Does the process map influence the outcome of quality improvement work? A comparison of a sequential flow diagram and a hierarchical task analysis diagram

Background  

Many quality and safety improvement methods in healthcare rely on a complete and accurate map of the process. Process mapping in healthcare is often achieved using a sequential flow diagram, but there is little guidance available in the literature about the most effective type of process map to use. Moreover there is evidence that the organisation of information in an external representation affects reasoning and decision making. This exploratory study examined whether the type of process map - sequential or hierarchical - affects healthcare practitioners' judgments.     

大连理工大学图书馆员的人格因素和职业现状分析

目的:通过对图书馆员的人格因素和职业现状分析,为图书馆的人力资源管理提供参数。方法:于2005-06/08纳入大连理工大学伯川图书馆馆员72人作为人格测试组,男7人,女65人;同时纳入2005-07前在职的全部馆员122人作为职业现状分析组,男26人,女96人。采用国际公认的卡特尔16种人格因素问卷,对人格测试组进行人格测试。问卷从16个相对独立的人格维度对人进行描绘,全套测试题共187题,每题设有a,b,c3种可供选择的答案。将测试结果输入心理测试软件系统,给出粗分和标准分,再运用软件进行数据的统计分析。对职业现状分析组的全体馆员进行了性别,年龄结构,男女馆员在各工作部门的分布,及馆员的学历构成,技术职称和领导职务的担任比例统计分析。观察人格测试组卡特尔16种人格因素问卷人格类型的次元因素和综合个性应用评价分数,并对全体馆员的自然状况列表进行统计分析,分析其职业现状。结果:发放卡特尔16种人格因素问卷72份,回收完整问卷46份,回收率63.9%,有效率100%。最终人格测试组46人进入结果分析,男5人,女41人。职业现状分析组122人,全部进入结果分析。①人格测试组聪慧性、幻想性、自律性均高于全国专业技术人员常模,差异有显著性意义(9.74±1.22;8.88±1.22;13.11±2.36,11.83±1.25;13.89±2.59,12.40±1.47;t=4.780,3.676,3.901,2.783,P<0.001～0.01)。被试馆员怀疑性和紧张性低于全国专业技术人员常模,差异有显著性意义(9.39±2.85,10.56±1.57;9.76±3.72,11.19±1.65;t=-2.783,-2.606,P<0.01,0.05)。②女性图书馆员占总人数的78.7%,男性图书馆员在年龄结构上处于年龄段的两端,在生理上处于成年早期(30.7%)和晚期(38.4%);女性馆员的年龄集中于30～50岁的年龄段(86.3%)。③男馆员在综合办公室、自动化部和技术服务部的人数分布方面占据优势地位(38.4%,11.5%,11.5%);而女性馆员集中于期刊咨询部、文献建设部、流通阅览部和回溯建库等信息服务咨询部门(24%,15.6%,40.6%,4.2%)。④男馆员在获得博士、双学士、学士学位,及本科、中专学历方面的人数比例大于女性馆员,而女性馆员在获得硕士学位及大专和较低学历方面所占的比例大于男性馆员。⑤男性馆员在高级技术职称和馆级领导高端决策层占优势,在初级和较低技术职称中占比例较大;女性馆员在中级技术职称中级领导层上占比例大于男性馆员。结论:图书馆员女性化,而男性馆员在知识结构、职称、高端决策层领导职务的担任和承担高技术性工作方面的整体水平优于女性馆员。更应着重分析女性图书馆员的生理、心理特点,人格因素和职业特征,进行人力资源的优化组合。     

成人骨髓间充质干细胞的体外培养及生物学特性

目的:观察成人骨髓间充质干细胞体外分离培养方法及其生物学特性,为骨髓间充质干细胞的临床应用奠定技术基础。方法:实验于2005-12在吉林省四平市中心医院中心实验室进行。实验材料:人骨髓间充质干细胞,Ficoll淋巴细胞分离液,胎牛血清,牛血清白蛋白,α-MEM培养基,胰蛋白酶,FITC标记的CD44和CD90。实验方法:①人骨髓间充质干细胞的分离与培养:采集成人骨髓,密度梯度法分离单个核细胞,条件培养基培养和扩增,倒置光学显微镜下观察细胞形态及生长情况。②人骨髓间充质干细胞生长曲线的测定:取生长良好的P1,P5,P10细胞,用胰酶消化,接种于24孔板培养,每天各取3孔消化计数细胞,取平均值,连续培养7d,绘制生长曲线。③人骨髓间充质干细胞表面标志的测定:取生长良好P5细胞进行免疫荧光染色鉴定(CD44,CD90并设同型对照)。④人骨髓间充质干细胞的冻存及复苏:收集生长良好细胞,计数细胞密度及冻前存活率。将细胞加入到细胞冻存液中液氮冷冻保存。30d后复苏细胞,每日倒置光学显微镜下观察细胞生长状况。结果:①倒置显微镜下观察细胞形态:倒置显微镜下观察细胞呈纤维形,漩涡状生长。②人骨髓间充质干细胞的生长曲线分析:传代的细胞生长较原代要快,从第10代开始细胞生长开始出现缓慢征象。③细胞表面标记检测结果:免疫荧光染色后细胞膜着色明显,CD44,CD90阳性率均大于90%。④细胞冻存及复苏生长特性分析:椎虫蓝计数细胞存活率90%以上,增殖能力强,和未冻存过的传代细胞具有同样的生长特性。结论:应用密度梯度法分离法能获得较高纯度的骨髓间充质干细胞,能在体外长期培养,在传代培养5代内生长旺盛且生物学特性稳定。     

Prominent posterior mitral annular calcification causing embolic stroke and mimicking left atrial fibroma

A 74-year-old woman status post-resection for hypertrophic cardiomyopathywas found to have a left atrial mass in the posterior mitralannulus encroaching upon and causing     

A chromosomal breakage syndrome with profound immunodeficiency

The chromosomal breakage syndromes--ataxia-telangiectasia, Fanconi's anemia, and Bloom's syndrome--are associated with growth failure, neurologic abnormalities, immunodeficiency, and an increased incidence of malignancy. The relationship between these features is unknown. We recently evaluated a 21-year-old female with more severe chromosomal breakage, immunodeficiency, and growth failure than in any of the mentioned disorders. As of November 1985, the patient remains clinically free of malignancy. At age 18, the patient's weight was 22.6 kg (50th percentile for seven years), height was 129 cm (50th percentile for eight years), and head circumference was 42 cm (50th percentile for six months). Laboratory studies demonstrated a marked decrease in both B and T cell number and function. The peripheral blood contained 400 to 900 lymphocytes/microL with 32% T11 cells, 17% T4 cells, and 21% T8 cells. The proliferative responses to phytohemagglutinin (PHA), pokeweed mitogen, and concanavalin A were less than 10% of control. There were 1% surface IgM positive cells, and serum IgG was 185 mg/dL, IgM 7 mg/dL, IgA 5 mg/dL. In lymphocyte cultures stimulated with the T cell mitogens PHA, phorbol ester, and interleukin 2, 55% of the banded metaphases demonstrated breaks or rearrangements. The majority of the breaks involved four fragile sites on chromosomes 7 and 14, 7p13, 7q35, 14q11, and 14q32. These are the sites of the genes for the T cell-antigen receptor and the immunoglobulin heavy chain and are sites of gene rearrangement in lymphocyte differentiation. Epstein-Barr virus stimulated B cells and fibroblast cultures also demonstrated a high incidence of breaks, but the sites were less selective. These findings suggest that the sites of chromosomal fragility in the chromosomal breakage syndromes may be informative and that factors other than the severity of the immunodeficiency or the high incidence of chromosomal damage may contribute to the occurrence of malignancy in the chromosomal breakage syndromes.