网络模式下临床医师绩效评价指标体系研究

为了充分利用医院信息网络信息，更为全面、客观地对医生进行评价，阐述建立网络模式下临床医师绩效评价指标体系的原则、方法，并对的建立指标体系的可信度及合理性进行了分析。     

A Theoretical Model of Transition to Practice for Athletic Trainers

ContextThe transition to practice of newly credentialed athletic trainers (ATs) has become an area of focus in the athletic training literature. However, no theoretical model has been developed to describe the phenomenon and drive investigation.ObjectiveTo better understand the lived experience of the transition to practice and develop a theoretical model of transition to practice for ATs.DesignQualitative study.SettingTelephone interviews.Patients or Other ParticipantsFourteen professional master''s athletic training students (7 men, 7 women, age = 25.6 ± 3.7 years, from 9 higher education institutions) in the first year of clinical practice as newly credentialed ATs.Data Collection and AnalysisParticipants completed semistructured phone interviews at 3 timepoints over 12 to 15 months. The first interview was conducted just before graduation, the second 4 to 6 months later, and the third at 10 to 12 months. The interviews were transcribed and analyzed using a grounded theory approach.ResultsWe developed a theoretical model to explain the causal conditions that triggered transition, how the causal conditions were experienced, the coping strategies used to persist through the first year of practice, and the consequences of those strategies.ConclusionsThe model provides a framework for new athletic training clinicians, educators, and employers to better understand the transition process in order to help new clinicians respond by accepting or adapting to their environment or their behaviors.     

Impacto de la ratio paciente-enfermera en los resultados de salud en los hospitales públicos del Servicio Andaluz de Salud. Estudio ecológico

AimTo analyse the patient-nurse ratio and its association with health outcomes in public hospitals of the Andalusian Health Service (SAS).MethodCross-sectional ecological study carried out in adult units of 26 Andalusian public hospitals. Data on structure (beds, type of unit, nursing control), management (average stay, index of use of stays, complexity index) and nursing staff were collected. They were extracted from official sources: CMBDA, SAS/Health Council (CS) publications and specific respondents to Nursing Directorates. The patient-nurse ratio was calculated and related to 19 indicators of hospital quality, safety, and mortality. Measures of central tendency and Spearman's correlation coefficient were used for statistical analysis.ResultsA response was obtained from 100% of the Andalusian hospitals. The average patient-nurse ratio in the three shifts was lower in hospitals with a broader portfolio of services-regional scope (11.6), followed by those with a medium portfolio-specialties (12.7) and hospitals with a basic portfolio- county (13.5). By type of unit, the medical units were 11.8 (SD = 1.8) lower than the surgical ones 13.5 (SD = 2.7). Significant differences were only found in medical units of regional hospitals 10.5 (SD = 1.4) and district hospitals 13.03 (SD = 1.46) (p = .001). In critical care, the ratio was greater than 2 patients per nurse in the three groups. When relating the ratio to health outcomes, 5 significant associations were found: pressure ulcers (p = .005), prevalence of nosocomial infections (p = .036), postoperative sepsis (p = .022), zero bacteraemia verification (p = .045) and mortality from heart failure (p = .004).ConclusionsThe results indicate a high patient-nurse ratio in adult hospitalization units and that there is a positive association between the patient-nurse ratio and worse results related to nursing care.     

Patient profiles as organizing HIV clinicians’ ART adherence management: a qualitative analysis

The effectiveness of antiretroviral therapy (ART) depends on optimal clinical management and patient adherence. Little is known about patient characteristics that clinicians consider in the management of ART adherence. Exploring this issue, five focus groups were conducted with 31 HIV-clinicians from across France. A qualitative typological analysis suggests that clinician management of patient adherence is based on characteristics that coalesce into seven patient profiles. For the “passive” patient, described as taking ART exactly as prescribed without questioning their doctor’s expertise, a directive and simple management style was preferred. The “misleading” patient is characterized as concerned with social desirability and as reporting no adherence difficulties for fear of displeasing their doctor. If clinical outcomes are suboptimal, the clinicians’ strategy is to remind them of the importance of open patient-clinician communication. The “stoic” patient is described as requesting and adequately taking the most potent ART available. Here, clinicians emphasize assessment of side effects, which the patient may minimize. The “hedonistic” patient’s festive lifestyle and sexual risk-taking are seen as compromising adherence; with them, clinicians stress the patient’s responsibility for their own health and that of their sexual partners. The “obsessive” patient is portrayed as having an irrational fear of ART failure and an inability to distinguish illusory from genuine adherence barriers. With this patient, clinicians seek to identify the latter. The “overburdened” patient is recognized as coping with life priorities that interfere with adherence and, with them, a forgiving ART is favored. The “underprivileged” patient is presented as having limited education, income and housing. In this case, clinicians seek to improve the patient’s living conditions and access to care. These results shed light on HIV clinicians’ ART adherence management. The value of these profiles for HIV care and patients should be investigated.     

Burnout and Resilience After a Decade in Palliative Care: What Survivors Have to Teach Us. A Qualitative Study of Palliative Care Clinicians With More Than 10 Years of Experience

ContextBurnout is common among palliative care clinicians (PCCs). Resilience helps to reduce burnout, compassion fatigue, and is associated with longevity in palliative care.ObjectivesWe aimed to study PCCs who have remained in the field for longer than 10 years to deepen our understanding on their views on burnout and resilience.MethodsWe conducted a qualitative study using semistructured interviews and purposive sampling on 18 PCCs – five doctors, 10 nurses, and three social workers who worked in various palliative care settings (hospital palliative care team, home hospice, and inpatient hospice). The mean age of the interviewees was 52 years, and the mean number of years practicing palliative care was 15.7 years (range 10–25). The interviews were recorded verbatim, transcribed, and analyzed using a grounded theory approach.ResultsFour major themes emerged from our analysis – struggling, changing mindset, adapting, and resilience. Intervening conditions, such as self-awareness, reflection, and evolution, were also important factors. The core phenomenon of our study was that of transformational growth – a process that PCCs have to go through before they achieve resilience. We also further classified resilience into both personal and collective resilience.ConclusionOur findings highlight the evolving process of transformational growth that PCCs must repeatedly undergo as they strive toward sustained resilience and longevity. It also stresses the importance of taking individual and collective responsibility toward building a culture of personal and team resilience.     

Deep venous thrombosis prophylaxis: Are guidelines being followed?

Introduction: The purposes of the present study were to determine whether patients in The Canberra Hospital are receiving appropriate Deep Venous Thrombosis (DVT) prophylaxis, and to ascertain the awareness of appropriate treatment by clinicians. Methods: Part 1 of the present study comprised of a point prevalence study of The Canberra Hospital inpatients. Patients were assessed for the risk of their developing DVT. The prophylaxis they were receiving was documented. In Part 2 of the present study, clinicians at The Canberra Hospital filled out a questionnaire that outlined three case scenarios. They were required to identify the risk group and appropriate prophylaxis for each group. Consultants, registrars and junior medical officers were assessed separately. Results: The results of Part 1 of the present study showed that the majority of inpatients in The Canberra Hospital are not receiving appropriate prophylaxes according to international guidelines. Graduated compression stockings are rarely used, and often ineffectively applied. All groups performed poorly in Part 2 of the present study. Participants were frequently unable to identify the risk group for a particular scenario. There was also confusion regarding the appropriate prophylaxis for a particular risk group. Discussion: Deep Venous Thrombosis is a major problem among hospitalized patients. However, despite its importance, there is a lack of appropriate prophylaxes being instituted. This, together with the poor performance of the participating clinicians in Part 2 of the present study, indicate that there are significant problems in The Canberra Hospital regarding DVT prophylaxes and that steps need to be taken to overcome these problems.     

基于AHP的医师工作能力评价指标体系设计

目的试图从确定医师工作能力评价指标体系入手，建立医师工作能力的评价模型。方法运用层次分析法对医师工作能力进行评价。结果阐述了建立医师工作能力评价模型的方法和步骤，初步建立起医师工作能力评价模型，评价指标体系包括3个层次、6个方面、15项评级指标。结论通过对所建指标体系的可信度和合理性进行的分析，证明该法具有科学性和可行性，为衡量和提高医师工作能力提供了借鉴。