Indonesia ergonomics roadmap: where we are going?

There are so many definitions for ergonomics terms such as human factors, human factors engineering, human engineering, human factors psychology, engineering psychology, applied ergonomics, occupational ergonomics, industrial ergonomics and industrial engineering. The most inclusive terms are ergonomics and human factors. Both represent the study of work and the interaction between people and their work environmental systems. The main objective is especially fitting with the need to design, develop, implement and evaluate human-machine and environment systems that are productive, comfortable, safe and satisfying to use. The work of the ergonomists in Indonesia--most of them are academicians--have one thing in common, i.e. with the appropriate type of ergonomic approaches to interventions; there would be improvements in productivity, quality of working conditions, occupational safety and health (OSH), costs reduction, better environment, and increase in profits. So many researches, training, seminars and socialization about ergonomics and OSH have been done concerning micro-to-macro themes; but it seems that we are practically still running at the same place up to now. In facts, workers are still working using their traditional or obsolete methods in poor working conditions. Accidents are still happening inside and outside industry with the main root-cause being human "unsafe behavior" and errors. Industrial products cannot compete in the global market, and so many manufacturing industries collapsed or relocated to foreign countries. This paper discusses such a roadmap and review what we ergonomists in Indonesia have done and where we are going to? This review will be treated in the field of ergonomics and OSH to take care the future Indonesia challenges. Some of the challenges faced are care for the workers, care for the people, care for the quality and productivity of work, care for the new advanced technologies, care for the environment, and last but not least care for the nation.     

Comparative Study of District and Community Hospitals

Opinions conflict on whether there is a place in the Health Service for general practitioner (community) hospitals in which the patients'' treatment is mainly the responsibility of their family doctors. The authors therefore analysed a sample of the patients admitted in the course of a year to a group of two general district hospitals with a comparable sample of the patients admitted to a general practitioner hospital. The aim was to analyse the type of care provided in the general practitioner hospital, to assess whether it was appropriate for the type of cases treated, and to decide whether the patients would have been better off in the district general hospital (and vice versa). The main conclusions are that a district hospital is best for serious illnesses needing skilled decisions and assessments but that most of the work of these hospitals is not of this kind and a community hospital staffed by general practitioners offers many advantages to patients—provided the work being done is constantly under critical assessment. The authors plead for special refresher courses under the N.H.S. for general practitioners working in community hospitals.     

Positive autoregulation of a KNOX gene is essential for shoot apical meristem maintenance in rice

Self-maintenance of the shoot apical meristem (SAM), from which aerial organs are formed throughout the life cycle, is crucial in plant development. Class I Knotted1-like homeobox (KNOX) genes restrict cell differentiation and play an indispensable role in maintaining the SAM. However, the mechanism that positively regulates their expression is unknown. Here, we show that expression of a rice (Oryza sativa) KNOX gene, Oryza sativa homeobox1 (OSH1), is positively regulated by direct autoregulation. Interestingly, loss-of-function mutants of OSH1 lose the SAM just after germination but can be rescued to grow until reproductive development when they are regenerated from callus. Double mutants of osh1 and d6, a loss-of-function mutant of OSH15, fail to establish the SAM both in embryogenesis and regeneration. Expression analyses in these mutants reveal that KNOX gene expression is positively regulated by the phytohormone cytokinin and by KNOX genes themselves. We demonstrate that OSH1 directly binds to five KNOX loci, including OSH1 and OSH15, through evolutionarily conserved cis-elements and that the positive autoregulation of OSH1 is indispensable for its own expression and SAM maintenance. Thus, the maintenance of the indeterminate state mediated by positive autoregulation of a KNOX gene is an indispensable mechanism of self-maintenance of the SAM.     

Primary coronary intervention for ST-elevation myocardial infarction in Indonesia and the Netherlands: a comparison

Background. Although the beneficial effects of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) have been demonstrated in a number of trials, most studies were conducted in Western countries. Experience, logistics and patient characteristics may differ in other parts of the world. Methods. Consecutive patients treated with primary PCI in Cinere Hospital, Jakarta, Indonesia, between January 2008 and October 2008 were compared with those treated in the Isala Clinics, Zwolle, the Netherlands. Results. During the study period, a total of 596 patients were treated by primary PCI, 568 in Zwolle and 28 in Jakarta. Patients in Indonesia were younger (54 vs 63 years), more often had diabetes (36 vs. 12%) and high lipids and were more often smokers (68 vs. 31%). Time delay between symptom onset and admission was longer in Indonesia. Patients from Indonesia more often had signs of heart failure at admission. The time between admission and balloon inflation was longer in Indonesia. At angiography, patients from Indonesia more often had multivessel disease. There was no difference in the percentage of restoration of TIMI 3 flow by primary PCI between the two hospitals. Conclusion. Patients with STEMI in Indonesia have a higher risk profile compared with those in the Netherlands, according to prevalence of coronary risk factors, signs of heart failure, multivessel disease and patient delay. Time delay between admission and balloon inflation was much longer in Indonesia, because of both logistic and financial reasons. (Neth Heart J 2009;17:418–21.)     

Contribution of general practitioner hospitals in England and Wales.

A survey of a one-in-seven sample of general practitioner hospitals in England and Wales, performed to determine the contribution they make to overall hospital work load and the attitudes of the general practitioners working in them, showed that 3% of acute hospital beds in England and Wales were in general practitioner hospitals, which provided initial hospital care for up to 20% of the population. Altogether 16% of general practitioners and 22% of consultants were on the staffs, and they coped with more than 13% of all casualties, 6% of operations, and 4% of x-ray examinations. Nearly a million casualties were treated at no cost to the National Health Service. Twenty new district general hospitals would be needed to cope with the work load currently dealt with by general practitioner hospitals. The results of this survey indicate that these smaller hospitals deal efficiently and cheaply with their work load, and that morale is high. General practitioner hospitals could have an important part to play in providing certain types of care, but there are no financial incentives to enable general practitioners to realise this potential fully.     

基于代谢组学分析的O-琥珀酰-L-高丝氨酸发酵调控

【目的】O-琥珀酰-L-高丝氨酸(O-succinyL-L-homoserine, OSH)是合成L-蛋氨酸、L-草铵膦等重要前体，在医药、农药、食品等领域具有重要的应用前景，其绿色高效制造受到广泛关注。本研究通过解析OSH发酵过程代谢途径和代谢产物变化规律，建立OSH发酵调控策略，提升其产量和糖酸转化率。【方法】运用代谢组学技术，系统考察OSH生产菌在发酵不同时间段的代谢物变化情况，探究与OSH合成显著关联的代谢途径，通过在不同时间外源添加关键代谢物，平衡关键代谢物及其前体通量，减少旁路途径对前体的竞争性利用。【结果】在5 L发酵罐中产量达70.1 g/L，糖酸转化率达0.52 g/g (葡萄糖)。【结论】研究结果表明，基于代谢组学分析技术的OSH发酵体系优化和发酵过程调控显著提升了目标产物生产效率，奠定了OSH的产业化基础。     

Durable power of attorney for health care. Are we ready for it?

Health care professionals need to be well informed about advance directives for medical care in the event a patient becomes incapacitated. The Patient Self-Determination Act requires that all patients be advised of their options at the time of hospital admission. Hospitals and health care professionals will need to work together to plan for implementing this law. We surveyed 215 physicians, nurses, and social workers at a Veterans Affairs Medical Center about the California advance directive, the Durable Power of Attorney for Health Care. Attitudes were generally positive. All of the social workers had heard of the durable power of attorney directive, but 36% of physicians and nurses had never heard of it and an additional 20% had no experience with one. For respondents who had heard of the directive, the mean knowledge score was 6.35 of a possible 10 (5 predicted by chance). Respondents brought up the issue of durable power of attorney with patients before a crisis only 19% of the time and determined whether one had been signed for only 16% of older patients in hospital. The most commonly cited reasons for failure to discuss this with patients were lack of proper forms, pamphlets, or a place to refer a patient. Of those who had ever seen such a document in use, 42% were aware of a problem with it at some time. Whereas attitudes toward advance directives are positive, many physicians and nurses had little knowledge of the Durable Power of Attorney for Health Care and were poorly equipped to discuss it with patients. We encourage educating hospital staff to prepare for the enactment of the Patient Self-Determination Act. We also recommend that the concerns raised by professionals about the use of a durable power of attorney be addressed.     

Physicians in health care management: 4. Case Mix Groups and Resource Intensity Weights: physicians and hospital funding.

In the second of two articles on Case Mix Groups (CMGs) and Resource Intensity Weights (RIWs) the authors describe how these measures are used to adjust the funding of hospitals in Ontario. Because CMGs and RIWs are based on medical chart information concerning diagnoses, concurrent illnesses and main procedures the role of physicians in recording this information is important to the outcome for hospital funding. CMGs and RIWs provide the basis for the calculations of the average cost per weighted case for hospitals and for groups of comparable hospitals. The Ontario Ministry of Health originally gave equity adjustment payments to hospitals with low average costs per weighted case to raise their funding toward norms of comparable hospitals. However, it is now proposed that hospitals with high average costs per weighted case be targeted for budget cuts. In the face of greater case-mix-based hospital funding in the future physician recording of information will be ever more critical.     

Isolation and characterization of a rice homebox gene, OSH15

In many eukaryotic organisms including plants, homeobox genes are thought to be master regulators that establish the cellular or regional identities and specify the fundamental body plan. We isolated and characterized a cDNA designated OSH15 (Oryza sativa homeobox 15) that encodes a KNOTTED-type homeodomain protein. Transgenic tobacco plants overexpressing the OSH15 cDNA showed a dramatically altered morphological phenotype caused by disturbance of specific aspects of tobacco development, thereby indicating the involvement of OSH15 in plant development. We analyzed the in situ mRNA localization of OSH15 through the whole plant life cycle, comparing the expression pattern with that of another rice homeobox gene, OSH1. In early embryogenesis, both genes were expressed as the same pattern at a region where the shoot apical meristem would develop later. In late embryogenesis, the expression pattern of the two genes became different. Whereas the expression of OSH1 continued within the shoot apical meristem, OSH15 expression within the shoot apical meristem ceased but became observable in a ring shaped pattern at the boundaries of some embryonic organs. This pattern of expression was similar to that observed around vegetative or reproductive shoots, or the floral meristem in mature plants. RNA in situ localization data suggest that OSH15 may play roles in the shoot organization during early embryogenesis and thereafter, OSH15 may be involved in morphogenetic events around the shoot apical meristem.     

Detection of Temporal Clusters of Healthcare-Associated Infections or Colonizations with Pseudomonas aeruginosa in Two Hospitals: Comparison of SaTScan and WHONET Software Packages

The identification of temporal clusters of healthcare-associated colonizations or infections is a challenge in infection control. WHONET software is available to achieve these objectives using laboratory databases of hospitals but it has never been compared with SaTScan regarding its detection performance. This study provided the opportunity to evaluate the performance of WHONET software in comparison with SaTScan software as a reference to detect clusters of Pseudomonas aeruginosa. A retrospective study was conducted in two French university hospitals. Cases of P. aeruginosa colonizations or infections occurring between 1^st January 2005 and 30^th April 2014 in the first hospital were analyzed overall and by medical ward/care unit. Poisson temporal and space-time permutation models were used. Analyses were repeated for the second hospital on data from 1^st July 2007 to 31^st December 2013 to validate WHONET software (in comparison with SaTScan) in another setting. During the study period, 3,946 isolates of P. aeruginosa were recovered from 2,996 patients in the first hospital. The incidence rate was 89.8 per 100,000 patient-days (95% CI [87.0; 92.6]). Several clusters were observed overall and at the unit level and some of these were detected whatever the method used. WHONET results were consistent with the analyses that took patient-days and temporal trends into account in both hospitals. Because it is more flexible and easier to use than SaTScan, WHONET software seems to be a useful tool for the prospective surveillance of hospital data although it does not take populations at risk into account.     

Coronary Care Units—The Status in California

In order to determine the status of Coronary Care Unit activity in California hospitals, especially as it pertains to nurse training, a survery was conducted by the California State Department of Public Health. More than 95 percent of hospitals that were questioned responded. Only one-third of the hospitals reported they neither had a unit nor plans to build one. All units in operation were either directed by an individual medical director or by a Coronary Care Unit Committee.The survey indicated that in some hospitals with operational units, nurses were not permitted to perform life-saving resuscitative procedures. All operational units reported in-service education programs of some type. Many hospitals indicated they would like to have Coronary Care Unit training programs to which they could send nurses. The reasons why nurses may not perform important resuscitative procedures are discussed as well as the need for Coronary Care Unit training programs for both physicians and nurses in California.     

医疗机构混合所有制的浙江实践与启示

医疗机构混合所有制是当前热点之一。文章通过对混合所有制及混合所有制医院概念与内涵的阐述,提出了混合所有制在医疗卫生领域的实现形式,并从理论上分析其可能对医院产生的影响。同时,以浙江Z医院为例,通过其改制前后变化和同地区规模最大、综合实力最强的R医院作了对比分析,发现其在社会效益、成本效率、服务质量和治理结构方面均取得了成功。最后,剖析了混合所有制改革能够在医疗卫生领域取得成功的原因,从而得出结论：医疗机构混合所有制改革应坚持公益性,建立科学的法人治理结构和良好的制度保障。     

Mutations that cause amino acid substitutions at the invariant positions in homeodomain of OSH3 KNOX protein suggest artificial selection during rice domestication

KNOX homeodomain (HD) proteins encoded by KNOTTED1-like homeobox genes (KNOX genes) are considered to work as important regulators for plant developmental and morphogenetic events. We found that OSH3, one of the KNOX genes isolated from a cultivar of Oryza sativa (Nipponbare), encodes a novel HD, which has two amino acid substitutions at invariant positions. Sequence analysis of OSH3 from various domesticated and wild species of rice has revealed that these substitutions are distributed only in Japonica and Javanica type of O. sativa, two groups of domesticated rice in Asia. Surprisingly, nucleotide sequences in the first intron are almost conserved in the rice strains that have the substitutions at the invariant amino acids. Overexpression studies revealed that these invariant amino acids are critical for the function of OSH3 in vivo. The facts that these substitutions occurred specifically at the functionally important amino acids and the sequences are conserved in intron where neutral mutations accumulate suggest the substitutions at the invariant positions of OSH3 have been fixed by artificial selections during domestication. Based on these observations, we hypothesize that OSH3 is responsible for one of the traits that are selectively introduced during the domestication of most of Japonica and a part of Javanica type of rice.     

OxDONS syndrome: the inevitable disease of the NHS reforms.

The financial demise of Oxford''s department of neurosurgery (OxDONS) was precipitated by the financial rules of the reformed NHS. In particular it was produced by the failure of "resources to follow patients"; the requirement that "prices have to follow costs"; and the use of private income for revenue expenditure, not capital expenditure. This process will eventually affect all hospital departments, but it affected the unit in Oxford sooner as it started as "efficient"--that is, underresourced--and has depended on income from extracontractual referrals and private work. Current NHS accounting rules act as a disincentive to private income being generated in NHS hospitals, and consultants should be aware of this.     

A loss-of-function mutation in the rice KNOX type homeobox gene, OSH3

KNOX homeodomain (HD) proteins encoded by KNOTTED1-like homeobox genes (KNOX genes) are thought to work as switches for cells to change from an indeterminate to a determinate state, although their direct functions are not clear. In the process of isolating KNOX genes from rice, we found that one gene, named OSH3, has two amino acid substitutions in three of the invariant amino acid residues in the HD of KNOX proteins. These amino acid substitutions are not universal in rice: two of the cultivars from the Indica variety of rice do not carry those substitutions but two of the cultivars from Japonica variety do. We tested the effect of these amino acid substitutions on their ability to form dimers and to induce abnormal morophologies when overexpressed in transgenic plants. We found that OSH3 without those substitutions can form dimers and can induce an abnormal phenotype in overexpression studies, and that OSH3 with those amino acid substitutions is defective in both. Based on these observations, we concluded that OSH3 from two of the cultivars from the Japonica variety could have lost its original function, or could have acquired a novel function by modifying the action of HD, or both.     

部队医院医疗风险管理存在的问题及对策分析

目的:近年来,医疗纠纷屡见不鲜,其中不乏军队医院。为此,我们对目前部队医院的医疗风险管理情况进行分析,深入总结军队医院管理存在的问题,并提出相应的对策以加强部队医院医疗风险的防范工作。方法:采取调查问卷方法对10所部队医院的一线医护人员就医疗风险相关问题进行调查,并对结果进行分析。结果:工龄低于5年的医务人员发生医疗风险的比率高于工作5年以上的人员;外科和妇产科医疗风险发生率较高;三级甲等医院医疗风险管理体系较三级乙等更完善。医院的管理制度、医务人员的工龄、科室的设置、风险教育及工作量等均与医疗风险的发生有着密切的关系。结论:部队医院应建立健全的风险预警系统与评价体系,提高医院对医疗风险的管理能力。医务人员应加强风险意识和法制意识,重视医患沟通,以促进医患关系和谐,从而减少或避免医疗纠纷的发生。     

Tissue establishment as a necessary institution within the country health care system: importance,requirements and structure

A tissue establishment is a unit or service, inside or outside of a public or private hospital, generally operated by public or non-profit-making bodies or in some countries by private profit-making institutions that procure, process, sterilise, store, and distribute sterilised human tissues to private or public hospitals to be used in certain medical treatments. Each tissue establishment should adopt the best possible structure, hired the necessary well-trained staff, according to the level of its activities, and should establish the necessary internal committees to ensure the highest quality of its operation. In addition, the tissue establishment should adopt a quality management system in order to reduce the risk and maximize the benefits of the transplantation process.     

Rural radiology: training

About half of the population of many countries live in rural areas and in these countries about half of the rural hospitals do not have X-ray services. Among the reasons for such a deficiency are the high cost and sophistication of radiological equipment, requiring fully trained technicians, and the high standard required for a radiologist's training, none of which a rural hospital can afford. Simplified equipment makes it possible for locally recruited auxiliary personnel to obtain radiographs of consistently acceptable quality after a short training period. The training of physicians in radiographic interpretation could also be abbreviated if it were directed at a limited range of basic X-ray examinations that provide essential diagnostic information in most clinical conditions. The activities of the World Health Organization in these areas is discussed.     

哈尔滨市十家医院医疗风险管理现状分析姜乃浒毛静馥△齐英△吴国松赵璐郭思佳刘行宇

目的：通过对哈尔滨市10家医院医疗风险管理现状调查,掌握医院医疗风险管理情况,找出存在的问题,提出改进对策,为医院制定科学、完善的医疗风险管理体系提供参考。方法：运用文献法、访谈法、特尔菲法、头脑风暴法等方法;应用SPSS、EXCEL统计软件对数据进行统计学处理。结果：三级医院在风险管理体系相比于二级医院更为完善;两级医院在医护人员独立工作能力,医疗药品和设备的准入,医疗风险信息系统使用,医护人员培训满意度等方面均具有较大差异;大多数医护人员愿意主动报告医疗纠纷;医患沟通效果较好,科室之间沟通协作也比较好。结论：目标医院基本上建立了医疗风险管理体系,但是在功能上、风险管理措施的制定及落实上尚不完善,医疗风险管理人员的专业素质有待提高,医院医疗风险管理意识尚需加强。     

30-Day Survival Probabilities as a Quality Indicator for Norwegian Hospitals: Data Management and Analysis

Background

The Norwegian Knowledge Centre for the Health Services (NOKC) reports 30-day survival as a quality indicator for Norwegian hospitals. The indicators have been published annually since 2011 on the website of the Norwegian Directorate of Health (www.helsenorge.no), as part of the Norwegian Quality Indicator System authorized by the Ministry of Health. Openness regarding calculation of quality indicators is important, as it provides the opportunity to critically review and discuss the method. The purpose of this article is to describe the data collection, data pre-processing, and data analyses, as carried out by NOKC, for the calculation of 30-day risk-adjusted survival probability as a quality indicator.

Methods and Findings

Three diagnosis-specific 30-day survival indicators (first time acute myocardial infarction (AMI), stroke and hip fracture) are estimated based on all-cause deaths, occurring in-hospital or out-of-hospital, within 30 days counting from the first day of hospitalization. Furthermore, a hospital-wide (i.e. overall) 30-day survival indicator is calculated. Patient administrative data from all Norwegian hospitals and information from the Norwegian Population Register are retrieved annually, and linked to datasets for previous years. The outcome (alive/death within 30 days) is attributed to every hospital by the fraction of time spent in each hospital. A logistic regression followed by a hierarchical Bayesian analysis is used for the estimation of risk-adjusted survival probabilities. A multiple testing procedure with a false discovery rate of 5% is used to identify hospitals, hospital trusts and regional health authorities with significantly higher/lower survival than the reference. In addition, estimated risk-adjusted survival probabilities are published per hospital, hospital trust and regional health authority. The variation in risk-adjusted survival probabilities across hospitals for AMI shows a decreasing trend over time: estimated survival probabilities for AMI in 2011 varied from 80.6% (in the hospital with lowest estimated survival) to 91.7% (in the hospital with highest estimated survival), whereas it ranged from 83.8% to 91.2% in 2013.

Conclusions

Since 2011, several hospitals and hospital trusts have initiated quality improvement projects, and some of the hospitals have improved the survival over these years. Public reporting of survival/mortality indicators are increasingly being used as quality measures of health care systems. Openness regarding the methods used to calculate the indicators are important, as it provides the opportunity of critically reviewing and discussing the methods in the literature. In this way, the methods employed for establishing the indicators may be improved.