The Bibbulung Gnarneep Project: practical implementation of guidelines on ethics in indigenous health research.

Human rights and ethical principles justify Indigenous control of health research conducted in Indigenous communities, but also emphasise the need for scientific rigour, knowledge and expertise, much of which currently resides with the non-Indigenous community. In 1994, we began development of the Bibbulung Gnarneep Project on Aboriginal maternal and child health in Perth, Western Australia. We describe the process of developing a protocol to ensure ethical conduct of this research through consultation and negotiation between Aboriginal and non-Aboriginal people involved in the project.     

Navigating the process of developing a research project in Aboriginal health

Research in Aboriginal health may be hampered by a lack of experience with the process of collaboration with Aboriginal communities, and additional ethics approval requirements. Awareness of resources and advice from Aboriginal mentors with in-depth knowledge of clinical and research issues can greatly assist researchers. A collaborative approach between researchers and Aboriginal communities is pivotal to developing a research project consistent with Indigenous cultural values and health concepts, with the potential to improve services and outcomes for Aboriginal peoples. Planning and broad consultation can ensure that research is feasible, ethical, culturally sensitive and beneficial. This article outlines lessons learned from personal experience of developing a project in Aboriginal health, which we hope may serve as a practical guide for others.     

Overseas-trained doctors in Aboriginal and Torres Strait Islander health services: many unanswered questions

Aboriginal and Torres Strait Islander health services are heavily dependent on overseas-trained doctors (OTDs). These OTDs are increasingly from countries with variable English language and educational equivalency compared with locally trained doctors. Aboriginal and Torres Strait Islander health services create particular demands for all doctors, such as negotiating "cultural domains" and acknowledging the contribution of Aboriginal health workers. Little is known about the roles and experience of OTDs in health service provision in Indigenous communities. Barriers to effective research into the experience of OTDs include privacy legislation and a lack of standardised data. Researching the narratives of OTDs in Indigenous health services offers an opportunity to explore the diversity and complexity of the cultural interfaces in health service provision.     

EBM and the health of Indigenous Australians

Implementing evidence-based medicine (EBM) in primary healthcare for Indigenous people will usually involve increasing services, particularly those for chronic conditions. As shown by the example of diabetes care, there are significant organisational, educational, economic, cultural and structural barriers to implementing EBM in many Indigenous communities. Many of these barriers could be reduced by better-organised service delivery systems at the community level, greater numbers of Indigenous health professionals and greater advocacy for healthy public policy by health services. There is evidence that delivering evidence-based primary healthcare, particularly for chronic diseases, can improve health outcomes in Indigenous communities. There is a need for more investment in strategies to implement EBM and evidence-based public health in Indigenous settings.     

The health of urban Aboriginal people: insufficient data to close the gap

The Australian Government has committed to reducing Indigenous disadvantage, including closing the life-expectancy gap within a generation, and to halving the gap in mortality rates for children under 5 years of age within a decade. Sixty per cent of the health gap between Indigenous and non-Indigenous Australians is attributable to the health of Indigenous people living in non-remote areas of Australia. We conducted a brief review of recent Australian original research publications on the health of the 53% of Indigenous people who live in urban areas, and found that data are sparse; there were only 63 studies in the past 5 years (11% of all articles about Indigenous health during this period). Although Indigenous Australians living in remote areas experience greater health disparity, the government will not achieve its aims without paying due attention to the non-remote-living population. More research is required, and particularly research that actually tests the impact of policies and programs.     

基于“健康中国”战略的公共图书馆健康信息服务

通过综述国内外公共图书馆健康信息服务研究文献，分析“健康中国”战略背景下公共图书馆开展公众健康信息服务的必要性和可行性，总结英国和美国的公共图书馆健康信息服务实践，提出了我国公共图书馆公众健康信息服务策略，即拓展健康信息服务功能、深化健康信息服务内容、针对服务对象提供分众服务及提升常态化应急信息服务能力。     

Indigenous child health: urgent need for improved data to underpin better health outcomes

Accurate data about Indigenous child health is vital to enable us to understand its current state, to acknowledge achievements, and to determine how to reduce inequalities between Indigenous and non-Indigenous children. We have identified a paucity of national, or nationally representative, data relating to Indigenous child health outcomes, and significant deficiencies in available data. A coordinated national approach will help address current data limitations, including lack of identification of Indigenous status, lack of currency, and lack of information about specific health disorders affecting Indigenous children. To ensure that health data collected are relevant and useful, Indigenous communities must have a role in data collection and management.     

卫勤力量优化部署机制与应用研究

本研究针对卫勤力量部署优化机制的理论难点和快速决策的应用重点问题,运用文献归纳法、专家咨询法和系统分析建立卫勘力量优化部署要素与优化决策逻辑模型,采用线性规划、整数规划、层次分析法、ARIMA-BP神经网络模型以及系统动力学等方法,构建各类卫勤力量优化部署模型,揭示了卫勤力量优化部署的内在特点与规律,综合地理信息系统、数据库技术、软件工程与决策支持系统等技术,研制卫勤力量优化部署决策支持系统与卫勤指挥作业箱,实现了不确定条件下卫勤力量部署快速决策的理论模型、信息化软件和装备工具系列成果,为多样化军事任务卫勤高效保障提供了理论依据,拓展了卫勤循证决策的研究领域.     

社区卫生服务中心老年人健康管理路径设计

为老年人提供健康管理服务可以有效地控制和延缓疾病的发生和发展,提高老年人生存质量。社区卫生服务中心进行老年人健康管理路径设计,是针对老年人建立一套标准化健康管理程序,从而规范健康管理行为、降低成本、减少因素干扰、提高服务质量。老年人健康管理路径设计基本框架应包含执行流程、执行内容、组成要素等方面,其基本框架分为一级路径和二级路径。一级路径为基本路径,所有健康管理对象都必需经过一级路径。在完成一级健康管理路径后,管理者将明确该管理对象的主要问题,并将其分配至对应的二级路径。每级路径都包含基本要素,明确服务对象、服务内容、服务标准及职责分工。进行老年人健康管理路径设计,有助于社区卫生服务机构规范服务流程,降低管理难度,提高服务质量和管理效率。     

Churches, academic institutions, and public health: partnerships to eliminate health disparities

The four principles represent a framework for improving the process of establishing sustainable partnerships between research, public health, and faith-based institutions that seek to eliminate health disparities. To improve the efficacy of partnerships with churches identification of potential partner churches must be deliberate, trusting relationships must be built, divergent perspectives must be communicated and reconciled, and some tangible power should be transferred to church and community leaders where feasible. We applaud the National Institutes of Health, through the National Center on Minority Health and Health Disparities', efforts to "promote coordination and collaboration among the agencies conducting or supporting minority health or other health disparities research." We recommend that the North Carolina Office of Minority Health and Health Disparities be charged with and provided adequate resources to facilitate this type of coordination and collaboration among North Carolina Department of Health and Human Services agencies that are disparities conducting or supporting minority health and health research. A special emphasis should be placed on partnerships that seek to engage communities of faith.     

Impact of worksite health promotion on health care costs and utilization. Evaluation of Johnson & Johnson's Live for Life program

This study explores the relationship between exposure to a comprehensive worksite health promotion program and health care costs and utilization. The experience of two groups of Johnson & Johnson employees (N = 5192 and N = 3259) exposed to Live for Life, a comprehensive program of health screens, life-style improvement programs, and worksite changes to support healthier life-styles, was compared with that of a control group (N = 2955) over a five-year period. To account for baseline differences, analyses of covariance produced adjusted means for inpatient hospital costs, admissions, hospital days, outpatient costs, and other health costs. Mean annual inpatient cost increases were $43 and $42 for two Live for Life groups vs $76 for the non-Live for Life group. Live for Life groups also had lower rates of increase in hospital days and admissions. No significant differences were found for outpatient or other health care costs.     

"Let's not talk about sex": reconsidering the public health approach to sexually transmissible infections in remote Indigenous populations in Australia

Sexually transmissible infections (STIs) are hyperendemic in some remote Indigenous populations in Australia. Screening programs have had some success in reducing the prevalence of STIs in specific populations, but there has been little overall improvement in the past 10 years. We question the usefulness of current practice and urge consideration of a new and radical approach. Instead of a "screen, treat and contact trace" strategy, we suggest adopting the same approach as currently accepted for trachoma control: populations reaching a threshold prevalence for a set of marker STIs (identified through sentinel surveillance) should be offered a treatment program aimed at the entire sexually active population. We also recommend a parallel program of health promotion and "life skills" education and outline the arguments for such a departure from currently accepted public health policy.     

Challenges in health and health care for Australia

The next Australian Government will confront major challenges in the funding and delivery of health care. These challenges derive from: Changes in demography and disease patterns as the population ages, and the burden of chronic illness grows; Increasing costs of medical advances and the need to ensure that there are comprehensive, efficient and transparent processes for assessing health technologies; Problems with health workforce supply and distribution; Persistent concerns about the quality and safety of health services; Uncertainty about how best to balance public and private sectors in the provision and funding of health services; Recognition that we must invest more in the health of our children; The role of urban planning in creating healthy and sustainable communities; and Understanding that achieving equity in health, especially for Indigenous Australians, requires more than just providing health care services. The search for effective and lasting solutions will require a consultative approach to deciding the nation's priority health problems and to designing the health system that will best address them; issues of bureaucratic and fiscal responsibility can then follow.     

Comprehensive health care for the elderly

Health care for the elderly in the United States remains fragmentary and noncomprehensive despite concern for the needs of an expanding elderly population and a new emphasis on geriatrics. Model health care programs for the elderly have been few and not generally applicable to central city populations. A model health care program has been designed to offer a continuum of comprehensive, multidisciplinary health care to Milwaukee elderly. An acute care unit for the elderly, rehabilitation-oriented nursing home, outpatient clinic, home care service, outreach clinics, rehabilitation day hospital, Alzheimer's Disease Day Care program, and acute geriatric psychiatric unit have been developed and integrated into one continuum of care. The program serves chiefly the frail elderly, who are demonstrated to be markedly impaired physically, mentally, and socially, requiring the services of multiple professionals to enable the patients to achieve maximum independence. Alternatives to institutionalization are emphasized, and geriatric education and research programs are part of the model program.     

Enhancing Quality of Patients Care and Improving Patient Experience in China with Assistance of Artificial Intelligence

Improving health of Chinese people has become national strategy according to the Healthy China 2030. Patient experience evaluation examines health care service from perspective of patients; it is important for improving health care quality. Applying artificial intelligence (AI) in patient experience is an innovative approach to assist continuous improvement of care quality of patient service. A nursing quality platform based on patient experience data which is empowered by AI technologies has been established in China for the purpose of surveillance and analysis of the quality of patient care. It contains data from nearly 1300 healthcare facilities, based on which portraits of nursing service qualities can be drawn. The patient experience big data platform has shown potentials for healthcare facilities to improve patient care quality. More efforts are needed to achieve the goal of enhancing people's sense of health gain.     

社区卫生技术人员继续医学教育必修课培训效果评估及需求探析

目的 了解北京市社区技术卫生人员继续医学教育必修课培训项目开展现状,征询社区技术卫生人员对培训课程内容、培训师资和培训方式等方面的参培需求并对培训项目将来的发展提出对策建议。 方法 根据北京市社区卫生技术人员继续医学教育必修课培训项目的历年基线资料及关键知情人访谈结果,编制调查问卷,采取分层随机抽样方法,从北京市的16个区中分层抽取6个区,在每个区各抽取10家社区卫生服务中心,按比例分层抽取共计1 410名参培学员进行问卷调查。 结果 参培学员对培训项目所包含课程的实用性和必要性较为认可,满意度较高,在培训形式方面更倾向于网上授课,亟须通过培训增强实践操作技能、专业基础知识和临床思维方法,同时对卫生政策解读、实时政治和医学人文等课程有更多期待。 结论 北京市继续医学教育必修课培训对于社区卫生技术人员的服务能力及服务理念起到了极大的推动作用,但仍需引导参培学员的合理预期,激发其内生动力,调动学员的学习主动性;政策引导与技术应用并举,妥善处理工学矛盾,不断提高参培学员学习的便利性;注重以需求为导向,线上线下培训并行,创建必修课教学新模式;强化教学管理,完善考核评价体系。以期不断契合参培学员的学习需求,进一步促进北京市社区卫生技术人员继续医学教育必修课培训项目的健康可持续发展。      

Family planning and community health services

Family planning must be integrated into the total Indian community health service. Family planning should be preparation from childhood onward for the role of responsible parenthood, and it must be considered part of the complete health program. The present network of health services is inadequate to cover the whole country. Private physicians should be used in the Maternity and Child Health Services program. The way family planning is taught in the medical colleges must be rethought. It is an interdisciplinary study, involving clinical, biological, and social aspects. Various family planning topics needing research are mentioned.     

Experience using the CQI model in health care management

This article describes practical applications of the Continuous Quality Improvement (CQI) concept applied to management of the Information Services Departments of a health care institution. The article is valuable for two reasons: (1) it is valuable as a successful application of CQI in an award-winning information services division of an award-winning health care institution, and (2) since the work of the information services function is so complex, has major interdependencies with many other functions throughout the entire organization, and is driven by fast-paced change, successful use in that function can be a model for other major functions of the hospital.     

老干部病房患者护理中实施持续护理质量改进的有效性探究

目的 观察并探讨在老干部病房实施持续护理质量改进(continuous quality improvement,CQI)的有效性。 方法 将杭州市第一人民医院2013年8月—2015年8月期间老干部病房120例患者随机分为干预组和对照组各60例。干预组60例老干部实施CQI的护理模式;对照组60例老干部实施常规护理干预。护理前后利用匹兹堡睡眠质量指数量表(PSQI)、日常生活能力评分(BI评分)和生活质量量表(SQLS)评分对患者的睡眠质量、生活质量进行评价,并从护士操作技能、责任制模式、服务态度、心理护理实践等方面调查患者满意度。 结果 2组护理前PSQI、BI评分和SQLS评分相比,差异不具有统计学意义(P＞0.05);护理后,干预组PSQI、BI评分和SQLS评分分别为(36.8±7.2)分、(76.2±8.5)分和(72.8±5.2)分,对照组为(49.7±11.4)分、(59.4±7.7)分和(56.5±6.8)分,干预组PSQI明显低于对照组,BI评分和SQLS评分明显高于对照组(P＜0.05);干预组对护士操作技能、责任制模式、服务态度、心理护理实践的满意率均明显高于对照组(P＜0.05)。 结论 老干部病房实施CQI护理模式能有效改善患者睡眠质量,提升患者的日常生活能力,患者对护理服务的满意度明显提高,值得在临床上进一步推广。