《素问玄机原病式》学术思想探讨

《素问玄机原病式》一书，发挥《内经》病机学说，弥补了原“病机十九条”过于简略之不足，创造性地继承和发展了《内经》理论，特别是首倡“六气皆从火化”之说；关于“相火”的论述，则为后世相火理论的形成奠定了基础；它还总结了温热病的治疗原则，对后世温病学派的形成产生了重要影响。     

RBRVS-KPI模式下公立医院绩效考核体系构建及应用

目的探讨如何将以资源为基础的相对价值比率（RBRVS）与关键绩效指标法（KPI）相结合,运用于公立医院绩效考核体系实践中。方法分析样本医院绩效考核体系的应用效果,根据医院总体目标,经过点值测算、指标选择,建立了一套具有医院特色的改良型RBRVS-KPI模式绩效考核体系。结果经实践,医疗质量和运行效率大幅度提高,在一定程度上促进了医院管理的精细化。结论RBRVS-KPI模式下的绩效考核体系较唯财务导向的绩效模式更能体现医护人员劳动价值,值得探索与推广。     

心脏介入药物涂层球囊临床使用合理性评价及干预研究

目的对某三级医院心脏介入药物涂层球囊的临床使用情况进行分析，评价其临床使用合理性。方法参考HB-HTA评价维度，从安全性、有效性、经济性3个方面制定评价指标体系，通过与药物洗脱支架进行对比，评价药物涂层球囊临床使用合理性，并将评价结果应用于管理决策。结果该药物涂层球囊临床使用有效性与药物洗脱支架基本一致，经济性具有一定优势，但在安全性方面有71.1％的病例存在未按说明书使用情况。制定改进措施并实施后，药物涂层球囊未按说明书使用病例比例由69%降为0%，同时患者人均药物涂层球囊费用由23 203.1元降至20 350.0元。结论医院开展医用耗材临床合理使用管理工作时，可参考HB-HTA模式，建立临床使用合理性评价指标体系，并进行定期评价，为管理决策提供依据，以提升医院耗材管理水平。     

Behavior Change Following Implementation of Home‐Based Life‐Saving Skills in Liberia,West Africa

Introduction: Home‐Based Life‐Saving Skills (HBLSS) has been fully integrated into Liberia's long‐term plan to decrease maternal and newborn mortality and morbidity, coordinated through the Ministry of Health and Social Welfare. The objective of this article is to disseminate evaluation data from project monitoring and documentation on translation of knowledge and skills obtained through HBLSS into behavior change at the community level. Methods: One year after completion of HBLSS training, complication audits were conducted with 434 postpartum women in 1 rural county in Liberia. Results: Sixty‐two percent (n = 269) of the women were attended during birth by an HBLSS‐trained traditional midwife or family member, while 38% (n = 165) were attended by a traditional midwife or family member who did not receive HBLSS training. Home‐Based Life‐Saving Skills–trained birth attendants performed significantly more first actions (life‐saving actions taught to be performed after every birth) than the attendants not HBLSS trained. Fourteen percent of our sample (n = 62) reported too much bleeding following the birth. Of these women, approximately half (n = 29) were attended by an HBLSS‐trained traditional midwife or family member. There was a significant difference in secondary actions (those actions taught to be performed when a woman experiences too much bleeding following childbirth) that were reported to have been performed by HBLSS‐trained attendants (mean 5.26, standard deviation [SD] 1.88) and untrained attendants (mean 2.73, SD 1.97; P < .0001). Discussion: Our findings suggest that HBLSS knowledge is being transferred into behavior change and used at the community level by traditional midwives and family members.     

EVIDENCE – BASED MEDICINE/PRACTICE IN SPORTS PHYSICAL THERAPY

A push for the use of evidence‐based medicine and evidence‐based practice patterns has permeated most health care disciplines. The use of evidence‐based practice in sports physical therapy may improve health care quality, reduce medical errors, help balance known benefits and risks, challenge views based on beliefs rather than evidence, and help to integrate patient preferences into decision‐making. In this era of health care utilization sports physical therapists are expected to integrate clinical experience with conscientious, explicit, and judicious use of research evidence in order to make clearly informed decisions in order to help maximize and optimize patient well‐being. One of the more common reasons for not using evidence in clinical practice is the perceived lack of skills and knowledge when searching for or appraising research. This clinical commentary was developed to educate the readership on what constitutes evidence‐based practice, and strategies used to seek evidence in the daily clinical practice of sports physical therapy.