对现阶段医疗机构药品购销模式的思考

药品作为治病救人的特殊商品,在医疗机构其零售价格受到广大患者高度关注,应接受到政府严格监管。针对当前药品流通领域存在的价格虚高、秩序混乱等问题,通过对药品购销价格政策的现状、存在问题进行分析,比较目前国内各地有代表性的医疗机构药品购销模式,探究其主要成因,特别是价格管制政策对药价虚高的影响,提出目前实行药品集中配送的购销思路与实施办法,缓解“看病贵”困局,进一步推动医药卫生体制改革。     

国内医疗机构药品拆零分装现状的系统综述

目的 了解我国医疗机构药品拆零分装的文献研究现状,为决策部门进一步规范药品经营管理提供决策依据。方法 采用系统综述的方法,检索中国生物医学文献数据库(CBM)2016年10月15日前发表的文献,通过两轮文献筛选,最终确定67篇文献进行分析。 结果 我国开展药品拆零方面的研究始于1997年,纳入的67项研究中,17.9%(12/67)的文献为原始研究,67.2%(45/67)的研究在三级医院开展,14项研究报告了门诊药房开展药品拆零分装的目的,部分研究报告了拆零方式、机构内拆零制度建设、拆零常见的问题以及质量改进措施等。 结论 当前,我国有关拆零的原始研究较少,大部分研究在三级医院开展,研究主要聚焦于拆零产生的问题。医疗机构内实际的拆零规模(品种数、金额)尚不知晓,有必要开展大规模的现场调研。     

对完善我国公立医院药品采购机制的建议

目的 为完善公立医院药品集中采购机制提供参考。方法 通过文献分析法和对比分析法总结并分析国内外公立医院药品集中采购模式和基药采购模式特点。结果 国内外不同的药品采购模式在采购目录、采购机构、采购方式、评标方式等方面都存在差异。结论 公立医院药品集中采购办法尚不完善,通过借鉴国际和基本药物采购经验,不断完善机构建设能力,发挥批量优势、实现招采合一,提高市场集中度、建立现代化物流系统等。     

新一轮药品集中采购价格10省份间对比研究

目的 研究我国10省份新一轮药品集中采购药品中标价格差异,为进一步完善我国各省的药品集中采购工作提供参考。 方法 基于“2015年全国样本医院药品采购排行榜” 和各省新一轮集中采购目录选择15种药品,通过对比研究法对15种药品的省间价格、国产药与进口药的价格进行分析,在借鉴世界卫生组织/国际卫生行动组织药品价格标准调查法的基础上,将各省的药品价格与国际参考价格进行对比分析。结果 同种药品在各省的采购价格不相同,福建省的价格明显低于其他省份的价格;少数进口药价格明显高于国产药价格;部分药品的中位价格比值超过了合理区间。结论 建议各省参考福建在药品集中采购方面的有益经验,完善各自的集中采购方案;各省应对国产通过一致性评价的仿制药、进口专利或原研药一视同仁,给予两者公平竞价的机会;将国际参考价格纳入限价参考体系中,制定更加合理的限价标准。     

安徽省药品集中招标采购配送工作的调研结果与思考

通过对安徽省6家不同所有制、不同规模、不同经营方式的药品流通企业的实地调研,了解药品流通企业及药品配送工作的基本情况,剖析了药品招标配送中存在的问题,对实施药品集中招标采购配送工作提出政策建议。     

某三级甲等医院营养类药物使用情况调查

目的:通过对某三级甲等医院2012年全年处方进行分析,调查营养类药物使用情况。方法:通过回顾性方法、Microsoft Excel 2007、SPSS 16.0对数据进行分析。结果:肠内营养乳剂(TP)使用量最大;葡萄糖注射液(20 ml)使用量排名第一;脑外科应用营养类药物比较多;肠外营养类药物的发放量大于肠内营养类药物,差异具有统计学意义(P0.05);营养类药物应用年龄区间大,男女比例约为1:1。结论:本研究调查此三级甲等医院营养类药物的使用情况,为医生、患者和医院管理者在选择营养类药物提供了参考,为我国基本药物目录修改提供了依据。     

2011 年度住院药房退药情况的调查及分析

目的:通过调查分析2011年度我院住院药房退药情况,加强药品的监督管理,促进合理用药.方法:分别统计外科,内科,妇产科,五官科,特需医疗科及其他科室的退药种类及数量和退药中数量较高的药品种类进行综合分析.结果:总退药比例占全部用药量的19.44％.总领药数和总退药数之间呈正相关(分别为r=0.971,P=0.001),其中退药量最大的科室为外科,退药量排名靠前的药品种类为抗生素类药品.结论:减少退药根本在于提升医师职业技能和职业素养,同时建立长久有效的制度和机制,以避免产生不必要的退药情况.     

附属医院晋升高级专业技术职务医疗业务考核的探索与实践

对附属医院晋升医、教、研高级专业技术职务医疗业务考核工作的现状进行介绍、分析,提出并探讨现行考核评价体系中存在的问题及解决方案, 以确保考核结果的客观、公正和透明。     

利用信息化手段的医院后勤综合调度平台“一体化”建设

医院后勤建设是医院整体工作的重要一环,但后勤本身发展往往与医院整体发展速度不同步。从改变后勤服务理念的角度入手,利用信息化的手段,建立符合当前后勤管理需要的“一体化”调度平台是一条新思路。通过一系列的流程再造和干预,实现报修和申请的全过程质量控制是解决目前后勤服务效率较低、服务能力不足、多头管理、圆圈现象、绩效考核与实际脱离等问题的有效途径。     

临床本科实习与住院医师规范化培训连贯性研究

医学教育具有其自身的特殊规律性,完整的医学教育制度是由院校教育、毕业后教育和继续教育组成的连续统一体。自2014年起,全国各地开始普遍实施住院医师规范化培训,为逐步建立专科医师规范化培训制度打下坚实的基础。以安徽医科大学为例,从内容连贯性和实际操作情况两个角度对临床本科实习内容与规范化培训内容进行比较,为实现阶梯式医学人才培养,完善专科医师规范化培训细则提供参考依据。

     

One Dog,but Which Dog? How Researchers Guide Participants to Select Dogs in Surveys of Human–Dog Relationships

Surveys and questionnaires are regularly used in studies of human–animal relationships. However, little attention has been given to understanding how survey participants are provided with instructions for the selection of a single animal within a multi-pet household, let alone the implications for reporting and interpreting data. We reviewed the instructions for the selection of an individual animal in studies addressing emotional or psychological attachment between people and dogs. By searching multidisciplinary journals from the year 2000 onwards, we identified a total of 128 papers, of which 63 met the inclusion criteria. Where selection criteria/instructions were not clear, authors were contacted. One in five studies (21%, or n = 13) did not report their instructions. When provided, instructions varied considerably. The most commonly provided direction was “favorite/closest relationship” (n = 12, or 19%). The remainder (n = 38, or 60%) were spread across eight different categories. Around half of the studies used a validated questionnaire that already contained an instruction, though a similar proportion of studies implemented author-designed instruments. Overall, the common absence and inconsistency of instructions for individual dog selection is taken to imply that there is no standard expectation or approach for instructions to be reported in studies of human relationships with dogs, or human–animal relationships more generally. We recommend further research on the implication of selection methods to ensure that instructions can be matched with specific research aims.     

广东省三级医院护理人力资源配置现状及对策研究

目的 了解广东省三级医院护 理人力资源的配置现状,探讨更合理的配置对策。方法 自行设计问卷,对广东省21个地市的76所三级医院护理人力资源数量、护理人力资源内部结构、人员流失、支持保障系统情况等现状进行研究分析。结果 8所（13.33%）医院未成立临床支持中心; 23所（38.33%）医院普通病房实际床位总数与普通病房护士总数比不达标;职业性别比例严重失衡,男性仅占2.61%;34岁及以下护士占76.38%;大专及以下学历占78.61%;高级职称占4.65%;近年离职比由3.62%上升至5.08%。结论 广东省三级医院护理人员非护理工作负担较重;人力资源总量相对不足,队伍结构欠合理;护士人力流失逐年增加。建议优化三级医院护理人力配置,重视临床服务指标,建立并完善后勤保障系统,积极开展护士岗位改革等是适应社会高速发展需求和护理学科专业化的重要举措。     

The alpha-galactosyl derivatives of ganglioside GD(1b) are essential for the organization of lipid rafts in RBL-2H3 mast cells

Gangliosides are complex glycosphingolipids that are important in many biological processes. The present study investigated the role of gangliosides in the organization of lipid rafts in RBL-2H3 mast cells and in the modulation of mast cell degranulation via FcRI. The role of gangliosides was examined using two ganglioside deficient cell lines (B6A4A2III-E5 and B6A4C1III-D1) as well as the parent cell line (RBL-2H3). All three cell lines examined express FcRI, Lyn, Syk and LAT. However, only in RBL-2H3 cells were FcRI, LAT and α-galactosyl derivatives of ganglioside GD_1b mobilized to lipid raft domains following FcRI stimulation. The inhibition of glycosphingolipid synthesis in RBL-2H3 cells also resulted in a decrease in the release of β-hexosaminidase activity after FcRI activation. The two mutant cell lines have a reduced release of β-hexosaminidase activity after FcRI stimulation, but not after exposure to calcium ionophore. These results indicate that the α-galactosyl derivatives of ganglioside GD_1b are important in the initial events of FcRI signaling upstream of Ca²⁺ influx. Since the initial signaling events occur in lipid rafts and in the mutant cell lines the rafts are disorganized, these results also suggest that these gangliosides contribute to the correct assembly of lipid rafts and are essential for mast cell activation via FcRI.     

Synthesis and molecular structure of 14,15-pyrrolidino-and 14,16-ethano derivatives of estrone

Hydrolysis of 3-methoxy-16alpha-nitro-14,17-ethenoestra-1,3,5(10)-trien-17beta-yl acetate under weakly basic conditions leads to formation of 3-methoxy-2'-oxopyrrolidino-[4',5':14beta,15beta]-estra-1,3,5 (10)-trien-17-one, the structure of which has been confirmed by X-ray analysis and some chemical transformations. The reactivity of 3-methoxy-16alpha-nitro-14,17-ethanoestra-1,3,5(10)-trien-17beta-yl acetate under various conditions of basic hydrolysis has been investigated. The derived compounds have been identified by means of NMR spectroscopy and X-ray analysis.     

Serine recombinases as tools for genome engineering

The serine recombinases differ mechanistically from the tyrosine recombinases and include proteins such as ?C31 integrase which, unlike Cre and Flp, promote unidirectional reactions. The serine recombinase family is large and includes many other proteins besides ?C31 integrase with the potential to be widely used in genome engineering. Here we review the details of the mechanism of the reactions promoted by the serine recombinases and discuss how these not only limit the utility of this class of recombinase but also creates opportunities for the engineering of new enzymes. We discuss the unanswered questions posed by genome engineering experiments in a variety of systems in which the serine recombinases have been used and finally describe more recently discovered serine recombinases that have the potential to be used in genome engineering.     

Geometry of nonbonded interactions involving planar groups in proteins

Although hydrophobic interaction is the main contributing factor to the stability of the protein fold, the specificity of the folding process depends on many directional interactions. An analysis has been carried out on the geometry of interaction between planar moieties of ten side chains (Phe, Tyr, Trp, His, Arg, Pro, Asp, Glu, Asn and Gln), the aromatic residues and the sulfide planes (of Met and cystine), and the aromatic residues and the peptide planes within the protein tertiary structures available in the Protein Data Bank. The occurrence of hydrogen bonds and other nonconventional interactions such as C-H...pi, C-H...O, electrophile-nucleophile interactions involving the planar moieties has been elucidated. The specific nature of the interactions constraints many of the residue pairs to occur with a fixed sequence difference, maintaining a sequential order, when located in secondary structural elements, such as alpha-helices and beta-turns. The importance of many of these interactions (for example, aromatic residues interacting with Pro or cystine sulfur atom) is revealed by the higher degree of conservation observed for them in protein structures and binding regions. The planar residues are well represented in the active sites, and the geometry of their interactions does not deviate from the general distribution. The geometrical relationship between interacting residues provides valuable insights into the process of protein folding and would be useful for the design of protein molecules and modulation of their binding properties.