我院康复医疗服务体系建设的做法与体会

哈尔滨医科大学附属第一医院积极探索新的服务体系,充分整合和利用黑龙江省康复资源和医疗卫生资源,在康复医疗服务体系建设、康复机构功能定位、双向转诊制度、康复人才培养等方面进行了积极的探索,康复医疗服务网络化管理模式初具雏形。     

部分国家和地区分级诊疗特点及启示

通过剖析部分国家和地区分级诊疗的特点,即分级诊疗是医疗卫生服务体系健全的自然结果,分级诊疗的实质在于服务整合,合理的支付制度是分级诊疗的重要促进因素;提出以强基层、建机制的原则发展分级诊疗,将医疗机构分工合作、服务功能整合作为分级诊疗的重要路径,增强医保对医疗服务体系的影响力以促进分级诊疗等建议。     

宁夏县级医院耳鼻咽喉科医疗服务能力分析

目的 通过对宁夏县级医院耳鼻咽喉科医疗服务现状的调查,了解其发展瓶颈与不足,提出提升宁夏县级医院耳鼻咽喉科医疗服务能力的建议。方法 采用整群抽样方法,对宁夏县级公立综合医院耳鼻咽喉科进行问卷调查,并抽样访谈部分医院耳鼻咽喉科主任,回收、整理、分析相关数据,定量定性分析调查医院耳鼻咽喉科医疗服务能力。结果 宁夏县级医院耳鼻咽喉科各项现状指标均低于县医院标准要求,科室人员与设备数量严重不足,可开展医疗技术项目少,门诊、出院人数逐年提高。结论 宁夏县级医院耳鼻咽喉科医疗服务能力不足,建议科室制定发展规划,创新发展方式;开发人力资源,提升技术水平;借助信息平台,共建学科联盟。     

护理人员个体因素对薪酬满意度影响的调查与分析

?????? 目的 通过对护理人员个体因素薪酬满意度的调查,了解护理人员个体因素对薪酬满意度的影响。 方法 应用方差分析和均值计算,判断护理人员个体因素的薪酬满意度及其影响。 结果 护理人员个体因素与薪酬满意度有显著差异（P﹤0.05）。年龄、工作年限、学历等因素对薪酬满意度的影响程度不同。 结论 护理人员对薪酬满意度整体满意度水平较低,年龄、工作年限、学历等因素是护理人员薪酬满意度的影响因素。     

非医疗技术因素对门诊患者满意度的调查与分析

?????? 目的 了解门诊患者对于非医疗技术服务的满意度现状,探讨影响门诊患者满意度的非技术因素。方法 对广州市某三甲医院2012年3—6月就诊的208名门诊患者进行问卷调查。结果 与“等候时间”、“诊疗费用”相关的满意度水平显著低于“服务态度”、“环境设施”类,且满意度水平存在着社会人口学差异。结论 医院应注重非医疗技术服务的改进,可从营造舒适就诊环境、加强医患沟通、降低医疗费用及合理门诊布局等方面入手。同时,优化门诊预约服务可有效提高门诊患者满意度。     

六西格玛管理法对围手术期服务质量改进的影响研究

目的 设计了综合医院围手术期六西格玛管理模式,并进行了试验研究,以评价应用效果。 方法 采用干预性研究方法,设立干预组和对照组。制定和筛选出评价指标,根据前后统计结果,判断总体改善和指标的变化情况。 结果 干预组总体有明显的改善,对照组总体改善不明显;干预组评价指标横比、纵比均有明显的改进。结论 围手术期六西格玛管理模式的应用可明显改善医院医疗服务质量,对医疗服务行为有较大的良性影响,并有利于医院文化建设。     

居民健康卡医疗机构应用及建设探讨

文章阐述了居民健康卡医疗机构应用的意义,介绍了居民健康卡医疗机构预约诊疗、门诊住院一卡通、门诊便捷输液、医疗救治联动服务和新农合一卡通等应用,分析了居民健康卡项目建设中政府主导与银医合作两种模式的特点,最后探讨了居民健康卡医疗机构应用重点建设内容。     

门诊知名专家团队服务模式的实践与探索

为深化公立医院改革,北京同仁医院积极开展门诊知名专家团队服务模式试点工作,建立医院内部层级诊疗服务新模式。通过门诊就诊流程调整、服务模式变革,破解“挂号难”“号贩子”等相关问题,实现了医院内部门诊资源的优化利用,是医院内部分级诊疗的有益实践与探索,真正体现了医疗机构“以患者为中心”的服务理念,也为未来广泛推广分级诊疗模式奠定了坚实的基础。     

实习前护理专科生的焦虑状况及影响因素分析

目的 了解 护理专科生实习前心理健康状况,探讨其实习前焦虑程度的影响因素。方法 收集2013级某中专院校护理专业10个班和某高等职业院校护理专业5个班的调查问卷,最终整理所得有效样本为578份。应用SPSS19软件进行统计分析。结 果 护生实习前心理健康问题除人际敏感和抑郁之外,均高于全国青年常模（P ＜0.05）;护生的焦虑水平与护生的人格特点、年龄有关;回归分析得出护生的学历、生源地、独生子女等对焦虑程度有明显影响,差异有统计学意义（P ＜0.05）。结论 掌握影响护生产生焦虑程度的因素,为护生护理教育提供依据。     

Ectogenesis and the case against the right to the death of the foetus

Ectogenesis, or the use of an artificial womb to allow a foetus to develop, will likely become a reality within a few decades, and could significantly affect the abortion debate. We first examine the implications for Judith Jarvis Thomson’s violinist analogy, which argues for a woman’s right to withdraw life support from the foetus and so terminate her pregnancy, even if the foetus is granted full moral status. We show that on Thomson’s reasoning, there is no right to the death of the foetus, and abortion is not permissible if ectogenesis is available, provided it is safe and inexpensive. This raises the question of whether there are persuasive reasons for the right to the death of the foetus that could be exercised in the context of ectogenesis. Eric Mathison and Jeremy Davis have examined several arguments for this right, doubting that it exists, while Joona Räsänen has recently criticized their reasoning. We respond to Räsänen’s analysis, concluding that his arguments are unsuccessful, and that there is no right to the death of the foetus in these circumstances.     

On the diversity of the Cladocera in the tropics

The mythical concept of an impoverished tropical cladoceran fauna is refuted. On a planetary scale, around half of the cladoceran species presently known occur exclusively in the tropics-subtropics, often with considerable restriction to particular geographical subzones. On a regional (political) scale, the situation is often unclear because of the continued fragmentary nature of studies, and because political units are not a good basis for biogeographical comparisons. At the finest level of resolution (lake-perlake comparisons), there appears to be an upper limit of c. 50 cladoceran species per individual lake. No significant difference between lakes in the temperate zone and in the tropics could be established here. Daphnia is largely absent from the tropics, but is replaced by more Sidids, Moinids, and Bosminids, such that the average cladoceran community in the limnetic zone of a tropical lake is not characterized by less species but rather by lower population densities. This, in turn, is considered a consequence of higher prevalent predation levels in the tropics.     

Tubular networks in the terminal endings of the visual receptor cells in the human,the monkey,the cat and the dog

Summary A tubular network was found in the terminal endings of the visual receptor cells in the human, the monkey (Macaca mulatta), the cat and the dog. These tubules are arranged in close groups in the vicinity of the synaptic lamellae and the invaginated dendrites. According to the form, diameter, density of the tubules and to the consistence of the network formed by them one can distinguish at these places an initial type (type I), a transitory (type II) and a vesicular one (type III). In the the type III branching, bizarre forms are frequent. The diameter of all the tubules reaches 500–600 Å, their density and walls being the same as in the synaptic vesicles.Similar networks also occur in the axons of the visual receptor cells of the monkey.

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Zusammenfassung In den Endigungen der Photorezeptorzellen von Mensch, Affe (Macaca mulatta), Katze und Hund kommen aus Tubuli bestehende Komplexe vor. Organellenartig in geschlossenen Gruppen angeordnet, liegen sie in Nähe der synaptischen Lamellen und der invaginierten Dendriten. An diesen Stellen kann man nach Form, Durchmesser, Dichte und Konsistenz der von den Tubuli gebildeten Komplexe drei Typen unterscheiden: 1. einen initialen (Typus I), 2. einen Übergangstypus (Typus II) und 3. einen vesiculären Typus (Typus III). In letzterem kommen häufig verzweigte, bizarre Formen vor. Der Durchmesser sämtlicher Tubuli erreicht 500–600 Å. Ihre Dichte und ihre Wand gleicht denen der synaptischen Vesikel.Ähnliche Komplexe fanden wir auch in den Axonen der Photorezeptorzellen vom Affen.

     

Assessing the Physiological State of the Fucoids from the Barents Sea Littoral by the End of the Polar Night

Methods of amperometry and potentiometric titration were used to follow dark respiration (DR) and apparent photosynthesis (AP) in the fucoids Ascophyllum nodosum (L.) Le Jol, Fucus vesiculosus L., and F. serratus L. from the Barents Sea littoral by the end of the 40-day-long polar night. The macroalgae were shown to manifest species-specific low rates of photosynthesis and respiration. However, in spite of their low photosynthetic status due to the effects of subzero temperature and prolonged low or zero illumination, the macroalgae have been able to restore DR and AP to the initial level already by the day 9; the ability to restore AP depended on the level of illumination. The study of the changes in the carbonate–bicarbonate system in the light and darkness demonstrated that the macroalgae grown in darkness, in contrast to those grown in twilight, could absorb bicarbonate in darkness; however, they lost this capacity after two-day-long illumination at an irradiance of 7 mol/(m² s). Bicarbonate uptake in darkness and the capacity to restore the systems of photosynthesis and respiration in fucoid cells are discussed in the context of algal energy metabolism under the polar night conditions.     

Arranging the elements of the potassium channel: the T1 domain occludes the cytoplasmic face of the channel

The voltage-gated potassium channel is currently one of the few membrane proteins where functional roles have been mapped onto specific segments of sequence. Although high-resolution structures of the transmembrane portions of three bacterial potassium channels, the tetramerization domain and the cytoplasmic ball are available, their relative spatial arrangement in mammalian channels remains a matter of ongoing debate. Cryo-electron microscopic images of the six transmembrane voltage-gated Kv channel have been reconstructed at up to 18 Å resolution, revealing that the T1 domain tetramerizes and is suspended below the transmembrane segments. However, the resolution of these images is insufficient to reveal the location of the third piece of the puzzle, the inactivating ball domain. We have used the aberrant interactions observed in a series of chimæric channels to establish that an assembled T1 domain restricts access to the cytoplasmic face of the channel, suggesting that the N-terminal ball and chain may be confined in the space between the T1 domain and the transmembrane portion of the channel.     

Feeding the vertebrate retina from the Cambrian to the Tertiary

The retina of the vertebrate eye is metabolically active and requires nutritive support. During the last 540 million years it has evolved into forms as complicated and nutritionally demanding as those found in avian or primate eyes. Diffusion from the choroid is generally able to supply the metabolic needs of thin retinae. However, when the thickness exceeds the limits of diffusion, structures are needed to supplement the vascular supply from the choroid. These supplemental nutritive devices include the choroidal gland, the falciform process and preretinal vascular plexus of fish, the conus papillaris of lizards, the pecten oculi of birds, the intraretinal vessels of mammals and a few novel systems that remain difficult to classify. These vascular systems are among the most variable features of the vertebrate eye. Here, we review classical and recent findings regarding such retinal nutrition systems, propose a three category classification for them based on histologic origins and speculate on the evolutionary forces which drove their development.     

Observations on the permeability of the choriocapillaris of the eye

Summary The choriocapillaris is a fenestrated capillary bed located posterior to the retinal pigment epithelium. It serves as the main source of supply to the photoreceptors, retinal pigment epithelium, and other cells of the outer retina. The permeability of these capillaries to intravenously injected ferritin (MW — approx. 480,000; mol. diam. 11 nm) was examined in the mouse, rabbit, and guinea pig, each of which is characterized by a different type of retinal vascularization. In all three species, the bulk of the ferritin remained in the capillary lumina, where it appeared to be blocked at the level of the diaphragmed fenestrae. Some ferritin was present in endothelial cell vacuoles. The results confirm previous work on the rat choriocapillaris and indicate that the barrier function of the choriocapillary endothelium is present even among species in which the retinal circulation differs significantly.Supported by NIH grant EY03418     

Separation of the pineal vesicle from the wall of the third ventricle during the post-hatching development of the chicken

Summary According to light- and electron-microscopic observations the pineal organ of the 3-day-old chicken consists of a prominent end vesicle and a tapering parenchymal stalk. During this stage the pineal lumen is in open communication with the third ventricle. However, in the 40-day-old chicken, which still possesses a well-developed end vesicle, the proximal portion of the pineal stalk displays regressive changes leading to local fragmentation. At this stage the pineal stalk is reduced, and the pineal lumen is missing. In 1-year-old chickens the parenchyma of the proximal portion of the stalk is further diminished, and in 3-year-old domestic fowl is completely displaced by bundles of collagenous fibers, only some nerve fibers being present. This post-hatching pineal development may reflect the sequence of changes leading from pineal sense organs to pineal glands.This work was supported by a grant-in-aid for Scientific Research from the Ministry of Education, Science and Culture of Japan