以管理成效为导向的医院职能部门绩效考核方法研究

目的 探索适应公立医院绩效评价背景的职能部门绩效考核方法。方法 在文献复习、专题小组讨论和专家访谈的基础上,调研不同类别公立医院进行分析,梳理公立医院职能部门绩效考核的概况、职能部门职责发展变化以及职能部门待解决的问题。结果 发现职能部门任务复杂化,面临系列问题亟待解决,现有的职能部门绩效考核方法有待发展。提出以管理成效为导向的职能部门绩效考核方法;从重点工作、日常行政工作、管理能力进行考核,旨在激励约束职能部门改进管理成效。结论 建立健全以管理成效为导向的职能部门绩效考核方法是促进公立医院执行公立医院绩效评价政策的有益探索。     

Solvent/Detergent Virally Inactivated Serum Eye Drops Restore Healthy Ocular Epithelium in a Rabbit Model of Dry-Eye Syndrome

Application of autologous serum eye drops (SEDs) is a recognized means to treat severe dry-eye syndrome (DES). Due to the inconvenience and difficulty of preparing SEDs from some patients, producing SEDs from allogeneic blood donations is gaining popularity. A major safety concern associated with allogeneic blood is virus transmission. We therefore herein evaluated the possibility of applying a solvent/detergent (S/D) treatment to inactivate viruses and studied the impacts of such treatment of SEDs to resolve DES in a rabbit model. Sera prepared from the blood of five rabbits were pooled and divided into two sub-pools. One was untreated (SEDs), while the other was virally-inactivated with 1% Tri-n-butyl phosphate/1% Triton X-45 at 31°C for 1 h (S/D-SEDs). DES was induced in rabbits using 0.1% benzalkonium chloride (BAC). Rabbits were divided into five groups of two rabbits each. One group was untreated (control), three were treated twice daily for 3 weeks using PBS, SEDs, or S/D-SEDs, and the last received an additional 0.1% BAC (as the negative control). The DES condition was determined by measuring aqueous tear secretion (Schirmer’s test), corneal fluorescein staining, a corneal histologic examination, TUNEL stain apoptosis, and corneal inflammatory marker (tumor necrosis factor-α, interleukin (IL)-1β, IL-8, and IL-6) expressions. We first confirmed that SEDs and S/D-SEDs had similar protein profiles and transforming growth factor (TGF)-β contents. Animal experiments showed that tear secretion did not significantly differ between the SED and S/D-SED groups but was significantly higher than in the PBS group. Eye fluorescein staining revealed dramatic improvements in epithelial defects in groups treated with SEDs or S/D-SEDs, and hematoxylin/eosin staining revealed microscopic epithelial layers similar to those of the untreated controls. Inflammatory markers and TUNEL studies showed that healthy epithelium had been restored in groups treated with SEDs or S/D-SEDs. In conclusion, this preclinical study supports the possibility of using S/D virally inactivated SEDs to treat DES and restore a normal epithelium.     

硕士研究生对高校附属医院教育管理满意度调查研究

??????? 目的 分析高校附属医院研究生对医院教育管理的满意度,为完善医院研究生教育和管理工作提供参考。方法 制定研究生对医院、科室及导师的评价指标,对中山大学附属第一医院522名硕士研究生进行现场问卷调查。结果 研究生对医院管理、科室教育和导师三个层面的整体满意度高于95%,发现了研究生对医院管理和教育不满意的具体方面。结论 高校附属医院要重视硕士生教育工作,改善医院和科室内人际关系,加强科室教学氛围,适当增加导师课题经费。     

Breathing through an inspiratory threshold device improves stroke volume during central hypovolemia in humans.

Inspiratory resistance induced by breathing through an impedance threshold device (ITD) reduces intrathoracic pressure and increases stroke volume (SV) in supine normovolemic humans. We hypothesized that breathing through an ITD would also be associated with a protection of SV and a subsequent increase in the tolerance to progressive central hypovolemia. Eight volunteers (5 men, 3 women) were instrumented to record ECG and beat-by-beat arterial pressure and SV (Finometer). Tolerance to progressive lower body negative pressure (LBNP) was assessed while subjects breathed against either 0 (sham ITD) or -7 cmH(2)O inspiratory resistance (active ITD); experiments were performed on separate days. Because the active ITD increased LBNP tolerance time from 2,014 +/- 106 to 2,259 +/- 138 s (P = 0.006), data were analyzed (time and frequency domains) under both conditions at the time at which cardiovascular collapse occurred during the sham experiment to determine the mechanisms underlying this protective effect. At this time point, arterial blood pressure, SV, and cardiac output were higher (P < or = 0.005) when breathing on the active ITD rather than the sham ITD, whereas indirect indicators of autonomic activity (low- and high-frequency oscillations of the R-to-R interval) were not altered. ITD breathing did not alter the transfer function between systolic arterial pressure and R-to-R interval, indicating that integrated baroreflex sensitivity was similar between the two conditions. These data show that breathing against inspiratory resistance increases tolerance to progressive central hypovolemia by better maintaining SV, cardiac output, and arterial blood pressures via primarily mechanical rather than neural mechanisms.     

Modeling coincidence detection in nucleus laminaris

A biologically detailed model of the binaural avian nucleus laminaris is constructed, as a two-dimensional array of multicompartment, conductance-based neurons, along tonotopic and interaural time delay (ITD) axes. The model is based primarily on data from chick nucleus laminaris. Typical chick-like parameters perform ITD discrimination up to 2 kHz, and enhancements for barn owl perform ITD discrimination up to 6 kHz. The dendritic length gradient of NL is explained concisely. The response to binaural out-of-phase input is suppressed well below the response to monaural input (without any spontaneous activity on the opposite side), implicating active potassium channels as crucial to good ITD discrimination.Abbreviations NL Nucleus Laminaris - NM Nucleus Magnocellularis - ITD Interaural Time Difference - BF Best Frequency     

TWO TYPES OF SENSORY PANELS OR ARE THERE MORE?

The purpose of this article is to discuss the issues associated with selecting assessors for sensory panels. It develops the argument that although there are many variations in the detail of how assessors are selected, all panels can be considered as either (1) selecting respondents to measure ingredient concentrations via perceptions or (2) selecting respondents to represent the response that would be obtained from a wider consumer population. The validity of the data collected, i.e., the extent to which the data collected measures what was originally intended, depends on the detail of how assessors were selected as well as a number of other factors.     

基于DRGs死亡风险分级在医疗质量评价中的应用

目的 基于DRGs探讨死亡风险分级评价医院医疗质量的方法。方法 以死亡风险分级方法评价医院整体医疗质量,进行科室间、专业间横向对比,并与总住院死亡指标进行比较。 结果 （1）总死亡率2015年0.137%低于2014年0.236%,低风险死亡率2015年0.008%高于2014年0,高风险死亡率2015年3.341%高于2014年1.773%;（2）非手术科室A和手术科室A在两类科室中总死亡率都是最高的,其中非手术科室A在中高风险和高风险死亡率是最高的,而手术科室A仅在中高风险死亡率是最高的。非手术科室B出现1例低风险死亡患者;（3）MDCR专业组总死亡率为0.15%居第六位,低风险和中低风险死亡率分别为0.01%和0.24%,其他专业组这两个死亡率都为0。 结论 基于DRGs死亡风险分级是评价医院医疗质量的有效方法。     

General practitioners' views about the statutory annual practice report.

OBJECTIVE--To ascertain the views of primary care professionals about the current purpose, uses, potential, and workload implications of the statutory general practice annual report. DESIGN--Postal questionnaire survey. SETTING--General practices in the Northern region. SUBJECTS--All practices in the region that were singlehanded, fundholding, non-fundholding and with more than five partners, and a one in three random sample of all non-fundholding practices (n = 318). RESULTS--263 practices responded (83%). The report took a median of 12 hours to produce (95% confidence interval 11 to 15 hours; interquartile range 7-35). The main perceived purpose of the report was to monitor practice activity (165 respondents; 63% (95% confidence interval 57% to 69%)), but 44 respondents (17%; 13% to 22%) produced it only because it was contractually required. Practices included statutory and non-statutory data in these reports and would have liked comparative practice activity information (155 respondents; 59%) and "good ideas" (165 respondents; 63%) fed back to them. Respondents would have liked the annual report used to improve practice development planning (122 respondents; 46% (40% to 52%)), to facilitate audit (115 respondents; 44% (38% to 50%)), and to influence resource allocation (104 respondents; 40% (34% to 46%)). One hundred and eighteen practices (45%; 39% to 51%) would produce an annual report even if not contractually required. Data collected were perceived to be already available elsewhere. CONCLUSIONS--Primary care professionals have concerns about the current annual report. They would prefer to collect relevant, standardised data which could lead to better audit, planning, and resource allocation.     

Pollinator size and its consequences: Robust estimates of body size in pollinating insects

Body size is an integral functional trait that underlies pollination‐related ecological processes, yet it is often impractical to measure directly. Allometric scaling laws have been used to overcome this problem. However, most existing models rely upon small sample sizes, geographically restricted sampling and have limited applicability for non‐bee taxa. Allometric models that consider biogeography, phylogenetic relatedness, and intraspecific variation are urgently required to ensure greater accuracy. We measured body size as dry weight and intertegular distance (ITD) of 391 bee species (4,035 specimens) and 103 hoverfly species (399 specimens) across four biogeographic regions: Australia, Europe, North America, and South America. We updated existing models within a Bayesian mixed‐model framework to test the power of ITD to predict interspecific variation in pollinator dry weight in interaction with different co‐variates: phylogeny or taxonomy, sexual dimorphism, and biogeographic region. In addition, we used ordinary least squares regression to assess intraspecific dry weight ~ ITD relationships for ten bees and five hoverfly species. Including co‐variates led to more robust interspecific body size predictions for both bees and hoverflies relative to models with the ITD alone. In contrast, at the intraspecific level, our results demonstrate that the ITD is an inconsistent predictor of body size for bees and hoverflies. The use of allometric scaling laws to estimate body size is more suitable for interspecific comparative analyses than assessing intraspecific variation. Collectively, these models form the basis of the dynamic R package, “pollimetry,” which provides a comprehensive resource for allometric pollination research worldwide.     

基于融合理念的公立医院内部绩效考核体系探索研究

目的 建立与公立医院目标任务及外部绩效评价相匹配的内部绩效考核体系。方法 监控样本公立医院内部绩效考核体系的运行状态,对现行内部绩效考核体系的运行效果及医务人员反馈意见进行分析。调研管理部门、临床科室,访谈部门科室管理人员。结果 总结了现行内部绩效考核体系待改进的问题,提出基于医疗过程和医疗结果相结合进行全面评价、改进内部绩效工资测算方法、建立完善职能部门绩效评价体系、建立绩效沟通数据平台、融合政策执行评估的改进方案。结论 内部绩效考核体系的动态改进是公立医院实现医院目标任务、执行外部绩效评价的必然要求。     

Human–Animal Bonds Between Zoo Professionals and the Animals in Their Care

Some human‐animal relationships can be so positive that they confer emotional well‐being to both partners and can thus be viewed as bonds. In this study, 130 delegates at zoo research and training events completed questionnaires in which they were asked about their professional work in the zoo and whether they believed they had established bonds with any animals. They were also asked to indicate agreement or disagreement with several statements about human‐animal bonds. Results showed that many zoo professionals consider that they have established bonds with some of their animals; 103 respondents believed that they had a bond with at least one animal, and 78 of these identified that the bond was with a zoo animal. The most frequent bonds reported were with primates (n = 24) and carnivores (n = 28). Perceived benefits of these bonds to the respondents included both operational (animal easier to handle, easier to administer treatments to) and affective (sense of well‐being, enjoyment at being with the animal). Identifying benefits to the animals was more difficult. Most respondents identified similar benefits for their animals as for themselves, i.e. operational (animal responded more calmly, appeared less stressed) and affective (animal appeared to enjoy contact with respondent, seemed more content). This suggests that bonding between zoo professionals and their animals could have profound consequences for the management and welfare of the animals, not to mention the job satisfaction of the people involved. Zoo Biol 31:13;–26, 2012. © 2010 Wiley Periodicals, Inc.     

Roaming Companion Cats as Potential Causes of Conflict and Controversy: A Representative Questionnaire Study of the Danish Public

Cats have grown in popularity as companion animals, but there are also people who strongly dislike them. Companion cats allowed to roam freely outdoors are seen by some as a nuisance. This paper, drawing on research conducted in Denmark, aims to quantify potentially conflicting attitudes to cats among the public that may feed into cat-related conflicts and controversies. Questionnaire data were collected from a representative sample of the Danish population (n = 2,003), where 21% (n = 415) owned cats and 79% (n = 1,588) did not. In all, 65% of respondents confirmed that they liked cats, 21% reported that they did not, and 14% were undecided. The main reasons for disliking cats concerned “behavior,” not hazards such as the spread of diseases and predation. Of the 21% of the surveyed Danes who reported that they currently had a cat in the household, 72% allowed their cat to roam outdoors. Sixty percent of the respondents did not perceive this as a problem. However, the potential for conflict was demonstrated by the fact that 27% of respondents regarded outdoor roaming as problematic. Of these, about a quarter saw free-roaming cats as a big problem and as a cause of strife between neighbors. Comparatively fewer of those who owned cats saw their animals as a cause of problems. Thus, only 12% of those owning outdoor cats thought that problems were caused when their cats defecated in a neighbor’s garden, which compares with the 17% of the total population who are bothered by other people’s cats defecating in their gardens. Our data show that while the majority of Danes believe cats should be allowed to roam in public spaces, a significant minority strongly dislikes cats and would prefer restrictions on roaming.     

The Views of Healthcare Professionals,Drug Developers and Regulators on Information about Older People Needed for Rational Drug Prescription

Background

The ICH E7 guideline intends to improve the knowledge about medicines in geriatric patients. As a legislative document, it might not reflect the needs of healthcare professionals. This study investigated what information healthcare professionals, regulatory agencies and pharmaceutical industries consider necessary for rational drug prescribing to older individuals.

Methods and Findings

A 29-item-questionnaire was composed, considering the representation in trials, pharmacokinetics, efficacy, safety, and convenience of use in older individuals, with space for additions. Forty-three European professionals with an interest in medication for older individuals were included. In order to investigate their relevance, five items were included in a second questionnaire, with 11 control items. Median scores, differences between clinical and non-clinical respondents and response consistency were analysed. Consistency was present in 10 control items. Therefore, all items of the first questionnaire and the five additional items were analysed. Thirty-seven (86%) respondents returned the first questionnaire; 31/37 (84%) the second. Information about age-related differences in adverse events, locomotor effects, drug-disease interactions, dosing instructions, and information about the proportion of included 65+ patients was considered necessary by most respondents. Clinicians considered information significantly more important than the non-clinical respondents about the inclusion of 75+, time-until-benefit in older people, anticholinergic effects, drug-disease interactions, and convenience of use. Main study limitations are the focus on information for daily practice, while the ICH E7 guideline is a legislative document focused on market approval of a new medicine. Also, a questionnaire with a Likert scale has its limitations; this was addressed by providing space for comments.

Conclusions

This study reveals that items considered necessary are currently not included in the ICH E7 guideline. Also, clinicians’ and non-clinicians’ opinions differed significantly in 15% of the items. Therefore, all stakeholders should collaborate to improve the availability of information for the rational prescribing to older individuals.     

综合医院单病种过程质量及其影响因素分析

目的 分析上海市浦东新区区属公立综合医院6个单病种的医疗规范性、治疗有效性、住院天数与医疗费用以及有关影响因素。 方法 按照国家卫生计生委单病种控制和临床路径要求,对浦东新区7所区属公立综合医院的肺炎、急性心梗死、心力衰竭、2型糖尿病、急性单纯性阑尾炎、计划性剖宫产等6个病种进行病案评价。 结果 (1)6个单病种的医疗规范率总体为40.94%,治疗有效率（治愈或好转率）总体为96.84%。（2）平均住院日为2型糖尿病最长,急性阑尾炎最短;医疗费用最高为急性心梗,最低为急性阑尾炎;此外,遵循单病种质量控制或临床路径要求可降低部分疾病的住院天数及住院费用。 结论 浦东新区卫生行政部门和医院应进一步加强病种质量控制管理,提高医疗质量。     

妇产科住院医师培训模式探讨及效果评价

目的 进行妇产科住院医师培训模式探讨及效果评价。方法 采取调查问卷，考核结果统计学处理等方法。结果 超过80%人员认为进行心内科、外科、急诊科轮转很有必要，时间分别为3、3、6个月适宜。参加相关科室轮转的住院医师与未参加者在执业医师、妇产科第一、二阶段临床技能考核通过率无差异，数值上参加相关科室轮转者高于未参加者。在辅助检查上，参加相关科室轮转者高于未参加者，差异具有统计学意义。结论 建议妇产科住院医师进行相关科室轮转，科室为心内科、外科及急诊科，时间分别为3、3、6个月，可增加临床知识的广度。     

Questionnaire identifying management practices surrounding calving on spring-calving dairy farms and their associations with herd size and herd expansion

Healthy calves are fundamental to any profitable dairy enterprise. Research to-date, has focused on year-round calving systems which experience many different challenges compared to spring-calving systems. The objective of the present study was to determine the on-farm dry cow, calving, and colostrum management practices of spring-calving dairy production systems, and quantify their associations with herd size and herd expansion status (i.e. expanding or not expanding). Information on these management practices was available from a survey of 262 Irish spring-calving dairy farmers, representative of the Irish national population. Herd expansion in the 2 years before, and the year that the survey was conducted was not associated with any of the management practices investigated. Fifty-three percent of respondents had an average calving season length of 10 to14 weeks with 35% of herds having a longer calving season. Previous research in cattle has documented that both colostrum source and feeding management are associated with the transmission of infectious disease from cow to calf. In the present study 60% of respondents fed calves colostrum from their own dam; however, 66% of those respondents allowed the calf to suckle the dam, 23% of survey respondents fed calves pooled colostrum. Larger herds were more likely (P<0.01) to use pooled colostrum supplies, while smaller herds were more likely (P<0.05) to allow the calf to suckle the dam. The majority (86%) of respondents had stored supplies of colostrum; average-sized herds had the greatest likelihood of storing colostrum (P<0.05), compared to other herd sizes; larger sized herds had a lesser likelihood (P<0.05) of storing colostrum in a freezer, compared to other herd sizes. Although freezing colostrum was the most common method used to store colostrum (54% of respondents), 17% of respondents stored colostrum at room temperature, 29% of which stored it at room temperature for greater than 4 days. The results from the present study indicate that a particular focus needs to be placed on calving and colostrum management because this study has highlighted a number of areas which are below international standards, and may have repercussions for calf health. Furthermore, management practices on larger farms could be improved and, as these represent the future of dairy farming, a focus needs to be placed on them. Expanding herds are not a particular concern as herd expansion, independent of herd size, does not seem to be associated with calving and colostrum management practices on Irish spring-calving dairy herds.     

On the ability of neurons in the barn owl's inferior colliculus to sense brief appearances of interaural time difference

Summary This paper investigates the ability of neurons in the barn owl's (Tyto alba) inferior colliculus to sense brief appearances of interaural time difference (ITD), the main cue for azimuthal sound localization in this species. In the experiments, ITD-tuning was measured during presentation of a mask-probe-mask sequence. The probe consisted of a noise having a constant ITD, while the mask consisted of binaurally uncorrelated noise. Collicular neurons discriminated between the probe and masking noise by showing rapid changes from untuned to tuned and back to untuned responses.The curve describing the relation between probe duration and the degree of ITD-tuning resembled a leaky-integration process with a time constant of about 2 ms. Many neurons were ITD-tuned when probe duration was below 1 ms. These extremely short effective probe durations are interpreted as evidence for neuronal convergence within the pathway computing ITD. The minimal probe duration necessary for ITD-tuning was independent of the bandwidth of the neurons' frequency tuning and also of the best frequency of a neuron. Many narrowly tuned neurons having different best frequencies converge to form a broad-band neuron. To yield the short effective probe durations the convergence must occur in strong temporal synchronism.Abbreviations ICc central nucleus of the inferior colliculus; - ICx external nucleus of the inferior colliculus; - ITD interaural time difference - LP Likelihood parameter     

Anchoring Vignettes in the Health and Retirement Study: How Do Medical Professionals and Disability Recipients Characterize the Severity of Work Limitations?

PurposeRecent studies report systematic differences in how individuals categorize the severity of identical health and work limitation vignettes. We investigate how health professionals and disability recipients characterize the severity of work limitations and whether their reporting patterns are robust to demographic, education, and health characteristics. We use the results to illustrate the potential impact of reporting heterogeneity on the distribution of work disability estimated from self-reported categorical health and disability data.MethodNationally representative data on anchoring disability vignettes from the 2004 Health and Retirement Study (HRS) are used to investigate how respondents with an occupation background in health and Social Security disability beneficiaries categorize work limitation vignettes. Using pain, cardiovascular health, and depression vignettes, we estimate generalized ordered probit models (N = 2,660 individuals or 39,681 person-vignette observations) that allow the severity thresholds to vary by respondent characteristics.ResultsWe find that health professionals (excluding nurses) and disability recipients tend to classify identical work limitations as more severe compared to non-health professional non-disabled respondents. For disability recipients, the differences are most pronounced and particularly visible in the tails of the work limitations distribution. For health professionals, we observe smaller differences, affecting primarily the classification of mildly and moderately severe work limitations. The patterns for health professionals (excluding nurses) are robust to demographics, education, and health conditions. The greater likelihood of viewing the vignette person as more severely work limited observed among disability recipients is mostly explained by the fact that these respondents also tend to be in poorer health which itself predicts a more inclusive scale.ConclusionsKnowledge of reporting scales from health professionals and disabled individuals can benefit researchers in a broad range of applications in health and disability research. They may be useful as reference scales to evaluate disability survey data. Such knowledge may be beneficial when studying disability programs. Given the increasing availability of anchoring vignette data in surveys, this is a promising area for future evaluation research.     

综合性医院临床科室目标管理指标体系构建研究

目的 通过建立科学的临床科室目标管理指标体系,指导医院采用量化指标科学评价临床科室发展能力和贡献,为更科学地实施医院目标管理奠定基础。 方法 通过文献调查和专家咨询等方法,构建综合性医院临床科室目标管理指标体系,并以2012年安徽医科大学第二附属医院实践数据进行实证分析。结果 建立包括4个一级指标、15个二级指标、71个三级指标的目标管理评价体系,并实证分析安徽医科大学第二附属医院目标管理考核成效,研究结果与预期目标基本一致。结论 本指标体系可以量化考核临床科室发展能力和贡献水平,与预期目标基本一致,可以为医院改进临床科室考核评价工作提供客观依据。