医院药品成本控制系统方法与实践

目的 探讨系统控制医院药品成本的有效方法。方法 在系统分析药品成本的基础上,通过实施药品集中供应改革和组合措施控制药品成本。结果 医院药品采购成本降低25%,药品综合成本有效降低。结论 降低药品成本需要创新方法,树立全员成本意识,贯穿于药品管理的全过程。     

降雨对草地土壤呼吸季节变异性的影响

利用土壤碳通量自动观测系统(LI-8150)对呼伦贝尔草原在自然降雨条件下的土壤呼吸作用进行了野外定位连续观测,研究结果表明:降雨对土壤呼吸作用存在激发效应和抑制效应,降雨发生后1-2 h内土壤呼吸速率可增加约1倍,当单次或者连续降雨累积量大于7-8 mm,或土壤含水量大于29%-30%时,降雨对土壤呼吸会产生明显的抑制作用。土壤呼吸的激发效应往往体现在次日,表现为次日平均土壤呼吸速率的显著升高;而抑制效应则在当日即可体现出来,表现为观测当日平均土壤呼吸速率的明显下降。土壤呼吸季节变异性与降雨频率和降雨强度密切相关,在降雨量一定的情况下,较低的降雨频率和较高的降雨强度会增加土壤呼吸的变异性。呼伦贝尔草甸草原而言,在生长季土壤平均含水量为16.5%时,土壤呼吸的温度敏感性值(Q₁₀)为2.12;而平均土壤含水量为26%时,Q₁₀值为2.82,明显高于前者,土壤含水量与Q₁₀之间存在正相关关系。降雨导致土壤呼吸的激发效应和抑制效应交替发生,使草地土壤呼吸的季节变异性增加,降雨格局变化必然会对草地碳循环和碳通量特征产生深刻影响。     

医用卫生材料存货管理模式的构建研究

??????在分析当前医院卫生材料存货管理中存在的主要问题的基础上,探索构建以库存管理为前提、存货成本控制为重点、资产收益率最大化为目标的卫生材料存货管控模式,以降低医院卫生材料的平均资金占用水平,提升存货周转率,最终加强医院的运营能力和服务能力。

     

国内临床医师绩效分配模式的现状、不足与对策

科学构建和优化医师绩效分配模式,着力体现医务人员技术劳务价值,关注医疗服务内涵,对有效调动医务人员工作积极性、提高公立医院运营效率和精细化管理水平有着重要意义。通过广泛文献研究,系统分析了我国目前公立医院绩效分配模式现状及存在的不足,同时针对存在的主要问题提出了相应的对策建议。     

上海市不同治理模式公立医院的运营状况分析

通过调查和现有资料收集,分析了目前上海市公立医院3种治理模式的运营状况,指出了对公立医院不同治理模式运营状况评价的必要性,揭示了公立医院不同治理模式下的医院运营状况,提出了公立医院治理结构改革应关注于治理要素有用的原则。

     

小儿与成人静脉留置针穿刺的护理成本比较与分析

目的 了解目前小儿与成人手术患者静脉留置针穿刺的护理成本投入。方法 根据项目综合评估和核算方法,分别核算小儿与成人静脉留置针穿刺的护理成本投入情况。结果 小儿与成人静脉留置针穿刺操作的平均护理成本已分别达到77.84元和25.62元,与现行收费标准存在巨大差异,小儿静脉留置针穿刺的护理成本远远高于成人。结论 全面客观地核算了静脉留置针穿刺的护理成本投入,为体现护理技术的价值提供了准确的依据。     

甘南地区二氧化碳施肥效应对生态系统的影响

陆地生态系统是全球第二大碳库,其碳收支一直是气候变化研究的热点领域,而研究二氧化碳（CO₂）施肥效应又是全球变化碳循环领域较为关注的前沿部分。CO₂与生态系统关系复杂,当前仍无法厘清CO₂对陆地生态系统碳循环的影响作用。基于太阳辐射数据、气温数据及归一化植被指数数据等,利用光能利用率遥感模型,模拟2019年甘南地区的碳循环,选取三个指标,即GPP （陆地生态系统总初级生产力）、NPP （净初级生产力）和NEP （净生态系统生产力）来分析甘南地区植被固碳的时空变化特征及CO₂施肥效应。结果表明：（1）甘南地区2019年植被固碳总量约为2611 tC。甘南地区生态系统GPP、NPP和NEP季节性特征明显,其值均在夏季达到最高;而在空间上,GPP、NPP表现为东高西低的特征,NEP呈现出北高南低的分布特征。（2） CO₂对GPP、NPP存在正向的施肥效应,分别增加了14.4%和14.3%;而对NEP具有负向反馈效应,使其减少了0.3%,并且CO₂对NEP的影响整体也表现为北高南低的特征。研究揭示出：虽然CO₂在提升GPP和NPP时,正向的施肥效应明显,但是对甘南地区的NEP,即固碳量来说,CO₂的影响却很有限。因此在研究CO₂施肥效应时不应一概而论,生态地理环境对其的影响不可忽视。研究可以为揭示陆地生态系统碳循环的动态机制提供一定的理论依据。     

精神卫生护理服务项目成本核算

???? 目的 为提高精神卫生护理服务项目的收费提供依据。 方法 采用全成本核算和剔除财政补助收入的成本核算方法。结果 精神特级护理成本为7.70元/小时,剔除财政后成本为7.40元/小时;一级和二级护理成本为135.00元/日和63.50元/日,而剔除财政补助后成本为130.50元/日和61.40元/日。结论 应提高精神科的护理服务项目的收费标准,同时标准应该体现护理级别。收费标准的确定按照护理服务项目的成本和剔除财政补助后的成本确定。

     

上海三级甲等医院移动医疗App应用现状调查

目的 全面了解上海市三级甲等医院App运营情况,探索进一步完善微信运营的有效措施。方法 应用文本分析法以及深度访谈法,以上海市40家三级甲等医院为调查样本,对其App应用软件的开通率、患者使用率以及功能建设情况进行调查。结果 在全市40家三级甲等医院中,App软件开通率为35%;在91助手、应用宝、乐商店等下载平台上,瑞金医院下载量最高,其余下载量均较低;在功能设置情况方面,领取报告、医院导航等互动功能开设率达85%,医院介绍、科室介绍等静态信息发布功能设置率仅为15%。结论 移动App正在不断深化服务内涵,提供细节服务,并汲取多方资源优势,采取互助共赢的合作模式。然而仍需通过院内院外、线上线下合作的方式加大推广力度,并进一步挖掘多方资源合作潜力,进一步探索细节服务。     

内蒙古不同类型草地土壤氮矿化及其温度敏感性

土壤氮矿化(Nitrogen mineralization)是土壤氮循环的重要环节,对土壤氮素供应以及植物生产力的维持具有十分重要的意义。沿中国东北草地样带(Northeastern China Transect, NECT)分别在典型草地、过渡草地及荒漠草地设置了3个实验样地,利用不同温度(5、10、15、20 ℃和25 ℃)和不同水分(30%、60%和90%土壤饱和含水量,Saturated soil moisture, SSM)的室内培养途径,探讨了不同类型草地的土壤氮矿化速率、土壤氮矿化的温度敏感性(Q₁₀)及其主要影响因素。实验结果表明:从典型草地至荒漠草地,土壤全碳、全氮、全磷、微生物生物量碳氮含量均表现为逐渐下降的趋势;类似地,土壤净氮矿化速率、硝化速率也逐渐降低。在20 ℃和60% SSM时,土壤净氮矿化速率表现为典型草地 (0.715 mg N kg^-1 d^-1) > 过渡草地 (0.507 mg N kg^-1 d^-1) > 荒漠草地 (0.134 mg N kg^-1 d^-1);相反,温度敏感性却逐渐升高,温度敏感性与基质质量指数呈负相关。草地类型和水分对于土壤净氮矿化速率、硝化速率具有显著影响,且二者间具有显著的交互效应。包含温度和水分的双因素模型可很好地拟合土壤氮矿化速率的变化趋势(P < 0.0001),二者可共同解释土壤硝化速率92%-96%的变异。土壤氮矿化沿着草地演替呈现出很好的空间格局、并与温度和水分具有密切关系,为解释内蒙古草地空间分布格局提供了理论基础。     

Expression,Purification, and Characterization of Recombinant Human α<Subscript>1</Subscript>-Antitrypsin Produced Using Silkworm–Baculovirus Expression System

Human α₁-antitrypsin (AAT) is the most abundant serine proteinase inhibitor (serpin) in the human plasma. Commercially available AAT for the medications of deficiency of α₁-antitrypsin is mainly purified from human plasma. There is a high demand for a stable and low-cost supply of recombinant AAT (rAAT). In this study, the baculovirus expression vector system using silkworm larvae as host was employed and a large amount of highly active AAT was recovered from the silkworm serum (~?15 mg/10 ml) with high purity. Both the enzymatic activity and stability of purified rAAT were comparable with those of commercial product. Our results provide an alternative method for mass production of the active rAAT in pharmaceutical use.     

An ambient water loop system for USP purified water

An ambient loop USP purified water system has been designed and implemented using carbon and ion exchange resin beds, ultraviolet light systems and polishing filters to produce water consistently meeting or exceeding all USP XXIII quality specifications for purified water. The circulation system is constructed of PVDF plastic piping material installed in a continuous fully-drainable loop. The system was sized for a pilot scale fermentation/harvest process at the 1000?l cultivation scale. This system passed all installation and operational qualification testing as well as sixty days of continuous performance qualification testing before entering into an ongoing monitoring regimen. Excursions outside acceptable water quality parameters during this extensive monitoring regimen were minimal. Sanitization of the system, along with bed and filter changes at the time of sanitization, was conducted every 3 to 6 months to insure consistent water quality.     

Effect of plant water deficit on the deoxynivalenol concentration in Fusarium-infected maize kernels

In current climate change scenarios, mean air temperatures and summer droughts are expected to increase over the long-term average in large parts of Europe. These changes will strongly affect the growth and health of cultivated plants. In a field experiment in 2009 and 2010 in rain-out shelters, the consequences of plant water availability under three water regimes on the severity of Fusarium ear rot, deoxynivalenol (DON) contamination and yield of maize were investigated. Water was provided exclusively to the plants by a mobile sprinkler system installed in the rain-out shelter. Three maize cultivars were supplied with 50, 75, and 125% of the long-term average monthly precipitation of the experimental site. In 2009, Fusarium graminearum-infected oat kernels were placed on the soil surrounding maize plants to promote ear infection, whereas in 2010, the maize silks were directly inoculated with suspensions of F. graminearum conidia. Heavy drought stress in the 50% water regime was reflected in the average ear yield of the three maize cultivars of 75?dt ha^-1 compared with 192?dt ha^-1 at 125% water. In this comparison, the DON concentrations in the kernels were fivefold higher at 50% water than at the high water regime: 380 compared with 75???g DON kg^-1 DM. In 2010, the drought stress symptoms were less pronounced than in 2009, and a much lower ear yield loss from 128 to 108?dt DM ha^-1 was observed with decreasing water supply. The DON contamination of the kernels was at a higher level than in 2009, but a similar upward trend from 330???g?kg ^-1 DM at 125% water supply to about 3.5-fold higher DON levels at 75 and 50% water supply was observed. These different yield responses presumably resulted from variable climatic conditions at the experimental site in the 2?years. The results of this study suggest that the risk of DON contamination of maize kernels increases when plants are grown under conditions of long-term water deficit.     

Investigation of a toxic water-bloom of Microcystis aeruginosa (Cyanophyceae) in Lake Akersvatn,Norway

During the summer and fall of 1984 and 1985, the eutrophic Lake Akersvatn in south-eastern Norway, used as reserve drinking water reservoir, was found to produce heavy water-blooms of the colonial blue-green alga Microcystis aeruginosa. Samples of the water-bloom were found to be toxic using the mouse bioassay. No toxin was found free in the water as detected by HPLC and mouse bioassay. The toxic cells (minimum lethal dose 8–15 mg/kg body weight in mice) and purified toxin (minimum lethal dose 50 μg/kg body weight in mice) showed signs of poisoning in laboratory rats and mice identical to that of other hepatotoxin-producing M. aeruginosa blooms and strains reported from other parts of the world. The toxin has chemical properties similar to the cyclic heptapeptide reported for a South African M. aeruginosa toxin. The toxin from Lake Akersvatn bloom material has a molecular weight of 994. The toxic bloom of M. aeruginosa persisted from August to November in 1984 and reappeared in July of 1985. While water from Lake Akersvatn was not used for municipal water supply during this period, the presence of toxic blue-green algae in a drinking water reservoir indicates the need to develop monitoring and detection methods for toxic cells and toxin(s).     

THE BIOSYNTHESIS OF OCTOPAMINE-CHARACTERIZATION OF LOBSTER TYRAMINE β-HYDROXYLASE

—Tyramine β-hydroxylase catalyzes the biosynthesis of octopamine in the lobster nervous system. This enzyme has been characterized and a rapid microassay, based on the enzymic release of tritiated water from [1,2-(side chain) ³H] tyramine, has been developed. Lobster tyramine β-hydroxylase resembled mammalian dopamine β-hydroxylase. The most conspicuous differences were that the lobster enzyme was inhibited by anions, particularly fumarate, and had a higher affinity for substrates. Tyramine β-hydroxylase activity was present in both particulate and soluble fractions of homogenates of the lobster nervous system. Bound activity, extracted by repeated freezing and thawing, was partially purified. The enzyme had the following properties: (1) The optimum pH for the conversion of tyramine to octopamine was 7·4. (2) The apparent Michaelis constant for tyramine was 0·15 mm and for ascorbic acid was 0·2 mm at pH 6·6. (3) The purified enzyme was inhibited by salts; the degree of inhibition was sensitive to the anion and decreased in the order chloride ? fumarate > sulphate > acetate. (4) Tyramine β-hydroxylase was inhibited by metal chelating agents and by cupric sulphate at concentrations greater than 10^?4m ; N-ethylmaleimide had no significant effect on activity in concentrations up to 3 mm . (5) The purified enzyme also β-hydroxylated dopamine to form norepinephrine, with an apparent Michaelis constant of 0·24 mm . This activity co-purified with tyramine β-hydroxylase, suggesting that a single enzyme catalyzed both reactions.     

基于模糊综合评判法的医院费用规制效果综合评价

??????? 目的 评价我国医疗费用规制策略效果,筛选优先干预策略。方法 运用模糊综合评判法对医院费用的重要规制手段：医疗服务定价方式、药品流通体制、医疗保险支付方式的重要性、可操作性、失效程度、干预迫切性四个维度进行综合评价。 结果 导致我国医疗费用控制效果不佳的首要原因在于药品流通体制的管制失效;现行医保支付方式对医疗费用的规制作用不强,这是导致快速上涨的医疗费用难以得到有效遏制控制的第二位原因。 结论 改善我国医疗费用规制效果的优先策略是进一步强化药品流通体制规制改革的推进力度;其次,亟待深化医保制度支付方式的费用控制机制探索,发挥医保制度作为第三方对医疗费用的重要规制作用。     

Biocompatibility evaluation of densified bacterial nanocellulose hydrogel as an implant material for auricular cartilage regeneration

Bacterial nanocellulose (BNC), synthesized by the bacterium Gluconacetobacter xylinus, is composed of highly hydrated fibrils (99 % water) with high mechanical strength. These exceptional material properties make BNC a novel biomaterial for many potential medical and tissue engineering applications. Recently, BNC with cellulose content of 15 % has been proposed as an implant material for auricular cartilage replacement, since it matches the mechanical requirements of human auricular cartilage. This study investigates the biocompatibility of BNC with increased cellulose content (17 %) to evaluate its response in vitro and in vivo. Cylindrical BNC structures (Ø48?×?20 mm) were produced, purified in a built-in house perfusion system, and compressed to increase the cellulose content in BNC hydrogels. The reduction of endotoxicity of the material was quantified by bacterial endotoxin analysis throughout the purification process. Afterward, the biocompatibility of the purified BNC hydrogels with cellulose content of 17 % was assessed in vitro and in vivo, according to standards set forth in ISO 10993. The endotoxin content in non-purified BNC (2,390 endotoxin units (EU)/ml) was reduced to 0.10 EU/ml after the purification process, level well below the endotoxin threshold set for medical devices. Furthermore, the biocompatibility tests demonstrated that densified BNC hydrogels are non-cytotoxic and cause a minimal foreign body response. In support with our previous findings, this study concludes that BNC with increased cellulose content of 17 % is a promising non-resorbable biomaterial for auricular cartilage tissue engineering, due to its similarity with auricular cartilage in terms of mechanical strength and host tissue response.     

Bilirubin oxidase from Magnaporthe oryzae: an attractive new enzyme for biotechnological applications

A novel bilirubin oxidase (BOD), from the rice blast fungus Magnaporthe oryzae, has been identified and isolated. The 64-kDa protein containing four coppers was successfully overexpressed in Pichia pastoris and purified to homogeneity in one step. Protein yield is more than 100?mg for 2?L culture, twice that of Myrothecium verrucaria. The k _cat/K _m ratio for conjugated bilirubin (1,513?mM^?1?s^?1) is higher than that obtained for the BOD from M. verrucaria expressed in native fungus (980?mM^?1?s^?1), with the lowest K _m measured for any BOD highly desirable for detection of bilirubin in medical samples. In addition, this protein exhibits a half-life for deactivation >300?min at 37?°C, high stability at pH?7, and high tolerance towards urea, making it an ideal candidate for the elaboration of biofuel cells, powering implantable medical devices. Finally, this new BOD is efficient in decolorizing textile dyes such as Remazol brilliant Blue R, making it useful for environmentally friendly industrial applications.     

Does foliage on the same branch compete for the same water? Experiments on Douglas-fir trees

Do branchlets within a branch have autonomous water supplies, or do they share a common water supply system? We hypothesized that if branchlets shared a common water supply, then stomatal conductance (g_s) on sunlit foliage would increase with reduced transpiration of competing foliage on the branch. We reduced transpiration of other foliage on the branch through bagging and shading, and we monitored the gas-exchange responses of the remaining sunlit foliage on the branch relative to control branches for several age classes of Douglas-fir trees (aged ~10 years, 20 years, and 450 years old). Contrary to our hypothesis, we found no increases in g_s in either young or old trees following transient reductions in the amount of transpiring leaf area. The diurnal change in water potential, mid-day stomatal closure and associated photosynthetic decline occurred at the same time and were of the same magnitude on both treated and untreated branches, with the exception of photosynthesis in one 450-year-old tree. Hydraulic conductance measurements of branch junctions indicate that xylem within branches is only partially interconnected which would reduce the effectiveness of shading as a means of increasing water supply to the remaining sunlit foliage. The lack of a response implies that when a branch is in partial shade, the remaining sunlit foliage has no advantage with respect to water status over foliage on a branch completely in the sun.     

城市供水系统对水中真菌数量和群落结构的影响

【背景】对于饮用水中的微生物污染,绝大多数研究集中在细菌、病毒及原虫和蠕虫。由于真菌中包含多种潜在致病菌,应当引起人们的关注。【目的】研究城市供水系统中真菌数量、群落组成变化及可能存在的潜在致病真菌。【方法】利用MEA和RB两种培养基,对供水系统中的原水和两个水厂净水工艺过程及不同供水模式用户龙头水样进行培养法计数统计。提取上述样本总DNA,并应用Illumina MiSeq平台进行ITS1区高通量测序。【结果】从15个样本中共获得有效序列579 470条,1 260个OTU,包含8个门26个纲67个目228个属的真菌。门水平上子囊菌门真菌为供水系统优势真菌,属水平上不同样本存在差异,但曲霉属和枝顶孢属真菌在所有样本中均存在;培养法和高通量测序结果共同显示,活性炭过滤出水真菌数量和物种丰富度均较前一工艺有所上升;氯化消毒对真菌数量、物种多样性及物种组成影响显著;经过供水管网输配和二次供水设施后,用户龙头水样本真菌数量和物种丰富度明显高于出厂水。【结论】供水系统中的优势真菌为子囊菌门(Ascomycota),该门真菌可穿透净水工艺过程的多级屏障;水厂净水工艺能有效去除水中可培养真菌,生物活性炭过滤工艺能够影响真菌数目及物种多样性;供水管网及二次供水设施是末端饮用水中真菌污染的重要来源;供水系统中存在潜在致病真菌。