临床中药学的实践与思考

目的：探讨临床中药学在医院的实践问题。方法：结合某医院临床中药学开展的实际情况,总结阐述了临床中药学的主要内容、模式和面临问题。结果：医院开展临床中药学促进了医师在中药应用上的合理程度,减少了中药在临床中的不良反应。结论：在医院开展临床中药学十分必要,可以为临床医师提供中药指导,为广大患者提供高质量的中药服务。     

专科医师培训工作的实践与认识

专科医师培训是医学生成长为能独立从事临床医疗工作医生的关键阶段．属于毕业后医学教育范畴．是医学教育连续统一体的重要组成部分．对提升临床医生的临床诊疗水平、提高医疗质量发挥着重要作用Ⅲ。而目前我国的专科医师培训工作尚处于试点阶段．在此阶段医院如何有效地做好专科医师培训工作．是医院管理者急需考虑的问题。本文以医院管理者的视角．简要介绍医院医师培训的概况．分析医院开展专科医师培训工作取得的经验．并结合工作实践提出做好专科医师培训工作的措施和建议。     

医院图书馆在临床科研中的作用

医院图书馆是医学科技创新的重要组成部分,是开展医疗、教学和科研工作的信息支撑体系。医院图书馆主要通过加强用户培训教育,开展编制二次文献工作;加强信息导航,开展定题服务,在临床科研中发挥着信息保障作用。     

军队医院临床合同制医师心理健康调查

目的了解某军队医院临床一线合同制医师心理的健康状况。方法采用精神症状自评量表（SCL-90）对某军队医院78名合同制医师和52名在编医师进行心理健康状况问卷调查。结果合同制临床医师组的焦虑分、抑郁分和总均分高于国内常模,差异有统计学意义;合同制临床医师组的焦虑分、抑郁分高于在编临床医师组,差异有统计学意义;在编临床医师组SCL-90各项指标与国内常模差异无显著性。结论该所军队医院临床一线管床的合同制医师存在心理健康问题,有必要针对临床一线管床的合同制医师开展心理健康促进工作。     

医院图书馆为社区医疗服务初探

随着社区医疗服务的开展,医疗服务走向社会。医院图书馆必须适应新形势,积极为社区医疗服务。我院图书馆通过设立流动车,延长开馆时间,开展电话预约借书,开展信息服务、为咨询服务等。拓宽服务内容,真正发挥医院图书馆为医院科研、临床、教学、防病服务的职能,使医院图书馆走出了一条为社区医疗服务的新路子。     

以需求为导向探索医院青年医师科研能力提升对策

目的 了解北京某医院青年医师科研需求,探讨科研能力提升的对策。方法 通过查阅医院科研管理部门的数据、发放调查问卷和访谈一线科室等方式,对医院青年医师科研需求进行调查分析。结果 当前青年医师开展科学研究的主要原因和障碍是职称晋升和临床工作繁忙,以及青年医师科研需求量大。结论 结合青年医师的实际需求,提出完善政策引导、院级基金支持、搭建科研技术平台和加强交流培训的对策,促进医院青年医师科研能力的提升。     

重视临床病例讨论制度 持续改进医疗质量

临床病例讨论制度是医学院校附属医院的优良传统,但随着医院内专科细化的趋势不断增强,全院性病例讨论制度逐渐淡化。为了提升医院整体医疗水平的内涵质量,我院自2007年开始改进并实施了全院临床病例讨论制度,定期选择合适病例在全院范围内开展讨论和分析,帮助临床医师尤其是年轻医师不断改进和完善诊断思路,     

区属三级综合医院临床科室医师编制测算的实践探索

<正>临床医师是医院人力资源的核心组成部分，其合理配置事关医院的可持续发展。自新型冠状病毒感染疫情发生以来，区属三级综合医院的临床医师除完成本职工作外，还先后承担了支援发热门诊、外派核酸采样、开展疫苗接种、进驻隔离酒店和方舱医院及定点医院从事诊疗工作等疫情防控任务，工作量增加；同时，医院临床科室医师配置也面临着更高的要求。如何对临床科室医师编制进行科学测算及合理配置，是摆在区属三级综合医院面前的重要课题。本文以广州市白云区第二人民医院的临床科室医师编制测算为例，探析其创新和不足，为其他区属三级综合医院的相关工作提供经验借鉴和方法参考。本研究所选取的临床科室医师为科室同时拥有门诊和住院病房，     

医院图书馆为患者服务———健康教育的新尝试

美国医学会指出：医院是健康教育机构,具有为患者及其家属进行健康教育的义务。而作为医学信息的集散地的医院图书馆,理应同医院临床科室一道,参与到对患者的健康教育工作中去。本文借鉴发达国家医院图书馆为患者服务的实践经验,提出了在医院图书馆开展为患者服务的建议与思考。     

医院临床医师心理健康影响因素分析

本文从工作负荷、工作风险、医疗纠纷、个人发展、收入和工作环境等方面,分析医院临床医师心理压力大的原因,提出医院应开展心理健康咨询、营造适宜的工作环境、和谐医患关系及关注重点人群等对策,缓解临床医师的心理压力。     

循证医学环境下的临床医学图书馆员工作意义与素质探讨

循证医学是20世纪90年代迅速发展起来的一种临床实践的新模式和医疗决策的新思维,标志着临床医学将从经验医学阶段进入循证医学阶段。文章简述了循证医学的概念及其现状,以及临床医学图书馆员的最新服务模式。从当前临床医学发展的需要、临床医师的需要、图书馆自身发展的需要3个方面,分析了在循证医学环境下,临床医学图书馆员参与循证医学工作的重要意义。详细阐述了临床医学图书馆员作为循证医学最佳证据的提供者之一,必须熟练掌握信息技术及EBM知识,具有扎实的专业知识和技能,才能参与到循证医学工作中,并主动为临床医师提供高质量的情报信息服务。     

Evidence-based medicine in primary care: qualitative study of family physicians

Background

The objectives of this study were: a) to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM) in primary care; b) to investigate the influence of patient preferences on clinical decision-making; and c) to explore the role of intuition in family practice.

Method

Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians.

Results

Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician.

Discussion

Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.

     

艾滋病预防干预与循证医学

艾滋病是一种正在全球肆虐病死率极高的慢性传染病,给许多国家和地区带来了严重的危害,为控制其传播,人类社会动用了比任何一种疾病都要多的资源。循证医学是当今世界医学领域最重要、最活跃、最前沿的新兴学科。随着循证医学的发展和循证决策的思想日渐深入人心,循证医学也为艾滋病防治的科学决策提供了新的思路。该文从循证医学的定义、步骤、分析方法以及艾滋病预防干预中的循证实践进行了初步的讨论。目前,循证医学在我国的艾滋病预防干预领域里才刚刚起步,它的推广还需不断努力探索,任重而道远。     

From eminence-based practice to evidence-based practice: a paradigm shift

Evidence-based medicine differs from the traditional approach to health care in that in addition to relying on clinical experience, expert opinion, and knowledge of pathophysiology for clinical decision-making, clinicians identify important knowledge gaps and information needs, formulate answerable questions, identify potentially relevant research, assess the validity of evidence and results, and apply research evidence to individual patients in a way that takes into account the patients' particular experiences, expectations, and values. It is becoming increasingly important that physicians learn the concepts of EBM because many EBM-related concepts have become a part of daily clinical practice. This article uses examples from orthopedics to outline EBM principles and methods and the advantages of EBM over traditional approaches. It also discusses challenges in implementing EBM and suggests EBM-related resources for physicians.     

The political contexts of evidence-based medicine: policymaking for daily hemodialysis

Policymakers and clinicians increasingly rely on evidence-based medicine (EBM) to make decisions about insurance coverage and clinical treatment. Conflicting value judgments about evidence and pressures exerted by stakeholders render health policymaking a political process. This paper examines how value judgments become embedded in the process of improving medical outcomes by focusing on health policymaking. Specifically, this paper highlights how EBM is variably used as a standard for decision-making depending on perceived risks by policymakers and what is on the competing agenda. I draw upon the case study of the policymaking process for the recent US bill, H.R. 1004: Kidney Patient Daily Dialysis Act, which would legislate daily hemodialysis (DHD) as a new renal replacement therapy modality, and provide federal medicare funding of hemodialysis from 3 to 6 times per week. DHD constitutes an ideal case study with which to explore the political underpinnings of EBM. The interpretations of substantial outcome data showing medical, quality of life, and hypothetical economic improvements of DHD over conventional dialysis are currently being contested in the medical and political spheres. Accordingly, the drive for what some stakeholders view as better evidence through randomized clinical trials is central to the debate and policymaking process. This paper underscores how the demand for, the interpretations, the funding for, and the use of evidence render EBM a political endeavor with vital ethical implications for clinical care.     

循证医学环境中的医学信息服务

循证医学是20世纪90年代诞生的一种新的临床医学模式.证据来源的筛选和最好证据的检索是循证医学实践的关键,这对图书馆医学信息服务提出了更高的要求,同时也促进了图书馆信息服务的发展.     

Who’s afraid of EBM? Medical professionalism from the perspective of evidence-based medicine

Evidence-based medicine (EBM) and medical professionalism are two prominent notions in current medical debates. However, proponents of professionalism fear a restriction in doctors’ freedom to make their best decisions for individual patients caused by the influence of EBM and highly standardised decision procedures. The challenge which EBM allegedly poses to physicians’ discretion forms the starting point for an analysis of the relationship between professionalism, as an inherent value system of medical practice, and EBM, as an approach to optimise the decision-making for individual patients. The analysis starts with a brief conceptual clarification of the ambiguous term “professionalism”. It then focuses on three key aspects of medical professionalism which may come into conflict with the basic tenets of EBM. The potential tensions between (a) professional autonomy and clinical practice guidelines, (b) individualised care and standardisation, and (c) esoteric authority and public accountability are analysed and a suggestion for reconcilement regarding each point is made. The article closes with a summary on how a better reflection on medical professionalism may help towards a fuller understanding of EBM and vice versa.     

Evidence-based medicine: a discussion of the most frequently occurring criticisms

Since the introduction of evidence-based medicine (EBM) into the field of health care in the early nineties some major criticisms have appeared in scientific literature. One of the most commonly heard objections to EBM is loss of therapeutic freedom. However even with the advent of EBM the physician continues to look for solutions that are tailored to the patient. The available evidence is often inadequate, there are many inconsistencies and contradictions in the research material and the published outcomes are distorted by publication bias. There is resistance to the opinion that randomized clinical trials (RCTs) provide the best foundations on which to build clinical policies. There must always be room for views expressed in other types of study. EBM is primarily for academics and does not take clinical expertise into account. However as the results of scientific research are becoming increasingly available to a wider public, patients are able to challenge the decisions made by their health-care practitioners and push them to provide the motivation for their decisions. Many health-care practitioners have commented that they always have to take the results of scientific research into account. One strength of EBM in this is the transparent manner in which the overview of the literature develops and the systematic approach to results from scientific study. After all, there is insufficient evidence that the EBM process works effectively and that it therefore improves patient care. It is true to say that patients who receive treatment of which the efficacy has been proven experience better treatment results than other patients. Setting up a definitive randomized study to answer this question would be difficult if not impossible. EBM is an aid to support clinical decision making. The development of principles on which to base this way of thinking and acting and the quest for suitable research designs and the most objective research results in order to be able to answer all the questions posed by caregivers, is not yet complete. EBM is just one of the weapons in the armoury of the caregiver in the battle for the optimal provision.     

Whither our art? Clinical wisdom and evidence-based medicine

The relationship between evidence-based medicine (EBM) and clinical judgement is the subject of conceptual and practical dispute. For example, EBM and clinical guidelines are seen to increasingly dominate medical decision-making at the expense of other, human elements, and to threaten the art of medicine. Clinical wisdom always remains open to question. We want to know why particular beliefs are held, and the epistemological status of claims based in wisdom or experience. The paper critically appraises a number of claims and distinctions, and attempts to clarify the connections between EBM, clinical experience and judgement, and the objective and evaluative categories of medicine. I conclude that to demystify clinical wisdom is not to devalue it. EBM ought not be conceived as needing to be limited or balanced by clinical wisdom, since if its language is translatable into terms comprehensible and applicable to individuals, it helps constitute clinical wisdom. Failure to appreciate this constitutive relation will help perpetuate medical paternalism and delay the adoption of properly evidence-based practice, which would be both unethical and unwise. This revised version was published online in July 2006 with corrections to the Cover Date.     

What constitutes evidence in hospital new drug decision making?

In National Health Service hospitals in the UK the introduction of new drugs is controlled by a local Drug and Therapeutics Committee (DTC), which is expected to apply the principles of evidence-based medicine (EBM). In the light of growing expenditure on drugs, there is interest in how the decisions are made that lead to the local acceptance or rejection of a new drug. In this study the DTCs of two general hospitals were observed, tape-recorded and analysed to determine what was considered as evidence and how it was used in decision making. Evidence, as constituted by DTC members, was issues that affected the decision-making process and included: clinical trial data, cost, pre-existing prescribing of the drug, pharmaceutical company activities, decisions of other DTCs, patient demand, clinician excitement, and personality of the applicant. Debate usually started with a discussion of the scientific evidence, then the cost would be considered. Often this evidence was either inadequate or insufficient enough for a locally implementable decision and further types of evidence would be brought in to try and estimate the likely impact of adopting the new drug. EBM, while used in decision making, was supplemented by local knowledge, although decisions were accounted for in the language of scientific rationality. Both abstract scientific rationality and the local rationality of practical healthcare provision were present in the decisions of the DTCs on the adoption, or otherwise, of new drugs into local formularies and healthcare. We suggest the coming together of local and abstract in local decision-making needs to be taken into account when formulating policy and providing decision support.