以公益性为导向的公立医院绩效工资分配测算方法研究

目的 建立与绩效考核体系相适应的、以公益性为导向的绩效工资分配测算方法。方法 依据绩效考核体系,建立测算方法框架;应用历史数据测试并完善方法;与原测算方法同步试运行,以完善测算方法。结果 建立基于科室难度系数测算KPI绩效工资,再由科室难度系数、质量控制评分校正的测算方法。结论 测算结果可控、合理、稳定,敏感体现指标变化,对医疗质量、效率、效益导向清晰,激励科室积极性,有利于发展公益性医院文化。     

BJ-DRGs在某综合医院科室住院服务评价中的应用研究

目的 利用“北京版诊断相关组”为风险调整工具,评价各科室住院服务产出,为医院精细化管理提供方向。方法 参照北京市临床重点专科评价方法选取指标及计算公式,分别对科室产出指标计量结果进行科室间比较和与前3年自身平均水平比较,进而评价分析。结果 全院住院服务水平逐步向好;各科室贡献水平不同,外科系统贡献优于内科系统,质量得分对排名影响较大。结论 多维度分析,改进住院服务评价方法适应科室间评价;以住院服务质量安全为评价重点;评价方法及结果应用需结合医院实际情况。     

临床医师薪酬分配与绩效实证研究

目的 研究基于绩效的临床医师薪酬分配办法和适当拉开薪酬差距是否能有效提升医院的绩效水平。方法 采用变异系数衡量临床医师的薪酬差距,采用对照研究的方法评估医院的绩效提升水平。结果 外科医师薪酬差距拉开幅度最大,其余依次为儿科、内科和医技科,2006—2010年医院绩效优于对照医院。结论 通过薪酬分配制度改革的实践,基于绩效适当拉开薪酬差距,激发临床医师的积极性,增强医疗团队活力,提高绩效水平,提升医院综合实力。     

北京市公立医院内部绩效考核分配现状与思考

目的 描述北京市公立医院内部绩效考核分配现状并分析。方法 通过文献查询梳理北京市公立医院绩效管理文献、专家咨询设计结构化访谈提纲,并对北京市公立医院绩效管理部门职员进行结构化访谈。结果 对北京市9家公立医院进行结构化访谈,对1家市属医院的绩效文献资料进行整理。描述了北京市公立医院绩效考核分配的指导思想、管理模式、管理办法、业务科室绩效考核分配模式、业务科室二次考核分配、护理垂直管理、行政后勤科室绩效考核分配、绩效考核信息化的现状。结论 北京市公立医院内部绩效考核体系是医院内部绩效考核历史模式与政策要求相互作用的结果,需要完善适合本医院文化的“本土化”绩效考核体系和分配测算方法。     

基于RBRVS的临床医师绩效分配模式模拟应用评价研究

目的 对上海某三甲医院某科室基于 以资源消耗为基础的价值评估体系临床医师绩效分配模式的模拟应用进行评价。方法 应用SPSS19.0统计软件对收集的数据进行描述性统计分析、t检验和双变量相关性分析。结果 两种分配模式之间各诊疗项目价值点数变化幅度差异性较大,以月度为基础的绩效分配结果差异有统计学意义,RBRVS分配模式与三、四级手术之间存在正相关关系。结论 以资源为基础的价值评估体系分配模式优于原单纯基于比价的基本点数法,能够有效评价医师技术劳务价值,有利于促进三、四级手术和疑难复杂疾病的开展,不断推进公立医院医疗业务结构优化。

     

公立骨科医院临床科室绩效综合评价 ——基于目标管理与加权TOPSIS法相结合的研究

目的 对骨科医院临床科室绩效进行综合评价,考察科室绩效的差异。方法 采用目标管理与加权TOPSIS相结合的方法,用各指标的月度绩效目标值对效率和效益指标作标化,从效率效益、质量和医德医风3个方面对骨科医院主要临床科室的月度绩效进行综合评价。结果 足外科绩效水平最高,康复和三大手科绩效水平位居前列,老年骨、ICU和骨病科绩效水平较低。结论 指标体系的构建有利于全面、动态地对医院临床科室进行综合评价;目标管理与加权TOPSIS相结合的方法所测量出的绩效水平与医院的实际发展情况相符,在骨科医院具有适用性。

     

数据包络分析在临床科室绩效管理中的应用

目的 通过总结数据包络分析在临床科室效率测算中的应用,为医院绩效管理提供一种量化管理技术。方法 应用数据包络分析测算临床科室的相对效率、生产率变化率。通过对测算结果的描述分析,得到临床科室的效率评价结果。将数据测算及分析结果与职能科室管理者对临床科室效率的定性评价进行比较。结果 测算数据的描述分析结果与临床科室绩效的管理者评价具有一致性。结论 数据包络分析在医院临床科室绩效管理中具有实际应用价值、是绩效管理者的有效管理技术。     

新疆某大型综合医院内科临床医师工作量分析

目的 通过对医师工作量的分析,找出造成医师工作负荷较重的原因,提出对策与建议。方法 采用问卷调查法和专家咨询法收集数据,运用SPSS20.0软件进行统计分析。结果 临床医师的实际工作量较大,且结合“标准工作时间”的医师工作量要大于医师的实际工作量,各科室均存在各级医师之间工作内容相互交叉的现象。结论 当前临床医师的工作量较重,影响了医疗质量和医院的发展,应适当增加临床医师的合理编配,优化各级医师结构,从而保证医疗质量,促进医院可持续发展。     

妇产科医师鉴别胜任特征研究

目的 获取绩效优秀妇产科医师区别于绩效普通妇产科医师的胜任特征。方法 在编制医师胜任特征词典的基础上,以10名绩优和10名绩平医师为研究对象,采用行为事件访谈法收集数据,对不同绩效组医师胜任特征的频次、平均等级分值和最高等级分值的差异采用Wilcoxon秩和检验进行分析。结果 鉴别胜任特征包括严谨细致、团队合作等18项特征。结论 鉴别胜任特征对妇产科医师人力资源规划、招聘、培训有一定参考价值。

     

医生对绩效考核与分配要素的认识与实践感受研究

目的 了解公立医院临床医生对绩效考核与分配要素重要性的认识与实践感受的差异以及临床医生绩效考核与分配的要素权重。方法 调研某公立医院各专业层面的临床一线医生,采用问卷测量的方法对绩效考核与分配要素进行检验,统计分析方法包括信度和效度分析、因子分析与配对样本t检验分析等。结果 通过分析,发现临床医生对绩效考核与分配部分要素重要性的认识与实践感受有统计学差异,临床医生认为绩效考核要素中最重要的是医德医风(0.363),绩效分配要素中最重要的是工龄(0.210)。结论 临床医生绩效考核与分配需突出医疗质量等主体要素,绩效制度只有获得临床医生的认可,医疗改革才能获得成功。     

scabrous Modifies Epithelial Cell Adhesion and Extends the Range of Lateral Signalling during Development of the Spaced Bristle Pattern in Drosophila

The role of scabrous (sca) in the evenly spaced bristle pattern of Drosophila is explored. Loss-of-function of sca results in development of an excess of bristles. Segregation of alternately spaced bristle precursors and epidermal cells from a group of equipotential cells relies on lateral inhibition mediated by Notch and Delta (Dl). In this process, presumptive bristle precursors inhibit the neural fate of neighbouring cells, causing them to adopt the epidermal fate. We show that Dl, a membrane-bound ligand for Notch, can inhibit adjacent cells, in direct contact with the precursor, in the absence of Sca. In contrast, inhibition of cells not adjacent to the precursor requires, in addition, Sca, a secreted molecule with a fibrinogen-related domain. Over-expression of Sca in a wild-type background, leads to increased spacing between bristles, suggesting that the range of signalling has been increased. scabrous acts nonautonomously, and we present evidence that, during bristle precursor segregation, Sca is required to maintain the normal adhesive properties of epithelial cells. The possible effects of such changes on the range of signalling are discussed. We also show that the sensory organ precursors extend numerous fine cytoplasmic extensions bearing Dl molecules, and speculate on a possible role for these structures during signalling.     

A 7-bp insertion in the 3' untranslated region suggests the duplication and concerted evolution of the rabbit SRY gene

In this work we report the genetic polymorphism of a 7-bp insertion in the 3'' untranslated region of the rabbit SRY gene. The polymorphic GAATTAA motif was found exclusively in one of the two divergent rabbit Y-chromosomal lineages, suggesting that its origin is more recent than the separation of the O. c. algirus and O. c. cuniculus Y-chromosomes. In addition, the remarkable observation of haplotypes exhibiting 0, 1 and 2 7-bp inserts in essentially all algirus populations suggests that the rabbit SRY gene is duplicated and evolving under concerted evolution.     

The Circadian Clock Gene Period1 Connects the Molecular Clock to Neural Activity in the Suprachiasmatic Nucleus

The neural activity patterns of suprachiasmatic nucleus (SCN) neurons are dynamically regulated throughout the circadian cycle with highest levels of spontaneous action potentials during the day. These rhythms in electrical activity are critical for the function of the circadian timing system and yet the mechanisms by which the molecular clockwork drives changes in the membrane are not well understood. In this study, we sought to examine how the clock gene Period1 (Per1) regulates the electrical activity in the mouse SCN by transiently and selectively decreasing levels of PER1 through use of an antisense oligodeoxynucleotide. We found that this treatment effectively reduced SCN neural activity. Direct current injection to restore the normal membrane potential partially, but not completely, returned firing rate to normal levels. The antisense treatment also reduced baseline [Ca²⁺]i levels as measured by Fura2 imaging technique. Whole cell patch clamp recording techniques were used to examine which specific potassium currents were altered by the treatment. These recordings revealed that the large conductance [Ca²⁺]i-activated potassium currents were reduced in antisense-treated neurons and that blocking this current mimicked the effects of the anti-sense on SCN firing rate. These results indicate that the circadian clock gene Per1 alters firing rate in SCN neurons and raise the possibility that the large conductance [Ca²⁺]i-activated channel is one of the targets.     

JL-DRGs在综合医院管理中的应用探讨

目的 探讨JL-DRGs在综合医院管理中的应用。方法 对2012年和2013年运行JL-DRGs管理前后的全部出院病例进行统计分析。结果 2013年开始全面运行JL-DRGs后平均住院日下降17.74%,均次费用下降13.49%,医保超支年度累计减少1 866万元,平均每月医保超支额度下降39.23%,医疗质量、效率均显著提升。结论 JL-DRGs在大型综合医院管理中应用效果好,可以积极促进医院提质升效并降低运营成本。     

Expression of the blood-group-related glycosyltransferase B4galnt2 influences the intestinal microbiota in mice

Glycans on mucosal surfaces have an important role in host–microbe interactions. The locus encoding the blood-group-related glycosyltransferase β-1,4-N-acetylgalactosaminyltransferase 2 (B4galnt2) is subject to strong selective forces in natural house-mouse populations that contain a common allelic variant that confers loss of B4galnt2 gene expression in the gastrointestinal (GI) tract. We reasoned that altered glycan-dependent intestinal host–microbe interactions may underlie these signatures of selection. To determine whether B4galnt2 influences the intestinal microbial ecology, we profiled the microbiota of wild-type and B4galnt2-deficient siblings throughout the GI tract using 16S rRNA gene pyrosequencing. This revealed both distinct communities at different anatomic sites and significant changes in composition with respect to genotype, indicating a previously unappreciated role of B4galnt2 in host–microbial homeostasis. Among the numerous B4galnt2-dependent differences identified in the abundance of specific bacterial taxa, we unexpectedly detected a difference in the pathogenic genus, Helicobacter, suggesting Helicobacter spp. also interact with B4galnt2 glycans. In contrast to other glycosyltransferases, we found that the host intestinal B4galnt2 expression is not dependent on presence of the microbiota. Given the long-term maintenance of alleles influencing B4galnt2 expression by natural selection and the GI phenotypes presented here, we suggest that variation in B4galnt2 GI expression may alter susceptibility to GI diseases such as infectious gastroenteritis.     

On the evolution of reproductive restraint in malaria

Malaria is one of the leading causes of death among infectious diseases in the world, claiming over one million lives every year. By these standards, this highly complex parasite is extremely successful at generating new infections. Somewhat surprisingly, however, many malaria species seem to invest relatively little in gametocytes, converting only a small percentage of circulating asexual parasite forms into this transmissible form. In this article, we use mathematical models to explore three of the hypotheses that have been proposed to explain this apparent 'reproductive restraint' and develop a novel, fourth hypothesis. We find that only one of the previous three hypotheses we explore can explain such low gametocyte conversion rates, and this hypothesis involves a very specific form of density-dependent transmission-blocking immunity. Our fourth hypothesis also provides a potential explanation and is based on the occurrence of multiple infections and the resultant within-host competition between malaria strains that this entails. Further experimental work is needed to determine which of these two hypotheses provides the most likely explanation.     

Identification of a common risk haplotype for canine idiopathic epilepsy in the ADAM23 gene

Background

Idiopathic epilepsy is a common neurological disease in human and domestic dogs but relatively few risk genes have been identified to date. The seizure characteristics, including focal and generalised seizures, are similar between the two species, with gene discovery facilitated by the reduced genetic heterogeneity of purebred dogs. We have recently identified a risk locus for idiopathic epilepsy in the Belgian Shepherd breed on a 4.4 megabase region on CFA37.

Results

We have expanded a previous study replicating the association with a combined analysis of 157 cases and 179 controls in three additional breeds: Schipperke, Finnish Spitz and Beagle (p_c = 2.9e–07, p_GWAS = 1.74E-02). A targeted resequencing of the 4.4 megabase region in twelve Belgian Shepherd cases and twelve controls with opposite haplotypes identified 37 case-specific variants within the ADAM23 gene. Twenty-seven variants were validated in 285 cases and 355 controls from four breeds, resulting in a strong replication of the ADAM23 locus (p_raw = 2.76e–15) and the identification of a common 28 kb-risk haplotype in all four breeds. Risk haplotype was present in frequencies of 0.49–0.7 in the breeds, suggesting that ADAM23 is a low penetrance risk gene for canine epilepsy.

Conclusions

These results implicate ADAM23 in common canine idiopathic epilepsy, although the causative variant remains yet to be identified. ADAM23 plays a role in synaptic transmission and interacts with known epilepsy genes, LGI1 and LGI2, and should be considered as a candidate gene for human epilepsies.

Electronic supplementary material

The online version of this article (doi:10.1186/s12864-015-1651-9) contains supplementary material, which is available to authorized users.     

A Conserved Region between the TPR and Activation Domains of p67phox Participates in Activation of the Phagocyte NADPH Oxidase

The phagocyte NADPH oxidase, dormant in resting cells, is activated during phagocytosis to produce superoxide, a precursor of microbicidal oxidants. The membrane-integrated protein gp91^phox serves as the catalytic core, because it contains a complete electron-transporting apparatus from NADPH to molecular oxygen for superoxide production. Activation of gp91^phox requires the cytosolic proteins p67^phox, p47^phox, and Rac (a small GTPase). p67^phox, comprising 526 amino acids, moves upon cell stimulation to the membrane together with p47^phox and there interacts with Rac; these processes are prerequisite for gp91^phox activation. Here we show that a region of p67^phox (amino acids 190–200) C-terminal to the Rac-binding domain is evolutionarily well conserved and participates in oxidase activation at a later stage in conjunction with an activation domain. Alanine substitution for Tyr-198, Leu-199, or Val-204 abrogates the ability of p67^phox to support superoxide production by gp91^phox-based oxidase as well as its related oxidases Nox1 and Nox3; the activation also involves other invariant residues such as Leu-193, Asp-197, and Gly-200. Intriguingly, replacement of Gln-192 by alanine or that of Tyr-198 by phenylalanine or tryptophan rather enhances superoxide production by gp91^phox-based oxidase, suggesting a tuning role for these residues. Furthermore, the Y198A/V204A or L199A/V204A substitution leads to not only a complete loss of the activity of the reconstituted oxidase system but also a significant decrease in p67^phox interaction with the gp91^phox NADPH-binding domain, although these mutations affect neither the protein integrity nor the Rac binding activity. Thus the extended activation domain of p67^phox (amino acids 190–210) containing the D(Y/F)LGK motif plays an essential role in oxidase activation probably by interacting with gp91^phox.     

Ancyronyx Erichson, 1847 (Coleoptera,Elmidae) from Mindoro,Philippines, with description of the larvae and two new species using DNA sequences for the assignment of the developmental stages

Ancyronyx buhid sp. n. and Ancyronyx tamaraw sp. n. are described based on adults and larvae, matched using their cox1 or cob DNA sequence data. Additional records of Ancyronyx schillhammeri Jäch, 1994 and Ancyronyx minerva Freitag & Jäch, 2007 from Mindoro are listed. The previously unknown larva of Ancyronyx schillhammeri is also described here, aided by cox1 data. The new species and larval stages are described in detail and illustrated by SEM and stacked microscopic images. Keys to the adult and larval Ancyronyx species of Mindoro and an updated checklist of Philippine Ancyronyx species are provided. The usefulness as bioindicators, the phylogenetic relationships and biogeographic aspects affecting the distribution patterns are briefly discussed.