浅谈药品标准执行中存在的问题及建议

通过阐述药品检验工作中执行标准的现状,分析其存在的问题,并提出一些建议及对策.希望尽快规范、统一药品标准,提高和完善我国的药品标准管理水平.     

Computerized Provider Order Entry—What are health professionals concerned about? A qualitative study in an Australian hospital

Purpose

To identify the main concerns of a broad range of hospital staff about the implementation of a new Computerized Provider Order Entry (CPOE) system for medication management.

Methods

The study was conducted in a large Australian teaching hospital using semi-structured interviews (n = 20) and focus groups (six focus groups involving a total of 30 participants) from a broad section of health professionals including doctors, nurses, managers, pharmacists and senior health executives. Systematic concurrent analysis of the data was undertaken by a team of researchers.

Results

We identified 20 recurrent themes related to nine areas of shared concern including work practices, software/hardware, relationships/communication, education and training, inexperienced staff and de-skilling. A higher level of analysis identified four interrelated constructs that highlight what people are concerned about: (1) Will it help? (2) Will it work? (3) Will we cope? (4) Will it impair existing interaction?

Limitations

The research provides a snapshot overview of perceptions from a range of hospital personnel in the lead up to CPOE implementation. Generalizability is limited by the size of the sample and the contextual circumstances of the hospital being studied.

Discussion

This work contributes valuable evidence about an often-neglected dimension in the evaluation of computer systems in hospitals, namely the pre-implementation concerns of staff. These pre-conceptions can have a significant effect on how technology is implemented and utilised. Acknowledging and addressing people's concerns can contribute to the establishment of durable channels of negotiation and communication. Further research informed by the findings of this study will help advance this process.     

感动服务在护理中的实施与评价

目的探讨感动服务在护理中的应用,提高护理质量和患者满意度,加强护理团队建设。方法树立感动服务的理念,制定活动方法与措施,并进行相关的培训,在活动开展前后对患者的满意度、主管护士知晓率进行调查。结果实施感动服务后,患者对护理服务的满意度、主管护士的知晓率及受表扬的护士人次数显著高于干预前。结论在护理中实施感动服务,能提高患者满意度和护理工作的质量。     

农村公共卫生服务包的筹资与提供策略

以服务包的形式提供公共卫生服务有着诸多的优势。笔者主要探讨项目筛选的原则、方法和步骤。对于筹资部分,主张明确各方责任,提高筹资的层次,加强经费的管理。由于政府直接提供卫生服务存在着“政府失灵”,所以公共卫生服务包的提供应以政府购买为主。通过对农村公共卫生服务包项目的筛选、筹资、提供等方面的探讨,分析农村公共卫生服务包的实施策略,可以促进更好地提供农村公共卫生服务。     

Evidence-Based Interventions in Schools: Developers’ Views of Implementation Barriers and Facilitators

This study examined the factors that are important to successful implementation and sustainability of evidence-based interventions in school settings. Developers of interventions that have been designated as “evidence-based” in multiple vetted lists and registries available to schools participated in a structured interview. The interview focused on potential facilitators and barriers to implementation and sustainability of their intervention. The interviews were transcribed and coded to identify similarities and differences among the responses as well as themes that cut across participants. Results indicated that those concerned with effective implementation and sustainability need to address several areas: (a) development of principal and other administrator support; (b) development of teacher support; (c) development of financial resources to sustain practice; (d) provision of high-quality training and consultation to ensure fidelity; (e) alignment of the intervention with school philosophy, goals, policies, and programs; (f) ensuring that program outcomes and impact are visible to key stakeholders; and (g) development of methods for addressing turnover in school staff and administrators.     

Implementation Intentions Facilitate Response Inhibition in Children with ADHD

Attention Deficit/Hyperactivity Disorder (ADHD) is associated with action control problems such as failure to inhibit inappropriate responses. Two studies investigated whether self-regulation by implementation intentions (if-then plans; Gollwitzer, P. M. (1999). Implementation intentions: Strong effects of simple plans. American Psychologist, 54, 493–503) facilitates response inhibition in children with ADHD. In Study 1, children with ADHD who furnished a suppression goal with implementation intentions improved inhibition of an unwanted response on a Go/No-Go task to the same level observed in children without ADHD. Study 2 showed that a combination of implementation intentions and psychostimulant medication resulted in the highest level of suppression performance in children with ADHD. Theoretical and applied implications of these results are discussed.

分诊叫号系统在我院的应用

目的减少患者就诊等侯时间,改善服务环境,提高工作效率。方法开发设计分诊叫号系统。简要介绍医院分诊叫号系统的工作流程,分析系统的主要功能和实现方法,并阐述实施过程中的注意事顷。结果优化服务流程和工作环境,提高了服务效率和质量,树立医院的良好形象。结论通过该系统有序地管理,使得医院的医疗秩序更加规范化。     

Interventions in Organizational and Community Context: A Framework for Building Evidence on Dissemination and Implementation in Health Services Research

The effective dissemination and implementation of evidence-based health interventions within community settings is an important cornerstone to expanding the availability of quality health and mental health services. Yet it has proven a challenging task for both research and community stakeholders. This paper presents the current framework developed by the UCLA/RAND NIMH Center to address this research-to-practice gap by: (1) providing a theoretically-grounded understanding of the multi-layered nature of community and healthcare contexts and the mechanisms by which new practices and programs diffuse within these settings; (2) distinguishing among key components of the diffusion process—including contextual factors, adoption, implementation, and sustainment of interventions—showing how evaluation of each is necessary to explain the course of dissemination and outcomes for individual and organizational stakeholders; (3) facilitating the identification of new strategies for adapting, disseminating, and implementing relatively complex, evidence-based healthcare and improvement interventions, particularly using a community-based, participatory approach; and (4) enhancing the ability to meaningfully generalize findings across varied interventions and settings to build an evidence base on successful dissemination and implementation strategies.     

Advancing the Science of Implementation: A Workshop Summary

While much has been written about reducing the gap between science and practice, relatively little progress has been made to develop a sound knowledge base underlying implementation of effective interventions. To respond to these challenges, the National Institute of Mental Health organized a workshop entitled, “Advancing the Science of Implementation: Improving the Fit between Mental Health Intervention Development and Service Systems.” Over the 2-day workshop, a multi-disciplinary group of intervention and services researchers, implementers, methodologists, organizational theorists, and clinicians was brought together in an “engaged scholarship” * format composed of small and large-group settings to discuss the development of a sound knowledge base on the implementation of evidence-based practices. Using three specific intervention categories, participants identified constructs seen to be important to the implementation of the model in real-world systems. Following each breakout session, attendees reconvened for a full group discussion and brief presentations were conducted to highlight interventions in the areas of organizational measures, social network analysis and field opportunities. This summary describes some of the constructs relevant to implementation research and presents research questions that, if studied, will lay a solid foundation for implementation research. Please do not cite without permission of authors.