基于岗位管理的基层医院专科护士使用及考核的现状调查研究

目的调查四川省基层医院专科护士使用和考核现状,对其使用和考核体系进行探索。方法于2017年9月7-15日,采用问卷调查法对四川省38所二级及三级乙等医疗单位专科护士的使用和发展现状进行调查。结果共有38所医院参与网络问卷调查,其中34.21%的医院未针对专科护士设置岗位,岗位职责不清晰。有73.68%的专科护士未进行资质再认证,60.53%的专科护士学成后未进行专科资质再考核。结论我国对专科护士能力的评价认证体系尚未形成统一标准,对专科护士的培养条件也未形成统一标准。护士岗位管理中设置专科护士岗位能促进专科护士的职业发展规划,有利于专科护士使用和考核。     

Developing a Brief Neuropsychological Battery for Early Diagnosis of Cognitive Impairment

ObjectivesEarly diagnosis of cognitive impairment is increasingly emphasized in the literature to facilitate timely preventive interventions. Although bedside cognitive tests such as the Montreal Cognitive Assessment (MoCA) are widely used for such early diagnostic purposes, they may not have comparable performance to a full neuropsychological battery (FNB) in diagnosing early cognitive impairment. This study investigated whether a small subset of neuropsychological tests can be added on to MoCA to match its performance to that of the FNB in discriminating mild cognitive impairment and dementia (MCI/dementia) from normal cognition.DesignCross-sectional diagnostic study.SettingAlzheimer's Disease Centers across the United States.ParticipantsOlder participants (≥50 years) who completed MoCA and the FNB (N = 9187).MeasuresThe study sample was split into two: the derivation sample (n = 1837) was used to develop a brief neuropsychological battery that best discriminated MCI/dementia (using the best-subset approach with 10-fold cross-validation); while the validation sample (n = 7350) verified its actual performance in discriminating MCI/dementia.ResultsA 3-item neuropsychological battery was identified, comprising MoCA, Benson Complex Figure Recall, and Craft Story 21 Delayed Recall. It had excellent performance in discriminating MCI/dementia from normal cognition (area under the receiver operating characteristic curve [AUROC] 90.0%, 95% confidence interval [CI] 89.2%-90.7%), which was comparable to that of the FNB (AUROC 88.4%, 95% CI 87.6%-89.2%). By contrast, MoCA alone had significantly worse AUROC (86.9%, 95% CI 86.0%-87.7%) than that of the FNB.Conclusions/ImplicationsUsing rigorous methods, this study developed a brief neuropsychological battery that maintained the brevity of a bedside cognitive test, while rivaling the diagnostic performance of an FNB in early cognitive impairment. This brief battery offers a viable alternative when the FNB is needed but cannot be feasibly administered in nonspecialty clinics. It can have a wider health systems effect of improving patients’ access to accurate diagnosis in early cognitive impairment and facilitating timely interventions to delay the progression of cognitive impairment.     

Enhancing Nurse Assessment of Alcohol and Drug Dependency: A Preliminary Study

The purpose of this project was to prepare nurses to provide brief interventions for clients with alcohol or other drug (AOD) dependency in order to reduce hospitalization, morbidity, and mortality. The project was a collaborative process between a major medical center and a school of nursing. Nurses were surveyed for understanding of alcohol and other drug assessment, and a day long training was provided to teach techniques of brief interventions. The short-term results included increased knowledge of nurses about AOD assessment. Long-term results indicated that 95% of patients referred to the AOD team were confirmed to have AOD problems (Dunn & Ries, 1997). This project documents the need for nurses to have more knowledge about AOD problems and brief intervention techniques.     

Assessment of sexual abuse and trauma: Clinical measures

Examined are several measures currently used in the assessment of child abuse, sexual abuse, and trauma. These measures include structured clinical interviews, self report measures, screening inventory, symptom checklist, and some measures that include decision making properties. Issues and implications for clinical practice are explored.     

Validation of a self-administered diet history questionnaire using multiple diet records

The validity of a self-administered diet history questionnaire has been estimated using as the reference data the mean of three 4-day diet records collected over the year prior to the administration of the questionnaire, in 1985–1986. Subjects were women ages 45–70 years, participants in the Women's Health Trial Feasibility Study, a multi-center clinical trial in which some women were randomized to be taught to adopt and maintain a low-fat diet, while others maintained their usual diet. The questionnaire produced group mean nutrient estimates closely approximating the values obtained by three 4-day records, e.g. in the usual-diet group, 37.7% of calories from fat by both food records and by questionnaire, and in the low-fat, group, 21.3% of calories from fat by food records and 23.7% of calories from fat by questionnaire. Correlations between questionnaire and diet records for per cent of calories from fat were 0.67 and 0.65 respectively in the two groups; most correlations were in the 0.5–0.6 range, and were similar to those achievable by a single 4-day food record.     

试论新世纪初期医院综合院力评价

作者阐述了医院综合院力的内涵与提出背景，提出了新世纪初期综合院力的评价内容体系，即一级评价内容7项，二级评价内容39项，三级评价内容15l项，并就各指标评价内容进行了讨论分析。     

Assessing the needs and quality of life of patients with HIV infection: development of theHIVOverview ofProblems-EvaluationSystem (HOPES)

Objective: To develop and evaluate the psychometric properties (reliability, validity etc.) of a comprehensive Quality of Life (QOL) tool, for patients infected with the human immunodeficiency virus (HIV), that was adapted from a previously validated cancer tool. Design: Cross-sectional, patient completed written surveys and interviews. Setting: The Medical Centers serving HIV infected patients in the Los Angeles community including UCLA, community physicians, Veterans Affairs Medical Centers, and a County hospital: and additional data contributed from Johns Hopkins University Medical Center CMV Retinitis Clinic. Patients: Patients (n=318) with HIV infection including asymptomatic (37%), ARC (20%), AIDS (25%) and AIDS with Cancer (18%) receiving health services at one of the above sites. Measurements: The patients self-administered the newly developed instrument, the HOPES (HIVOverview ofProblems-EvaluationSystem), other QOL related tools including the Medical Outcomes Study instrument adapted for HIV (MOS-HIV) the Profile of Mood States (POMS), the Perceived Adjustment to Chronic Illness Scale (PACIS), and the Physical Activity Scale (PAS). Brief interview to assess the Karnofsky Performance Status Score (KPS). Measured sociodemographic characteristics included age, sex, race, HIV risk factor, education etc. Assessed medical history, current medications, HIV clinical classification. Main results: The sociodemographic and medical characteristics of the sample resemble those of the general population with HIV infection in this geographic area: 96% male, 28% nonwhite, 84% homosexual contact as risk factor, 75% receiving antiretroviral therapy. The adaptation of the cancer QOL instrument to HIV appears to have face and content validity according to patients and health professionals who care for HIV infected patients. Analyses of the psychometric properties found that the HOPES has a similar structure to its parent instrument following factor analyses which results in five summary scales representing the Physical, Psychosocial, Medical Interaction, Sexual and Significant Other/Partners domains in addition to a Global Score. Internal consistency of 35 subscales is high with a mean alpha coefficient of 0.82. Correlations of the HOPES summary scales with other QOL instruments are in the predicted directions. Comparing patients within the HIV clinical diagnostic categories on the HOPES Global, Physical, and Psychosocial Summary Scales indicates that Asymptomatic Patients have better QOL than symptomatic patients. This finding is also found in the other QOL instruments which provides evidence of construct validity. Conclusions: The HOPES is an excellent tool for identifying the problems and needs of patients with HIV infection and for assessing their quality of life. It is reliable, valid and acceptable to patients. The tool may be especially useful in developing a normative data base.This paper is dedicated to the memory of Jimmy Stophel who died of AIDS and whose sense of humour improved the quality of many people's lives.This research was supported in part by the UCLA AIDS Clinical Research Center and CARES Consultants. To obtain information about the HOPES, please contact C. A. Coscarelli Schag, CARES Consultants, 2210 Wilshire Blvd., Suite 359, Santa Monica, CA 90403, USA.     

Assessment in undergraduate psychiatric education

An assessment of medical students' psychiatric performance demonstrated no association between the ability to rate psychopathology or to observe interview behaviour and traditional written methods of academic achievement. This is in accordance with those few studies which have addressed this issue and indicates that there may well be at least three independent skills involved in clinical decision-making: the ability to engage in interpersonal interaction and elicit information; and the ability to acquire and use academic knowledge. This is consistent with work suggesting that maturational and learning processes influence clinical reasoning, and demonstrates that each component should be addressed in assessing students in psychiatry.