如何减少医院建设项目的超投资

医院建设项目超投资的原因是预算考虑不周,方案制定不细,从而在源头埋下隐患。如何把预算做得周密严谨,如何把握好建筑布局与运行管理和成本的关系,是检验医院管理者的一项艰巨细致的重要工作。可从学习经验、反复论证、把控风险等方面来着手。     

The Effects of Guanfacine and Phenylephrine on a Spiking Neuron Model of Working Memory

We use a spiking neural network model of working memory (WM) capable of performing the spatial delayed response task (DRT) to investigate two drugs that affect WM: guanfacine (GFC) and phenylephrine (PHE). In this model, the loss of information over time results from changes in the spiking neural activity through recurrent connections. We reproduce the standard forgetting curve and then show that this curve changes in the presence of GFC and PHE, whose application is simulated by manipulating functional, neural, and biophysical properties of the model. In particular, applying GFC causes increased activity in neurons that are sensitive to the information currently being remembered, while applying PHE leads to decreased activity in these same neurons. Interestingly, these differential effects emerge from network-level interactions because GFC and PHE affect all neurons equally. We compare our model to both electrophysiological data from neurons in monkey dorsolateral prefrontal cortex and to behavioral evidence from monkeys performing the DRT.     

英国初级卫生保健质量与结果框架解析

目的 了解英国初级卫生保键质量与结果框架,为改善我国全科服务质量提供经验借鉴.方法 文献综述与定性访谈.结果 质量与结果框架作为全科服务合同的一部分,目的是通过引进激励机制改进服务质量,制定一套反映全科医疗服务质量的指标和评分体系,通过综合打分对全科医生的服务进行衡量.结论 在完善的组织管理、疾病登记体系和信息系统的支撑下,质量与结果框架有利于对全科服务进行标准化评估,统一的定价和支付体系有利于减少不同地区初级卫生保健的服务差异,激励了全科诊所服务的积极性.但也有专家学者指出了其中的一些弊端,有待进一步修正和完善.     

Client-centred occupational therapy with children: A critical perspective

Abstract

Background: Client-centredness is a central theme within occupational therapy; however, its application within clinical practice has not been thoroughly examined within the literature. Aim: The aim of this practice reflection is to provide a critical perspective on client-centredness in occupational therapy practice with children. Methods: Two action points of the Canadian Practice Process Framework (CPPF): Set the Stage and Agree on Objectives and Plan are applied to examine the concept of client-centred practice using a common practice example. Results: There are multiple benefits to using a client-centred approach to goal setting and developing a therapy plan. Practical challenges to client-centred practice include a lack of time, organizational support, and professional autonomy. Therapists may exert power over clients by enforcing institutional policies that prioritize the client diagnosis and organizational processes. Conclusion: The authors support a client-centred approach to occupational therapy practice with children but suggest that therapists may feel conflicted in trying to apply these principles within the current context of rehabilitation for children. Occupational therapists are encouraged to identify opportunities where they can advocate for a client-centred approach to services.     

支撑角度对选择性激光熔覆制作下颌双侧游离端牙列缺损可摘局部义齿支架适合性的影响

目的评价选择性激光熔覆(selective laser melting,SLM)技术制作下颌双侧游离端牙列缺损可摘局部义齿支架过程中支撑角度对支架适合性的影响。方法以下颌双侧游离端牙列缺损石膏模型为原始模型,设置对照组排除系统误差后,使用钛合金粉末,SLM制作支撑角度分别为0°(水平组)、45°(45°组)和90°(垂直组)的可摘局部义齿支架(每组6个)。将支架戴入原始模型,通过复模法获得具备支架组织面形态的石膏模型。用三维扫描仪分别扫描原始模型和复模得到的石膏模型,数据导入Geomagic Qualify软件,通过目测法以及分析支架组织面与模型的间隙评价支架的适合性。结果3组可摘局部义齿支架与石膏模型紧密贴合,无明显翘动。水平组支架与模型间的总体偏差[(0.146±0.017)mm]显著小于45°组和垂直组[分别为(0.182±0.015)和(0.185±0.022)mm](P<0.05),45°组与垂直组间差异无统计学意义(P>0.05)。水平组支托处偏差显著小于45°组(P<0.05),垂直组支托处偏差与水平组、45°组间差异均无统计学意义(P>0.05);水平组卡环处偏差显著小于45°组和垂直组(P<0.05),45°组与垂直组卡环处偏差差异无统计学意义(P>0.05);3组支架舌杆处偏差差异均无统计学意义(P>0.05)。结论通过3种支撑角度SLM制作的下颌双侧游离端牙列缺损可摘局部义齿支架的适合性均可满足临床要求,推荐优先选择水平向支撑角度制作义齿支架。     

Using the Consolidated Framework for Implementation Research to Identify Barriers and Facilitators for the Implementation of an Internet-Based Patient-Provider Communication Service in Five Settings: A Qualitative Study

Background

Although there is growing evidence of the positive effects of Internet-based patient-provider communication (IPPC) services for both patients and health care providers, their implementation into clinical practice continues to be a challenge.

Objective

The 3 aims of this study were to (1) identify and compare barriers and facilitators influencing the implementation of an IPPC service in 5 hospital units using the Consolidated Framework for Implementation Research (CFIR), (2) assess the ability of the different constructs of CFIR to distinguish between high and low implementation success, and (3) compare our findings with those from other studies that used the CFIR to discriminate between high and low implementation success.

Methods

This study was based on individual interviews with 10 nurses, 6 physicians, and 1 nutritionist who had used the IPPC to answer messages from patients.

Results

Of the 36 CFIR constructs, 28 were addressed in the interviews, of which 12 distinguished between high and low implementation units. Most of the distinguishing constructs were related to the inner setting domain of CFIR, indicating that institutional factors were particularly important for successful implementation. Health care providers’ beliefs in the intervention as useful for themselves and their patients as well as the implementation process itself were also important. A comparison of constructs across ours and 2 other studies that also used the CFIR to discriminate between high and low implementation success showed that 24 CFIR constructs distinguished between high and low implementation units in at least 1 study; 11 constructs distinguished in 2 studies. However, only 2 constructs (patient need and resources and available resources) distinguished consistently between high and low implementation units in all 3 studies.

Conclusions

The CFIR is a helpful framework for illuminating barriers and facilitators influencing IPPC implementation. However, CFIR’s strength of being broad and comprehensive also limits its usefulness as an implementation framework because it does not discriminate between the relative importance of its many constructs for implementation success. This is the first study to identify which CFIR constructs are the most promising to distinguish between high and low implementation success across settings and interventions. Findings from this study can contribute to the refinement of CFIR toward a more succinct and parsimonious framework for planning and evaluation of the implementation of clinical interventions.

ClinicalTrial

Clinicaltrials.gov NCT00971139; http://clinicaltrial.gov/ct2/show/NCT00971139 (Archived by WebCite at http://www.webcitation.org/6cWeqN1uY)     

Implementation of pregnancy weight management and obesity guidelines: a meta‐synthesis of healthcare professionals' barriers and facilitators using the Theoretical Domains Framework

Obesity in pregnancy is rising and is associated with severe health consequences for both the mother and the child. There is an increasing international focus on guidelines to manage the clinical risks of maternal obesity, and for pregnancy weight management. However, passive dissemination of guidelines is not effective and more active strategies are required for effective guideline implementation into practice. Implementation of guidelines is a form of healthcare professional behaviour change, and therefore implementation strategies should be based on appropriate behaviour change theory. This systematic review aimed to identify the determinants of healthcare professionals' behaviours in relation to maternal obesity and weight management. Twenty‐five studies were included. Data synthesis of the existing international qualitative and quantitative evidence base used the Theoretical Domains Framework to identify the barriers and facilitators to healthcare professionals' maternal obesity and weight management practice. The domains most frequently identified included ‘knowledge’, ‘beliefs about consequences’ and ‘environmental context and resources’. Healthcare professionals' weight management practice had the most barriers compared with any other area of maternal obesity practice. The results of this review will be used to inform the development of an intervention to support healthcare professional behaviour change.     

Full‐Arch Implant‐Supported Fixed Dental Prosthesis Retained by a Combination of Galvano‐Telescopic Copings and Screws: A Clinical Report

Full‐arch screw‐retained implant‐supported fixed dental prostheses have a high long‐term success rate and are considered the gold standard by many clinicians. However, accurate fabrication of a passive fit long‐span prosthesis can be challenging. A novel intraoral adhesion method using galvano‐telescopic copings was proposed as a way of improving prosthetic fit for edentulous patients. This report describes the treatment of a 74‐year‐old female with a full‐arch implant‐supported dental prosthesis, supported by a combination of galvano‐telescopic copings and screws to prevent retention loss. Four years have passed since this superstructure was placed, during this time she exhibited a good clinical course with no inflammation noted in surrounding tissues. Treatment with an implant‐supported fixed dental prosthesis, retained by a combination of galvano‐telescopic copings and screws, can be a useful alternative treatment for edentulous patients.