基于XML的结构化电子病历系统的实施及问题探讨

目的探讨结构化电子病历系统在医院的实施情况。方法针对结构化电子病历系统特点,提出合理的实施计划及流程。对主任医师、主治医师、经治医师进行分级培训和实践操作,而经治医师是培训的主体。继之正式启用该系统,并对病历书写进行实时监控。结果根据计划流程安排,顺利实施该系统,达到了预期目的。结论保证系统顺利实施,医院管理者下定决心必须启用是关键;各职能部门及临床科室的协调配合是成功实施的前提;完好的培训是实施的基础。     

护理安全教育在护理学基础实验教学中的实施

目的 探讨在护理学基础实验教学中实施护理安全教育的教学效果.方法 选择我校2008级本科护生200名,随机分成对照组和实验组各100名,对照组采用传统教学方法,实验组则将护理安全教育融入护理学实验教学过程中,学期结束后进行护理操作考试,并对实验组护生进行问卷调查.结果 实验组护生护理操作考试成绩明显优于对照组(P＜0.05),实验组护生对该教学模式评价较好.结论 将护理安全教育融入到护理学基础实验操作教学中,不但提高了护生护理操作技术水平,而且使护生认识到了安全护理的意义,养成了安全护理习惯,提高了安全护理的意识.     

Knowledge translation is the use of knowledge in health care decision making

Objective

To provide an overview of the science and practice of knowledge translation.

Study Design

Narrative review outlining what knowledge translation is and a framework for its use.

Results

Knowledge translation is defined as the use of knowledge in practice and decision making by the public, patients, health care professionals, managers, and policy makers. Failures to use research evidence to inform decision making are apparent across all these key decision maker groups. There are several proposed theories and frameworks for achieving knowledge translation. A conceptual framework developed by Graham et al., termed the knowledge-to-action cycle, provides an approach that builds on the commonalities found in an assessment of planned action theories.

Conclusions

Review of the evidence base for the science and practice of knowledge translation has identified several gaps including the need to develop valid strategies for assessing the determinants of knowledge use and for evaluating sustainability of knowledge translation interventions.     

Development and implementation of Models of Care for musculoskeletal conditions in middle-income and low-income Asian countries

This chapter discusses the challenges faced in the development and implementation of musculoskeletal (MSK) Models of Care (MoCs) in middle-income and low-income countries in Asia and outlines the components of an effective MoC for MSK conditions. Case studies of four such countries (The Philippines, Malaysia, Bangladesh and Myanmar) are presented, and their unique implementation issues are discussed. The success experienced in one high-income country (Singapore) is also described as a comparison. The Community Oriented Program for Control of Rheumatic Diseases (COPCORD) project and the role of Asia Pacific League of Associations for Rheumatology (APLAR), a professional body supporting MoC initiatives in this region, are also discussed. The experience and lessons learned from these case studies can provide useful information to guide the implementation of future MSK MoC initiatives in other middle-income and low-income countries.     

Process evaluation of implementation strategies to reduce potentially inappropriate medication prescribing in older population: A scoping review

ObjectivesSeveral implementation strategies can reduce potentially inappropriate medication (PIM) prescribing. Although use of PIMs has declined in recent years, it remains prevalent. Various strategies exist to improve the appropriateness of medication use. However, little is known about the processes of these different implementation strategies. This scoping review aims to investigate how the process evaluation of implementation strategies for reducing PIM prescribing in the older population has been studied.MethodsWe searched for process evaluations of implementation strategies for reducing PIM prescribing in PUBMED, SCOPUS and Web of Science published between January 2000 and November 2019 in English. We applied the following inclusion criteria: patients aged ≥65 years, validated PIM criteria, and implementation process evaluated. The review focuses on decision support for health care professionals. We described the findings of the process evaluations, and compared the authors’ concepts of process evaluation of the included publications to those of Proctor et al.( 2010).ResultOf 9131 publications screened, 29 met our inclusion criteria. Different process evaluation conceptualizations were identified. Most process evaluations took place in the initial stages of the process (acceptability, adoption, appropriateness, and feasibility) and sustainability and implementation costs were seldom evaluated. None of the included publications evaluated fidelity.Multifaceted interventions were the most studied implementation strategies. Medication review was more common in acceptability evaluations, multidisciplinary interventions in adoption evaluations, and computerized systems and educational interventions in feasibility evaluations. Process evaluations were studied from the health care professionals’ viewpoint in most of the included publications, but the management viewpoint was missing.DiscussionThe conceptualization of process evaluation in the field of PIM prescribing is indeterminate. There is also a current gap in the knowledge of sustainability and implementation costs. Clarifying the conceptualization of implementation process evaluation is essential in order to effectively translate research knowledge into practice.     

刍议医院纪检监察在医院建设中的作用和实施

随着社会经济的快速发展,国内医疗事业的竞争日益激烈,医疗机构需要积极提高自身的业务水平和管理水平,才能强化医疗技术水平,获得更多的社会经济效益。在国内医疗体制深化变革的趋势下,纪检监察在医院建设中发挥着越来越重要的作用,主要职责是管理和监督医院各项制度的落实、健康环境的建设等,旨在规范机构医疗服务,提高机构服务质量,促使医院树立良好的社会形象,保障医院的社会经济效益。该文针对医院纪检监察在医院建设中的作用和实施展开分析。     

家庭医生政策执行方式的行为逻辑

本文采用扎根理论,利用2017—2018年上海3家社区卫生服务中心的访谈材料,从执行者行为的微观角度归纳并构建家庭医生如何选择政策执行方式的理论解释。研究归纳了家庭医生相关政策的执行中存在的三类政策执行方式:忠实执行、积极变通和消极变通。这三类政策执行方式因政策与情境契合度(简称契合度)的不同而区分。其中契合度较高时,容易发生忠实执行,即完全忠实于政策设计的执行方式;当政策与情境有不契合时,执行成本升高,出于职责观念和行政压力,执行者首先使用积极变通来降低执行成本,用自由裁量权在操作中对政策作修补和本土化,从而实现政策初衷;消极变通因任务契合度过低且具有强制性而产生,消极变通中出现了目标替代,仅表面应付上级考核指标,降低了执行成本、维护了岗位利益。结论:政策执行方式的行为逻辑可以通过契合度、职责观念、执行成本三个因素得到解释。本文整体、平衡地关注了消极与积极的政策变通,弥补以往研究只关注消极变通的不足;建议应完善决策制度保证基层执行者的决策参与,从而提升决策质量。