某医院安全文化的测评现状分析及对策

目的 了解某医院医务人员的医院安全文化认知情况,并与国内外的研究成果相比较,为制定医院安全文化提升策略提供可靠依据。方法 采用问卷调查法,借助中文版的HSOPSC问卷对目标医院医务人员的安全文化认知进行调查,测评维度和条目的积极反应率。结果　医务人员对于安全文化的积极反应率排名在前三位的维度为：科室内部团结（84.25％),组织的持续改进与学习（82.74％）,对差错的反馈与沟通（76.37％）。积极反应率最低的维度为人员配置（35.26％）。结论　目标医院的安全文化总体比较积极,但在人员配置和沟通的开放性方面仍需进一步完善。     

医院评审管理信息系统的建设与应用实践

新一轮医院评审提出了管理模式从粗放的行政化管理转向精细的信息化管理的指导原则,同时引入了自我评价理念和评建并举制度。围绕原卫生部《三级综合医院评审标准》,结合日常质量管理工作,利用信息化、网络化技术,建立了基于多层B/S架构的评审管理信息系统,并遵循PDCA质量改进模式,按照计划组织、执行落实、检查复核与评价改进的工作流程开展信息化评审与质量自评。评审管理信息系统的应用,帮助医院建立起了一整套规范化的自评流程,提升了医院的自评能力,推动了院内质量监测和改进机制的建立,完善了医院的质量管理体系。     

主辅分离下大型公立医院创新发展运行模式探索

创新作为现代医院发展的支点,是医院科学运营的动力。企业医院主辅分离后,通过观念创新、技术创新、服务创新和整体发展规模的精心规划,在决策方向、经营运作、核心能力、整体规模上的重点把握和持续创新,提升了医院科学发展力、市场适应力和持续创新力,实现了医院的跨跃式发展。     

医院临床科室主任绩效评价体系框架的设计

????? 医院临床科室主任作为学科带头人和科室管理者,对医院科室管理水平的提升和医院发展战略目标的实现发挥着重要作用。结合绩效管理理论,对临床科室主任的绩效内涵进行了界定,并构建了临床科室主任绩效评价维度模型和科室主任绩效评价体系框架,为科学、全面地对临床科室主任绩效进行评价提供参考。

     

基于SWOT分析的区域医疗中心发展战略探讨

在深化医药卫生体制改革的背景下,区域医疗中心传统的管理模式越来越难以适应新的形势。根据战略管理理论,在全面分析上海市浦东新区中南部区域医疗中心——浦东医院内、外部环境变化的基础上,探讨了浦东医院的战略发展战略。     

上海市级医院消防安全团队建设的研究与实践

消防安全是医院运行的第一道防线,医院消防队伍对于保障大型市级医院的正常运作有着十分重要的作用。研究通过实地调研和问卷调查形式,对上海市7家市级医院的消防安全团队建设进行分析,并提出改善团队建设的建议。     

国家临床重点专科科室文化建设的探索与实践

科室文化是科室的灵魂,该文论述了首都医科大学附属北京天坛医院神经外科在科室建设中注重以人为本,结合自身特点打造具有科室特色并与医院愿景、文化相适应的科室文化。在实践中验证了科室文化建设在科室管理中的重要性,探讨了如何在新形势下加强科室文化建设。     

我国医院经营绩效考核指标体系浅析

通过文献分析,对医院经营绩效考核的概念、考核指标体系的现状、医院绩效评价的方法、评价体系存在的问题和对策进行了描述和归纳,对深化医院管理理论研究、促进医院经营绩效考核评价的科学性及医院管理决策的民主化与现代化有十分重要的意义。

     

县级医院取消药品加成政策分析

在对两试点地区县级医院取消药品加成现状总结的基础上,运用利益相关者理论分析县级医院取消药品加成后各利益相关方的改变,得出县级医院取消药品加成后可能产生的负性影响以及若想取得较好的改革效果所应具备的配套措施,为各地县级医院实施取消药品加成改革提供政策建议。     

基于企业资源计划系统的医院运营管理公理化设计

在深化我国医药卫生体制改革的过程中,为适应医院日益增长的管理需求,将企业资源计划（ERP）理念运用到医院运营管理中,以实现对医院运营的有效管理为目标,运用独立公理对医院运营管理ERP系统进行功能设计,降低设计的复杂性,改善了医院运营管理的运作流程,提升了医院整体运营效益,提高了医院运营管理的水平,是实现医院战略的有力保障。     

Diagnosis of Bacterial Bloodstream Infections: A 16S Metagenomics Approach

Background

Bacterial bloodstream infection (bBSI) is one of the leading causes of death in critically ill patients and accurate diagnosis is therefore crucial. We here report a 16S metagenomics approach for diagnosing and understanding bBSI.

Methodology/Principal Findings

The proof-of-concept was delivered in 75 children (median age 15 months) with severe febrile illness in Burkina Faso. Standard blood culture and malaria testing were conducted at the time of hospital admission. 16S metagenomics testing was done retrospectively and in duplicate on the blood of all patients. Total DNA was extracted from the blood and the V3–V4 regions of the bacterial 16S rRNA genes were amplified by PCR and deep sequenced on an Illumina MiSeq sequencer. Paired reads were curated, taxonomically labeled, and filtered. Blood culture diagnosed bBSI in 12 patients, but this number increased to 22 patients when combining blood culture and 16S metagenomics results. In addition to superior sensitivity compared to standard blood culture, 16S metagenomics revealed important novel insights into the nature of bBSI. Patients with acute malaria or recovering from malaria had a 7-fold higher risk of presenting polymicrobial bloodstream infections compared to patients with no recent malaria diagnosis (p-value = 0.046). Malaria is known to affect epithelial gut function and may thus facilitate bacterial translocation from the intestinal lumen to the blood. Importantly, patients with such polymicrobial blood infections showed a 9-fold higher risk factor for not surviving their febrile illness (p-value = 0.030).

Conclusions/Significance

Our data demonstrate that 16S metagenomics is a powerful approach for the diagnosis and understanding of bBSI. This proof-of-concept study also showed that appropriate control samples are crucial to detect background signals due to environmental contamination.     

Role of calpain-9 and PKC-δ in the apoptotic mechanism of lumen formation in CEACAM1 transfected breast epithelial cells

CEACAM1-4S (carcinoembryonic antigen-related cell adhesion molecule 1) is a type I membrane protein with a short (12-amino acid) cytoplasmic tail. Wild type CEACAM1-4S-transfected MCF7 cells form glands with lumena when grown in 3D culture, while null mutations of two putative phosphorylation sites (T457A and S459A) in the cytoplasmic domain fail to undergo lumen formation. When gene chip analysis was performed on mRNA isolated from both wild type and T457A,S459A mutated CEACAM1-4S-transfected MCF7 cells grown in 3D culture, calpain-9 (CAPN9) was identified out of over 400 genes with a > 2 log 2 difference as a potential inducer of lumen formation. Inhibition of CAPN9 expression in MCF7/CEACAM1-4S cells by RNAi or by calpeptin or PD150606 inhibited lumen formation. Transfection of CAPN9 into wild type MCF7 cells restores lumen formation demonstrating that calpain-9 may play a critical role in lumen formation. Additionally, we demonstrate that the apoptosis related kinase, PKC-δ, is activated by proteolytic cleavage during lumen formation exclusively in wild type CEACAM1-4S-transfected MCF7 cells grown in 3D culture and that lumen formation is inhibited by either RNAi to PKC-δ or by the PKC-δ inhibitor rottlerin.     

Receptors for C3 and IgG on macrophage, neutrophil and eosinophil colony cells grown in vitro.

Macrophage, neutrophil, and eosinophil colony cells from bone marrow culture in semisolid agar medium were studied for membrane C3 and IgG receptors. The capacity of these cells to bind either erythrocytes-19S antibody-complement (EAC) or erythrocyte-7S antibody (EA7S) complexes was measured using the rosette method. Whereas macrophage and neutrophil colony cells showed receptors for both C3 and IgG, eosinophil colony cells appear to bear only IgG receptors. Studies correlating colony age and the presence of receptors showed that 60 to 70% of the cells from 3-day-old macrophage colonies were reactive for EAC and EA7S contrasting with 80 to 90% of the cells from 6- to 12-day-old colonies. Neutrophils behaved somewhat differently: EAC and EA7S reactive cells were seen in colonies after 4 or 5 days in culture and comprised only 50 to 60% of the colony population. Eosinophilic colonies showed 50 to 60% EA7S reactive cells after 6 to 7 days in culture, but no EAC reactive cells were found among these colonies at any time. The characteristics and properties of the receptors detected on colony cells were similar to those on macrophages and neutrophils from normal peritoneal fluid or bone marrow. Most macrophage colony cells were actively phagocytic whereas neutrophils and eosinophilic colony cells failed to show phagocytosis under the same conditions.     

Development of a membrane dialysis bioreactor and its application to a large-scale culture of a symbiotic bacterium,Symbiobacterium thermophilum

A simple membrane dialysis bioreactor was developed for a large-scale axenic culture of Symbiobacterium thermophilum, a symbiotic thermophile that requires co-cultivation with an associating thermophilic Bacillus strain S for normal growth. The bioreactor consisted of an outer- and an inner-coaxial cylindrical compartment bordered across a dialyzing membrane, which enabled a 1 l-scale dialysis culture with exchange of low molecular metabolites between the two compartments to be performed. Using the bioreactor, growth characteristics of S. thermophilum and Bacillus strain S were assessed under two medium conditions. The growth of S. thermophilum was measured by quantitative PCR because the bacterium formed no visible colonies and gave abnormally low turbidity. In medium containing 2% tryptone peptone, S. thermophilum proliferated up to 4x10(7) cells/ml, and strict dependence on the co-culture with Bacillus strain S was observed. On the other hand, medium containing 0.5% yeast extract not only facilitated the growth of S. thermophilum in the co-culture (6x10(7) cells/ml), but also allowed limited pure growth independent of Bacillus strain S (1x10(7) cells/ml), implying that some component of yeast extract can partially replace the growth requirement of S. thermophilum supplied by Bacillus strain S. Both the oxidative redox potential values and the cell morphology in the independently growing culture suggested the occurrence of marked unbalanced growth possibly caused by significant metabolic changes. The bioreactor is applicable to the analyses of culturing characteristics in symbiotic systems between free-living microorganisms.     

Transformation of human embryonic cells by the Rous sarcoma virus and the polyomavirus depending on the mitotic cycle phase]

The whole cycle of skin-muscle embryonic human tissue culture is 18 hours, with phases S, G1, G2 and M being 7, 6, 4 and 1 hour, respectively. The mitotic index of this culture is 28%. The maximum sensitivity of these synchronized cell cultures to transforming activity of the Rous and Sindai viruses was observed in phase S. The infection of synchronized primary embryonic human fibroblasts in phase S with the polyoma virus together with the Sindai virus has resulted in single cases of transformation. Similar results were obtained with non-synchronized human cultures.     

Tauroconjugation of cholic acid stimulates 7 alpha-dehydroxylation by fecal bacteria.

We examined the effect of the type of cholic acid conjugation (taurine-conjugated, glycine-conjugated, or unconjugated cholic acid) on cholic acid 7 alpha-dehydroxylation by intestinal flora. Cholic acid 7 alpha-dehydroxylation in fecal cultures, in cultures of a defined limited flora consisting of a mixture of seven bacterial species isolated from the intestinal tract, and in a binary culture of a 7 alpha-dehydroxylating Clostridium species plus a cholic acid-deconjugating Bacteroides species was studied. We found that tauroconjugation of cholic acid significantly (P < 0.05) increased bacterial 7 alpha-dehydroxylation of cholic acid into deoxycholic acid from 34 to 55% in fecal cultures, from 45 to 60% in defined limited fecal cultures, and from 75 to 100% in binary cultures. Equimolar concentrations of free taurine did not stimulate 7 alpha-dehydroxylation in fecal cultures or in the defined limited flora, but free taurine did stimulate 7 alpha-dehydroxylation in the binary culture. In the binary culture of Clostridium species strain 9/1 plus Bacteroides species strain R1, the minimal flora capable of increased 7 alpha-dehydroxylation of taurocholic acid, strain R1 deconjugated taurine and rapidly reduced it to H2S. Bacteroides species strain R1 did not grow unless taurine or another appropriate reducible sulfur source was present. Clostridium species strain 9/1 did not grow or 7 alpha-dehydroxylate unless H2S or another source of reduced sulfur was present. We conclude that the increased 7 alpha-dehydroxylation of tauroconjugated cholic acid depends on the reduction of taurine to H2S, which is a necessary growth factor for the 7 alpha-dehydroxylating bacteria.     

Expression of the hepatitis B virus surface antigen in Drosophila S2 cells

Drosophila melanogaster S2 cells were transfected with a plasmid vector (pAcHBsAgHy) containing the S gene, coding for the hepatitis B virus surface antigen (HBsAg), under control of the constitutive drosophila actin promoter (pAc), and the hygromycin B (Hy) selection gene. The vector was introduced into Schneider 2 (S2) Drosophila cells by DNA transfection and a cell population (S2AcHBsAgHy) was selected by its resistance to hygromycin B. The pAcHBsAgHy vector integrated in transfected S2 cell genome and approximately 1,000 copies per cell were found in a higher HBsAg producer cell subpopulation. The HBsAg production varied in different subpopulations, but did not when a given subpopulation was cultivated in different culture flasks. Higher HBsAg expression was found in S2AcHBsAgHy cells cultivated in Insect Xpress medium (13.5 μg/1E7 cells) and SFX medium (7 μg/1E7 cells) in comparison to SF900II medium (0.6 μg/1E7 cells). An increase of HBsAg was observed in culture maintained under hygromycin selection pressure. Data presented in the paper show that S2AcHBsAgHy cells produce efficiently the HBsAg which is mainly found in the cell supernatant, suggesting that HBsAg is secreted from the cells. The data also show that our approach using the Drosophila expression system is suitable for the preparation of other viral protein preparation.     

A trial of the use of mupirocin in the nasal carriage of Staphylococcus aureus in medical personnel]

Many hospital-acquired purulent diseases and wound infections are due to multiresistant hospital strains of Staphylococcus aureus. The role of S. aureus nasal carriage in development of wound infections due to autoinfection is confirmed. Not only inpatients but also hospital staff can be highly colonized with coagulase positive staphylococci. The S. aureus persistence in hospital personnel results in distribution of the microorganisms in the environment. Therefore, detection of S. aureus carriers without signs of the infection among the hospital personnel and eradication of the pathogen make it possible to control outbreaks of S. aureus infection in hospitals. Clinical efficacy of nasal ointment of mupirocin in the treatment of S. aureus carriers among the intensive care personnel of the N. N.Blokhin Cancer Research Center was evaluated. S. aureus nasal carriage was diagnosed in 17 (26 per cent) out of 65 persons. All the isolates were susceptible to oxacillin. 5-7 days after discontinuation of the mupirocin nasal ointment use eradication of S. aureus was stated in 100 per cent of the cases. The effect was still observed in 94 per cent of the cases in 1 month, in 76 per cent of the cases in 5-6 months and in 60 per cent of the cases in 8-9 months. It is believed that mupirocin nasal ointment (Bactroban) is convenient to use, low toxic and highly active in the treatment of persons with S. aureus nasal carriage.     

我国医院文化建设及其相关作用

医院精神文化是医院文化的核心,而精神文化的关键是医院经营的基本信念,即医院的价值观。我国已有一些有关医院价值观、医院文化作用的研究,但较大样本、跨地区的、定量研究不足,一些研究分析可能存在聚集性偏倚。为了有利于构建我国医院良好的价值观和医院文化,提高病人和员工医院的满意度,有必要在我国开展更系统的有关医院价值观的实证研究,分析医院文化的作用。     

精细化管理下医院后勤文化建设的实践探索

在现代医院管理工作中,有效推行精细化管理直接关系着医院的服务水平和管理水平,而医院后勤工作的顺利进行则是医院整体能够良好运作的重要保障,二者在相互关联与协作中共同推进了医院的发展。通过对医院后勤文化建设的重要性及必要性的分析,介绍了精细化管理下医院后勤文化建设的方法与实践,突出医院后勤文化建设实施精细化管理的可行性。