Care work in changing welfare states: Nordic care workers’ experiences

This article focuses on Nordic eldercare workers and their experiences of working conditions in times of change and reorganisation. In recent years New Public Management-inspired ideas have been introduced to increase efficiency and productivity in welfare services. These reforms have also had an impact on day-to-day care work, which has become increasingly standardized and set out in detailed contracts, leading to time-pressure and an undermining of care workers’ professional discretion and autonomy. The empirical data comes from a survey of unionised eldercare workers in home care and residential care in Denmark, Finland, Norway and Sweden (N = 2583) and was analysed by bi- and multi-variate methods. The care workers reported that they found their working conditions physically and mentally arduous. They had to a great extent experienced changes for the worse in terms of working conditions and in their opportunity to provide good quality care. In addition, the majority felt they did not receive support from their managers. An alarming finding was that one out of three care workers declared that they had seriously considered quitting their jobs. Care workers with multiple problems at work were much more likely to consider quitting, and the likelihood was increasing with the number of problems reported. Furthermore, care workers lacking support from their managers had double odds of wanting to quit. The Nordic welfare states with growing older populations are facing challenges in retaining care staff in the eldercare services and ensuring they have good working conditions and support in their demanding work.     

Review Manager(RevMan)——临床医生通向Meta分析的桥梁

循证医学的理念在不断地影响着不同专业的医学工作者,他们非常关心的一个问题是:什么叫Meta分析、如何进行?Review Manager(RevMan)是Cochrane协作网提供给评价者准备和维护更新Cochrane系统评价而设计的软件,是专门为临床医生度身订做的、用于完成Meta分析的软件,本文作者以“图文并茂”的形式向广大读者介绍Review Manager 4.2的具体操作过程,相信对初次从事系统评价的人员较好地应用Review Manager会有所帮助。 循证医学编辑部     

社区健康管理师功能定位的思考与探索

现阶段,对社区健康管理师功能清晰的定位,有利于推动社区健康管理师职业发展,满足社区居民健康服务需求。社区健康管理师功能定位须满足立足需求、立足社区、差异化、分级定位4个基本原则。本文在政策文件梳理和实践探索的基础上,详细制定了不同级别社区健康管理师的职业功能、工作内容和技能要求,为推动社区健康管理师职业的发展提供借鉴。     

Review Manager 5软件在诊断准确性试验的Meta分析中的应用

Review Manager(RevMan)5软件中增加了诊断准确性试验(DTA)的Meta分析的功能,然而软件所提供的使用手册中并未介绍如何使用这一功能。本文结合实例介绍利用RevMan 5软件行DTA的Meta分析的方法;同时结合实例介绍如何整理DTA的数据并按二分类数据录入RevMan 5.2中,得出DTA的Meta分析的阳性似然比、阴性似然比和诊断比值比这三个指标的汇总结果。     

PCSK9 inhibitor access barriers—issues and recommendations: Improving the access process for patients,clinicians and payers

The proprotein convertase subtilisin/kexin type 9 inhibitors or monoclonal antibodies likely represent the greatest advance in lipid management in 30 years. In 2015 the US Food and Drug Administration approved both alirocumab and evolocumab for high‐risk patients with familial hypercholesterolemia (FH) and clinical atherosclerotic cardiovascular disease requiring additional lowering of low‐density lipoprotein cholesterol. Though many lipid specialists, cardiovascular disease prevention experts, endocrinologists, and others prescribed the drugs on label, they found their directives denied 80% to 90% of the time. The high frequency of denials prompted the American Society for Preventive Cardiology (ASPC), to gather multiple stakeholder organizations including the American College of Cardiology, National Lipid Association, American Association of Clinical Endocrinologists (AACE), and FH Foundation for 2 town hall meetings to identify access issues and implement viable solutions. This article reviews findings recognized and solutions suggested by experts during these discussions. The article is a product of the ASPC, along with each author writing as an individual and endorsed by the AACE.     

The immunogenicity of injectable collagen. II. A retrospective review of seventy-two tested and treated patients

Sera were collected from seventy-two patients who had been exposed to a preparation of a bovine collagen implant in widespread clinical use for correction of dermal defects ( Zyderm Collagen Implant [hereafter referred to as "the implant"]; Collagen Corporation, Palo Alto, CA). Thirty-one of these patients had reported implant site reactions alone, thirty-five had reported generalized symptoms without implant site involvement, and six had reported implant site reactions accompanied by generalized symptoms. Results of a radioimmunoassay performed on these sera showed that elevated levels of anti-implant antibodies correlated significantly with localized responses at injection sites. Conversely, systemic complaints could not be correlated with either skin reactions or antibody titers. In previous clinical studies, increasing numbers of exposure to this material were not shown to increase the likelihood of an immune response developing at implant sites. Therefore, immune responses to this implant are typically localized reactions that manifest within the first two exposures to the implant material.     

An evaluation of the current mentorship/preceptorship practices for newly qualified radiographers in Northern Ireland

IntroductionMentorship/Preceptorship (M/P) has been utilised within the nursing profession since the early 1980's. Successful, structured M/P programmes can be hugely beneficial to Northern Ireland (NI) Trusts who recruit regularly and often rely on the fluidity of staff movement regionally. In the absence of standardised tools to accurately and universally measure the competency of newly qualified Radiographers (NQR) as they evolve, establishing the benchmark for effective practice within Radiology departments in NI is difficult and highly subjective at best. This study aimed to evaluate the current M/P strategies within NI as perceived by NQR and Radiology Managers (RM).MethodsA mix of both qualitative and quantitative data was obtained using questionnaires through a scoping exercise. Opinions were sought from a target audience of NQR, who began full-time employment following graduation in 2018, and RM involved in the delivery of current M/P programmes within the NI Trusts.ResultsResponses were gained from all five NI trusts to achieve a representative regional sample, with final opinions of RM (n = 8, 54%) and NQR (n = 30, 67%) received. With the exception of one response, all NQRs confirmed receiving some form of M/P support within their inaugural post.ConclusionSignificant variations were apparent in both the structure and delivery of Trust M/P induction programmes, calling into question the comparable competency of NQRs regionally.Implications for practiceThe disparity in approach towards M/P programmes across NI, and subsequent lack of comparability of NQR competence, endorses the development of a more robust and universal method for the regional assessment of NQRs, such as that of the ‘Flying Start NHS®’ programme utilised by National Health Service (NHS) Scotland, in combination with knowledge and skills framework (KSF) practices in supervision.     

卫生应急管理人员培训需求分析

目的：通过培训需求分析,为建立一个针对性强的应急管理人员培训方案提供建议。方法：采用问卷调查方法,从培训内容、时间、方式、方法、师资、考核和结业六大方面进行需求分析。结果：卫生应急的概述内容、卫生应急管理的方法与技能、卫生应急响应与处理应作为培训重点。培训方式可采用短期集中培训、国内考察和学术会议（讲座）;教学方法为案例讨论和专题讲座。结论：我国的卫生应急知识体系还不成熟,缺乏相应的适宜教材与师资,需要不断丰富相关知识和技术。