医院行政管理人员培训需求的调查研究

目的 明确医院行政管理队伍培训需求,为建立规范化培训体系,提高医院管理水平奠定基础。方法 采用问卷调查法,面向医院行政管理人员开展个人培训需求意愿、医院内部管理体系运行现状及个人岗位胜任能力调查,在此基础上进行组织、岗位及个人层面的培训需求分析。结果 医院行政管理人员接受培训的意愿较为突出,而不同层级之间对培训内容、时间及方式的需求存在明显差异。结论 医院行政管理人员具有较为强烈的培训需求,建立一套科学实用的长效培训机制是建设高素质医院管理队伍的基础性工程。     

住院医师规范化培训管理现状调查与分析

目的 调查分析医院开展住院医师规范化培训现状。方法 选取2011—2013年进入医院住院医师规范化培训基地的住院医师,采用现场发放调查问卷方法进行无记名调查分析。将调查内容分为报名招录、轮转培训、各类考核、组织管理和其他板块。结果 96.7%认为医院招录过程合理或基本合理,92.6%认为培训计划制定具有一定的合理性,90.1%住院医师能够按照规定完成培训内容,各类考核内容基本能够反映住院医师的培训水平。在众多培训期间存在困难中,依次为收入偏低、个人婚恋生育计划难以实施以及工作和学习压力过大。结论 住院医师基本认同目前医院的培训管理制度和方法,逐步提高住院医师薪酬待遇,有效疏导培训压力和加强师资队伍建设是提高住院医师培训积极性和培训质量的保证。     

广西百色市辖区医院急诊科医务人员岗前培训情况调查

目的了解广西百色市辖区医院急诊医务人员岗前培训情况及其需求。方法采用普查的方法,对广西百色市辖区二级以上医院的急诊科2016年度新进医务人员进行问卷调查,辅以电话访谈及现场走访。结果 97%医务人员接受过以心肺复苏、电除颤、气管插管、呼吸机使用为内容的岗前培训。结论广西百色市辖区二级以上医院急诊科2016年度新进医务人员对岗前培训基本满意,并认为培训内容仅仅部分满足临床需要,部分内容医护应分别培训,可根据不同的培训内容灵活采用各种教学形式及培训方法,以提高岗前培训的质量。     

陕西省医院药学技术人员继续教育现状与需求分析

目的 了解陕西省公立医院药学技术人员继续教育的现状、存在的问题及需求状况。方法 采用整群随机抽样的方法,分别在陕南、关中、陕北各抽取2所三级医院和6所二级医院,采用调查问卷和现场访谈法对各医院药学技术人员进行问卷调查和访谈。结果 针对当前的培训现状,47.61%的人认为培训机会比较适中,36.36%的人认为培训内容不足,31.58%的人每个月培训一次,44.26%的人认为培训的意义非常大;现阶段的问题集中在培训内容缺乏实践性、培训的时间太短以及培训授课速度过快3个方面,对未来继续教育内容的期望集中体现在药学基础知识、药学信息服务和临床药学3个方面。结论 应从继续教育的内容、培训形式、培训时间、费用负担以及培训频次等多个方面作合理安排和准备。     

贵州省县级医院决策者的管理培训现状及需求调查

目的 为制订县级医院决策者培训计划提供依据,对贵州省县级医院决策者的管理培训现状及需求进行调查。方法 以贵州省县级医院决策者为调查对象,按照研究主题设计调查表,实施调查,获取数据进行分类整理、分析。结果 （1）医院决策者以中青年为主,分布于40～50岁;大学本科、副高及中级职称为主;（2）岗位前所学专业主要为临床医疗,专业管理人员少;从事管理5～15年占总体的59.31%;65.24%为兼职管理人员。（3）接受3个月以内的培训（65.80%）,3个月以上培训（9.52%）,未接受过培训（24.67%）;大部分人员接受过管理知识培训（21.21%～64.50%）,就培训内容而言,仅有接受医疗法律法规的决策者超过50%,绝大部分调查培训内容均未超过50%。（4）最需要的培训知识为战略管理（49.78%）、经营管理（53.25%）、人力资源管理（51.56%）、医院信息系统管理（45.89%）、领导科学（51.52%）。结论 县级医院决策者其培养时间及培养内容不足,医院决策者管理能力尚需加强。     

医学工程人员培训及工作满意度现状分析

目的 对医学工程人员的基本情况、培训情况、培训需要以及工作满意度情况调查,为医学工程人员的继续教育和管理提供建议。方法 取武汉三级医院8家、二级医院2家,在每家医院的医学工程部门中随机抽取15名进行问卷调查。结果 调查医学工程人员138名,大专及以下学历占47.9%;97.8%的医学工程人员愿意接受在职教育和培训的意愿;对职称、收入、在医院的地位、晋升机会满意的比例为17.4%、13.1%、15.2%、19.6%。讨论 医学工程人员整体学历偏低;医学工程人员培训需求较大;医学工程人员对职称、收入、在医院的地位、晋升机会、在职教育和培训的机会等满意度均较低。医院应建立科学的职业晋升制度、激励制度、培训方案,同时鼓励医学工程人员积极参加培训。     

加强医院中层干部培训,提升廉政风险防范能力

目的探讨加强医院中层干部培训后,提升廉政风险防范能力的实施及应用效果。方法通过制定相应的培训计划,组织实施综合素质教育,并在培训过程中,加强理想信念教育,提高情商,同时综合国内外的形势分析,进行柔性管理,指导如何舒缓管理压力等一系列内容培训。结果通过培训提高了中层干部的综合素质。结论加强医院中层干部培训,廉政风险防范能力得到明显提升。     

综合性医院初级医生全科化培养探讨

简要概述了国外医院住院医师培养,总结了当前医院在初级医生培养中存在的问题。以南京军区南京总医院为例,着重从制度保障、培训内容、培训方式3个方面论述了初级医生全科化培养模式的实践方法。     

9所大学附属医院职业化管理认知及培训需求分析

目的 调查并分析某医科大学9所附属医院职能部门工作人员对管理人员职业化的认知和培训需求。方法 采用整群抽样法,向9所附属医院的职能部门工作人员发放调查问卷,调查内容包括个人基本情况、工作情况、培训情况等五部分内容,共发放799份问卷,回收799份问卷,回收率100%。结果 9所附属医院职能部门工作人员中,有78.7%对未来职业发展有信心,21.0%认为目前的医院管理职业化建设不完善,57.5%认为医院中高层管理者应该来源于卫生管理专业人员,59.4%认为培训次数不够,60.4%认为迫切需要进行管理知识培训。结论 大多数医院管理人员对未来职业化发展有信心,但是目前医院管理知识培训存在不足,建议大学与附属医院合作开展系统的个性化的医院管理知识培训,提高医院管理水平,促进管理队伍职业化发展。     

职业化培训对医院管理人员提升管理效能的重要性

有效的管理对医院履行社会责任至关重要,医院管理人员作为管理队伍的中坚力量,需要在日常管理工作中充分运用前沿的管理理念,将管理工作制度化、规范化、信息化及人性化,及时反馈患者、医务人员的需求及满意度,提高管理效能和服务质量。因此,加强医院管理人员职业化培训就显得尤为重要。本文从教育培训、准入制度、激励机制、评价体系等方面分析现阶段职业化培训的有效做法,探讨医院管理人员职业化建设对提升医院管理效能的必要性及重要性。     

Chloroquine sensitizes breast cancer cells to chemotherapy independent of autophagy

Chloroquine (CQ) is a 4-aminoquinoline drug used for the treatment of diverse diseases. It inhibits lysosomal acidification and therefore prevents autophagy by blocking autophagosome fusion and degradation. In cancer treatment, CQ is often used in combination with chemotherapeutic drugs and radiation because it has been shown to enhance the efficacy of tumor cell killing. Since CQ and its derivatives are the only inhibitors of autophagy that are available for use in the clinic, multiple ongoing clinical trials are currently using CQ or hydroxychloroquine (HCQ) for this purpose, either alone, or in combination with other anticancer drugs. Here we show that in the mouse breast cancer cell lines, 67NR and 4T1, autophagy is induced by the DNA damaging agent cisplatin or by drugs that selectively target autophagy regulation, the PtdIns3K inhibitor LY294002, and the mTOR inhibitor rapamycin. In combination with these drugs, CQ sensitized to these treatments, though this effect was more evident with LY294002 and rapamycin treatment. Surprisingly, however, in these experiments CQ sensitization occurred independent of autophagy inhibition, since sensitization was not mimicked by Atg12, Beclin 1 knockdown or bafilomycin treatment, and occurred even in the absence of Atg12. We therefore propose that although CQ might be helpful in combination with cancer therapeutic drugs, its sensitizing effects can occur independently of autophagy inhibition. Consequently, this possibility should be considered in the ongoing clinical trials where CQ or HCQ are used in the treatment of cancer, and caution is warranted when CQ treatment is used in cytotoxic assays in autophagy research.     

Endoplasmic reticulum stress mediating downregulated StAR and 3-beta-HSD and low plasma testosterone caused by hypoxia is attenuated by CPU86017-RS and nifedipine

Background  

Hypoxia exposure initiates low serum testosterone levels that could be attributed to downregulated androgen biosynthesizing genes such as StAR (steroidogenic acute regulatory protein) and 3-beta-HSD (3-beta-hydroxysteroid dehydrogenase) in the testis. It was hypothesized that these abnormalities in the testis by hypoxia are associated with oxidative stress and an increase in chaperones of endoplasmic reticulum stress (ER stress) and ER stress could be modulated by a reduction in calcium influx. Therefore, we verify that if an application of CPU86017-RS (simplified as RS, a derivative to berberine) could alleviate the ER stress and depressed gene expressions of StAR and 3-beta-HSD, and low plasma testosterone in hypoxic rats, these were compared with those of nifedipine.     

Rational Design of Broad Spectrum Antibacterial Activity Based on a Clinically Relevant Enoyl-Acyl Carrier Protein (ACP) Reductase Inhibitor

Determining the molecular basis for target selectivity is of particular importance in drug discovery. The ideal antibiotic should be active against a broad spectrum of pathogenic organisms with a minimal effect on human targets. {"type":"entrez-nucleotide","attrs":{"text":"CG400549","term_id":"34399433","term_text":"CG400549"}}CG400549, a Staphylococcus-specific 2-pyridone compound that inhibits the enoyl-acyl carrier protein reductase (FabI), has recently been shown to possess human efficacy for the treatment of methicillin-resistant Staphylococcus aureus infections, which constitute a serious threat to human health. In this study, we solved the structures of three different FabI homologues in complex with several pyridone inhibitors, including {"type":"entrez-nucleotide","attrs":{"text":"CG400549","term_id":"34399433","term_text":"CG400549"}}CG400549. Based on these structures, we rationalize the 65-fold reduced affinity of {"type":"entrez-nucleotide","attrs":{"text":"CG400549","term_id":"34399433","term_text":"CG400549"}}CG400549 toward Escherichia coli versus S. aureus FabI and implement concepts to improve the spectrum of antibacterial activity. The identification of different conformational states along the reaction coordinate of the enzymatic hydride transfer provides an elegant visual depiction of the relationship between catalysis and inhibition, which facilitates rational inhibitor design. Ultimately, we developed the novel 4-pyridone-based FabI inhibitor PT166 that retained favorable pharmacokinetics and efficacy in a mouse model of S. aureus infection with extended activity against Gram-negative and mycobacterial organisms.     

Small molecule sensitization to TRAIL is mediated via nuclear localization,phosphorylation and inhibition of chaperone activity of Hsp27

The small chaperone protein Hsp27 confers resistance to apoptosis, and therefore is an attractive anticancer drug target. We report here a novel mechanism underlying the tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) sensitizing activity of the small molecule {"type":"entrez-nucleotide","attrs":{"text":"LY303511","term_id":"1257646067","term_text":"LY303511"}}LY303511, an inactive analog of the phosphoinositide 3-kinase inhibitor inhibitor {"type":"entrez-nucleotide","attrs":{"text":"LY294002","term_id":"1257998346","term_text":"LY294002"}}LY294002, in HeLa cells that are refractory to TRAIL-induced apoptosis. On the basis of the fact that {"type":"entrez-nucleotide","attrs":{"text":"LY303511","term_id":"1257646067","term_text":"LY303511"}}LY303511 is derived from {"type":"entrez-nucleotide","attrs":{"text":"LY294002","term_id":"1257998346","term_text":"LY294002"}}LY294002, itself derived from quercetin, and earlier findings indicating that quercetin and {"type":"entrez-nucleotide","attrs":{"text":"LY294002","term_id":"1257998346","term_text":"LY294002"}}LY294002 affected Hsp27 expression, we investigated whether {"type":"entrez-nucleotide","attrs":{"text":"LY303511","term_id":"1257646067","term_text":"LY303511"}}LY303511 sensitized cancer cells to TRAIL via a conserved inhibitory effect on Hsp27. We provide evidence that upon treatment with {"type":"entrez-nucleotide","attrs":{"text":"LY303511","term_id":"1257646067","term_text":"LY303511"}}LY303511, Hsp27 is progressively sequestered in the nucleus, thus reducing its protective effect in the cytosol during the apoptotic process. {"type":"entrez-nucleotide","attrs":{"text":"LY303511","term_id":"1257646067","term_text":"LY303511"}}LY303511-induced nuclear translocation of Hsp27 is linked to its sustained phosphorylation via activation of p38 kinase and MAPKAP kinase 2 and the inhibition of PP2A. Furthermore, Hsp27 phosphorylation leads to the subsequent dissociation of its large oligomers and a decrease in its chaperone activity, thereby further compromising the death inhibitory activity of Hsp27. Furthermore, genetic manipulation of Hsp27 expression significantly affected the TRAIL sensitizing activity of {"type":"entrez-nucleotide","attrs":{"text":"LY303511","term_id":"1257646067","term_text":"LY303511"}}LY303511, which corroborated the Hsp27 targeting activity of {"type":"entrez-nucleotide","attrs":{"text":"LY303511","term_id":"1257646067","term_text":"LY303511"}}LY303511. Taken together, these data indicate a novel mechanism of small molecule sensitization to TRAIL through targeting of Hsp27 functions, rather than its overall expression, leading to decreased cellular protection, which could have therapeutic implications for overcoming chemotherapy resistance in tumor cells.     

USP7 inhibitor P22077 inhibits neuroblastoma growth via inducing p53-mediated apoptosis

Neuroblastoma (NB) is a common pediatric cancer and contributes to more than 15% of all pediatric cancer-related deaths. Unlike adult tumors, recurrent somatic mutations in NB, such as tumor protein 53 (p53) mutations, occur with relative paucity. In addition, p53 downstream function is intact in NB cells with wild-type p53, suggesting that reactivation of p53 may be a viable therapeutic strategy for NB treatment. Herein, we report that the ubiquitin-specific protease 7 (USP7) inhibitor, {"type":"entrez-protein","attrs":{"text":"P22077","term_id":"134707","term_text":"P22077"}}P22077, potently induces apoptosis in NB cells with an intact USP7-HDM2-p53 axis but not in NB cells with mutant p53 or without human homolog of MDM2 (HDM2) expression. In this study, we found that {"type":"entrez-protein","attrs":{"text":"P22077","term_id":"134707","term_text":"P22077"}}P22077 stabilized p53 by inducing HDM2 protein degradation in NB cells. {"type":"entrez-protein","attrs":{"text":"P22077","term_id":"134707","term_text":"P22077"}}P22077 also significantly augmented the cytotoxic effects of doxorubicin (Dox) and etoposide (VP-16) in NB cells with an intact USP7-HDM2-p53 axis. Moreover, {"type":"entrez-protein","attrs":{"text":"P22077","term_id":"134707","term_text":"P22077"}}P22077 was found to be able to sensitize chemoresistant LA-N-6 NB cells to chemotherapy. In an in vivo orthotopic NB mouse model, {"type":"entrez-protein","attrs":{"text":"P22077","term_id":"134707","term_text":"P22077"}}P22077 significantly inhibited the xenograft growth of three NB cell lines. Database analysis of NB patients shows that high expression of USP7 significantly predicts poor outcomes. Together, our data strongly suggest that targeting USP7 is a novel concept in the treatment of NB. USP7-specific inhibitors like {"type":"entrez-protein","attrs":{"text":"P22077","term_id":"134707","term_text":"P22077"}}P22077 may serve not only as a stand-alone therapy but also as an effective adjunct to current chemotherapeutic regimens for treating NB with an intact USP7-HDM2-p53 axis.     

Enzymatic measurement of phosphatidic acid in cultured cells

In this work, we developed a novel enzymatic method for measuring phosphatidic acid (PA) in cultured cells. The enzymatic reaction sequence of the method involves hydrolysis of PA to produce glycerol-3-phosphate (G3P), which is then oxidized by G3P oxidase to generate hydrogen peroxide. In the presence of peroxidase, hydrogen peroxide reacted with Amplex Red to produce highly fluorescent resorufin. We found that lipase from Pseudomonas sp. can completely hydrolyze PA to G3P and FAs. The calibration curve for PA measurement was linear between 20 and 250 µM, and the detection limit was 5 µM (50 pmol in the reaction mixture). We also modified the method for the enzymatic measurement of lysophosphatidic acid. By this new method, we determined the PA content in the lipid extract from HEK293 cells. The cellular content of PA was decreased with increasing cell density but not correlated with the proliferation rate. The diacylglycerol kinase inhibitor {"type":"entrez-nucleotide","attrs":{"text":"R59949","term_id":"830644","term_text":"R59949"}}R59949 markedly reduced the cellular PA content, suggesting the diacylglycerol kinase activity was involved in a large part of the PA production in HEK293 cells. This novel method for PA quantification is simple, rapid, specific, sensitive, and high-throughput and will help to study the biological functions of PA and its related enzymes.     

Direct activation of human phospholipase C by its well known inhibitor u73122

Phospholipase C (PLC) enzymes are an important family of regulatory proteins involved in numerous cellular functions, primarily through hydrolysis of the polar head group from inositol-containing membrane phospholipids. U73122 (1-(6-((17β-3-methoxyestra-1,3,5(10)-trien-17-yl)amino)hexyl)-1H-pyrrole-2,5-dione), one of only a few small molecules reported to inhibit the activity of these enzymes, has been broadly applied as a pharmacological tool to implicate PLCs in diverse experimental phenotypes. The purpose of this study was to develop a better understanding of molecular interactions between U73122 and PLCs. Hence, the effects of U73122 on human PLCβ3 (hPLCβ3) were evaluated in a cell-free micellar system. Surprisingly, U73122 increased the activity of hPLCβ3 in a concentration- and time-dependent manner; up to an 8-fold increase in enzyme activity was observed with an EC50=13.6±5 μm. Activation of hPLCβ3 by U73122 required covalent modification of cysteines as evidenced by the observation that enzyme activation was attenuated by thiol-containing nucleophiles, l-cysteine and glutathione. Mass spectrometric analysis confirmed covalent reaction with U73122 at eight cysteines, although maximum activation was achieved without complete alkylation; the modified residues were identified by LC/MS/MS peptide sequencing. Interestingly, U73122 (10 μm) also activated hPLCγ1 (>10-fold) and hPLCβ2 (～2-fold); PLCδ1 was neither activated nor inhibited. Therefore, in contrast to its reported inhibitory potential, U73122 failed to inhibit several purified PLCs. Most of these PLCs were directly activated by U73122, and a simple mechanism for the activation is proposed. These results strongly suggest a need to re-evaluate the use of U73122 as a general inhibitor of PLC isozymes.     

The Chemical Uncoupler 2,4-Dinitrophenol (DNP) Protects against Diet-induced Obesity and Improves Energy Homeostasis in Mice at Thermoneutrality

The chemical uncoupler 2,4-dinitrophenol (DNP) was an effective and widely used weight loss drug in the early 1930s. However, the physiology of DNP has not been studied in detail because toxicity, including hyperthermia and death, reduced interest in the clinical use of chemical uncouplers. To investigate DNP action, mice fed a high fat diet and housed at 30 °C (to minimize facultative thermogenesis) were treated with 800 mg/liter DNP in drinking water. DNP treatment increased energy expenditure by ∼17%, but did not change food intake. DNP-treated mice weighed 26% less than controls after 2 months of treatment due to decreased fat mass, without a change in lean mass. DNP improved glucose tolerance and reduced hepatic steatosis without observed toxicity. DNP treatment also reduced circulating T3 and T4 levels, Ucp1 expression, and brown adipose tissue activity, demonstrating that DNP-mediated heat generation substituted for brown adipose tissue thermogenesis. At 22 °C, a typical vivarium temperature that is below thermoneutrality, DNP treatment had no effect on body weight, adiposity, or glucose homeostasis. Thus, environmental temperature should be considered when assessing an anti-obesity drug in mice, particularly agents acting on energy expenditure. Furthermore, the beneficial effects of DNP suggest that chemical uncouplers deserve further investigation for the treatment of obesity and its comorbidities.     

皮肤病专科医院电子病历的设计与应用

???????目的 研究与开发具有皮肤病专科特色的电子病历系统,以实现皮肤科病人医疗信息的采集、加工、存储、传输和服务。方法 以windows sqlserver2005为后台数据库,以XML、C#为开发语言,建立皮肤病结构化病历。结果 该系统运行良好,安全稳定、易维护、通用性好。有效地提高了医生书写病历的速度和质量,并具有皮疹数码照片嵌入等功能。结论 本研究实现了具有皮肤病专科特色的电子病历系统,值得皮肤病医院推荐使用。     

医院临床科室质量与安全管理架构的探讨

随着人们对健康的不断关注,促进临床医疗服务质量的持续改进,是现阶段医院质量与安全管理工作的重点。提出应强化科室质量与安全管理小组职责,构建临床科室质量与安全管理的九项工作架构,不断引领临床科室逐步落实医院各项管理要求,以达到质量持续改进的目标。