护士长的工作方式对护患关系的影响

目的 探讨护士长的工作方式对护患关系的影响。方法 护士长改变传统的工作方式，每天与病人家属进行有效沟通，主要针对新病人、危重症病人、临出院病人。结果 实验组病人家属对护理工作的满意度较对照组有明显改善。结论 与病人家属建立良好的护患关系，为患者及家属提供优质的服务，是改善护患关系的重要举措。     

河南省医师执业环境现况调查与发展对策研究

目的 了解河南省医师执业环境现状,探讨其存在的问题,为改善医师执业环境提出建议。方法河南省医师协会组织多个专科分会,采用集中填答法进行问卷调查。结果 医师每周平均工作时间是54小时,80.1%的医师认为执业环境差;工作压力来源排前三位的是患者的期望值高、医疗纠纷多、患者和公众对医生不信任;患者暴力频度和家属暴力频度很频繁或较频繁的数据都高于10%;62.2%的医师认为社会地位低于4年前水平,子女报考医学院校的意愿选择不愿意的占66.8%。结论 应加快基层医疗机构的建设,缓解医生工作压力;重视医德医风建设;正确发挥媒体导向作用;加强法制建设,改善医师执业环境。     

前馈控制在ICU护理质量控制中的应用

目的 探讨ICU实施前馈控制的方法和效果,以提高护理质量。方法 在ICU病区建立质量控制架构（三级质控网）,采用前馈质控方法,对ICU护理工作进行全面质量控制管理。结果 实施前馈质控后,病房护理管理质量、消毒隔离质量、护理文件书写质量、教学质量、家属满意度、护士工作满意度等各项指标评分都有明显提高,不良事件发生率明显下降,差异有统计学意义(P<0.01)。结论 前馈控制方法整体上提高了ICU风险管理能力、护理管理效率和护理质量。     

住院医师/专科医师对规范化培训带教师资和培训管理的满意度调查分析

目的 调查参加规范化培训的住院/专科医师对带教师资综合职业能力和培训管理的满意度,进一步了解不同医院开展毕业后医学教育所面临的问题和进行毕业后医学教育规范化培训异同。方法 采用自制问卷对成都市4所三级甲等医院598名住院/专科医师进行问卷调查,对收集的数据进行因子分析和方差分析。结果 受调查的598名住院/专科医师对带教师资的综合职业能力的满意度评分在3.83～4.11之间﹝满分为5分﹞,而对培训管理的满意度评分在2.91～3.75之间,且不同医院住院/专科医师的满意度有差异性﹝P﹤0.05﹞。结论 无论教学医院还是非教学医院,都应加强带教师资建设和培训管理,才能提高住院/专科医师对规范化培训的满意度,以促进住院/专科医师规范化培训的顺利开展。     

基于品管圈的单孔腹腔镜胆囊切除术知晓率 ——以提高老年患者知晓率为例

目的 提高老年患者对单孔腹腔镜胆囊切除术的知晓率。方法 开展品管圈活动,找出老年患者对该术知晓率低的原因,制定并实施相应措施。结果 经医生判断符合该术标准的老年患者,对手术的知晓率、选择率显著增加;术后疼痛评分降低,住院时间缩短,家属的负担减轻,对护理工作的满意度提高;护理人员的专业知识、解决问题及人际关系能力、创新精神提高。结论 品管圈活动提高老年患者对单孔腹腔镜胆囊切除术的知晓率和护理人员的综合素质。     

临床路径在神经根型颈椎病保守治疗中的应用与变异管理

目的 评价临床路径在神经根型颈椎病保守治疗中的应用效果。方法 通过制订临床路径,将实施临床路径前后病人的住院天数、医疗费用、健康知识评分、满意度进行比较并对出现的变异进行管理。结果 实施临床路径提高了医务人员工作的主动性,加强了医患沟通,使患者住院天数、医疗费用有所下降,健康知识掌握情况、满意度有所提高。统计学分析差异有显著性。结论 临床路径作为一种新型的医疗质量管理模式,值得在临床推广应用。临床执行过程中应注意对变异的管理。     

浙江省儿科医生工作满意度与离职意愿调查

目的 了解浙江省儿科医生工作满意度和离职意愿现状,分析满意度和离职意愿的影响因素。方法 抽取浙江省儿科医生414名,采取问卷调查法,运用明尼苏达工作满意度短式量表和离职意愿量表进行调查。结果 浙江省儿科医生本科学历居多,大多来自三级医院;总体满意度与职称、收入成正相关,与专业背景、离职意愿负相关（P＜0.05）;外在满意度与学历、专业背景、离职意愿负相关（P＜0.05）;内在满意度与年龄、职称、儿科工作年限、收入、医院等级正相关,与离职意愿负相关（P＜0.05）;离职意愿与年龄、职称、儿科工作年限、收入、各满意度负相关（P＜0.05）。结论 提高儿科医生满意度要重点提高其外在满意度,即工作环境、职位的晋升、收入等;提高收入可以明显降低儿科医生离职意愿;专业背景是满意度和离职意愿共同的影响因素,儿科专业背景的儿科医生具有更好的从业稳定性。     

带教师资对规范化培训住院/专科医师综合职业能力的满意度调查分析

目的 调查带教师资对参加规范化培训的住院/专科医师综合职业能力的满意度。方法 采用自制问卷,对成都市4所三级甲等医院515名带教师资进行问卷调查,每项的满意度按5分记数,最高分5分,对收集的数据进行因子分析和方差分析。结果 受调查的515名师资对住院医师的综合职业能力的满意度评分均值为（3.48±0.58）分,不同医院的带教师资对住院/专科医师的满意度评价有差异性﹝P﹤0.05﹞。结论 人事关系类别是影响师资与学员相互之间的满意度因素之一,因此,无论教学医院还是非教学医院都应注意人事制度改革带来的多元化人力资源管理。

     

北京市医师多点执业政策患者认知与需求调查与分析

目的 通过问卷调查研究分析患者对目前北京市医师多点执业政策的认知和需求情况。方法 在北京地区8家医疗机构内,对959名就诊患者进行问卷调查,统计并分析患者人群对医师多点执业政策的评价。结果 患者人群对医师多点执业政策的总体支持率较高,达到77.0%。结论 医师多点执业政策是一项利国利民的好政策,不过尚需进一步完善并且有效地实施,才能取得好的成效。     

壳聚糖酶的克隆表达与壳寡糖的制备分析

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。     

国内外蝗害治理技术现状与展望

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、...     

Kinetics and thermodynamics of peroxidase- and laccase-catalyzed oxidation of N-substituted phenothiazines and phenoxazines

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 ×10⁷M⁻¹s⁻¹to 2.6×10⁸M⁻¹s⁻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 1.8×10⁵M⁻¹s⁻¹ to 2.0×10⁷M⁻¹s⁻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 1.6×10⁸M⁻¹s⁻¹ and a reorganization energy of 0.30 eV. The respective parameters for laccase were 5.0×10⁷M⁻¹s⁻¹ and 0.29 eV. Received: 20 September 1999 / Accepted: 24 February 2000     

Coiled-coil nanomechanics and uncoiling and unfolding of the superhelix and alpha-helices of myosin

The nanomechanical properties of the coiled-coils of myosin are fundamentally important in understanding muscle assembly and contraction. Force spectra of single molecules of double-headed myosin, single-headed myosin, and coiled-coil tail fragments were acquired with an atomic force microscope and displayed characteristic triphasic force-distance responses to stretch: a rise phase (R) and a plateau phase (P) and an exponential phase (E). The R and P phases arise mainly from the stretching of the coiled-coils, with the hinge region being the main contributor to the rise phase at low force. Only the E phase was analyzable by the worm-like chain model of polymer elasticity. Restrained molecular mechanics simulations on an existing x-ray structure of scallop S2 yielded force spectra with either two or three phases, depending on the mode of stretch. It revealed that coiled-coil chains separate completely near the end of the P phase and the stretching of the unfolded chains gives rise to the E phase. Extensive conformational searching yielded a P phase force near 40 pN that agreed well with the experimental value. We suggest that the flexible and elastic S2 region, particularly the hinge region, may undergo force-induced unfolding and extend reversibly during actomyosin powerstroke.     

Synthesis of hapten and conjugates of coumestrol and development of immunoassay

3-O-Carboxymethylcoumestrol was prepared as the hapten for immunoassay by a partial alkylation of coumestrol with ethyl chloroacetate in acetone alkalized with potassium carbonate. 3-O-Ethoxycarbonylmethylcoumestrol was separated by column chromatography and finally was hydrolyzed with formic acid. 1H and 13C NMR data (APT, COSY, HMQC, and HMBC) revealed that the reaction was regioselective, as 3-O-ethoxycarboxymethylcoumestrol was the only monosubstituted derivative. The hapten was then conjugated to bovine serum albumin and used for immunization of rabbits. A radioimmunoassay (RIA) system was established based on the polyclonal antiserum and a 125I-labeled hapten-tyrosine methyl ester conjugate as the radioligand. Parameters of the RIA: sensitivity: 12 pg per tube, 50% intercept: 140 pg per tube, working range: 20-4000 pg per tube. The cross-reactivity of a panel isoflavonoid and lignan phytoestrogens was either negligible (e.g. formononetin 0.07%; biochanin A 0.06%) or not detectable at all. The major immunoreactive peak in HPLC fractions from an alfalfa extract had the same retention time as coumestrol standard and represented 94.8% of the signal. The remaining 5.2% of immunoreactivity was distributed between five minor peaks. We conclude that after the validation for particular matrices, the method will be a useful tool for analysis of coumestrol, especially in low volume and low concentration samples.     

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

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。     

Effect of soil salinity and water stresses on growth and content of nitrogen,chloride and phosphate of wheat and triticale

Summary Three wheats and one triticale were grown, up to flowering stage, in pots on calcareous soil adjusted to a range of salinities (S₁=3.5, S₂=6, S₃=8.5, and S₄=11 mmhos/cm, 20°C, soilpaste extract) by adding solution consisting of 3∶2∶1 of Na-, Ca- and Mg chlorides in chemical equivalent amounts. Moisture in the pots was kept at 100% (W₁), 40% (W₂) and 20% (W₃) of the available water. The vegetative growth, nitrogen and phosphate were affected by S and W treatments, chloride was affected only by S. The interaction S×W affected only dry weight. Varietal effect was observed between wheat as a group and triticale. Multiple quadratic regression equations of these properties on salinity and water revealed that the higher the available water the wider the range of tolerable salinity. Triticale was relatively more tolerant to water stress. Salinity increases Cl and decreases N, whereas water stress enhances N accumulation to a certain extent. However, in triticale at S₃ and S₄ the effect of water stress on N was overshadowed by the excessive salinity. This did not occur for the wheat (Florence). P trends were described. R² for P was low (0.7435–0.3603) which made interpretations rather difficult.     

放牧对牧草光合作用、呼吸作用和氮、碳吸收与转运的影响

研究放牧对草地植物生理活动的影响,对于揭示草地放牧演替的生理机制有重要意义.大量研究表明,家畜放牧对牧草光合作用、呼吸作用以及C和N吸收与转运的影响,可以分为生理伤害和生理恢复2个阶段.放牧通过改变草地冠层结构影响牧草光合作用,净光合作用速率短期内迅速下降,随着叶面积指数增加又逐渐上升,呼吸作用有相似的变化趋势.牧草放牧后再生长所需的C和N最初主要来自根系和留茬中的贮藏物质,此后随着牧草生长恢复逐渐由同化作用供给,C代谢与土壤N水平负相关.放牧后牧草生理活动变化与牧草遗传特性、种间竞争、家畜放牧特征、非生物环境等因素密切相关.