地市级三级综合医院创伤急救体系探索

创伤急救体系的建立对区域内严重创伤患者的救治具有重要意义。结合医院实际,以国家卫生健康委员会相关文件为依据,成立创伤医学中心,构建创伤急救体系。创伤急救体系的建立使创伤患者急救反应时间、严重创伤患者平均救治时间缩短,创伤患者死亡率下降,患者抢救成功率和满意度提高,有效提升了创伤救治能力与水平。     

我军新时期任务中的急救医疗服务体系

急救医疗服务体系，将急诊急救与疾病危重期紧密结合起来，体现出很高的效率性。通过创伤急救医疗服务体系的建立，可提高战创伤救治技术水平，搭建平战结合我军卫勤保障任务准备平台，形成军队医院急救医疗优势，促进我军综合医疗水平的提高。创伤救治和以创伤救治为特色急救医疗服务体系的完善，是我军卫勤保障任务的职能要求，应作为部队医院急诊急救工作的主要方向。     

大城市区域性创伤急救模式的进一步探索

针对创伤救治存在的问题,探讨了大城市区域性创伤急救网络体系和一体化救治模式的结构组成,并对创伤急救的救治程序与功能定位做了进一步完善,同时明确了分级救治、伤情评估和检伤分类等概念。     

军队医院建设创伤急救中心的实践与思考

本文总结了建立创伤急救中心的做法：一是加强组织领导，建立科学合理的组织机构；二是完善规章制度，建立创伤急救快速绿色通道；三是强化技术培训，提高救治能力；四是合理投入，改善创伤救治条件；五是加强对外联络，建立军警联动机制。建立创伤急救中心是军队医院增强卫勤保障能力的重要手段，是新时期军队医院发展的重要途径。     

灾难医学救援基本技术培训

灾难医学救援基本技术培训又称灾难医学救援的"在职教育"。笔者简要介绍了灾难医学救援基本技术的内容,包括创伤急救、心肺复苏、检伤分类、紧急救治、医疗后送等技术,并对国内外培训的理念和做法进行分析并提出建议。     

严重创伤院内急救程序的建立

根据我国现有的医疗技术条件,结合国内外严重创伤急救模式和存在的问题,将模式研究的方法引入到创伤急救程序的研究,研究如何建立严重创伤院内急救程序.我院进行了严重创伤院内急救程序的探索与实践,以组织高效救治、缩短术前时间、提高救治成功率为基本原则,建立了以院内救治时间控制模式为特征的急救程序.该方法可有效提高救治成功率,减少伤残率,并能有效促进严重创伤院内救治的整体化、系统化与专业化进程.     

创伤急救一体化的实践与探索

论述了创伤救治新理念,阐述了创伤急救从传统模式向现代模式转变,即急诊科创伤急救模式由“全科型”向“专业化”转变、创伤医师培养模式由“通科型”向“专业型”转变。通过我院急诊科在创伤急救的快速临床反应机制、急诊创伤重点救治机制、创伤急救院内衔接机制和协调机制、急诊创伤病房规范化管理机制及创伤急救小组运作机制的实践,探讨了构建基于“三环理论”急诊科创伤急救一体化模式。     

重度创伤1568例急诊救治模式的探讨

目的分析和探讨重度创伤在急诊救治中最佳的救治模式。方法回顾分析诊治的重度多发伤患者1568例的临床资料，对存在的问题进行探讨。结果1568例重度创伤患者中有79例在未到手术室之前已经死亡；手术1489例，术中死亡14例，术后死亡33例，植物生存17例，留有不同程度残疾335例，痊愈1090例。结论重度创伤救治的成功率与急救医师的救治水平、急救模式、相关科室间的统筹配合的默契程度等密切相关。     

急救三环理论在抗震救灾医疗救护中的应用

2003年10月中华医学会急诊医疗分会第五届委员会第二次全体会议提出并确定了创伤急救"三环理论"的概念,即院前急救、急诊科的救治和创伤重症监测与救治.几年来,它对指导创伤急救工作起到了积极的作用.     

重庆市大足区某急救创伤中心收治的创伤病例院前特征分析

目的 分析重庆市大足区某急救创伤中心收治的创伤病例的院前流行病学特征,为合理配置院前急救资源、提高创伤救治水平提供客观依据.方法 收集2015-2019年重庆市大足区某急救创伤中心的院前创伤病例资料,并对其特征进行分析.结果 共纳入创伤病例20 129例,跌倒伤为主要创伤种类,占32.32％,其次是交通伤,占29.35...     

Managerial skills of principal physicians assessed by their colleagues. A lesson from Finland

The purpose of this paper was to discover the views of doctors regarding the managerial skills of their principal physicians and the views of doctors of their postgraduate specialist training in management. This was done by sending out a questionnaire to every second physician registered in 1977-1986 in Finland. They were asked to evaluate their principal physician's managerial skills using a visual analogue scale. A five-point Likert scale was used to inquire how much training doctors had received for different professional tasks, including management, during their specialist training. Of all the 318 principal physicians in this study, 85 percent reported that they had had too little training for managerial skills. It was found that doctors in leading positions, both in public hospitals and the primary health care sector, are aware of the need of training for managerial and leadership skills.     

Modifications in service delivery and clinical treatment for women diagnosed with severe mental illness who are also the survivors of sexual abuse trauma

Sexual abuse trauma and chronic revictimization are central to the experience of many women diagnosed with severe mental illness. The high reported prevalence rates of sexual abuse trauma among these women necessitate that program planners and clinicians be prepared to adapt their treatment interventions for use with trauma survivors. This article describes how current treatment approaches for women diagnosed with severe mental illness can be adapted to accommodate the special needs and vulnerabilities of sexual abuse trauma survivors. A history of trauma added to the clinical picture of longstanding and severe mental illness poses new diagnostic and treatment considerations, which are discussed. The full range of rehabilitation services—case management, residential placement and supervision, inpatient hospitalization, medication management, network intervention, and socill skills training—must be grounded in an understanding of the trauma experience, informed by accurate assessment of the trauma, and accommodated to the woman’s specific history of sexual abuse trauma.     

Monitoring the development of clinical skills during training in a clinical placement

Background The education and training of health care practitioners has undergone recent reform, and indicate that curricula should place emphasis on the development of clinical skills and attitude. The purpose of this study was two‐fold: to define the key skills necessary for a competent dietetic student practitioner and to devise a reliable assessment tool to measure and track performance in these key skill areas throughout the period of clinical placement. Methods Key clinical skills were identified by a concensus group of experienced dietitians and academic practitioners. An assessment tool was then developed to measure these attributes in 43 students undertaking clinical placement at a number of training centres in Scotland. Development of skills was tracked for the entire duration of placements using the novel assessment tool. The assessment tool used a visual analogue scale (VAS) as the measuring score. Results A high level of skill attainment was equated with high VAS scores. Performance in three of the four key skills (written skills: r = 0.762, P ≤ 0.001; interviewing skills: r = 0.697, P < 0.001; and dietary assessment technique: r = 0.697, P ≤ 0.001) showed impressive correlation co‐efficients, indicating a striking and significant positive correlation with the length of training. A high skill performance level attainment was achieved by week 16/17 of training. Conclusion The authors are confident that the assessment tool is valid and reliable and measures skill performance objectively. A high level of skill attainment was observed in most students by about the mid‐point in training: this allows the student to consolidate these skills in the latter stages of training which is in keeping with educational and practice philosophy of placement learning outcomes.     

行业培训是输血事业稳步发展的关键

目的探讨不同等级医院、不同岗位的培训对提高输血水平、推进输血事业稳步发展的作用。方法针对管理层、临床医护人员的不同需求选择培训教材,从输血基本知识、基本技能等方面进行系统培训,并将相关法规条款细化融于课程中,探索适合,临床用血单位的行业培训模式。结果学员知识层次、操作技能及软硬件配备等均有一定改善,推动了输血医学的学科建设,提高了临床输血水平。结论有针对性地选择培训教材,采取业务知识和实践技能相结合的分层次、多维度的培训模式,可有效提高输血行业从业人员的素养,进而保障临床输血安全。     

吉林幼儿园教师健康素养相关知识技能干预效果评价

了解吉林省幼师健康素养现状及干预效果,为积极开展相关干预工作提供依据.方法 便利整群抽取吉林省10个地区16所幼儿园的622名幼师,以地区为单位随机分为干预组和对照组,围绕洗手刷牙、气道异物阻塞处理(海姆立克急救法)、外伤处理及拨打求救电话的健康素养相关知识与技能开展培训和资料收集.结果 干预前,干预组洗手刷牙、海姆立克急救法、外伤处理及拨打求救电话的健康素养具备率分别为42.3%,29.2%,26.3%,63.5%,对照组分别为39.0%,32.6%,22.6%,64.8%,2组间差异均无统计学意义(x2值分别为0.986,2.001,0.745,1.203,P值均>0.05);干预组在干预后洗手刷牙、海姆立克急救法、外伤处理及拨打求救电话的健康素养相关知识与技能均高于对照组,差异均有统计学意义(P值均<0.05).结论 健康素养相关知识技能教育培训可有效提高幼师健康素养水平及自信心.政府及相关教育机构应定期、全面系统且有针对性的开展培训.     

GP-BASED EMERGENCY RESPONSE IN RURAL AREAS: IS THERE A NEED?

Rural general practitioners (GPs) traditionally provide the initial care for the very ill and severely traumatised in small and medium-sized rural hospitals. It has been said that these patients would be better managed in a level 1 trauma centre. The present paper will test this hypothesis and shows that the benefits of the expertise available in the large centres may be outweighed by the loss of life in the prehospital phase, most of which occurs before the arrival of the ambulance. General practitioner involvement would enhance the current early retrieval system. Very ill and severe trauma should be assessed and stabilised in the most appropriate local facility. Routine by-passing of local emergency medical services should be avoided. A national standard for training rural GPs in emergency management skills is needed. Emergency facilities and equipment must be maintained and improved throughout rural Australia. These facilities and their staff must be accredited so that the ambulance service can more appropriately determine its transport priorities.     

多元训练模式提高军队医院护理队伍战救能力

目的探讨提高多元化护理队伍战救能力的方法。方法开展多元训练模式:以知识竞赛模式促进战救理论知识的普及,以技能比武形式促进战救五项技术的掌握,以情景模拟形式提高特殊环境战创伤的救护,以规范化培训方式促进战救技能训练常态化,以心理训练方式提高应付突发事件的适应能力。结果护理队伍尤其是文职护士队伍军事素质,战救能力明显提高,实现了精减整编后多元化护理队伍战救能力的无缝隙衔接与过渡。结论多元模式战救技能训练是提高护理队伍战救能力,保障基层部队官兵健康的较好手段。     

Building capacity in health facility management: guiding principles for skills transfer in Liberia

Background  

Management training is fundamental to developing human resources for health. Particularly as Liberia revives its health delivery system, facility and county health team managers are central to progress. Nevertheless, such management skills are rarely prioritized in health training, and sustained capacity building in this area is limited. We describe a health management delivery program in which a north and south institution collaborated to integrate classroom and field-based training in health management and to transfer the capacity for sustained management development in Liberia.     

艾滋病防治人员随访管理能力培训效果评价

目的 探讨艾滋病防治工作人员的随访管理能力及培训效果,为进一步提升艾滋病防治人员的随访管理能力提供依据。方法 通过问卷调查的方式,在培训前后对学员的随访管理能力及培训满意度进行测评,并对培训效果相关影响因素进行Logistic回归分析。结果 学员随访知识得分由培训前的（5.91±1.58）分提高到（8.23±1.73）分（t = 8.711,P ＜ 0.001）,随访管理能力得分由培训前的（26.92±3.93）分提高到（31.17±3.19）分（t=8.400,P ＜0.001）,差异均有统计学意义。培训前后分析评价能力、政策执行能力、交流沟通能力、文化技能、社区实践能力、专业基础知识得分差异有统计学意义（P ＜ 0.05）。进一步分析显示,影响培训效果的主要因素有:职称（OR = 3.521）、单位级别（OR = 4.299）和培训次数（OR = 2.833）。超过90%的学员对培训效果感到满意,提示教与学都达到了培训预期的目标和要求。结论 培训取得了较好的效果,提高了艾滋病防治人员的随访管理能力,该培训模式和方法可行有效。     

Managerial activities and skills of nurse managers: an exploratory study

In this study, the authors used the activity competency model (Wu, Chen, and Lin 2004) to investigate the perceived importance of managerial activities and skills required of three levels of nurse managers. They identify the portfolio of the management activities and the needed skills at each management level. The results of this study provide guidelines for management development programs, training, and career planning for nurse managers, and can also serve as guidelines for recruiting and selecting effective nurse managers.