普适计算环境下信任机制的研究进展

在普适计算环境下,各种资源、设备和用户均是高度动态变化的,服务请求者和服务提供者一般互相不了解,因此普适计算环境下各陌生实体间的相互认证是传统的基于身份的认证机制无法解决的.普适计算信任建模机制可以解决普适计算环境下的不确定性问题,为陌生实体间建立信任关系,因此成为普适计算中的一个研究热点.基于此,本文对于目前国外关于普适计算信任建模机制的研究现状做了一个总结,通过分析和比较,给出了普适计算信任建模的设计原则,探讨了普适计算信任建模问题的未来发展方向.     

Exploring elements of interprofessional collaboration between pharmacists and physicians in medication review

In medication review involving community pharmacists and physicians, there is an underlying assumption that if community pharmacists provide evidence based pharmacotherapeutic recommendations, physicians, in turn, will implement these recommendations. However, although in general medication review has been shown to improve the quality of medicine use, medication management plans arising from the medication review process are not always implemented. There is a need for better understanding of the factors that influence outcomes in medication review. The current paper will address some cultural and procedural factors that may assist in understanding outcomes in medication review using research into collaboration from areas outside the healthcare as a framework.     

Trust in the medical profession: conceptual and measurement issues

OBJECTIVE: To develop and test a multi-item measure for general trust in physicians, in contrast with trust in a specific physician. DATA SOURCES: Random national telephone survey of 502 adult subjects with a regular physician and source of payment. STUDY DESIGN: Based on a multidimensional conceptual model, a large pool of candidate items was generated, tested, and revised using focus groups, expert reviewers, and pilot testing. The scale was analyzed for its factor structure, internal consistency, construct validity, and other psychometric properties. PRINCIPAL FINDINGS: The resulting 11-item scale measuring trust in physicians generally is consistent with most aspects of the conceptual model except that it does not include the dimension of confidentiality. This scale has a single-factor structure, good internal consistency (alpha = .89), and good response variability (range = 11-54; mean = 33.5; SD = 6.9). This scale is related to satisfaction with care, trust in one's physician, following doctors' recommendations, having no prior disputes with physicians, not having sought second opinions, and not having changed doctors. No association was found with race/ethnicity. While general trust and interpersonal trust are qualitatively similar, they are only moderately correlated with each other and general trust is substantially lower. CONCLUSIONS: Emerging research on patients' trust has focused on interpersonal trust in a specific, known physician. Trust in physicians in general is also important and differs significantly from interpersonal physician trust. General physician trust potentially has a strong influence on important behaviors and attitudes, and on the formation of interpersonal physician trust.     

577名大学生人际容纳、信赖他人及相关因素的研究

目的探讨大学生人际容纳度和信赖他人度及其影响因素。方法对577名高校大学生的容纳他人量表和信赖他人量表测试结果分析，对筛查出的高分组和低分组就其性别、城乡、家庭类型、不同专、此经统计学处理，分析其可能影响的相关因素。结果容纳他人量表[（男性136人，高分组48人，低分组88人；女性441人，高分组229人，低分组212人），x^2=11．5，P≤0．01；（独生子女198人，高分组84人，低分组114人；多子女大家庭359人，高分组182人，低分组177人），x^2=3．62，P≤0．05]结果的差异有显著性，在性别、家庭类型及某些专业之间较为明显。信赖他人量表的差异显著性则除家庭经济状况以外，大多数不同专业均差异有显著性。结论独生子女、男性、较富裕的家庭经济状况可能会降低大学生对他人容纳度，本研究被试的大学生群体信赖他人程度普遍较高，除家庭经济状况以外，所学专业有可能是造成信赖他人度差异的影响困素。     

Ulysses directives in The Netherlands: opinions of psychiatrists and clients

In this article we present a study on the opinions of Dutch psychiatrists and clients on Ulysses directives. In-depth interviews were conducted with 18 clients and 17 psychiatrists. Most respondents were proponents of Ulysses directives. The most frequently mentioned objective of these directives was to secure timely admission to hospital, although a large minority was mainly interested in giving patients influence on treatment decisions. Psychiatrists differed on how much autonomy they preferred with regard to decisions about the moment of admission and kind of treatment. Clients also differed in this respect. Pressure from others to execute a Ulysses directive, and premature admission to the hospital were mentioned as risks of Ulysses directives. Crisis cards were seen as an alternative by many psychiatrists and some clients. Recommendations are made for a good functioning of Ulysses directives, and the appropriateness of crisis cards as an alternative for a number of patients is discussed.     

Public health in Primary Care Trusts: a resource needs assessment

BACKGROUND: This study was commissioned by the UK Health Development Agency to provide a snapshot of how, at the outset of the 2002 NHS reorganisation, Primary Care Trust (PCT) staff and Professional Executive Committee (PEC) members perceived their public health roles and functions, the opportunities and barriers to delivering those roles and functions and the development needs in order to fulfill them. METHODS: Taped group interviews were conducted with PECs of eight PCTs (covering a range of settings, size and stage of organisational development), followed up by structured telephone interviews with 35 frontline staff from four of the PCTs. Analysis was through content analysis and counting of themes including a quantitative assessment of the occurrence of themes and comparison between different categories of participants. RESULTS: PEC members and frontline staff (particularly community based staff) were keen to address a broad public health agenda within the new PCTs, however a number of barriers to the ability of the PCT to fulfill its Public Health role were identified. The most important were lack of resources (staff and staff time) in the context of a host of competing agendas and excessive clinical workloads. There was a clear difference among frontline staff between those who were practice or community based-many practice-based frontline staff did not acknowledge any major public health dimensions to their daily work. A number of detailed suggestions for improvement were made. CONCLUSION: At the start of the 2002 NHS reorganisation, PCTs need to improve their organisational capacity to address the public health if they are to deliver health improvement as envisaged. We make recommendations which should allow PCTs to perform their public health functions more effectively.     

Developing a social perspective in mental health services in primary care

The influence of Primary Care Trusts (PCTs) on the reorganisation of UK health and social care provision is already considerable. As well as challenging institutionalised processes of care, PCTs are encouraging innovation. This article reflects on a service pioneered by a small group of mental health social workers, which has been reconfigured within a new PCT, illuminated by examples of direct therapeutic work and service user feedback. In the new service, the practical application of a social perspective in mental health provision is demonstrated by eligibility criteria based on social context as well as psychological adversity. Possible developments arising from the prospective, multidisciplinary team membership and interface with secondary care are anticipated.