创伤专科护士岗位职责核心指标体系的初步构建

目的构建符合我国创伤救治体系架构特征的创伤专科护士岗位职责核心指标体系, 为创伤中心设置创伤专科护士岗位提供参考。方法通过文献研究法和小组讨论法构建创伤专科护士岗位职责核心指标体系初稿。应用Delphi专家咨询法对来自全国7个省(市)的15位专家进行两轮咨询, 确定指标体系终稿。计算两轮咨询专家的积极系数、权威系数(Cr)、肯德尔协调系数(Kendall′sW)、各级指标的重要性赋值均数及变异系数(CV)。结果两轮咨询专家的积极系数均为100%, Cr为0.953。第2轮咨询的Kendall′sW为0.188(χ2=155.29, P<0.001), 所有指标的重要性赋值均数范围为4.27～5.00分, CV均<0.25分。最终构建的创伤专科护士岗位职责核心指标体系包含7项Ⅰ级指标和49项Ⅱ级指标。结论创伤专科护士岗位职责核心指标体系科学合理、内容全面, 可以为我国创伤专科护士岗位设置提供参考依据。     

我国空运后送护理安全管理评价指标体系的构建研究

目的 初步构建我国空运后送护理安全管理评价指标体系,旨在降低空运后送伤病员护理安全隐患,有效减少不良事件的发生.方法 通过文献回顾法、专家议题小组法初步拟定专家咨询问卷;采用德尔菲法对不同专业的15位专家进行两轮专家咨询;使用Excel 2010、SPSS 23.0软件和yaahp层次分析软件对数据进行汇总分析,筛选指标并确定指标权重.结果 两轮咨询专家积极系数均为100％,专家权威系数均在0.912以上,肯德尔和谐系数差异均有统计学意义(P<0.05).最终确定包含5项一级指标、16项二级指标、85项三级指标的我国空运后送护理安全管理评价指标体系.结论 初步构建的我国空运后送护理安全管理评价指标体系具有较高的科学性和实用性,专家意见较为集中,经进一步验证后可作为空运后送护理安全评价工具.     

军队医院灾难救援机动护士能力体系的构建

目的 构建军队医院灾难救援机动护士能力体系,以更好地适应军队医院灾难救援任务需求。方法 查阅国内外文献,初步形成军队医院机动护士灾难救援能力体系的草案,采用德尔菲法,对来自全国军队医院、院校、研究所的20名专家进行两轮专家咨询,最终确立军队医院机动护士灾难救援能力体系。结果 两轮专家函询问卷的有效回收率均为100%,权威系数分别为0.89、0.88,专家咨询协调系数经χ²检验后均有统计学意义(P<0.01),专家咨询后各指标的变异系数为0.025～0.181。构建的军队医院机动护士灾难救援能力体系包括4个一级指标、24个二级指标。结论 军队医院机动护士灾难救援能力体系构建方法科学,专家积极性和权威性高,各指标专家咨询意见趋于一致,可用于军队医院机动护士灾难救援能力的评估和培养。     

我国飞行护士培养目标的探讨

目的：探讨我国飞行护士培养目标的具体内容,为未来选拔及培训飞行护士提供理论依据。方法采用文献分析法、专家访谈法形成专家咨询问卷,对不同领域的15名专家进行两轮Delphi专家咨询。结果构建了我国飞行护士培养的总体目标和具体目标,其中具体目标包括3个一级指标和22个二级指标。两轮专家咨询的问卷回收率均为100%,专家对一、二级指标的权威系数均在0.87以上,两轮咨询的所有肯德尔协调系数差异均有统计学意义（均P＜0.01）。结论专家的积极性和权威程度高,意见协调性好,所形成的培养目标合理,具有可操作性。     

武警部队医院卫勤应急药材保障评价指标体系的构建

 目的 构建武警部队医院卫勤应急药材保障评价指标体系。方法 在参考国内外相关资料文献、分析影响药材保障的主要环节和要素的基础上, 采用访谈法、问卷调查法、德尔菲法、层次分析法, 进行两轮专家咨询论证。结果 初步构建武警部队医院卫勤应急药材保障评价指标体系的结构框架。该框架由4个一级指标构成, 它包括制度预案、药材供给、信息通讯、配套措施。另外, 从众多初选指标中选出最具代表性和可操作性的14个指标构成了二级指标。结论 通过卫勤应急药材保障评价, 指出药材保障方案的可行性, 发现药材保障的薄弱环节和不足之处, 并提出改进意见和建议。     

门诊医疗质控重点指标的构建与实践

目的 构建门诊医疗质控重点指标体系，以提高门诊医疗质量和患者满意度。方法 通过文献研究和专家访谈，形成咨询问卷，运用德尔菲法对17名专家进行两轮专家咨询，确立构建门诊医师医疗质控重点指标。提取医院HIS系统相关数据和移动终端满意度调查结果。结果 两轮专家函询的回收率均为100%,专家权威系数大于0.7,筛选后门诊医师质控重点指标体系包括3个一级指标、12个二级指标，指标问卷调查的克朗巴赫系数为0.728。从指标体系实践结果来看，预约挂号率增高了29.09%,基本药物占比增加了2.75%,门诊病历打印率增加了28.28%,出诊考勤合格率和患者满意度均有明显提升。结论 构建的医疗质控重点指标定位准确、导向性强，数据可量化，可用于门诊医疗质控，提升患者满意度。     

介入专科护士理论知识体系的构建

目的 通过构建介入专科护士理论知识体系,为介入专科护士培养和理论课程设置提供参考.方法 应用德尔菲法对16名专家进2轮函询,确立理论知识大纲要点.结果 2轮专家函询的积极性均为100％,专家咨询的权威系数为0.89,判断系数0.89,熟悉程度0.89,均>0.7.最终确定的理论知识体系包括5项一级指标,21项二级指标....     

机动卫勤分队文职人员管理探讨

探讨医院机动卫勤分队文职人员管理中存在的问题及解决问题的应对措施。将本组3年来13名机动卫勤分队非现役文职人员在机动卫勤分队中存在的问题进行分析。通过加强政治教育,强化岗位练兵,加强综合集成训练,运用激励机制等措施,提高了文职人员的军事素质,同时也提高了军队医院机动卫勤分队的保障能力。     

青藏线医院机动卫勤分队卫勤协同的探讨

立足青藏线某军队医院实际,着眼多样化军事任务卫勤保障课题,以多部门卫勤协同为方向,从卫勤协同的部门与内容、方法等方面分析探讨了机动卫勤分队卫勤协同的实践做法,提出了不同部门组织协同的注意事项,解决了医院应急机动力量执行任务时单靠自身力量难以胜任工作的现实问题,为机动卫勤分队科学化、规范化、高效化实施应急救援奠定了合作基础。     

层次分析法在武警部队医院卫勤应急药材保障评价指标体系的应用

 目的 探讨层次分析法在武警部队医院卫勤应急药材保障评价指标体系中的应用。方法 运用层次分析法,在建立递阶层次关系的基础上,通过构建判断矩阵、聘请专家对评价指标的重要性进行打分评判、计算各评价指标的权重并进行判断矩阵的一致性检验,确定武警部队医院卫勤应急药材保障评价指标体系的各级指标权重。结果 根据统计学公式得到武警部队医院卫勤应急药材保障评价指标体系4个一级指标和14个二级指标的最终权重。结论 层次分析法用于武警部队医院卫勤应急药材保障评价指标体系可确定权重系数,且操作实施方便易行,简单实用。     

某大型舰船护理核心技术体系研究

目的 构建某大型舰船护理核心技术体系。方法 采用文献研究法、专家会议法、德尔菲法和层次分析法对20名专家进行两轮函询,选用SPSS 17.0、yaahp 10.3软件进行统计分析。结果 两轮问卷有效回收率均为100%,专家权威系数为0.88、0.90,协同系数0.216~0.416。最终确定包括舰船一般护理技术、急救技术、特殊护理技术、战创伤护理技术4个方面的某大型舰船护理核心技术体系,权重依次为0.093、0.305、0.143、0.459。结论 专家积极性和权威程度高,意见协调性较好,构建的护理核心技术体系可为开展护理技术培训提供理论参考依据。     

Chinese expert consensus on the clinical applications of aminolevulinic acid-based photodynamic therapy in female lower genital tract diseases (2022)

IntroductionWith the younger onset age of female lower genital tract diseases, there are increasing demands for protecting organ and tissue structures to preserve fertility and, therefore, effective fertility-sparing treatments that cause minimal normal tissue damage and less adverse reactions are urgently needed.ObjectiveThis study is aimed at reviewing information and achieving consensus on recommendations on the clinical applications of aminolevulinic acid-based photodynamic therapy (ALA-PDT) in female lower genital tract diseases.MethodsMembers of the expert panel held online and in-person meetings to discuss and revise drafts created by the steering committee based on the literature review and the clinical experiences of the expert panel. Opinions of the experts were transcribed and discussed in detail to ensure that the consensus statement best reflects the current advances in the field and the experts’ view.ResultsAfter numerous rounds of meetings, experts unanimously agreed on the importance of ALA-PDT in the treatment of cervical squamous intraepithelial lesions (SIL), vaginal SIL, vulvar SIL, vulvar lichen sclerosus (VLS), and condyloma acuminatumon (CA). Experts also reached consensus on the recommended treatment regimen and treatment methods.ConclusionThis consensus aimed to provide practical basis and guidance for the clinical applications of ALA-PDT in female lower genital tract diseases in China. Of note, this is the only expert consensus prepared by board-certified specialists in gynecology and obstetrics in China. More evidence-based clinical studies should be made to update and expand the current recommendations.     

Die Rolle des medizinischen Sachverständigen – gesetzliche Vorgaben und Entscheidungen der Rechtsprechung

There are special circumstances, named by the jurisprudence, when experts can be refused as prejudiced and there is a civil law concerning the liability of medical experts in cases where an incorrect expert opinion was presented. Additionally, every physician working as an expert has to achieve personal requirements, such as strict neutrality and objectiveness. This includes an appropriate appearance in court, but also personal liability insurance and an expert opinion written or presented understandable also for prosecutors, lawers and judges.     

Diagnostic performance of an expert system for interpretation of 99mTc MAG3 scans in suspected renal obstruction.

The purpose of the study was to compare diuresis renography scan interpretation generated by a renal expert system with the consensus interpretation of 3 expert readers. METHODS: The expert system was evaluated in 95 randomly selected furosemide-augmented patient studies (185 kidneys) obtained for suspected obstruction; there were 55 males and 40 females with a mean age +/- SD of 58.6 +/- 16.5 y. Each subject had a baseline (99m)Tc-mercaptoacetyltriglycine ((99m)Tc-MAG3) scan followed by furosemide administration and a separate 20-min acquisition. Quantitative parameters were automatically extracted from baseline and furosemide acquisitions and forwarded to the expert system for analysis. Three experts, unaware of clinical information, independently graded each kidney as obstructed/probably obstructed, equivocal, and probably nonobstructed/nonobstructed; experts resolved differences by a consensus reading. These 3 expert categories were compared with the obstructed, equivocal, and nonobstructed interpretations provided by the expert system. Agreement was assessed using weighted kappa, and the predictive accuracy of the expert system compared with expert readers was assessed by the area under receiver-operating-characteristic (ROC curve) curves. RESULTS: The expert system agreed with the consensus reading in 84% (101/120) of nonobstructed kidneys, in 92% (33/36) of obstructed kidneys, and in 45% (13/29) of equivocal kidneys. The weighted kappa between the expert system and the consensus reading was 0.72 and was comparable with the weighted kappa between experts. There was no significant difference in the areas under the ROC curves when the expert system was compared with each expert using the other 2 experts as the gold standard. CONCLUSION: The renal expert system showed good agreement with the expert interpretation and could be a useful educational and decision support tool to assist physicians in the diagnosis of renal obstruction. To better mirror the clinical setting, algorithms to incorporate clinical data must be designed, implemented, and tested.     

省级放射卫生技术机构能力评估体系构建初探

目的:探索构建省级放射卫生技术机构的能力评估体系。方法:基于Donabedian模型和主要工作职责,构建省级放射卫生技术机构能力评估体系的逻辑框架和能力指标库;运用德尔菲专家咨询法和层次分析法确定各指标及其权重;并开展全国省级放射卫生技术机构能力自测与评估。结果:评估体系包括3个一级指标、11个二级指标、30个三级指标...     

Executive competencies of nurses in the Veterans Health Administration

This study identifies competencies and accompanying skills, knowledge, and abilities (SKAs) required by the Veterans Health Administration (VHA) nurse executives. Using the Delphi decision-making method, 144 VHA directors of nursing identified five top competencies necessary for nurse executives. An expert panel sorted competencies into the eight core domains of the VHA high-performance development model. Next, nurse executives rated SKAs by using a 7-point importance scale. Response rates were 34% and 48.2% for Delphi rounds 1 and 2, respectively. Round 1 generated 245 unique nurse executive competencies. In round 2, the highest rated SKAs involved ethical conduct, decision-making, abilities to continuously learn and lead, staffing, and conflict-resolution skills. Competency list outcomes are expected to be useful for executive self-assessment, professional development, and identification of continuing education needs. Specific SKAs can provide a means for development of job requirements and career performance criteria.     

Die Rolle des medizinischen Sachverständigen – gesetzliche Vorgaben und Entscheidungen der Rechtsprechung

Medical experts are needed to help judges reach a decision. Experts writing their opinion are not simple witnesses, but authorities on a special subject. They ordered by, for example, the prosecution or a civil, social or criminal court, and although regarded as an auxiliary person to support the judges, experts can make mistakes. There is a civil law concerning the liability of medical experts and it is possible to refuse an expert named by the prosecution or a court.     

建立介入手术改良预警评分的可行性调查

目的探讨建立适合介入手术特点和需要的患者术中病情评分体系,为准确评估和有效预警患者术中病情,给予针对性护理方案提供参考依据。方法采用文献分析法、头脑风暴法、专家访谈法,设计调查问卷及量表,面向介入护理人员开展网络调查,利用SSPS统计分析调查结果。结果经调查研究分析,81.9%被调查专家认为有必要或非常有必要建立介入手术室改良早期预警评分(MEWS);调查量表信度系数值为0.885,KMO值为0.794,Bartlett球形检验的Approx. Chi-Square值为1096.854(自由度为66),达到显著水平(P<0.001),量表信度效度较高。以得分5分占比在75%以上和平均分在4.5分上为阈值,建立的介入手术MEWS包括心率、意识、收缩压、血氧饱和度、过敏体质等5个观测指标。结论介入护理人员对建立介入MEWS具有较高的认同度,构建介入手术MEWS具有一定的可行性、客观性和实用性,可为下一步深入开展实际应用探索提供理论基础。