The impact of a clinical training unit on integrated child health care in Mexico.

This study had two aims: to describe the activities of a clinical training unit set up for the integrated management of sick children, and to evaluate the impact of the unit after its first four years of operation. The training unit was set up in the outpatient ward of a government hospital and was staffed by a paediatrician, a family medicine physician, two nurses and a nutritionist. The staff kept a computerized database for all patients seen and they were supervised once a month. During the first three years, the demand for first-time medical consultation increased by 477% for acute respiratory infections (ARI) and 134% for acute diarrhoea (AD), with an average annual increase of demand for medical care of 125%. Eighty-nine per cent of mothers who took their child for consultation and 85% of mothers who lived in the catchment area and had a deceased child received training on how to recognize alarming signs in a sick child. Fifty-eight per cent of these mothers were evaluated as being properly trained. Eighty-five per cent of primary care physicians who worked for government institutions (n = 350) and 45% of private physicians (n = 90) were also trained in the recognition and proper management of AD and ARI. ARI mortality in children under 1 year of age in the catchment area (which included about 25,000 children under 5 years of age) decreased by 43.2% in three years, while mortality in children under 5 years of age decreased by 38.8%. The corresponding figures for AD mortality reduction were 36.3% and 33.6%. In this same period, 11 clinical research protocols were written. In summary, we learned that a clinical training unit for integrated child care management was an excellent way to offer in-service training for primary health care physicians.     

The impact of a normoglycemic management protocol on clinical outcomes in the trauma intensive care unit

BACKGROUND: The purpose of this study was to determine if protocol-driven normoglycemic management in trauma patients affected glucose control, ventilator-associated pneumonia, surgical-site infection, and inpatient mortality. METHODS: A prospective, consecutive-series, historically controlled study design evaluated protocol-driven normoglycemic management among trauma patients at Vanderbilt University Medical Center. Those mechanically ventilated > or =24 hours and > or =15 years of age were included. A glycemic-control protocol required insulin infusion therapy for glucose >110 mg/dL. Control patients included those who met criteria, were admitted the year preceding protocol implementation, and had hyperglycemia treated at the physician's discretion. RESULTS: Eight hundred eighteen patients met study criteria; 383 were managed without protocol; 435 underwent protocol. The protocol group had lower glucose levels 7 of 14 days measured. After admission, both groups had mean daily glucose levels <150 mg/dL. No difference in pneumonia (31.6% vs 34.5%; p = .413), surgical infection (5.0% vs 5.7%; p = .645) or mortality (12.3% vs 13.1%; p = .722) occurred between groups. If one episode of blood glucose level was > or =150 mg/dL (n = 638; 78.0%), outcomes were worse: higher daily glucose levels for 14 days after admission (p < .001), pneumonia rates (35.9% vs 23.3%; p = .002), and mortality (14.6% vs 6.1%; p = .002). One or more days of glucose > or =150 mg/dL had a 2- to 3-fold increase in the odds of death. Protocol use in these patients was not associated with outcome improvement. CONCLUSIONS: Protocol-driven management decreased glucose levels 7 of 14 days after admission without outcome change. One or more glucose levels > or =150 mg/dL were associated with worse outcome.     

How to plan, deliver and evaluate a training session

The long term aim of general practice teaching is to train competent general practitioners to provide high quality care to patients in any setting. The Royal Australian College of General Practitioners' (RACGP) curriculum sets educational outcomes for postgraduate general practice training programs throughout Australia. Registrars have input to this process by reflecting on their learning needs and developing learning plans. This article discusses the teaching of practical procedures in general practice and describes the planning, delivery and evaluation of an educational session about the management of shoulder conditions for general practice registrars.     

Establishing a psychiatry clerkship in a clinical teaching unit

Difficulties arising during the establishment of a clinical unit students' clerkship programme are presented. These are reviewed to establish general principles important for the successful introduction of such clerkships. Particular emphasis is laid on continual evaluation, and the results of one such evaluation are discussed.     

Fluid and electrolyte management: putting a plan in motion

Fluid and electrolyte management is challenging for clinicians, as electrolytes shift in a variety of settings and disease states and are dependent on osmotic changes and fluid balance. The development of a plan for managing fluid and electrolyte abnormalities should start with correcting the underlying condition. In most cases, this is followed by an assessment of fluid balance with the goal of achieving euvolemia. After fluid status is understood and/or corrected, electrolyte imbalances are simplified. Many equations are available to aid clinicians in providing safe recommendations or at least to give a starting point for correcting the abnormalities. However, these equations do not take into consideration the vast differences between clinical scenarios, thus making electrolyte management more challenging. The supplementation plan, whether delivered intravenously or orally, must include an assessment of renal and gastrointestinal function, as most guidelines are established under the assumption of normal digestion, absorption and excretion. After the plan is developed, frequent monitoring is vital to regain homeostasis. A fluid and electrolyte management plan developed by a multidisciplinary team is advantageous in promoting continuity of care and producing safe outcomes.     

临床技能训练中心的建设与管理探讨

当今高等教育发展的趋势,是注重动手能力、创造能力和综合素质的培养,如何解决学生在临床技能训练方面的薄弱,成为当前医学院校亟需解决的首要问题。临床技能培训中心的建立,让学生在进入临床实习前接受扎实的基本功训练,取得良好的教学效果。本文总结了学校建设技能培训中心的经验,探讨了在新形势下开展临床教学和实践的方向。     

个性化质量控制计划及其对临床实验室质量管理的影响

个性化质量控制计划(individualized quality control plan,IQCP)是一个基于不同临床实验室风险评估和特定条件而产生的全方位的质量保证方案,由美国联邦医疗保险和医疗补助服务中心(the Centers for Medicare & Medicaid Services,CMS)在42 CFR 493.1256法规条款中颁布,从2016年1月份开始在遵循临床实验室改进法案修正案(Clinical Laboratory Improvement Amendments,CLIA)的临床实验室推行,主要针对非豁免检测项目。本文通过介绍IQCP的内容、使用范围和制定方法,跟进国际上临床实验室和监管机构对IQCP的理解和执行情况,尝试探讨IQCP对中国临床实验室尝试新的质量管理的意义和启发,为进一步探索如何在符合我国国家法律法规的框架下,引导不同地区不同层级检验机构在实验室管理行为上采取针对性的措施和个性化的解决方案提供思路。     

Feasibility analysis of a personalized training plan for learning research methodology

OBJECTIVES: To determine the performance in learning clinical research methodology (CRM) by means of the Keller Plan (KP), to assess its impact on attitudes towards research (AR) and to estimate its acceptability. DESIGN: An educational intervention trial was employed with control group (CG) and random assignment. SETTING: The Family and Community Medicine Teaching Unit in Valencia, Spain, 1997. SUBJECTS: Third-year family residents. RESULTS: In the KP both specific written self-teaching material and interactive computer programme were used, focusing on the tutored resident, with compulsory assessments to continue. In the CG a conventional course was followed. Knowledge of CRM and the AR test (previously validated in another study) were measured at the start. Four tests of successive knowledge, time spent studying, tutorials, final AR test and acceptability were conducted. Non-parametric tests were used. Forty (89%) residents participated, 22 were assigned to KP and 18 to CG. Similar basic characteristics, with exception of AR test (medians 55 Keller, 58 control). KP knowledge tests significantly higher (P = < 0.05) than the CG (medians 101, 88) along with time spent studying (medians 53, 23.4 h). There were no significant differences in AR test, although there was an improvement in both groups, significant in KP but not in CG (median increase of 4.5 and 2). Nine residents used and positively assessed the computer programme. Better acceptability was obtained by the KP in overall evaluation, recommendation of the method and learning dynamic. CONCLUSIONS: The KP obtained better knowledge, motivated studying and was positively accepted.     

医学影像计算机管理的方案选择和试验

本文介绍了医院信息系统的现状和近期发展方向,对医学影像管理的四种方案进行了比较,通过一个医学影像管理系统的试验过程有其令人满意的结果,说明开发上型图像管理系统的条件已完全具备。     

Developing an information management plan

Developing a good information management plan is a major project, but it can be accomplished by taking small incremental steps and making sure your team stays focused. Several good things will be produced as a result of your hard work. Your patients will ultimately receive better care due to the availability of more timely information. The hospital will gain cost effectiveness when the information is integrated. Society as a whole will benefit from the sharing of unidentifiable patient information through research.