公立医院管理体制改革探析

为了弄清什么是公立医院的管理体制,公立医院管理体制改革的对象是什么等问题,通过系统阅读和整理若干文献, 认为：公立医院管理体制改革不是简单的“管办分开”,其本身并非改革的目的,而只是完善公立医院管理体制的手段;也不等于单纯地建立医院管理理事会。改革我国公立医院陈旧落后的管理体制就是要做到：在公立医院的外部治理上,转变政府职能,实现政府的宏观规划监管职能与微观经营管理职能分开,让医院获得经营管理的自主权;在公立医院的内部治理上,建立以医院管理理事会为核心的法人治理结构,在公立医院拥有充分自主权的前提下,实现公立医院的决策权、执行权与监督权的独立与相互制衡。     

建立以理事会为核心的公立医院法人治理结构的实践与思考

齐齐哈尔市中医医院在产权制度改革基础上，探索建立了以理事会为核心的公立医院法人治理结构。政府将公立医院进行股份制改造，将经营权让渡给决策层，决策层在保留重大决策权和监督功能的前提下，再让渡给医院管理层，使公立医院的规模资产不断聚和、资产效率显著提高。     

公立医院理事会战略绩效监管责任研究

公立医院理事会是统一行使所有者权力的组织,同时也是相关者表达利益诉求的场所,承担着监管公立医院战略绩效的责任。理事会及理事的工作方式与承担战略绩效监管责任之间存在一定的矛盾,这就要求设置隶属于理事会的办事机构和对理事会成员实施有效的激励约束。     

部分国家和地区公立医院社会医疗保险制度比较

通过对法国、德国、日本、韩国和我国台湾地区5个实行社会保险制度的典型国家或地区公立医院基本情况的梳理,总结以上国家及我国台湾地区公立医院规模、布局、结构和功能等现状。提出公立医院改革的建议：医院规模和布局建设应遵循公平、效率与适应性原则,不断优化公立医院布局,严格控制公立医院成本。     

公立医院理事会绩效评价指标体系的构建

目的 构建公立医院法人治理结构改革试点理事会绩效评价的指标体系。方法 首先通过文献研究和个人深入访谈法构建北京公立医院理事会绩效评价初步指标体系，然后通过德尔菲专家咨询法对指标体系进行优化。结果 专家打分结果显示，三级指标中，有4个指标的均值在重要性、可操作性和敏感性中只有一个维度小于7分，有3个指标的变异系数在重要性、可操作性和敏感性中只有一个维度大于0.3。结论 理事会绩效评价指标体系中理事会结构较理事会运作过程和结果的可操作性高，但重要性敏感性较低；有3个增加的三级指标分别是“战略与政策制定的效果评价”、“理事的培训效果评价”和“卫生行政部门对医院的绩效评价。     

拓展、创新与深化：对我国公立医院治理与改革的思考

我国公立医院改革在初步阶段已经取得一定成效。如在公立医院服务体系建设、县级公立医院改革、惠民便民措施推广以及多元化办医格局推进等方面取得一定进展。基于我国公立医院治理与改革的政策背景,从法人治理、协同治理、医药服务价格体系、激励机制以及基于多元化治理理念的公立医院监管五个方面,分析了公立医院治理与改革中面临的主要挑战,并对公立医院治理与改革的未来趋势作出判断与展望。     

部分国家和地区公立医院单体规模比较研究

目的 分析不同卫生服务体制的部分国家和地区公立医院单体规模状况,为我国公立医院单体规模发展提供借鉴依据。方法 采用文献研究与描述性分析方法比较不同国家和地区公立医院单体规模。结果 服务人口和功能定位对公立医院单体规模影响较大,公立医院的单体床位规模一般不会超过1000张,经济发达国家或地区公立医院的床位规模偏小,人员配备充裕。结论 把控我国公立医院的单体规模,促进医院规模向集约型方式转变。     

上海市不同治理模式公立医院的运营状况分析

通过调查和现有资料收集,分析了目前上海市公立医院3种治理模式的运营状况,指出了对公立医院不同治理模式运营状况评价的必要性,揭示了公立医院不同治理模式下的医院运营状况,提出了公立医院治理结构改革应关注于治理要素有用的原则。

     

公益化视角下公立医院社会责任体系构建

公立医院是我国医疗服务的主体,同时也是社会责任的必然承担者。公益化视角下公立医院在获取自身生存和发展的同时,应最大程度地承担起“救死扶伤、生命至上”的社会责任新内涵。公立医院社会责任缺失与医疗市场越位、政府补偿缺位及医务人员宗旨意识错位有关。公益化视角下公立医院社会责任体系重建要改革公立医院运行机制、统筹利用社会各方力量、积极营造社会责任的文化氛围、提高医院综合管理水平及建立基于公益性的绩效考核方案。因此,要发挥公立医院社会责任要正确认识公立医院社会责任本质,应正确处理好社会责任与经营性之间的关系及充分发挥公立医院社会责任的利益相关方力量。有关企业社会责任及治理结构的理论和方法对研究医院相关问题有重要借鉴作用,但不能照搬,中国经济、管理和卫生领域专家在公立医院社会责任及实现机制方面的探索还有许多工作要做。     

公立医院法人治理结构与改革

随着国务院医改近期重点实施方案的出台,公立医院法人治理结构的改革模式也渐渐明朗。公立医院法人治理结构改革是创新公立医院体制机制的关键任务之一,是维护公立医院公益性的重要制度保障。针对公立医院法人治理结构的内涵作了阐述,从公立医院的多层委托代理关系、产权制度等多角度分析了我国公立医院法人治理结构的现状和问题,提出了我国公立医院法人治理结构改革的具体措施。     

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.