我国医院床位资源利用现状与供需分析研究

目的 了解我国医院床位资源配置现状并进行分析。方法 采用供需平衡法对我

国医院床位配置总数供需求进行分析。结果 2005—2014年间,我国医院床位总数逐年上涨,医院床位总体供求平衡。但各级医院间床位利用率差距较大,床位资源同时存在利用过度与利用不足。结论 提高医疗技术水平,优化整体服务效率,加快信息资源配置,联动各级资源共享,发展基层医疗服务,分流医院诊疗负担。

     

武汉“1+8”城市圈医疗长效监管必要性研究

武汉“1+8”城市圈的确立,为优化城市圈内医疗资源的配置、整合提供了机遇。在新形势下,利用好这一有利时机,对促进城市圈内医疗系统又快又好地发展具有重要意义。通过对武汉“1+8”城市圈9个城市的卫生局局长等医院监管相关知情人分别进行医疗长效监管方面的深度访谈,了解到城市圈内医疗监管不足的主要表现及原因,为探索改进“两型社会”建设中医疗监管与改革提供参考依据。     

大型综合医院医疗服务半径研究

目的：探讨大型医院神经内科医疗服务半径的基本情况及变化趋势,为科室健康发展、合理配置医疗资源提供科学依据,并以此为基础建立一个临床科室服务半径的分析模型。方法：利用军队医院信息管理系统中病案管理子系统建立数据库,对住院患者病案首页信息的基本情况进行单因素统计分析,并利用地理信息系统直观描述该院患者来源分布频率,定量研究医院服务半径的影响因素。结果：在2007—2010年收治的26528例地方患者中,男性多于女性,60岁以上老年人居多;本市住院病人数量呈逐年下降的趋势,而距离西安市较远的地区和外省病人数量呈逐年上升趋势。定量研究医院服务半径的影响因素发现,可能的影响因素有患者年龄、疾病病种、是否手术、住院日、医疗费用、医疗性质等方面（P〈0．05）。结论：在医疗服务市场竞争中,医院医疗服务半径的拓展与医疗服务满意度、社会经济发展、新医改的不断推进、品牌营销策略等影响因素密切相关。     

重组模式下三级公立医院优质资源下沉县域的实践

如何实现区域卫生资源的合理流动与全局统筹,提升区域卫生资源的可及性和使用率,是破解我国基层群众就医难题的关键问题之一。文章结合河南省新滑医院的办院实例,对医院运营中取得了成绩和存在问题进行总结和分析,并尝试分析论述有效促进三级医院下移优质医疗资源到基层的策略。     

自发型医疗联合体运行机制研究 ——以大连医科大学附属第二医院医疗联盟为例

采用扎根理论的研究方法，应用NVIVO11质性研究软件对国内自发型医联体的典型代表大连医科大学附属第二医院医疗联盟的运行机制进行研究。研究发现，“自发自愿”的成立动因、“协商谈判”合作机制、第三方参与机制、正式与非正式关系连接纽带是自发型联盟的四大运行机制。自发型医疗联盟对于区域医疗资源科学配置、合理有序分级诊疗格局的形成、基层服务能力提升等方面起到积极推动作用。     

辽宁省医疗资源纵向整合模式特征及效果分析

通过对辽宁省县级综合医院的调查,分析了自2008年以来辽宁省启动实施医疗资源纵向整合改革的特征和效果。反映出通过医疗资源纵向整合的实施,推动城市大医院的优质医疗资源向县及县以下流动,有利于改变医疗卫生资源配置不均衡的状况;提升县医院医疗服务效率,增强医疗服务能力;有利于增加医院住院医疗服务数量,降低新农合县外转诊率增幅。     

基于数学优化的手术室调度研究

手术室是医院的重要医疗资源,通过有效流程优化及使用麻醉恢复室,其运转效率不断提高,但是仍然不能满足患者和临床科室日益增长的医疗服务需求,仍然存在手术室过度利用和利用不足的情况。人工手术资源调度一定程度提高手术资源利用效率,而借助计算机系统的数学协同优化的手术资源调度,能弥补人工调度的不足,实现系统资源匹配与动态实时优化,有效减少手术患者住院等待时间、提高手术资源利用效率。     

基于排队论的门诊挂号收费窗口的配置

在国内,总能看到各大医院门诊都排着长长的队,究其原因是因为门诊工作量大,而医疗资源相对有限,当现有的医疗资源无法满足源源不断到来的病患时,就会不可避免的出现排队现象,这其中反映最为突出的就是挂号缴费等待时间长。本文将选取襄阳市某中医医院的实例,应用排队论的数学模型,分析该院门诊收费挂号窗口配置的合理性,为医院科学管理提供理论依据和指导,从而达到缩短患者就诊时间,提高服务满意度的目标。     

从供给侧结构性改革视角看三级医院医疗资源下沉

面对区域医疗资源布局失衡、城乡医疗卫生资源配置不均衡的现状,我国部分地区开始落实推行三级医院医疗资源下沉,通过举例分析浙江、河南、福建医疗资源下沉的不同实践模式,从供给侧视角分析优质医疗资源下沉中存在的困境。建议大力推进供给侧结构改革,增加医疗资源的供给,加大政府财政对医疗资源的投入,并坚持市场机制在资源配置中的决定性作用;鼓励社会资本办医,增加供给的主体;鼓励执业医师多点执业缓解医疗人才供给的不足,促进医疗供给结构调整,促使医疗资源下沉。     

壳聚糖酶的克隆表达与壳寡糖的制备分析

目的:克隆壳聚糖酶基因于大肠杆菌中实现高表达,制备壳寡糖。方法:以枯草芽孢杆菌总DNA为模板扩增壳聚糖酶基因(CSN),克隆至载体pET23a(+)上,转化菌株BL21(DE3)。重组子经0.5 mmol/L IPTG诱导后,SDS-PAGE和质谱检测与鉴定重组酶。酶纯化后水解壳聚糖,薄层色谱分析其水解产物。结果:质谱证明壳聚糖酶(31.5kDa)成功表达,表达量占菌体总蛋白的45%左右。纯化后重组酶浓度为900 mg/L,纯度95%、回收率85%,酶活力为10 000 U/mg。壳聚糖降解产物为壳二糖至壳四糖。结论:原核表达载体pET23a(+)-CSN构建正确,壳聚糖酶表达量与活性高,适用于水解壳聚糖制备壳寡糖。     

国内外蝗害治理技术现状与展望

本文首先概述了国内外蝗虫发生与为害的态势,总结了现阶段我国蝗虫发生与为害的主要特点:即农田飞蝗暴发频繁而且严重,草原土蝗的发生时常造成严重的经济损失,而且侵入城市干扰市民生活,我国与周边国家之间蝗虫过境迁移频繁,使用化学农药污染环境和农产品;分析了国内外蝗虫防治对策与技术的发展现状,重点介绍了应急防治和可持续治理对策、...     

Molecular characterisation of species and genotypes of Cryptosporidium and Giardia and assessment of zoonotic transmission

The molecular characterisation of species and genotypes of Cryptosporidium and Giardia is essential for accurately identifying organisms and assessing zoonotic transmission. Results of recent molecular epidemiological studies strongly suggest that zoonotic transmission plays an important role in cryptosporidiosis epidemiology. In such cases the most prevalent zoonotic species is Cryptosporidium parvum. Genotyping and subtyping data suggest that zoonotic transmission is not as prevalent in the epidemiology of giardiasis. Molecular characterisation of Cryptosporidium and Giardia is a relatively recent application that is evolving as new genes are found that increase the accuracy of identification while discovering a greater diversity of species and yet unnamed taxa within these two important genera. As molecular data accumulate, our understanding of the role of zoonotic transmission in epidemiology and clinical manifestations is becoming clearer.     

Synthesis and turnover of cerebrosides and phosphatidylserine of myelin and microsomal fractions of adult and developing rat brain.

The synthesis and turnover of cerebrosides and phospholipids was followed in microsomal and myelin fractions of developing and adult rat brains after an intracerebral injection of [U-14C]serine. The kinetics of incorporation of radioactivity into microsomal and myelin cerebrosides indicate the possibility of a precursor-product relationship between cerebrosides of these membranes. The specific radioactivity of myelin cerebrosides was corrected for the deposition of newly formed cerebrosides in myelin. Multiphasic curves were obtained for the decline in specific radioactivity of myelin and microsomal cerebrosides, suggesting different cerebroside pools in these membranes. The half-life of the fast turning-over pool of cerebrosides of myelin was 7 and 22 days for the developing and adult rat brain respectively. The half-life of the slowly turning-over pool of myelin cerebrosides was about 145 days for both groups of animals. The half-life of the rapidly turning-over microsomal cerebrosides was calculated to be 20 and 40 h for the developing and adult animals respectively. The half-life of the intermediate and slowly turning-over microsomal cerebrosides was 11 and 60 days respectively, for both groups of animals. The amount of incorporation of radioactivity into microsomal cerebrosides from L-serine was greatly decreased in the adult animals, and greater amounts of the precursor were directed towards the synthesis of phosphatidylserine. In the developing animals, considerable amounts of cerebrosides were synthesized from L-serine, besides phosphatidylserine. The time-course of incorporation indicated that a precursor-product relationship exists between microsomal and myelin phosphatidylserine. The half-life of microsomal phosphatidylserine was calculated to be about 8 h for the fast turning-over pool in both groups of animals.     

Identification and composition of the tonsillar and anal enterococcal and streptococcal flora of dogs and cats

Enterococcus faecalis was the most frequently isolated enterococcal species from anal swabs and tonsils of dogs and cats, although in the anal samples from dogs Ent. hirae was found almost as often as Ent. faecalis. Most Ent.faecium strains from dog tonsils differed from those associated with humans and other animals in that they fermented sorbitol. Typical Ent. avium as well as atypical Ent. avium -like strains were seen in dogs, while the related species Ent. raffinosus was associated with cat tonsils. Enterococcus cecorum also occurred mainly in cats. Certain atypical strains, presumptively identified as Ent. cecorum , shared characteristics with Ent. columbae.
The most frequent streptococcal species in tonsils of cats and dogs were Streptococcus suis and Strep. canis. Streptococcus canis and Strep. bovis predominated in anal swabs. The canine Strep. suis differed from the common porcine strains in fermenting mannitol.
Forty-seven of the 288 isolates examined could not be identified or related to known species. The characteristics of two groups of these bacteria, provisionally called 'Ton 31 group' and 'O7 group' are described.     

Coiled-coil nanomechanics and uncoiling and unfolding of the superhelix and alpha-helices of myosin

The nanomechanical properties of the coiled-coils of myosin are fundamentally important in understanding muscle assembly and contraction. Force spectra of single molecules of double-headed myosin, single-headed myosin, and coiled-coil tail fragments were acquired with an atomic force microscope and displayed characteristic triphasic force-distance responses to stretch: a rise phase (R) and a plateau phase (P) and an exponential phase (E). The R and P phases arise mainly from the stretching of the coiled-coils, with the hinge region being the main contributor to the rise phase at low force. Only the E phase was analyzable by the worm-like chain model of polymer elasticity. Restrained molecular mechanics simulations on an existing x-ray structure of scallop S2 yielded force spectra with either two or three phases, depending on the mode of stretch. It revealed that coiled-coil chains separate completely near the end of the P phase and the stretching of the unfolded chains gives rise to the E phase. Extensive conformational searching yielded a P phase force near 40 pN that agreed well with the experimental value. We suggest that the flexible and elastic S2 region, particularly the hinge region, may undergo force-induced unfolding and extend reversibly during actomyosin powerstroke.     

Carnitine and creatine content of tissues of normal and alloxan-diabetic sheep and rats

The concentration of carnitine in liver increased 28-fold and urinary carnitine excretion 5-fold in alloxan-diabetic sheep. In contrast there were no similar increases in alloxan-diabetic rats. The creatine content of liver decreased 3-fold and creatine excretion decreased 2-fold in diabetic sheep. In contrast the creatine content of liver increased nearly 4-fold in diabetic rats with no change in creatine excretion. The marked increased in production of carnitine by the liver of the diabetic sheep appears possible because of decreased production and excretion of creatine.