病案管理如何应对医、教、研发展

本文着重讨论了病案管理如何促进医疗、教学、科研的发展。病案管理人员在为医、教、研服务的过程中,要不断更新自己的知识水平,提高自身素质。运用高新技术,采用科学的病案管理模式。变被动为主动,及时、有效、准确地为医、教、研提供最有价值的资料、数据。同时实现自身价值和病案价值。     

潍坊市卫生检验人员现状调查分析

目的 调研潍坊市卫生检验人员现状，为疾病预防控制机构中该类人员的合理配置提供参考。方法 对2004年在岗卫生检验人员从年龄、学历、职称、从事卫生检验工作年限及性别构成方面进行对比分析，探讨各因素问存在的差异及对整体状况的影响。结果 在岗卫生检验人员137人，占卫生技术人员的17．34％；男性卫生检验人员仅为46人，占33．58％；从事卫生检验5a以下人员比例较低；无学历人员偏多；卫生检验人员业务技术职称明显低于监督人员，尤其高级职称人员明显不足。结论 应增加卫生检验人员数量，合理调控卫生检验人员学历、性别和业务技术职称比例，提高人员整体素质。     

关于《针灸学》教学中几个常见问题的讨论

笔者结合多年来在<针灸学>教学及临床中的心得、体会,就教材的编排、针刺操作时的指力、快速进针法、重插轻提、轻插重提、守气、穴位针刺深度等方面进行了讨论,以期初学者在<针灸学>的学习过程中,对有关知识的掌握有所帮助.     

基于常规和三元整合教育方案对超低出生体重儿住院期间父母焦虑抑郁影响的历史对照研究

目的 评价专业人员-父母-住院早产儿三元整合教育方案(三元整合教育方案)在超低出生体重早产儿(ELBW)中的临床应用效果。方法 选取复旦大学附属儿科医院2个年度ELBW的连续样本,对照组常规护理教育方案,实验组三元整合教育方案,采用贝克焦虑量表 (BAI)和贝克抑郁量表第2版(BDI-Ⅱ)作为评价焦虑和抑郁的工具,比较不同教育方案父母的焦虑、抑郁程度的差别和父母入院时和出院前焦虑、抑郁水平。结果 实验组79对父母、对照组64对父母进入本文分析。实验组ELBW平均孕周小于对照组,试管婴儿比例高于对照组,机械通气时间长于对照组,但住院时间并不长于对照组,母乳喂养率也较对照组明显增高,差异均有统计学意义。入院时实验组和对照组BAI粗分[(18.9±9.8)vs (17.1±10.2)]和BDI-Ⅱ评分[(17.2±8.8)vs (16.0±9.0)],中重度焦虑[(37/128) vs (36/158)]和中重度抑郁的例数[(38/128) vs (51/158)],差异均无统计学意义;实验组和对照组出院时较入院时BAI粗分下降了(11.0±6.5)分和(8.5±2.3)分,BDI-Ⅱ评分下降了(11.3±8.1)分和(9.1±7.9)分,中重度焦虑和中重度抑郁的例数均有明显下降,差异均有统计学意义;实验组焦虑和抑郁评分改善值好于对照组,差异有统计学意义。入院时父亲焦虑和抑郁评分均较高于母亲,差异均有统计学意义。结论 三元整合教育方案明显降低了ELBW父母焦虑、抑郁的水平,在单中心的历史对照研究中得到较好的验证。     

‘Sometimes your safety goes a bit by the wayside’ … exploring occupational health and safety (OHS) with student nurses

Because nursing is a high risk profession in terms of occupational health and safety (OHS), the topic of OHS is an important component of student nurse education and practice. Seeking ways to enhance curricular content and foster student health, safety and wellbeing is an ongoing pursuit. This pilot study explored nursing student perspectives about OHS in the clinical setting to develop an understanding of student views that could enlighten teaching about this topic within the undergraduate nursing course. Focus groups were held with pre-registration student nurses in two discrete cohort levels (first and third year). Themes were identified from the focus group discussion about trust, knowledge and responsibility. The students demonstrated a sound grasp of clinical hazards and associated administrative controls. Strengthening student awareness of higher order controls and their evaluation would augment their knowledge of legislative requirements. Students may benefit from learning about a risk management approach to OHS which would provide them with a structured basis for problem solving. This may assist them with clinical reasoning about health and safety issues and empower them in aspects of self-care.     

Maternal education level and low birth weight: a meta-analysis

ObjectiveTo assess the association between maternal education level and birth weight, considering the circumstances in which the excess use of technology in healthcare, as well as the scarcity of these resources, may result in similar outcomes.MethodsA meta-analysis of cohort and cross-sectional studies was performed; the studies were selected by systematic review in the MEDLINE database using the following Key**words socioeconomic factors, infant, low birth weight, cohort studies, cross-sectional studies. The summary measures of effect were obtained by random effect model, and its results were obtained through forest plot graphs. The publication bias was assessed by Egger's test, and the Newcastle-Ottawa scale was used to assess study quality.ResultsThe initial search found 729 articles. Of these, 594 were excluded after reading the title and abstract; 21, after consensus meetings among the three reviewers; 102, after reading the full text; and three for not having the proper outcome. Of the nine final articles, 88.8% had quality ≥ six stars (Newcastle-Ottawa Scale), showing good quality studies. The heterogeneity of the articles was considered moderate. High maternal education showed a 33% protective effect against low birth weight, whereas medium degree of education showed no significant protection when compared to low maternal education.ConclusionsThe hypothesis of similarity between the extreme degrees of social distribution, translated by maternal education level in relation to the proportion of low birth weight, was not confirmed.     

Transport Mobility for Children and Adolescents with Cerebral Palsy (CP)

Background: The transport mobility of children and adolescents with cerebral palsy (CP) is of vital interest for the individual, as well as for society. Enhanced transport mobility can be related to improved functional health status and a higher degree of autonomy, which in turn may reduce the demand for societal support. UN Resolution 48/96, together with Swedish legislation and ''Vision Zero'' have in different ways established that the transport system must be designed to meet also the needs of children and adolescents with disabilities. Hence, it is necessary to identify and eliminate obstacles hindering children and adolescents with CP from using public transport and other means of transport, such as their own cars, at the same level as other members of society. However, in the case of children and adolescents with CP, the transport situation and the learner driver's educational situation have so far been largely unknown. Aim: The general aim of the thesis was to describe and analyse, from a legislative and a public health perspective, the transport mobility situation for children and adolescents with CP. Furthermore, the general aim was to identify obstacles for the target group to use public transport and other means of transportation, at the same level as other members of the society, and to suggest improvements that will remove the identified obstacles. Material and methods: Several different data collection methods were used. Data, concerning travel habits and parents' perceived risks regarding transportation, were taken from a postal questionnaire addressed to parents of children and adolescents with CP. In order to estimate the numbers of potential learner drivers with CP in each age group in Sweden, a literature review was conducted, based on Swedish material. Furthermore, logbooks for learner drivers with CP were analysed retrospectively, in order to identify procedures, problems and key tasks in their driver education. Visual search strategies for learner drivers with CP were analysed, utilizing an eye tracker, and an attempt was made to introduce a screening tool for predicting the outcome of driver education. Results: Children and adolescents with CP were found to be transported under unsafe conditions, causing worry among their parents. When transporting children in the family vehicle, the parents were exposed to a very heavy burden, which increased their worry. The prevalence of potential learner drivers with CP who were in need of highly specialised driver education, including individually adapted driver training vehicles, was estimated to be 0.15 per 1,000 of a population-based age group of learner drivers in Sweden. Complex procedures, structural problems and financial obstacles made it difficult for adolescents with CP to obtain a driving licence and an adapted vehicle. The total duration of the driving tuition given by a driving instructor was found to be almost nine times higher for learner drivers with CP than for non-disabled learner drivers. Visual search strategies among learner drivers with CP were found to be less flexible than among other learner drivers. This fact indicated a need for better methods of teaching such strategies to this group as an integral component of their driver education. The validity of the motor-free visual perceptual test, TVPS-UL, for predicting the outcome of driver education for learner drivers, was found to be low. In order to find a reliable and valid screening tool for this purpose, future studies should focus on cross-validation of visual perceptual and dual task performance tests for different types of independent variables, such as obtaining a driving licence or not, accident involvement and driving ability. Conclusion: The transport system was found, from a legislative and public health perspective, to be unsuitable to meet the needs of children and adolescents with CP. Suggestions for improving transport mobility for children and adolescents with CP are provided. Several of these suggestions are practical, concrete and contextual for Swedish conditions, and some of them necessitate future research. However, a number of these suggestions are also applicable in an international context.     

Evaluating the impact of a pharmacist-led prescribing feedback intervention on prescribing errors in a hospital setting

BackgroundPrescribing errors are prevalent in hospital settings with provision of feedback recommended to support prescribing of doctors. Feedback on prescribing has been described as feasible and valued but limited by doctors, with pharmacists described as credible facilitators of prescribing feedback. Evidence supporting prescribing feedback has been limited to date. A formalised programme of pharmacist-led prescribing error feedback was designed and implemented to support prescribers.ObjectiveTo evaluate the impact of a prescribing feedback intervention on prescribing error rates and frequency of prescribing error severity and type.MethodProspective prescribing audits were undertaken across sixteen hospital wards in a UK teaching hospital over a five day period with 36 prescribers in the intervention group and 41 in the control group. The intervention group received pharmacist-led, individualised constructive feedback on their prescribing, whilst the control group continued with existing practice. Prescribing was re-audited after three months. Prescribing errors were classified by type and severity and data were analysed using relevant statistical tests.ResultsA total of 5191 prescribed medications were audited at baseline and 5122 post-intervention. There was a mean prescribing error rate of 25.0% (SD 16.8, 95% CI 19.3 to 30.7) at baseline and 6.7% (SD 9.0, 95% CI 3.7 to 9.8) post-intervention for the intervention group, and 19.7% (SD 14.5, 95% CI 15.2 to 24.3) at baseline and 25.1% (SD 17.0, 95% CI 19.8 to 30.6) post-intervention for the control group with a significant overall change in prescribing error rates between groups of 23.7% (SD 3.5, 95% CI, ?30.6 to ?16.8), t(75) = ?6.9, p < 0.05. The frequency of each error type and severity rating was reduced in the intervention group, whilst the error frequency of some error types and severity increased in the control group.ConclusionPharmacist-led prescribing feedback has the potential to reduce prescribing errors and improve prescribing outcomes and patient safety.     

Undergraduate nursing education reform in France: from vocational to academic programmes

DEBOUT C., CHEVALLIER‐DARCHEN F., PETIT DIT DARIEL O. & ROTHAN‐TONDEUR M. (2012) Undergraduate nursing education reform in France: from vocational to academic programmes. International Nursing Review Background: France is currently implementing a number of reforms to the healthcare and education systems. Within this context, a comprehensive reform of undergraduate nurse education was launched in 2009, bringing nurse education closer to the higher education environment. It is likely in future to move from being vocational towards becoming an academic educational programme. Aim: In this paper, the 2009 reform of the French pre‐registration nursing curriculum will be analysed in light of the European framework. Process: The pedagogical approach, methods and content of nursing education in France are undergoing an in‐depth reorganization. The main innovation that the reforms introduce is a competency‐based approach. France is joining the group of countries that require first degree‐level entry to the nursing profession. Conclusion: There are still many unanswered questions regarding the competencies and qualifications required by both the academic and clinical educators many of whom have not been previously involved in research or publications. The future status of nursing science is unclear, as is the way in which the nursing profession will be able to retain control over its educational mechanisms.     

The TEACCH program for children and adults with autism: A meta-analysis of intervention studies

The intervention program for autism known as Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) is considered an emerging practice for autism. In the present study we used state-of-the-art meta-analytical procedures to examine the pooled clinical effects of TEACCH in a variety of outcomes. A total of 13 studies were selected for meta-analysis totaling 172 individuals with autism exposed to TEACCH. Standardized measures of perceptual, motor, adaptive, verbal and cognitive skills were identified as treatment outcomes. We used inverse-variance weighted random effects meta-analysis supplemented with quality assessment, sensitivity analysis, meta-regression, and heterogeneity and publication bias tests. The results suggested that TEACCH effects on perceptual, motor, verbal and cognitive skills were of small magnitude in the meta-analyzed studies. Effects over adaptive behavioral repertoires including communication, activities of daily living, and motor functioning were within the negligible to small range. There were moderate to large gains in social behavior and maladaptive behavior. The effects of the TEACCH program were not moderated by aspects of the intervention such as duration (total weeks), intensity (hours per week), and setting (home-based vs. center-based). While the present meta-analysis provided limited support for the TEACCH program as a comprehensive intervention, our results should be considered exploratory owing to the limited pool of studies available.