主诊医师团队负责制在

主诊医师团队负责制应用于区域疾病综合防治工作，是提高卫生资源利用效率、提升疾病区域综合防治的有效措施。立足于提高区域卫生服务水平，系统介绍了“三级医院-社区卫生中心”主诊医师团队负责制优化模式的实践概况、具体措施和主要成效，提出了改进医疗质量、开展疾病区域综合防治的新思路。     

基于主诊医师负责制的住院绩效考核模式探讨

目的 建立主诊医师负责制下的住院绩效分配新模式,以适应医药分开改革的新要求。方法 探索基于医疗成果产出的岗位绩效管理考核和分配新制度,重点激励各主诊医师组医疗产出的工作量和工作难度,促使各主诊医师组增加服务量、提高技术水平和诊治疾病的难度。结果 以某科室各主诊医师组为例,从科室管理、团队建设、学科发展、工作效率等角度分析医改前后转变。结论 重点激励分配制度,逐步被医务人员所接受,并取得较为明显的成效。     

“理事会制”管理模式下支援县级医院的探讨

介绍了北京大学第一医院以“全面合作、委托管理、理事会领导下的院长负责制” 管理模式对密云县医院实施对口支援的做法，并就管理新模式进行总结分析，为进一步开展城乡医院对口支援工作提供新思路及相关政策建议。     

360度评估在综合医院内科科主任查房质量监控中的应用

目的 探讨360度评估应用于综合医院内科科主任查房质量监控的可行性和实用性。方法 依据360度评估的原则，选择上级、平级、下级及外部评估者作为评估对象，分别针对各类评估者制定不同的评估内容，采用专家评议法确定各部分内容的权重，采用现场评估的方法收集评估资料。结果 360度评估用于科主任查房的质量监控可以全面、有效地收集内科科主任查房质量的信息，可以及时发现内科科主任查房中存在的问题。结论 采用360度评估对内科科主任查房质量进行监控具有一定的可行性和实用性。     

基于信息平台的公立医院科主任绩效考核实证研究

???? 目的 探讨实施科主任绩效考核对提高科主任绩效和医院绩效的效果。方法 采用近3年科主任绩效考核平均分变化趋势,判断科主任绩效考核整体效果;利用与上海市市级综合性医院绩效数据均值横向比较的方法,评估医院绩效提升的效果。结果 科主任绩效考核平均分持续提高,医院绩效优于上海市市级综合性医院绩效均值。结论 通过科主任绩效考核实践,发挥考核的导向作用,深化信息平台建设,落实医院各项管理措施,科主任绩效和医院绩效得到明显提升。

     

基于“理事会制”的县级医院医疗服务能力建设探索

介绍北京大学第一医院以“全面合作、委托管理、理事会领导下的院长负责制”管理模式对北京市密云区医院围绕“学科能力建设”“管理体系建设”两个维度开展对口支援工作,提升了北京市密云区医院医疗服务水平及医疗管理水平,并就下一阶段工作提出相关建议。     

大学附属医院临床科主任工作业绩考核评价体系研究

为了改善医院绩效,以目标管理法为理论基础,采用关键绩效指标法建立大学附属医院临床科主任工作业绩考核指标评价体系,并应用层次分析法进行权重分析,得出各层级指标的权重值,各指标的重要程度符合科主任的实际工作要求。以此对临床科主任的工作进行科学、有效的考核,提升临床科室绩效管理水平。     

小型猪涩脉模型的建立与评价

目的基于小型猪的生理特点及循环系统与人类极为相似的特征，通过药物对其造模，建立一种新型的脉诊动物教学模型并对其进行评价。方法选用中华实验用成年小型猪6只（体重20±1．6kg，选取心率〈100次/min）。采用戊巴比妥钠麻醉，定位取脉位置，切脉后，用NX-8型脉诊仪同步采取正常脉图、二导心电图，血流动力学参数，血流变学指标。耳大静脉心得安注射液及葡聚糖T-500静脉给药进行造模，观察造模后一般情况（心率、皮肤颜色）及指下脉形变化，同步描记脉图及二导心电图，涩变后记录数值：不同时间点的心率变化；主波高（HB）、升支斜率（Sup）、降支斜率（Sdown）、降中峡位置（即降中峡高，主波高HE/HB）、升支时间，脉波周期（TAB/TAG）、主波峰时间，脉波周期（TB/TAG）；并采集造模后血流动力学及血流变学各项参数。结果6头小型猪均造模成功，指下感觉涩变明显；脉图变化显著；与造模前相比HB、Sup、Sdown、HE/HB、TAB/TAG、TB/TAG差异均有显著性（除SdownP〈0．05外，其余均P〈0．01）。血流动力学及血流变学相关参数差异也均有显著。讨论通过运用小型猪建立涩脉模型成功、方法可靠，小型猪应用于脉诊教学实验方法简便、损伤小、可重复运用，有充分的可行性，以此为基础可以建立多种脉诊模型，以补充脉诊实验教学中的空白。     

中国科学院昆明灵长类研究中心成立

经过多次论证和审核,中国科学院昆明灵长类研究中心(Kunming Primate Research Center,CAS)(以下简称“灵长类中心”)近日正式成立。“灵长类中心”是中国科学院下属的一个非法人研究单元,挂靠中国科学院昆明动物研究所(以下简称昆明动物所),并借鉴国际化管理模式,实行管理委员会领导下的主任负责制。     

引入手术危险评分细化外科手术分级准入的探索

分析了当前外科手术权限管理方法和存在的问题。作为心血管病专科医院，尝试引入外科术前危险评分，对手术进行分级，建立手术准入控制系统和手术医师档案系统，全面记录医师外科手术情况，为评价医师技术能力和科学地审核医师手术权限申请提供了量化依据。     

Characteristics of the membranes of the pellicle of the ciliatePseudomicrothorax dubius

Summary The membranes of the pellicle of the ciliatePseudomicrothorax dubius are investigated using thin section electron microscopy and freeze-fracture replicas. The plasma membrane is covered by a surface coat and is connected to the outer alveolar membrane by short, sometimes branched, bridges. The inner alveolar membrane is coated on both sides. The epiplasm lies in intimate contact with the cytoplasmic surface of this membrane, and there is a corresponding deposit on the other surface. This deposit is regularly striated.The epiplasmic layer and the alveoli are interrupted at sites of cytotic activity,e.g., the attachment sites of trichocysts, the cytoproct, and the parasomal sacs. The striated deposit ends where the epiplasm ends, indicating a direct relationship between these two epimembranous layers.There is a deposit along the sides of the first part of the tip of the trichocysts, and in this region the trichocyst membrane is free of intramembranous particles.The membrane of the parasomal sacs has a coat on both surfaces. That on the extraplasmic surface is similar to the surface coat of the plasma membrane. The origin of the cytoplasmic coat is unknown. The cytotic activity of these sacs is indicated by their highly irregular profiles.     

The early development of the tail and the transformation of the shape of the nucleus of the spermatid of the domestic fowl,Gallus gallus

Summary The differentiation of the spermatid, especially in reference to the formation of the flagellum, and transformation of the shape of the nucleus was investigated in the domestic fowl.In the early stage of the spermatid, a prominent Golgi apparatus appears around the centrioles. The Golgi vesicles then surround the axial-filament complex which develops from the distal centriole. These vesicles fuse to form continuous membrane at the earliest stage of flagellar formation, and in the succeeding stage Golgi lamellae are attached to the plasma membrane of the developing flagellum. From these observations, it is assumed that Golgi apparatus may be a source of the membrane system of the flagellum.The microtubules distributed around the nucleus form the circular manchette. The anterior region of the nucleus with the manchette is cylindrical in shape and the posterior region without it remains irregular in shape. When the circular manchette has been completed, the whole nucleus acquires a slender cylindrical shape. The circular manchette then changes into the longitudinal manchette. The nuclei of spermatids without a longitudinal manchette are abnormal in shape. In view of these observations it is assumed that the nuclear shaping of the spermatid may be accomplished by circular manchette and the maintenance of shape of the elongated nucleus by longitudinal manchette.The authors wish to thank Mr. Takayuki Mori for his helpful suggestions and technical advices     

Characterization of the composition of the aqueous humor and the vitreous body of the eye of the frog Rana temporaria L

This study aimed to analyze the aqueous humor (AH) and the vitreous body (VB) of the eye of the adult frog Rana temporaria L. as a representative species of amphibians, which lead a semi-terrestrial life. The presence of collagen, albumin, uric acid and electron donors was shown in both media; however, there are slight differences in their concentrations. To determine collagen, a spectral-fluorescent probe, cyanine dye, was used. The presence of collagen in AH of the frog was found at the first time. The total content of electron donors (ascorbic and uric acids, tryptophan, and tyrosine) in VB and HA was roughly estimated at ~ 1.5 × 10^− 4 mol/L. Both VB and AH absorb light in similar UV regions. The total protein and albumin contents in AH were found to be somewhat higher than those in VB. The uric acid content was at an equally low level in both intraocular media. It is supposed that the similarity of VB and AH compositions shown in this work is due to some exchange between VB and AH contents in the course of accommodation. The role of intraocular fluids in physiological functions of the eye and in protecting the retina against UV light is discussed.     

Observations on the permeability of the choriocapillaris of the eye

Summary The choriocapillaris is a fenestrated capillary bed located posterior to the retinal pigment epithelium. It serves as the main source of supply to the photoreceptors, retinal pigment epithelium, and other cells of the outer retina. The permeability of these capillaries to intravenously injected ferritin (MW — approx. 480,000; mol. diam. 11 nm) was examined in the mouse, rabbit, and guinea pig, each of which is characterized by a different type of retinal vascularization. In all three species, the bulk of the ferritin remained in the capillary lumina, where it appeared to be blocked at the level of the diaphragmed fenestrae. Some ferritin was present in endothelial cell vacuoles. The results confirm previous work on the rat choriocapillaris and indicate that the barrier function of the choriocapillary endothelium is present even among species in which the retinal circulation differs significantly.Supported by NIH grant EY03418