Why Patients Visit Dentists – A Study in all World Health Organization Regions

ObjectiveThe dimensions of oral health–related quality of life (OHRQoL) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the major areas where patients are impacted by oral diseases and dental interventions. The aim of this study was to evaluate whether dental patients' reasons to visit the dentist fit the 4 OHRQoL dimensions.MethodsDentists (N = 1580) from 32 countries participated in a web-based survey. For their patients with current oral health problems, dentists were asked whether these problems were related to teeth, mouth, and jaws' function, pain, appearance, or psychosocial impact or whether they do not fit the aforementioned 4 categories. Dentists were also asked about their patients who intended to prevent future oral health problems. For both patient groups, the proportions of oral health problems falling into the 4 OHRQoL dimensions were calculated.ResultsFor every 100 dental patients with current oral health problems, 96 had problems related to teeth, mouth, and jaws' function, pain, appearance, or psychosocial impact. For every 100 dental patients who wanted to prevent future oral health problems, 92 wanted to prevent problems related to these 4 OHRQoL dimensions. Both numbers increased to at least 98 of 100 patients when experts analyzed dentists' explanations of why some oral health problems would not fit the four dimension. For the remaining 2 of 100 patients, none of the dentist-provided explanations suggested evidence against the OHRQoL dimensions as the concepts that capture dental patients' suffering.ConclusionOral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact capture dental patients' oral health problems worldwide. These 4 OHRQoL dimensions offer a psychometrically sound and practical framework for patient care and research, identifying what is important to dental patients.     

问题导向式护理干预对老年2型糖尿病患者自护能力及疾病感知能力的影响

目的探究问题导向式护理干预对老年2型糖尿病（T2DM）患者自护能力和疾病感知能力的影响。 方法选择2016年11月至2018年11月海军第九七一医院的老年T2DM患者42例,进行为期6个月的问题导向式护理干预。对比护理干预前后患者的血糖控制情况、自护能力和疾病感知能力。自护能力使用糖尿病自护行为量表进行评价,疾病感知能力使用糖尿病疾病感知问卷简表进行评价。干预前后各指标的比较采用t检验。 结果与干预前比较,护理干预后患者的空腹血糖、餐后2 h血糖、糖化血红蛋白均明显下降（t=5.183、14.188、4.926,P<0.05）,自护能力各项目（总体饮食、具体饮食、运动、血糖测试、足部护理、吸烟）和疾病感知能力各项目（认知描绘、情绪描绘、综合理解）评分均明显提高（t=14.730、12.965、6.414、10.995、10.525、10.502、9.879、10.926、23.662,P<0.05）。 结论问题导向式护理干预能够通过提高老年T2DM患者的自护能力和疾病感知能力,达到更好地控制血糖的目的。     

From a conceptual problem-oriented electronic patient record model to running systems: a nationwide assessment

BACKGROUND: The development of problem-oriented conceptual models for electronic patient record (EPR) systems can improve data communication between health professionals. But little has been done so far to investigate to what extent it is possible to implement such models in operational EPR systems. OBJECTIVE: In this paper, we measure the conformance between a conceptual model and the various ways it is implemented within general practitioners' (GPs') electronic patient records. METHODS: We started from a simple problem-oriented conceptual model and we defined an original discriminating method to assess its implementation. This method is scenario-based (dummy patient), functional, and relative (comparison between software systems). Each implementation is assessed by two evaluators and the final result is a "success/failure" score. The assessment was performed within the scope of the official Belgian accreditation procedure for GPs' electronic patient records, which is voluntary, publicly funded, and based on a dynamic quality improvement paradigm. Almost all Belgian GPs' software systems (17) were assessed. The robustness of our results was assessed through a sensitivity analysis. RESULTS: We found that 65% (11/17) of the software systems currently used succeeded in implementing the problem-oriented conceptual model with a high confidence level (error rate<10%). The results were widely accepted by the software developers. CONCLUSIONS: A problem-oriented conceptual model can be successfully implemented in many operational EPR systems. The quality of the implementation can be assessed. Our results could be used at the international level to improve semantic interoperability between patient information systems, for instance in relation to broader conceptual models such as the European CONTsys pre-norm.     

Problem-oriented patient record model as a conceptual foundation for a multi-professional electronic patient record

OBJECTIVE: It is widely accepted that the development of electronic patient records, or even of a common electronic patient record, is one possible way to improve cooperation and data communication between nurses and physicians. Yet, little has been done so far to develop a common conceptual model for both medical and nursing patient records, which is a first challenge that should be met to set up a common electronic patient record. In this paper, we describe a problem-oriented conceptual model and we show how it may suit both nursing and medical perspectives in a hospital setting. METHODS: We started from existing nursing theory and from an initial model previously set up for primary care. In a hospital pilot site, a multi-disciplinary team refined this model using one large and complex clinical case (retrospective study) and nine ongoing cases (prospective study). An internal validation was performed through hospital-wide multi-professional interviews and through discussions around a graphical user interface prototype. To assess the consistency of the model, a computer engineer specified it. Finally, a Belgian expert working group performed an external assessment of the model. RESULTS: As a basis for a common patient record we propose a simple problem-oriented conceptual model with two levels of meta-information. The model is mapped with current nursing theories and it includes the following concepts: "health care element", "health approach", "health agent", "contact", "subcontact" and "service". These concepts, their interrelationships and some practical rules for using the model are illustrated in this paper. Our results are compatible with ongoing standardization work at the Belgian and European levels. CONCLUSIONS: Our conceptual model is potentially a foundation for a multi-professional electronic patient record that is problem-oriented and therefore patient-centred.     

问题导向干预对卵巢癌患者应对方式及心理弹性的影响

目的探讨问题导向干预对卵巢癌患者应对方式及心理弹性的影响。方法选取96例卵巢癌患者,随机分为两组各48例,对照组行常规护理,观察组在对照组基础上行问题导向护理干预,比较两组的应对方式和心理弹性。结果干预后,观察组的面对评分显著高于对照组,屈服和回避评分显著低于对照组,心理弹性各项目评分均显著高于对照组(P<0.05)。结论问题导向干预能有效缓解卵巢癌患者的负面情绪,增加积极应对方式,提升心理弹性,促进患者转归。     

以问题为导向的团队合作模式在提升急重症护士科研能力中的作用

目的提高急重症护理人员发现临床问题及科研创作的能力。 方法分别将组建科研创作组前后急重症医学中心的科研创作过程设为对照组和观察组,观察组按6个阶段实施团队科研创作,6个阶段包括：收集筛选临床护理问题、资料查询、确定命题、小组撰写、集中修改及成果发表。观察两组课题撰写立项、论文发表、核心期刊论文占比、专利成果等科研成果指标。 结果采取以问题为导向的团队科研创作模式,与组建科研论文创作小组前比较,护理人员在课题撰写、专利成果和论文创作成果等指标,两组比较差异有统计学意义(P值分别<0.05及<0.01)。 结论采取以问题为导向的团队创作模式,能明显提高护理人员发现问题的能力,提高创作积极性及科研创作能力。     

医学信息管理专业学生计算思维能力的培养

以计算机网络课程教学为例,探讨医学信息管理专业学生计算思维能力的培养。将灵活多样的教学模式引入计算机网络教学过程中,从基于问题导向的理论教学、项目驱动式的实验教学、融会贯通的课程设计以及多元评价考核方式4方面阐述该教学形式的应用及效果。     

Prevention for elderly people: demand-oriented or problem-oriented?

Objective

To examine the association between self-expressed information needs and corresponding observed health and lifestyle issues in elderly people.

Methods

Data were used from the 2006 community health survey in Utrecht, a medium-sized city in the Netherlands. Data of 1634 people aged 55 years and older were available for analyses (response 64%). Multivariate logistic regression analyses were used to examine possible associations between expressed information needs and variables on demographics, lifestyle risk behaviours, physical and psychosocial health.

Results

Several significant associations were found between information needs and corresponding health and lifestyle problems. However, the explanatory power of the observed problems was generally low, explaining only 7% of the informational needs on lifestyle, and 17% and 28% of the informational needs on physical and psychosocial health, respectively.

Conclusions

The findings suggest that prevention amongst the elderly should not be solely based on information needs, but also on observed lifestyle and health. Implications for the use of different approaches of prevention and behavioural models underlying interventions are discussed.     

以问题为导向的目标教育对临时回肠造口患者自护行为及生活质量的影响

目的 探讨以问题为导向的目标教育对临时回肠造口患者自护行为及生活质量的影响。方法 选取2018年6月—2019年6月普外科收治的临时回肠造口患者92例,按照随机数字表法将所有患者分为对照组及观察组,各46例,对照组行常规健康指导,观察组以问题为导向对患者实施肠造口自我管理,比较2组患者自护行为及生活质量,并记录2组随访期间造口并发症发生率。结果 干预后观察组自护意愿、自护知识、自护技能及自护能力总评分均高于对照组(P＜0.05)。观察组造口并发症发生率明显低于对照组(χ²=48.470,P<0.001)。观察组干预后躯体症状、认知理解能力、社会角色功能、社交能力、情绪控制能力及总分均高于对照组(P＜0.05)。结论 以问题为导向的目标教育可提高临时回肠造口患者自护行为,降低造口相关并发症,提高患者生活质量。     

以问题为导向的小组教学在《护理教育学》教学中的应用

目的 探究以问题为导向的小组教学在《护理教育学》教学中的应用。方法 采用便利抽样法选取护理本科班参与《护理教育学》授课的76名学生为研究对象,将接受传统教学授课的学生纳入对照组（n=38）,接受以问题为导向的小组教学授课的学生纳入观察组（n=38）,评价两组学习效果、信息意识以及教学满意度。采用SPSS 20.0进行t检验和卡方检验。结果 观察组学生平时成绩、期末考试成绩及总成绩分数均高于对照组（P<0.05）;两组学习前信息行为倾向评分、信息认知评分及总分比较差异无统计学意义,学习后上述评分均上升,观察组高于对照组（P<0.05）;观察组学生教学效率、激发学习主动性、教学方式方法、带教教师态度满意率均高于对照组（P<0.05）。结论 在《护理教育学》教学中采用以问题为导向的小组教学,可提升学生学习效果、信息意识以及教学满意度,可在教学中推广。