A study on creating a promotion index system of medical quality in Grade Ⅲ hospitals in Beijing

To explore how to create and optimize a promotion index system of medical quality evaluation, this article focuses on the hospital visiting process from patients, using analyzing collected those index system from couples of Grade Ⅲ hospitals in Beijing, and combining the results of literal study, field study and specialist consult, according to the different situation of general hospitals and specially hospitals, with the spirit of "maintaining the patients benefits, safeguarding the patients safety,and enhancing the medical quality", introduces the framework of the promotion index system, the rules to select the indicator, and so on, and discusses several problerns related to creating the index system.     

主题创意设计理念在实验诊断学慕课设计中的新应用

随着"互联网+高等教育"打破传统教育的时空界限和学校围墙,慕课平台的大力发展,慕课建设成为如今教学模式的新改革,中国医科大学附属第一医院实验诊断学教研室承担《实验诊断学》的慕课课程建设工作,并首次将主题创意设计的理念应用于医学教育的慕课建设中。课程内容涵盖目前5大专业,9章,19节,82个热门检测项目。本文从主题创意设计的课程设计理念、构建课程框架、组建主题创意团队等多方面探讨实验诊断学慕课课程建设的过程,并通过微信公众号分别对在校学生和社会人士进行关于主题创意设计理念的慕课设计的教学效果评价及满意度调查。调查结果显示在校学生及在职人员实验组的随堂小考成绩、满意度调查得分均高于对照组,差异具有统计学意义(t=4.266、4.689、4.198、3.869,P <0.001)。主题创意设计理念的慕课设计,有助提高学生对实验诊断课程的兴趣,提高慕课教学的教学质量,且在医学继续教育的领域,也可对相关专业的在职人员起到继续教育的作用。     

Femoral vein transposition is a durable hemodialysis access for patients who have exhausted upper extremity options

ObjectiveAccess surgeons often encounter patients with end-stage renal disease who have exhausted all upper extremity hemodialysis access options. Although the lower extremity is often the next alternative, prosthetic lower extremity access can be prone to infectious complications and historically has poor patency. We describe our contemporary experience with an autogenous femoral vein transposition (FVT) arteriovenous fistula.MethodsAll FVTs performed at an academic medical center from 2006 to 2018 were analyzed. FVTs were placed after upper extremity access was deemed no longer possible by the treating surgeon. Patient demographics, comorbidities, and access history were described, and perioperative and short-term outcomes, including maturation, were analyzed.ResultsTwenty-one patients treated with FVT were identified. The mean age was 55.3 ± 11.1 years; 23.8% were female, and 71.4% were African American. The median body mass index was 27.1 kg/m² (range, 17-46 kg/m²). Comorbidities included hypertension (100%), diabetes (61.9%), coronary artery disease (57.1%), congestive heart failure (47.6%), and obesity (38.1%). Twenty patients had at least one prior arm access, whereas 13 patients (61.9%) had more than three prior arm accesses. Seventeen patients (81%) had central venous stenosis or occlusion confirmed on preoperative imaging. The mean operative time was 250 minutes (range, 144-406 minutes), and estimated blood loss was 140.5 mL. Preanastomotic tapering was performed in 20 (95.2%) patients. Four (19%) patients returned to the operating room within 30 days. Thirty-day postoperative cardiac and wound complications occurred in 9.5% and 19% of patients, respectively. Distal arterial ischemia requiring revascularization occurred in one (4.8%) patient at 7 months. There were no access-related infections that resulted in fistula ligation. There was no mortality at 30 days. Successful fistula maturation rate at 6 months was 88.9%. At 1 year, primary and secondary patency rates were 65.9%, and 94.7%, respectively.ConclusionsAlthough autogenous FVT performed in patients without upper extremity options has a significant wound complication rate, it is associated with an outstanding maturation rate and excellent patency rates at 1 year. This access should be readily considered in hemodialysis patients without upper extremity access options.     

疗愈氛围在改扩建医疗建筑中的营造

概述了改扩建医疗建筑疗愈氛围设计的研究背景和研究意义,并基于疗愈理念,详细阐述了在项目建设的各个实施阶段应关注的重点。     

对我国附条件批准上市化药药学技术要求的思考

我国2019年修订的《药品管理法》首次在法律层面提出附条件批准上市,标志着我国正式实施附条件批准上市制度。本文通过比较我国与欧美地区附条件批准上市药品的法规与技术要求,借鉴欧美地区对附条件批准化学药品的药学审评经验,探讨我国附条件批准上市化学药品的药学审评技术要求。     

超临界CO_2从柴胡中萃取挥发油及其皂甙的研究

目的 :研究超临界CO2 萃取柴胡挥发油和皂甙的工艺。方法 :主要探讨压力、温度、时间、流量、夹带剂等条件对收率的影响 ,确定超临界CO2 萃取柴胡挥发油和皂甙的最佳条件。并将挥发油的超临界CO2 萃取法与传统的水蒸气蒸馏法进行比较 ,同时 ,用GC/MS法对挥发油进行分离鉴定。结果 :挥发油的萃取压力为 2 0MPa ,温度 30℃ ;解析釜I压力为 12MPa ,温度 6 5℃ ;解析釜Ⅱ压力为 6MPa ,温度 40℃ ;萃取时间 4h ,CO2 流量为每1kg原料 10～ 2 0kg·h-1。柴胡皂甙的萃取压力是 30MPa ,温度 6 5℃ ;解析釜I压力为 12MPa ,温度 5 5℃ ;解析釜Ⅱ压力为 6MPa ,温度 43℃ ;萃取时间 3h ,CO2 流量为每 1kg原料 2 0～ 2 5kg·h-1。结论 :超临界CO2 提取挥发油比传统法优越 ,表现在收率大大提高 ,提取时间短等方面。挥发油由己醛等 2 2个化学成分组成。加入乙醇等夹带剂 ,并升高压力和温度 ,才能提出柴胡皂甙。     

八段锦应用背景下八段操的创编缘由及其术势介绍

八段锦运动在防治疾病方面取得了显著效果,但八段锦在推广中仍面临一些问题,如不同地区的八段锦运动在职业、学历、年龄、性别等方面分布不均匀,练习场地较为单一,练习环境依赖度较高,练习时间较长,欠灵活等。为了改善上述问题,进一步提高八段锦在不同职业、学历、年龄、性别人群中的推广度,在健身气功·八段锦的基础上创编了一套与现代牵伸技术相融合的八段操。本文从八段锦目前存在的问题引出八段操创编缘由及术势介绍,为开展临床随机对照研究提供理论指导和依据,旨在推广八段操以促进全民健康。     

The Mediating Role of Boundary Creation around Work-Related ICT Use between Segmentation Preference and Psychological Detachment

Work-related use of ICT (W_ICT) at home has been found to relate to important employee outcomes in their work and family lives. However, little is known about how individuals can actively apply strategies or tactics to utilize the advantages or reduce the disadvantages of W_ICT. In the current study, based on boundary theory, we examined the interaction effect of segmentation preference and boundary control in creating the boundary around W_ICT and its subsequent positive effect on individuals’ psychological detachment. Results based on a sample of 560 Chinese full-time employees showed that only for individuals with higher boundary control, segmentation preference positively promotes boundary creation around W_ICT that subsequently positively predict psychological detachment. These findings provide a deeper understanding of how individuals with high segmentation preference can achieve psychological detachment through actively creating boundaries around W_ICT use at home.     

松萝酸制备工艺的研究

目的:探讨松萝酸提取工艺新方法及进行检测鉴定。方法:采用热乙醇回流提取法,离心分离得到松萝酸、蒸发皿蒸干,收集后为纯品。用紫外UV-2204型光谱仪、熔点测定仪进行定性分析,用高效液相色谱仪对纯度进行测定。结果:从植物松萝中提取松萝酸纯度达到99.87%,熔点、紫外吸收光谱分析与标准品相一致。结论:该提取工艺简单,成本低,适合规模化生产,对环境无污染,有利于松萝酸的开发利用。