It Takes a Village… RN Diploma to BSN Program

Educational mobility is familiar to diploma and associate degree faculty and is emphasized in the Institute of Medicine Report, The Future of Nursing. Utilizing this premise, a team of nurse educators and administrators implemented the principles of organizational redesign, change process, and project planning to facilitate a transformation from a hospital-based diploma program to a university bachelor of science in nursing program. The process described truly exemplifies the fact that “it does take a village” to create success.     

Costs and effects of new professional roles: Evidence from a literature review

One way in which governments are seeking to improve the efficiency of the health care sector is by redesigning health services to contain labour costs. The aim of this study was to investigate the impact of new professional roles on a wide range of health service outcomes and costs.A systematic literature review was performed by searching in different databases for evaluation papers of new professional roles (published 1985–2013). The PRISMA checklist was used to conduct and report the systematic literature review and the EPHPP-Quality Assessment Tool to assess the quality of the studies.Forty-one studies of specialist nurses (SNs) and advanced nurse practitioners (ANPs) were selected for data extraction and analysis. The 25 SN studies evaluated most often quality of life (10 studies), clinical outcomes (8), and costs (8). Significant advantages were seen most frequently regarding health care utilization (in 3 of 3 studies), patient information (5 of 6), and patient satisfaction (4 of 6). The 16 ANP studies evaluated most often patient satisfaction (8), clinical outcomes (5), and costs (5). Significant advantages were seen most frequently regarding clinical outcomes (5 of 5), patient information (3 of 4), and patient satisfaction (5 of 8).Promoting new professional roles may help improve health care delivery and possibly contain costs. Exploring the optimal skill-mix deserves further attention from health care professionals, researchers and policy makers.     

The influence of lysosomal stability of silver nanomaterials on their toxicity to human cells

How silver nanomaterials (Ag NMs) could induce toxicity has been debated heatedly by many researchers. We utilized Ag nanoclusters (Ag NCs) with the same size and ligand protection but different core surface speciation. Ag⁺-rich NCs (Ag⁺-R NCs) and their counterpart, the reduced Ag⁰-rich NCs (Ag⁰-R NCs) are synthesized to represent possible dichotomous stages in silver nanomaterial degradation process. Here we show Ag⁰-R NCs induce higher cellular toxicity when compared to Ag⁺-R NCs. This cellular toxicity is brought about via the modulation of reactive oxygen species (ROS) in cells as a result of the more rapid release of Ag species from Ag⁰-R NCs and subsequent oxidation into Ag⁺ in the lysosomal compartment. The weaker Ag⁰-R bond greatly potentiated the release of Ag species in the acidic and enzymatic processes within the lysosomes. Since lysosomes are absent in bacteria, increasing silver nanomaterials stability may lower toxicity in mammalian cells whilst not reducing their efficacy to fight bacteria; this redesign can result in a safer silver nanomaterial.     

Perceptions of a service redesign by adults living with type 2 diabetes

Title.  Perceptions of a service redesign by adults living with type 2 diabetes.
Aim.  This article is a report of a study conducted to explore the perceptions of adults with type 2 diabetes towards the service redesign.
Background.  Diabetes is reaching epidemic proportions and the management of this chronic illness is changing in response to this challenge. In the United Kingdom, there is ongoing restructuring of healthcare services for people with chronic illnesses to ensure that their general health and clinical needs are met predominantly in primary care.
Method.  An explorative qualitative approach was used. Eight focus groups were conducted with 35 people with type 2 diabetes in one urban location between 2003 and 2004. Five focus groups were conducted with people who had recently experienced the restructured service and three groups with people who had up to 2 years' experience of the new service. Concurrent data collection and thematic analysis were conducted by three researchers and credibility and verification sought by feedback to participants.
Findings.  Five main themes were identified: impact of living with diabetes; understanding diabetes; drivers for organizational change; care in context and individual concerns. Participants identified issues for ongoing development of the service.
Conclusion.  People with type 2 diabetes appreciate their care management within the primary care setting where there has been investment in staff to deliver this care. Healthcare resources are required to support the development of staff and the necessary infrastructure to undertake management in primary care. Policy makers need to address the balance of resources between primary and secondary care.     

超大型医院门诊流程再造应用研究

南京医科大学第一附属医院针对近年来门诊量越来越多的现象，对门诊实施门诊流程再造和重组，实现医院经营方式和管理方式的根本转变。通过重新设计作业流程，改善医院绩效，提高医院竞争力。     

重建学科体系 资源潜力得到释放

简述了医院通过以病种、器官、组织系统等为纽带的业务指导和行政党务领导关系的有机结合，构建“专科中心一二级科三级科”学科建设新模式。三级科是医院日常业务独立运行和经济独立核算的最小单位；二级科由三级科和主护理病区组成，是医院行政管理、业务督导、支部活动的基本单位；专科中心以器官、系统等为纽带，由数个二级科组成，是医院进行学科管理的学术性组织。三级学科体系实行动态管理，根据绩效考核结果、学科发展需要、人员变动情况，对三级学科进行新增、合并、改组。