平均住院日指特定时期出院患者平均住院时长,是评估医院运行效率、医疗水平及医疗质量的重要指标.合理的平均住院时长,对于合理配置医疗资源、提高医疗资源利用效率具有重要意义.超时限住院患者是平均住院日延长的主要原因之一,不仅导致医疗资源过度消耗,影响医院社会经济潜能,也增加了患者和家庭的经济和心理负担[1].本研究以某三甲医院2017年出院患者病案首页信息为数据来源,研究>30 d住院日患者的影响因素,为制定缩短平均住院日的相关政策提供数据支撑,以达到有效利用医疗资源的目的.

自2011年,鱼精蛋白断货引发全国各大医院心脏手术停做以来,关于低价药供应不足或断货的事件屡见报端.低价药的供应不足给人民和医疗机构带来严重的影响.本文对低价药供应不足的现状进行了分析,建议为了保障低价药的供应政府相关部门药品政策、药品生产销售企业、医疗机构及医护人员、药品消费者等应采取相应的措施.

Hospital informatization platform provides support for electronization clinical pathway management. The electroni-zation clinical pathway management based on informatization platform can decrease the workload of medical staff,make the execu-tion,feedback,variance analysis and real-time monitoring of clinical pathways more efficient. The reasonable electronization clinical pathway management system would be established through disease selection on the basis of DRGs,data preparation and combination of hospital practice. The effect of the informatization based clinical pathway and its problems were analyzed.

The paper analyzed the feasibility of the application of PDCA cycle on the clinical path management.Combined with hospital practice,and from four linkages: plan stage(P),development stage(D),check stage(C),and feedback processing,continuous improvement stage(A),the paper summarized how PDCA cycle was applied to the clinical path management.Meanwhile,it was pointed out that the combination of PDCA cycle and clinical path management has a very important significance to promote the orderly development of clinical pathway.

Background The ovine Major Histocompatibility Complex (MHC) harbors genes involved in overall resistance/susceptibility of the host to infectious diseases. Compared to human and mouse, the ovine MHC is interrupted by a large piece of autosome insertion via a hypothetical chromosome inversion that constitutes ~25% of ovine chromosome 20. The evolutionary consequence of such an inversion and an insertion (inversion/insertion) in relation to MHC function remains unknown. We previously constructed a BAC clone physical map for the ovine MHC exclusive of the insertion region. Here we report the construction of a high-density physical map covering the autosome insertion in order to address the question of what the inversion/insertion had to do with ruminants during the MHC evolution. Results A total of 119 pairs of comparative bovine oligo primers were utilized to screen an ovine BAC library for positive clones and the orders and overlapping relationships of the identified clones were determined by DNA fingerprinting, BAC-end sequencing, and sequence-specific PCR. A total of 368 positive BAC clones were identified and 108 of the effective clones were ordered into an overlapping BAC contig to cover the consensus region between ovine MHC class IIa and IIb. Therefore, a continuous physical map covering the entire ovine autosome inversion/insertion region was successfully constructed. The map confirmed the bovine sequence assembly for the same homologous region. The DNA sequences of 185 BAC-ends have been deposited into NCBI database with the access numbers HR309252 through HR309068, corresponding to dbGSS ID 30164010 through 30163826. Conclusions We have constructed a high-density BAC clone physical map for the ovine autosome inversion/insertion between the MHC class IIa and IIb. The entire ovine MHC region is now fully covered by a continuous BAC clone contig. The physical map we generated will facilitate MHC functional studies in the ovine, as well as the comparative MHC evolution in ruminants.

Previous DNA sequencing of BAC clones covering entire ovine MHC (OLA) region resulted in identification of approximately 130 functional genes in the region, of which 8 were predicted by computer software to be exclusively existed in sheep, but not in any other species known to date. In the present study, we successfully identified and cloned cDNA sequence of OaN2, OaN5, and OaN6 from representative sheep tissues, confirmed their existence in reality. The sequences obtained experimentally exactly identical to those predicted previously. The length of cDNA fragments for OaN2, OaN5, and OaN6 was 270 bp, 309 bp, and 205 bp, respectively, with GenBank accession number assigned as JF330782 (OaN2), JF330783 (OaN5), and JF330784 (OaN6). Northern analyses indicated that the mRNA transcripts of OaN2 were mainly seen in ovine mesenteric lymph nodes and spleen, while OaN5 was observed in only in mesenteric lymph nodes. In contrast, OaN6 transcripts were detected in all tissues except for liver and heart. Western blot showed that OaN2 protein expression level was detected in mesenteric lymph nodes, spleen, and liver, essentially consistent with that of mRNA transcripts. Immunohistochemistry analysis showed that OaN2 protein was highly expressed in ovine mesenteric lymph nodes, moderately expressed in, and not expressed in heart, liver, and pancreas, consistent with the results of Western blotting. The cloning and expression analysis of 3 novel genes provide a basis for revealing their specificities and would be helpful to further study of their expression profile and their potential functions.

Objective: Analyze the impact of NCMS(new cooperative medical scheme) on rural medical institutions,and give suggestions for the sustainable development of medical institutions and the NCMS.Methods: Collect and analyze the efficiency and the account materials of the county-level healthcare departments and the town-level health centers of Zhen'an County in 2003 and 2006.Results: The implementation of NCMS produced an effect on the increase of the outpatient medical service;the service quality of the county-level medical institutions and the town-level health centers needs to be enhanced in spite of the increase of in-patient medical service;the medical institutions' income increased,and the medical service fees increased rapidly;the expenditure per person and time rose sharply.Conclusions: Management mechanism of NCMS should be further developed,construction and supervision of the county-level medical sectors and the town-level health centers,especially supervision of the quality of medical sectors be enhanced;the payment system be changed to control the growth rate of medical expenses.