Burnout and work-family conflict among nurses during the preparation for reevaluation of a grade A tertiary hospital

Objectives： To gain a better understanding of nurse burnout and work-family conflict for nurses and to help the hospital prepare for hospital grade reevaluation.Methods： This study is a cross-sectional study, and 95 nurses participated. The questionnaires included MBI and Carlson work-family conflict questionnaires, and the data were analyzed using SPSS 17.Results： A total of 71.6% of nurses worked over 8 h per day during the last two months before the reevaluation. The total score of burnout of nurses was 66.84 ± 12.60, and the proportion of heavy work burnout was 44.2%. The personal accomplishment takes the heaviest portion（80.0%）. The total score of work-family conflict is 55.19 ± 9.27. The scores of work-to-family conflict are all higher than that of family-to-work conflict. The time dimension had the highest score.Conclusions： During the preparation period, nurses suffered from a heavy workload and intense job burnout, and many aspects of work-family conflict existed.

Study on Health Management and Service Model of Chifeng Class 3A General Public Hospital

This study investigates the construction of a health management service mode based on large-scale comprehensive hospitals by analyzing health management service modes at home and abroad,that is,taking the Affiliated Hospital of Chifeng University as an example,establish a health examination hospital,undertake core tasks such as health service operation process,system,monitoring,and system formulation,and take the best medical resources.Attract social medical resources to collaborate and give health service mode of health status monitoring,evaluation,and intervention to health service objects,aided by advanced medical technology.To extend the traditional health management service with the hospital as the protagonist to health management with participation from family and society beyond the hospital,forming a closed-loop,rapid,and efficient health service management system.Thus,through graded quality services,to lessen the difficulties of patients seeing a doctor and to solve the problem of overcrowding and minor ailments in major hospitals.

Characterization of Class 1 Integron Gene Cassettes among Clinical Bacteria Isolated from One Large Hospital in Northern China

The class 1 integron and complex gene cassettes among different species of clinical isolates in northern China were characterized in this study. 383 clinical isolates were obtained from northern China, and class 1 integrons containing gene cassettes widely distributed among gram negative clinical isolates was observed. We find that the class 1 integron showed positive correlation with multidrug resistance phenotype of gram negative bacteria. In addition, we find that isolates belonged to one species harbored different types of gene cassette arrays, while same types of gene cassette arrays were observed in different species of isolates. The diversity of gene cassette arrays among the isolates indicated the complexity of multidrug resistance in clinical isolates in northern China.

Genomic profiling of lower-grade gliomas uncovers cohesive disease groups:implications for diagnosis and treatment

Lower-grade gliomas(including low-and intermediate-grade gliomas,World Health Organization grades II and III)are diffusely infiltrative neoplasms that arise most often in the cerebral hemispheres of adults and have traditionally been classified based on their presumed histogenesis as astrocytomas,oligodendrogliomas,or oligoastrocytomas.Although the histopathologic classification of lower-grade glioma has been the accepted standard for nearly a century,it suffers from high intra-and inter-observer variability and does not adequately predict clinical outcomes.Based on integrated analysis of multiplatform genomic data from The Cancer Genome Atlas,lower-grade gliomas have been found to segregate into three cohesive,clinically relevant molecular classes.Molecular classes were closely aligned with the status of isocitrate dehydrogenase(IDH)mutations,tumor protein 53 mutations and the co-deletion of chromosome arms 1 p and 19q,but were not closely aligned with histologic classes.These findings emphasize the potential for improved definition of clinically relevant disease subsets using integrated molecular approaches and highlight the importance of biomarkers for brain tumor classification.

Study of Cofactors Associated with Precancerous High-Grade Cervical Lesions at the Teaching Hospital Gabriel Touré, 2010 to 2015

Introduction: High grade dysplasia of the cervix has a high incidence and can progress to cervical cancer. The aim was to study cofactors associated with high-grade cervical dysplasia. Methodology: This was a retrospective case-control study without matching. Women with high grade dysplasia were the cases while those with a normal screening test represented the controls. The study took place at the Gabriel Touré University Hospital Center in Bamako. We included 351 cases and 420 controls. The capture and analysis were performed using the SPSS 20 software. A univariate and multivariate logistic regression analysis was performed for the analysis of risk cofactors. The statistical tests used were the odds ratio and its confidence interval and the statistical significance threshold was set at p Results: In univariate analysis, the co-factors statistically significantly associated with the occurrence of high-grade dysplasia were parity 0.6 (0.5 - 0.9), gestational 0.7 (0.5 - 0.9), smoking of the spouse 3.4 (1.1 - 11.3), the non-schooling 1.4 (1.2 - 2.1). In multivariate analysis after adjusting for confounding factors, two co-factors have significantly increased the risk of high-grade dysplasia: lack of schooling 1.4 (1.2 - 2.0) and polygamy 1.5 (1.4 - 2.5). Conclusion: At the end of this study, polygamy and lack of schooling were the main risk factors. The prevention of cervical cancer will go through the education of girls and women as well as communication for behavioral change and social change.

Probe in college English teaching in Grade-C class

College English is not only an essential curriculum of language, but also is an extremely important curriculum of cultural in college education. As a result of various factors, there are individual differences in college students＇ English study. Therefore, to gradually improve all the students＇ English, graded teaching becomes the best choice. In this thesis, graded teaching will be studied from several respects. And I hope it can give some slight help to some of college teachers.

MOOC Learner’s Final Grade Prediction Based on an Improved Random Forests Method

Massive Open Online Course(MOOC)has become a popular way of online learning used across the world by millions of people.Meanwhile,a vast amount of information has been collected from the MOOC learners and institutions.Based on the educational data,a lot of researches have been investigated for the prediction of the MOOC learner’s final grade.However,there are still two problems in this research field.The first problem is how to select the most proper features to improve the prediction accuracy,and the second problem is how to use or modify the data mining algorithms for a better analysis of the MOOC data.In order to solve these two problems,an improved random forests method is proposed in this paper.First,a hybrid indicator is defined to measure the importance of the features,and a rule is further established for the feature selection;then,a Clustering-Synthetic Minority Over-sampling Technique(SMOTE)is embedded into the traditional random forests algorithm to solve the class imbalance problem.In experiment part,we verify the performance of the proposed method by using the Canvas Network Person-Course(CNPC)dataset.Furthermore,four well-known prediction methods have been applied for comparison,where the superiority of our method has been proved.

Modeling Crash Risk at Rail-Highway Grade Crossings by Track Class

The Federal Railroad Administration (FRA)’s Web Based Accident Prediction System (WBAPS) is used by federal, state and local agencies to get a preliminary idea on safety at a rail-highway grade crossing. It is an interactive and user-friendly tool used to make funding decisions. WBAPS is almost three decades old and involves a three-step approach making it difficult to interpret the contribution of the variables included in the model. It also does not directly account for regional/local developments and technological advancements pertaining to signals and signs implemented at rail-highway grade crossings. Further, characteristics of a rail-highway grade crossing vary by track class which is not explicitly considered by WBAPS. This research, therefore, examines and develops a method and models to estimate crashes at rail-highway grade crossings by track class using regional/local level data. The method and models developed for each track class as well as considering all track classes together are based on data for the state of North Carolina. Linear, as well as count models based on Poisson and Negative Binomial (NB) distributions, was tested for applicability. Negative binomial models were found to be the best fit for the data used in this research. Models for each track class have better goodness of fit statistics compared to the model considering data for all track classes together. This is primarily because traffic, design, and operational characteristics at rail-highway grade crossings are different for each track class. The findings from statistical models in this research are supported by model validation.

The Inquiry of the Junior Graded Teaching Method——A Case Study

Graded teaching divides students into classes in which students are at the same level.Graded teaching is the variant and development of traditional methods.This article makes some introduction of graded teaching,has a review of the theoretical development and tries to analyses its advantages and disadvantages.Lastly,we have some specific requirements for teachers.

“Six-and-twelve” score for outcome prediction of hepatocellular carcinoma following transarterial chemoembolization. In-depth analysis from a multicenter French cohort

The“six-and-twelve”(6&12)score is a new hepatocellular carcinoma(HCC)prognostic index designed for recommended transarterial chemoembolization(TACE)candidates.Quick and easy to use by the sum of tumor size(cm)and number,this model identifies three groups with different survival time(the sum is≤6;or>6 but≤12;or>12);a survival benefit with TACE can be expected for HCC patients with a score not exceeding twelve.Recently,Wang ZW et al showed that the“6&12”model was the best system correlated with radiological response after the first TACE.Thus,we wanted to assess its survival prediction ability as well as its prognostic value and compared it to other systems(Barcelona Clinic Liver Cancer,Hong Kong Liver Cancer(HKLC)staging,Albumin-Bilirubin grade,tumor nodularity,infiltrative nature of the tumor,alpha-fetoprotein,Child-Pugh class,and Performance Status score,Cancer of the Liver Italian Program,Model to Estimate Survival for HCC scores,up-to-seven criteria)different from Wang ZW et al study in a multicenter French cohort of HCC including only recommended TACE candidates retrospectively enrolled.As previously demonstrated,we show that the"6&12”score can classify survival within this French cohort,with a prognostic value comparable to that of other systems,except HKLC staging.More importantly,the“6&12”score simplicity and ability in patients’stratification outperform other systems for a routine clinical practice.

PLDMLT:Multi-Task Learning of Diabetic Retinopathy Using the Pixel-Level Labeled Fundus Images

In the field of medical images,pixel-level labels are time-consuming and expensive to acquire,while image-level labels are relatively easier to obtain.Therefore,it makes sense to learn more information(knowledge)from a small number of hard-to-get pixel-level annotated images to apply to different tasks to maximize their usefulness and save time and training costs.In this paper,using Pixel-Level Labeled Images forMulti-Task Learning(PLDMLT),we focus on grading the severity of fundus images for Diabetic Retinopathy(DR).This is because,for the segmentation task,there is a finely labeled mask,while the severity grading task is without classification labels.To this end,we propose a two-stage multi-label learning weakly supervised algorithm,which generates initial classification pseudo labels in the first stage and visualizes heat maps at all levels of severity using Grad-Cam to further provide medical interpretability for the classification task.A multitask model framework with U-net as the baseline is proposed in the second stage.A label update network is designed to alleviate the gradient balance between the classification and segmentation tasks.Extensive experimental results show that our PLDMLTmethod significantly outperforms other stateof-the-art methods in DR segmentation on two public datasets,achieving up to 98.897%segmentation accuracy.In addition,our method achieves comparable competitiveness with single-task fully supervised learning in the DR severity grading task.

ARC/INFO信息系统在农地分等定级中的应用──以武汉市狮子山地区的土系为例

本文着重探讨地理信息系统PCARC/INFO在农用土地分等定级研究中的方法和过程，将ARC/INFO与关系数据库系统（FDXBASE）集成一体，实现地理空间数据和土地属性数据的自动连接，以及农地分等定级信息的快速查询与检索。以土系作为评价单元，通过分析，定量地反映了研究区土地的质量状况。

基于Kano模型的三甲医院门诊服务调查分析

目的以西部一所综合性三级甲等医院为例,验证Kano模型应用在三级甲等医院门诊服务内容调查分析中的可行性与开展后的应用效果。方法运用自行设计的Kano调查问卷,对门诊700名就诊的患者开展调查,通过Kano模型质量属性分类方法将门诊服务内容进行归类。结果门诊服务内容按照Kano质量属性分类为必备质量、一维质量、魅力质量、逆向质量的分别有8项、8项、3项、2项。结论 Kano模型应用在三级甲等医院门诊服务内容的分类中能够从定性层次上挖掘出服务需方对医疗机构潜在的服务需求。要实现一次卓有成效的管理,在控制基本质量的同时,我们还需要不断完善一维质量与创造魅力质量。

FOCUS-PDCA循环法干预对Ⅰ类切口预防使用抗菌药物影响的回顾性分析

目的:以医院等级评审为契机,探讨某院Ⅰ类切口围手术期预防用药的管理方法,提高抗菌药物的应用合理性。方法:利用FOCUS-PDCA循环法对Ⅰ类切口抗菌药物的预防使用进行干预,选取该院2015年1~12月全部Ⅰ类切口患者出院病例进行回顾性分析,根据干预进程分为4个阶段,对每一阶段的抗菌药物应用指标进行比较,评价围术期抗菌药物的合理使用改进效果。结果:与干预前比较,干预第三阶段的Ⅰ类切口预防用药比例从62.90%降至28.32%,术前给药时机合理率从50.1%升至71.0%,品种选择合理率由53.5%提高至79.5%,预防用药疗程合理率从26.8%上升至56.3%,差异均有统计学意义(P<0.01),而干预前后手术部位感染率无明显差异(P>0.05)。多项指标的好转促进了该院等级评审相关条款评分结果的提升。结论:医院等级评审中利用FOCUSPDCA循环法规范Ⅰ类切口围术期抗菌药物预防使用效果显著。

DEA法对乌鲁木齐市三级医院ICU护理效率的评价

目的应用数据包络分析法分析乌鲁木齐市7所三级公立医院ICU的护理效率,探讨效率不佳的原因。方法对7所三级公立医院的ICU应用问卷调查法和工时测定法,收集各ICU的2项投入指标(护理总工时、护士人数)和1项产出指标(全年收治患者数),运用数据包络分析法进行分析研究。结果 7所医院ICU中,6所医院ICU相对无效,无效的ICU可以通过理想值的测算有目的地改善各指标值,使之达到相对有效。结论乌鲁木齐市三级医院ICU的护理效率总体不高,管理者应重视并根据实际情况来完善各方面工作流程。

基于DEA的北京三级医院运营效率比较研究

目的对北京地区三级医院运营效率进行比较研究,为提高医院服务效率提供决策参考。方法以北京市12所三甲综合医院为研究对象,收集2009年度4个投入指标和5个产出指标进行DEA分析。结果 9家医院(75.0%)处于DEA有效状态,3家医院(25.0%)处于非DEA有效状态。结论北京市三甲综合医院运营效率整体水平较高,医院之间运营效率差异较小;少数医院处于规模不经济状态,运营效率有待进一步提高。

基于Malmquist指数的北京三级医院全要素生产率分析

目的测量综合三级医院全要素生产率的变化状况,为提高医院运营效率提供决策依据和参考。方法收集北京市12所三甲医院2007～2009年3年面板数据(4项投入指标,5项产出指标),应用数据包络分析(DEA)的Malmquist模型进行分析。结果 3年间样本医院全要素生产率的年平均增长率为33.7%,进一步分解发现:技术进步年均增长率为达到33.4%,技术效率、纯技术效率增长率分别为0.2%,而规模效率没有变化。结论北京地区三级综合医院全要素生产率增长较为显著,其增长贡献主要来源于技术进步,并且不存在技术衰退;为最大限度提高医院生产率,应加强医院内部管理,激发技术效率和规模效率;在医院生产率测量和效率评价研究中,宜吸收患者和公共利益维度的评价指标。

PDCA理论在我院医学装备管理中的应用

改革的深入和医院的发展对设备处的要求逐步提高,设备处工作的持续改进在现代医院管理中尤其重要。本文从对PDCA理论(戴明环)的认识出发,结合2013年我院设备采购和迎接三甲复审两方面工作,探讨如何持续改进设备处工作。

基于MassMotion仿真的三甲医院急诊科感控管理优化研究

选取某三甲医院急诊科一层特定时间段所有患者就诊全过程的行为数据,将患者行为数据输入到Mass Moton行人模拟软件中,模拟三种不同管理策略下的急诊科状况,对比不同的模拟结果,对急诊科感控管理策略进行优化。

北京市A类三级定点医院2002—2005年医保费用分析

目的分析北京市医疗保险A类三级定点医疗机构的费用增长趋势,为制定北京市的医保政策提供依据。方法采用Excel2003建立数据表,对2002—2005年2月北京市8家A类三级定点医疗机构的次均住院费用、次均药费、次均检查费、次均材料费和个人自付比例分别进行分析。结果北京市8家A类三级定点医疗机构的次均费用增长减慢,次均药费和次均检查费有下降趋势,但次均材料费和个人自付比例增长趋势未改变。个人自付比例与次均材料费呈正相关(相关系数0.003,P=0.004)。结论:抑制个人自付比例和医保费用增长的重点是抑制材料费的增长。