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探讨北京市“医药分开”改革对临床医师用药行为的影响。方法 以北京市试行“医药分开”的部分医院为研究现场,随机抽取800名临床医师进行问卷调查,分析该项改革对临床医师用药行为的影响。结果 临床医师对“医药分开”改革的知晓率为99.5%。“医院宣传”、“专项培训”、“电视广播”为临床医师了解政策的三大主要途径。改革后,92.1%的临床医师更加重视规范诊疗、合理用药;94.4%的临床医师控制大处方,减少开方用药的数量、金额;89.9%临床医师受开药收入、提成、回扣的影响降低。结论 “医药分开”改革对试点医院临床医师的用药行为产生积极影响,规范医师处方行为,加强合理用药,基本实现了改革预期目标。 相似文献
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实行医药分开、破除以药补医无疑是公立医院改革的关键领域,不仅有着复杂的历史背景,而且涉及多个利益相关者。在此项改革推进过程中,政府有关部门出台相关政策,探索出了改革支付方式、降低或取消药品加成、实行收支两条线管理、设立独立于医院外的药品管理中心等4种医药分开的实现形式。后以药补医时代,政府责任主要在:通过约束公立医院的逐利性缓解“看病贵”;促使医疗技术服务价格回归价值以改善“看病难”;通过合理财政投入、有力政策保障,主导公立医院落实公益性。 相似文献
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进一步明确医药分开政策目的及策略。方法 采用文献回顾性研究法,对医药利益链条及其形成原因,以及解决策略进行系统性地总结和分析。结果 现有研究一是认为医疗服务提供方拥有垄断地位造成利益链条存在,因而提出消除垄断;二是认为扭曲的“白色”或不良的“灰色”激励机制造成利益链条存在,因而提出完善“白色”或消除“灰色”激励机制的综合策略。结论 医药利益链条产生更深层次的原因是,非营利性的公立医疗机构不合理地追求经济利益,医生采用不合理方式追求部分合理经济利益。因此,医药分开目的应是让公立医疗机构真正成为非营利机构,使医生依靠技术获得合理的经济回报,让公立医疗机构、医生、政府、患者、药品企业及流通商间激励相容。建议采用外部补偿和内部薪酬制度为重点的综合改革策略,形成各利益相关方激励相容的良好局面,自然消除公立医疗机构、医生与药品销售间利益链条。 相似文献
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Pushkar Shejwalkar 《Inorganica chimica acta》2011,366(1):209-218
New sulfur derivatives of phosphoramidite ligands were synthesized and the impact of the sulfur unit on the spectroscopic properties of their rhodium and iridium complexes was investigated. The new ligands Bn2NPSCH2CH2Sa(P-Sa) (Bn = benzyl, 4), Bn2NPSCHCHSa(CH2)3CaH2(P-Sa)(Ca-Sa) (6) and Bn2NP(4-XC6H4OMe)2 (X = S, 7a; X = O, 7b) were converted to the rhodium and iridium complexes trans-[Rh(CO)Cl(L)2] (L = 4, 6, 7), [RhCl(COD)(L)] (L = 4, 6, 7), [IrCl(COD)(7a)] and [IrCl2Cp∗(6)]. For comparison, some phosphoramidite complexes of these formulations also were synthesized. The new metal complexes were spectroscopically analyzed. For the carbonyl complexes, the νCO IR stretching frequencies were lower than for the corresponding phosphite and phosphoramidite ligands. The 1JPRh coupling constants for the rhodium complexes with the new ligands were also smaller than for the respective phosphoramidite and phosphite complexes. Finally, the 1JPSe coupling constants of the selenides of the new ligands were lower than those of the phosphoramidite ligands but higher than for PPh3. The spectroscopic data reveal that the new thio ligands 4, 6 and 7a are more electron donating than phosphites and phosphoramidites but less electron donating than PPh3. 相似文献
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Astrocytes transport the monocarboxylate acetate, but synaptosomes do not. The reason for this is unknown, because both preparations express monocarboxylate transporters (MCT). The transport and metabolism of lactate, another monocarboxylate, was examined in these two preparations, and the results were compared to those for acetate. Lactate transport is more rapid in astrocytes than in synaptosomes, but of lower affinity (Kms of 17 and 4 mM, respectively). Lactate (0.2 mM) is metabolized to CO2 more rapidly in synaptosomes than in astrocytes (rates of 0.37 and 0.07 nmol x mg protein(-1) x min(-1), respectively). The reason for this is unclear, but cellular differences in lactate dehydrogenase isotype expression may be involved. Acetate is metabolized to CO2 more rapidly in astrocytes than in synaptosomes (rates of 0.43 and 0.02 nmol x mg protein(-1) x min(-1), respectively). This is likely due to cellular differences in the expression of monocarboxylate transporter subtypes. 相似文献
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Hand JW 《Progress in biophysics and molecular biology》2007,93(1-3):192-194
The first and second sessions of the Workshop focussed on the basics of ultrasound and infrasound, their applications in both industry and medicine, and metrology and protection standards for ultrasound applications. 相似文献
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Gonzalez-Reimers E Rodriguez-Moreno F Martinez-Riera A Mas-Pascual A Delgado-Ureta E Galindo-Martin L Arnay-de la Rosa M Santolaria-Fernandez F 《Biological trace element research》1999,68(1):41-49
To elucidate accumulation of minerals in human iliac arteries with aging, the content of minerals was analyzed by inductively
coupled plasma atomic emission spectrometry. Bilateral common, internal, and external iliac arteries of 16 men and 8 women,
ranging ages from 65 to 93 yr, were examined. It was found that an extremely high accumulation of calcium and phosphorus occurred
in the common iliac artery at old age, being higher than that of the internal and external iliac arteries. It should be noted
that the accumulation of calcium and phosphorus is the highest in the common iliac artery among the human arteries examined
to date.
Regarding sexual differences, the content of calcium and phosphorus in the common and internal iliac arteries was higher in
women than in men, whereas their content in the external iliac artery was lower in women than in men. 相似文献
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J. Morley M.A. Bray R.W. Jones D.H. Nugteren D.A. van Dorp 《Prostaglandins & other lipid mediators》1979,17(5):729-736
The ability of partially purified human and guinea-pig haematogenous cell populations, when cultured in vitro, to metabolise arachidonic acid (AA) has been studied. Supernatants from 24 hour cell culture have been subjected to analysis for products of AA metabolism by gas chromatography with electron-capture detection.The cell types studied were human peripheral blood monocytes (both glass adherent and non-adherent), neutrophils, eosinophils and leukemic leucocytes; thoracic duct lymphocytes and lung alveolar macrophages. From the guinea-pig, induced and non-induced macrophage or neutrophil enriched peritoneal exudate populations, lymph node cells, peritoneal eosinophils and peripheral blood platelets were examined. Supernatants were assayed for the presence of PGE2, PGD2, PGF2α, TXB2 and 6-keto-PGF1α. In all types studied PGE2 and TXB2 were the major products formed. The identification of PGE2 and TXB2 was confirmed by GC/MS with multiple ion monitoring.The results have been compared with other reports and their possible significance discussed in relation to the proposed role of prostaglandins as mediators and modulators in immunopathology. 相似文献
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Allergic asthma can be precipitated by many factors. For the atopic person, fungus, pollen, dust mites, cockroach antigens, and diesel exhaust are all agents that may trigger an allergic attack. Cytokines and chemokines are integral mediators of fungal asthma. From the earliest time points, they recruit and activate the cells required for the clearance of fungus as well as being critical factors involved in the immunopathology of this disease. In the final analysis, it is clear that these mediators can act to the benefit or the detriment of the host. 相似文献
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Sandra M. Vaz 《Archives of biochemistry and biophysics》2009,484(2):127-431
In spite of the many studies on protein modifications by reactive species, knowledge about the products resulting from the oxidation of protein-aromatic residues, including protein-derived radicals and their stable products, remains limited. Here, we compared the oxidative modifications promoted by peroxynitrite and myeloperoxidase/hydrogen peroxide/nitrite in two model proteins, ribonuclease (6Tyr) and lysozyme (3Tyr/6Trp). The formation of protein-derived radicals and products was higher at pH 5.4 and 7.4 for myeloperoxidase and peroxynitrite, respectively. The main product was 3-nitro-Tyr for both proteins and oxidants. Lysozyme rendered similar yields of nitro-Trp, particularly when oxidized by peroxynitrite. Hydroxylated and dimerized products of Trp and Tyr were also produced, but in lower yields. Localization of the main modified residues indicates that peroxynitrite decomposes to radicals within the proteins behaving less specifically than myeloperoxidase. Nitrogen dioxide is emphasized as an important protein modifier. 相似文献