医院开展慢性病患者健康教育效果评价

目的了解患者对慢性病防治知识掌握情况、行为改变和因高血压、糖尿病及并发症再次入院情况,评价临床医生健康教育的效果。方法对2011—2012年入住河北省邯郸市第四医院内科的所有高血压、糖尿病及并发症患者1728例,按照简单随机化分组方法分为干预组(838例)和对照组(890例),干预组在治疗的同时强化慢性病防治知识健康教育,对照组不作要求。患者出院后2年内以问卷调查的形式进行回访调查,了解2组患者临床指征、行为改变及慢性病防治知识掌握情况。结果干预前,2组患者在性别、年龄和疾病构成,以及接受健康教育方面均无差异(P0.05)。干预后,干预组患者慢性病防治知识知晓率均在97.1%以上,对照组为45.7%~99.4%(P0.01);干预组患者吸烟、饮酒减少比例分别为27.4%和25.7%,对照组则为20.8%和19.8%;干预组患者在合理膳食、控制体重和适量运动方面分别达到37.9%、83.8%和62.6%,对照组分别为14.3%、65.2%和37.3%,干预组行为改变高于对照组(P0.05);干预组患者临床指标基本正常比例为72.8%、再入院比例9.7%,对照组则分别为61.0%和16.0%(P0.01)。结论临床医生在治疗的同时开展健康教育,患者更易于接受并付诸行动,提高了慢性病的疗效,从而取得更好的健康教育效果。     

Risk perceptions,sexual attitudes,and sexual behavior after HPV vaccination in 11–12 year-old girls

ObjectivesAmong 11–12 year-old girls who received the human papillomavirus (HPV) vaccine, we explored, over the subsequent 30 months: (1) trajectories of knowledge about HPV/HPV vaccines and vaccine-related risk perceptions; (2) whether knowledge and risk perceptions impacted sexual attitudes and sexual experience; (3) whether mothers, clinicians, and media influenced girls’ risk perceptions, attitudes, and behavior.MethodsGirls and mothers (n = 25 dyads) completed separate, semi-structured interviews within 2 days of, and 6, 18, and 30 months after, their first HPV vaccine dose. Knowledge, risk perceptions related to HPV and other sexually transmitted infections (STIs), and attitudes about sexual behaviors were assessed. Sexual experience was assessed at girls’ 30 month interviews. Clinicians completed interviews at baseline. Transcribed interviews were analyzed using framework analysis.ResultsGirls’ baseline knowledge was poor but often improved with time. Most girls (n = 18) developed accurate risk perceptions about HPV but only half (n = 12) developed accurate risk perceptions about other STIs by 30 months. The vast majority of girls thought that safer sex was still important, regardless of knowledge, risk perceptions, or sexual experience. Girls whose HPV knowledge was high at baseline or increased over time tended to articulate accurate risk perceptions; those who were able to articulate accurate risk perceptions tended to report not having initiated sexual activity. Girls whose mothers demonstrated higher knowledge and/or communication about HPV vaccination tended to articulate accurate risk perceptions, whereas clinicians and media exposure did not appear to influence risk perceptions.ConclusionsHigher knowledge about HPV vaccines among mothers and girls was linked with more accurate risk perceptions among girls. Clinicians may play an important role in providing education about HPV vaccines to mothers and girls.     

Obstacles to 12-step group participation as seen by addiction professionals: Comparing Norway to the United States

Twelve-step groups (TSGs) are a valuable recovery resource for substance-dependent individuals. However, some aspects of these fellowships are controversial and may limit clinician referrals. This study describes attitude- and knowledge-based barriers to TSG participation as seen by addiction professionals in Norway, a treatment culture in which less than 5% of programs use the 12-step philosophy, and compares the findings with those of a similar study in the United States. Data were collected in Norway in mid-2008 using a self-administered questionnaire, and the U.S. sample was obtained from historical data. The Norwegian professionals (n = 291) considered the religious aspects of TSGs a considerable obstacle to participation, whereas the U.S. providers (n = 100) did not. Treatment providers unfamiliar with the 12-step philosophy need to be better informed of TSGs' “higher power” concept to educate patients and maximize the utilization of TSGs.     

查阅手术相关记录对手术分类正确率的影响

文章通过手术分类工作中几种情况的实例分析,如：手术名称须使用一组编码来表明;手术名称与实际术式不符;手术名称不完整;手术名称笼统等方面,阐明手术分类的编码原则与临床医师书写手术操作名称存在一些差异.为确保编码的准确性要培训临床医师认识到规范手术操作名称的书写的重要性,同时编码人员在工作中养成查阅手术相关记录的习惯,保持与临床的良好沟通,不断积累丰富的工作经验,从而保证病案信息资料更好地为医院管理等各方面服务.     

临床医师对循证医学的认知及应用情况调查

对山西省6所三甲医院373名临床医师进行匿名问卷调查及抽样访谈,结果显示不同职称临床医师对循证医学认知和应用情况有所不同,随职称升高情况有所好转,但仍存在不足。基于此探讨相应对策,即多途径、多方式普及循证医学知识,培养临床循证医学思维,促进其临床实践。     

临床医师对临床监察员满意度调查分析

目的 探讨临床医师对临床监察员(CRA)的满意度及其影响因素,对CRA的教育提出合理化建议.方法 从5所三级甲等医院参加过临床试验的临床医师中随机抽取160名进行问卷调查,调查问卷采用李克特量表(Likert scale)5点测量法,内容包括4个层面12个维度,即工作态度、专业知识和能力、沟通协调能力、项目管理能力.利用SPSS 15.0软件进行数据处理和统计分析.用列联表的x2分析调查对象的属性特征与其对CRA总体满意度的关联性.结果 12项指标均值在2.28～3.75,总体满意度不高.其中,对CRA的服务意识、试验方案熟悉程度和CRF填写方面的满意度最高,分别为74.04％、61.70％,其余10项指标的满意度均＜50.00％.卡方分析结果显示,性别、学历、职称与总体满意度没有关联;参加过和未参加过培训的人员的总体满意度存在差异(P＜0.05),参与试验数量不同的人员之间总体满意度也存在显著差异(P＜0.01).结论 临床医师对CRA的总体满意度不高,通过加强CRA的培训、建立CRA职业资格准人制度和加强临床医生对临床试验的重视和临床试验的能力以规范临床试验行业发展,提高我国的临床试验水平.     

Reports

This paper proposes the clinical setting as an ideal learning environment for the development of skills conducive to collaborative practice. The argument is supported by findings from a small evaluation study. One cohort of physiotherapy students (n = 43) were surveyed immediately prior to their graduation in 1997, regarding their experience of the availability and quality of interprofessional learning opportunities in the various clinical placement areas, that comprised the final and intensive component of their clinical education programme. Their perception of interprofessional learning processes and outcomes was explored and their views as to factors that facilitated or inhibited their learning elicited. Interprofessional learning opportunities were available across the practice spectrum with a slightly more positive 'snapshot' of collaborative practice in the acute sector depicted. Case conferences, team meetings, ward rounds and discharge planning were confirmed as important interprofessional learning activities. Innovative methods of promoting collaborative practice and prerequisite skills, used currently by therapists, acting as clinical educators, emerged as potential strategies for interprofessional clinical education. The importance of the educational skill and orientation of the clinical educator in nurturing team skills development in students was highlighted.     

北京市某医院临床医生心理压力现状研究

目的：了解医生心理压力现状,探索医生心理压力相关因素及压力来源。方法采用自编基本信息采集问卷、压力评价问卷的组合问卷,对北京市某家三甲医院231名医生进行调查访问。结果不同科室医生压力水平差异具有统计学意义(P <0.05),并受年龄、收入、家庭情况、睡眠质量等基本因素的影响。医生心理压力主要来自于人际社交、家庭问题、工作问题、社会环境、科研学习等多个方面,不同科室、不同性别的医生心理压力主要来源有差别。结论医生心理压力较大,并因其科室分工、薪金收入、家庭环境等不同而在压力水平和压力来源等方面呈现差异。