DRGs方法在临床亚专科医疗服务绩效评价中的应用

目的 运用疾病诊断相关组指标对研究医院“消化系统大手术”亚专科住院医疗服务绩效进行评价,为医院加强精细化医院管理和学科建设提供数据支持。方法 以“国家版诊断相关组”作为风险调整工具,从能力、效率和安全3个维度对样本医院“消化系统大手术”亚专科住院医疗服务绩效进行评价。结果 2008—2015年,样本医院亚专科总权重逐年增加,2015年亚专科病例数占到了市属医院的50.27%;时间消耗指数0.91,但费用消耗较市属医院平均水平高24%;2015年GB15、GB25疾病组死亡率均为0,GB11、GB23疾病组死亡率低于市属医院平均水平。结论 2008—2015年,样本医院“消化系统大手术”亚专科医疗服务能力稳步提升,在市属医院范围内具有明显优势;但须注意在保持服务效率和安全优势的同时,增加GB11、GB23疾病组病例的收治,并应注意严格控制患者住院费用。     

辽宁省医疗资源纵向整合模式特征及效果分析

通过对辽宁省县级综合医院的调查,分析了自2008年以来辽宁省启动实施医疗资源纵向整合改革的特征和效果。反映出通过医疗资源纵向整合的实施,推动城市大医院的优质医疗资源向县及县以下流动,有利于改变医疗卫生资源配置不均衡的状况;提升县医院医疗服务效率,增强医疗服务能力;有利于增加医院住院医疗服务数量,降低新农合县外转诊率增幅。     

公立医院医疗服务价格动态调整机制的构建

随着医改的不断推进，医药分开已成为深化医改的共识，其中医疗服务价格的适时调整也提上医改议程。文章按照“总量控制、结构调整、有升有降、逐步到位”的原则，探索通过构建医疗服务成本与价格指数模型，监测、比对二者背离程度，结合医院内部加强成本控制的精细化管理和医保基金的分配情况，提出医疗服务价格动态调整的方法和可行性路径。     

省级医疗中心托管县级公立医院的实践与思考

托管作为医疗资源流动的有效形式,越来越多地被应用到公立医院改革的探索中。武汉大学人民医院托管汉川市人民医院的实践表明,由省级医疗中心托管县级公立医院,通过移植管理理念、扶持学科建设、加快人才培养、提高诊疗水平,短期内能够带动基层医院人才、技术、专科实力的大幅提升,初步实现“大病不出县”的新医改目标。这一实践中,四方满意是目标,体制机制是前提,文化融合是关键,医院发展是动力。     

基于京津冀一体化构想下的中医医疗联盟模式探讨

在中央提出京津冀协同发展的重大战略背景下,为了适应区域医疗均质化和医改的需要,为区域内百姓提供更优质的医疗服务,试构想创建中医医疗联盟。在医疗一体化建设方面,北京中医医院有着很好的中医联盟建设基础,试从北京中医医院医疗联盟建设的角度,对京津冀一体化构想下的医院托管模式进行探讨。     

托管模式下医院学科建设策略探讨

省部级医院托管地市级医院是深化医药卫生体制改革的重要举措。通过从同济医院输入先进的管理机制与优秀业务技术骨干,建立鄂南医疗联合体,形成了“省—市—县”医疗联盟体系,使国内顶级的优质管理、人力、技术资源层层下沉,托管医院整体医疗技术水平实现重大突破,学科建设取得显著成效,带动了区域内医疗联合体成员医院快速发展。     

公立医院社工志愿服务失灵成因与对策探讨

医院志愿服务活动是社会志愿服务的重要组成部分,而社工作为医疗志愿服务的主体关系到医疗志愿服务的质量和发展。公立医院社工志愿服务中出现的“志愿失灵”问题具有其特殊的表现形式。通过分析公立医院社工志愿服务失灵产生的原因,对医院志愿服务专业化建设提出对策。     

分级诊疗制度的上海模式及推进建议

分级诊疗是医改核心目标,也是各地探索方向。通过文献及二次资料分析和专家咨询法,归纳出“控制顶端、强化承接、联合均衡、需方引导”的分级诊疗上海模式。该模式下,住院病人分流效果明显,而囿于三级医院动力和社区承接能力的不足,门诊病人下沉仍有较大空间。建议在坚持已有模式基础上,发展医院集团以增加三级医院下沉门诊病人动力,拓展社区药品可及性、推动医生多地点执业、发展互联网医疗以加强社区承接能力。     

对新医改下病人就医需求的认识与思考

“以病人为中心”是全球一致认同的观点。病人到医院就医时的需求是什么,并未被所有医护人员所理解。在医药卫生体制改革的背景下,如果弄不清病人就医需求是什么,医改就不能满足大众和社会的需求。通过对病人就医心理的分析,阐述了病人对医院和医生的需求,概括起来就是“4C”,包括：方便、关爱、疗效和费用。这四个方面是改善医患关系、防范医疗风险、保障医改成功的重要因素。     

PDCA框架下公立医院战略管理的实施

公益性和可持续发展是公立医院改革的核心,医院战略管理是实现公立医院改革总体目标的基本途径。北京安贞医院在PDCA框架下实施医院战略管理,通过对医院发展环境的总体分析,结合医院自身实际,重点确立了医院发展的“两大能力建设”和“两个根本转变”,即以提高“整体服务能力”和“可持续发展能力”为重点,实现由“大专科、小综合”向“强专科、大综合”转变,由“规模效益型”向“学院型医院”转变。不断提升服务意识、加强学科管理、注重内涵建设,推进了医院管理创新和可持续发展。     

Quantitative proteomics for identifying biomarkers for Rabies

Introduction

Rabies is a fatal acute viral disease of the central nervous system, which is a serious public health problem in Asian and African countries. Based on the clinical presentation, rabies can be classified into encephalitic (furious) or paralytic (numb) rabies. Early diagnosis of this disease is particularly important as rabies is invariably fatal if adequate post exposure prophylaxis is not administered immediately following the bite.

Methods

In this study, we carried out a quantitative proteomic analysis of the human brain tissue from cases of encephalitic and paralytic rabies along with normal human brain tissues using an 8-plex isobaric tags for relative and absolute quantification (iTRAQ) strategy.

Results and conclusion

We identified 402 proteins, of which a number of proteins were differentially expressed between encephalitic and paralytic rabies, including several novel proteins. The differentially expressed molecules included karyopherin alpha 4 (KPNA4), which was overexpressed only in paralytic rabies, calcium calmodulin dependent kinase 2 alpha (CAMK2A), which was upregulated in paralytic rabies group and glutamate ammonia ligase (GLUL), which was overexpressed in paralytic as well as encephalitic rabies. We validated two of the upregulated molecules, GLUL and CAMK2A, by dot blot assays and further validated CAMK2A by immunohistochemistry. These molecules need to be further investigated in body fluids such as cerebrospinal fluid in a larger cohort of rabies cases to determine their potential use as antemortem diagnostic biomarkers in rabies. This is the first study to systematically profile clinical subtypes of human rabies using an iTRAQ quantitative proteomics approach.     

Protocols for data generation for predictive modeling

Summary Essential to the development of useful predictive models for foods is the collection of appropriate data. Within the UK Predictive Food Microbiology Program, a series of documents have been produced to aid the standardization of data collection by a number of laboratories. Documents include a protocols form, notes on experimental design, notes on the accuracy of counts by plating, the preferred method of calculating a plate count value, preferred MPN tables and the preferred methods of recording data values. These documents have proven useful in aiding collaboration between laboratories.     

Breeding for abiotic stresses for sustainable agriculture

Using cereal crops as examples, we review the breeding for tolerance to the abiotic stresses of low nitrogen, drought, salinity and aluminium toxicity. All are already important abiotic stress factors that cause large and widespread yield reductions. Drought will increase in importance with climate change, the area of irrigated land that is salinized continues to increase, and the cost of inorganic N is set to rise. There is good potential for directly breeding for adaptation to low N while retaining an ability to respond to high N conditions. Breeding for drought and salinity tolerance have proven to be difficult, and the complex mechanisms of tolerance are reviewed. Marker-assisted selection for component traits of drought in rice and pearl millet and salinity tolerance in wheat has produced some positive results and the pyramiding of stable quantitative trait locuses controlling component traits may provide a solution. New genomic technologies promise to make progress for breeding tolerance to these two stresses through a more fundamental understanding of underlying processes and identification of the genes responsible. In wheat, there is a great potential of breeding genetic resistance for salinity and aluminium tolerance through the contributions of wild relatives.