试析围手术期安全管理的切入点

通过建立信息技术控制体系和JCI标准下管理制度保障体系,不断优化工作流程,强化质量监控部门管理职能,定期开展临床技能培训,能够实现围手术期患者安全目标。     

健康中国战略下护理在社会服务领域发展内涵与对策

在深化医药卫生体制改革,推进健康中国和健康老龄化的新形势下,护理发展应以健康中国为导向。通过阐述护理事业发展现状及面临新要求,解读护理学的内涵与外延,提出护理学科在社会服务领域发展的必要性及可操作性,对护理学科在社会服务领域的发展趋势进行探讨。     

军队传染病医院援外防控埃博拉疫情的工作与启示

2014年9—11月,解放军第302医院派遣一支由30人组成的医疗队赴西非塞拉利昂执行抗击埃博拉疫情的任务,在2个月的时间里,依托当地医院改建成了留观中心,收治埃博拉疑似患者274例,对塞拉利昂疫情防控起到了重要作用,实现了中塞双方工作人员“零感染”,圆满完成了国家和军队赋予的任务。通过归纳总结在人员抽组、培训,医疗后勤物资准备,医疗队选址及改造,规章制度建设,工作人员管理等方面的经验,为今后疫情防控工作提供指导。     

地方政府托管办院模式SWOT分析

为满足新兴城区和欠发达地区优质医疗资源需求,突破大型医院发展瓶颈,地区政府与大型医院合作办院越来越多。文章根据协作双方对土地、基本建筑、医护人员、医疗设备等项目的不同投入程度,对办院模式分为托管、接管、合作三种模式。以中山大学附属第三医院岭南医院为例,通过SWOT分析法对托管办院模式的优势、劣势、威胁与机会进行了分析,充分认可了托管办院这一模式的合理性,并提出在吸引、留住人才和产权问题两个方面的建议,以期对协作办院的进一步完善提供思路。     

国内临床医师绩效分配模式的现状、不足与对策

科学构建和优化医师绩效分配模式,着力体现医务人员技术劳务价值,关注医疗服务内涵,对有效调动医务人员工作积极性、提高公立医院运营效率和精细化管理水平有着重要意义。通过广泛文献研究,系统分析了我国目前公立医院绩效分配模式现状及存在的不足,同时针对存在的主要问题提出了相应的对策建议。     

对手术室准时开台实施精益管理的探索

??????? 目的 对手术室准时开台实施精益管理的研究,有效发挥手术室资源来探讨精益管理的可行性。方法 医院对手术室手术安排以及对手术医师、麻醉医师、手术护士实施面部指纹考勤等一系列的精益管理手段来促使手术室准时开台的实施。结果 通过对手术室准时开台实施精益管理,手术准时开台率由原来的42.12%上升至现在的92.60%,手术周转时间缩短,成效显著(P<0.01)。结论 精益管理能有效提高手术室准时开台,保障手术顺利进行。     

我国医疗联合体发展的动态分析

目的 对我国医疗联合体各阶段发展进行动态分析。方法 运用文献荟萃分析的方法,针对医疗联合体产生发展的各时期特征进行阶段划分。结果 我国医疗联合体自产生时起可分为3个发展时期,分别为1980—1989年萌芽期,医联体萌芽产生;1990—2009年形成期,医联体缓慢发展、典型类型形成;2010年至今发展期,医联体快速发展。结论 随着医改的深化,我国医疗联合体将不断改革发展,概念不断完善、类别更为丰富、紧密程度更受重视。

     

公立医院医疗政策性亏损财政补偿方式研究

从区域政府财政投入角度出发,结合理论和实际情况进行分析,确立公立医院医疗政策性亏损补偿的分类测算、相对效率、投入——产出最优及动态性4个原则,并提出融合了相应激励制约机制指标体系在内的测算方法。     

临床科研管理系统在医院临床研究中的价值分析

目的 探讨临床科研管理系统在临床科室科研管理工作中的重要作用及推广价值。方法 使用SPSS15.0软件对数据进行统计分析,入组率比较采用χ²检验。结果 采用临床科研管理系统后,前3个月入组率不断升高,然后持续稳定在较高水平,前3个月的入组率（18.83%）明显低于后12个月的入组率（28.22%）,差异有统计学意义（P = 0.006）。目前已经有15项在研课题登记在案,科室科研氛围良好。结论 推行临床科研管理体系后,科研工作在数量和质量上均有了长足的发展和进步,在医院中具有推广价值。     

公立医院医疗服务成本及效率分析

随着医院卫生体制改革的不断深入,医院靠高收费、高要价维持的现状将被改变。目前公立医院的医疗服务成本居高不下,医疗资源紧张,如何有效控制成本、提高资源使用效率是公立医院的管理重点与难点。以某三甲公立医院4个科室2008年的相关数据为基础,分析了各科室成本构成及效率。结果表明,人员支出在成本中占据较大比重,奖金大大超过工资,奖金制度不尽合理,医师人数严重不足,病床使用率超过100%,病床周转次数较低。针对这些问题提出建立全面的绩效考核指标、控制材料费用、建立术前评估制度等建议。     

河北省乡镇卫生院卫生技术人员培训模式研究

对河北省40所乡镇卫生院和528名卫生院卫生技术人员培训现况分析,卫生院各种学习条件均不足,对培训需求迫切。培训资源短缺、工作与学习矛盾和培训经费缺乏是主要原因。分析了最主要的培训内容需求,对培训模式进行了探讨。     

以利益均衡构筑权利保障——浅析侵权责任法立法价值取向及其对医疗机构的几点启示

利益均衡旨在于利益关系主体之间寻找平衡点,尽可能将内部矛盾冲突降低到最低限度,保持利益体系和利益格局的稳定,其最终目的是实现权利保障,而法律制度的确立则是最有公信力的长效调整机制和保障机制。从侵权责任法医疗损害侵权行为构成要件和归责原则的确认、“举证责任倒置”的改变、医用产品连带责任和不必要检查侵权的规定等几个方面,体现出其以医患双方利益均衡为前提、确保双方权利充分保障的立法价值取向。立足于此,医疗机构应树立对医方权利和患方权利给予同等重视、理解患者合法权利内容、界定合理的医患双方权利义务界限、增强权利自我维护意识的发展观念。     

利用信息化手段的医院后勤综合调度平台“一体化”建设

医院后勤建设是医院整体工作的重要一环,但后勤本身发展往往与医院整体发展速度不同步。从改变后勤服务理念的角度入手,利用信息化的手段,建立符合当前后勤管理需要的“一体化”调度平台是一条新思路。通过一系列的流程再造和干预,实现报修和申请的全过程质量控制是解决目前后勤服务效率较低、服务能力不足、多头管理、圆圈现象、绩效考核与实际脱离等问题的有效途径。     

临床路径管理系统对医院运营效率的影响研究

目的 以某综合性三甲医院2010—2011年普通外科7个住院病种为研究对象,探讨临床路径管理应用系统对医院运营效率的影响。 方法 采用病例对照研究方法。 结果 (1) 研究组住院日中位数为11天,明显低于对照组住院日中位数（P＜0.05）;(2) 研究组平均住院费用为30 826.90元,对照组平均住院费用与研究组平均住院费用相比无显著差异（P＞0.05）。结论 医院临床路径管理系统可以有效的缩短患者住院天数,对于控制住院费用有间接控制作用,但没有直接降低住院费用。     

Synthesis, crystal structure, magnetic and redox properties of copper(II) complexes of N-alkyl(aryl) tBu-salicylaldimines

A series of novel copper(II) complexes, L₂Cu with newly synthesized 3,5--salicylaldimine (or 5--salicylaldimine) ligands derived from 2,4-di-tert-butyl phenol (or 4-tert-butyl phenol) and alkyl (aryl) amines have been prepared and their spectroscopic (IR, UV-Vis, ESI-MS), X-ray, magnetic and redox properties have been investigated. The X-ray crystallography analysis shows that all complexes are monomeric and their copper(II) centers are surrounded by phenolate oxygens and imine nitrogen atoms. Therefore, the coordination sphere around the copper atoms is N₂O₂ as seen in galactose oxidase active site. In addition, the geometric configurations of all complexes are square planar or slightly distorted square planar. The crystal system for all complexes is monoclinic, except for which is orthorhombic. The temperature dependence of magnetic susceptibility of complexes confirms the mononuclear structure of complexes. Oxidation of the Cu(II) complexes yielded the corresponding Cu(II)-phenoxyl radical species during the cyclic voltammetry experiments.     

Tryptophanase in aqueous methanol: the solvent effects and a probable mechanism of the hydrophobic control of substrate specificity

To shed light on the mechanism of hydrophobic control in reactions of microbial tryptophanase the direct effect of the solvent hydrophobicity on affinities of amino acid inhibitors was first examined. Values of inhibition constants (K_i) for a variety of amino acids were determined in 37.5% aqueous methanol, and no general correlation between the change of K_i, on passing from water to aqueous methanol, and amino acid hydrophobicity was found. The solvent effects on the separate stages of the external aldimine formation (K_D) and deprotonation to form a quinonoid intermediate (K_q) were determined for the reactions of tryptophanase with 2-oxindolyl- -alanine and -alanine by stopped-flow technique. For 2-oxindolyl- -alanine, which is a close transition-state analogue for the enzyme reaction with natural substrate, the decrease in the affinity in aqueous methanol is associated exclusively with the α-proton abstraction stage but not with the preceding formation of external aldimine. We conclude that the environment of amino acid side chains in the active site cannot be considered to be permanently hydrophobic irrespective of the bound amino acid. We suggest that complexes of tryptophanase with amino acids may exist either in a hydrophobic, presumably “closed”, conformation, where bound amino acids are isolated from the solvent, or in an accesible to solvent, “open”, conformation, depending on the structure of the bound amino acid and stage of the catalytic mechanism. For 2-oxindolyl- -alanine the transfer from an open to a closed conformation probably accompanies deprotonation of the external aldimine. The change of the active site hydrophobicity may provide an efficient way of modulating the relative acid–base properties of the catalytic groups to ensure the movement of protons in the “correct” direction depending on the elementary stage of catalysis.     

Model for the three-dimensional structure of vitronectin: predictions for the multi-domain protein from threading and docking.

The structure of vitronectin, an adhesive protein that circulates in high concentrations in human plasma, was predicted through a combination of computational methods and experimental approaches. Fold recognition and sequence-structure alignment were performed using the threading program PROSPECT for each of three structural domains, i.e., the N-terminal somatomedin B domain (residues 1-53), the central region that folds into a four-bladed beta-propeller domain (residues 131-342), and the C-terminal heparin-binding domain (residues 347-459). The atomic structure of each domain was generated using MODELLER, based on the alignment obtained from threading. Docking experiments between the central and C-terminal domains were conducted using the program GRAMM, with limits on the degrees of freedom from a known inter-domain disulfide bridge. The docked structure has a large inter-domain contact surface and defines a putative heparin-binding groove at the inter-domain interface. We also docked heparin together with the combined structure of the central and C-terminal domains, using GRAMM. The predictions from the threading and docking experiments are consistent with experimental data on purified plasma vitronectin pertaining to protease sensitivity, ligand-binding sites, and buried cysteines.     

Regulatory volume decrease in cardiomyocytes is modulated by calcium influx and reactive oxygen species

We investigated the role of Ca²⁺ in generating reactive oxygen species (ROS) induced by hyposmotic stress (Hypo) and its relationship to regulatory volume decrease (RVD) in cardiomyocytes. Hypo-induced increases in cytoplasmic and mitochondrial Ca²⁺. Nifedipine (Nife) inhibited both Hypo-induced Ca²⁺ and ROS increases. Overexpression of catalase (CAT) induced RVD and a decrease in Hypo-induced blebs. Nife prevented CAT-dependent RVD activation. These results show a dual role of Hypo-induced Ca²⁺ influx in the control of cardiomyocyte viability. Hypo-induced an intracellular Ca²⁺ increase which activated RVD and inhibited necrotic blebbing thus favoring cell survival, while simultaneously increasing ROS generation, which in turn inhibited RVD and induced necrosis.