临床医学专业学位研究生培养与住院医师规范化培训的衔接

探讨临床医学专业学位研究生培养与住院医师规范化培训衔接的必要性和可行性,提出从规范考生专业背景、提高复试有效性、修订研究生培养方案、实行开放灵活的教学管理、转变导师选聘和激励机制、优化临床执业医师报考条件等方面,推进二者有效衔接,为全面提高临床医学人才培养质量提供对策。     

Becoming “At Home” in Home Modifications: Professional Reasoning Across the Expertise Continuum

ABSTRACT

Professional reasoning used by occupational therapists in home modifications as they develop from novice to expert was explored in this grounded theory study. Eight occupational therapists participated in multiple interviews and member checks about home modifications training and practice. Formal academic and experiential learning provided the foundation for reasoning systems and habits of practice. As therapists gained expertise, they were able to shift their primary focus from systematic reasoning steps to focus on the comprehensive, client-centered, and contextual picture. Creative educational strategies support confidence in engaging in home modifications practice.     

The effect of the developing role of the maternity support worker on the professional accountability of the midwife

The recent rise in the number of maternity support workers (MSWs) in the United Kingdom (UK) has been welcomed by midwifery managers and supported by social policy surrounding improvements in maternity care. The training and role of the MSW varies considerably. Whilst most training is undertaken through clinical practice, more recent advances in the preparation of MSWs have resulted in them not only being trained to National Vocational Qualification (NVQ) Level 3, but also to foundation certificate or degree level. Consequently some MSWs are performing tasks that would traditionally be undertaken by a midwife, potentially leading to the erosion of the midwife's role in the future. From current evidence, midwives are not fully aware of how the developing role of MSWs may affect their own professional accountability. This paper therefore aims to challenge midwives into reconsidering how MSWs may be effectively incorporated into the midwifery team such that the quality of care is not compromised and the midwife's professional accountability is never put at risk.     

Midwifery in a new context: expanding our reference points and embracing new representations of pregnancy and birth

Objective

to learn the adaptations and transformations that midwives from abroad must go through in order to integrate into the practice of Quebec midwifery, which is founded on a concept of birth akin to the holistic model.

Design

qualitative research achieved through semi-structured interviews with an ethnological approach for data collection and analysis.

Setting

Quebec, Canada.

Participants

11 immigrant midwives practising in Quebec. Interviews were also conducted with midwives from Quebec trained abroad (3) and trained in Quebec (5).

Findings

the greatest challenge for most of the midwives interviewed has been the change of professional culture. Shifting from a technocratic or medical practice model towards a holistic practice model has expanded their points of reference. Medical knowledge has become a type of shared knowledge, with each contributor judged equally important. Nature and humanity now prevail over technology. The woman has become the primary reference source for decision-making. For some midwives of foreign origin, integration into the Quebec practice provided an opportunity to reflect upon or modify their perception of pregnancy. In terms of representations, although most of the midwives interviewed now consider childbirth a life-affirming experience; for others, it represents a potential risk of complications or catastrophes. This apprehensiveness is more significant among midwives who have been trained in a medical model and who come from a country where the medical culture is socially dominant.

Key conclusions

midwives from highly medicalized environments face a greater adjustment when integrating into Quebec's practice culture. They must shift from a ‘risk’ mindset to a ‘confidence’ mindset and develop their trust in the normal process of pregnancy and childbirth. They must acquire a sense of inner security on which they can rely instead of systematically resorting to technological referents. This adjustment of referents and representations is an operative transformation process that is often accompanied by changes in identity.

Implications for practice

to facilitate the integration of immigrant midwives, it is important to consider the professional culture changes they face. If they are to use a holistic practice model, they must engage in introspection. They must reflect on pregnancy and childbirth if they are to consider these events first and foremost as a healthy, integral part of women's lives.     

江门地区职业女性感染高危型人乳头瘤病毒的调查

目的:了解江门地区职业女性高危型人乳头瘤病毒(HPV)的感染状况,为宫颈癌防治提供理论依据。方法:2008年10月～2009年10月期间,采取高危型HPV病毒基因多重荧光PCR检测技术对江门地区1 300名职业女性进行免费检查,并对高危型HPV感染者的年龄阶段、取材生理周期、宫颈情况进行分析。结果:1 300名女性共检出高危型HPV阳性者103例,平均年龄为(39±9)岁,感染率为7.92%;其中20岁～、31岁～、46岁～、61岁～年龄组间,31岁～年龄组的感染率最高9.50%(67/705),它们之间的差异有统计学意义(P<0.05);宫颈情况方面,发生Ⅲ度宫颈糜烂者感染率最高31.58%(12/38),它们之间的差异有统计学意义(P<0.05);高危性HPV感染者取材生理周期的分布中,黄体期、排卵期、卵泡期和绝经期之间的差异没有统计学意义(P>0.05)。结论:江门地区职业女性高危型HPV感染率相对较低,高危型HPV的感染与年龄阶段、宫颈糜烂程度密切相关,应该积极开展高危型HPV的筛查工作,有效降低该人群宫颈癌的发生率和致死率。     

免费师范生学习适应性与一般自我效能感、专业承诺的相关研究

[目的]了解免费师范生的学习适应性现状与其一般自我效能感、专业承诺之间的关系,发现其中存在的问题,提出对策。[方法]采用调查法对570名免费师范生进行测查,进行相关研究。[结果]免费师范生的学习适应性在不同人口学变量上差异显著;其学习适应性与其一般自我效能感、专业承诺及其各维度均存在不同程度的正相关;其一般自我效能感与专业承诺的各维度在不同程度上可直接预测和影响学习适应性水平。[结论]免费师范生的总体学习适应性水平不高,教师应加强对免费师范生的专业思想教育,提升其自我效能感,促进其学习适应性的提高。     

杭州地区医院感染管理专职人员职称晋升调研

目的 了解杭州地区医院感染管理专职人员职称晋升情况.方法 对杭州地区所有二级以上医疗机构进行调查.结果 共调查41所医院、125名医院管理者以及69名医院感染管理专职人员;专职人员初级、中级职称占81.1％、43.5％,专职人员认为职称晋升困难是造成感染控制队伍不稳定的原因之一;79.2％医院管理者及63.8％专职人员认识到无医院感染专业技术职称,已经成为职称晋升的主要困难之一.结论 建立专业的医院感染职称晋升体系,不断提高专职人员整体素质,成为稳定与建设专业队伍的关键.     

医院高级专业技术职务评审工作中存在的问题及建议

医院的高级专业技术职务评审工作是一项涉及面广、涉及人员多、环节多、政策性和专业性很强的工作,所以对高级专业技术职务评审工作中不断出现新情况和新问题要及时发现并加以解决.本文针对医院在高级专业技术职务评审工作中存在的问题进行分析,提出看法及相关建议.     

医护一体化责任制合作模式对提高护士综合护理能力的影响

目的：探讨医护一体化责任制整体护理合作模式对护士床边综合护理能力的影响,使医生、护士、患者更加满意。方法制定出从入院时、住院期间、出院时一整套的医护一体化合作责任制护理模式,采用调查表,对医护人员对医护合作态度得分、床边综合能力考核结果、患者满意度、医生满意度和护士满意度进行问卷调查,同时采集护理质量及不良事件等数据,与实施医护一体化合作责任制护理模式前的调查结果进行比较。结果实施医护一体化合作责任制护理模式前,护士满意度、医生满意度及患者满意度分别为（4．06±0．39）,（4．18±0．41）,（4．03±0．36）分,实施后分别为（4．42±0．41）,（4．38±0．26）,（4．36±0．38）分,较实施前明显提高,差异有统计学意义（t值分别为7．5895,7．0062,3.5418;P＜0．01）。床边综合能力明显提高,差异具有统计学意义（ P＜0．01）;临床效果评分在病情掌握、并发症预防、理论知识、专业护理能力方面实施后分别为（4．81±0．31）,（3．59±0．24）,（3．92±0.44）,（3．91±0．40）分,较实施前的（3．04±0．55）,（2．91±0．31）,（3．29±0．26）,（3．67±0．47）分明显提高,差异有统计学意义（t值分别为30．711,19．000,13．503,4．260;P＜0．01）。结论实施医护一体化合作责任制护理模式,能有效提高护理质量及护士的专业护理能力,降低不良事件的发生率,充分发挥护士的优势,有效地促进医护合作,达到患者满意的目的。