实行院长负责制的背景、内容及对人员表现的影响

研究院长负责制的实施背景,内容及对人员表现的影响。选择社会经济水平不同的B县（较富裕）和C县（较贫困）两个县进行调查,以召开专题小组讨论（focus group discussion)和知情者访谈（key informant interview)的定性调查方法为主,结合医院收支,诊疗等方面的定量数据进行分析。结果提示院长负责制受到院长,卫技人员的普遍拥护,调动院长与职工的工作积极性。实行院长负责制期间,两个县医院的医疗活动,经济创收,满意度与人员培训方面均有所改善。分析“放权”政策的局限性以及改善人员表现应采取的措施。讨论袄地并完善院长负责制要正确处理扩大自主权和强化束约力的辩证关系和正确认识与理解新形势下的院长负责制等问题。     

Contacting your GP when the surgery is closed: issues of location and access

This paper examines spatial variation in the delivery of out of hours care through general practice, in two Health Authorities in northwest England. It demonstrates considerable variations in the type of care provided to patients in different parts of the region. These differences are not due primarily to either the geographical or socio-economic characteristics of the areas. Rather, the type of out of hours care delivered depends much more on variations in the structure and organization of service delivery. These factors, in turn, largely reflect the history of service development in each area and the ethos of individual general practitioners instrumental in establishing the service.     

Monitoring medical students' professional attributes: development of an instrument and process

Purpose: To describe and evaluate the implementation of an instrument and process to assess and monitor professional attributes in medical students. Method: The instrument was developed following a survey of professional attributes of concern displayed by medical students. This was followed by development and validation, amongst medical faculty staff and students, of the instrument and its supporting process. Evaluation was by recording participation rates by staff and by determining the consistency of the instrument across dimensions and across clerkships. Implementation in practice is described by using a case study based on one school's first year of use amongst all the students. Results: In its first year of use 7,418 forms were distributed to 376 students and 6,621 forms were returned (89%). The instrument's reliability was greatest where staff were diligent in ensuring thorough implementation. The process was able to detect students of concern and provide effective remediation and ongoing monitoring. Conclusion: The process that has been developed is sensitive, robust and is able to detect, monitor and remedy attributes traditionally regarded as difficult to define and defend. The strengths of the process lie in (1) clear definitions of acceptable and unacceptable behaviors, (2) reliance on observations by more than one person and over more than a single time period, (3) the ability to provide a longitudinal view of student's progress. This revised version was published online in September 2006 with corrections to the Cover Date.     

Phenotypic and genotypic relationship between Campylobacter spp isolated from humans and chickens in Northern Ireland--a comparison of three phenotyping and two genotyping schemes

Human campylobacteriosis is currently the most common cause of acute bacterial gastroenteritis on the island of Ireland, accounting for over 3,000 laboratory reports per year, where circa 2,000 reports originate from the Republic of Ireland and circa 1,000 reports from Northern Ireland. Elsewhere, consumption of contaminated poultry has been associated with the zoonotic transmission of disease, therefore it was the aim of this study to examine the phenotypic and genotypic relatedness of campylobacters isolated from chickens and humans locally. Sixty isolates were subtyped using phenotyping techniques (biotyping, phage-typing), as well as genotyping techniques (multilocus enzyme electrophoresis (MEE), ribotyping) and the data compared. The frequency of shared phenotypes and genotypes between poultry and humans varied depending on the typing technique employed ranging from 98.2% of human isolates sharing a similar resistotyping (MAST) disc type with poultry strains to 20% similarity with MEE typing. Overall, this small study is the first report on phenotypic and genotypic relatedness between human and poultry campylobacters in Northern Ireland, isolated under controlled conditions. The study demonstrated an association between chicken and human sub-species types, taken from a relatively contained epidemiological environment. Further work is required with larger numbers of isolates coupled with typing schemes, which are able to reliably cluster strains from chicken and humans, which share high degrees of clonality, before local poultry can be conclusively proven to be a significant source of human campylobacteriosis.     

Sulfated polysaccharides of brown seaweed Cystoseira canariensis bind to serum myostatin protein

Natural sulfated polysaccharides (SPs) derived from brown seaweed comprise a complex group of macromolecules with a wide range of important physiological properties. SPs have been shown to bind and directly regulate the bioactivity of growth factors and cytokines such as basic fibroblast growth factor, interferon, various enzymes and transforming growth factor. Myostatin is a member of the transforming growth factor-beta (TGF-beta) family that acts as a negative regulator of skeletal muscle mass. In this work we demonstrated that SPs isolated from the brown seaweed Cystoseira canariensis bind to the myostatin protein in serum.     

Pulmonary vascular responses to hypoxia and hyperoxia in healthy volunteers and COPD patients measured by electrical impedance tomography

BACKGROUND: Electrical impedance tomography (EIT) is a noninvasive imaging technique using impedance to visualize and measure blood volume changes. STUDY OBJECTIVE: To examine the validity of EIT in the measurement of hypoxic pulmonary vasoconstriction (HPV) and hyperoxic pulmonary vasodilation in healthy volunteers and COPD patients. PARTICIPANTS: Group 1 consisted of seven healthy volunteers (mean age, 46 years; age range, 36 to 53 years). Group 2 comprised six clinically stable COPD patients (mean age, 65 years; age range, 50 to 74 years). INTERVENTIONS: EIT measurements were performed in healthy subjects while they were breathing room air, 14% oxygen (ie, hypoxia), and 100% oxygen (ie, hyperoxia) through a mouthpiece. Maximal impedance change during systole (DeltaZsys) was used as a measure of pulmonary perfusion-related impedance changes. Stroke volume (SV) was measured by means of MRI. In the COPD group, EIT and SV also were determined, but only in room air and under hyperoxic conditions. RESULTS: The data were statistically compared to data for the room air baseline condition. In the volunteers, the mean (+/- SD) DeltaZsys for the group was 352 +/- 53 arbitrary units (AU) while breathing room air, 309 +/- 75 AU in hypoxia (p < 0.05), and 341 +/- 69 AU in hyperoxia (not significant [NS]). The mean MRI-measured SV was 83 +/- 21 mL while breathing room air, 90 +/- 29) mL in hypoxia (NS), and 94 +/- 19 mL in hyperoxia (p < 0.05). In the COPD patients, the mean DeltaZsys for this group was 222 +/- 84 AU while breathing room air and 255 +/- 83 AU in hyperoxia (p < 0.05). In this group, the SV was 59 +/- 16 mL while breathing room air and 61 +/- 13 mL in hyperoxia (NS). Thus, the volunteer EIT response to hypoxia is not caused by decreased SV, because SV did not show a significant decrease. Similarly, in COPD patients the EIT response to hyperoxia is not caused by increased SV, because SV showed only a minor change. CONCLUSION: EIT can detect blood volume changes due to HPV noninvasively in healthy subjects and hyperoxic vasodilation in COPD patients.