A process evaluation of implementing a vocational enablement protocol for employees with hearing difficulties in clinical practice

Objective: A multidisciplinary vocational rehabilitation programme, the Vocational Enablement Protocol (VEP) was developed to address the specific needs of employees with hearing difficulties. In the current study we evaluated the process of implementing the VEP in audiologic care among employees with hearing impairment. Design: In conjunction with a randomized controlled trial, we collected and analysed data on seven process parameters: recruitment, reach, fidelity, dose delivered, dose received and implemented, satisfaction, and perceived benefit. Study sample: Sixty-six employees with hearing impairment participated in the VEP. The multidisciplinary team providing the VEP comprised six professionals. Results: The professionals performed the VEP according to the protocol. Of the recommendations delivered by the professionals, 31% were perceived as implemented by the employees. Compliance rate was highest for hearing-aid uptake (51%). Both employees and professionals were highly satisfied with the VEP. Participants rated good perceived benefit from it. Conclusions: Our results indicate that the VEP could be a useful treatment for employees with hearing difficulties from a process evaluation perspective. Implementation research in the audiological setting should be encouraged in order to further provide insight into parameters facilitating or hindering successful implementation of an intervention and to improve its quality and efficacy.     

论我国医患冲突成因及和谐关系构建

目前我国医患之间的矛盾与冲突，实质上是新时期我国社会矛盾在卫生工作中的具体表现，反映了社会群体在经济状况、价值取向、角色意识、道德水平、法律法规等多方面的矛盾与冲突。和谐医患关系应是构建我国和谐社会的内容之一。和谐医患关系的构建需要完善的社会医疗保障体系建立、国家卫生行政管理加大、财政补偿合理投入、医疗服务质量提高、医学知识教育普及与提高、媒体理性传播、社会大众道德控制水平提升，法律法规完善等全方位的努力，有赖于医事主体双方及全社会的关注与通力改善。     

Paediatric cardiac arrest and resuscitation provided by physician-staffed emergency care units

Background: Most paediatric cardiac arrest studies have been conducted in the USA, where paramedics provide prehospital emergency care. We wanted to study the outcome of paediatric cardiac arrest patients in an emergency medical system which is based on physician staffed emergency care units.
Methods: We analysed retrospectively the files of 100 prehospital cardiac arrest patients from Southern Finland during a 10-year study period. The patients were less than 16 years of age.
Results: Fifty patients were declared dead on the scene (DOS) without attempted resuscitation, and cardiopulmonary resuscitation (CPR) was initiated in 50 patients. The sudden infant death syndrome was the most common cause of arrest in the DOS patients (68%) as well as in those receiving CPR (36%). Asystole was the initial cardiac rhythm in 70% of the patients in whom CPR was attempted. Resuscitation was successful in 13 patients, 8 of whom were ultimately discharged. Six of the patients survived with mild or no disability and 4 of them had near-drowning aetiology. In multivariate analysis, the short duration of CPR (≤15 min) was the only factor significantly associated with better survival.
Conclusions: Although prehospital care was provided by physicians, the overall rate of survival was found to be equally poor as reported from systems with paramedics. The only major difference between physician- and paramedic-staffed emergency care units is the ability of physicians to refrain from resuscitation already on the scene when prognosis is poor.     

Utility of pulmonary function testing in the management of chronic obstructive pulmonary disease

This study sought to measure the effect of pulmonary function testing (PFT) data on the decisions made by generalist physicians in the management of chronic obstructive pulmonary disease (COPD). 148 physicians were randomly assigned to two groups, both of which were asked to manage two identical fictitious but representative cases of COPD, which included history, physical, x-ray, and laboratory results. The experimental group received PFT results in addition. No significant difference was noted between the two groups in management based on availability of PFT data. The optimum utility of PFT data in the management of COPD may be exaggerated and has yet to be determined. Received from the Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Presented at the Annual Scientific Meeting of the American College of Chest Physicians, October 28, 1992, Chicago, Illinois.     

中医诊治妇科病的经验

重点论述妇女月经周期的生理变化及施治用药规律,介绍崩漏、痛经、闭经的临床诊治用药经验,有一定的参考价值。     

Unemployment and health impairments: Longitudinal analyses for the Federal Republic of Germany

In recent years many studies of unemployment and health haveshown that unemployed persons are in poorer health. However,one question remained unanswered: is the poorer health of theunemployed caused by unemployment Itself (causation hypotheses)or is it a result of selection processes, whereby people inpoor health are more likely to lose their job and less likelyto be re-employed (selection hypothesis)? Findings from a studybased on the longitudinal data of the German Socio-economicPanel (1984–1988, N=5, 516 persons, 18–64 years)are presented. All health indicators (health satisfaction, chronicillness, handicaps in fulfilling daily life tasks, disability)showed poorer outcomes for the unemployed persons, even aftercontrolling for the possible confounding effects of sodo-demographicvariables. Unemployed persons also consulted a physician morefrequently and were hospitalized more often. But longitudinalanalyses (of becoming unemployed and of re-employment) did notlend much support to the causation hypothesis. Instead, a constantlevel of health satisfaction for persons losing their job andfor the re-employed compared to their initial ratings supportedthe selection hypotheses. This means that in the Federal Republicof Germany persons in poorer health are more likely to losetheir jobs and persons in better health are more likely to bere-employed.     

噪声作业人员职业体验研究

采用华西医科大学劳动卫生教研室研制的系统化职业心理测验（ＯＰＴ）软件，对四川第一棉纺织厂织布车间噪声（１０１．２ｄＢ（Ａ））作业女工９８人职业体验进行考察。以ＯＰＴ常模女性工人组为对照（年龄、工龄、文化程度等与观察组同），按标准化ＯＰＴ方法实施测验和统计分析。结果提示噪声作业女工职业体验欠佳，职业满意度、工作生活质量均低于常模。     

钱育寿老中医临证经验拾萃

本文对名老中医钱育寿主任医师以法系病治疗小儿呕吐、厌食、积滞、泄泻等脾胃系疾病;从肝立论治疗小儿百日咳、盘肠气痛、黄疸、疝气;分证论治治疗小儿咳嗽、麻疹、风痧、奶痧、丹痧等出疹性疾病的经验进行探讨。总结了钱老灵活的辨证思想,分析了他独特的用药方法,并结合现代药理研究,介绍了钱老创制的若干疗效卓著的经效方剂。     

The Effect of Presleep Focal Attention Load on Subsequent Sleep Patterns

The hypothesis that a load on focal attention prior to sleep results in subsequent changes in sleep patterns was investigated. Eight females and 2 males slept in the laboratory for 4 nights: 2 adaptation nights, 1 experimental night preceded by a focal attention load, and 1 control night preceded by relaxed activity. On the experimental night, time in bed, total sleep time, and stage REM sleep were significantly longer than on the control night. The results support the hypothesis and suggest that attention during REM sleep has a unique character.