脑卒中后吞咽障碍患者“互联网+延续护理”实施障碍的质性研究

目的 了解脑卒中后吞咽障碍患者“互联网+延续护理”实施障碍因素,为针对性干预提供参考。方法 以理论域框架为指导制定访谈提纲,对25名医护技人员进行半结构式访谈,运用主题分析法分析资料、提炼主题（障碍因素）。结果 提炼出医护技人员缺乏劳动价值获得感、缺乏自我效能感,患者吞咽障碍康复行为欠佳等14个主题（障碍因素）,分别归属为社会/职业角色和身份,能力信念,记忆、注意力与决策过程,环境与资源以及社会影响5个理论域。结论 脑卒中后吞咽障碍患者“互联网+延续护理”实施的障碍因素较多,应针对障碍因素进行干预,创造有利条件为患者提供持续的高品质康复护理。     

电子健康档案建设中的利益相关者分析

通过利益相关者理论分析电子健康档案建设中的利益相关者。主要利益相关者是居民、卫生行政部门、基层医疗卫生机构、医务人员、软件供应商,次要利益相关者是公共卫生专业机构、财政部门、其他相关行政部门和第三方。通过分析,提出推进电子健康档案建设的对策建议。     

初级卫生保健发展回顾与疾控作用的思考

  目的  评价国家基本公共卫生服务项目的实施效果,为基本公共卫生服务项目的可持续发展与实施提供循证依据与政策建议。  方法  以Donabedian质量理论为理论框架,从结构、过程、结果3个维度对中国2009 — 2019年公开发表的研究报告和现场定性访谈中基本公共卫生服务项目的实施效果进行综合评价。  结果  中国基本公共卫生服务体系逐步建立,筹资水平与服务内容不断提升,绩效考核机制不断完善,人民健康水平有所改善,城乡健康差距不断缩小,基层服务能力有所提升;但服务项目的动态调整机制尚未建立,“医防两张皮”现象普遍,基层信息化水平仍需提高。  结论  国家基本公共卫生服务项目取得了明显的成效,但在服务项目调整机制、医防融合及信息化建设等方面仍需改进。     

首发脑卒中患者康复锻炼行为执行意向及影响因素分析

目的 了解首发脑卒中患者康复锻炼行为执行意向水平及其影响因素,为脑卒中患者康复锻炼行为的干预提供参考.方法 采用一般资料调查表、中文版脑卒中康复自我效能量表、社会支持量表、自行设计的脑卒中患者康复锻炼行为执行意向问卷对177例首发脑卒中患者进行调查.结果 首发脑卒中患者康复锻炼行为执行意向得分62.69±17.27.回...     

EURIPA: EUROPEAN RURAL AND ISOLATED PRACTITIONERS ASSOCIATION

Abstract

Point-of-care tests are biomedical tests on patients’ specimens like blood, saliva, urine or faeces, which can be used near the patient, without interference of a laboratory. The use of these tests, many of which have been recently developed, is increasing in general practice, where they add to the GP's set of diagnostic instruments. The question is, however, whether they always contribute to an effective and high-quality diagnostic process by GPs. We present a set of criteria that can be used by guideline developers, regional primary care organizations and individual GPs to evaluate a new point-of-care test in a practice setting. These criteria do not relate only to their use and quality. A point-of-care test needs to be evaluated in the right population and for the right indications, and GPs then need to use them for the indications for which they were evaluated. Expanding the range of indications can lead to an increase in false-positive and false-negative test results.     

Implementation of an inpatient smoking cessation programme in a Veterans Affairs facility

Aims and objectives. To test the transportability and implementation of the Tobacco Tactics intervention using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, for inpatient units at the Jesse Brown Veterans Affairs Medical Center. Background. Smoking rates are high among veterans. While the Department of Veterans Affairs has standardised outpatient cessation clinics, inpatient cessation services, known to be efficacious, are only sporadically provided. Design. This was a phase 4, pre and postimplementation study of the Tobacco Tactics intervention. Methods. A unique convenience sample of inpatient veteran smokers was recruited both before (n = 54) and after (n = 50) implementation of the Tobacco Tactics programme. Participants completed baseline and 30‐day follow‐up surveys along with urine cotinine test kits. In addition, staff completed anonymous surveys during the preintervention period (n = 158) and two months after (n = 81) the Tobacco Tactics training. Bivariate analyses compared preintervention vs. postintervention patient and staff characteristics using Chi‐square, Fisher’s Exact or Student’s t‐test. p‐values <0·05 were considered significant. Results. Patient‐reported receipt of services and satisfaction was 10% higher in the postintervention compared to the preintervention group. Quit rates were 3% higher in the postintervention than in the preintervention group. The mean number of cigarettes smoked per day increased from 13 to 15 in the preintervention group, while the mean number of cigarettes smoked per day decreased from 14 to 9 in the postintervention group. Staff’s confidence in their ability to provide cessation services improved greatly posttraining (p = 0·0017) as did self‐reported delivery of cessation services (p = 0·0154). Conclusions. With as little as one‐hour training for nurses, the Tobacco Tactics intervention has the potential to be widely disseminated in the Department of Veterans Affairs. Relevance to clinical practice. The implementation of inpatient smoking interventions has the potential to improve quit rates and decrease morbidity and mortality in the Department of Veterans Affairs.     

Using the NHS sustainability framework to understand the activities and resource implications of Canadian nursing guideline early adopters

Aims and objectives. To examine the activities and resource implications for the initial cohort of healthcare organisations involved in the introduction of multiple nursing guidelines. Background. The Best Practice Spotlight Organization initiative was launched in 2003 as part of the Registered Nurses’ Association of Ontario’s Best Practice Guidelines programme. While previous research has evaluated improvements in patient care and outcomes, there has been limited research from an organisational perspective on the activities conducted to introduce nursing guidelines. Design. Secondary analysis of retrospective narrative data. Methods. We conducted a content analysis of the 2004–2006 annual reports from the seven participating sites. We used both deductive and inductive approaches to categorise the guideline implementation activities and their resource implications. Results. All sites reported implementing multiple guidelines (four to nine guidelines per site) and used a wide range of implementation activities that clearly addressed nine of the 10 NHS Sustainability dimensions. The dimension not reported was benefits beyond helping patients. All sites established steering committees that involved staff and senior leaders, reviewed selected guidelines and recommendations, reviewed existing policies and procedures and developed new policies and procedures, recruited champions or peer mentors, applied for additional external funding to support activities, developed relationships with external clinical partners, included guideline implementation in orientation, developed intra‐agency web‐based and print communications for the project, and evaluated practice changes. For each of these activities, the sites reported expenditures and resource usage. Conclusions. The organisational processes used for the introduction of new nursing guidelines in Canada are remarkably consistent with factors identified by leaders and change agents in the UK who developed the NHS Sustainability Model. Relevance to clinical practice. A multidimensional framework for sustainability is useful for planning successful guideline implementation across an organisation. Examples of specific activities and resource implications for organisational change are provided.     

融合成果导向教育理念的“线上+线下”混合式数字图像处理课程教学设计与实施

介绍成果导向教育教学理念,详细阐述“线上+线下”混合式教学设计过程,包括设计流程、教学目标、课程实施、学习成果及教学评价等,以期激发学生学习兴趣,提高教学效果。