Hospital-based utilization management: a cross-Canada survey.

Utilization management attempts to measure, understand and, when appropriate, reduce hospital use. We conducted a telephone survey to determine the status of utilization management in Canadian hospitals. The sample comprised a random selection of 30% of acute-care hospitals with over 100 beds for adults in Ontario and Quebec and all such hospitals in the other provinces. Of the 123 chief executive officers contacted 99 (80%) claimed to have a utilization management program. Of those, 90 (91%) agreed to participate in an in-depth survey or to designate a senior administrator to be interviewed who was most knowledgeable about the program. High occupancy rates and funding issues were the most common environmental triggers for the development of utilization management programs; funding issues were listed more frequently by respondents in Ontario than by those elsewhere (p = 0.0008). Retrospective review alone was used in half of the hospitals, concurrent review or some mixed approach being used in the other half. Ontario and the Atlantic provinces were more reliant than the rest of the country on retrospective review alone (p = 0.0032). Most of the hospitals used peer review and education to stimulate corrective action. Of the respondents 67% indicated that the medical staff supported the utilization management program, and 53% reported that the program had a positive impact on the relationship between administrative and medical staff. Most of the respondents were unsure of the program's impact on the quality of care or the rate of unnecessary hospital admission. However, retrospective review alone was found to be less successful in reducing inappropriate utilization than either concurrent review or combined review (p = 0.0048).     

Nurse practitioners in primary care III. The southern Ontario randomized trial

A group of nurses who formerly had performed office functions received a special university-based educational program designed to prepare them to assume much of primary care management as nurse practitioners. The associated family physicians would shift their role to general supervision and attention to difficult clinical problems. To test this new form of practice, two complementary randomized trials have been conducted in south-central Ontario. The particular trial reported here was intended to assess the influence of the educational program on the changing roles of the professional personnel. The nurses of 14 family medical practices, with the physicians' support and commitment to participation, applied for the new training. Seven applicants were randomly selected to receive the training and their corresponding practices became the experimental group, while the remaining nurses and practices were retained as controls. During the subsequent year of investigation important changes occurred in professional roles of the experimental group. Nurse practitioners spent more time in clinical activities than conventional office nurses. The shift was not at the expense of time devoted to clinical work by physicians. Doctors delegated more professional activities to nurse practitioners than to conventional nurses. Except for remuneration (affected by legal constraints) job satisfaction among experimental physicians and nurses remained high after one year of experience with the new method.     

积极心理学视野下师范院校留守经历学生心理健康现状研究

目的以留守经历为切入口,探讨积极心理学视野下,师范院校大学生心理健康水平现状,以期从实证角度帮助促进大学生心理健康和谐发展。方法选取安徽省阜阳市、安庆市部分师范院校大学生为被试,调查学生留守经历状况,并综合运用SCL-90症状自评量表了解学生心理健康状况。结果父母外出情况、父母外出打工年限、学生开始留守年龄段、与父母团聚频率的不同,学生的心理健康水平也存在显著差异,父母双方均外出、父母外出打工年限超过1年、学生开始留守年龄段在小学及以前、与父母团聚频率在半年以上的学生心理健康水平低于父母其中一人外出、父母外出打工年限在1年以下、学生开始留守年龄段在初中以上、与父母团聚频率在半年以内的学生（P < 0.01）。结论曾经的留守经历对师范院校大学生心理健康存在一定影响,作为教育者应有针对性地对学生进行心理健康教育。     

标准化病人在妇产科学临床教学中的应用效果

目的 探讨标准化病人（standardized patient,SP）在妇产科学临床教学中的应用效果.方法 选择在湖北医药学院第三临床学院见习的2010级五年制临床医学专业120名学生为研究对象,将其随机分为两组,实验组60人,对照组60人,分别进行SP强化训练和常规教学训练.训练结束后对两组学生进行理论及临床技能考核;同时,就教学情况对两组学生进行问卷调查.结果 实验组学生对教学的满意度高于对照组学生,对知识的掌握和对从业后接诊患者的自信心优于对照组,两者差异具有统计学意义（P＜0.01）.理论考试结果显示,客观题成绩及知识点错误数,两组学生比较差异无统计学意义（P＞0.05）;但是,实验组学生的临床病例分析成绩高于对照组学生,知识点错误数低于对照组学生,其差异具有统计学意义（P＜0.05）.临床技能考核成绩比较,实验组学生的病史采集、妇科检查及产科检查等专科检查成绩高于对照组学生（P＜0.05）,尤其在医患沟通、临床思维方面,实验组学生成绩明显好于对照组学生,差异具有统计学意义（P＜0.01）.结论 妇产科学临床教学中,应用标准化病人可以提高医学生的临床实践技能。     

双师制在医学检验实验教学中的应用

目的探索双师制带教方法在医学检验实验教学中的应用。方法把2010级医学检验技术班76名同学,按学号分成两组,学号为奇数组实行双师制带教,另一组实行传统带教。比较两组学生病理检验技术、免疫学检验和微生物学检验的平时实验、实验技能和理论考试的成绩。结果病理检验技术、免疫学检验和微生物学检验三门课程中双师制组学生的平时实验、实验技能和理论考试成绩均明显高于传统带教组学生(P<0.05)。结论双师制教学有助于提高和规范学生的实验操作技能,加深对理论知识的理解。     

基于在线课程的“2+1”对分课堂在医学统计学本科教学中的应用

目的探索基于在线课程的"2+1"对分课堂在医学统计学本科教学中的应用效果。方法将2017年春季学期选修医学统计学的临床医学专业326名本科生随机分为普通班和试验班,普通班140名学生作为对照,采用传统方法授课;试验班186名学生,采用基于在线课程的"2+1"对分课堂教学,将在线自学、课堂授课、课堂讨论等有机结合。比较两个班学生的评价信息以及考试成绩。采用SAS 9.4进行定量资料描述及t检验、轶和检验。结果相较普通班,试验班学生认为基于在线课程的"2+1"对分课堂,更注重学科交叉(P<0.01),对能力培养有帮助(P=0.008),更利于从事科研(P=0.012);试验班学生综合满意度更高(P<0.01)。试验班学生在课终考试中综合案例分析题得分更高(P<0.01)。结论基于在线课程的"2+1"对分课堂教学效果优于传统模式,值得在高校教学中应用和推广。     

“临床学院”模式与传统模式对学生理论和实践效果的比较

目的:比较医学生"临床学院"模式与传统模式对其理论和实践成绩的差异。方法:同一年级学生随机分成实验组和对照组,并根据两组学生毕业理论考试成绩和实践操作成绩进行比较。结果:实验组在大内科成绩和操作技能上的成绩高于对照组,而对照组在大外科综合成绩上高于实验组,差异均有意义P<0.05。结论:在"临床学院"模式与传统模式教学背景下,医学生学业成绩与预期效果存在一定差异。这种差异因素与"临床学院"教学环境可能存在一定关联。     

Pelvic examination teaching: linking medical student professionalism and clinical competence

The Professional Patient teaching program is an essential part of assuring competency in the performance of the pelvic examination and professional behaviors. Through a series of integrated teaching sessions from the first year reproductive anatomy laboratory, the second year basic clinical pelvic examination teaching program, to the third year teaching program, students perform at an enhanced level of clinical competency and professional behavior. A Professional Patient commented: "We create a safe environment where medical students not only learn the clinical portion of the exam, but also focus on the patient as the primary source of information on patient comfort. Students receive immediate feedback from us and have ample opportunity to ask questions about aspects of the clinical pelvic examination or doctor/patient communication skills. We guide them, teach them, and help them prepare for examinations with other patients who will not be as open or in tune with their bodies as we are."     

Videotape educational program for people with asthma.

A videotape educational program was produced for use in adults with asthma. The program provided an overview of lung function, the physiologic abnormalities and treatment of asthma, and the approach to common problems encountered by the patients. Its benefits were examined in a randomized controlled study. The efficacy of the program in 62 patients whose mean duration of illness was 17 years was assessed by comparing the level of knowledge of the experimental group immediately after viewing the tape with that of the controls, who had not seen it; the experimental group scored significantly higher than the control group. Retention of knowledge attributed to the program was assessed after a mean interval of 16 months. The knowledge test score of the experimental group was found to have decreased to the level of the control group. The main areas in which the experimental group lost knowledge were self-care and drug therapy for asthma. The medical status of the two groups did not change appreciably over the period of the study.     

以临床胜任力为导向的CBL在急危重症护理本科教学中的实践

目的探讨临床胜任力为导向的病例教学(case-based learning,CBL)在急危重症护理学本科教学中的可行性和有效性。方法将急危重症护理本科生120人随机分为CBL教学组和传统教学组。根据每次实习学生人数,CBL教学组分为数个小组,每小组固定一个带教教师,并以小组为单位进行临床教学实践;传统教学组采用既往的临床实习教学方式,即一个学生固定跟随一个带教教师。采用理论考试、技能考试以及问卷调查等多种考核方式评价两组的教学效果,采用SPSS 21.0软件行t检验和卡方检验。结果与传统教学组相比,CBL教学组在理论考试[(92.5±3.0)vs.(85.3±3.3)]和技能考试[(93.1±4.5)vs.(88.1±3.4)]方面均更好,且差异有统计学意义(P<0.05);在对教学满意度调查方面,CBL教学组优于传统教学组。结论以临床胜任力为导向的CBL教学应用于急危重症护理本科教学是可行的,能有效培养学生的临床思维和提高实际的临床胜任力。     

儿科学新型网络考试平台及题库建设的应用研究

目的探讨儿科学新型网络考试平台及题库的应用效果。方法以病例为基础建立儿科学新型题库并整合到网络考试平台上。选择中国医科大学2014级五年制临床医学专业8个班的学生作为研究对象。随机分为2组,实验组4个班(n=115人),对照组4个班(n=120人)。两组学生实习课均采用以问题为导向的教学方法(problem-based learning,PBL)联合以病例为基础的教学方法(case-based learning,CBL)进行授课。实验组学生应用考试平台的练习题部分进行辅助教学,对照组学生无练习题辅助教学。对照组参加传统考试,实验组使用新型考试平台考试,再分别进行问诊考核。对实验组学生进行问卷调查。结果实验组学生理论成绩、总成绩均优于对照组(P<0.05),实验组学生问诊成绩优于对照组(P<0.01)。问卷调查结果显示,大部分学生认为应用新型题库及考试平台能增加对儿科学的学习兴趣,增强临床思维及临床能力等,学生普遍希望继续应用新型题库和考试平台(98.26%)。结论儿科学新型题库及新型考试平台适合于新时代儿科学的发展需求,应用前景广阔。     

Study of teaching residents how to teach

In the study reported here, the authors evaluated the effectiveness of a teaching skills program for residents. Twenty-two residents in obstetrics and gynecology, medicine, and family medicine were randomly assigned to control and experimental groups. The experimental groups received instruction and feedback about teaching skills during their first and second postgraduate years. Both groups were evaluated at three times: in the first year before the instructional program, in the second year during the instructional program, and in the third year six months after instruction. During each study phase, videotapes were made of each resident teaching a student in the context of a case presentation. Trained raters evaluated eight teaching skills exhibited in the videotapes. In general, there was greater increase and less decline in the scores of the experimental than the control groups. These data suggest that teaching skills can be improved by instruction and that without support residents' teaching skills do not improve in relation to their clinical competence.     

“学生模拟问诊”联合SimMan模拟人在内科临床见习中的应用

目的：探讨＂学生模拟问诊＂联合SimMan模拟人在内科临床见习教学中的作用。方法：学生随机分为实验组与对照组,分别实施模拟教学及传统教学,通过学生对教学效果的评价进行检验。结果：实验组比较对照组上课更有热情,病史采集更加全面,病人能配合良好,而且学生对病人更能感同身受。结论：＂学生模拟问诊＂结合SimMan模拟人体格检查在内科临床见习教学中作用显著。     

Integrating basic science and clinical teaching for third-year medical students

A two-month program for third-year students at the Albert Einstein College of Medicine of Yeshiva University provides a model for integrating basic sciences and clinical training. Entitled The Scientific Basis of Clinical Medicine, the course involves more than 100 basic science instructors and clinical instructors and is designed to foster recognition that good patient care requires physicians to evaluate the latest evidence of medical researchers. It also demonstrates the importance of lifelong learning in a field that constantly changes. Since 1978, the course has been offered in the spring of the third year after students as demonstrating "the continuum from basic science to clinical medicine" and as moderately successful in achieving its other objectives. Students view both its content and its less pressured environment after an intense year of clinical training as its major strengths.     

PBL式妇产科学双语教学应用研究

目的：探讨PBL式妇产科学双语教学的可行性及成效。方法：将基础知识水平相同的60名七年制临床医学专业学生分为实验组和对照组,对两组学生采取不同的教学方法,比较教学效果。结果：实验组学生对妇产科学的学习积极性显著改进,学生的理论成绩,技能测试,态度评估均优于对照组学生。结论：PBL式妇产科学双语教学可以提高教学效果和学生素质,值得我们不断探索和研究。     

Cardiovascular disease risk reduction for tenth graders. A multiple-factor school-based approach

All tenth graders in four senior high schools (N = 1447) from two school districts participated in a cardiovascular disease risk-reduction trial. Within each district, one school was assigned at random to receive a special 20-session risk-reduction intervention and one school served as a control. At a two-month follow-up, risk factor knowledge scores were significantly greater for students in the treatment group. Compared with controls, a higher proportion of those in the treatment group who were not exercising regularly at baseline reported regular exercise at follow-up. Almost twice as many baseline experimental smokers in the treatment group reported quitting at follow-up, while only 5.6% of baseline experimental smokers in the treatment group graduated to regular smoking compared with 10.3% in the control group. Students in the treatment group were more likely to report that they would choose "heart-healthy" snack items. Beneficial treatment effects were observed for resting heart rate, body mass index, triceps skin fold thickness, and subscapular skin fold thickness. The results suggest that it is feasible to provide cardiovascular disease risk-reduction training to a large segment of the population through school-based primary prevention approaches.     

程序化健康教育对婴幼儿腹泻的作用

目的探讨程序化健康教育对婴幼儿腹泻的作用。方法将84例婴幼儿腹泻患儿随机分为试验组43例和对照组41例,对照组采用传统健康教育方法教育,试验组按整体护理程序对患儿及家属实施程序化健康教育。观察2组患儿家属对婴幼儿腹泻病相关知识和技能的知晓程度;2组患儿的住院时间、红臀发生情况。结果试验组患儿家属对婴幼儿腹泻病相关知识和技能的知晓程度明显优于对照组(P<0.05),且试验组患儿的平均住院时间、红臀的发生均少于对照组。结论采用程序化健康教育能明显提高患儿家属的健康知识水平,缩短患儿的平均住院时间,减少红臀发生。     

PBL教学法与翻转课堂相结合的教学模式在大学英语读写教学中的应用

目的 探讨如何应用“翻转课堂与PBL教学法相结合”的课堂教学模式提高学生英语读写能力, 提高课堂有效性.方法 在大学英语读写教学中, 将2015级学生随机分为2组, 一组为实验组, 采用“翻转课堂与PBL教学法相结合”的课堂教学模式教学, 共43人;另一组为对照组, 采用传统课堂教学模式, 共43人.2组的授课教师相同.将2组教学效果进行对比性研究.采用基础数据分析和问卷调查的方法, 从学生期末成绩、学习过程中相关数据、学生对学习成效的满意情况、2种课堂教学模式的反应以及教师收集的2种课堂教学模式教学相关数据等方面进行了调查研究, 对比实验组和对照组的学习成效.结果 学期结束时, 实验组比对照组期末考试成绩和及格率明显提高 (P<0.05) ;在对2种课堂教学模式进行的问卷调查中, 实验组学生投入到学习过程中的时间比对照组多.学生认为采用“翻转课堂与PBL教学法相结合”的课堂教学模式下, 不仅学生课堂专注度、自主学习能力、课堂参与率、英语读写能力明显提高 (P<0.05) , 而且学生期末考试成绩平均分高于传统课堂的期末考试成绩平均分, 学生对这种课堂教学模式满意度高 (P<0.05) .结论 “翻转课堂与PBL教学法相结合”的课堂教学模式能促进学生自主学习, 注重学生吸收及内化所学知识, 提高学生的学习兴趣及学习效率, 提升教师教学相长能力.     

医学本科生科研素质培养实践

本文旨在探讨医学本科生早期接触科研对其科研素养的培养方式和效果影响。结合教师的科研项目,每年从主动申请的三年级本科学员中筛选3~5名学员参加科室不同课题组的项目。根据学员意愿,或参加科研项目中的部分实验,或单独完成小课题,或就某个问题在教师指导下撰写综述。近10年有25名学员参加了病理学教研室的本科生早期科研活动,共发表论文19篇。参加实验研究的学员,绝大部分都能进行科学实验,并具有一定的独立性,科研思维和动手能力得到锻炼;撰写综述的学员,不仅拓宽了知识面,还培养了文献检索、阅读、综合写作和批判性思维能力。因此,早期科研素养培养有利于调动学生参与科研的积极性与主动性,参加实验研究和专题综述可以在不同层面提升医学本科生的科研能力与科学素养。     

Surveillance de la santé à l''école maternelle.

In contrast to the traditional program of health assessment of schoolchildren based on periodic physical examination, the program described in this paper is based on the integration of information and data obtained by observation through the school year from parents, teachers and the school nurse, who coordinates the program. The numbers and the types of problems and the date on which they were identified are compared in an experimental group of 557 kindergarten children and a matched control group of 498 children in whom the traditional program was maintained. For problems of hearing, enuresis, learning and behaviour the number of cases detected was significantly greater in the experimental group than in the control group. Each element of the proposed program is analysed and the advantages of an integrated approach to health assessment of schoolchildren are underlined.