非药物医嘱闭环管理探讨

通过建立由医嘱开立系统、临床数据平台、预约系统、各专科专项信息系统组成的医嘱闭环管理系统,实现信息交互共享,使检查、检验、输血、手术、治疗类等非药物医嘱各执行环节实时准确操作和记录,形成管理闭环。这避免了医疗差错发生,规范了诊疗流程,使医嘱执行全过程准确记录且可追溯,并对医嘱管理信息实时质控。下一步需加大信息化建设力度,对医嘱记录信息进行全方位监控和处理分析,从而进一步提高医疗质量。     

The impact of subthalamic deep brain stimulation on belief revision and social validation

We investigated whether Deep Brain Stimulation (DBS) of the subthalamic nucleus (STN) influences social validation as measured by a Judge-Advisor task. In contrast to healthy controls and patients with their DBS OFF, patients with their stimulation switched on do not experience a gain of confidence after receiving competent advice.     

Ward nurses' evaluation of critical care outreach

Following the recommendation to introduce critical care outreach, two different models on two hospital sites were introduced within a large teaching Trust. To establish ward nurses' views and opinions of important components of the two outreach models, a questionnaire survey was undertaken involving 134 ward nurses on the awareness of outreach, accessibility of outreach and usage of outreach. The results identified a high level of user satisfaction amongst ward nurses. Awareness of critical care outreach and how to access the service within a hospital site was good, with little differences between the two different models. Outreach was found to provide ward nurses with better skills, more knowledge, advice and support. Providing a 24-h service and continual critical care education and training opportunities are the suggested ways to improve outreach in the future.     

Treatment of sleep problems in families with small children: is written information enough?

The aim of this study was to evaluate a standardized sleep programme, i.e. a two-step variation of graduated extinction, where the child is first taught to fall asleep by him/herself at bedtime (first intervention) and 2 wk later also after night wakings (second intervention). The outcome after consultations with a therapist followed by telephone support during both interventions was compared with the outcome after giving written information only during the first intervention and therapist support during the second. A total of 67 families with infants exhibiting spontaneous awakening and crying episodes during the night were randomly assigned to either programme. There were no significant differences in terms of outcome between the two groups. In both groups the number of registered night wakings decreased immediately following the first intervention. At registration, at 1 mo and 3 mo later, all parents, with the exception of one couple at the 3-mo follow-up, reported that the sleep problem had improved. Conclusion: If parents experience their infant's night awakenings as a problem, teaching their infant to fall asleep by him/herself usually solves this problem quickly. Written information is in most cases sufficient to help parents introduce the new evening routines.     

Advice for the management of low back pain: a systematic review of randomised controlled trials

To synthesise the evidence relating to the effectiveness of advice, the relevance of its content and frequency, and to compare the advice being offered to acute, subacute and chronic low back pain (LBP) patients. A systematic review of Randomised Controlled Trials (RCTs) using advice, either alone or with another intervention. The QUOROM guidelines and the Cochrane Collaboration Back Review Group Guidelines for Systematic Reviews were followed throughout: methodological assessment identified RCTs of ‘high’ or ‘medium’ methodological quality, based on their inclusion of at least 50% of the specified internal validity criteria. Outcome measures were analysed based on five recommended core outcome domains; pain, work disability, back-specific function, generic health status and satisfaction with care. Relevant RCTs (n=56) were scored for methodological quality; 39 RCTs involving 7347 patients qualified for inclusion, based upon their methodological quality. Advice as an adjunct to exercise was most effective for improving pain, back-specific function and work disability in chronic LBP but, for acute LBP, was no more effective for improving these outcomes than simple advice to stay active. Advice as part of a back school was most effective for improving back-specific function in subacute LBP; these trials generally demonstrated long-term positive results. Advice as an adjunct to exercise was the most common form of treatment for acute and chronic LBP; advice as part of a back school was most commonly used for subacute LBP. Fifteen percent of acute LBP trials had a positive outcome, compared to 86% and 74% of subacute and chronic LBP trials respectively. A wide variety of outcome measures were used, making valid comparisons between treatment outcomes difficult. The advice provided to patients with LBP within RCTs varied considerably depending on symptom duration. The findings of this review have important implications for clinical practice, and for the design of further clinical trials in this area. Advice to stay active is sufficient for acute LBP; however, it appears that RCTs do not commonly reflect these recommendations. No conclusions could be drawn as to the content and frequency of advice that is most effective for subacute LBP, due to the limited number and poor quality of RCTs in this area: this review provides preliminary support for advice as part of a back school approach. Given that the effectiveness of treatment for subacute symptoms will directly influence the development of chronicity, these results would suggest that education and awareness of the causes and consequences of back pain may be a valuable treatment component for this patient subgroup. For chronic LBP there is strong evidence to support the use of advice to remain active in addition to specific advice relating to the most appropriate exercise, and/or functional activities to promote active self-management. More investigation is needed into the role of follow-up advice for chronic LBP patients.     

零售药店承接医疗机构药房职能的思考

我国医改方案中明确提出医药要分开,《全国药品流通行业发展规划纲要(2011～2015年)》提出"鼓励连锁药店积极承接医疗机构药房服务和其他专业服务",而承接医疗机构药房职能是一个系统而又复杂的工程。本文对我国零售药店现状进行分析,提出零售药店承接医疗机构药房职能的建议。     

To you I am listening: Perceived competence of advisors influences judgment and decision-making via recruitment of the amygdala

Considering advice from others is a pervasive element of human social life. We used the judge-advisor paradigm to investigate the neural correlates of advice evaluation and advice integration by means of functional magnetic resonance imaging. Our results demonstrate that evaluating advice recruits the “mentalizing network,” brain regions activated when people think about others' mental states. Important activation differences exist, however, depending upon the perceived competence of the advisor. Consistently, additional analyses demonstrate that integrating others' advice, i.e., how much participants actually adjust their initial estimate, correlates with neural activity in the centromedial amygdala in the case of a competent and with activity in visual cortex in the case of an incompetent advisor. Taken together, our findings, therefore, demonstrate that advice evaluation and integration rely on dissociable neural mechanisms and that significant differences exist depending upon the advisor's reputation, which suggests different modes of processing advice depending upon the perceived competence of the advisor.     

‘Doctor - when can I drive?’ – Advice obstetricians and gynaecologists give on driving after obstetric or gynaecological surgery

Advising patients when to drive after surgery is a common practice which gynaecologists need to do on a regular basis as a part of their duty to patients. We carried out a literature search regarding advice given on driving after gynaecological surgical procedures, and found no study or research on this area. We then carried out a questionnaire survey of 99 gynaecologists in Northern Ireland. We have identified wide variation in clinical practice, and advocate a United Kingdom wide survey and further studies to find out optimum time to drive after different gynaecological surgeries. There is a need for national guidelines on driving after surgery, which would be of great benefit to gynaecologists, patients, motor insurers, police and all other interested parties.     

Randomized controlled trial of motivational interviewing compared with drug information and advice for early intervention among young cannabis users

Aim To test the effectiveness of motivational interviewing (MI) in comparison with drug information and advice in opportunistically securing reductions in drug‐related risk among young cannabis users not seeking help. Design Randomized controlled trial. Setting Eleven London Further Education colleges. Participants A total of 326 students aged 16–19 years who smoked cannabis weekly or more frequently. Interventions Participants were randomized to a single‐session intervention of MI or drug information and advice‐giving. Measurements Cannabis use, cigarette smoking and alcohol consumption and harm outcomes were assessed after both 3 and 6 months. Findings No differences were found between MI and drug information and advice, although MI fidelity was not high. There were wide‐ranging individual practitioner effects on observed outcomes and a practitioner–intervention interaction was detected in relation to cannabis cessation after 3 months. Change over time was more pronounced for cannabis use than for other drug use. Conclusions Further study of the nature and consequences of MI fidelity, and individual practitioner effects more generally, is needed. Advice may be an effective brief intervention with young cannabis users in its own right and should be evaluated further in trials.