The Patient-Centred Clinical Method. 2. Definition and Application

In this article, the patient-centred clinical method is describedin operational terms. Definitions are given for the patient'sexpectations, feelings and fears. The physician behaviours describedare: facilitations, acknowledgements, cut-offs and returns.Using the definitions, a method was devised for scoring videotapedinterviews for the degree of ‘patient-centredness’.The method proved to have good inter-observer reliability.     

The Patient-Centred Clinical Method. 1. A Model for the Doctor-Patient Interaction in Family Medicine

This article describes a patient-centred clinical method appropriatefor family medicine. The method is designed to attain an understandingof the patient as well as his disease. This two-fold task isdescribed in terms of two agendas: the physician's and the patient's.The key to an understanding of the patient's agenda is the physician'sreceptivity to cues offered by the patient, and behaviour whichencourages him to express his expectations, feelings and fears.The physician's agenda is the explanation of the patient's illnessin terms of a taxonomy of disease. In the patient-centred clinicalmethod, both agendas are addressed by the physician and anyconflict between them dealt with by negotiation. This is contrastedwith the disease-centred method in which only the doctor's agendais addressed. Further articles will describe the patient-centredmethod in operational terms.     

临床路径教学法在ICU新进护士前3个月护理带教中的应用效果观察

目的探讨在ICU新进护士的前3个月护理带教中,采取临床路径教学法的效果。方法选取该院2016年1月—2018年1月ICU新进的60名护士为研究对象,将护士分成两组,即研究组与对照组,每组30名,对照组采取一对一的护理带教模式,研究组则采取临床路径教学法的护理带教模式,观察两组带教效果。结果护理带教后,研究组护士在理论与操作考核成绩上均要显著高于对照组(P<0.05);研究组新进护士对临床实践能力、应急能力、工作能力及学习兴趣的认可率均显著高于对照组(P<0.05)。结论针对ICU新进护士,在前3个月的护理带教中,实施临床路径教学法的带教模式,可显著提高护士理论与操作能力,且护士对护理带教模式的认可度也高。     

吉妮环12个月临床效果观察

作为第三代宫内节育器,吉妮环以其独特的无支架、可弯曲、固定式、铜离子宫底释放等优点,消除了支架刺激,适合各种大小、不同形状的子宫,显著提高了避孕效果,降低了脱落率、移位率、带器妊娠率,改善了带环后腰酸、腹痛、出血等不适症状,使用推广后受到广大育龄妇女的青睐[1].     

The Course of Depressive Symptoms Over 36 Months in 696 Newly Admitted Nursing Home Residents

ObjectivesTo investigate the course of depressive symptoms in newly admitted nursing home (NH) residents and how resident characteristics were associated with the symptoms. To identify groups of residents following the same symptom trajectory.DesignAn observational, multicenter, longitudinal study over 36 months with 7 biannual assessments.Setting and ParticipantsRepresenting 47 Norwegian NHs, 696 residents were included at admission to a NH.MethodsDepressive symptoms were assessed with the Cornell Scale for Depression in Dementia (CSDD). We selected severity of dementia, functional impairment, physical health, pain, use of antidepressants, age, and sex as covariates. Time trend in CSDD score was assessed by a linear mixed model adjusting for covariates. Next, a growth mixture model was estimated to investigate whether there were groups of residents following distinct trajectories in CSDD scores. We estimated a nominal regression model to assess whether the covariates at admission were associated to group membership.ResultsThere was a nonlinear trend in CSDD score. More severe dementia, a lower level of functioning, poorer physical health, more pain, use of antidepressants, and younger age at admission were associated with higher CSDD scores. Growth mixture model identified 4 groups: (1) persistent mild symptoms (32.6%), (2) persistent moderate symptoms (50.8%), (3) increasing symptoms (5.1%), and (4) severe but decreasing symptoms (11.6%). A lower level of functioning, poorer physical health, more pain, use of antidepressants, and younger age at admission were associated with higher odds for belonging to the severe but decreasing symptoms group compared with the persistent mild symptoms group.Conclusions and ImplicationsMost NH residents were in trajectory groups with persistent mild or moderate depressive symptoms. Residents with more severe dementia, lower levels of functioning, poor physical health, severe pain, younger age at admittance, and who are using antidepressants should be monitored closely and systematically with respect to depression. Taking actions toward a more personalized treatment for depression in NHs is a priority and should be investigated in future studies.     

临床模拟训练法在《内科护理学》实验中的应用研究

目的：探讨临床模拟训练法在《内科护理学》实验中的应用效果。方法：以本校2009级5年制护理学专业某班60名学生为研究对象,在《内科护理学》实验教学中采取临床模拟训练法,并进行问卷调查,每一条目分值1~4分。结果：各问卷条目得分均值为2.5179~3.2857。结论：学生对临床模拟训练法的认可度较高,在培养学生的临床护理思维能力和创新能力方面具有积极意义。     

基层部队医院检验装备培训方法探讨

目的探讨基层部队医院检验装备培训的方法及效果。方法采取"分层次教学、理论与操作分别考核"的方法,提高综合训练能力。结果理论考核优良率达92.7%,操作考核优良率达93.6%。结论"分层次教学、理论操作考核"训练法是科学的训练方法,通过短期培训能够很好地解决基层部队医院因装备不会使用,致使装备等人的现象,对提高基层部队医院的卫生装备使用率和卫勤保障能力具有积极影响。     

The Future of Clinical Training in Psychotherapy

No abstract available for this article.     

Can Relaxation Training Reduce Emotional Eating in Women with Obesity? An Exploratory Study with 3 Months of Follow-Up

Stress and negative emotions have been shown to be critical factors in inducing overeating as a form of maladaptive coping in some patients with obesity. We evaluated the efficacy of a 3-week relaxation protocol enhanced by virtual reality and portable mp3 players in reducing emotional eating in a sample of 60 female inpatients with obesity who report emotional eating, using a three-arm exploratory randomized controlled trial with 3 months of follow-up. The intervention included 12 individual relaxation training sessions provided traditionally (imagination condition) or supported by virtual reality (virtual reality condition). Control participants received only standard hospital-based care. Weight, behavior and psychological data were collected and analyzed. Relaxation training was effective in reducing emotional eating episodes, depressive and anxiety symptoms, and in improving perceived self-efficacy for eating control at 3-month follow-up after discharge. The virtual reality condition proved better than the imagination condition in the reduction of emotional eating. Weight decreased in subjects in all three conditions without significant differences between them, probably due to the common treatment all inpatients received. We conclude that relaxation training supported by new technologies could be a useful tool for reducing emotional eating episodes and thereby reducing weight and obesity.     

基于PDPC法精准培训模式在提升新入职护士规范化培训中临床思维能力的应用效果

目的探讨以PDPC法进行精准培训,对新入职护士规范化培训中提升临床思维能力的应用效果。方法回顾性分析设定2017年7月—2018年6月70名新入职护士作为对照组,采用常规培训模式;2018年7月—2019年6月新入职护士70名作为观察组,采用PDPC法精准培训模式。比较两组护士思维能力评分、客观结构化临床考试得分。结果实施后比较两组护士的临床思维能力评分、客观结构化临床考试得分高于对照组,差异有统计学意义(P<0.05)。结论以PDPC法精准培训模式在新入职护士规范化培训中应用,能增强护士结合理论知识运用于临床情景、提高实操水平,提升临床思维能力,提升护理培训质量,更快适应临床工作模式。     

应用PBL法对临床护士进行英语口语培训的研究

目的探讨PBL法在临床护士英语口语能力培训中的效果。方法将60名英语基础较好的临床护士．随机分为试验组和对照组,每组30名。对照组通过参加科室和医院的常规培训,试验组在常规培训的基础上采用PBL法进行英语口语培训．评价英语口语掌握效果。结果试验组英语口语测试成绩较学习之前有显著提高,并优于对照组（P〈0．01）。结论应用PBL法进行英语口语培训有助利于提高临床护士的口语表达和交流能力,适于在临床护士的英语口语的培训中应用。     

Changes in the Severity of Frailty Among Older Adults After 12 Months of Supervised Home-Based Physical Exercise: A Randomized Clinical Trial

ObjectiveTo investigate the effects of 12 months of physiotherapist-supervised, home-based physical exercise on the severity of frailty and on the prevalence of the 5 frailty phenotype criteria, using secondary analyses.DesignRandomized clinical trial, with 1:1 allocation into 12-month home-based physical exercise, or usual care. The multicomponent exercise sessions (60 minutes) were supervised by the physiotherapist and included strength, balance, functional, and flexibility exercises twice a week at participants' homes.Setting and ParticipantsHome-dwelling older adults aged ≥65 years who were frail (meeting 3-5 criteria) or prefrail (1-2 criteria) according to frailty phenotype criteria.MethodsThe severity of frailty (nonfrail, prefrail, or frail) was assessed using frailty phenotype criteria, and the prevalence of each frailty criterion (weight loss, low physical activity, exhaustion, weakness, and slowness) were assessed at baseline and at 12 months.ResultsTwo hundred ninety-nine persons were included in the analyses, of whom 184 were prefrail and 115 were frail at baseline. Their mean age was 82.5 (SD 6.3) years, and 75% were women. There was a significant difference between the exercise and usual care groups' transitions to different frailty states from baseline to 12 months among those who at baseline were prefrail (P = .032) and frail (P = .009). At 12 months, the mean number of frailty criteria had decreased in the exercise group (?0.27, 95% CI –0.47, ?0.08) and remained unchanged in the usual care group (0.01, 95% CI –0.16, 0.18; P = .042). The prevalence of the exhaustion (P = .009) and the low physical activity (P < .001) criteria were lower at 12 months in the exercise group than in the usual care group.Conclusions and ImplicationsThe severity of frailty can be reduced through 12-month supervised home-based exercise training. Exercise should be included in the care of older adults with signs of frailty.     

Using The Case Study Method in the Training of Psychotherapists

The case study method (CSM) has been effectively used to train lawyers, business people, and teachers. Just as the CSM has proven useful in training of these professional groups, so too can it prove useful in training beginning psychotherapists. In this paper, the CSM is described, two psychotherapy case examples are presented to illustrate its use, and its potential value in edcation psychotherapists in training is considered.     

Clinical Quality Performance in U.S. Health Centers

Objective

To describe current clinical quality among the nation''s community health centers and to examine health center characteristics associated with performance excellence.

Data Sources

National data from the 2009 Uniform Data System.

Data Collection/Extraction Methods

Health centers reviewed patient records and reported aggregate data to the Uniform Data System.

Study Design

Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance.

Principal Findings

Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well.

Conclusions

Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients.     

微课结合案例教学法在年轻护士临床规范化培训中的应用

目的探讨微课结合案例教学法在年轻护士临床规范化培训中的应用方法和效果。方法以该院2017届培训的44名年轻护士为干预组,予以微课结合案例教学;以2016届培训的52名年轻护士为对照组,予以传统带教。比较观察两组培训后考核成绩及学习兴趣、学习能力、分析能力、合作能力提升率。结果干预组理论知识考核成绩(89.74±6.25)分,实践技能考核成绩(84.53±7.29)分,明显高于对照组(P<0.05)。干预组学习兴趣、学习能力、分析能力、合作能力提升率分别为86.36%、77.27%、70.45%、50.00%,不同程度高于对照组。结论微课结合案例教学法用于临床规范化培训可有效提高年轻护士理论知识、实践技能与能力。     

Effect of Body Weight Changes on Changes in Ambulatory and Standardized Non-Physician Blood Pressures Over Three Years

PURPOSE: This study examines the relationship of changes in body mass index (BMI) to changes in measures of both casual and ambulatory blood pressures over three years.

METHODS: In this prospective study of men aged 30–60 years, a cohort of 198 participants was followed for three years. Height, weight, demographic characteristics, and casual and ambulatory measures of blood pressure (BP) were obtained at baseline and 3-year follow-up.

RESULTS: Change in BMI was significantly associated with change in all ambulatory (awake, work, home, and sleep) and casual systolic and diastolic blood pressures. After controlling for age and race/ethnicity, the association remained significant for nine of the twelve BP change measures. Further tests show that the effect of a change in BMI on BP change does not vary across the six systolic blood pressures or across the six diastolic measures. An average-height man gaining 5 kg (11 pounds) typically exhibited a 2.5 mm Hg increase in systolic and a 1.8 mm Hg increase in diastolic casual and ambulatory BPs. There is no evidence that changes in BP were associated with age, race/ethnicity (blacks vs. Hispanics vs. whites), or the average of the baseline and follow-up levels of BMI. In addition, the impact of weight gain is similar in magnitude, but in the opposite direction, to that of weight loss.

CONCLUSIONS: Changes in BMI over three years predict changes in ambulatory and standardized non-physician BPs. These changes in BP are not related to average BMI level or age.     

贵阳市两社区居民居住环境和个人健康调查分析

为评估贵阳市空气污染物对贵阳市民健康的影响,对2015年贵阳市空气质量较好的花溪区阳光社区和空气质量较差的南明区油榨社区进行居民居住环境和个人健康进行调查,调查结果显示,南明区油榨社区和花溪区阳光社区家庭居住环境和个人健康基线基本一致,差异不显著。