ICU 护 理人员心理授权与工作倦怠的相关性研究

目的探讨ICU护理人员心理授权与工作倦怠的相关性。方法选取北京市2所三级甲等综合性医院12个监护室190名护理人员,采用心理授权量表、中式工作倦怠量表进行调查。结果发放问卷190份,有效回收182份．有效回收率为95．79％。ICU护理人员心理授权处于中等水平,中式工作倦怠状况较严重,相关分析表明ICU护理人员心理授权总分与工作倦怠总分呈显著负相关（r=-0．71,P〈0．01）,且心理授权各维度与工作倦怠各维度均呈负相关（P〈0．05）。心理授权各维度对工作倦怠各维度均存在预测作用。结论心理授权能够有效预测ICU护理人员工作倦怠,提高护理人员心理授权水平,对于有效缓解ICU护理人员工作倦怠具有重要作用。     

Physician awareness and attitudes regarding early warning score systems in mainland China: a cross-sectional study

INTRODUCTIONThe purpose of this study was to assess the application of the early warning score system (EWS-S) and gauge physician awareness, perceptions of necessity and attitudes regarding these tools based on previously experienced unnoticed clinical deterioration (CDET).METHODSA cross-sectional survey was carried out via an online questionnaire at a large 3,500-bed Class 3A general hospital in China. A total of 299 physicians of adult general wards were asked to answer a translated questionnaire that was localised from the original version. Demographic profiles of patients were included as well as three other sections assessing awareness of CDET/EWS-S and gauging attitudes towards and perceptions of the necessity of EWS-S at our hospital.RESULTSA high level of physician awareness of the CDET problem was observed. Most physicians knew about the existence of a systematic assessment tool for clinical application. Physicians with previous experience in reanimation, unplanned transfer to intensive care unit (UTICU) and/or death tended to consider EWS-S necessary in attentive and well-trained staff (p < 0.05). Physicians who had previous experience with UTICU were more likely to recommend implementing EWS-S in their wards compared with those without such experience (p < 0.05).CONCLUSIONMost physicians have positive attitudes towards EWS-S. However, their awareness should be further heightened. Physicians who had previous experience with CDET/UTICU were more likely to employ EWS-S in their clinical practices. To better facilitate the implementation of EWS-S in Chinese hospitals, existing facilities, policy supports, standardised managements and the development of information systems should be strengthened.     

The burden of the digital environment: a systematic review on organization-directed workplace interventions to mitigate physician burnout

ObjectiveTo conduct a systematic review identifying workplace interventions that mitigate physician burnout related to the digital environment including health information technologies (eg, electronic health records) and decision support systems) with or without the application of advanced analytics for clinical care.Materials and MethodsLiterature published from January 1, 2007 to June 3, 2020 was systematically reviewed from multiple databases and hand searches. Subgroup analysis identified relevant physician burnout studies with interventions examining digital tool burden, related workflow inefficiencies, and measures of burnout, stress, or job satisfaction in all practice settings.ResultsThe search strategy identified 4806 citations of which 81 met inclusion criteria. Thirty-eight studies reported interventions to decrease digital tool burden. Sixty-eight percent of these studies reported improvement in burnout and/or its proxy measures. Burnout was decreased by interventions that optimized technologies (primarily electronic health records), provided training, reduced documentation and task time, expanded the care team, and leveraged quality improvement processes in workflows.DiscussionThe contribution of digital tools to physician burnout can be mitigated by careful examination of usability, introducing technologies to save or optimize time, and applying quality improvement to workflows.ConclusionPhysician burnout is not reduced by technology implementation but can be mitigated by technology and workflow optimization, training, team expansion, and careful consideration of factors affecting burnout, including specialty, practice setting, regulatory pressures, and how physicians spend their time.     

Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty

The present study compares academic and clinical faculty affiliated with a major teaching hospital in terms of work characteristics, job stress, conflict between work and personal life, job and life satisfaction, and perceived health. There were no significant differences between the two physician groups on job satisfaction, total stress, anxiety, or depression scores. However, academic faculty reported working longer hours, taking less vacation time, and spending more time in research and teaching, but seeing fewer outpatients. Academic physicians experienced more conflict between work and personal life, were burdened by a variety of time pressures, and were less satisfied with their finances, but experienced fewer recent episodes of physical illness than clinical faculty. However, compared with what is known about the general population, both physician samples seemed equally or more satisfied with their health and their lives.     

公立医院医生工作满意度与工作投入之间的关系研究

  目的  了解公立医院医生工作满意度与工作投入的水平,分析工作满意度与工作投入两者之间的交互关系,探讨工作满意度各维度如何影响工作投入,为提高公立医院医生的工作投入水平提供参考依据。  方法  在四川省6家公立医院（3家三级医院和3家二级医院）中通过方便抽样得到638份医生调查问卷进行数据描述与分析。采用Pearson相关方法分析工作满意度和工作投入之间的相关关系,多重线性逐步回归方法分析工作投入及各维度的影响因素。  结果  工作满意度中,医生评分对人身安全（3.77±0.87）、领导认同与支持（3.59±0.77）、工作压力（3.51±0.81）的满意度较高。工作投入及各维度的均分分别为:工作投入总均分（4.02±0.99）、奉献（4.21±1.13）、专注（4.19±1.08）、活力（3.63±1.04）。工作满意度中,报酬与待遇、工作环境、社会认可、组织管理、领导认同与支持与工作投入及各维度存在正相关。工作满意度中,社会认可、领导认同与支持、工作成就、人身安全、组织管理5个维度对工作投入及各维度有显著影响作用。  结论  重视医生被认可、自我实现的高层次需要、医患沟通、医生的个人发展,提高医生的工作满意度,可提高医生的工作投入水平。     

放射人员职业紧张水平和工作满意度的调查与分析

目的：了解新疆各级医院和企业从事放射工作人员的职业紧张水平和工作满意度,探索职业紧张的影响因素。方法：整群随机抽取348名放射人员,采用职业紧张量表（OSI-R,1998）和工作满意度问卷进行职业紧张水平和对工作满意程度的测评。结果：企业和男性的放射人员承受的职业紧张压力更大,对工作的满意度更低;具有大专学历、年龄在40～50岁之间、从事放射工作≥25年的放射人员承受职业紧张压力最小,应对职业压力的能力最强,对工作的满意度较高。不同婚姻状态和民族的放射人员的职业紧张水平及对工作的满意程度是相同的。结论：放射工作是一个紧张的职业。针对放射人员的紧张反应及其影响因素,采取有针对性的干预措施,以降低放射人员的职业紧张程度,提高工作满意度,保护和促进放射人员的工作能力。     

Associations of physician burnout with organizational electronic health record support and after-hours charting

In 2017, 43.9% of US physicians reported symptoms of burnout. Poor electronic health record (EHR) usability and time-consuming data entry contribute to burnout. However, less is known about how modifiable dimensions of EHR use relate to burnout and how these associations vary by medical specialty. Using the KLAS Arch Collaborative’s large-scale nationwide physician (MD/DO) data, we used ordinal logistic regression to analyze associations between self-reported burnout and after-hours charting and organizational EHR support. We examined how these relationships differ by medical specialty, adjusting for confounders. Physicians reporting ≤ 5 hours weekly of after-hours charting were twice as likely to report lower burnout scores compared to those charting ≥6 hours (aOR: 2.43, 95% CI: 2.30, 2.57). Physicians who agree that their organization has done a great job with EHR implementation, training, and support (aOR: 2.14, 95% CI: 2.01, 2.28) were also twice as likely to report lower scores on the burnout survey question compared to those who disagree. Efforts to reduce after-hours charting and improve organizational EHR support could help address physician burnout.     

妇产科规范化培训医师工作压力现状与影响因素研究

目的 调查妇产科规范化培训医师工作压力现状,分析影响其工作压力的因素。方法 选取2019年6月至2020年5月北京市某三甲医院规范化培训基地的住院医师232名为研究对象。采用问卷调查方法,收集一般情况,包括性别、年龄、专业、学历、工作经历、规培时间、收入满意度和对规培必要性的认同度。通过工作压力源量表进行压力现状与影响因素分析。其中工作压力源量表得分越低,反映其压力越大。采用SPSS 22.0软件对数据进行t检验和卡方检验。结果 妇产科规培医师工作压力总分在所有科室中偏低（67.02±12.65）分（P<0.001）,其中“工作量及时间分配”（7.11±2.42）分、“工作环境及资源”（7.21±2.34）分、“管理及人际关系”（15.66±3.69）分为主要压力源,与其他各科室比较差异有统计学意义（P<0.001）。单因素分析结果显示：不同收入满意度之间工作压力得分差异有统计学意义（P=0.003）。结合多重线性回归方程结果,收入满意度不同的妇产科规培医师在“专业及工作”“工作量及时间分配”和“工作环境及资源”3方面压力源总分随满意度下降,得分越低压力越大,差异有统计学意义（P值分别为0.006、0.008、0.012）。而涉及“病人诊疗”和“管理及人际关系”方面,收入满意度不同的规培医师总分差异无统计学意义（P值分别为0.067和0.057）。结论 妇产科规培医师压力普遍偏大,来自临床与医疗相关的事务是其工作压力的主要来源,而收入满意度是其工作压力的主要影响因素。     

A network collaboration implementing technology to improve medication dispensing and administration in critical access hospitals

We report how seven independent critical access hospitals collaborated with a rural referral hospital to standardize workflow policies and procedures while jointly implementing the same health information technologies (HITs) to enhance medication care processes. The study hospitals implemented the same electronic health record, computerized provider order entry, pharmacy information systems, automated dispensing cabinets (ADC), and barcode medication administration systems. We conducted interviews and examined project documents to explore factors underlying the successful implementation of ADC and barcode medication administration across the network hospitals. These included a shared culture of collaboration; strategic sequencing of HIT component implementation; interface among HIT components; strategic placement of ADCs; disciplined use and sharing of workflow analyses linked with HIT applications; planning for workflow efficiencies; acquisition of adequate supply of HIT-related devices; and establishing metrics to monitor HIT use and outcomes.     

惠州市儿科护士工作压力来源与工作满意度的相关性研究

目的：调查15家综合医院及2家妇幼保健院的252名儿科注册护士工作满意度及工作压力源的现状,明确两者之间的关系。方法采用明尼苏达满意度问卷及护士工作压力源量表对252名临床儿科护士开展临床调研,并对其结果进行分析。结果护士工作压力源总均分为（11.92±3.01）分,各维度得分由高到低依次为工作时间安排、护士职业观念、沟通交流、工作条件及疾病护理。护士职业观念的问题、沟通交流的问题、工作条件的问题及疾病护理的问题与工作目的呈正相关（P〈0.05）,工作时间安排的问题与学历呈负相关（P〈0.05）,沟通交流的问题与编制呈负相关（P〈0.05）。护士工作满意度总均分为（2.03±0.47）分,护士总体工作压力与外在满意度、内在满意度、一般满意度及总体满意度呈负相关（P〈0.05）。结论医院管理层应重视儿科护士的压力源情况,并采取针对性干预措施减轻其压力,进而使护士获得较为满意的身心体验,从而保证护理质量。     

Prediction of patient disposition: comparison of computer and human approaches and a proposed synthesis

ObjectiveTo compare the accuracy of computer versus physician predictions of hospitalization and to explore the potential synergies of hybrid physician–computer models.Materials and MethodsA single-center prospective observational study in a tertiary pediatric hospital in Boston, Massachusetts, United States. Nine emergency department (ED) attending physicians participated in the study. Physicians predicted the likelihood of admission for patients in the ED whose hospitalization disposition had not yet been decided. In parallel, a random-forest computer model was developed to predict hospitalizations from the ED, based on data available within the first hour of the ED encounter. The model was tested on the same cohort of patients evaluated by the participating physicians.Results198 pediatric patients were considered for inclusion. Six patients were excluded due to incomplete or erroneous physician forms. Of the 192 included patients, 54 (28%) were admitted and 138 (72%) were discharged. The positive predictive value for the prediction of admission was 66% for the clinicians, 73% for the computer model, and 86% for a hybrid model combining the two. To predict admission, physicians relied more heavily on the clinical appearance of the patient, while the computer model relied more heavily on technical data-driven features, such as the rate of prior admissions or distance traveled to hospital.DiscussionComputer-generated predictions of patient disposition were more accurate than clinician-generated predictions. A hybrid prediction model improved accuracy over both individual predictions, highlighting the complementary and synergistic effects of both approaches.ConclusionThe integration of computer and clinician predictions can yield improved predictive performance.     

从员工满意角度改善民营医院文化建设策略探讨

目的：分析民营医院文化建设与员工满意度的相关性,探讨基于员工满意度的民营医院文化建设策略。方法：选取我国中部某省9家民营家医院的员工进行问卷调查,采用典型相关分析法分析医院文化建设与员工满意度的相关性。结果：医院文化建设的各个方面与员工满意度的不同层面均有不同程度的相关性。其中,与员工内在满意度相关性较大的依次为医院文化建设的整体状况、医院精神建设、医德医风建设、职工素质优化和制度文化建设;与员工外在满意度相关性较大的依次为医院文化建设的整体状况、医院精神建设及医德医风建设;与员工一般满意度相关性较大的依次为医院文化建设的整体状况、医院精神建设、医德医风建设、制度文化建设和职工素质优化。结论：通过改善民营医院文化建设能够提高员工的满意度。     

安徽省三级医院信息人员工作满意度及其影响因素分析

目的:调查安徽省三级医院信息人员工作满意度情况,并分析其影响因素.方法:采用JSS工作满意度量表调查安徽省25家三级医院258名信息工作人员的工作满意度情况,并通过多因素线性回归分析其影响因素.结果:医院信息人员工作满意度总分平均分为(140.19±23.18)分,9个维度中得分较高的是领导满意度评分(19.35±3.67)分、同事满意度(17.44±2.99)分和沟通满意度(16.84±3.66)分,得分较低的是薪酬满意度(13.19±3.80)分、工作流程满意度(13.58±2.74)分和晋升满意度(14.32±3.75)分.不同年龄、学历、职称、工作年限和近3年培训次数的信息人员工作满意度评分差异均有统计学意义(P<0.05～P<0.01).多因素线性回归分析显示,医院信息人员工作满意度与职称和近3年培训次数呈正相关关系(P<0.05和P<0.01),与工作年限呈负相关关系(P<0.05).结论:薪酬、工作流程及晋升是三级医院信息人员工作满意度主要瓶颈;职称、工作年限和培训次数是信息人员工作满意度的主要影响因素.     

临床医学专业毕业生综合能力评价及影响因素研究

目的 调查西安某医学院校临床医学专业毕业生的综合能力及影响因素,为完善临床医学专业学生培养模式、提高其综合能力提供科学依据。方法 以《中国本科医学教育标准——临床医学专业（2016版）》为参考,自行设计含有4个维度62个条目的《临床医学专业毕业生综合能力评价问卷》;采用随机抽样的方法以西安某医学院校临床医学专业毕业生为研究对象,对其综合能力现状进行调查;并采用SPSS 22.0统计软件包分析数据,利用多元线性回归法分析其影响因素。结果 临床医学专业毕业生临床能力领域得分最高（3.05±0.84）,其次为职业素养领域（2.48±0.81）,得分最低的是科学与学术领域（1.89±0.68）。各因子得分中排在前3名的依次是临床执业能力（3.39±0.76）、理论知识掌握情况（3.55±0.48）和医学知识掌握情况（2.98±0.81）,得分最低的3个因子依次是文献检索能力（1.31±0.64）、全球健康问题（1.49±0.82）和自我提升意愿及能力（1.81±0.73）。利用多元逐步回归法分析综合能力影响因素,得出最优方程：Y=8.412+0.063X₆+0.190X₈+0.266X₁₀+0.031X₁₁+0.187X₁₂（X₆为工作单位层次,X₈为学习成绩排名,X₁₀为实践教学满意度,X₁₁为教学模式满意度,X₁₂为毕业后再教育满意度）。其中实践教学满意度、毕业后再教育满意度和教学模式满意度越高,学生成绩排名越高,临床毕业生的综合能力得分越高。就业层次在综合医院的毕业生,其综合能力得分要高于社区/乡镇医院等基层医院的毕业生。结论 临床医学专业学生在培养的过程中应提高实践教学质量、完善教学模式,加大科学与学术领域的培养,提高基层医疗机构再教育投入力度,提高毕业生再教育满意度,从而提高临床医学专业毕业生综合能力。     

A comprehensive digital phenotype for postpartum hemorrhage

ObjectiveWe aimed to establish a comprehensive digital phenotype for postpartum hemorrhage (PPH). Current guidelines rely primarily on estimates of blood loss, which can be inaccurate and biased and ignore complementary information readily available in electronic medical records (EMR). Inaccurate and incomplete phenotyping contributes to ongoing challenges in tracking PPH outcomes, developing more accurate risk assessments, and identifying novel interventions.Materials and MethodsWe constructed a cohort of 71 944 deliveries from the Mount Sinai Health System. Estimates of postpartum blood loss, shifts in hematocrit, administration of uterotonics, surgical interventions, and diagnostic codes were combined to identify PPH, retrospectively. Clinical features were extracted from EMRs and mapped to common data models for maximum interoperability across hospitals. Blinded chart review was done by a physician on a subset of PPH and non-PPH patients and performance was compared to alternate PPH phenotypes. PPH was defined as clinical diagnosis of postpartum hemorrhage documented in the patient’s chart upon chart review.ResultsWe identified 6639 PPH deliveries (9% prevalence) using our phenotype—more than 3 times as many as using blood loss alone (N = 1,747), supporting the need to incorporate other diagnostic and intervention data. Chart review revealed our phenotype had 89% accuracy and an F1-score of 0.92. Alternate phenotypes were less accurate, including a common blood loss-based definition (67%) and a previously published digital phenotype (74%).ConclusionWe have developed a scalable, accurate, and valid digital phenotype that may be of significant use for tracking outcomes and ongoing clinical research to deliver better preventative interventions for PPH.     

三级生物安全防护实验室职业紧张分析

目的三级生物安全实验室(Biosafety level 3 laboratory,BSL-3实验室)工作人员因面对高致病性病原微生物操作和特殊工作环境而存在的工作压力可能不利于风险控制而增加意外事故,本研究分析BSL-3实验室工作人员的职业紧张度及紧张源,为控制实验室风险提供依据。方法以JDC模式和ERI模式为理论基础,对"中文版简明职业紧张问卷"改编成适用于BSL-3实验室工作人员的职业紧张评估问卷,调查了上海、浙江、江苏、福建、武汉五个省市的六家BSL-3实验室的87位工作人员职业紧张状况。结果研究得出年龄、工作年限、工作身份、BSL-3实验室所操作微生物的种类、传播途径及在BSL-3实验室内进行动物实验是显著影响BSL-3实验室工作人员职业紧张水平的因素。结论 20-39岁、低工作年限、固定工作人员、进行呼吸道传播病原微生物操作、动物实验以及多种病原微生物操作的工作人员职业紧张程度较高。     

The impact of the heparin-induced thrombocytopenia (HIT) computerized alert on provider behaviors and patient outcomes

Objective

The aim of this study was to measure the effect of an electronic heparin-induced thrombocytopenia (HIT) alert on provider ordering behaviors and on patient outcomes.

Materials and Methods

A pop-up alert was created for providers when an individual''s platelet values had decreased by 50% or to <100 000/mm³ in the setting of recent heparin exposure. The authors retrospectively compared inpatients admitted between January 24, 2008 and August 24, 2008 to a control group admitted 1 year prior to the HIT alert. The primary outcome was a change in HIT antibody testing. Secondary outcomes included an assessment of incidence of HIT antibody positivity, percentage of patients started on a direct thrombin inhibitor (DTI), length of stay and overall mortality.

Results

There were 1006 and 1081 patients in the control and intervention groups, respectively. There was a 33% relative increase in HIT antibody test orders (p=0.01), and 33% more of these tests were ordered the first day after the criteria were met when a pop-up alert was given (p=0.03). Heparin was discontinued in 25% more patients in the alerted group (p=0.01), and more direct thrombin inhibitors were ordered for them (p=0.03). The number who tested HIT antibody-positive did not differ, however, between the two groups (p=0.99). The length of stay and mortality were similar in both groups.

Conclusions

The HIT alert significantly impacted provider behaviors. However, the alert did not result in more cases of HIT being detected or an improvement in overall mortality. Our findings do not support implementation of a computerized HIT alert.     

Anxiety,depression, and stress in caregivers of children and adolescents with mental disorders in Ghana and implications for medication adherence

ObjectiveThis study assessed levels of anxiety, depression, and stress among family caregivers of children and adolescents with mental disorders in Ghana and the implication on medication adherence.DesignA cross-sectional study.SettingThe study was conducted at the outpatient departments of the three main public psychiatric hospitals in Ghana.ParticipantsTwo hundred and ten non-paid family caregivers of children and adolescents with mental disorders were recruited for this study.Main Outcome MeasureThe study assessed symptoms of anxiety, depression and stress among the caregivers and estimated caregiver-reported medication adherence.ResultsAbout 56.2%, 66.2% and 78% of the caregivers experienced severe anxiety, severe depression and moderate to severe stress symptoms respectively. From the multiple logistic regression model, while anxiety was significantly affected by religion and education, depression was influenced by sex, age, marital status, proximity to facility, and employment status. Female caregivers had about four times higher odds of being depressed compared to male caregivers (aOR: 3.81, 95% CI: 1.66 – 8.75). The caregiver-reported medication adherence was 11.9%. Anxiety was significantly predictive of medication adherence.ConclusionMost family caregivers of children and adolescents with mental disorders experienced symptoms of anxiety, depression and stress with anxiety having implications for medication adherence. The study findings underscore the need to consider psychological characteristics of caregivers and the provision of mental health support for them, as part of the routine health care for children and adolescents with mental disorders.FundingNone indicated