基于系统论的护理不良事件管理模式构建与探讨

目的 以贝塔朗菲系统论为依据,构建新的医院护理不良事件管理模式,杜绝或减少各类不良事件的发生,保证患者安全。方法 通过一线护士将临床工作中的安全隐患上报护理部,护理部与相关处室沟通,医院各处室管理层及时解决存在的问题。结果 通过扩大隐患事件上报范围,护理隐患事件上报率较未扩大前增加275.7%;同类护理隐患事件未再发生或明显减少。结论 “护理部首接,多职能科（处）合作”的不良事件管理模式,促进了医院服务效率与质量的提高,保障了患者的就医安全。     

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。

     

上海三级甲等医院移动医疗App应用现状调查

目的 全面了解上海市三级甲等医院App运营情况,探索进一步完善微信运营的有效措施。方法 应用文本分析法以及深度访谈法,以上海市40家三级甲等医院为调查样本,对其App应用软件的开通率、患者使用率以及功能建设情况进行调查。结果 在全市40家三级甲等医院中,App软件开通率为35%;在91助手、应用宝、乐商店等下载平台上,瑞金医院下载量最高,其余下载量均较低;在功能设置情况方面,领取报告、医院导航等互动功能开设率达85%,医院介绍、科室介绍等静态信息发布功能设置率仅为15%。结论 移动App正在不断深化服务内涵,提供细节服务,并汲取多方资源优势,采取互助共赢的合作模式。然而仍需通过院内院外、线上线下合作的方式加大推广力度,并进一步挖掘多方资源合作潜力,进一步探索细节服务。     

北京地区不同级别医院医生职业幸福感现状及影响因素

目的 对不同级别医院医生的职业幸福感进行测评,了解当前不同级别医院医生的职业幸福感现状及影响因素。方法 采用自编社会人口学信息调查表和工作幸福感量表等对北京市三种不同级别医院医生进行问卷调查。结果 三级医院医生职业幸福感最低。不同级别医院医生职业幸福感在情感和认知两个维度上的差异均具有显著性（P<0.01）。多元线性分析结果显示,对不同级别医院医生职业幸福感有显著影响的因素有所不同。结论 要高度关注三级医院医生的职业幸福感,医生职业幸福感的提高有赖于医院和医生双方共同努力。     

临床医生诊疗现场信息需求现状的初步研究

??????? 目的 探索在医疗信息化背景下,医生诊疗患者过程中的信息需求特点,以帮助找到对策,提高医疗质量。方法 采用问卷调查结合半结构化访谈调查北京大学两家附属医院272名住院医生。结果 医生工作强度高,信息需求大,综合医院门诊医生平均每半天看30位患者;在诊疗过程中,综合医院医生56.1%每天出现≥6次信息需求。这些信息需求最多出现在制定医疗方案阶段;对于两医院的医生,网络信息资源也是一个重要信息获取途径;医生希望信息资源具有信息权威准确、及时更新,载体方便携带、随时可查询及结合临床实际、诊疗方案实现常规化等特点。结论 医生在给患者看病过程中普遍存在信息需求。移动医疗、临床路径结合循证医学有很强的应用前景。     

小儿与成人静脉留置针穿刺的护理成本比较与分析

目的 了解目前小儿与成人手术患者静脉留置针穿刺的护理成本投入。方法 根据项目综合评估和核算方法,分别核算小儿与成人静脉留置针穿刺的护理成本投入情况。结果 小儿与成人静脉留置针穿刺操作的平均护理成本已分别达到77.84元和25.62元,与现行收费标准存在巨大差异,小儿静脉留置针穿刺的护理成本远远高于成人。结论 全面客观地核算了静脉留置针穿刺的护理成本投入,为体现护理技术的价值提供了准确的依据。     

质量控制在病案管理工作中的应用效果分析

目的 通过建立病案质控部门,提高病案管理工作的质量和效率。通过对医院17个科室的病历质控前与质控后的工作效果分析,强调质控工作在病案管理中的重要性。方法 医院对17个科室病历的终末质量进行控制,主要采用对比法与描述统计学方法对质控前与指控后的病案质量进行质控工作的效果分析。结果 通过在病案管理中加入质量控制,病案质量得到显著提高,甲级病案率显著上升,乙级病案率下降,无丙级病案,病案书写中的具体问题也得到改善。结论 病案质控对病案质量提升有显著成效。     

医院聘用制医务人员组织承诺与工作满意度相关分析

?????? 目的 分析医院聘用制医务人员组织承诺及其与工作满意度的关系,为提高聘用制医务人员组织忠诚、稳定医务人员队伍提供有益的参考。方法 以该院2006年度及2009年度入职的聘用制医务人员为对象,使用组织承诺量表及明尼苏达满意度问卷进行调查研究。结果 样本医院聘用制医务人员的总体组织承诺、情感承诺、继续承诺、规范承诺得分分别为(58.53士16.69)分、(21.50士6.02)分、(18.59士5.44)分、(18.45士7.20)分;组织承诺与工作满意度有显著的相关性,内在满意度与组织承诺之间相关性最为显著（r=0.676,P<0.01）。结论 通过提高聘用制医务人员的工作满意度特别是内在满意度能有效提高其组织承诺。     

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。     

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。     

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。     

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。     

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.     

KatG from Salmonella Typhimurium is a peroxynitritase

Pathogenic bacteria elicit protective responses to oxidative and nitrosative stresses. Although such responses are generally distinct, it was recently reported in Mycobacterium tuberculosis that catalase-peroxidase (KatG), a classical defence against peroxides, also exhibits peroxynitritase activity. Here, the katG gene from Salmonella Typhimurium was cloned and protein purified and characterised. An increase in the rate of decomposition of peroxynitrite was observed for KatG from the enterobacterium with a second-order rate constant of 4.2 × 10⁴ M⁻¹ s⁻¹ at pH 7.4, 25 °C. This enzyme was able to reduce dihydrorhodamine oxidation by peroxynitrite to ∼83%. Given the peroxynitritase activity demonstrated here it is likely that KatG may play a wider role in the detoxification of oxidative stresses than previously thought.     

Molecular characterization of β1,4-galactosyltransferase 7 genetic mutations linked to the progeroid form of Ehlers-Danlos syndrome (EDS)

β1,4-Galactosyltransferase 7 (β4GalT7) is a key enzyme initiating glycosaminoglycan (GAG) synthesis. Based on in vitro and ex vivo kinetics studies and structure-based modelling, we molecularly characterized β4GalT7 mutants linked to the progeroid form of Ehlers-Danlos syndrome (EDS), a severe connective tissue disorder. Our results revealed that loss of activity upon L206P substitution due to altered protein folding is the primary cause for the GAG synthesis defect in patients carrying the compound A186D and L206P mutations. We showed that R270C substitution strongly reduced β4GalT7 affinity towards xyloside acceptor, thus affecting GAG chains formation. This study establishes the molecular basis for β4GalT7 defects associated with altered GAG synthesis in EDS.     

Kinetics and mechanism of the aquation of the trinuclear cation, [μ3-oxo-triaqua-hexakis(acetato)tris(iron(III))]in perchloric acid media

The aquation of the title complex cation in aqueous perchloric acid proceeded via two steps, both postulated to be the proton attack on the oxygen atom which binds the acetate ligand to the metal centre, followed by Fe-O bond cleavage. This was followed by rapid decomposition to produce aqueous iron(III) and acetate ions. The first-order rate constants for the first and second steps at 25 °C are: k₁ = (4.16 ± 0.58) × 10⁻² s⁻¹ and k₂ = (2.09 ± 0.42) × 10⁻³ s⁻¹, respectively, and their corresponding activation parameters are . The spontaneous hydrolysis rate constants for the first and second steps were also determined at 25 °C and ionic strength of 1 mol dm⁻³ and they are k₀ = (3.10 ± 0.82) × 10⁻³ s⁻¹ and , respectively. The corresponding activation parameters are .     

Sterol chemical configuration influences the thermotropic phase behaviour of dipalmitoylphosphatidylcholine bilayers containing 5α-cholestan-3β- and 3α-ol

It is commonly believed that all membrane sterols are rigid all-trans ring systems with a fully extended alkyl side-chain and that they similarly influence phospholipid bilayer physical properties. Here, we report the sterol concentration-dependent, thermotropic phase behaviour of binary dipalmitoylphosphatidylcholine (DPPC)/sterol mixtures containing two similar 5α-H sterols with different functional group orientations (3α-OH or 3β-OH), which adopt an ideal all-trans planar ring conformation but lack the deformed ring B conformation of cholesterol (Chol) and epicholesterol (Echol), using differential scanning calorimetry (DSC). Our deconvolution of the DSC main phase transition endotherms show differences in the proportions of sterol-poor (sharp) and sterol-rich (broad) domains in the DPPC bilayer with increasing sterol concentration, which delineate gel/liquid-crystalline (P_β′/L_α) and disordered gel (L_β)/liquid-ordered (l_o) phase regions. There are similarities in the DPPC main phase transition temperature, cooperativity and enthalpy for each 3β-ol and 3α-ol pair with increasing sterol concentration and differences in the parameters obtained for both the sterol-poor and sterol-rich regions. The sterol-poor domain persists over a greater concentration range in both 3α-ol/DPPC mixtures, suggesting that either those domains are more stable in the 3α-ols or that those sterols are less miscible in the sterol-rich domain. Corresponding parameters for the sterol-rich domain show that at sterol concentrations up to 20 mol%, the 5α-H,3β-ol is more effective at reducing the phase transition enthalpy of the broad component () than Chol, but is less effective at higher concentrations. Although mixtures containing Echol and 5α-cholestan-3α-ol have similar positive slopes below 7 mol% sterol, suggesting that they abolish the L_β/l_o phase transition equally effectively at low concentrations, Echol is more effective than the saturated 3α-ol at higher sterol concentrations. A comparison of obtained for the saturated and unsaturated pairs suggests that the latter sterols stabilize the l_o phase and broaden and abolish the DPPC main phase transition more effectively than the saturated sterols at physiologically relevant concentrations, supporting the idea that the double bond of Chol and Echol promotes greater sterol miscibility and the formation of l_o phase lipid bilayers relative to corresponding saturated sterols in biological membranes.     

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.