医疗服务收费纳入病历印证管理工作探讨

目的 探讨病历作为医疗服务收费记录依据的办法及实施措施。方法 现场调研与统计分析相结合。结果 统计分析发现,医疗服务收费纳入病历印证管理工作对出院患者满意度有显著影响,通过实施医疗服务收费纳入病历印证工作,完善了医院收费内控制度,遏制了因收费不合理而导致的国度医疗现象,提高了出院患者的满意度。结论 病历可以作为医疗收费的最终记录依据,应加强病历印证医疗服务收费管理。     

临床常见护理文件缺陷原因分析与对策

目的分析临床常见护理文件缺陷的原因,并提出改进措施,以规范护理文件书写,减少医疗纠纷的发生。方法总结我院2013年1月~2014年10月出院病历2846份,并对记录缺陷进行分析和提出改进措施。结果存在书写缺陷病历1366份,占48%。主要缺陷为护理记录单,占缺陷的62%。结论加强护理记录质量管理,增强护理质量风险意识,是提高护理文书书写质量,减少医疗纠纷的重点。     

中药房药品管理质控对策研究

目的探讨医院中药库药品管理现状并分析质控管理对策。方法通过改革前(2011年1月~2013年1月)和改革后(2013年2月~2015年2月)的对比研究,提出科学、有效的管理措施。结果改革管理前后药品不良事件比较,改革管理后,库存不足、药品丢失、药品过期与调配差错发生率显著低于改革管理前(均P0.05),质量评分显著提高(P0.05)。结论改革后管理措施有助于提高中药质量管理效果,减少药品不良事件,降低差错率,提高质量评分,值得应用。     

临床路径在精神科精神分裂症护理安全管理中的应用观察

目的观察临床路径在精神科精神分裂症护理安全管理中的应用。方法将我院收治的120例精神分裂症患者随机分为对照组和观察组各60例,对照组患者实施常规安全管理,观察组患者实施临床路径护理安全管理,并对两组患者的管理效果进行分析。结果观察组的护理满意度为93.33%高于对照组的75.00%,组间比较差异有统计学意义(P0.05);观察组患者意外差错事件发生率为5.00%低于对照组的18.33%,组间比较差异有统计学意义(P0.05)。结论通过对精神科患者实施临床路径护理安全管理,能显著提高护理满意度,降低意外差错事件发生率,值得临床推广应用。     

基于患者满意度的医疗服务质量持续改进管理

目的 探索和建立以患者满意度为导向的医疗服务质量持续改进管理新模式。方法 分别于2013年7—8月（改进前）和2014年3—4月（改进后）两个阶段的各500例出院患者采用随机留置问卷法进行问卷调查。对调查的数据采用SPSS17.0进行统计分析，并对比两次调查结果。结果 经过有针对性地实施改进措施半年后，再次调查时亟需改进的3个指标的满意度显著改善。结论 以患者满意度为导向的医疗服务质量持续改进管理，对提升医疗服务质量有着积极的推动作用，是医院运营思想的变革。     

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。     

无缝隙对接服务工程中医疗服务管理理念的探究

目的:探究创新医疗卫生服务管理理念的开展、实施无缝隙对接服务工程的成果以及具体方法。方法:对本院2013年1月-2013年12月期间的门诊量、出住院病人数、人均住院天数、患者满意度等资料进行回顾性的分析,对采用无缝隙对接服务工程的前、后的成果进行对比研究。结果:2013年1月-2013年12月期间本院门诊量、出院人数较去年同期分别增长了9.19%和14.0%;患者平均住院12.1 d,同比减少了0.7 d;患者满意度达到了98.7%,接到投诉312次,同比减少了200余次。结论:无缝对接工程的实施,改造并创新了医疗服务管理的理念,对于提高患者满意度,实现了社会、经济效益的双收具有积极意义。     

护士优化组合在门急诊输液室护理管理中的应用

目的探讨护士优化组合在门急诊输液室护理管理中的实施效果。方法我院于2014年6月~2015年5月以来对输液室护士实行"将点兵"、"兵点将"的双向选择组合方式进行优化组合,并选择2013年6月~2014年5月随机排班护士进行对照观察,并比较两组护理工作效率和患者满意度。结果护士优化组合后患者的等待时间及护理差错和护理投诉的发生率均低于对照组,护士优化组合在技术水平、护理态度和输液室环境等方面的满意率均高于对照组。结论门诊输液室护士实施优化组合管理可降低护理差错,提高护理工作效率,提高患者满意度,值得在护理管理工作中推广应用。     

心内科住院患者人性化护理问题的分析与对策研究

目的:探讨心内科实施人性化护理的问题及产生问题的原因,寻找有效的解决措施。这对提高护理质量,有效保证住院患者的安全,促进住院患者身心健康有重要意义,同时,也为临床护理提供依据。方法:对我院2011年1月-2011年3月心内科住院患者进行护理满意度和护理需求问卷调查。结果:调查数据显示,实施人性化护理患者的满意度为89.86%,较2010年有较大的提高。导致患者不满意的原因依次为护患沟通不足、护理人员专业素质差、护理人员缺乏经验和个别护理人员职业道德低下。根据患者需求调查数据显示,患者在病房环境、个人隐私尊重与保护、服务态度、医疗技术操作水平及职业道德5个方面还有较大需求。结论:人性化护理对改善医患关系,提高护理安全,促进患者的身心健康有积极的作用。依据调查的患者需求量,人性化护理还需要有针对性的改进和提高。     

临床路径管理实践中若干问题探讨

临床路径是一种质量效益型医疗管理模式,在现代医院管理中广泛应用。通过实施临床路径,可以规范诊疗行为、提高医疗质量、保障医疗安全、促进医疗费用合理化、提高患者满意度。对临床路径管理实践中的常见问题进行了分析,并对相关问题提出了若干针对性的解决措施,包括加强临床路径知识再教育和再培训,强调多学科、多部门共同参与以及通过信息化建设提高变异管理效能等。     

Lamellar cationic lipid‐DNA complexes from lipids with a strong preference for planar geometry: A Minimal Electrostatic Model

We formulate and analyze a minimal model, based on condensation theory, of the lamellar cationic lipid (CL)‐DNA complex of alternately charged lipid bilayers and DNA monolayers in a salt solution. Each lipid bilayer, composed by a random mixture of cationic and neutral lipids, is assumed to be a rigid uniformly charged plane. Each DNA monolayer, located between two lipid bilayers, is formed by the same number of parallel DNAs with a uniform separation distance. For the electrostatic calculation, the model lipoplex is collapsed to a single plane with charge density equal to the net lipid and DNA charge. The free energy difference between the lamellar lipoplex and a reference state of the same number of free lipid bilayers and free DNAs, is calculated as a function of the fraction of CLs, of the ratio of the number of CL charges to the number of negative charges of the DNA phosphates, and of the total number of planes. At the isoelectric point the free energy difference is minimal. The complex formation, already favoured by the decrease of the electrostatic charging free energy, is driven further by the free energy gain due to the release of counterions from the DNAs and from the lipid bilayers, if strongly charged. This minimal model compares well with experiment for lipids having a strong preference for planar geometry and with major features of more detailed models of the lipoplex. © 2014 Wiley Periodicals, Inc. Biopolymers 101: 1114–1128, 2014.     

Influence of haptic guidance in learning a novel visuomotor task

In (re)learning of movements, haptic guidance can be used to direct the needed adaptations in motor control. Haptic guidance influences the main driving factors of motor adaptation, execution error, and control effort in different ways. Human-control effort is dissipated in the interactions that occur during haptic guidance. Minimizing the control effort would reduce the interaction forces and result in adaptation. However, guidance also decreases the magnitude of the execution errors, which could inhibit motor adaptation. The aim of this study was to assess how different types of haptic guidance affect kinematic adaptation in a novel visuomotor task. Five groups of subjects adapted to a reaching task in which the visual representation of the hand was rotated 30°. Each group was guided by a different force field. The force fields differed in magnitude and direction in order to discern the adaptation based on execution errors and control effort. The results demonstrated that the execution error did indeed play a key role in adaptation. The more the guiding forces restricted the occurrence of execution errors, the smaller the amount and rate of adaptation. However, the force field that enlarged the execution errors did not result in an increased rate of adaptation. The presence of a small amount of adaptation in the groups who did not experience execution errors during training suggested that adaptation could be driven on a much slower rate and on the basis of minimization of control effort as was evidenced by a gradual decrease of the interaction forces during training. Remarkably, also in the group in which the subjects were passive and completely guided, a small but significant adaptation occurred. The conclusion is that both minimization of execution errors and control effort drives kinematic adaptation in a novel visuomotor task, but the latter at a much slower rate.     

Boosting Power‐Generating Performance of Triboelectric Nanogenerators via Artificial Control of Ferroelectric Polarization and Dielectric Properties

Low output current represents a critical challenge that has interrupted the use of triboelectric nanogenerators (TNGs) in a wide range of applications as sustainable power sources. Many approaches (e.g., operation at high frequency, parallel stacks of individual devices, and hybridization with other energy harvesters) remain limited in solving the challenge of low output current from TNGs. Here, a nanocomposite material system having a superior surface charge density as a triboelectric active material is reported. The nanocomposite material consists of a high dielectric ceramic material, barium titanate, showing great charge‐trapping capability, together with a ferroelectric copolymer matrix, Poly(vinylidenefluoride‐co‐trifluoroethylene) (P(VDF‐TrFE)), with electrically manipulated polarization with strong triboelectric charge transfer characteristics. Based on a contact potential difference study showing that poled P(VDF‐TrFE) has 18 times higher charge attracting properties, a fraction between two components is optimized. Boosting power‐generating performance is achieved for 1130 V of output voltage and 1.5 mA of output current with this ferroelectric composite‐based TNG, under 6 kgf of pushing force at 5 Hz. An enormously faster charging property than traditional polymer film‐based TNGs is demonstrated in this study. Finally, the charging of a self‐powering smartwatch with a charging management circuit system with no external power sources is demonstrated successfully.     

医疗收费信息平台管理流程标准化研究

医疗收费信息平台是医疗收费的基础,总结多年医疗收费信息化管理经验,对医疗收费信息平台管理标准化流程及其具体实施方法进行了阐述,希望能对医院规范医疗收费信息平台流程管理有一定的参考价值。     

Highly Efficient Perovskite Solar Cell Photocharging of Lithium Ion Battery Using DC–DC Booster

Solar cells become a viable energy source to charge lithium ion batteries. Here a simple and efficient photocharging design approach is demonstrated, where a promising low cost single junction solar cell such as perovskite solar cell or dye sensitized solar cell efficiently charges a Li₄Ti₅O₁₂‐LiCoO₂ Li‐ion cell using a DC–DC voltage boost converter. The converter boosts the low input voltage of a single junction solar cell to charge a lithium ion cell and offers advantages including maximum power point tracking of solar photovoltaics and overvoltage protection for the lithium ion cell. This is the first demonstration of this technology. This approach leads to the highest reported overall efficiency of 9.36% and average storage efficiency of 77.2% at 0.5 C discharge for a perovskite solar cell‐converter charging. The high efficiency for the perovskite solar cell‐converter charging is attributed to maximum power harvesting along with high power conversion efficiency of the perovskite solar cell and low potential polarization between the charge and discharge voltage plateaus for the Li₄Ti₅O₁₂‐LiCoO₂ Li‐ion cell.     

Suppressing Energy Loss due to Triplet Exciton Formation in Organic Solar Cells: The Role of Chemical Structures and Molecular Packing

In the most efficient solar cells based on blends of a conjugated polymer (electron donor) and a fullerene derivative (electron acceptor),ultrafast formation of charge‐transfer (CT) electronic states at the donor‐acceptor interfaces and efficient separation of these CT states into free charges, lead to internal quantum efficiencies near 100%. However, there occur substantial energy losses due to the non‐radiative recombinations of the charges, mediated by the loweset‐energy (singlet and triplet) CT states; for example, such recombinations can lead to the formation of triplet excited electronic states on the polymer chains, which do not generate free charges. This issue remains a major factor limiting the power conversion efficiencies (PCE) of these devices. The recombination rates are, however, difficult to quantify experimentally. To shed light on these issues, here, an integrated multi‐scale theoretical approach that combines molecular dynamics simulations with quantum chemistry calculations is employed in order to establish the relationships among chemical structures, molecular packing, and non‐radiative recombination losses mediated by the lowest‐energy charge‐transfer states.     

Effect of electrical charges and fields on injury and viability of airborne bacteria

In this study, the effects of the electric charges and fields on the viability of airborne microorganisms were investigated. The electric charges of different magnitude and polarity were imparted on airborne microbial cells by a means of induction charging. The airborne microorganisms carrying different electric charge levels were then extracted by an electric mobility analyzer and collected using a microbial sampler. It was found that the viability of Pseudomonas fluorescens bacteria, used as a model for sensitive bacteria, carrying a net charge from 4100 negative to 30 positive elementary charges ranged between 40% and 60%; the viability of the cells carrying >2700 positive charges was below 1.5%. In contrast, the viability of the stress-resistant spores of Bacillus subtilis var. niger (used as simulant of anthrax-causing Bacillus anthracis spores when testing bioaerosol sensors in various studies), was not affected by the amount of electric charges on the spores. Because bacterial cells depend on their membrane potential for basic metabolic activities, drastic changes occurring in the membrane potential during aerosolization and the local electric fields induced by the imposed charges appeared to affect the sensitive cells' viability. These findings facilitate applications of electric charging for environmental control purposes involving sterilization of bacterial cells by imposing high electric charges on them. The findings from this study can also be used in the development of new bioaerosol sampling methods based on electrostatic principles.     

Using ICD‐9 codes to establish prevalence of malformations in newborn infants

BACKGROUND The International Classification of Disease (ICD‐9) codes are used to identify, after discharge, diagnoses from a review of the medical record and provide the basis for reimbursement. These codes have been used to establish the prevalence of malformations and to assess potential teratogens. We have analyzed the accuracy of codes 740 to 759.9 to identify newborn infants with malformations. METHODS The diagnoses and ICD‐9 codes in the medical records of 1000 consecutive live‐born and stillborn infants were compared to the information provided in the medical records of those infants. RESULTS One hundred twenty‐seven of the 1000 infants had ICD‐9 codes between 740 and 759.9. 67 (52.8%) of the codes identified minor features, such as birth marks and minor anomalies. Twenty‐three (18.1%) of the codes designated a malformation and were correct. Two types of errors were identified in another 33 infants (26%) whose codes designated a malformation: either the pediatricians' notes described a less severe finding or the fact that there was no such abnormality. In addition, four malformed infants were missed in pregnancies that were either terminated electively or stillborn, as they did not have medical records. CONCLUSION The ICD‐9 codes 740 to 759.9 identified accurately some infants ( 18% ) with malformations, but identified incorrectly many others. The accuracy of the coding for identifying malformations would be improved if (1) the findings of the examining pediatricians were considered; (2) normal features of prematurity, such as patent foramen ovale and patent ductus arteriosus, were not considered malformations; (3) minor physical features were not assigned ICD‐9 codes within the 740 to 759.9 sequence. Birth Defects Research (Part A) 2012. © 2012 Wiley Periodicals, Inc.     

Effect of introducing a short amyloidogenic sequence from the Aβ peptide at the N‐terminus of 18‐residue amphipathic helical peptides

Fibril formation is the hallmark of pathogenesis in Alzheimer's disease and other amyloid disorders caused by conformational alterations leading to the aggregation of soluble monomers. Aβ40 self‐associates to form amyloid fibrils. Its central seven‐residue segment KLVFFAE (Aβ16–22), which is thought to be crucial for fibril formation of the full‐length peptide, forms fibrils even in isolation. Context‐dependent induction of amyloid formation by such sequences in peptides, which otherwise do not have that propensity, is of considerable interest. We have examined the effect of introducing the Aβ16–22 sequence at the N‐terminus of two amphipathic helical 18‐residue peptides Ac‐WYSEMKRNVQRLERAIEE‐am and Ac‐KQLIRFLKRLDRNLWGLA‐am, which have high average hydrophobic moment <μH> values but have net charges of 0 and +4, respectively, at neutral pH. Upon incubation in aqueous buffer, fibril‐like aggregates were discernible by transmission electron microscopy for the peptide with only 0 net charge, which also displayed ThT binding and β‐structure. Although both the sequences have been derived from amphipathic helical segments in globular proteins and possess high average hydrophobic moments, the +4 charge peptide lacks the ability to form fibrils, while the peptide with 0 charge has the tendency to form fibrillar structures. Variation in the net charge and the presence of several glutamic acids in the sequence of the peptide with net charge 0 appear to favor the formation of fibrils when the Aβ16–22 sequence is attached at the N‐terminus. Copyright © 2011 European Peptide Society and John Wiley & Sons, Ltd.