模拟诊疗在留学生心血管内科实习带教中的应用研究

目的　探讨模拟诊疗在留学生心血管内科实习带教中的应用效果。方法　将35名留学生随机编号，分成试验组和对照组。试验组18名学生分成3组（每组6名）进行模拟诊疗教学，对照组17名学生进行常规实习。通过填写评价单和相关的临床能力测试对两组教学效果进行评价。选用SPSS 19.0软件进行t检验。结果　参与模拟诊疗教学的留学生均希望在各科实习中多采用此方法。在临床能力测试方面，试验组学生在病史采集[（22.16±2.17）vs.（20.33±2.03）]、体格检查[（23.05±1.79）vs.（19.78±2.05）]及回答问题[（23.50±1.47）vs.（19.56±1.92）]方面均优于对照组，差异有统计学意义（P<0.05）。但是在病历书写方面，两组差异无统计学意义（P>0.05）。结论　利用高仿真的模拟诊疗教学手段，弥补了留学生在实习期间不能充分接触患者的缺陷，有助于提高其临床操作技能、增强医患沟通能力等医学职业素养。     

占永立教授从咽论治IgA肾病的理论与实践探析

本文从理论与临床实践2方面总结了占永立教授从咽论治IgA肾病的经验。占教授将Ig A肾病分为3型进行辨证论治:1)肺气不足,热毒扰咽证; 2)脾气虚弱,热邪客咽证; 3)肾阴亏虚,余热留咽证。治疗上以清热解毒利咽为主,兼以扶正,根据病情灵活选方用药,取得较好的临床疗效。     

Implantación de Guías de buenas prácticas en España a través del Programa de Centros Comprometidos con la Excelencia en Cuidados®

The implementation of Best practice guidelines is effective in improving clinical practice and reducing clinical variability. The Best Practice Guidelines of the Ontario Nurses Association have been implemented in Spain since 2012 following the principles of the Canadian programme of the Best Practice Spotlight Organisations® (BPSO®). The Nursing and Healthcare Research Unit (Investén-isciii) coordinates this programme in Spain, having been nominated BPSO Host by the Ontario Nurses Association.Four strategies were followed: translation of the Best Practice Guidelines, dissemination of same and of the programme, implementation of the Best Practice Guidelines and assessment of the results in competitively selected centres, and, finally, the development of sustainability mechanisms.Implementation is based on the theoretical Knowledge to Action model, which establishes a cycle of 6 phases: identification of the problem and training of selected BPSO®; adaptation to the local context; assessment of facilitators and barriers; adaptation and implementation of interventions; monitoring and evaluation of results, and sustainability. Each of these phases incorporate evidence-based elements that promote the effectiveness of implementation, such as the competitive selection of candidates to participate in the programme, selection by the institution of the guidelines to be implemented, leadership by nurses with a multi-professional approach, planning of the process from work structures that are non-vertical but with the support of the institution, the simultaneous use of multiple strategies, ongoing assessment and feedback of results. All of which is mentored and supported by the BPSO Host.There are currently 27 institutions in Spain of different characteristics that implement a total of 20 clinical guidelines. The scope and structure of the programme has recently been extended with regional BPSO Host coordinating centres, which has brought the number of institutions to 36 and the number of implemented clinical guidelines to 22.The programme has had a positive impact on organisations and the system, on care processes and on patient health. This is evidenced by enriched evidence-based professional practice, the promotion of collaborative networking and by improved patient health outcomes and the quality of care provided.     

思维导图在本科护生精神科实习带教中的应用

目的　探讨思维导图在本科护生精神科实习带教中的应用效果。方法　选取2018年6月至12月31名本科护生为试验组，采用思维导图进行带教；选取2019年4月至7月32名本科护生作为对照组，采用传统的带教方法进行带教。比较两组前后评判性思维能力、对带教方法的评价，以及两组护生的理论、操作考试成绩。采用SPSS 20.0进行t检验、卡方检验和秩和检验。结果　试验组在评判性思维能力量表各项得分明显提高，由带教前的（248.09±24.45）分提高至（331.03±14.31）分，且高于对照组（P<0.05）。试验组在带教方法肯定性评价各项得分均高于对照组，差异均有统计学意义（P<0.05）。试验组带教后理论成绩为（88.35±7.71）分、操作考试成绩为（86.45±5.03）分，对照组带教后理论成绩为（74.41±10.27）分、操作考试成绩为（81.02±6.64）分，两组比较差异有统计学意义（P<0.05）。结论　运用思维导图对精神科护生进行临床带教，提高了护生学习积极性，学习由被动变主动，同时促进了护生评判性思维能力培养，值得临床推广。     

Enhancing medical radiation science education through a design science research methodology

Recently, there has been a call for research-informed and research-developed practice in health sciences education. This prompts the consideration of alternative suitable research approaches that could be used to enhance health sciences education practice, including medical radiation sciences education (MRSE) practice. In this discussion paper, the authors uphold design science research (DSR) methodology as a suitable research approach to enhance MRSE practice and research. An overview of the DSR methodology and an example of a project that used DSR methodology are presented to demonstrate the application of this methodology in MRSE practice and research. The paper concludes that the use of DSR methodology could be instrumental in addressing practice related challenges while developing a theoretical contribution to the discipline.     

Practice guidelines: the radiology perspective

Clinical practice guidelines have emerged as a reality for medical practitioners over the past 20 years. Although virtually all groups interested in the development of practice guidelines hope for improvements in patient care, secondary expectations vary widely among those using them. Their use in daily practice by physicians has met with resistance from barriers including concerns of “cookbook” medicine, a loss of autonomy, and increased professional liability. The recent experience of the ACR in addressing these challenges illustrates that physicians are receptive to steps perceived to mitigate the risks accompanying the use of guidelines as well as to efforts to increase their understanding of implementing guidelines in clinical practice. The experiences of other medical societies and an inventory of future trends reveal additional challenges associated with the use of practice guidelines, as third parties look to guidelines as points of reference for gauging the performance of health care providers.     

基层药品不良反应监测体系建设的实践和探讨

目的 探讨基层药品不良反应监测网络建设模式,为药品不良反应监测组织体系的完善提供参考.方法 通过建立山东省基层药品不良反应监测网络的实践,研究、分析基层药品不良反应监测网络的建设模式.结果 建立了高效、快捷的三级药品不良反应监测网络,促进了山东省药品不良反应监测工作的全面发展.结论 建立健全机构设施完备、职责明确、运作规范的基层监测网络,有利于完善我国药品不良反应监测组织体系,推动药品不良反应监测工作的深入开展.