“GLTC”医患沟通模式引入住院医师规范化培训实践中的应用研究

目的:探讨"GLTC"医患沟通模式引入住院医师规范化培训实践中的应用效果。方法:选取120名规范化培训医师随机分成试验组和对照组各60名,对照组采用传统的工作模式,工作中也融入医患沟通;试验组采用"GLTC"医患沟通模式进行系统的临床实践训练,实践前进行系统的理论培训,实践中加强医方示善、医方倾听、医患交流的训练。患者对两组规范化培训医师的满意度和规范化培训医师的自我评价进行比较。结果:试验组的满意度100%明显高于对照组80.0%,P0.05;试验组的自我评价优良率98.3%明显高于对照组78.3%,P0.05;试验组发生医患纠纷发生率0.0%明显低于对照组10.0%,P0.05。结论:将"GLTC"医患沟通模式引入住院医师规范化培训实践中可以很好的提高住院医师的工作效率,提高患者的满意度,减少医患纠纷的发生。     

护患沟通技巧对急诊抢救成功率及护理满意度的影响

目的探讨护患沟通技巧对提高急诊抢救成功率及护理满意度的影响。方法将2015年12月—2016年12月收治的危重症患者60例随机分为观察组和对照组,各30例,对照组予以常规护理,观察组予以加强护患沟通技巧的护理操作,采用焦虑自评量表(self-rating anxiety scale,SAS)评分,抑郁自评量表(self-rating depression scale,SDS)评价两组心理状态;统计两组护理满意度和急诊抢救成功率。计量资料比较采用t检验;计数资料比较采用χ2检验,P0.05为差异具有统计学意义。结果观察组护理满意度评分高于对照组,观察组急诊抢救成功率96.7%高于对照组73.3%,差异有统计学意义(均P0.05);观察组SAS评分、SDS评分[(43.86±4.17)分、(49.24±1.33)分]低于对照组[(51.77±4.66)分、(56.46±1.58)分],差异有统计学意义(均P0.05)。结论护患沟通技巧的合理应用可提高抢救成功率和护理满意度。     

PDCA循环法在超声诊断科教学查房管理中的应用效果

目的 探讨PDCA循环法在超声诊断科教学查房管理中的应用效果。方法 将2019年1-12月（未采用PDCA循环法）的51位住院医师作为对照组，将2020年1-12月（采用PDCA循环法）的51位住院医师作为观察组。对比两组住院医师的各项考核成绩及对教学方法的满意度。结果 考核结果显示，观察组住院医师的专业理论知识、实践操作技能、临床思维能力以及医患沟通评分与对照组对比明显更高，差异有统计学意义（P<0.05）；教学满意度方面，观察组住院医师对教学态度、教学技巧以及教学效果的满意度均高于对照组，差异有统计学意义（P<0.05）。结论 PDCA循环法用于超声诊断科教学查房管理中可有效强化培训教学质量，提升住院医师的专业知识与实践能力。     

放松训练在突发性耳聋患者中的临床疗效评价

目的 探讨放松训练对突发性耳聋患者康复的临床疗效.方法 将突发性耳聋患者120例,随机分为实验组和对照组,各60例.实验组在与对照组采取相同的治疗和常规护理的基础上,每日早晚各加1次放松训练护理.两周后对两组患者的焦虑、抑郁值、睡眠情况及听力恢复程度进行评分.结果 实验组患者的焦虑抑郁明显低于对照组,差异有统计学意义(P＜0.05);实验组睡眠质量及听力恢复程度明显高于对照组(P＜0.05).结论 放松训练是突发性耳聋患者有效的护理措施.     

实施"病友之家"对乙型肝炎患者出院后遵医行为影响的研究

目的加强医护患的沟通,提高乙型肝炎患者出院后遵医行为.方法实施乙型肝炎"病友之家",选取实施前100例作为对照组,实施后100例作为实验组,并对实施前后住院乙型肝炎患者出院后进行遵医行为的观察.结果乙型肝炎患者出院后除注射干扰素的遵医行为两组无明显差异外(P＞0.9),其他医嘱内容,实验组的遵医行为明显优于对照组(P＜0.05).实验组对护理工作的满意度明显高于对照组(P＜0.05).结论实施乙型肝炎"病友之家",有利于提高乙型肝炎患者出院后遵医行为,提高服务质量.     

健康管理对糖尿病患者认知和行为改变的效果评价

[目的]对糖尿病患者进行健康管理,并从认知、行为、生活质量、焦虑程度4个方面进行评价,以探寻有效的健康管理模式. [方法]选取某市三甲医院内分泌科门诊糖尿病患者114名,随机分为干预组(57人)和对照组(57人).两组均逐一填写调查问卷,对干预组实施为期5个月的健康管理,5个月后,两组患者再次填写问卷.[结果]5个月后,干预组其认知、行为评分均增高,改变具有统计学意义(P＜0.05),而对照组行为评分出现下降.干预组生活质量评分、焦虑评分均降低,其改变具有统计学意义(P＜0.05).对照组生活质量评分、焦虑评分均增高.[结论]健康管理能有效提高糖尿病患者的认知,熏塑健康的生活方式,提高生活质量.     

认知功能训练对脑卒中后认知障碍患者康复疗效的研究

[目的]研究认知功能训练对脑卒中后认知障碍患者康复的疗效.[方法]将96例合并有认知障碍的脑卒中患者随机分为训练组和对照组,训练组在常规康复的基础上给予认知康复训练,对照组予以常规康复训练,训练时同为2个月.在训练前、训练后1个月及2个月分别用简易智能状态检查(mini-mental state examination,MMSE)量表、Fugl-Meyer量表及改良Barthel指数对患者认知、运动功能分级及日常生活活动能力进行评定.[结果]两组患者训练前认知、运动功能分级及日常生活活动能力差异无统计学意义(P＞0.05).两组患者训练1个月对Fugl-Meyer量表评分及Barthel指数差异无统计学意义(P＞0.05).MMSE评分差异有统计学意义(P＜0.05);2个月时,两组患者之间MMSE、Fugl-Meyer量表及Barthel指教差异有统计学意义(P＜0.025).[结论]对于合并有认知障碍的脑卒中患者,同时给予认知康复训练和常规康复训练,有利于其认知功能、运动功能和日常生活活动能力的改善,有助于患者的全面康复.     

学生模拟标准化病人教学模式对中职护理专业学习能力及考试成绩的影响

目的：观察学生模拟标准化病人（SSP）教学模式对中职护理专业学习能力及考试成绩的影响。方法：选取2019级中职护理专业3年级学生96人,根据学号尾号奇偶数将其分为对照组与观察组,各48例。两组学生均在即将进入临床实习前1个月接受强化实训。对照组根据中等职业学校护理专业教学标准实施传统教学,观察组实施SSP教学。比较两组学生学习能力、考试成绩、临床能力及教学满意度。结果：观察组学生问诊能力、身体评估能力评分较对照组高（P＜0.05）;两组实训后理论考试、操作考试评分均提高,且观察组改善更佳（P＜0.05）;观察组临床沟通能力、临床处置、健康教育评分较对照组高（P＜0.05）;观察组教学满意度较对照组高（P＜0.05）。结论：学生模拟SSP教学模式可提高中职专业学生学习能力、临床应对能力及考试成绩,提升学生对教学的满意度。     

双导师制度联合多学科协作教学模式在住院医师规范化培训中的应用效果

目的 探讨在住院医师规范化培训中实施双导师制度联合多学科协作教学模式的效果。方法 选择2019年8月—2022年8月在滁州市第一人民医院进行住院医师规范化培训的72名住培医师作为研究对象,根据1∶1随机数字表法把住培医师分为研究组36名与对照组36名,对照组采取双导师制度教学,研究组在双导师制度教学的基础上联合多学科协作教学模式,6个月后比较两组技能操作、理论成绩、Mini-CEX评分、临床差错事件发生率和住培医师的培训满意度。结果 研究组的技能操作、理论成绩明显高于对照组(P<0.05)。研究组在Mini-CEX评分的病史询问、体格检查、沟通技巧、临床判断、人文关怀、组织效能、整体表现等均显著高于对照组(P<0.05)。研究组的诊断错误、医嘱错误、职业伤害、医患矛盾等临床差错事件发生率为5.56%,对照组为25.00%,研究组与对照组相比明显降低(P<0.05)。研究组的培训满意度为100.0%,对照组为83.33%,研究组明显高于对照组(P<0.05)。结论 双导师制度联合多学科协作教学模式应用于住院医师规范化培训不仅能提高住培医师理论和技能考核成绩、Min...     

以护士为主导康复锻炼对于双相情感障碍患者的影响

目的 探究以护士为主导的康复锻炼在双相情感障碍患者中的应用效果.方法 双相情感障碍患者80例随机分成对照组和实验组,所有患者都采用常规药物治疗,对照组采用常规护理方法,实验组在对照组患者护理的基础上增加以护士为主导的康复锻炼干预;护理两个月后比较两组患者治疗前后的简明精神病量表(Brief Psychiatric Rating Scale,BPRS)评分、生命质量评分、健康知识的知晓率、护理满意度.结果 护理2个月后,实验组患者的BPRS总得分、敌对猜疑因子评分均显著低于对照组(P＜0.05).干预前,两组患者的SQLS总分、心理社会、动机/精力、症状/不良反应等得分差异不具有统计学意义(P＞0.05);干预后,两组患者的上述评分均差异显著(P＜0.05).实验组患者对健康知识的知晓率(95％)高于对照组(75％),护理满意度(95％)高于对照组(82.5％),差异均有统计学意义(P＜0.05).结论 以护士为主导的康复锻炼有利于改善患者精神症状,提高患者对健康知识的知晓率和满意度,值得临床推广.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.