Kd mice had significantly reduced serum glucose levels and increased serum insulin levels at 12 months of age. Glucose tolerance test at an older age also indicated a persistently higher insulin level in betaSSTR5Kd mice. Further studies of betaSSTR5Kd mice had revealed elevated serum C-peptide levels at both 3 and 12 months of age, suggesting that these mice are capable of producing and releasing insulin to the periphery. These results support the hypothesis that SSTR5 plays a pivotal role in the regulation of insulin secretion in the mouse pancreas.     

2018年中国植物科学若干领域重要研究进展

2018年中国植物科学继续呈现快速发展的态势, 我国科学家在国际植物科学主流学术刊物发表论文数量大幅增加, 取得了多项具有重要影响的成果。调控植物生长-代谢平衡实现可持续农业发展入选2018年度中国科学十大进展; 中国被子植物区系进化历史研究入选2018年度中国生命科学十大进展。以水稻为代表的农作物和果蔬等经济作物研究在国际上已呈现出明显的优势, 若干领域已从“追赶”状态跨越到“领跑”地位。该文对2018年中国科学家在植物科学若干领域取得的重要研究成果进行了概括性评述, 旨在全面追踪和报道当前中国植物科学领域的发展前沿和热点, 展示中国科学家所取得的杰出成就。     

我国葫芦科植物离体培养研究进展

葫芦科植物包括多种瓜类蔬菜,对其进行离体培养研究具有重要的理论和实践意义.综述了国内在葫芦科植物器官培养、体细胞胚胎发生、花药培养、原生质体培养和体细胞杂交及离体遗传转化等方面取得的研究进展,并对葫芦科植物离体培养、遗传转化与育种的前景作了展望.     

Changes in aquatic vegetation in Rhine floodplain streams in Alsace in relation to disturbance

Abstract. Changes are described in aquatic vegetation in oligotrophic, groundwater-fed Rhine floodplain streams in Alsace (eastern France), resulting from disturbance. Disturbance factors include changes in nutrients, either permanent ones - effluent from a waste water treatment plant or trout hatcheries - or periodic ones: flooding. Regular inputs of high levels of phosphate and ammonia modified the macrophyte vegetation in these streams. The floristic composition, which was characteristic of oligotrophic waters upstream of the eutrophicated sector, changed to that of a eutrophic situation as originally found downstream. Periodic disturbance by floods which normally occur once a year, irregularly eutrophicates the small streams, causing the development of a mixture of eutrophic and oligotrophic species. Six macrophyte communities are distinguished, indicating different trophic levels. The aquatic vegetation is adapted to the variations of phosphate and ammonia levels. Hence, aquatic macrophytes can be used as bio-indicators of fluctuations in water nutrient levels in relation to the type of disturbance.     

Apoptosis in experimental myocardial infarction in situ and in the perfused heart in vitro

We report the appearance of apoptotic cells in experimental myocardial infarction (rabbit heart) in in situ and in vitro preparations. Apoptosis was recognized by intravital staining with Hoechst 33342 (Ho342), by nick-end labeling (TUNEL) and by DNA laddering. A steady rise in the relative number of apoptotic cardiomyocytes (apoptotic index) was noted in in situ preparations. Apoptosis was first noted 6 h after the onset of ischemia with its highest value occurring after 72 h. Apoptotic nuclei were absent in remote areas of the left and right ventricles. Apoptotic nuclei within the infarcted area showed diminished intensity of Ho342 fluorescence. Three days after ischemia, a border zone adjacent to the infarcted area consisting of apoptotic macrophages was recognized. A novel finding was the appearance of apoptotic cardiomyocytes in the isolated perfused ischemic heart. Occurring as early as 50 min after the onset of ischemia, a high apoptotic index was present adjacent to the ligature placed around the coronary artery. This observation provides the opportunity to selectively examine factors leading to apoptosis in the ischemic heart under controlled experimental conditions.     

Morphine-potentiated platelet aggregation in in vitro and platelet plug formation in in vivo experiments

The detailed mechanisms underlying morphine-signaling pathways in platelets remain obscure. Therefore, we systematically examined the influence of morphine on washed human platelets. In this study, washed human platelet suspensions were used for in vitro studies. Furthermore, platelet thrombus formation induced by irradiation of mesenteric venules with filtered light in mice pretreated with fluorescein sodium was used for an in vivo thrombotic study. Morphine concentration dependently (0.6, 1, and 5 microM) potentiated platelet aggregation and the ATP release reaction stimulated by agonists (i.e., collagen and U46619) in washed human platelets. Yohimbine (0.1 microM), a specific alpha(2)-adrenoceptor antagonist, markedly abolished the potentiation of morphine in platelet aggregation stimulated by agonists. Morphine also potentiated phosphoinositide breakdown and intracellular Ca(2+) mobilization in human platelets stimulated by collagen (1 microg/ml). Moreover, morphine (0.6-5 microM) markedly inhibited prostaglandin E(1) (10 microM)-induced cyclic AMP formation in human platelets, while yohimbine (0.1 microM) significantly reversed the inhibition of cyclic AMP by morphine (0.6 and 1 microM) in this study. The thrombin-evoked increase in pH(i) was markedly potentiated in the presence of morphine (1 and 5 microM). Morphine (2 and 5 mg/g) significantly shortened the time require to induce platelet plug formation in mesenteric venules. We concluded that morphine may exert its potentiation in platelet aggregation by binding to alpha(2)-adrenoceptors in human platelets, with a resulting inhibition of adenylate cyclase, thereby reducing intracellular cyclic AMP formation followed by increased activation of phospholipase C and the Na(+)/H(+) exchanger. This leads to increased intracellular Ca(2+) mobilization, and finally potentiation of platelet aggregation and of the ATP release reaction.