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新医改方案中明确提出了健全基层医疗卫生服务体系,建立城市医院与社区卫生服务机构的分工协作机制,引导一般诊疗下沉到基层,逐步实现社区首诊、分级医疗和双向转诊,缓解目前“看病难、看病贵”的就医矛盾。双向转诊是实施医疗卫生体制改革的突破方略。对双向转诊模式进行实践和研究,以期最终实现医疗资源的节约和人民群众的就医方便。 相似文献
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目的 探讨转诊患者对上下级医疗机构医疗服务、转诊服务的认知行为及其影响因素,以期明确“患者角度”医疗服务体系存在的问题,并提出构建与优化分级医疗服务体系的建议。方法 分别在东、中、西地区选择有转诊经验的患者为样本,收集其基本情况、健康状况、就诊行为、对双向转诊的认知、满意度情况及其评价等信息,运用卡方检验、秩和检验和ordinal logistic进行分析。结果 82.7%的患者赞成疾病首诊应在基层医疗机构,但缺乏对基层医疗机构的信任。在患者看来,提高基层医务人员水平和医疗费用报销比例是影响其择医的主要因素。患者对医疗机构间转诊制度满意程度受地区、患者年龄、就医方便程度、转诊过程的方便程度等因素影响。结论 患者对于分级医疗的认识存在误区,且对基层医疗机构明显缺乏信任感。应从改善基层医疗机构服务能力、加强信息引导和健康教育、梯度化医疗保险制度等方面优化分级医疗体系建设。 相似文献
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通过国内外相关文献资料的患者门诊就医行为分析和研究,发现并总结出患者就医行为的影响因素、不同病种和不同人群的就医流向趋势。其研究结果可为我国分级诊疗的基层首诊、双向转诊等相关政策的制订和完善提供较为准确的理论依据,以促进分级诊疗的健康发展。 相似文献
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目的 调查日间手术病人术后安全性及患者的价值感知、风险感知。方法 问卷调查和电话调查。结果 609例患者调查结果显示:日间手术患者对医疗服务的满意度96.2%,对医疗质量的满意度为95.9%;日间手术患者出院后再住院率为0.05%,再就诊率2.9%;64.9%的患者意识到日间手术模式较住院手术具有更高的便利价值,49.1%的患者意识到日间手术模式的货币价值, 57.0 %的患者意识到日间手术的社会价值;风险感知方面,50.4%的患者担心如果出现不适后,不能得到及时的处理;22.0%的患者对没有医护人员照护下的康复,在心理上的准备不足。结论 日间手术模式是一种安全有效的医疗模式,对这种模式患者具有较高的价值感知,同时也存在较高的风险感知。 相似文献
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为响应国家卫计委全面推进分级诊疗工作的号召,解决百姓看病难、看病贵以及医疗资源不均衡的问题,西安市雁塔区作为陕西省城市医院分级诊疗首个试点,探索组建了以西安交通大学第一附属医院为核心的区域医疗联合体,并且将区域内各个医疗卫生机构的医疗资源整合在一起,搭建起地方区域分级诊疗信息共享平台。通过区域卫生分级诊疗信息平台的建立,实现了区域内医疗卫生机构基本业务信息系统数据的交换和共享,解决了医疗机构、卫生管理机构“信息孤岛”问题,建立起基层首诊、双向转诊、急慢分治、上下联动的分级诊疗模式,全面带动了陕西省医疗机构分级诊疗工作的开展。 相似文献
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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。 相似文献
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国内外蝗害治理技术现状与展望 总被引:3,自引:0,他引:3
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、... 相似文献
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Synthesis and turnover of cerebrosides and phosphatidylserine of myelin and microsomal fractions of adult and developing rat brain. 总被引:5,自引:1,他引:5
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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. 相似文献
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L.A. Devriese J.I. Cruz Colque P. De Herdt F. Haesebrouck 《Journal of applied microbiology》1992,73(5):421-425
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. 相似文献
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. 相似文献
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Molecular characterisation of species and genotypes of Cryptosporidium and Giardia and assessment of zoonotic transmission 总被引:4,自引:0,他引:4
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. 相似文献
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白术同源四倍体的诱导和鉴定及其与二倍体过氧化物酶的比较 总被引:18,自引:0,他引:18
以白术(Atractylodes macrooephala Koidz.)二倍体组培苗为材料,对其四倍体诱导方法进行研究,共获得45个白术同源四倍体株系,为优良株系的选育提供了材料。此外,还分析比较了其中8个白术四倍体株系与二倍体的过氧化物酶同工酶(POD)的酶谱差异,发现四倍体各株系过氧化物酶同工酶谱比二倍体的均多了Rf0.310的谱带,且总过氧化物酶比活力也发生了很大改变,对探讨白术四倍体优良株系的生理生化机理具有一定的参考价值。 相似文献
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Juozas Kulys Kastis Krikstopaitis Arturas Ziemys 《Journal of biological inorganic chemistry》2000,5(3):333-340
N -substituted phenothiazines (PTs) and phenoxazines (POs) catalyzed by fungal Coprinus cinereus peroxidase and Polyporus pinsitus laccase were investigated at pH 4–10. In the case of peroxidase, an apparent bimolecular rate constant (expressed as k
cat/K
m) varied from 1 ×107 M−1 s−1to 2.6×108 M−1 s−1 at pH 7.0. The constants for PO oxidation were higher in comparison to PT. pH dependence revealed two or three ionizable
groups with pK
a values of 4.9–5.7 and 7.7–9.7 that significantly affected the activity of peroxidase. Single-turnover experiments showed
that the limiting step of PT oxidation was reduction of compound II and second-order rate constants were obtained which were
consistent with the constants at steady-state conditions. Laccase-catalyzed PT and PO oxidation rates were lower; apparent
bimolecular rate constants varied from 1.8×105 M−1 s−1 to 2.0×107 M−1 s−1 at pH 5.3. PO constants were higher in comparison to PT, as was the case with peroxidase. The dependence of the apparent
bimolecular constants of compound II or copper type 1 reduction, in the case of peroxidase or laccase, respectively, was analyzed
in the framework of the Marcus outer-sphere electron-transfer theory. Peroxidase-catalyzed reactions with PT, as well as PO,
fitted the same hyperbolic dependence with a maximal oxidation rate of 1.6×108 M−1 s−1 and a reorganization energy of 0.30 eV. The respective parameters for laccase were 5.0×107 M−1 s−1 and 0.29 eV.
Received: 20 September 1999 / Accepted: 24 February 2000 相似文献