Care provided by general practitioners to patients with psychotic disorders: a cohort study

Background

There is a decline in the relative numbers of general practitioners in Germany. Earlier research showed that the professional relationship between general practitioners and specialists is overshadowed by conflicts which could influence medical students not to choose a career in general practice. The aim of the study is to analyse potential discrepancies between general practitioners' self-perception of their professional role and their social self-image in relation to medical specialists and to identify potential barriers that might prevent medical students from becoming a general practitioner.

Methods

A qualitative study design consisting of 16 interviews with general practitioners was chosen. Data analysis was carried out using the qualitative content analysis by Philipp Mayring.

Results

There is a discrepancy between general practitioners' professional self-perception and how they perceive they are viewed by specialists. General practitioners communicate a positive self-perception of their professional role. While general practitioners think that specialists in outpatient care have a positive view on general practice, it is assessed to be negative by specialists working in hospitals and as medical teachers.

Conclusion

The negatively influenced social self-image may originate particularly from "badmouthing" general practitioners at universities and in hospitals. "Badmouthing" demonstrates the importance of the consideration of psychological aspects in medical teachers and hospital specialists acting as role models. Negative comments should be considered as an important factor in influencing medical students and trainees' career choices. These aspects should be more integrated in future medical education curricula.     

The Representation of Causality and Causation with Ontologies: A Systematic Literature Review

ObjectiveTo explore how disease-related causality is formally represented in current ontologies and identify their potential limitations.MethodsWe conducted a systematic literature search on eight databases (PubMed, Institute of Electrical and Electronic Engendering (IEEE Xplore), Association for Computing Machinery (ACM), Scopus, Web of Science databases, Ontobee, OBO Foundry, and Bioportal. We included studies published between January 1, 1970, and December 9, 2020, that formally represent the notions of causality and causation in the medical domain using ontology as a representational tool. Further inclusion criteria were publication in English and peer-reviewed journals or conference proceedings. Two authors (SS, RM) independently assessed study quality and performed content analysis using a modified validated extraction grid with pre-established categorization.ResultsThe search strategy led to a total of 8,501 potentially relevant papers, of which 50 met the inclusion criteria. Only 14 out of 50 (28%) specified the nature of causation, and only 7 (14%) included clear and non-circular natural language definitions. Although several theories of causality were mentioned, none of the articles offers a widely accepted conceptualization of how causation and causality can be formally represented.ConclusionNo current ontology captures the wealth of available concepts of causality. This provides an opportunity for the development of a formal ontology of causation/causality.     

WHO《新型冠状病毒感染暴发时社区、家庭和医疗卫生机构照护中医用口罩的使用指南》解读

 

有效预防和控制新型冠状病毒的暴发流行是政府、公众及每位卫生专业人员面临的严峻挑战。在新型冠状病毒暴发时期,世界卫生组织（WHO）发布《新型冠状病毒暴发时社区、家庭和医疗卫生机构照护中医用口罩的使用指南》,对从事公共卫生、感染的预防和控制的卫生专业人员、卫生管理人员、卫生保健和社区卫生工作人员医用口罩的使用提出了指导性的建议。本文对该指南进行解读,了解在社区、家庭和医疗卫生机构照护中医用口罩 佩戴和管理的建议,旨在为口罩的正确佩戴,合理使用,避免资源浪费提供科学依据。

     

医院志愿者队伍建设与工作模式探讨

介绍医疗志愿者的现状,阐述综合医院集团化发展进程中成立“志愿者之家”组织的意义与目的,建立了符合集团化医院实际的志愿者管理制度,就目前医院志愿者队伍中人员结构的层次进行分析,探讨各层次志愿者在医院提供服务时的优势与劣势,为今后“志愿者之家”队伍建设提供理论支持。     

Accomplishing ‘the case’ in paediatrics and child health: medicine and morality in inter‐professional talk. White S. (2002) Sociology of Health and Illness, 24, 409–435.

This paper presents data from a recently completed ESRC‐funded ethnography of social relations and case formulation in an integrated child health service, comprising paediatric in‐patient and out‐patient, child and adolescent mental health and child development services. Children present to the services with symptoms or troubles for which there are often competing biological, neurological, genetic and/or psychosocial models of causation. As a consequence, clinicians’ talk is oriented to deciding between three main potential types of case formulation: medical, psychosocial and not just medical. These three formulations are not static ideal‐types. They are highly contestable and require complex practical and rhetorical work, through which facts and evidence are selectively invoked and different parties to the case are granted attributes that construct and reconstruct past events to render ambiguous symptoms or events understandable. In particular, moral judgements and complex characterizations about the child's parents, or significant others, often form an indispensable warrant for these formulations. By analysing professional narratives about cases, this paper develops previous ethnographic work on the classification in medical work of children and adults as good or bad, appropriate or inappropriate, culpable or blameless, and renders visible a repertoire of moral formulations about childhood and child care. In particular, judgements about the adequacy of parental love are central to clinical reasoning.     

2013 年中国医疗器械对外贸易进强出弱简

医疗器械产业伴随着科学技术的发展,特别是医疗技术的发展,已经成为一个迅猛增长的“朝阳行业”。医疗器械产业也日益成为衡量一个国家科学技术、工业制造水平的具有参考价值的产业。进入21世纪以来,随着世界贸易经济的发展,国际化进程的深化,科学技术从发达国家向发展中国家转移,发展中国家加工成本优势的释放,使得医疗器械的国际间贸易的发展正处于一个良好的上升势头。过去的一年,中国医疗器械贸易整体发展水平继续向深度和广度迈进,但是随着中国经济的发展,医疗器械行业面临着艰巨的结构调整与转型升级。本文重点对我国医疗器械进口产品和出口产品进行了系统分析,分析了我国当前医疗器械贸易现状、面临的贸易问题和产业结构优化的现状,对今年发展趋势进行了初步判断。     

Taking the measure of the profession: Physician associations in the measurement age

Systematic measurement of healthcare services enables evaluation of health professionals' quality of work. Whereas policy makers find measurement a useful mechanism for quality improvement, a public choice perspective implies that physicians would resent such an initiative, which undermines their professional autonomy.In this article, we compare two healthcare systems of economically developed countries – Israel and the UK. Both systems share common features such as universal coverage, strong state intervention, and enthusiasm for New Public Management. In both countries, quality measurement was introduced in acute care hospitals at around the same time. However, while the UK succeeded in establishing a framework of surgical outcome measures during the 2000s, a similar initiative in Israel failed completely during the 1990s. We also refer to subsequent quality indicator efforts in Israel, in both community and hospital frameworks, that were more successful, but in a way that reinforces our central thesis.We contend that differences in reform outcomes stem from the medical profession's reaction to government's endeavors. This response, in turn, hinges on the professional organizations' relative institutional position vis-a-vis state authorities. This study constitutes a unique investigation of the medical profession's response to critical quality measurement reforms. Most importantly, it stresses the institutional position of medical associations as the primary factor in explaining cross-case variation in government's success in introducing quality measurement.     

一起医务人员疥疮医院感染暴发的应急对策

目的 探讨疥疮医院感染暴发的应急对策.方法 医院2011年2月因1例挪威疥疮引起医务人员疥疮医院感染暴发,采取流行病学调查分析和医疗干预落实环境消毒措施.结果 调查接触暴露的医务人员60名,其中医务人员感染疥疮26例,感染率为43.33％;迅速诊断首发病例,给予疥疮相关知识的教育指导,感染者和接触暴露者使用药物治疗或预防,环境消毒等措施得到落实;一周内感染流行得到了控制.结论 挪威疥疮具有高度接触传染性,可能导致医院感染暴发;避免疥疮医院感染蔓延扩散,须采取快速、彻底的措施.     

The control of mosquito-borne diseases in New York City

Mosquito control began in New York City in 1901. Large-scale efforts to drain marshlands occurred through the 1930s, and aerial application of pesticide occurred as early as 1956. Components of early mosquito-borne disease control were reimplemented in 1999–2000 in response to an outbreak of West Nile virus, and included promoting public and health professional awareness regarding disease causation and prevention, providing free government laboratory testing, case reporting, mapping of mosquito breeding sites and their elimination or application of larvicide to them, and adult mosquito control. Because a potential for various mosquito-borne diseases in New York City persists, continued efforts are warranted to limit mosquito breeding, to monitor adult mosquito populations for the presence of human pathogens, and to establish protocols and capacity for adult mosquito control.     

The changing assessments of John Snow's and William Farr's cholera studies

This article describes the epidemiological studies of cholera by two major British investigators of the mid-nineteenth century, John Snow and William Farr, and it asks why the assessments of their results by contemporaries was the reverse of our assessment today. In the 1840s and 1850s Farr's work was considered definitive, while Snow's was regarded as ingenious but flawed. Although Snow's conclusions ran contrary to the exceptations of his contemporaries, the major reservations about his cholera studies concerned his bold use of analogy, his thoroughgoing reductionism, and his willingness to ignore what seemed to be contrary evidence. Farr's electic use of current theories, his reliance multiple causation, and his discovery of a mathematical law to describe the outbreak in London in 1849 was much more convincing to his contemporaries. A major change in thinking about disease causation was needed before Snow's work could be widely accepted. William Farr's later studies contributed to that acceptance.     

Kenneth J. Rothman and multicausality in epidemiology

BackgroundThe sufficient-component cause model is one of several conceptual models for causation that appeared in the 1970s in response to the problem of multicausality in chronic diseases.MethodsThe aim of this article is to present the Rothman model as he introduced it in his seminal article “Causes,” written in 1976.ResultsWe show that: the notion of sufficiency and necessity, as opposed to the notion of probability, succeeded in forming a valid concept of cause; that this theoretical model recently introduced in other models of causality in epidemiology did not always succeed in solving the several practical problems related to multicausality, which Rothman wanted to solve by defending a working definition of causality.ConclusionDespite its weaknesses, the Rothman model has contributed significantly to the understanding of what a cause is in epidemiology, making it possible to address this question from a point of view unfamiliar to the “risk factor” approach to diseases.     

医院党建工作中的人文关怀实践探析

当前,深化人文关怀思想,建立现代化医院已经成为我国医疗卫生事业的发展主题。本文以党建工作为基础,深入探讨医院党建工作中在人文关怀实践的作用,这对“中国梦”时代背景下的医院建设发展具有重要意义。     

国有医院负债率合理范围的界定与分析

近年来，我国国有医疗机构的负债问题逐渐受到各级部门的重视，并成为政府部门和医院管理者关注的热点。准确把握医院负债的规模和界定医院负债率合理范围是当前医院实现高起点、超常规、快节奏可持续发展的迫切任务。文章在分析有关财务理论基础上，结合我国医疗市场现状和国有医院特点，对某地区医院的负债率进行个案分析，以探讨医院合理负债率范围和负债规模。     

From context to contexting: professional identity un/doing in a medical leadership development programme

Physicians are known for safeguarding their professional identities against organisational influences. However, this study shows how a medical leadership programme enables the reconstruction of professional identities that work with rather than against organisational and institutional contexts to improve quality and efficiency of care. Based on an ethnographic study, the results illustrate how physicians initially construct conflicting leadership narratives – heroic (pioneer), clinical (patient's guardian) and collaborative (linking pin) leader – in reaction to changing organisational and clinical demands. Each narrative contains a particular relational-agentic view of physicians regarding the contexts of hospitals: respectively as individually shapeable; disconnected or collectively adjustable. Interactions between teachers, participants, group discussions and in-hospital experiences led to the gradual deconstruction of the heroic –and clinical leader narrative. Collaborative leadership emerged as the desirable new professional identity. We contribute to the professional identity literature by illustrating how physicians make a gradual transition from viewing organisational and institutional contexts as pre-given to contexting, that is, continuously adjusting the context with others. When engaged in contexting, physicians increasingly consider managers and directors as necessary partners and colleague-physicians who do not wish to change as the new ‘anti-identity’.     

Accomplishing 'the case' in paediatrics and child health: medicine and morality in inter-professional talk

This paper presents data from a recently completed ESRC funded ethnography of social relations and case formulation in an integrated child health service, comprising paediatric inpatient and outpatient, child and adolescent mental health and child development services. Children present to the services with symptoms or troubles for which there are often competing biological, neurological, genetic and/or psychosocial models of causation. As a consequence, clinicians’ talk is oriented to deciding between three main potential types of case formulation –medical, psychosocial and not just medical. These three formulations are not static ideal‐types. They are highly contestable and require complex practical and rhetorical work, through which facts and evidence are selectively invoked and different parties to the case are granted attributes which construct and reconstruct past events to render ambiguous symptoms or events understandable. In particular, moral judgements and complex characterizations about the child’s parents, or significant others, often form an indispensable warrant for these formulations. By analysing professional narratives about cases, this paper develops previous ethnographic work on the classification in medical work of children and adults as good or bad, appropriate or inappropriate, culpable or blameless, and renders visible a repertoire of moral formulations about childhood and child care. In particular, judgements about the adequacy of parental love are central to clinical reasoning.     

医疗服务质量管理新策略

随着医疗市场的竞争,医疗服务质量的含义发生了新的变化,新的医疗服务质量管理理论、方法也被不断引进。本文介绍了医疗服务质量的概念、医疗服务质量管理理论、方法以及改进服务、提高医疗服务质量的建议,这有利于我国医疗机构明确认识,改善服务,提高服务质量,增加医院的竞争力。     

关于建立医院伦理委员会的思考

社会主义市场经济的建立以及科学技术的进步,极大地推动了医学科学事业的迅猛发展,同时亦会产生出许多医患矛盾和医德难题,从而在客观上越来越迫切地要求基层医疗单位建立专门机构来研究、协调和解决这些新矛盾、新问题。那么,医院伦理委员会的建立就成为必然,作者从世界性医德难题的出现入手,重点阐述了医院伦理委员会产生的社会历史背景,及其内涵特征、地位功能等,并对医院伦理委员会建立过程中应注意的几个问题提出了独特的看法。     

An outbreak of multiply-resistant Klebsiella pneumoniae in the Grampian region of Scotland

A predominantly hospital-based outbreak of multiply-resistant Klebsiella pneumoniae capsular type K₂ (MRK) expressing expanded spectrum β-lactamase (ESBL) activity and fully sensitive only to the carbapenems and amikacin is described. The organism was isolated from 283 patients between March 1992 and September 1995. The outbreak started in the intensive care unit (ICU) of a major acute hospital and spread through surgical wards, a medical ward, a geriatric unit in a separate hospital and various other local hospitals. Environmental screening revealed extensive ward contamination. The decline of the outbreak after the spring of 1995 coincided with the re-emphasis of standard infection control procedures and the launch of a works programme aimed at addressing underlying sites of environmental contamination. Of the 283 cases, 166 (59·0%) were detected through a specially instigated case finding programme. The MRK caused 11 cases of septicaemia, two postoperative intra-abdominal abscesses, one case of postoperative meningitis, 102 cases of urinary tract infection and 28 wound infections and was isolated from the respiratory tracts of five patients with ventilator associated pneumonia. The difficulty in controlling the outbreak is ascribed to heavy environmental contamination, frequent inter- and infra-hospital patient transfers and prolonged carriage of the outbreak strain.     

加强旅医院院长领导力的几点建议

旨在探索军队旅医院院长领导力的问题;通过研究得出,旅医院院长领导力具有5个内涵维度:卫勤组织指挥能力、医疗专业技术能力、人际沟通协调能力、人格感召激励能力、创新变革决策能力;提出加强旅医院院长领导力的建议.     

罕见病防治:不仅仅是知识和技术

  目的  评估中国临床医生对罕见病的认知程度,为进一步提高罕见病认知度和诊疗水平提供参考。  方法  利用2018年唐山地区医生罕见病诊治现状调查数据,采用描述性统计方法和logistic回归模型,探讨认知度在医生个人特征、所在医院特征、日诊疗量和知识获取渠道等方面的差异,分析临床医生罕见病认知度及其影响因素。  结果  本科和硕士及以上临床医生对于罕见病的认知得分相对于专科医师高出0.59分（P < 0.01）和0.79分(P < 0.01),在三级医院工作的医生对于罕见病的认知得分比二级医院高出0.64分(P < 0.01);与治疗1～2位患者的医生比较,治疗3～5位患者/h和治疗 > 5位患者/h的医生认知得分分别高出0.24分（P < 0.05）和1.10分（P < 0.05）。  结论  提升临床医生教育水平和临床治疗经验,有助于罕见病的及时发现、减少误诊率及减少患者因误诊导致的额外负担。