旅客餐车工作人员卫生知识培训效果评价

目的了解旅客餐车工作人员在工作态度、标准执行及食品安全知识等方面的情况,为评价旅客餐车工作人员卫生知识培训效果提供依据。方法对参加卫生知识培训的旅客餐车工作人员在培训前后分别使用统一问卷进行调查,调查内容为基本情况、工作态度以及食品安全知识,规范行为执行情况以培训前后监督所检查情况为依据,数据整理后,得到正确态度持有率、规范行为执行率、卫生知识知晓率。结果开展卫生知识培训后,旅客餐车工作人员卫生知识知晓率、规范行为执行率较培训前有统计学意义,其中后厨工作人员培训效果最为明显,而现场观摩方式培训效果较集中资料授课方式有统计学差异。结论开展健康教育夯实食品安全知识,是执行标准化作业的有效途径。     

住院医师人文医学执业技能核心课程培训需求分析

目的 分析上海某大学附属三级医院在住院医师规范化培训阶段的住院医师对人文医学核心课程培训的需求,为后续规划与开展有效的人文医学执业技能培训提供参考.方法 自行设计调查问卷进行调查,问卷内容主要为一般情况,核心课程设置情况以及培训考核方式等内容,对调查结果进行统计分析.结果 人文医学执业技能培训得到了住院医师较高程度的认可与重视,初步确立了培训核心课程等要素,并对人文医学培训的实施、考核、反馈等方面提出了一些意见与建议.结论 人文医学核心课程的培训应尽快纳入住院医师规范化培训体系中,开展人文医学核心课程培训有利于提升住院医师人文医学素养,有利于完善和提高住院医师规范化培训内涵.     

从教师角度探讨农村全科医生转岗培训中的问题与对策

目的 了解农村全科医生转岗培训中存在的问题,寻求解决措施.方法 采用问卷调查法和访谈法,调查参培学员转岗培训的相关情况.结果 农村全科医学培训中,学员存在培训目的不清、从业愿望不强、医学基础知识薄弱等问题;培训过程中存在课程设置不合理、培训时间安排不合理、教学形式单一等问题.结论 应强化责任教育、完善培训方式、灵活安排培训内容,以保证培训效果落到实处.     

中外合作培训卫生防疫人才

<正> 卫生部和联合国儿童基金会(UNICEF)合作培训中国卫生防疫人才项目,1982年至1989年已进行了两个合作周期。儿基会无偿援助电化教学设备、培训用部分实验设备、聘请外国专家来华讲学及培洲中于心师资出国学习、考察经费等,国内投资用改善教学、实验和学员生活条件等。本文侧重反映陕西培训中心培训项目执行情况。 1 培训中心基本情况全国卫生防疫人员陕西培训中心附设在陕西省卫生防疫站,由一名副站长负责,具体工作由教育科与有关科室承办,主要任务是培训新疆、西藏、内蒙、青海、宁夏、甘肃等少数民族省区和陕西省的卫生防疫人员,培训的主要专业有计划免疫、流行病、儿少     

“首届西藏基层骨干医生培训班”培训需求与效果评估分析

目的了解培训班藏区基层卫生技术人员的培训需求和效果,进而为该项目的持续培训以及藏区基层卫生技术人员的其他培训提供参考依据。方法采用现场问卷调查的方法,自行设计评估问卷,对首期培训班100名藏区基层卫生技术人员进行问卷调查。结果通过对首期培训班培训内容的需求、培训过程的评价(包括培训过程中的组织情况、教学方式和时间安排等各维度的评价情况分析)、培训效果的评价三方面进行分析,结果表明本次培训班课程设置模块合理,能够反映西藏基层卫生服务的实际需要,培训过程及培训效果都比较满意。结论考虑藏区的特点,适当调整培训班课程结构与内容,合理安排培训时间,丰富培训形式及内容,为以后的各期培训做好准备。     

心内科临床护理管理中护士分层培训的应用分析

目的探讨心内科临床护理管理中护士分层培训的应用价值。方法该院心内科于2018年4月在护士培训中实施分层培训,对比培训前后1年内护士综合能力评分;分别选取培训前后1年内200例患者,对比患者护理满意情况、护理不良事件发生情况。结果与培训前比较,培训后护士基础护理、病房护理、专科护理、服务态度等评分均明显提高(P<0.05);与培训前比较,培训后护理不良事件发生率明显下降,患者对护理满意度评分明显提高(P<0.05)。结论心内科临床护理管理中实施护士分层培训有助于提高护士综合技能,降低护理不良事件的发生,改善护患关系。     

4省(区)乡镇防保人员继续教育及核心知识需求情况调查

[目的]分析乡镇防保人员继续教育情况,为防保人员继续教育进行针对性的改进提供参考依据.[方法]以问卷形式调查江西、贵州、广西及浙江4个样本省乡镇防保人员的继续教育情况,进行统计分析. [结果]目前乡镇防保人员的培训缺乏系统的计划,不能保证人人都有培训机会.培训形式单一,以短期培训为主.本单位内部培训或业务学习情况不太理想,对防保人员的学分考查不严格. [结论]应采取加强核心知识的培训、加强内部培训和学分制考核等有效措施不断强化乡镇防保人员的继续教育,并且系统化、制度化.     

云南省怒江州妇幼卫生人员培训实践与效果*

目的对云南省怒江州妇幼卫生人员培训实施情况及培训效果进行分析,为进一步提升妇幼卫生人员能力提供科学依据。方法通过问卷调查、访谈和实地考察等多途径收集相关资料,对怒江州妇幼卫生人员培训实施情况及其效果进行分析。结果小规模、指导性的参与式培训充分调动了学员的积极性,让其能够快速有效掌握相关知识和技能。国家级和省级专家亲自指导示教也让学员感受到了重视和动力,培训结束后多数学员在工作中都积极运用了培训所学的知识和技能。结论本土化培训教材有助于提高培训的适宜性;参与式培训方法有效提升学员参与程度;逐级培训机制有助于提升培训效果的可持续性。     

甘肃省部分地区乡村医生现状及培训状况调查

目的对参加甘肃中医药大学2017年乡村医生进修培训的乡村医生进行调查,了解甘肃省乡村医生的基本情况、在岗培训情况和对本次培训的满意度及建议,提出相关的对策和建议。方法从参加甘肃中医药大学2017年乡村医生进修培训的乡村医生中随机抽取629人进行问卷调查,回收有效问卷574份。调查内容包括乡村医生队伍的基本情况、在岗培训情况、本次培训在学时安排和授课等方面的满意度及建议等。调查结果采用SPSS 19.0软件进行统计分析。结果我省乡村医生队伍老龄化现象已有所改善,35～55岁占79.96%;学历结构偏低,本科及以上学历仅占0.17%;执业化程度较低,执业(助理)医师仅占9.93%,低于全国平均水平;工作量较大,日工作时间8 h及以上占57.14%,78.92%的村医既从事乡村医生工作又务农;收入较低,85.89%的村医月收入在2 000元以下,76.31%的村医无养老保险;在岗培训情况不理想,55.23%的人员未参加过培训;本次培训调查学员对培训的时间、地点和师资均比较满意,理论培训课程学时安排满意度平均得分(4.08±0.06)分,教师授课满意度平均得分(4.14±0.13)分。结论乡村医生队伍依然是我省医疗卫生服务体系的薄弱环节,应继续加强乡村医生队伍的建设;保障乡村医生的收入,完善乡村医生的养老制度;根据乡村医生的实际工作需求加强乡村医生在岗培训。     

巡警现场急救知识需求分析及培训模式研究

目的分析巡警现场急救知识需求情况，探索建立现场急救知识培训模式。方法问卷调查某市210名巡警现场急救知识需求情况，并进行系统培训。培训前后分别进行急救知识水平测试。结果巡警现场急救知识掌握水平较低，且多数未经过系统、规范的培训。培训前后巡警现场急救知识测试成绩有显著性差异（P〈0．001）。通过培训，巡警现场急救知识整体掌握水平和对外伤急救技术、心肺复苏术、急症处理技术等的掌握水平均显著提高。结论建立巡警现场急救知识培训模式应充分考虑培训机构、内容、方式、时间、考核及法律保障等，同时需要将现场急救知识培训纳入警察学校教育和在职继续教育，并完善相关激励机制。     

Ranking of priorities in employees' reward and recognition schemes: from the perspective of UAE health care employees

A reward and recognition (RR) system is a tool widely applied by organizations to motivate their employees. Outstanding employees expect their effort to be acknowledged by the organization. However, the variety of rewards and recognitions systems used by organizations may be perceived differently by different employees. The diverse workforce structure in the United Arab Emirates (UAE) poses various challenges for organization managers. Managers need to implement the shrewd RR system which best fits their diverse workforce. This research studied how medical sector employees in the private and public health sector view the RR systems in the UAE. Two lists, comprising 26 major approaches to RR, were prepared and its items prioritized by taking inputs from 250 employees working in more than 30 varied public and private health care organizations in the UAE. The findings of the research are expected to provide guidelines for developing appropriate RR systems for organizations in general, and UAE health care organizations in particular.     

Overuse and underuse of diagnostic upper gastrointestinal endoscopy in various clinical settings.

OBJECTIVES: To describe and compare both overuse and underuse of diagnostic upper gastrointestinal endoscopy in different settings. DESIGN: Merging of data from three prospective observational studies. The appropriateness and necessity of indications for gastroscopy were evaluated using explicit criteria developed by a standardized expert panel method (RAND-UCLA). Inappropriate endoscopies represent overuse. Necessary indications not referred for the procedure constitute underuse. SETTING: Three primary care outpatient clinics, 20 general practices, three gastroenterology practices, two district and one university hospitals. SUBJECTS: A third of the collective were consecutive ambulatory patients with upper abdominal complaints, whereas the other two thirds were ambulatory and hospitalized patients referred for the procedure. MAIN OUTCOME MEASURES: Proportions of overuse and underuse in the different settings. RESULTS: A total of 2885 patients were included (mean age, 49 years, 52% male, 2442 outpatients), 1858 patients underwent > or = 1 endoscopy. Among 2086 endoscopies, 805 (39%) were inappropriate, most of which were performed for dyspepsia (83%). Overuse was higher in young, foreign, female patients and lower in inpatient settings, the latter reflecting a different distribution of presenting symptoms. Among 1646 patient visits in primary care, overuse represented 148 endoscopies (9%). Underuse was identified in 104 of the same patient visits (6%) and was higher as patient age increased; there were no significant differences between men and women. CONCLUSIONS: Rates of overuse and underuse depend mainly on case presentation and patient characteristics. Both over- and underuse should be addressed to maintain and improve quality of care.     

高校医院院外医疗保健工作探讨

目的 为适应人们对医疗和健康日益增长的需求,高校医院须及时调整服务理念和方向。院外医疗保健是高校医院走出医院,服务社区,加强健康宣教和院前救治的具体体现,此文探讨院外医疗保健的工作方法和流程。方法 从人员选派、药品物品准备、院外救治等方面制定统一规范流程,定期进行急救知识培训和急救演练,以及院外医疗保健工作的分析总结,做好健康宣教和现场救治工作。结果 及时有效地处理各种突发健康状况和身体伤害,全力维护师生员工的身体健康。结论 在实践中探索和完善院外医疗保健工作的规范化、系统化和科学化。     

郴州农村妇女卫生保健意识及健康教育需求调查

目的:了解湖南省郴州市农村妇女卫生保健意识及其健康教育需求,为进一步提高健康教育质量提供依据。方法:结合预防医学本科生社会实践,组织大学生对郴州市保和乡326名农村妇女进行问卷调查。结果:大部分调查对象的卫生保健意识较差,近1年来,40.5%的妇女出现过生殖道感染症状;卫生保健意识主要与年龄、文化程度有关(P0.05);调查对象对健康教育的需求主要是儿童保健、常见妇科疾病预防和孕产期保健等方面的知识。结论:应针对不同年龄、不同文化层次的农村妇女进行相应的健康教育,健康教育的方式应多种多样。大学生组织的社会实践活动在农村妇女的健康促进工作中有着重要的作用。     

Improvements in Health Status after Massachusetts Health Care Reform

Context

Massachusetts enacted health care reform in 2006 to expand insurance coverage and improve access to health care. The objective of our study was to compare trends in health status and the use of ambulatory health services before and after the implementation of health reform in Massachusetts relative to that in other New England states.

Methods

We used a quasi-experimental design with data from the Behavioral Risk Factor Surveillance System from 2001 to 2011 to compare trends associated with health reform in Massachusetts relative to that in other New England states. We compared self-reported health and the use of preventive services using multivariate logistic regression with difference-in-differences analysis to account for temporal trends. We estimated predicted probabilities and changes in these probabilities to gauge the differential effects between Massachusetts and other New England states. Finally, we conducted subgroup analysis to assess the differential changes by income and race/ethnicity.

Findings

The sample included 345,211 adults aged eighteen to sixty-four. In comparing the periods before and after health care reform relative to those in other New England states, we found that Massachusetts residents reported greater improvements in general health (1.7%), physical health (1.3%), and mental health (1.5%). Massachusetts residents also reported significant relative increases in rates of Pap screening (2.3%), colonoscopy (5.5%), and cholesterol testing (1.4%). Adults in Massachusetts households that earned up to 300% of the federal poverty level gained more in health status than did those above that level, with differential changes ranging from 0.2% to 1.3%. Relative gains in health status were comparable among white, black, and Hispanic residents in Massachusetts.

Conclusions

Health care reform in Massachusetts was associated with improved health status and the greater use of some preventive services relative to those in other New England states, particularly among low-income households. These findings may stem from expanded insurance coverage as well as innovations in health care delivery that accelerated after health reform.     

Managed Care Organizational Characteristics and Health Care Use among Children with Special Health Care Needs

Objective. To examine the relationship between features of managed care organizations (MCOs) and health care use patterns by children.
Data Sources. Telephone survey data from 2,223 parents of children with special health care needs, MCO-administrator interview data, and health care claims data.
Study Design. Cross-sectional survey data from families about the number of consequences of their children's conditions and from MCO administrators about their plans' organizational features were used. Indices reflecting the MCO characteristics were developed using data reduction techniques. Hierarchical models were developed to examine the relationship between child sociodemographic and health characteristics and the MCO indices labeled: Pediatrician Focused (PF) Index, Specialist Focused (SF) Index, and Fee-for-Service (FFS) Index, and outpatient use rates and charges, inpatient admissions, emergency room (ER) visits, and specialty consultations.
Data Collection/Extraction Methods. The telephone and MCO-administrator survey data were linked to the enrollment and claims files.
Principal Findings. The child's age, gender, and condition consequences were consistent predictor variables related to health care use and charges. The PF Index was associated with decreased outpatient use rates and charges and decreased inpatient admissions. The SF Index was associated with increased ER visits and decreased specialty consultations, while the FFS Index was associated with increased outpatient use rates and charges.
Conclusion. After controlling for sociodemographic and health characteristics, the PF, SF, and FFS indices were significantly associated with children's health care use patterns.     

Patient satisfaction with health care services at a national institute of ophthalmology

Little is known about how patients in developing countries, such as Vietnam, are satisfied with eye care services. The purpose of this study was to assess the satisfaction with health services and its associated factors among patients attending a national institute of ophthalmology in Vietnam. In a cross‐sectional study utilizing quantitative methods, 500 inpatients and their relatives attending a national institute of ophthalmology in Vietnam were approached for data collection. The results indicated that under 50% of the patients were satisfied with eye care services. However, when classified by level of satisfaction, only 6.8% were very satisfied with all domains of care. There was no significant difference in satisfaction by gender and income, while significant differences by department, residence, and education were found. Patients who were from rural areas, were better educated, and used the services of the glaucoma department, were more satisfied with eye care than those from urban areas, were less educated, and used the services of treatment‐on‐demand department. Multivariable regression detected 2 main factors, gender and location, associated with patient satisfaction. Patients who were female and came from rural and remote areas were more likely to be satisfied than patients who were male and living in urban areas. The study suggests that to continue to improve health care quality, it is important to eliminate differences in providing eye care services regardless of whether patients are male or female, and whether they come from a rural or urban area.     

Clinical Quality Performance in U.S. Health Centers

Objective

To describe current clinical quality among the nation''s community health centers and to examine health center characteristics associated with performance excellence.

Data Sources

National data from the 2009 Uniform Data System.

Data Collection/Extraction Methods

Health centers reviewed patient records and reported aggregate data to the Uniform Data System.

Study Design

Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance.

Principal Findings

Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well.

Conclusions

Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients.     

Care management for depression in primary care practice: findings from the RESPECT-Depression trial

PURPOSE This qualitative study examined the barriers to adopting depression care management among 42 primary care clinicians in 30 practices.METHODS The RESPECT-Depression trial worked collaboratively with 5 large health care organizations (and 60 primary care practices) to implement and disseminate an evidence-based intervention. This study used semistructured interviews with 42 primary care clinicians from 30 practice sites, 18 care managers, and 7 mental health professionals to explore experience and perceptions with depression care management for patients. Subject selection in 4 waves of interviews was driven by themes emerging from ongoing data analysis.RESULTS Primary care clinicians reported broad appreciation of the benefits of depression care management for their patients. Lack of reimbursement and the competing demands of primary care were often cited as barriers. These clinicians at many levels of initial enthusiasm for care management increased their enthusiasm after experiencing care management through the project. Psychiatric oversight of the care manager with suggestions for the clinicians was widely seen as important and appropriate by clinicians, care managers, and psychiatrists. Clinicians and care managers emphasized the importance of establishing effective communication among themselves, as well as maintaining a consistent and continuous relationship with the patients. The clinicians were selective in which patients they referred for care management, and there was wide variation in opinion about which patients were optimal candidates. Care managers were able to operate both from within a practice and more centrally when specific attention was given to negotiating communication strategies with a clinician.CONCLUSIONS Care management for depression is an attractive option for most primary care clinicians. Lack of reimbursement remains the single greatest obstacle to more widespread adoption.