医学生时间管理倾向与成就动机的相关研究

目的 探讨医学生时间管理倾向与成就动机的相关关系,为医学生提高时间管理能力提出合理建议.方法 本次研究应用青少年时间管理倾向量表与成就动机量表对3所医学院校共600名医学生进行问卷测试,运用SPSS17.0对结果进行分析.结果 (1)3所医学院校的医学生在时间管理倾向上无显著差异,不同年级间存在显著差异,其中大一和大五学生在时间管理倾向的总均分与3个分量表的平均分均高于其他3个年级;(2)时间管理倾向各维度与其追求成功动机呈显著正相关(P<0.01或0.05),与避免失败动机呈显著负相关(时间价值感除外)(P<0.01);(3)成就动机各维度对时间管理倾向有显著的预测作用.结论 医学生时间管理倾向与成就动机呈显著相关关系,成就动机对医学生时间管理倾向有显著的预测作用.     

Alpha7 Nicotinic Acetylcholine Receptors Modulate Motivation to Self-Administer Nicotine: Implications for Smoking and Schizophrenia

Individuals diagnosed with schizophrenia have an exceptionally high risk for tobacco dependence. Postmortem studies show that these individuals have significant reductions in α7 nicotinic acetylcholine receptors (nAChRs) in several brain areas. Decreased α7-mediated function might not only be linked to schizophrenia but also to increased tobacco consumption. The purpose of this study was to determine whether pharmacological blockade of α7 nAChRs would increase motivation of rats to intravenously self-administer nicotine (NIC) during a progressive ratio schedule of reinforcement (PR). Before PR, rats received local infusions of 0, 10, or 20 pmol of a selective α7 nAChR antagonist, α-conotoxin ArIB [V11L,V16D] (ArIB) into the nucleus accumbens (NAc) shell or the anterior cingulate cortex, brain areas that contribute to motivation for drug reward. We additionally sought to determine whether local infusion of 0, 10, or 40 nmol of a selective α7 nAChR agonist, PNU 282987, into these brain areas would decrease motivation for NIC use. Infusion of ArIB into the NAc shell and anterior cingulate cortex resulted in a significant increase in active lever pressing, breakpoints, and NIC intake, suggesting that a decrease in α7 nAChR function increases motivation to work for NIC. In contrast, PNU 282987 infusion resulted in reductions in these measures when administered into the NAc shell, but had no effect after administration into the anterior cingulate cortex. These data identify reduction of α7 nAChR function as a potential mechanism for elevated tobacco use in schizophrenia and also identify activation of α7 nAChRs as a potential strategy for tobacco cessation therapy.     

The Impact of Managed Care on the Practice of Occupational Therapy by Hand Therapists

Current Occupational Therapy (OT) literature on managed care is limited to opinion or anecdotal experience. Questionnaires were mailed to 214 OTs practicing as hand therapists nationwide to test the null hypothesis that there was no difference in reimbursement or barriers to practice for OT services between patients enrolled in managed care organizations and those enrolled in fee-for-service insurance plans. Statistically significant results were obtained indicating greater barriers to reimbursement for OT under managed care. The primary effect has been the increased administrative demands it places on both therapists and patients. [Article copies available for a fee from The Haworth Document Delivery Service: 1–800–342–9678. E-mail address: getinfo@haworth.com]     

Motivation in medical education and patient communication. The EGPRN meeting in Zurich,Switzerland, October 2010

Abstract

The European General Practice Research Network held an international research meeting on ‘Motivation in medical education and patient communication’ in Zürich, Switzerland, in October 2010. The two authors were keynote speakers, who introduced the theme from different angles and summarized and reflected on individual papers presented at the conference. The theme of the conference underlined the importance of communication in general practice and of motivation in medical education in particular. There were a variety of papers each addressing in its own way the topic of this meeting. We conclude that it is still uncommon to use psychological theories on motivation in research on motivation and patient communication in general practice/family medicine. Motivation and readiness to change are essential concepts in experimental health services research. Research designs increasingly follow the Framework for the Evaluation of Complex Interventions in Health Care as suggested by the British Medical Research Council. However, there are also difficulties related to classical experimental designs that have to be critically discussed.     

Pay for Performance Improves Rural EMS Quality: Investment in Prehospital Care

Objective. To evaluate the effect of a system of financial reward for emergency medical technicians (EMTs) who meet selected quality marker goals. Methods. This project was reviewed by an institutional review board (IRB) andwas found to be exempt from IRB review. Two operational andfour clinical markers were targeted for improvement. Baseline performance measurements were retrospectively measured for the preceding year, andchallenging but achievable goals for improvement were established. Operational markers included completing run reports within three hours after completion of the run andcall-to-en route (“out-of-chute”) times of less than 90 seconds for emergency calls on our first-line ambulance. Clinical markers included the use of aspirin in adults with nontraumatic chest pain, electrocardiogram (ECG) performance in adults with nontraumatic chest pain, documentation of pain assessment andintervention in patients with traumatic hip pain, anddocumentation of the time of onset of symptoms in stroke calls. Each full-time EMT could earn up to $1,000 in addition to baseline pay, with part-time EMTs eligible for prorated amounts. Results. Postincentive run reports were completed within three hours 99.7% of the time, with 21 of 24 providers meeting the goal 100% of the time. Before the incentive, reports were completed within three hours 64% of the time, with only two of 23 providers meeting the goal 100% of the time. The out-of-chute goal of less than 90 seconds was met 98.7% of the time, compared with 90.1% before the incentive. Aspirin use in adult nontraumatic chest pain improved from 68% to 96.3%, andECG performance in this group improved from 43% to 87.8%. Documentation of the time of onset of symptoms in stroke patients improved from 97% to 100%, andthe assessment of andintervention for pain in traumatic hip pain patients improved from 56% to 100%. Conclusion. Financial motivation improved targeted quality measures in this rural emergency medical service. It appears to be a useful adjuvant to traditional quality improvement mechanisms.     

A mixed method evaluation of a group‐based educational programme for CPAP use in patients with obstructive sleep apnea

Rationale, aims and objectives Continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) has a low long‐term adherence. Educational interventions are few and sparsely described regarding content, pedagogical approach and participants' perceptions. The aim was to describe adherence to CPAP treatment, knowledge about OSA/CPAP, as well as OSA patients' perceptions of participating in a group‐based programme using problem‐based learning (PBL) for CPAP initiation. Educational programme The PBL programme incorporated elements from theories and models concerning motivation and habits. Tutorial groups consisting of four to eight patients met at six sessions during 6 months. Methods A sequential explanatory mixed method design was used on 25 strategically selected patients. Quantitative data regarding, clinical variables, OSA severity, CPAP use, and knowledge were collected at baseline, after 2 weeks and 6 months. Qualitative data regarding patients' perceptions of participation were collected after 6 months by semi‐structured interviews using a phenomenographic approach. Results 72% of the patients were adherent to CPAP treatment after 2 weeks and 6 months. All patients improved their baseline knowledge about OSA and CPAP after 2 weeks and sustained it after 6 months. Anxiety and fear, as well as difficulties and needs were motivational factors for participation. Patients described the difficulties of behavioural change, an awareness that improvements do not occur immediately, a realization of the importance of both technical and emotional support and the need for a healthier lifestyle. Conclusion and practice implications A group‐based programme using PBL seems to facilitate adaptive and developmental learning and result in acceptable CPAP adherence levels.     

风湿免疫科护士正念对成就动机的影响研究

目的 探讨风湿免疫科护士正念对成就动机的影响,为护理管理者促进风湿免疫科护士的专业发展提供参考依据.方法 运用正念量表和成就动机量表对327名风湿免疫科护士进行测试.结果 风湿免疫科护士正念总均分为（3.18±0.37）分,处于中等水平;成就动机总均分为（0.51±0.09）分,且追求成功的动机高于避免失败的动机;觉知的行动、观察和描述能联合预测成就动机31.1％的变异量.结论 正念能有效联合预测风湿免疫科护士的成就动机,护理管理者应进一步培养风湿免疫科护士的正念水平以提高其成就动机水平.     

The Power of the Social Environment in Motivating Persons with Dementia to Engage in Occupation: Qualitative Findings

ABSTRACT

A key element in persons with dementia's occupational engagement is the degree to which the social environment supports participation. This article summarizes the results of a qualitative study of eight assisted living facility residents, that explored volition in persons with moderate dementia. Extensive interviewing and observation were followed by the primary researcher's engagement and documentation of each resident in therapeutic activity sessions. Data were analyzed using van Manen's phenomenological approach, and three themes emerged. One, potency of the social environment, is the focus of this article. From the eight participants, two case studies are presented, one demonstrating the positive impact of therapeutic communication and social support on volitional behavior and occupational engagement and the other demonstrating the inhibiting effect of lack of therapeutic social interaction. Each case is analyzed using Epp's (2003, Person-centred dementia care: A vision to be refined. The Canadian Alzheimer's Disease Review, 14–18) Person-Centered Care model techniques and interaction modes recommended by Taylor's (2008, The intentional relationship: Occupational therapy and use of self. Philadelphia: F.A. Davis.) Intentional Relationship Model. The article concludes with recommendations for promoting positive social interactions at the client, staff/family, and systems levels.