浅论深化公立医院人事制度改革

目的探讨如何深化公立医院人事制度改革。方法分析我国公立医院人事管理存在的问题,探讨深化我国公立医院人事制度改革原则、方法和内容。结果公立医院人事制度改革目前正处于起步阶段,尚存在很多问题,需要采取多种综合的方法,创新性地进行改革。结论为了促进公立医院体制、机制改革,必须加快公立医院人事制度改革进程。     

医院人事档案管理现状及实现信息化管理初探

在中央组织部、人事部、卫生部联合下发的《关于深化卫生事业单位人事制度改革的实施意见》的指导下,我院人事制度改革日益深化,近年来依据文件精神推行了定岗定编,全员聘用合同制,主任护士长竞争上岗,技术职称职务评聘分开,以实绩聘用相应岗位等诸多人事制度的改革,使得医院的人事制度改革取得了较大的成果。     

医院人事制度改革浅析

我院作为昌吉州党委和州人民政府确定的事业单位人事制度改革试点单位,认真贯彻中组部、人事部、卫生部《关于深化卫生事业单位人事制度改革的实施意见》,积极推行人事制度改革和分配制度改革,并取得了初步的成效。     

公立医院去行政化长路漫漫

7月30日,湖北省出台《关于进一步深化全省事业单位人事制度改革的实施意见》（以下简称《意见》）。这是全国第一份涉及全面深化事业单位人事制度改革的省级“落地”文件。《意见》指出,湖北省将逐步取消学校、科研院所、医院等事业性质单位的行政级别,建立多种形式法人治理结构,分类推进事业单位人事制度改革。     

关于岗位设置管理的思考

随着社会主义市场经济的建立和完善,事业单位的人事制度改革刻不容缓。作为事业单位人事制度改革的一项重要内容,岗位设置不仅是事业单位人事制度改革的基础,还是事业单位深化人事制度改革的重要内容和举措。本文从医院岗位设置管理与聘用工作的实际出发,探讨了如何科学、合理地进行岗位设置与聘用。     

全面深化人事制度改革的做法与体会

卫生系统人事制度改革是“三项制度改革”的重点,也是难点。随着经济体制改革的不断深化,现行的卫生人事制度面临着更为严峻的形势。近两年来,我院从深化人事制度改革入手,从满足社会需求和工作需要出发,转换医院内部运行机制,增强医院发展的活力。我们的做法是:1 认清形势.统一思想,变压力为动力。 为了保证改革的顺利实施,我首先从以下几个方面统一全院干部、职工的思想。1.1 人事制度改革是当前市场经济改革大形势的需要     

探索医院人事制度改革的新路与成效

人事制度改革是医院各项改革的重点也是难点，加强人事制度改革是深化医院改革的重要部分，是适应社会主义市场经济促进医院发展的组织保证，我院自1998年以来，按照“以病人为中心，深化医院改革”的总体方案，本着“务实、精干、高效”的原则，对医院人事制度进行了大胆的改革实践。取得了较好的成效。     

深化医院人事体制改革的探讨

深化医院人事体制改革的探讨湖南医科大学附属湘雅医院（长沙４１００Ｏ８）孟玉兰关键词人事体制改革，医院分类号Ｒ１９７．３２１人事制度的改革是其他一切改革的基础和保证。没有人事制度的改革，人的积极性就调动不起来。我院的人事制度改革是从１９９４年执行全员聘...     

在全国卫生人事工作会议上的讲话

这次会议的主要任务是,认真学习国务院办公厅转发的国家体改办筹八部门《关于城镇医药卫生体制改革的指导意见》(以下简称《指导意见》)和2000年全国卫生厅局长会议精神,研究贯彻中央组织部、人事部和卫生部联合下发的《深化卫生事业单位人事制度改革的实施意见》(以下简称《实施意见》),交流各地在卫生人事制度改革方面的经验,进一步深化卫生人事制度改革,推进城镇医药卫生体     

思想政治工作在推动医院人事制度改革中的作用

人事制度改革作为医院改革的重要内容,政策性较强,敏感度较高,牵涉面较广,涉及医院全方位的工作及多方面的利益调整.因此,改革的难度是较大的.医院进行人事制度改革,应符合医院自身特点,建立人员能进能出、职务能上能下、待遇能降能升、公开、公平竞争,择优,充满生机与活力的用人机制.充分发挥思想政治工作的作用,做好宣传、解释和思想教育工作,是医院人事制度改革得以顺利进行和深化的根本保证.能使改革得到全院各方面的理解、支持和配合,促进医院各项工作稳步向前推进.医院内部改革主要包括医院管理体制和人事分配制度改革两部分,而其中难点是人事分配制度改革,所以搞好医院人事制度改革对于推动和保障医疗卫生改革具有非常重要的意义.而充分发挥思想政治工作的作用,是医院人事制度改革得以顺利进行和深化的根本保证.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.