国外农村基层医师医学培养项目实施现状、成效及评价的系统综述

背景　2010年我国农村订单定向医学生免费培养工作启动，旨在为农村地区培养具备本科学历的全科医生，缓解农村地区基层医师匮乏的现状。本研究通过系统综述了解国外类似项目的实施现状、成效及评价，为我国农村订单定向医学生培养工作评价和改善提供理论参考。目的　了解国外农村基层医师医学培养项目实施现状、成效及评价指标方法等。方法　2019年2-7月，采用系统综述的方法，以“医学教育”“医学教育+医学本科生”“医学院校教育”“医学生”“住院医师规范化培训”“医学专业+人力资源”“农村地区”“农村基层医疗服务”“医师执业地点”“农村基层医师”“农村基层医师培养”“农村医学实习”“农村临床见习”为检索词，检索Ovid MEDLINE、PubMed、Cochrane及Google Scholar主要英文数据库，获取2000-01-01至2019-01-01发表的关于全球农村基层医师院校教育及住院医师培训等项目的实施现状、成效及评价的英文文献。结果　最终纳入53篇文献，分别来自美国、加拿大、澳大利亚、日本、泰国及南非6个国家，包括20个院校教育项目和6个住院医师培训项目。文献显示各国农村基层医师培养项目均具有指向性招生策略、面向农村卫生和全科医学的临床课程体系、以农村执业的家庭医生为临床导师及农村地区临床实践基地等要素；培养项目学生选择家庭医学为执业专业、农村地区执业率和长期农村保留率均明显高于非培养项目学生，两者国家医疗执照考试成绩和通过率无明显差异。长期农村地区临床实践培训、招生策略倾斜农村成长背景学生及农村执业的家庭医生导师是影响项目最终效果的关键因素。结论　医学教育是解决农村基层医师匮乏的有效途径。国外农村基层医师培养项目的招生策略、临床课程体系设置、导师指导及评价可为我国农村订单定向医学生培养工作提供有益参考。     

临床论坛中医护理适宜技术的应用与实践

张掖市人民医院中医科护理工作注重整体护理及辩证施护，依托中医护理特色和优势，积极探索开展拔罐、刮痧、灸法、中药离子导入、隔物灸等中医护理技术操作，实现了社会效益和经济效益双赢。进一步总结经验，从开展护理技能竞赛，严格落实护理制度，加强护理技术教育培训方面加强中医护理适宜技术的应用与实践。     

Effectiveness of health-related quality-of-life measurement in clinical practice: a prospective,randomized controlled trial in patients with chronic liver disease and their physicians

Background This study assessed the effectiveness of computerized measurement and feedback of health-related quality of life (HRQoL) in daily clinical practice in patients with chronic liver disease. Methods One hundred and sixty-two patients (61% men; mean age 47.5 years) regularly completed computerized HRQoL questionnaires before each consultation for the duration of 1 year. Six physicians were randomly assigned to the experimental group and received an instant online graphical output of data. Five other physicians were randomly assigned to the control group and conducted their consultations as usual. Differences between groups on generic- and disease-specific HRQoL, patient management, and patient satisfaction with the consultation were assessed, as were physicians’ experiences with HRQoL data and effects on their consultations. Results No direct effect of the experimental condition on patients’ HRQoL was found. However, an interaction effect of the experimental condition and age was found: older patients in the experimental group had significantly better disease-specific HRQoL (F = 4.16; P = 0.04) and generic mental HRQoL (F = 4.62; P = 0.03) than patients in the control group. Also, male patients in the experimental group had better generic mental HRQoL than patients in the control group (F = 6.10; P = 0.02). Physicians in the experimental group altered their treatment policy significantly more often than did physicians in the control group (z = −3.73, P = 0.00), and their experiences with the availability of HRQoL information were generally positive. The scores on patient satisfaction with the consultation did not differ significantly between the experimental and control groups (z = −1.20, P = 0.23). Conclusions Computerized measurement and feedback of HRQoL in a daily clinical practice of an outpatient department of hepatology did not improve HRQoL for the entire group of chronic liver patients but, rather, improved disease-specific HRQoL of older patients with chronic liver disease and mental HRQoL of older patients and male patients with chronic liver disease. It also had an effect on patient management.     

我国15省(市)糕点生产企业卫生规范实施状况调查

[目的]了解糕点生产企业卫生规范实施状况及实施过程中存在的主要问题,为<糕点厂卫生规范>的修订提供参考依据,推动"规范"的有效实施.[方法]选择全国15个省(市)的266家糕点企业,参照卫生部颁布的GB8957-1988<糕点厂卫生规范>(以下简称规范)设计调查表,对"规范"内客实施情况进行现况调查.[结果]建厂时间在10年左右的企业的"规范"符合率最高为74.08%;符合率随企业生产规模的增大而不断提高;"规范"中"企业的卫生管理"、"卫生与质量检验管理"以及"工厂设计与设施的卫生"的实施情况与规范要求相差较大,分别为60.2%,60.2%,68.5%.[结论]卫生监督部门应加强对重点问题企业和"规范"实施率偏低环节的监管,并根据我国企业状况对"规范"进行修订.     

医院信息系统实施中的几个问题

医院在信息系统实施过程中常常面临以下困难：没有合理的实施流程可参考，没有标准的数据定义格式可借鉴，没有规范的文档记录可辅助等。建议以“总体规划、分步实施”为医院信息系统实施原则。给出了医院信息系统实施流程。同时论述了在医院信息系统实施过程中规范系统数据和完善过程文档等问题，以期对其他医院和系统供应商的医院信息系统顺利上线有所帮助。     

The implementation of snoezelen in psychogeriatric care: an evaluation through the eyes of caregivers

Many intervention studies lack an investigation of the extent to which the intervention was implemented as intended, which makes outcome measures difficult to interpret. The aim of the present study was to gain insight into the implementation process of snoezelen in 24-h dementia care. The intervention in each of six experimental wards comprised training sessions in 'snoezelen for caregivers', evaluated using a questionnaire. To study experience with implementation, the follow-up and general meetings (20 in total) were attended and semi-structured interviews (six in total) were conducted. The results indicated that the implementation of snoezelen effected a change from task-oriented care to resident-oriented care. The nursing assistants also experienced changes at the resident level and organisational changes. However, the lack of intervention in the organisational structure and obstructive factors such as under-staffing seemed to get in the way of the integration of multi-sensory stimulation in the daily care in two of the six wards.     

Evaluation of top-down implementation of health regulations in the transport sector in a 5-year period

Objective A collective labour agreement concerning extended rest periods during long-distance shuttle bus trips of Dutch long-distance coach drivers was established in 1997. The main purpose of this study was to evaluate the extent to which top-down implementation of these health regulations, with respect to rest times and subjective health complaints in the private passenger-transport sector, succeeded in the year 2002.Methods A questionnaire study was carried out on 440 coach drivers and 97 of their employers. The questionnaire for coach drivers focused on the frequency they received the required rest times and on their health status. The questionnaire for employers focused on the number of rest hours that their companies scheduled for long-distance shuttle bus trips for their drivers. Motives for not scheduling the required rest hours were noted as well.Results Almost every employer (93%) and three-quarters of the drivers (72%) reported at least 12 h rest time before a long-distance shuttle bus trip, as required. Approximately half of the employers (57%) reported planning the required rest during and after these bus trips. Fewer than one-quarter of the drivers (24%) received at least 10 h rest at their destination and fewer than half of the coach drivers (42%) always receive the required 24 h rest after the trip. In addition, the significant results are indicative of a positive relationship between the duration of the rest period during and after the long-distance shuttle bus trip and the level of health complaints of the coach drivers.Conclusions Top-down implementation of health regulations with respect to rest times resulted in successful implementation after 5 years in approximately half of the companies. Longer rest times during the high season of 2002 were associated with less health complaints at the end of that season.     

Using an action research process in pharmacy practice research—A cooperative project between university and internship pharmacies

BackgroundAction research (AR) is a common research-based methodology useful for development and organizational changes in health care when participant involvement is key. However, AR is not widely used for research in the development of pharmaceutical care services in pharmacy practice.ObjectivesTo disseminate the experience from using AR methodology to develop cognitive services in pharmacies by describing how the AR process was conducted in a specific study, and to describe the outcome for participants.MethodsThe study was conducted over a 3-year period and run by a steering group of researchers, pharmacy students, and preceptors. The study design was based on AR methodology. The following data production methods were used to describe and evaluate the AR model: documentary analysis, qualitative interviews, and questionnaires.ResultsExperiences from using AR methodology and the outcome for participants are described. A set of principles was followed while the study, called the Pharmacy-University study, was being conducted. These principles are considered useful for designing future AR studies. Outcome for participating pharmacies was registered for staff-oriented and patient-oriented activities. Outcome for students was practice as project leaders and enhancement of clinical pharmacy-based skills. Outcome for researchers and the steering group conducting the study was in-depth knowledge of the status of pharmacies in giving advice to patient groups, and effective learning methods for students.ConclusionDeveloping and implementing cognitive pharmaceutical services (CPS) involves wide-reaching changes that require the willingness of pharmacy and staff as well as external partners. The use of AR methodology creates a platform that supports raising the awareness and the possible inclusion of these partners. During this study, a set of tools was developed for use in implementing CPS as part of AR.