四川大学医院管理MBA项目的学员满意度分析及启示

目的调查四川大学医院管理MBA项目的学员满意度,分析其影响因素,寻求相关启示,为现代医院管理者决策提供参考依据。方法以2006年2010年四川大学医院管理MBA项目学员为研究对象,采用自制的调查问卷,对参与培训的336名学员进行统一的问卷调查,对结果采用logistic回归分析。结果发放问卷336份,回收有效问卷320份,有效回收率95%。86.2%的学员表示对培训项目的效果满意。课程内容的实践性、培训组织管理模式、是否有丰富的个案分析等因素与学员满意度有关（P〈0.05）。结论要做好医院管理MBA的培训项目,需要关注影响学员满意度的因素,需在课程内容设计、培训模式改进、案例资料库的甄选等方面努力,从而设计更符合现代医院管理需要的MBA培训课程。     

Palytoxins: Biological and chemical determination

Palytoxin (PLTX) is a marine polyether toxin with a very large and complex molecule that has both lipophilic and hydrophilic areas. It presents the longest continuous carbon atoms chain known to exist in a natural product second only to maitotoxin.This toxin was first isolated from Palythoa toxica and was subsequently reported in dinoflagellates of the genus Ostreopsis. Although PLTX has so far been associated with ciguateric fish poisoning (CFP), recent evidence suggests that PLTXs should be excluded from CFP toxins. NMR and LC-MS/MS techniques have enabled the isolation of 10-15 new analogues from dinoflagellates ever since their first discovery.Literature data on biological origin, poisonings and chemistry of certain naturally occurring PLTX analogues, commonly known as ostreocins, are detailed herein. This paper reviews all reported biological and chemical analysis methods to date for this group of compounds.     

SCIT Versus SLIT: Which One Do You Recommend,Doc?

Allergic rhinitis is a prevalent condition that has a significant impact on the quality of life of many patients. When initial therapy fails to control the symptoms, allergen immunotherapy (AIT) has been suggested as an option by the Joint Task Force on Practice Parameters. The 2 main forms of AIT are via subcutaneous and sublingual routes, called subcutaneous immunotherapy and sublingual immunotherapy, respectively. There is debate about which is the better option for patients with each method offering its own pros and cons. We present 2 patients with allergic rhinitisAR that were deemed good candidates for AIT and explore current evidence for both subcutaneous immunotherapy and sublingual immunotherapy. The advantages and disadvantages of each method are discussed with the goal of providing a framework for the physician when deciding on AIT for their patients. In addition, we explore the use of AIT in patients with asthma and atopic dermatitis as potential patient populations that may benefit from the treatment. We use the discussion to provide recommendations regarding which method of AIT is best suited for both our patients.     

医院科学管理理念与实践

经验型管理模式已不适应市场经济飞速发展的需要;以现代的管理理念指导实践,将会提高医院管理绩效;管理者的素质对医院发展的影响至关重大;引进MBA促进管理队伍的规范化、智能化,是医院迎接入世挑战的需要;坚持"以人为本"的原则,充分体现"人是最宝贵的管理资源",将最大限度地发挥人才潜力;人事、分配制度改革是医院在学科建设、人才培养、质量控制、经济管理和后勤保障等方面高效运转的保证;营建现代化医院文化,建树医院形象工程,是对医院无形资产的有益放大.     

Leveraging Interactive Patient Care Technology to Improve Pain Management Engagement

Background: Most children experience pain in hospitals; and their parents report dissatisfaction with how well pain was managed. Engaging patients and families in the development and evaluation of pain treatment plans may improve perceptions of pain management and hospital experiences. Objectives: The aim of this performance improvement project was to engage patients and families to address hospitalized pediatric patients' pain using interactive patient care technology. The goal was to stimulate conversations about pain management expectations and perceptions of treatment plan effectiveness among patients, parents, and health care teams. Methods: Plan-Do-Study-Act was used to design, develop, test, and pilot new workflows to integrate the interactive patient care technology system with the automated medication dispensing system and document actions from both systems into the electronic health record. Setting: The pediatric surgical unit and hematology/oncology unit of a free-standing, university-affiliated, urban children's hospital were selected to pilot this performance improvement project because of the high prevalence of pain from surgeries and hematologic and oncologic diseases, treatments, and invasive procedures. Results: Documentation of pain assessments, nonpharmacologic interventions, and evaluation of treatment effectiveness increased. The proportion of positive family satisfaction responses for pain management significantly increased from fiscal year 2014 to fiscal year 2016 (p = .006). Conclusion: By leveraging interactive patient care technologies, patients and families were engaged to take an active role in pain treatment plans and evaluation of treatment outcomes. Improved active communication and partnership with patients and families can effectively change organizational culture to be more sensitive to patients' pain and patients' and families' hospital experiences.     

Mannosamine–biotin as a novel masking agent for coating IgG for immune response silencing and augmentation of antibody–antigen interaction

A variety of protein-coating procedures are used to modify proteins’ properties. The principle coating agent used is PEGylation, in which proteins are coated by conjunction to polyethylene glycol (PEG). In the present study, we describe a novel approach that makes use of small molecules with multifunctional groups as the protein-coating agent. The new coating molecule was produced by reacting two endogenous molecules, mannosamine and biotin, to form mannose–biotin adducts (MBA). hIgG was coated with MBA at various MBA/protein ratios. The immunogenicity of MBA-coated hIgG was tested in chickens. A dose-responsive effect of MBA/hIgG ratio on immune response suppression was detected, with an optimal masking effect at a 12:1 ratio. The immune response to MBA-coated hIgG was about eightfold lower than that to PEG-coated hIgG. MBA also increased antibody–antigen-binding affinity, and decreased recognition of the Fc domain of MBA-coated hIgG by Fc receptor and secondary antibodies. While the PEG molecule consists of inert repeating units of ethylene oxide with no additional functional group to allow for potentially desirable modifications, the MBA has several functional groups, including vicinal hydroxyls, which can easily be converted to active residues such as aldehydes or carboxyls. This may be of importance for developing passive immunizations or for achieving tolerance of the immune response to an immunogenic molecule or virus. In summary, we developed a new protein-coating molecule with the ability to mask foreign antigens and in the case of antibodies, to enhance activity.     

Remote Patient Monitoring Using Mobile Health for Total Knee Arthroplasty: Validation of a Wearable and Machine Learning–Based Surveillance Platform

BackgroundRecent technologic advances capable of measuring outcomes after total knee arthroplasty (TKA) are critical in quantifying value-based care. Traditionally accomplished through office assessments and surveys with variable follow-up, this strategy lacks continuous and complete data. The primary objective of this study was to validate the feasibility of a remote patient monitoring (RPM) system in terms of the frequency of data interruptions and patient acceptance. Second, we report pilot data for (1) mobility; (2) knee range of motion, (3) patient-reported outcome measures (PROMs); (4) opioid use; and (5) home exercise program (HEP) compliance.MethodsA pilot cohort of 25 patients undergoing primary TKA for osteoarthritis was enrolled. Patients downloaded the RPM mobile application preoperatively to collect baseline activity and PROMs data, and the wearable knee sleeve was paired to the smartphone during admission. The following was collected up to 3 months postoperatively: mobility (step count), range of motion, PROMs, opioid consumption, and HEP compliance. Validation was determined by acquisition of continuous data and patient tolerance at semistructured interviews 3 months after operation.ResultsOf the 25 enrolled patients, 100% had uninterrupted passive data collection. Of the 22 available for follow-up interviews, all found the system motivating and engaging. Mean mobility returned to baseline within 6 weeks and exceeded preoperative baseline by 30% at 3 months. Mean knee flexion achieved was 119°, which did not differ from clinic measurements (P = .31). Mean KOOS improvement was 39.3 after 3 months (range: 3-60). Opioid use typically stopped by postoperative day 5. HEP compliance was 62% (range: 0%-99%).ConclusionsIn this pilot study, we established the ability to remotely acquire continuous data for patients undergoing TKA, who found the application to be engaging. RPM offers the newfound ability to more completely evaluate the patients undergoing TKA in terms of mobility and rehabilitation compliance. Study with more patients is required to establish clinical significance.     

Incidence,Causes, and Timing of 30-Day Readmission Following Total Knee Arthroplasty

BackgroundIt is important to study the incidence and causes of readmissions in order to understand why they occur and how to reduce them. This study looks at a national sample of patients following total knee arthroplasty (TKA) to identify incidences, trends, causes, and timing of 30-day readmissions.MethodsPatients undergoing primary TKA from 2012 to 2016 in the American College of Surgeons National Surgical Quality Improvement Program database were identified (n = 197,192). Patients with fractures (n = 177), nonelective surgery (n = 2234), bilateral TKA (n = 5483), and cases with unknown readmission status (n = 1047) were excluded, leaving a total of 188,251 cases. Linear regression analysis was used to determine trends over time.ResultsThe incidence of overall 30-day readmission following primary TKA from 2012 to 2016 was 3.19% (6014/188,251), with significant decreases in readmission rates during this time (β = ?0.001, P < .001). The top 5 causes of readmission included superficial surgical site infection (SSI; 9.7%), non-SSI infection (9.5%), cardiovascular complications (CV; 9.3%), gastrointestinal complications (8.8%), and venous thromboembolisms (8.8%). The most common cause of readmission during postoperative week 1 was CV complications (12.2%), week 2 was superficial SSI (11.6%), week 3 was deep SSI (11.4%), and week 4 was deep SSI (12.4%).ConclusionOverall, 30-day readmissions following TKA were found to significantly decline from 2012 to 2016. The most common causes of overall readmission included superficial SSI, non-SSI infection, CV complications, gastrointestinal complications, and venous thromboembolisms. However, the most common causes of readmission changed from week to week postoperatively. This data may help institutions develop policies to prevent unplanned readmissions following TKA.