回访5462人次出院患者的护理体会及对临床管理工作的启示

目的探索护理临床管理和患者健康教育工作的新思路。方法统计2011年6月~2013年12月份出院患者回访记录资料,从患者对自我疾病的管理、患者或家属对回访工作的认识、患者对医疗护理工作的意见或建议等三方面进行汇总分析。结果患者对自我疾病的管理方面:能对自身病情进行出院后自我疾病管理者2531人次(占46.3%);执行治疗方案依从性差者有354人次(占6.4%);能定期门诊随访2089人次(占38.2%);日常生活管理差434人次(占7.9%)。患者或家属对回访工作的认识方面:患者或家属对回访的专科护士态度友好,对其健康教育欣然接受,并表示感谢。患者对医疗护理工作的意见或建议方面:医生与患者沟通的时间少。结论专科护士的专业回访受到患者或家属的认可,能增进患者和医护人员之间的信任感,延伸健康教育工作个体化指导,增加患者或家属的被尊重感,有利于临床管理工作的改进。     

科研型实验室在研究型医院研究工作主体人员科研能力培养中的作用探讨

研究型医院在医疗卫生事业的临床诊疗水平、科研、教学工作中起到引领作用。其科研的主体为临床医生和专业型研究生,科研能力的培养对于研究型医院主体工作人员具有重要意义。科研型实验室是医学院校及其教学医院培养研究生和临床医生科研创新能力和开展科学研究的平台基地之一。就科研型实验室在临床专业型研究生和临床医生继续教育中科研能力培养的补充作用进行讨论,探讨科研型实验室如何通过搭建有利于医学专业型研究生和临床医生的开展科研工作的平台、促进专业型研究生和临床医生科研能力的培养和提高以及加强研究生和临床医生科研中合作意识,进而对临床医生和专业型研究生科研能力培养起到积极作用。     

Pain assessment and management in the NICU: analysis of an educational intervention for health professionals

Objectiveto study the perception of a Neonatal Intensive Care team on pain assessment and management before and after an educational intervention created and implemented in the unit.Methodsintervention study developed as action research, in three phases. In Phase 1, a quantitative study was performed to identify how professionals perceive pain management in the unit. In Phase 2, an educational intervention was carried out, using the Operational Group (OG), which defined strategies to be adopted to seek improvements in pain assessment and management. In Phase 3, the initial questionnaire was reapplied to assess professionals’ perceptions about the subject after the intervention. All professionals directly working in newborn care were included.Resultsthe perception of professionals about pain management and assessment in the unit showed a statistically significant difference between the two phases of research, highlighting the increase in frequency of reference for evaluation and use of some method of pain relief procedures for most analyzed procedures. Participation in training (one of the strategies defined by the operational group) was reported by 86.4% of the professionals. They reported the use of scales for pain assessment, established by the protocol adopted in the service after the intervention, with a frequency of 94.4%. Changes in pain assessment and management were perceived by 79.6% of the participants.Conclusionthe professionals involved in the educational intervention observed changes in pain management in the unit and related them to the strategies defined and implemented by the OG.     

家庭医生职业认同状况及社会弹性对其影响研究

背景　近年来,医生离职事件屡见不鲜,而家庭医生作为社区的健康管家,若产生离职意愿不仅影响其职业发展,更不利于实施全民健康规划。目前,国内的家庭医生主要由基层全科医生担任,在自身工作外还需提供上门服务,更容易使家庭医生产生职业倦怠。如何避免家庭医生离职,增强其职业认同是关键所在。目的　探讨社会弹性对家庭医生职业认同的影响,以期提高家庭医生的职业认同,促使家庭医生制度可持续推进,为基层患者提供更优质的医疗服务。方法　2018年10月-2019年6月,采用分层多阶段随机抽样的方法,以浙江省行政区分类作为分层的依据,根据经济发展程度,选取杭州、宁波、温州、金华、湖州、舟山、台州、丽水8个城市,再根据基层卫生院的发展状况抽取321个卫生院,选取其中的2 500名家庭医生进行问卷调查,调查内容包括一般资料及《家庭医生职业认同调查表》。通过多元逐步线性回归,分析社会弹性与家庭医生职业认同各维度间的关系。结果　共发放问卷2 500份,收回2 319份,有效问卷2 261份,有效回收率为90.44%。家庭医生职业认同总分（3.6±0.7）分,职业期望维度得分（3.0±1.0）分,职业归属维度得分（3.4±1.3）分,职业价值观维度得分（4.1±1.2）分,职业认知维度得分（3.5±1.0）分,职业行为维度得分（4.1±1.1）分。多元逐步线性回归结果显示,创新能力、心理弹性、社区包容、机会平等、社会支持是家庭医生职业认同的影响因素（P<0.05）,创新能力、机会平等是家庭医生职业期望的影响因素（P<0.05）,创新能力、心理弹性、社区包容、机会平等、社会支持是家庭医生职业归属的影响因素（P<0.05）,心理弹性、社区包容、机会平等、社会支持是家庭医生职业价值观的影响因素（P<0.05）,创新能力、社区包容、社会支持是家庭医生职业认知的影响因素（P<0.05）,创新能力、心理弹性、社区包容是家庭医生职业行为的影响因素（P<0.05）。结论　浙江省家庭医生的职业认同感总体水平处于中等偏上,仍有提升空间。社会弹性中的创新能力、心理弹性、社区包容、机会平等、社会支持均能影响家庭医生的职业认同感,其中机会平等是影响家庭医生职业认同的首要因素。     

叙事教学法在培训新入产房助产士助产职业能力的应用

目的 探讨叙事教学法在培训新入产房助产士助产职业能力的应用效果。方法 选取2016年5月～2019年8月入我院工作的30名新入产房助产士,按照不同的教学方法分为观察组和对照组,每组15人;观察组采用叙事教学法,对照组采用传统教学法。教学结束后对两组助产士进行妇产科学教材理论知识,实践考核成绩,产妇对两组助产士满意度及投诉情况,助产士对教学法的效果评价和教师对助产士综合能力评价调查。结果 观察组的理论知识和实践综合考核高于对照组,差异有统计学意义(P0.05);观察组产妇对助产士满意度高于对照组,投诉情况低于对照组,差异有统计学意义(P0.05);观察组带教老师对助产士综合能力评价高于对照组,差异有统计学意义(P0.05);观察组剖宫产、产后出血、新生儿窒息低于对照组,差异有统计学意义(P0.05)。结论叙事教学法有助于培养助产士对妇产科学理论知识及操作的学习积极性,提高助产士的理论知识和助产技能,提升了专科职业能力。     

翻转课堂教学对大学生专业性求助态度影响的实证研究

目的探讨翻转课堂教学对大学生心理求助态度的影响。方法采用小规模限制性在线课程和体验式教学相结合的方式开展心理健康课程。在课程开始之前与结束之后,以寻求专业性心理帮助态度的量表(郝志红2007年修订版)与寻求专业心理求助的自我污名量表(Vogel等编制)为工具,对随机选取的258名被试的求助态度与自我污名进行测量。采用SPSS 22.0、应用配对样本t检验统计与分析相关数据。结果回收有效量表242份。其统计结果表明,翻转课堂减轻了自我污名(t=2.067,P=0.040),提升了学生的专业性心理求助意愿(t=2.438,P=0.015)。课程开始之前,高投入组学生与低投入组学生的求助态度(t=0.515,P=0.607)与自我污名(t=0.432,P=0.666)得分差异无统计学意义;课程结束后,高投入组学生求助态度得分显著高于低投入组(t=2.401,P=0.018),高投入组学生自我污名得分低于低投入组(t=2.185,P=0.031)。结论翻转课堂教学有助于减轻自我污名评价,让学生形成更加积极的求助态度。在知识学习、自我表露、自我反思层面投入度越高的学生,其态度转变越为明显。     

Perceived Roles and Collaboration Between Neuropsychologists and Speech-Language Pathologists in Rehabilitation

The purpose of the current study was to determine perceptions of neuropsychologists (NPs) and speech-language pathologists (SLPs) regarding each other's roles in the rehabilitation setting, and to assess the type and extent of collaborations. Participants were 311 SLPs and 77 NPs working in a rehabilitation setting. Results indicated a great deal of overlap between the roles of SLPs and NPs. While there was much agreement about roles, misperceptions were evident with regard to some of the domains of assessment and treatment. A need for increased collaboration on planning assessments and treatment was evident. The results suggest the need for training of both disciplines in interdisciplinary collaboration and in roles of rehabilitation team members.     

国内外非酒精性脂肪性肝病诊疗指南的异同

随着肥胖和代谢综合征的流行,非酒精性脂肪性肝病(NAFLD)现已成为欧美发达国家慢性肝病的首要病因.NAFLD患者全因死亡率增高,NAFLD/单纯性脂肪肝(NAFL)/非酒精性脂肪性肝炎(NASH)患者首要死因为心血管疾病,肝病死亡率增高见于NASH患者,近10余年来欧美发达国家因NASH而接受肝移植患者的比例逐年增加.为了规范内科医师和预防保健人员NAFLD的诊治,美国肝病学会、胃肠病学院和胃肠病学会共同起草了《非酒精性脂肪性肝病诊疗指南》.     

A qualitative study of Korean music therapist's turnover experiences

Nine Korean music therapists’ turnover experiences were examined using consensual qualitative research. Five domains and 24 categories were created from the cross-analysis of the data. The domains of this study were: (a) factors contributing to turnover; (b) burnout; (c) turnover procedure; (d) changes after turnover; and (e) factors contributing to retention. Based on the frequency label of each category, three types of categories were generated: general (8–9 cases), typical (5–7 cases), and variant (2–3 cases). The result showed that the lack of recognition for music therapy among administrators, supervisors, and peer therapists contributed to music therapists’ turnover decision. However, it was found that these participants had a strong sense of professionalism, which was expressed through their work, regardless of the various challenges posed by environmental conditions. In fact, financial sources such as work conditions and salary were only categorized as variant whereas the professional incentives were identified generally across participants in this study.