全身炎症反应综合征辨治浅析——附366例临床分析

目的探讨全身炎症反应综合征（SIRS）的中医学病机及治疗对策。方法对366例小儿SIRS进行辨证分型，并在治疗时按病种各自随机分为两组，对照组采用西医治疗，治疗组采用中西医结合治疗；观察两组体温和白细胞计数恢复正常的时间。结果治疗组疗效明显优于对照组。结论SIRS属于中医某些证的范畴，根据八纲辨证原则分实热证、虚热证、气阴虚证、真热假寒证及阴阳衰竭证五大证类，分别施治可简化诊断与治疗。     

循证医学在儿科教学中的应用体会

目的：探讨循证医学教学模式对儿科教学效果的影响。方法：选取2个基本条件相同的临床医学本科班分别用不同的教学方法进行儿科教学，比较循证医学教学模式（实验组）与传统讲授法（对照组）在儿科教学中的教学效果。结果：实验组学生的理论成绩，临床实习效果综合测试成绩、学习兴趣、对教学的满意度等方面明显优于对照组。结论：循证医学教学模式有利于培养学生的思维能力及自我教育能力，从而提高医学生的综合素质。     

医疗费用供方支付方式比较研究

本文通过比较预算支付、按人头支付、按服务项目支付和按病种补偿的优缺点,得出:任何支付方式都有正负两方面的作用,将几种支付方式结合起来的支付方式可能抵消各自的缺点,从而可以构造出较好的支付方式。     

The nurse match instrument: Exploring professional nursing identity and professional nursing values for future nurse recruitment

From April 1st 2015 it will be mandatory for Higher Education Institutions (HEI) in the United Kingdom (UK) providing pre-qualifying health care higher education to use a Values Based Recruitment (VBR) tool, to ensure only the candidates with the “right” personal identity and values commensurate with the Professional Identity of Nursing (PIN) are accepted for nurse education. “Nurse Match” instrument was developed to enhance the recruitment and selection of candidates for pre-qualifying nursing. Action Research into PIN commenced with voluntary, purposive, convenience samples of qualified nurses (n = 30), Service Users (N = 10), postgraduate diploma nurses in mental health (N = 25), third year mental health branch students (N = 20) and adult and child student nurses in years 2 and 3 (N = 20) in Focus Groups. Data collection and analysis occurred concomitantly between July 2013 and October 2014, aided by NVivo 10 software and revealed Key Quality Indicators (KQIs) of the social construction of PIN. Construct development included a literature review spanning the last fifteen years, which identified four main themes;1. Nursing's ethics and values.2. Nursing's professional identity and caring.3. Nursing's emotional intelligence.4. Nursing's professionalism.Nurse Match offers an evidence-based enhancement to VBR, for future nurse recruitment locally, nationally and internationally.     

Students’ perceptions of using Problem-Based Learning (PBL) in teaching cognitive communicative disorders

Problem-Based Learning (PBL) is an educational model that is characterized by student-centered learning and classroom discussion using clinically based problems. This study examines students’ perceptions of PBL as an alternative approach of learning in speech-language pathology and investigates if these perceptions change over time as a function of students’ learning experience with PBL. Written reflections by 96 graduate-students in a graduate elective course on cognitive-communicative disorders were analyzed using content analysis. Common words or phrases in each reflection paper were identified, grouped and coded into consistent themes. Percentage changes of these themes across a semester were also followed. A total number of 883 positive and 165 negative comments were identified. Thirteen positive and seven negative themes relative to students’ perception of the inclusion of PBL were yielded. The advantages of PBL were found to outweigh its disadvantages. Moreover, accumulated experience with this approach was found to eliminate some initial perceived drawbacks about PBL. The extra efforts to engage students in interactive discussion as well as higher order critical thinking and knowledge application were acknowledged through student feedback. Future studies should investigate how PBL can be of greater use in other areas in communication sciences and disorders.     

A new clinical complexity model for the Australian Refined Diagnosis Related Groups

BackgroundThe Australian Refined Diagnosis Related Groups (AR-DRG) underwent a major review in 2014 with changes implemented in Version 8.0 of the classification. The core to the changes was the development of a new methodology to estimate the Diagnosis Complexity Level (DCL) and to aggregate the complexity level of individual diagnoses to the complexity of an entire episode, resulting in an Episode Clinical Complexity Score (ECCS). This paper provides an overview of the new methodology and its application in Version 8.0.MethodThe AR-DRG V8.0 refinement project was overseen by a Classifications Clinical Advisory Group and a Diagnosis Related Groups (DRG) Technical Group. Admitted Patient Care National Minimum Dataset and the National Hospital Cost Data Collection were used for complexity modelling and analysis.ResultIn total, Version 8.0 comprised 807 DRGs, including 3 error DRGs. Of the 321 Adjacent DRGs (ADRGs) that had a split, 315 ADRGs used ECCS as the only splitting variable while the remaining 6 ADRGs used splitting variables other than ECCS: 2 used age and 4 used transfer.Discussion and conclusionA new episode clinical complexity (ECC) model was developed and introduced in AR-DRG V8.0, replacing the original model introduced in the 1990s. Clear AR-DRG structure principles were established for revising the system. The new complexity model is conceptually based and statistically derived, and results in an improved relationship with actual variations in resource use due to episode complexity.     

Comparison of Medical Priority Dispatch (MPD) and Criteria Based Dispatch (CBD) relating to cardiac arrest calls

Background

Prompt emergency medical service (EMS) system activation with rapid delivery of pre-hospital treatment is essential for patients suffering out-of-hospital cardiac arrest (OHCA). The two most commonly used dispatch tools are Medical Priority Dispatch (MPD) and Criteria Based Dispatch (CBD). We compared cardiac arrest call processing using these two dispatch tools in two different dispatch centres.

Methods

Observational study of adult EMS confirmed (non-EMS witnessed) OHCA calls during one year in Richmond, USA (MPD) and Oslo, Norway (CBD). Patients receiving CPR prior to call, interrupted calls or calls where the caller did not have access to the patients were excluded from analysis. Dispatch logs, ambulance records and digitalized dispatcher and caller voice recordings were compared.

Results

The MPDS-site processed 182 cardiac arrest calls and the CBD-site 232, of which 100 and 140 calls met the inclusion criteria, respectively. The recognition of cardiac arrest was not different in the MPD and CBD systems; 82% vs. 77% (p = 0.42), and pre-EMS arrival CPR instructions were offered to 81% vs. 74% (p = 0.22) of callers, respectively. Time to ambulance dispatch was median (95% confidence interval) 15 (13, 17) vs. 33 (29, 36) seconds (p < 0.001) and time to chest compression delivery; 4.3 (3.7, 4.9) vs. 3.7 (3.0, 4.1) min for the MPD and CBD systems, respectively (p = 0.05).

Conclusion

Pre-arrival CPR instructions were offered faster and more frequently in the CBD system, but in both systems chest compressions were delayed 3–4 min. Earlier recognition of cardiac arrest and improved CPR instructions may facilitate earlier lay rescuer CPR.