General practice pharmacists in England: Integration,mediation and professional dynamics

BackgroundA number of key publications in recent years have advocated a more integrated vision of UK primary care involving increased multi-professional communication and understanding. This has resulted in a marked change in the roles being undertaken by pharmacists. Community pharmacists have traditionally provided a medicine supply function and treated minor ailments in addition to delivering a suite of locally commissioned services; however these functions have not necessarily been part of a programme of care involving the other clinicians associated with the patient. An integrated model of care would see much closer working between pharmacy and general practice but also with pharmacists not only working with, but in the practice, in an enhanced patient-facing role, trained as independent prescribers. This has implications for the dynamics amongst professionals in this environment.ObjectivesThis exploratory multiple case study attempts to explore these changing dynamics across ten GP surgeries throughout the South-East of England.MethodsSemi-structured, in-depth interviews were conducted with one nurse, one pharmacist and one physician from each clinic, and survey data was collected from 38 patients who had appointments with a pharmacist.ResultsThe data suggested that the pharmacists who had enhanced roles perceived some uncertainty about their professional role and identity, which resulted in instability and insecurity and that this uncertainty led to both professional and interprofessional tension with their primary care colleagues. The survey data revealed that n = 35 (92%) patients stated they were ‘very satisfied’ or ‘satisfied’ with their appointment. And n = 37 (97%) were ‘very comfortable’ or ‘comfortable’ discussing their medications with the pharmacist. In addition, 36 patients (95%) reported that they strongly agreed or agreed with the clinical recommendations made by the pharmacist.ConclusionsThese findings are discussed in relation to role expansion and professional/interprofessional relations before key practical suggestions are offered.     

基层医疗卫生服务整合的国际经验及对我国的启示

目的:总结典型国家基层卫生服务提供中实现医防整合的经验,为我国基层医疗卫生服务整合提供借鉴。方法:本研究方法为文献研究。结果:在个人层面,英国、泰国、古巴培养全科医生作为"守门人"并将其作为提供医防整合服务的主体;在机构层面,各国基层机构组成服务网络,内部强调跨学科合作;在体系层面,通过横向合作和有序的首诊与转诊协调服务;国家立法保障和健康保险筹资等引导支持基层医疗卫生服务整合。结论:培养和配置高质量的医防一体的全科医生、促进机构跨学科融合、通过立法和筹资体系予以保障是各国提供基层整合型服务的核心,值得我国基层医防服务整合借鉴。     

面向医患连接的慢性病诊后服务平台设计与应用

目的:构建面向医患连接的慢性病诊后服务平台,实现院内院外慢性病患者诊疗的无缝连接。方法:针对慢性病患者需长期干预指导的需求,重点解决医患连接、健康宣教、体征监测和个性化指导等难题,设计和实现慢性病诊后服务平台。结果:平台投入实际使用,共服务患者1.5万人次以上而且易使用、易维护。结论:面向医患连接的诊后服务方式,实现了慢性病患者的持续干预指导,促进医患关系和谐,提升了慢病治疗的效果以及患者体验。     

构建数字化、可视化教学平台实现妇产科学教学手段多元化

介绍了构建数字化、可视化教学平台,实现妇产科教学手段多元化的做法。内容包括多媒体课件开发制作,利用医学视听教材,建设妇产科图片数据库,建设妇产科标本库(馆),利用模型、模块进行模拟操作,加强实践技能培养和通过临床见习、实习将理论应用于实践等问题。     

中药口服与灌肠配合氦-氖激光治疗老年人慢性肾功能衰竭临床观察

观察调中益肾活血通腑中药口服与灌肠配合低能量氦 -氖激光血管内照射(ILIB)疗法对老年人慢性肾功能衰竭 (CRF)的疗效。治疗组予中药口服与灌肠配合ILIB疗法 ,并与阳性对照药依那普利作比较。结果 :两组病例在Scr、BUN、尿蛋白方面均有显著降低 ,但治疗组在改善临床症状、提高红细胞SOD及血浆免疫球蛋白方面均优于对照组。结论 :调中益肾活血通腑中药口服与灌肠配合ILIB疗法具有明显改善老年CRF的肾功能、调整胃肠机能、提高机体免疫能力的作用。     

Midterm results of mobile-bearing knee replacements

We examined the clinical and radiographic results of 93 patients affected by knee arthritis or osteonecrosis subjected to unilateral cementless mobile-bearing total knee arthroplasty with the LCS prothesis (Depuy/Johnson & Johnson). The mean follow-up was 9.5 years (range, 7–12 years). Clinical evaluation was performed using the Knee Society rating system, while radiographic evaluation was done according to the Knee Society roentgenographic system. At the latest follow-up, the mean knee score was 87 points: the functional score improved from 40 to 90. Radiolucent lines were small and not progressive. The implant survival at 12 years was 88%. Six knees (7%) required revision for implant-related problems. We conclude that the mobile-bearing prosthesis is a successful device even at long-term follow-up.     

生物化学与细胞生物学课程整合的探讨

为了适应新世纪教学内容和课程体系改革的要求,我校借鉴美国哈佛大学医学院的经验,将生物化学与细胞生物学两门课程整合为“细胞的化学与生物学”。整合后在减少两个学科间重复内容、增加学科间联系、减少学时、早期接触临床、培养学生分析解决问题的能力、创新能力等方面有了很大改进,为这两门课程的改革开辟了新途径。     

HBV DNA及HBxDNA亚片段在肝癌细胞内的整合及作用

为探讨ＨＢＶＤＮＡ及其亚基因片段ＨＢｘＤＮ在肝细胞肝癌（ＨＣＣ）中整合特点用机制，制备了地高辛标记的３．２ｋｂＨＢＶＤＮＡ全基因及０．５９ｋｂＨＢＶＤＮＡ／ＢａｍＨＩ，ＢｇｌⅡＢＨｘＤＮＡ亚基因探针。点杂交、原位杂交及Ｓｏｕｔｈｅｒｎ杂交检测ＨＢＶＤＮＡ的存在情况，筛选ＨＢＶＤＮＡ纯整合标本，以ＨＢｘＤＮＡ探针检测ＨＢｘＤＮＡ在ＨＣＣ染色体的整合。结果显示ＨＢＶＤＮＡ在肝细胞内以核型为主（７０％）     

我国医院信息系统必走整合之路

论述了我国医院信息系统(HIS)整合的重要意义和原则,介绍了HIS整合的方法措施以及经验.