中医药在美国参与抗疫的障碍和机遇

中医药治疗新型冠状病毒肺炎(以下简称新冠肺炎)的"中国经验"要进入美国医疗系统会遇到很多障碍,包括中医药的定位、医院系统的屏障、专业执照的限制等等。海外中医界期待中国中医药临床研究的数据能够跨过循证医学的门槛,希望能用不可拒绝的诉求,以破例的方式打开西方现有医疗制度的壁垒。其实,无论海外中医界最终能以何种方式参与,这次百年不遇的抗疫大战可能成为一次发展的契机。作者特别提醒海外中医界关注大疫之后医疗需求的变化和中医针灸擅长领域的真正机遇。     

社会办医的新时期：机遇、挑战与对策

国家对社会资本举办医疗机构的重视不断增强,社会办医的发展具备政策、经济和社会等方面的条件,社会办医发展不断加速.但加快发展社会办医仍然存在目标和定位不清、社会资本引入动力不足、可持续性发展困难、政府和市场角色混淆和监管不力等问题.本文在分析了社会办医发展现状的基础上明确了加快发展社会办医的机遇与挑战,并提出了应对挑战的对策建议,即拓宽社会办医的服务内容与人群、创造良好的资本进入环境、促进社会办医可持续性发展、明确政府和市场在社会办医中的职能和加强对社会办医的监管.     

Reports

This paper proposes the clinical setting as an ideal learning environment for the development of skills conducive to collaborative practice. The argument is supported by findings from a small evaluation study. One cohort of physiotherapy students (n = 43) were surveyed immediately prior to their graduation in 1997, regarding their experience of the availability and quality of interprofessional learning opportunities in the various clinical placement areas, that comprised the final and intensive component of their clinical education programme. Their perception of interprofessional learning processes and outcomes was explored and their views as to factors that facilitated or inhibited their learning elicited. Interprofessional learning opportunities were available across the practice spectrum with a slightly more positive 'snapshot' of collaborative practice in the acute sector depicted. Case conferences, team meetings, ward rounds and discharge planning were confirmed as important interprofessional learning activities. Innovative methods of promoting collaborative practice and prerequisite skills, used currently by therapists, acting as clinical educators, emerged as potential strategies for interprofessional clinical education. The importance of the educational skill and orientation of the clinical educator in nurturing team skills development in students was highlighted.     

药物基因组学临床部署现状及在中国的机遇与挑战

药物基因组学（pharmacogenomics,PGx）作为精准医学临床部署的首选领域,具有广阔的发展前景。目前国外已将抗肿瘤、慢病管理、华法林抗凝等领域的PGx数据部署到电子病历系统中,以辅助临床决策。而我国因电子病历系统升级改造复杂,基因检测技术不高、费用高昂,PGx知识库缺乏等多方面复杂因素制约,PGx的临床部署仍存在巨大挑战。作者旨在借鉴PGx临床部署在国外取得的成绩,分析其在我国临床部署中面临的机遇和挑战,以推进我国PGx临床部署的顺利开展和实施,贯彻落实其在临床辅助决策系统中的应用。     

中国免疫规划工作面临的挑战和机遇与对策

在总结中国免疫规划工作与分析国内外现状的基础上,剖析了新时期中国免疫规划工作面临的挑战与机遇,并对如何做好中国免疫规划工作提出了若干具体对策。     

Night shift work experiences among Iranian nurses: a qualitative study

Aim:  To describe the perceptions held by Iranian registered nurses (IRNs) concerning their night shift work experiences.
Background:  Due to the nature of nursing work and the need for 24-h coverage every day, the majority of nurses work night shifts in their professional practice. Evidence from several studies indicates that night working is a challenge for most nurses. This situation can cause many forms of physical and emotional stress.
Methods:  A qualitative design was used with purposeful sampling. Eighteen IRNs from four different general educational hospitals in Iran took part in the study. Data were collected via semi-structured interviews and analysed according to qualitative content analysis.
Findings:  Three main themes were identified from the data: (a) socio-cultural impacts of night work, (b) health-related impacts of night work, and (c) night work as an opportunity for gaining more clinical experiences and learning more.
Conclusion:  The impact of shift work on nurses' daily professional behaviour and adverse health outcomes related to shift work should be well understood and considered when organizing healthcare systems. We need to identify ways to support nurses who work nights and also give attention to the caregiver's needs.     

Brachytherapy in India: Learning from the past and looking into the future

India has a longstanding tradition in the practice of brachytherapy and has actively contributed to the scientific literature by conducting prospective studies, clinical audits, developing innovative techniques, and performing randomized studies. Indian investigators have also contributed to international collaborative research, education, training programs along with guideline development for brachytherapy in cervix and head and neck cancers. The present article summarizes the key contributions to scientific literature, current infrastructure, skill set for brachytherapy, existing challenges, and strategy to further strengthen brachytherapy practice in the next decade.     

Work environment issues and intention-to-leave in Portuguese nurses: A cross-sectional study

This study extends the Registered Nurses Forecasting (RN4CAST) study evidence base with newly collected data from Portuguese nurses working in acute care hospitals, in which the measurement of the quality of work environment, workload and its association with intention-to-leave emerge as of key importance. Data included surveys of 2235 nurses in 144 nursing units in 31 hospitals via stratified random sampling. Multilevel multivariate regression analysis shows that intention-to-leave is higher among nurses with a specialty degree, nurses aged 35–39, and in nursing units where nurses are less satisfied with opportunities for career advancement, staffing levels and participation in hospital affairs. Analysis with moderation effects showed the observed effect of age and of having a specialty degree on intention-to-leave during the regression analysis is reduced in nursing units where nurses are more satisfied with opportunities for career advancement. The most important finding from the study suggests that promoting retention strategies that increase satisfaction with opportunities for career advancement among Portuguese nurses has the potential to override individual characteristics associated with increased turnover intentions.