研究生在校期间创新能力属性的变化分析

目的:探讨研究生读研期间创新能力各属性的变化情况,寻找其薄弱环节。方法:以某军医大学一、二年级研究生为对象,应用Williams创新能力量表,比较研究生总体、不同年级、不同学历研究生1年后创新能力各属性的变化情况。结果:在所观测的1年中,1研究生总体冒险性和好奇性的变化没有统计学差异(P0.05),想象力得分下降(t=6.203,P0.001),而挑战性得分升高(t=-5.566,P0.001);2一年级研究生想象力得分下降(t=6.258,P0.001),挑战性得分升高(t=4.466,P0.001);二年级仅挑战性升高(t=-3.068,P0.01);3博士研究生好奇性和想象力下降(t=2.910,2.917;P0.01),而挑战性升高(t=-3.732,P0.001),硕士研究生想象力得分下降(t=5.304,P0.001),挑战性得分升高(t=-4.433,P0.001)。结论:想象力是研究生创新能力培养的薄弱环节:科研训练对于培养研究生创新能力非常重要。     

A Delphi consensus study introducing a Problem And attRibutes‐bAsed DIabetes self‐manaGeMent (PARADIGM) intervention for patients with type 2 diabetes

AimEncouraging patients to improve their self-management behavior based on a strict definition of the intervention is important for a standardized delivery but, until recently, there was no consensus on the core attributes that define such an intervention. The purpose of this study is to generate a core-attribute based and stakeholder-informed problem-based curriculum for promotion of type 2 diabetes self-management structured around five core attributes derived from a previous concept analysis that defined the intervention.MethodsUsing a Delphi process for consensus achievement, physicians, clinical epidemiologists and allied health care professionals completed eleven rounds of online meetings over 6 months.ResultsCore self-management skills were identified by consensus for each of the five attributes and then used to design a model case and interactions of a problem-based self-management education intervention for delivery in a health care setting. Five model cases and associated interactions were developed by consensus for delivery in group-based and problem-based learning sessions.ConclusionsThe final structured curriculum will be useful to inform and standardize diabetes self-management based on a clear conceptual definition of the intervention and can thus help make the latter more effective tools for encouraging persons with type 2 diabetes to self manage their condition.     

凤阳县2005年伤寒暴发流行特征分析

目的研究凤阳县2005年伤寒暴发流行特征,为今后的防治工作提出科学依据。方法对2005年伤寒暴发资料进行统计分析。结果此次暴发主要集中在10～12月,11月达到最高峰,10～20岁病人为主（69.2%）,学生为主要人群（56.7%）。配对病例对照研究发现,在外就餐是发病主要原因（OR=5.71,P〈0.01）。结论加强餐饮业卫生的管理和监督、改变不良卫生习惯是防止伤寒暴发的关键措施;流行早期及时采取严格、有效的措施是短期内疫情得到有效控制的保证。     

Towards a better understanding of self-management interventions in type 2 diabetes: A concept analysis

ObjectivesDiabetes self-management educational (DSME) interventions can vary considerably, and it is unclear what is the operational conceptualization of the ideal delivery to individuals with type 2 diabetes (T2D).DesignFrom a search conducted concurrently we extracted and evaluated the 50 most recently published DSME intervention studies. Based on an analysis of these studies, we undertook a concept analysis using the Walker and Avant framework.ResultsFive attributes describing the concept were recognized and organized into two groups. Group (a): skills related attributes that included (1) decision making, (2) problem solving and (3) taking action. Group (b): information related attributes that included (4) patient-provider interaction and (5) resource utilization.ConclusionsThe outcomes of this study make the operational conceptualization of the ideal DSME intervention measurable through its attributes and hence clarifies its delivery. This will improve the implementation of the key attributes in diabetes self-management intervention programs for T2D.     

广州、东莞和深圳的全科医疗特征功能比较研究

目的:评价和比较广州、东莞和深圳三个城市四种全科医疗模式下全科医疗特征功能,为制定政策和强化全科医疗特征功能提供依据。方法:采用二阶段抽样,首先抽取广州市3家社区卫生服务中心,东莞市2家社区卫生服务中心,深圳市3家社康中心和深圳市1家公立医院,然后采用方便抽样的方法,使用本土化后的基础保健工具PCAT-AE对社区卫生服务中心/医院的病人进行问卷调查,测量病人对基础保健服务的体验。共有1 712名病人参与调查,其中有效问卷为1 645份。结果:深圳港大医院的全科医疗特征功能总体得分(55.3)要高于广州社区(45.9)、东莞社区(49.2)和深圳社区(51.7)的得分,且P0.05。结论:全科医疗特征功能总体较低,不同全科医疗实践模式显现不同特点,要针对每个地区的具体情况不断完善全科医疗功能服务。     

全科医疗特征功能视角下分级诊疗的定义及制度层次

明确分级诊疗定义和内涵是建立和完善分级诊疗制度的逻辑起点,是制度的基础性研究。本文在剖析国际上分级诊疗的相关概念、探求分级诊疗本质的基础上,辨析了国内分级诊疗的定义。认为国内分级诊疗制度存在以下不足:以疾病诊治的单一维度作为三级医疗服务分工依据,忽略了人们对医疗服务体系间接性医疗服务功能的需求;导致服务体系规划忽略了非直接性医疗服务功能,缺失了具有特征功能的全科医疗与专科医疗之间的分化和互补;全科医疗和专科医疗之间功能清晰、界限分明的医疗卫生服务体系结构尚未形成;用组织治理取代了原本属于全科医疗和专科医疗之间的专业治理。最后,本文从全科医疗特征功能视角,完善了分级诊疗的定义;尝试回答了分级诊疗的三个基础性问题,并归纳提出分级诊疗制度应该包括微观、中观、宏观三个层次。     

全科医疗特征功能的评价、影响因素分析及政策涵义

目的:全科医疗特征功能是构成基础保健高绩效的基础,是区别于专科医疗的核心所在。本研究将测量全科医疗特征功能,剖析其影响因素,探讨问题原因,为制定强化全科医疗特征功能政策提供依据。方法:使用本土化的基础保健测量工具PCAT-AE,选择8家社区卫生服务中心和深圳市港大医院全科医疗门诊部作为调查机构。采用面对面、一对一形式的问卷调查方法,共调查1 712名病人,有效问卷1 645份。结果:全科医疗特征功能总分49.0分,首诊利用(69.8)、连续性(63.1)和文化胜任力(51.2)维度得分相对较高,可及性(40.8)和以社区为导向(31.0)维度得分相对较低。全科医疗特征功能得分受人口社会学特征、健康特征和服务利用等多种因素影响,特征功能对病人的满意度起积极作用(OR1)。结论:国内全科医疗特征功能得分较低,与国外相比差距较大。可以从病人个体、组织和系统三个层面,全面强化全科医疗特征功能。     

Natural orifice translumenal surgery: Flexible platform review

Natural orifice translumenal surgery (NOTES) has garnished significant attention from surgeons and gastroenterologists, due to the fusion of flexible endoscopy and operative technique. Preliminary efforts suggest that NOTES holds potential for a less invasive approach with certain surgical conditions. Many of the hurdles encountered during the shift from open to laparoscopic surgery are now being revisited in the development of NOTES. Physician directed efforts, coupled with industry support, have brought about several NOTES specific devices and platforms to help address limitations with current instrumentation. This review addresses current flexible platforms and their attributes, advantages, disadvantages and limitations.     

Statistical control of the production of blood components by control charts of attribute to improve quality characteristics and to comply with current specifications

Statistical process control (SPC) is closely related to good quality control practices in the manufacturing process. One of the primary goals is to detect unnatural patterns, allowing the production service to control the conformity of the blood components produced. Despite being recommended by national and international standards, its exercise is not uniform, and sometimes the methodology used is misinterpreted as SPC. When the input data has a Gaussian distribution, control charts for variables are proposed. However, when the data distribution is not normal, control charts for attributes are suggested. This article presents and discusses four statistical procedures for the control of attributes using p-, np-, u-, and c-charts. An empirical demonstration shows these models are reliable for in routine use in the Blood Establishment quality control, as also suggests the use when the control charts for variables are inapplicable.