中国剖宫产瘢痕部位妊娠文献调查与思考

目的 了解剖宫产瘢痕部位妊娠(cesarean scar pregnancy,CSP)现状。 方法 在"万方数据"中,逐条下载、学习关于CSP所有中文文章,按"发表时间"所在年度、"作者单位"所在省/直辖市和所在医院等级、相关合并症等进行统计分析。 结果 ①万方数据中关于CSP的文献共4 784篇,共计138 188病例,最早发表于1999年,按"发表时间"所在年度进行统计,随着年度增长,无论是文献数还是病例数,其构成比均呈逐年迅速增加趋势。②"作者单位"所涉及的省/直辖市共有30个,占88.24%。"作者单位"前5位省份是河南、广东、江苏、浙江和湖北省,最后5位是黑龙江、海南、宁夏、甘肃和青海省。③按"作者单位"所在医院级别进行统计,三级医院、二级医院、一级医院、计划生育指导服务站等其他医疗单位及无法考查"作者单位"所在医院级别或未记录"作者单位"的文献数分别占59.39%、31.00%、2.72%、1.44%及5.45%,病例数分别占59.68%、31.35%、2.74%、1.22%及5.01%。 结论 提高CSP认识,控制剖宫产率,特别是减少社会因素剖宫产,提高产科质量与手术质量,注重剖宫产术中"子宫切口处理模式",进行前瞻性、大样本、多角度、多中心的临床观察和研究,以期找到CSP病因或危险因素,避免或减少CSP的发生,避免发生医源性并发症与医疗纠纷,提高广大育龄妇女的身体、心理健康与生活质量,是产科医师当前面临的重要课题。      

An analysis of electronic health record-related patient safety concerns

Objective

A recent Institute of Medicine report called for attention to safety issues related to electronic health records (EHRs). We analyzed EHR-related safety concerns reported within a large, integrated healthcare system.

Methods

The Informatics Patient Safety Office of the Veterans Health Administration (VA) maintains a non-punitive, voluntary reporting system to collect and investigate EHR-related safety concerns (ie, adverse events, potential events, and near misses). We analyzed completed investigations using an eight-dimension sociotechnical conceptual model that accounted for both technical and non-technical dimensions of safety. Using the framework analysis approach to qualitative data, we identified emergent and recurring safety concerns common to multiple reports.

Results

We extracted 100 consecutive, unique, closed investigations between August 2009 and May 2013 from 344 reported incidents. Seventy-four involved unsafe technology and 25 involved unsafe use of technology. A majority (70%) involved two or more model dimensions. Most often, non-technical dimensions such as workflow, policies, and personnel interacted in a complex fashion with technical dimensions such as software/hardware, content, and user interface to produce safety concerns. Most (94%) safety concerns related to either unmet data-display needs in the EHR (ie, displayed information available to the end user failed to reduce uncertainty or led to increased potential for patient harm), software upgrades or modifications, data transmission between components of the EHR, or ‘hidden dependencies’ within the EHR.

Discussion

EHR-related safety concerns involving both unsafe technology and unsafe use of technology persist long after ‘go-live’ and despite the sophisticated EHR infrastructure represented in our data source. Currently, few healthcare institutions have reporting and analysis capabilities similar to the VA.

Conclusions

Because EHR-related safety concerns have complex sociotechnical origins, institutions with long-standing as well as recent EHR implementations should build a robust infrastructure to monitor and learn from them.     

医学检验专业本科毕业论文分析和思考

目的分析医学检验专业本科生毕业论文存在的主要问题,提出改进措施。方法对医学检验专业2008届69名本科毕业生的毕业论文现状进行分析。结果共62名教师指导2008届69名学生完成毕业论文,毕业论文成绩呈正态分布,优秀论文较少,占4．38％;良好比例相对较大,占65．21％;中等占30．43％。结论提高毕业论文的质量要从毕业论文的各环节抓起,应对毕业论文的全过程实施质量监控。     

Gloves and Ebola virus:a consideration of the penetration possibility based on nanostructure consideration

<正>To the editor,Ebola virus infection is the new deadly viral infection that is presently problematic in many countries in Africa.The prevention of this disease seems to be difficult and the rapid distribution of disease becomes the important issue for further discussion.As noted by Muyembe-Tamfum et al.[1],one of the major disease control measures is the distribution of protective equipment to health care workers.Gloves are important protective equipments     

Addressing a community's cancer cluster concerns

The felling of a telecommunications mast highlighted a community's concern regarding an alleged cancer cluster of eleven cases in a small rural area of Northern Ireland. At the request of the Local District Council, the Northern Ireland Cancer Registry (NICR) undertook an investigation. After extensive searching and contact with the community, only 6 of the alleged cases could be identified. Of these six, two did not have cancer and one had a non-malignant tumour. In addition to the three confirmed cancer cases, a search of the NICR database identified a further 17 cancers of mixed types in keeping with the population pattern of cancers.

Standardised incidence and mortality rates were within, or lower than, the expected level. The results were presented to the local community at an open meeting. Despite extensive media interest when the issue of the alleged cluster was first raised, the negative findings received only local media attention. This study illustrates the value of an accurate population cancer registry in addressing cancer cluster concerns.

     

How to take deontological concerns seriously in risk-cost-benefit analysis: a re-interpretation of the precautionary principle

In this paper the coherence of the precautionary principle as a guide to public health policy is considered. Two conditions that any account of the principle must meet are outlined, a condition of practicality and a condition of publicity. The principle is interpreted in terms of a tripartite division of the outcomes of action (good outcomes, normal bad outcomes and special bad outcomes). Such a division of outcomes can be justified on either "consequentialist" or "deontological" grounds. In the second half of the paper, it is argued that the precautionary principle is not necessarily opposed to risk-cost-benefit analysis, but, rather, should be interpreted as suggesting a lowering of our epistemic standards for assessing evidence that there is a link between some policy and "special bad" outcomes. This suggestion is defended against the claim that it mistakes the nature of statistical testing and against the charge that it is unscientific or antiscientific, and therefore irrational.     

Occupational health concerns: An analysis of physical activity of submariners

BackgroundSubmarine crew have low physical activity by virtue of their professional requirements. Lack of space and inadequacy of regeneration capabilities render physical activity almost impossible during deployments. However, sufficient data for physical activity levels and trends are required to measure the magnitude of inactivity.MethodsData was collected from 362 personnel belonging to six submarines and one submarine base using Global Physical Activity Questionnaire. Four study groups were defined: Base, Refit, Operational/Harbour and Operational/Sea.ResultsOverall, 30.11% of the crew had insufficient physical activity (4.04% in Base, 5.75% in Refit, 15% in Ops/Harbour and 91.67% in Ops/Sea groups). Of the total physical activity, 48.7% was contributed by activity at work, 18.71% by travel related activity and 32.62% by recreational physical activity. Base group recorded the highest recreational activity of 1468.28 Minutes-per-Week. Recreational activity contributed 43.22% to total physical activity for this group. Mean total physical activity was highest for ≥45 years and lowest for ≤24 years. ≥45 years old also recorded the highest recreational activity.ConclusionThe greatest cause for concern comes from the crew in operational submarines and the younger crew. Physical activity profile of the crew when at sea cannot be changed and greater research is required to assess the long-term health effects of physical inactivity in this group. However, what can be modified are the work schedules for refit submarines and operational submarines when in harbour. Targeted interventions and strategies are required to establish sustainable behaviour patterns with regards to physical activity in these groups.     

口腔专业医学生临床实习前后关注问题的调查与分析

目的调查和分析不同年级口腔医学专业学生的心理特点,了解其心理变化,为实习生的实习前辅导和在校学生的合理培养提供实证依据。方法对175名不同年级口腔专业学生以匿名问卷调查形式,就学生临床实习前后担心及关注问题,未来职业方向的选择等进行调查。结果大一（47％）、大三（43％）、大五（45％）的学生在未来均想从事口腔修复专业工作,30％及39％的大二和大四的学生希望从事口腔正畸专业工作;97％的学生在实习前最关注实习医院的带教教师水平,实习后79％的学生则认为实习医院最重要;67％的学生在实习前最担心患者对其治疗结果不满意,实习后51％的学生最担心影响考研。结论应重视提高教育者自身修养,根据实习前后的调查情况,引导学生结合个人兴趣及实践技能掌握情况选择正确的就业方向,同时鼓励学生开阔视野,不能只注重眼前利益,为将来走向医疗岗位为患者服务打好坚实的基础。     

Motivation for and concerns about entering a medical programme

The motivation for and concerns about studying medicine and future career plans of students at the Faculty of Medical Sciences, The University of the West Indies (UWI), were studied using a cross-sectional survey that included Year 1 medical students at both the Mona (Jamaica) and St Augustine (Trinidad and Tobago) medical schools of the UWI. The data were collected using a self-administered questionnaire containing structured questions on demographics and family background, motivation for and concerns about studying medicine and future career preferences. A total of 193 students took part in the study, 103 from Mona and 90 from St Augustine (88% response rate). Seventy per cent of the students were between 18 to 22 years of age with 59% being females. The highest rated motives for studying medicine were the 'opportunity for working with people' and an 'interest in human biology'. Female students scored significantly higher for the motive of an 'opportunity for working with people', while males rated the 'social prestige/status' significantly higher. The greatest concerns of the students were 'fear of failure' and 'contracting diseases'. The female students had a greater concern for dealing with the long hours involved in medical training than their male counterparts. Surgical specialties (43%), family medicine (38%) and paediatrics (34%) were the top choices of the students for future specialty and more women than men chose obstetrics. Although the motives that students have reported are varied, there was a reasonable spread of desirable motives. This study provides a baseline for observing possible changes as students advance through medical training. A programme of study that strives to maintain these well-placed motives while providing opportunities for dealing with the concerns of the students will assist in creating caring, empathetic physicians for the Caribbean.     

Teenage pregnancy--causes and concerns

Adolescent pregnancy is alarmingly common in India. These young girls face considerable health risks due to higher maternal and perinatal mortality. Early child bearing is not only a health problem for mother and child but is also associated with serious socio-economic and demographic implications as well. In developing countries 20% to 60% of young women's pregnancies and births are unintended, most coming sooner than planned. In India some demographers have estimated that if marriages were postponed from the age of 16 to 20 years, the number of births would decrease by 20 to 30 per-cent. That is the reason one of the socio-demographic goals set by national population policy, 2000 is to promote delayed marriages for girls, not earlier than age of 18 years and preferably after 20 years of age. It is important to maximise utilisation of prenatal, intranatal and postnatal care services among adolescent mothers. Lastly, it is important to improve the heamoglobin status and nutrition and empower our girls by educating them and making them aware of disadvantages of anaemia, early marriage and also of legal laws against teenage marriages.     

公立医院深化落实“放管服”改革提升财务管理水平探析

随着国家"放管服"改革的深入开展,公立医院在财务管理中应切实落实"放管服"精神,把工作落到实处。一是做好制度建设,从制度建设的全面性、适应性和及时性进行探索。二是解决"报销难、报销繁"问题,改变服务模式,提升服务效率;注重系统建设,将财务管理嵌入信息系统,通过系统建设实现财务管控的目的。三是做好成本核算工作,助力医院和科室发展。公立医院在业财融合过程中,应始终将服务临床、为患者提供优质服务放在第一位。     

医学生课外阅读取向的调查与思考

为了解当前医学院校本科学生的阅读结构及其影响因素,本研究采用无记名问卷调查方法对某医学院校医学生的阅读状况进行了调查,并对调查结果进行了分析研究。研究结果表明,医学生的阅读结构存在较大偏差,父母亲的文化程度、日平均阅读时间、月平均阅读量、阅读目的、了解新书的途径、学校图书馆藏书情况、阅读规划、日常学习等因素均会影响医学生的阅读结构。因此,树立导读理念,构建社会、学校、家庭三位一体的阅读体系,加强对医学生阅读的引导,优化医学生的阅读结构,将有助于医学生人文素养的提高,培养充满人文关怀精神的医学生。