耶鲁抽动症整体严重度量表对抽动障碍患儿的临床评估

目的引进耶鲁抽动症整体严重度量表(YGTSS)并评估其与临床症状轻重的关系，以及以量表积分在观察者间的一致性。 方法2001年7月至2002年6月成都市儿童医院全文翻译YGTSS，未予修改，观察72例抽动患儿YGTSS总积分与临床抽动症状严重度分型的关系和该量表积分进步率与治疗后症状改善程度的关系(临床效度检验)，观察24例患儿该量表运动和发声抽动数量、频度、强度、复杂性、干扰性5个维度积分及总积分在观察者间一致性。 结果抽动患儿该量表总积分与临床抽动症状严重度分型之间和该量表积分进步率与治疗后症状改善程度之间有较好的效度(F值分别为59.31和124.44，P均<0.01)，运动和发声抽动数量、频度、强度、复杂性、干扰性5个维度积分及总积分的组内相关系数(ICC)值均大于0.7，显示较好的观察者间一致性。 结论耶鲁抽动症整体严重度量表中译本具有较好的信度和效度，是衡量抽动症状严重程度的工具之一。     

A qualitative analysis of patients’ perception of microwave endometrial ablation as a satisfactory treatment for heavy menstrual blood loss

To explore and analyse patients’ views and comments on microwave endometrial ablation (MEA), we designed a simple and concise questionnaire of 10 items that the participants answered by ticking boxes. They were invited to add their own comments and opinions if they wished. The questionnaire survey was posted to 470 patients who were treated with MEA at Derriford Hospital between 1997 and 2003. We received replies from 343 patients (73%), of whom 165 included handwritten comments (48%). These were reviewed using content thematic analysis. This paper describes the findings of this analysis. Of the 343 respondents, 127 expressed their satisfaction, 32 would recommend MEA to others, and 17 claimed that MEA had transformed their lives. They used words such as “delighted,” “grateful,” “fantastic,” “I cannot tell you how wonderful it has been,” “freedom at last,” “I feel so much better within myself,” “I cannot begin to describe the feelings of well-being and relief I have experienced since I had this treatment,” and “it has changed my life from being housebound to never giving my periods a thought.” Thirty-eight patients were not satisfied; of these, 14 were experiencing moderate to severe pain, and six claimed to have developed severe pain de novo. Their comments included “I was disappointed MEA did not work for me” and “I get heavy bleeding and pain each month, [whereas] before I had no period pains at all.” In conclusion, MEA has been a “miracle cure” for many women who responded, with around 77% being satisfied with this treatment. For a small number, MEA was not successful. For some women, pain was a problem that either developed de novo or was preexisting in the form of dysmenorrhoea. In this paper we also mention success rates and figures from quantitative studies, and we recommend including quotes from satisfied patients in patient information leaflets to further help women and their physicians make informed choices about managing heavy menstrual blood loss, particularly when medical treatment is known to be less successful and with some women being concerned about its side effects.Shortly after this paper was submitted, Emad Louis tragically died from complications following surgery, whilst waiting to take up his post as a Consultant at St. Mary’s Hospital, Isle of Wight. We remember him with great affection as a wonderful colleague, who is held in the highest regard by his patients and all who worked with him. He is greatly missed.He leaves a wife and son who are enormously proud that his research has been published.     

Train the trainers!

With the introduction of training programmes and logbooks for basic postgraduate training and subspecialty training, the European Board and College of Obstetrics and Gynaecology has given impulses to harmonise training in obstetrics and gynecology in the European Union. Current changes in the practice of medicine, among which the European Working Time Directive, numbers of surgical procedures decreasing, more demanding patients and a change in work ethos, challenge both trainers and trainees to optimise postgraduate training. For training to be effective and efficient, it is necessary to clearly define learning goals and outcomes and to create a stimulating educational environment. This requires trainers who (a) have knowledge of adult learning and educational theory and (b) will act as facilitators of the learning process of postgraduate trainees. Most of the doctors involved in postgraduate training have not had any formal formation to be a trainer. Teacher professionalisation offers the medical professional a framework to increase efficiency as a trainer. In this article, an introduction to educational practice for the medical professional is given. Several aspects of adult learning, such as the learning cycle, appraisal and assessment, and giving feedback, are discussed.     

对北京市妇幼保健机构测评指标体系的研究

论述了北京市妇幼保健机构测评体系的依据、范围及内容。主要对原有的评审指标体系进行了调整、重新组合和分配 ,并且增加了“财务状况分析”、“领导行为与组织文化”两个全新的成分 ,决定将新的测评体系分为由内部因素和外部因素共同作用的“机构生存条件与发展能力评估”部分主要由内部因素影响的“机构工作评审”部分 ,以区别机构领导者的责任与今后努力方向之间的差别 ,减少评审时所表现的行为畸变和信息偏倚。     

上海市卫生学科带头人的选拔培养和绩效分析

上海卫生系统选拔 10 2名德才兼备的优秀中青年科技人才进入上海市卫生系统百名跨世纪优秀学科带头人培养计划 ,由市卫生局给予启动基金 ,并与入围者所在单位及其上级主管部门共同制定培养计划 ,签订培养合同 ,落实培养措施 ,对培养对象的实际业务水平、组织管理能力、学术地位、知名度的提高以及医、教、研实际成绩进行全过程的跟踪和考核评估。绩效分析表明 ,通过 5年～ 7年的重点培养和锻炼 ,他们业已成为本市第一代优势学科带头人 ,从整体上推进了上海卫生事业发展和医学水平的提高。     

医院发展力模型体系及其意义

回顾了企业成长理论的发展过程 ,指出企业成长理论之不足在于只重视企业“具有的” ,而忽视了顾客“需要的”。结合医疗行业特点 ,认为目前医院综合实力评价模型也存在同样问题。提出了用医院发展力来评价医院未来发展的模型 ,其构成因素包括物力、人力、品牌竞争 3个方面 ,并论述了医院发展力作为评价医院发展模型的应用价值。     

Education Time Out and Debrief: Structured Implementation of Perioperative Resident Technical Education Discussion

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乳腺癌PICC化疗患者自我管理行为测评量表的开发与应用

目的 开发乳腺癌经外周静脉置入中心静脉导管（PICC）化疗患者自我管理行为测评量表,并进行效度和信度检验。方法 参考美国斯坦福大学患者教育研究中心Dr.Kate.Lorig等创建的《慢性病自我管理研究测量表》及其评分标准,结合乳腺癌PICC患者自我管理内容,经参考文献、专家评定,修订成《乳腺癌PICC化疗患者自我管理行为测评量表》。量表包括5个维度,19项量化指标,共78个条目。192例乳腺癌PICC化疗患者参加了调查。结果 有效问卷178份,量表的内容效度指数（CVI）为0.906,总体Cronbach’α系数为0.892。采用因子分析法,提取出特征根大于1的公因子4个,解释总方差的41.180%,每个条目在相应因子上的负荷均在0.3以上。结论此测评量表具有较好的效度和信度,为研究者提供了乳腺癌PICC化疗患者自我管理行为评价和干预的工具。     

Personality disorder-The rules of engagement

This paper sets out the size and pressing nature of the problem of personality disorder and attempts to provide clinicians with a coherent strategy for the assessment of personality disorder, with special emphasis on determining who should be taken on for treatment.