临床医生科研需求分析与均衡科研管理初探

笔者通过相关文献分析和归纳,设计了《临床医生科研需求调查表》,对60位临床医生科研活动的主观愿望和客观需求进行调查,分析临床医生开展科研活动的主观意愿与医院提供的科研环境之间的差距,提出均衡科研管理模式,为科研条件和管理策略的改进提供依据,促进科研管理的不断改善。     

临床医生药事服务工作量测算研究

目的探讨科学的药事服务工作量测算方法,以某三甲医院为例测算临床医生药事服务工作量,为决策者提供方法和数据支持。方法采用文献查阅、头脑风暴和专家咨询法确定测量参数和测算方法,通过调查获取药事服务工作量数据,运用SPSS 17.0软件对数据进行统计分析。结果临床医生药事服务工作量的量化参数为"工作时间"和"价值含量",不同职称和学历的调查对象对药事服务工作量的评估没有统计学差异(P>0.05)。结论药事服务工作量点数受医生职称、学历和工作地点等因素的影响较小,研究所探讨的量化参数和测算方法具有一定的可行性和科学性,但有待进一步论证和实践。     

Conducting exposure and response prevention treatment for contamination fears during COVID-19: The behavioral immune system impact on clinician approaches to treatment

The coronavirus disease 2019 (COVID-19) pandemic sparked significant anxiety regarding viral rates and means of transmission. Heightened concerns about contamination have prompted new hygienic strategies to vigilantly guard against infection, including hand washing immediately after touching foreign objects or suspected contaminants. This has presented a critical challenge for the delivery of exposure and response prevention (ERP) therapy to individuals with contamination fears due to Obsessive Compulsive Disorder (OCD), as providers must manage not only their clients’ attitudes and reactions but their own as well. In this investigation, self-identified anxiety and OCD treatment specialists (N = 139) provided demographic information, including their anxiety and OCD caseloads, and completed measures related to intolerance of uncertainty (IUS-SF; Carlton et al., 2007), beliefs about exposure therapy (TBES; Deacon et al., 2013), and emotional reactions to physical sensations (The Chills; Maruskin et al., 2012). We tested the hypothesis that intolerance of uncertainty and activation of the behavioral immune system (BIS; Schaller & Park, 2011), a mechanism theoretically activated by the prominent emergence of pathogens to protect against illness would predict attitudes toward exposure. The Chills Scale was used to assess BIS activation, a broad assessment of vasoconstriction responses associated with different emotional reactions, and includes a subscale (coldness) that evaluates vasoconstriction associated with defense against pathogens. Both coldness and OCD caseload, but not anxiety caseload or subscales of intolerance of uncertainty, emerged as significant predictors of clinicians’ beliefs about exposure; increases in OCD caseload were also related to decreases in negative beliefs about exposure. Findings are useful in determining methods for aiding clinicians in developing effective approaches to contamination fears during and post-pandemic that include addressing their own BIS-related concerns and mapping out means for social behavioral norms associated with engaging in exposure treatment.     

Book Reviews

Background: Addressing the long-term consequences of stroke is a top 10 research priority, and understanding the views of different stakeholders is essential in designing appropriate patient-centred multidisciplinary rehabilitation.

Aims: This study reports on the perspectives of 38 individuals who live with or work with aphasia: people with aphasia (PWA), family members (FM) and friends, and speech and language therapists (SLTs), about its consequences in the daily lives of PWA.

Method &; Resources: In total, 14 PWA, 14 FM and 10 SLTs participated in the study. All participants were interviewed about the consequences of stroke and aphasia. Small focus groups were used with some participants. In-depth semi-structured interviews were used with other participants. Interviews were carried out in groups or individually in order to accommodate severe aphasic impairments or respondents with fewer years of education. Interviews were video or audio-recorded. Verbal and non-verbal communication was transcribed and analysed qualitatively using content analysis. Data was coded and mapped onto the ICF framework.

Outcomes &; Results: All three groups reported consequences in Body Functions and Body Structures, primarily in Mental Functions (Specific Mental Functions and Global Mental Functions) and Neuromusculoskeletal and Movement-Related Functions. Within Specific Mental Functions, PWA emphasised Expression of Oral Language, whereas FM and SLTs emphasised Emotional Functions. Within Global Mental Functions, PWA and FM emphasised Energy and Drive Functions, whereas SLTs emphasised Temperament and Personality Functions. Some consequences were shared between PWA and SLTs (Sensory Functions and Pain, and Functions of the Digestive, Metabolic and Endocrine Systems), whilst others were specific to SLTs alone (Voice and Speech Functions, and Cardiovascular, Haematological, Immunological and Respiratory Systems). All three groups reported consequences in Activities and Participation in Major Life Areas; Community, Social and Civic Life; Interpersonal Interactions and Relationships; Communication; and Mobility. Some consequences were shared by PWA and FM (Domestic Life), and others by FM and SLT (Self Care). Consequences in General Tasks and Demands were only described by SLTs and in Learning and Applying Knowledge by PWA. Both PWA and FM reported a general Loss of Autonomy.

Conclusions: PWA, FM and SLTs reported a considerable range of stroke and aphasia consequences in the daily life of those who live with it. They were concerned to different degrees with language, physical and emotional changes, and impact on communication, mobility, self-care, relationships, leisure and work. Professionals’ practices in Portugal need to be changed in order to consider these findings.     

Nursing clinical practice changes to improve self‐management in chronic obstructive pulmonary disease

Aim

To propose nursing clinical practice changes to improve the development of patient self‐management.

Background

Chronic obstructive pulmonary disease is one of the main causes of chronic morbidity, loss of quality of life and high mortality rates.

Introduction

Control of the disease's progression, the preservation of autonomy in self‐care and maintenance of quality of life are extremely challenging for patients to execute in their daily living. However, there is still little evidence to support nursing clinical practice changes to improve the development of self‐management.

Methods

A participatory action research study was performed in a medicine inpatient department and the outpatient unit of a Portuguese hospital. The sample comprised 52 nurses and 99 patients. For data collection, we used interviews, participant observation and content analysis.

Results

The main elements of nursing clinical practice that were identified as a focus for improvement measures were the healthcare model, the organization of healthcare and the documentation of a support decision‐making process. The specific guidelines, the provision of material to support decision‐making and the optimization of information sharing between professionals positively influenced the change process. This change improved the development of self‐management skills related to the awareness of the need for ‘change’, hope, involvement, knowledge and abilities.

Discussion

The implemented changes have improved health‐related behaviours and clinical outcomes.

Conclusion

To support self‐management development skills, an effective nursing clinical practice change is needed. This study has demonstrated the relevance of a portfolio of techniques and tools to help patients adopt healthy behaviours.

Implications for nursing and/or health policy

The involvement and participation of nurses and patients in the conceptualization, implementation and evaluation of policy change are fundamental issues to improve the quality of nursing care and clinical outcomes.     

How clinicians in neonatal care see the introduction of neonatal nurse practitioners

The aim of this study was to investigate the views of UK clinicians in neonatal care who were working with nurses trained as neonatal nurse practitioners (NNPs). A questionnaire survey was used with a total sample of senior clinicians in the 66 neonatal units with one or more qualified NNPs. The main outcome measures were type and frequency of response, and similar data from NNPs were used to make comparisons. Data were returned from 57 of the 66 clinicians contacted (86%). NNP clinical practice as perceived by them was largely similar to that recorded by NNPs, though the clinicians expected more NNP involvement in some procedures (inserting central venous lines, umbilical arterial catheters, chest drains and peripheral arterial cannulae) than was actually found. Perceptions of the NNP role were similar, though the clinicians were significantly less likely to see taking a case-load, conducting a ward round, accepting outside referrals and taking charge of emergency transfers as integral elements. Reflections on the utilization of NNPs in neonatal care and the impact on junior medical staff education referred to NNPs filling gaps, a reduction in the intensity of work, improvements in training and in the quality of care.

Conclusion : The introduction of NNPs is seen positively from the perspective of clinicians working alongside them in neonatal care. The development of similar models of care in countries where the introduction of NNPs is being considered is likely to be similarly supported.     

Eternity and clinical translation of speech-language pathology research

The work we do as clinicians and researchers is forever vulnerable to political trends which can cause dramatic and rapid change in higher education. A current example is the funding of universities according to the value of their research outputs. In comparison to some other domains of health care, the discipline of speech-language pathology is particularly vulnerable to such politics. If we have evolved, we can devolve. The thesis here is that this matter concerns clinicians and clinical researchers, and that both parties need to shore up their relationship to ensure that this discipline has a guaranteed passage into eternity. This can be achieved by sharpening the focus of clinical research and driving its translation into clinical practices. The different and complementary contributions that clinicians and clinical researchers can make to that pursuit are discussed. It is argued that clinicians and clinical researchers can best pursue their necessary relationship with models of spatial cohabitation, and four models are presented for how that might be achieved. The paper concludes with some speculations about alternatives to eternity for the discipline of speech-language pathology.     

处方书写不合格情况调查分析

目的:调查分析本院处方书写不合格情况,进一步提高医师正确书写处方的好习惯,加强药师对处方的审核力度.方法:采用回顾性分析方法,抽取本院2010年处方12 186张,依据<处方管理办法>(中华人民共和国卫生部第53号令于2007年2月14日发布)中的有关规定,对处方进行检查.结果:不合格处方共321张,占抽查总数的2.6...     

医学专业精神培养的教学模式研究

近年来,在世界范围内,医疗服务提供体系的变化、市场机制的引入以及卫生体制改革中的误区等都对传统医学专业精神形成了强大的挑战,因此进行在市场经济条件下医学专业精神培养的教学模式改革,对于增强医患关系、构建和谐社会具有重要的理论与实践意义。在此分析了目前我国医学教育中临床医师专业精神的现状及其产生原因,并对医学专业精神培养的教学模式进行了探讨。     

迎接信息时代的循证医学

Notlongago ,myclassmatesandIfinishedthecoursesofevidence basedmedicine (EBM )offeredtoseven year classmedicalstudents.Afterclass,wehadahotdiscussionaboutEBM .WeallagreedthatthemodeofEBMistheinevitabletendencyofthedevelopmentofmedicalsciencesinthe 2 1 stcentury ,andthatthetheoryofEBMisanessentialpartofbasicmedicaleducationforyoungclinicians.The 2 1 stcenturyisaninformationagecharacterizedbyexplosionofknowledge.Researcheshaveshowasthattheamountofadvancedknowledgewemasteredwilldecreaseobvio…