基于危机管理理论的H7N9型禽流感等公共健康危机事件应对探讨

各类公共健康危机事件频发引发人们对其如何应对的探讨，危机管理理论为其提供了科学有效的理论依据，公共健康危机事件应对可以从危机的预防、准备、确认、控制、解决和总结6个方面开展。当前的实际工作中，应该重点加强危机的预防和危机事件应对总结。     

Development of a new tool for predicting the behavior of individuals with intellectual disability in the dental office: A pilot study

BackgroundThe dental treatment of individuals with intellectual disability can represent a considerable professional challenge.ObjectiveTo develop a model for predicting the behavior of patients with intellectual disability in the dental office.MethodsThe study group comprised 250 patients with Down syndrome (DS), autism spectrum disorder (ASD), cerebral palsy (CP), idiopathic cognitive impairment or rare disorders. We collected their demographic, medical, social and behavioral information and identified potential predictors (chi-squared test). We developed stratified models (Akaike information criterion) to anticipate the patients'behavior during intraoral examinations and to discern whether the dental treatment should be performed under general anesthesia. These models were validated in a new study group consisting of 80 patients. Goodness of fit was quantified with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUC). We developed a mathematical algorithm for executing the models and developed software for its practical implementation (PREdictors of BEhavior in Dentistry, “PREBED”).ResultsFor patients with DS, ASD and CP, the model predicting the need for physical restraint during examination achieved a PPV of 0.90, 0.85 and 1.00, respectively, and an NPV of 0.66, 0.76 and 1.00, respectively. The model predicting the need for performing treatment under general anesthesia achieved a PPV of 0.63, 1.00 and 1.00, respectively, and an NPV of 1.00, 1.00 and 0.73, respectively. However, when validating the stratified models, the percentage of poorly classified individuals (false negatives + false positives) ranged from 24% to 46.6%.ConclusionsThe results of the PREBED tool open the door to establishing new models implementing other potentially predictive variables.     

主动脉夹层术后患者心理状况及躯体症状对生活质量的影响

目的 探讨主动脉夹层术后患者心理状况、躯体症状对其生活质量的影响及作用机制，为制订干预计划提供参考。方法 采用广泛性焦虑障碍量表、患者健康问卷抑郁量表、躯体症状量表、12项简明健康状况调查表对327例主动脉夹层术后患者进行调查，根据相关性分析结果提出假设，应用AMOS软件进行结构方程模型分析。结果 主动脉夹层术后患者生活质量得分（81.56±7.36）分，焦虑得分2.00(0, 3.00)分，抑郁得分2.00(0, 3.00)分，躯体症状得分5.00(2.00, 8.00)分；焦虑、抑郁、躯体症状对生活质量有直接影响，焦虑、抑郁通过躯体症状对生活质量有间接影响（均P<0.05）。结论 主动脉夹层术后患者生活质量处于中等偏上水平，应早期对主动脉夹层术后患者的心理状况与躯体症状进行动态评估与监测，及时进行心理干预和症状管理，以改善其生活质量。     

The effects of physical environments in medical wards on medication communication processes affecting patient safety

Physical environments of clinical settings play an important role in health communication processes. Effective medication management requires seamless communication among health professionals of different disciplines. This paper explores how physical environments affect communication processes for managing medications and patient safety in acute care hospital settings. Findings highlighted the impact of environmental interruptions on communication processes about medications. In response to frequent interruptions and limited space within working environments, nurses, doctors and pharmacists developed adaptive practices in the local clinical context. Communication difficulties were associated with the ward physical layout, the controlled drug key and the medication retrieving device. Health professionals should be provided with opportunities to discuss the effects of ward environments on medication communication processes and how this impacts medication safety. Hospital administrators and architects need to consider health professionals' views and experiences when designing hospital spaces.     

Effects of Terrorist Charges and Threatening Conduct on Mock Jurors’ Decisions

Terror management theory posits that fear of death influences judgments in criminal cases. A between-subjects study examined the influence of mortality and terrorism salience in the context of life-threatening versus non-threatening criminal conduct on mock jurors’ emotions and judgments of convictions by 485 jury-eligible Australian citizens. Mortality salience did not impact upon mock jurors’ judgments, indicating that exposure to a criminal trial mitigated the effect. The participants reported more negative emotions with a suspect charged with a terrorism than non-terrorism crime, independently of criminal conduct. Mock jurors were more likely to convict a suspected terrorist (66.4%) than a defendant charged with murder when the criminal conduct entailed throwing a paint bomb (54.0%). When the actus reus was life-threatening, they were more likely to convict a defendant charged with intent to murder (81.5%) than with a terrorist crime (69.7%). The findings indicated that jurors can be influenced by numerous factors at court, including fear of death.     

隐性思想政治教育在医务工作规范化管理中的重要作用

隐性思想政治教育具有方式的多样性、过程的隐蔽性、内容的丰富性等特征，从而可以在医务工作规范化管理中发挥极其重要的作用，实践中要从明确职责、整合力量、加大投入、科学规划等方面着手促进这种作用的发挥。     

The Transformation of Diabetes Care Through the Use of Person-Centered Data

The health care industry is undergoing a major transformation. Despite spending more on health care than any other country, the United States has not seen a commensurate improvement in the quality of care. Chronic disease management puts the greatest burden on the health care system with estimates suggesting that 3 of 4 health care dollars are spent on managing chronic disease. Moreover, the number of older patients with chronic conditions, like diabetes, is rising as expected, which only serves to worsen the physician shortage problem we are currently experiencing, and further increase health care costs. Unless new models of health care are established for these patients, they simply will not be served. Consistent with the message above, there are generally 3 universal health care needs, (1) improved outcomes, (2) expanded access, and (3) optimized cost and efficiency. It is likely the future state will involve value-based health care, with payment based on outcomes, not services rendered, and incentives tied more directly to the value delivered. Medical device providers will be held more accountable for positive outcomes, and to ensure success, they will need to create better solutions with their therapies. Instead of the touch point with patients being solely at the time of a procedure or sale of the device, it is likely companies will need to drive toward a more comprehensive partnership with patients, providers, and payers, extending the scope of services and interactions to provide a continuum of care. In general, companies will need to start to think of their most important customers as people living with a condition, as opposed to patients needing immediate medical devices. In this article, I discuss the challenges of health care today and present some of the opportunities to revamp health care delivery in diabetes by leveraging the pervasive use of mobile technologies and digital data.