PDCA循环在全科医师规范化培养社区带教管理中的应用研究

目的 探讨PDCA循环模式在全科医师规范化培养社区带教管理的应用效果.方法 选取2018年1-10月在静安区某两家全科医师规范化培养社区教学基地学员16例为对照组,再选取2019年1-10月学员16例为观察组.对照组学员以传统模式开展全科医师社区培训,观察组采用PDCA循环管理模式进行全科医师社区培训质量控制管理.项目结束后,对两组全科学员的教学效果、满意度及患者对学员满意度进行比较.结果 观察组全科学员的理论知识和操作技能考试成绩明显高于对照组(P<0.05),满意度高于对照组(P<0.05),且患者对全科学员满意度高于对照组(P<0.05).结论 PDCA循环管理模式可改善全科医师规范化培养社区基地带教质量,提高学员带教满意度及患者对学员的满意度.     

全科医生社区实践培训中的管理初探

目的 探索全科医师社区实践过程中的管理模式.方法 根据全科医学科医师培训标准细则、大纲要求结合我们4年的社区实践和管理经验,拟定符合我中心的带教计划、实施方案和实践评估标准,按照标准积极培养全科医生.结果 通过实践,进一步完善社区实践教学计划,改进教学方法和评估标准,建立起较科学、完整的全科医生社区实践教学管理模式,全面培养全科医生.结论 通过实践,还需进一步完善全科医生社区实践教学过程中的带教计划、实施方案和实践评估标准,使全科医生社区实践过程中的教学管理有据可依.     

全科医师规范化培训社区基地教学方法初探

目的探索全科医师培养社区基地规范带教方法和管理模式。方法通过对全科医师规范化培养的40名学员进行问卷调查和现场访谈,对社区教学基地教学情况进行评估。结果对师资、教学内容、教学效果评价,满意和较满意的均占90％以上,最欢迎“一对一”教学模式,主要问题是以专科方法带教全科医师。结论全科医师社区带教已经取得一定经验,但在全科理念,师资水平上需进一步提高。     

全科医师职业教育认知调查分析

目的：通过对全国部分省市临床工作者在全科医师职业教育方面的认知开展调查研究和分析,为完善全科医师职业教育体系提供科学建议。方法以文献回顾法和专家访谈法,设计调查问卷,调查83名全科医学教学者和109名全科医学执业者,调查教、学双方对我国全科医师职业能力、职业教育的认知。结果被调查者认为患者对全科（社区）医师服务能力满意程度并不高（31．2％）。超过50．0％被调查者认为在本科学历教育中专门开设全科医学专业、毕业后开展医学继续教育项目作用较大。对全科医师培训基地的运作效果满意的仅有17．7％。在需求方面,超过90％的被调查者期望提高全科医师待遇和社会地位,77．1％认为要增加临床实践和技术操作。教学者对教材、临床技能评估方法、带教能力提出更高要求。结论提升教学者的带教能力和全科医师实践能力,健全全科医师职业教育体系,创造全科医师职业发展的有利环境。     

系列之一全科医师岗位培训大纲

一、培训目标 通过培训使学员掌握全科医学的基本理论、基础知识和基本技能,熟悉全科医疗的诊疗思维模式,提高其对社区常见健康问题和疾病的防治能力,具有为人民健康服务的职业道德,能够运用生物-心理-社会医学模式,以维护和促进健康为目标,向个人、家庭、社区提供公共卫生和基本医疗服务,达到全科医师岗位基本要求.     

全科医师骨干培训大纲

一、培养目标遵循以全科医学的基本理论为指导,社区卫生需求为导向,实践、思考、学习为方法,培养全科医师的综合服务能力为目标,通过较为系统的全科医学及相关理论、临床和社区实践技能培训,培养学员热爱、忠诚社区卫生服务事业的精神,掌握全科医疗的工作方式,全面提高其对社区常见病多发病的诊断、鉴别诊断、转诊、预防保健和健康教育技能,具有一定的社区卫生服务组织管理能力,达到全科医师骨干的基本要求,成为社区卫生服务队伍中的业务骨干人才。     

全科医师规范化培训需求研究

目的 :探讨全科医师规范化培训需求的理论结构,为健全优化全科医师规范化培训理论实践框架提供参考依据。方法 :2015年10月至2016年3月,对全科医师规范化培训相关人员进行半结构式访谈,采用Nvivo 8.0中文软件进行资料分析。结果 :全科医师培训需求的理论结构可分为4个维度19个成分;不同角色对全科医师规范化培训需求认知存在差异,全科学员更重视对于奉献精神的道德培训,带教老师则更重视耐心及爱岗敬业,全科医师更重视合作意识与交往能力,培训基地管理人员更重视临床诊疗能力的培训。结论 :全科医师的培训应以社会需求为首要,尊重全科医学临床实践特点,安排满足全科医师培训需求、又易于实践操作的培训计划,不断优化培训结构,改革培训方法,最终制定出适合广大全科医师的系统化的培训策略。     

我们承担全科医师急诊急救培训的做法和体会

北京急救中心作为全市 11家全科医学培训基地之一的单位 ,于 1999年 9月初承担了首届全科医学骨干班学员的急诊、急救专业培训任务。对此 ,我们就如何建立全科医学培训模式 ,以达到和满足社区卫生服务需求进行了探索。一、我们开展全科医师培训的做法(一 )采用有的放矢的教学方法 :对于全科医师培养事先应了解全科医师培训目标、内容和工作特点及学员所具有的水平。尔后制订有的放矢、切实可行的培训方案。学员来中心时 ,首先集中岗前教育。岗前培训的内容 :讲授现代急救医学新进展 ;讲授中心急救医疗工作概况和急救专业特点与要求。通过教…     

新冠肺炎疫情下全科医师规范化培训社区教学的实践与思考*

突如其来的新型冠状病毒感染肺炎(以下简称新冠肺炎)疫情是对社区卫生防控体系和能力的一次大考,也给全科医师规范化培训(以下简称规培)社区教学带来很大的挑战。上钢社区卫生服务中心根据上海市新冠疫情形势的变化情况,对疫情特殊时期"理论+实战+云端"教学模式进行了合理探索,将教学扩展到疫情一线,针对疫情中全科医生应具备的技能,开展实战教学与线上教学,保证教学质量,完成教学任务。通过对比学员培训前后新冠肺炎相关理论知识成绩及处理能力,发现运用该模式教学后,规培医师对突发公共卫生事件应急处置能力提升显著。这种在实践中不断探索与提升全科规培教学水平的"理论+实战+云端"教学模式,为特殊时期全科医师规范化培训社区教学提供了新的思路。     

全科医师医院感染相关知识及技能培养模式的探讨

目的探讨全科医师医院感染相关知识及技能培养模式的改革与创新,以期降低社区感染率。方法选取医院实习的全科医师作为研究对象,以2010年7月-2011年1月实习的189名全科医师为对照组,以2011年7月-2012年1月实习的195名全科医师作为观察组;对照组采取传统方式进行带教与培训,观察组采取自行设计符合卫生部全科医师培训要求的培养模式进行社区带教管理;对比两组考核结果,评估培养新模式的优劣并提出改进方法。结果对照组189名医师的综合实习成绩评定合格162名,合格率为80.4%,观察组195名医师合格183名,合格率为93.8%,组间比较差异有统计学意义(P<0.05);观察组全科医师实习后医院感染相关知识和技能得分分别为(92.1±7.5)分和(90.3±9.4)分,对照组分别为(84.4±9.3)分和(81.1±11.9)分;两组比较差异均有统计学意义(P<0.05);观察组全科医师对各项满意度调查其满意度均明显高于对照组(P<0.05)。结论采取自行设计符合卫生部全科医师培训要求的培养模式进行社区带教管理,全科医师考核成绩明显得到提高。     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.     

The Life Events Inventory: re-scaling based on an occupational sample.

The objective of this study was to compare the validity of the original weightings used by the Life Events Inventory (LEI) with those obtained from a contemporary occupational sample. Fifty male and 62 female manufacturing employees (age range 16-55 years) assigned scores to each item on a slightly modified version of the LEI scale. The current sample consistently assigned higher weights to events/items than did the original sample, but there was high agreement in terms of item ranking. Some distinct age and gender differences in scoring were apparent, and are discussed further. It was concluded that when separate weightings are employed for age and gender groups, the LEI remains a useful tool for quantifying background levels of stress in both workplace stress audits and epidemiological studies where statistical control for non-occupational sources of stress is required.     

Maxillofacial injuries related to work accidents: a new concept of a hospital-based full electronic occupational trauma surveillance system

The objective of this study was to investigate the occurrence of occupational maxillofacial injuries using a newly installed relational database. Twenty-six injuries were identified out of 28,624 patients admitted to the emergency unit during a 12 month period. Falls from height or being struck by moving objects were common causes of these injuries. Two-thirds of those identified were construction workers. This paper demonstrates the power of modern databases to identify specific occurrences that may provide the basis for prevention in the future.     

Rôles physiologiques des endocannabinoïdes dans le contrôle de l’homéostasie énergétique

Endocannabinoids are endogenous lipids which modulate the release of neurotransmitters and activate different signaling pathways, through the binding to cannabinoïd receptors, CB1 and CB2. Endocannabinoids are involved in the control of a variety of behavioural and neuroendocrine functions, including feeding behaviour. In the central nervous system, they essentially modulate the expression of orexigen or anorexigen neuropeptides thus resulting in the stimulation of food intake. Their peripheral targets are mainly the liver and the white adipose tissue where they stimulate lipogenesis, through the modulation of several enzymes and proteins expressions. Cannabinoïd receptor agonists are nowadays prescribed to improve appetite of people suffering from cancer or AIDS. In the same way, CB1 antagonist, such as Rimonabant, could provide efficient treatment of obesity.     

Stress in police officers: a study of the origins,prevalence and severity of stress-related symptoms within a county police force

BACKGROUND: High levels of stress-related illness are causing concern across industry. Against a background of impending legislative moves to try to improve this situation, there is a need to identify key work-related stressors. Police work tends to be regarded as inherently stressful because of the personal risk of exposure to confrontation and violence and the day-to-day involvement in a variety of traumatic incidents. As a result, high levels of stress-related symptoms might be expected in this population. OBJECTIVE: To examine the sources of stress-related symptoms within police officers and measure the prevalence of significant associated mental ill-health. METHOD: A cross-sectional questionnaire survey of a population of 1206 police officers was performed to assess levels of strain associated with a series of potential home and work related stressors. Participants were then split into low and high scoring groups on the basis of a General Health Questionnaire (GHQ) threshold score in order to identify those stressors most associated with mental ill-health effects. RESULTS: Occupational stressors ranking most highly within the population were not specific to policing, but to organizational issues such as the demands of work impinging upon home life, lack of consultation and communication, lack of control over workload, inadequate support and excess workload in general. The high scoring group constituted 41% of the population and differed significantly from those with low scores in perception of all stressors, ranking both personal and occupational stressors more highly, and from personality constraints appeared significantly more 'stress-prone'. A significant association between gender and mental ill-health was found, with females more likely to score more highly on the GHQ than males. CONCLUSION: This study confirms previous findings of organizational culture and workload as the key issues in officer stress. Given that the degree of symptomatology appears to be worsening, management action is required. Further research is indicated within the police population into a possible increased susceptibility in female officers.