品管圈对缩短精神科急诊患者就诊等待时间的效果探讨

目的探讨品管圈对缩短精神科急诊患者就诊等待时间的效果。方法选取2019年7月至2020年6月于我院精神科急诊就诊的300例患者作为研究对象,150例予以常规就诊指导的患者纳入对照组,150例予以品管圈就诊指导的患者纳入观察组。比较两组的就诊等待时间及护理满意度。结果观察组的就诊等待时间显著短于对照组,护理满意度评分显著高于对照组(P<0.05)。结论品管圈可缩短精神科急诊患者的就诊等待时间,提高患者的护理满意度。     

整体责任制护理对乳腺癌手术患者生活质量及护理满意度的影响

目的探讨整体责任制护理对乳腺癌手术患者生活质量及护理满意度的影响。方法选取2019年6月至2020年6月期间于我院行手术治疗的71例乳腺癌患者,随机分为两组。对照组35例采用常规护理,观察组36例采用整体责任制护理。比较两组护理前后的生活质量及护理满意度。结果护理后,两组的生活质量各维度评分均显著高于护理前,且观察组的生活质量评分均显著高于对照组(P <0.05)。观察组的护理满意度为91.67%,显著高于对照组的68.57%(P <0.05)。结论整体责任制护理可有效改善乳腺癌手术患者的生活质量,提升其护理满意度。     

Ethical beliefs and behaviors of pediatric psychologists: a survey.

There is an absence of data concerning the beliefs about and compliance with ethical principles of pediatric psychologists. Survey data were collected from 169 psychologist members of the Society of Pediatric Psychology (Division 12, Section 5 of APA) regarding the degree to which they engaged in each of 101 behaviors and the degree to which they considered each behavior ethical. The data were categorized and examined in terms of the APA Ethical Principles. Results indicated that pediatric psychologists show significantly different beliefs and behavior comparing children, adolescents, and their parents. A "majority belief" scale was developed where 80% of pediatric psychologists agreed that a clinical behavior was ethical or not ethical. Female pediatric psychologists, compared to males, more strongly endorsed the majority belief items (p less than .01). In addition, psychologists who graduated from APA-approved graduate programs more strongly endorsed the majority belief items than did psychologists from non-APA programs (p less than .05). Increased awareness of ethical issues is hoped to improve self-regulation by psychologists.     

The Professional Adolescence of Clinical Child and Adolescent Psychology and Pediatric Psychology: Grown Up and Striving for Autonomy

We review the present and future of the specialty field of clinical child and pediatric psychology. The progress in education and training, science, practice, and organizational developments in this specialty is described with attention to the special issues of the developing field. Clinical child and pediatric psychology are well positioned for continued healthy development.     

临床专业学位硕士研究生导师考核指标的制订与初步应用

住院医师规范化培训的核心内容是临床实践能力培养,同时也是专业学位研究生培养的主要内容。随着专业学位研究生培养与住院医师规范化培训并轨,专业学位研究生导师考核体系应纳入研究生临床技能培训质量指标。通过文献检索、专家咨询等方法合理设置指标结构、考核内容,确定权重,建立临床医学专业学位硕士研究生导师考核细则,引导专业学位研究生导师加强研究生临床技能培养,提高专业学位研究生培养质量。     

Epidermal-cell-based therapy as an adjunct to healing second degree burns—A randomized controlled pilot study

BackgroundHealing of partial-thickness (2a and 2b) burns is notoriously unpredictable as far as healing time, scarring and (hypo)pigmentation is concerned. Epidermal blister grafting is an autologous grafting technique involving transfer of epidermal islands without dermal elements. Cellutome™ is an FDA-acknowledged epidermal harvesting device. This proof-of-concept study evaluates whether blister grafting of partial-thickness burns results in improved healing compared to standard acellular treatment.MethodsThis is a randomized controlled trial with 8 patients in which each patient received both treatments randomized to different burn sites. Healing was assessed at regular intervals. Twelve months after treatment, outcomes were measured with the Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), photography, spectrometry, Semmes-Weinstein Filaments, cutometry and high-resolution ultrasound.ResultsAreas treated with epidermal blister grafting healed slightly faster than acellular treatment. Epidermal treatment yielded healing with less erythema, closer to that of surrounding normal skin (p = 0.0404). Donor sites were not visible and not measurably different than normal skin.ConclusionsResults favor cellular over acellular technique for the treatment of partial-thickness (2a and 2b) burns. Significant improvement in erythema implies a higher quality healing process. Further studies should look primarily at larger areas of treatment, and larger sample size.     

基于“互联网+医联体”的老年慢病患者延续护理实践

目的 构建基于“互联网〖HT6K〗+医联体”的老年慢病患者延续护理模式,并评价实施效果。方法 1所三级医院、1所二级医院、1所社区医院、14家社区卫生服务中心和43家村卫生室建立医联体,对医联体内出院的老年慢病患者,开展“互联网+延续护理”服务。实施前后对患者的满意度、照顾者负担及护士职业认同感进行测评。结果 实施2年7个月,共开展“互联网〖HT6K〗+医联体”延续护理服务1 859例次,胃管护理最多（37.32%）,其次为导尿及相关护理（35.87%）;患者对9个条目的满意率为75.59%~100%;实施后,照顾者负担评分显著降低,护士职业认同感得分显著提高（均P<0.05）。结论 基于“互联网〖HT6K〗+医联体”的老年慢病患者延续护理满足了老年慢病患者的需求,提高患者的满意度,减轻照顾者负担,提升护士职业认同感。     

Effect of combined erector-spinae plane blocks on the immediate postoperative neuronal and stress biomarkers after thoracoscopic radical resection for lung cancers

BackgroundThis study evaluates the impact of general anesthesia combined with erector spinae plane blocks (ESPB) on patients who underwent thoracoscopic radical resection (TRR) for lung cancer.MethodsThere involved a total of 108 patients undergoing TRR for lung cancers. Patients enrolled were equally allocated into experimental group (general anesthesia combined with ESPB) and control group (general anesthesia). The following parameters, including baseline characteristics, serum markers of neurological disorders, postoperative pain degree, dosage of narcotic, adverse events and early postoperative rehabilitation quality, were compared between the two groups.ResultsBased on Visual Analogue Scale, the postoperative pain degree was significantly lower in experimental group on 6h postoperative (P<0.001). And markedly lower results were observed in the levels of serum markers of neurological disorders in the experimental group one day after surgery (all P<0.05). Moreover, the dosage of narcotic and early postoperative rehabilitation quality based on QoR-40 scale were significantly lower in experimental group (all P<0.05).ConclusionAdding ESPB with general anesthesia reduce the postoperative pain up to 6 h, reduce the requirement of postoperative narcotic and help early postoperative rehabilitation quality.     

From context to contexting: professional identity un/doing in a medical leadership development programme

Physicians are known for safeguarding their professional identities against organisational influences. However, this study shows how a medical leadership programme enables the reconstruction of professional identities that work with rather than against organisational and institutional contexts to improve quality and efficiency of care. Based on an ethnographic study, the results illustrate how physicians initially construct conflicting leadership narratives – heroic (pioneer), clinical (patient's guardian) and collaborative (linking pin) leader – in reaction to changing organisational and clinical demands. Each narrative contains a particular relational-agentic view of physicians regarding the contexts of hospitals: respectively as individually shapeable; disconnected or collectively adjustable. Interactions between teachers, participants, group discussions and in-hospital experiences led to the gradual deconstruction of the heroic –and clinical leader narrative. Collaborative leadership emerged as the desirable new professional identity. We contribute to the professional identity literature by illustrating how physicians make a gradual transition from viewing organisational and institutional contexts as pre-given to contexting, that is, continuously adjusting the context with others. When engaged in contexting, physicians increasingly consider managers and directors as necessary partners and colleague-physicians who do not wish to change as the new ‘anti-identity’.     

QT间期离散度与小儿川崎病心肌损伤的相关性分析

目的研究心电图QT间期离散度(QTd)和校正QT间期离散度(QTcd)与川崎病(KD)急性期患儿心肌损伤标志物的相关性及对心肌损伤的诊断价值。方法选取2017年10月至2019年10月期间台州市中心医院收治的急性期KD患儿53例和同期健康儿童50例为研究对象,均采用12导联心电图测量QTd和QTcd,同时采集KD患儿入院时外周静脉血并检测血清肌钙蛋白(cTnI)和肌酸激酶同工酶(CK-MB)水平,以cTnI和CK-MB均高于正常值为诊断标准将患儿分为损伤组和正常组,比较两组QTd和QTcd。结果 KD患儿QTd和QTcd均明显高于健康儿童(t值分别为14.924、19.164,均P <0.05)。损伤组KD患儿血清cTnI和CK-MB水平明显高于正常组(t值分别为6.676、6.640,均P <0.05),心电图QTd和QTcd也明显高于正常组(t值分别为2.621、3.604,均P <0.05)。KD患儿QTd与血清cTnI和CK-MB水平均无明显相关性(r值分别为0.059、0.171,均P>0.05),QTcd与血清cTnI和CK-MB水平均呈明显正相关性(r值分别为0.413、0.490,均P <0.05)。心电图QTd和QTcd判断KD患儿急性期心肌损伤的曲线下面积(AUC)分别为0.639和0.819,灵敏度分别为47.06%和73.53%,特异度均为84.21%。结论急性期KD患儿QTd和QTcd明显延长,其中QTcd与血清cTnI和CK-MB水平具有明显正相关性,对心肌损伤诊断和严重程度评估均具有重要参考价值。