我国公立医院病人安全文化的现状研究

目的 构建适合我国公立医院的病人安全文化测评量表,并分析我国公立医院病人安全文化现状。方法 对我国东、中、西部3省（直辖市）54所公立医院员工进行问卷调查。结果 中国版医疗机构病人安全文化调查量表信、效度可以接受;我国公立医院病人安全文化处于中上水平（总体平均分为3.80分）;在“害怕受责备与惩罚”“害怕受羞辱”“提供安全的医疗保健”和“组织安全资源”的维度上,评分相对较低;不同地区、等级公立医院病人安全文化存在一定差异。结论 我国公立医院病人安全文化尚未达到令人满意的程度,政府卫生主管部门和医院管理者需要营造更好的病人安全文化,尤其应加强西部地区医院和二级医院的病人安全文化建设。     

病人安全文化与医疗服务结局的关联性分析

目的 探讨病人安全文化与医疗服务结局的关联性。方法 采用自行设计的病案评阅表对我国东、中、西3省（直辖市）18所公立医院的社区获得性肺炎、急性心肌梗塞、急性左心功能衰竭、计划性剖宫产和胆囊结石合并急性胆囊炎5个病种进行调查；通过机构问卷调查，收集医院层面的医疗服务状况数据；采用中国版医疗机构病人安全文化调查量表进行病人安全文化调查。结果 在医院层面上，未发现病人安全文化与医疗服务状况各指标的关联性；在病种层面上，多因素分析也未显示病人安全文化与治愈好转状况、住院天数和住院总费用的关联性。结论 病人安全文化对医疗服务结局的影响不显著，可能是通过间接途径作用于医疗服务结局。     

基于文献计量学的《中国医院管理》文献可视化分析

目的 通过文献计量学方法,探索《中国医院管理》的发展脉络及医院管理领域近年来的科研合作演进过程。方法 利用信息可视化分析软件CiteSpace,对近10年（2006—2015年）间刊发在《中国医院管理》的科学文献进行文献计量学分析（共有4 169篇文献纳入）。结果 其中高产作者有方鹏骞、薛迪、吴群红等,分别达到56篇、51篇、22篇。高产单位有华中科技大学同济医学院医药卫生管理学院、哈尔滨医科大学附属第一医院和首都医科大学卫生管理与教育学院,合作频次分别达到187次、96次和56次。其中“公立医院”“医院管理”“医疗质量”等关键词共现率较高均超过100次。2013年后“医药分开”“患者安全”“合理用药”和“县级公立医院等”等内容逐渐成为研究热点。结论 《中国医院管理》杂志是广大读者了解和学习医院管理领域研究热点和重大成果的重要平台。     

我国公立医院病人安全文化的影响因素分析

目的 探索我国公立医院病人安全文化的影响因素。方法 采用中国版医疗机构病人安全文化调查量表对我国东、中、西3省（直辖市）54家公立医院员工进行问卷调查。结果 管理者对病人安全文化总体评价高于医生、护士和医技人员;儿科、ICU、急诊科的员工评价相对较低,而眼耳鼻喉科的员工评价较高。在调整员工个人特征后,湖北省医院病人安全文化评分较高,但湖北省内各医院间病人安全文化差异较大。结论 我国公立医院管理者应加强与临床一线人员的交流与沟通,关注儿科、ICU和急诊科病人安全文化的建设,积极探索改善区域内病人安全文化的有效途径。     

管办分开下公立医院运行机制改革与实践

在管办分开下进行了公立医院管理机制的探索与实践。通过优化医院战略定位与管理、创新分管领导条块负责、试行按绩激励、建立中层干部契约化管理、实施临床科室分类目标责任管理,探索“四步考核”绩效考核,强化医疗质量管理执行与督查分设,研究科室投入与科室效益及其战略发展定位相结合的资产运行,实践人才培养与引进“四轮驱动”,提升医院文化导向机制系列改革,创新了医院管理体制,同时医院在医疗、科研、人才、经营、文化建设方面也得到了迅速提升。     

医院文化管理对医务人员组织承诺的影响探讨

随着医改进程的加快,特别是公立医院改革的深化,公立医院传统的人事管理模式将发生根本性的改变。介绍了医院文化管理对医务人员组织承诺的影响,提出从培养共同的价值观与目标愿景、完善“以人为本”的管理模式、发挥领导者的重要作用三个方面提高医务人员组织承诺。     

我院实施“无障碍就医”的做法与成效

自2013年开始,青岛大学医学院附属医院实施“无障碍就医”以来,医院在各个方面都取得了显著成效。文章通过对“无障碍就医”工程实施的动因、意义、主要做法和成效进行剖析,为公立医院探索内部管理方式改革,实现患者便捷就医、安全就医的目标,缓解群众“看病难、看病贵”问题提供了有益的借鉴。     

基于供应链的公立医院体外诊断试剂管理

公立医院体外诊断试剂管理因试剂种类复杂,横跨药品和医疗器械两个行业,监管有一定难度,导致试剂的“进、销、存”缺乏整体性管理,严重影响医院的医疗安全和运行效率。江苏省人民医院采用信息化手段,运用供应链管理的理念来研发体外诊断试剂管理项目,实现医院体外诊断试剂的精细化的管理,有效地提高医疗安全。     

我国公立医院在移动医疗中的服务供给变革 ——来自我国科技影响力前100家医院的实证研究

为了解我国公立医院在移动端医疗服务供给的代表性情况,将2015年度中国医院科技影响力排名（综合）前100的医院作为调查对象,从服务供给渠道、服务供给内容、服务供给方式、服务供给合作4个方面,对比分析公立医院从传统医疗到移动医疗的变革。结果发现被调查医院十分重视移动端的渠道建设,大多已在App和微信这两大移动流量入口进行了布局;服务内容在医疗流程基础上形成了多种衍生和创新;服务提供方式逐渐向场景化导航和移动O2O医疗转变;医院之间、医院和技术公司的合作越来越频繁。这些变革也将反过来促进医院流程优化、互联互通、多方博弈的深化治理。

     

试论我国公立医院改革的关键点

提出了我国公立医院改革的关键点是：（1）公立医院应聚焦于病人的价值;（2）构建整合的医疗服务体系,使不同级别的公立医院提供不同环节的医疗服务;（3）使不同级别公立医院的医疗服务价格和医疗保险的共付比例不同,促使病人合理选择医院和医生;（4）改善公立医院内部管理和外部监督。     

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.     

Scurvy in capybaras bred in captivity in Argentine

In order to determine if the absence of vitamin C in the diet of capybaras (Hydrochoerus hydrochaeris) causes scurvy, a group of seven young individuals were fed food pellets without ascorbic acid, while another group of eight individuals received the same food with 1 g of ascorbic acid per animal per day. Animals in the first group developed signs of scurvy-like gingivitis, breaking of the incisors and death of one animal. Clinical signs appeared between 25 and 104 days from the beginning of the trial in all individuals. Growth rates of individuals deprived of vitamin C was considerably less than those observed in the control group. Deficiency of ascorbic acid had a severe effect on reproduction of another population of captive capybaras. We found that the decrease in ascorbic acid content in the diet affected pregnancy, especially during the first stages. The results obtained suggest that it is necessary to supply a suitable quantity of vitamin C in the diet of this species in captivity.     

Changes in lactate dehydrogenase activity in chicken tissues in hyperthyreosis in ontogenesis

The lactate dehydrogenase activity in reactions of lactate oxidation and synthesis was studied in subfractions of the chicken brain, heart and liver at the embryonal, early postembryonal and adult stages of development after thyroxine administration. It has been shown that during embryogenesis thyroxine predominantly enhanced the rate of lactate oxidation in the mitochondrial tissues. A marked increase in the lactate synthesis was found in cytoplasm of the adult chicken tissues. Specificity of enzyme activity alterations was detected in the chicken brain during ontogenesis after thyroxine administration.     

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.