Exploring Antipsychotic Prescribing Behaviors for Nursing Home Residents With Dementia: A Qualitative Study

Objectives

Caution is advised when prescribing antipsychotics to people with dementia. This study explored the determinants of appropriate, evidence-based antipsychotic prescribing behaviors for nursing home residents with dementia, with a view to informing future quality improvement efforts and behavior change interventions.

2021—2022年版英国质量与结果框架的设计及其对我国的启示

我国基层医疗卫生机构在承担基本公共卫生服务和基本医疗服务项目方面存在绩效考核体系和支付制度不完善的问题。英国质量与结果框架（QOF）经过多次调整,最新版本更加注重慢性病防控与疾病管理质量。本研究从管理与运作体系、指标体系的演变历程及新版（2021—2022年版）指标构成、计分规则和按绩效付费规则等方面对英国QOF进行介绍,并剖析了英国新版QOF的设计细节和运行情况。本研究发现,英国QOF是一个以结果为导向的质量控制系统和以报酬为导向的激励机制,其以主要慢性病及其危险因素为管理重点,通过设置三级指标体系,并规定指标分值和每分值对应的金额,实现将全科诊所服务质量与其绩效报酬相联系,能够从整体上提高英国卫生系统的效能。借鉴QOF的经验,我国应完善基本公共卫生服务规范与绩效考核指标体系、基层门诊慢性病支付方式,促进基本公共卫生服务资金和基本医疗保险基金的统筹使用。     

Developing a framework for meaningful use of personal health records (PHRs)

Significant advancements have been made in the technological development of the personal health record (PHR). The goal of the PHR is to encourage patients and health consumers to take individual responsibility for their health by being more engaged in the health care process through the use of the PHR. Many PHR applications are extensions of the electronic health record (EHR) and have limited patient input in their design. As more patients and health consumers use PHRs, there is an increasing need to understand the ways in which patients or health consumers use them. The major objective of this paper is to introduce a framework for understanding meaningful use of PHRs and to discuss the associated challenges that may impede meaningful use. The primary challenges that may hinder meaningful use of PHRs relate to health system challenges such as health care regulatory and managerial policies and multiple institutional, societal, cultural, and economic issues. Additional challenges, such as technology, design, usability, and implementation, still exist that relate to socio-technical issues.     

Towards a better understanding of self-management interventions in type 2 diabetes: A concept analysis

ObjectivesDiabetes self-management educational (DSME) interventions can vary considerably, and it is unclear what is the operational conceptualization of the ideal delivery to individuals with type 2 diabetes (T2D).DesignFrom a search conducted concurrently we extracted and evaluated the 50 most recently published DSME intervention studies. Based on an analysis of these studies, we undertook a concept analysis using the Walker and Avant framework.ResultsFive attributes describing the concept were recognized and organized into two groups. Group (a): skills related attributes that included (1) decision making, (2) problem solving and (3) taking action. Group (b): information related attributes that included (4) patient-provider interaction and (5) resource utilization.ConclusionsThe outcomes of this study make the operational conceptualization of the ideal DSME intervention measurable through its attributes and hence clarifies its delivery. This will improve the implementation of the key attributes in diabetes self-management intervention programs for T2D.     

2010年我国家庭人均自报食盐消费情况分析

目的 了解2010年我国家庭人均每日食盐消费情况.方法 利用2010年中国慢性病监测家庭问卷调查数据,分析我国家庭人均每日食盐消费量及过量食盐消费比例,描述不同地区、城乡的分布,比较其差异.共有92 814户家庭纳入分析.结果 2010年我国家庭人均食盐摄入10.6 g/d,城市（9.1 g/d）低于农村（11.5 g/d）,东、中、西部地区盐摄入量依次增加,西部农村地区盐摄入量最高（12.5 g/d）,东部城市地区最低（8.6 g/d）.家庭人均每日食盐摄入量超过膳食指南盐摄入建议量（6 g/d）的比例为72.6％,农村（78.3％）高于城市（63.5％）.家庭人均每日食盐摄入量超过我国慢性病防治规划2015年减盐目标（9g/d）的比例为38.1％,农村（44.0％）高于城市（28.8％）,西部地区高于中部和东部.结论 2010年我国家庭人均食盐摄入过高,在西部农村地区尤为突出,需要制定减盐干预策略,加强健康教育,防控高盐饮食危害.     

Learning from the lived experience of functionally healthy older adults: What does it mean to be “healthy”?

BackgroundReports of older adults’ perceptions of ageing and health generally do not consider individual health status, instead presenting large cohort data or focussing on specific population groups. Moreover, qualitative studies have largely included participants with suboptimal health.AimThis study aimed to examine functionally healthy older adults’ perceptions of health and healthy ageing.MethodTwenty-two functionally healthy older adults living independently in the community (aged 61–83 years; 68% female) participated in six focus groups to explore their perceptions about “health” and “healthy ageing”. Quantitative measures were used to describe participants’ health status.FindingsSeven themes describing participants’ experiences of healthy ageing were identified: “know thyself”, “knowledge and information management”, “choices, agency, and control”, “autonomy and flexibility”, “being strategic”, “community connections”, and “getting more out of life”. Key competencies for healthy ageing were subsequently derived, drawing connections between beliefs, behaviours, and knowledge about healthy ageing.DiscussionThe identified health behaviours perceived to be important for healthy ageing align with previous reports. The subsequent overarching healthy-ageing competencies (“recognise opportunity”, “strategise”, “maximise benefits”, and “active participation”) present important pillars underpinning the process of healthy ageing that have not been previously considered in this context.ConclusionThe behaviours perceived to influence older adults’ health are varied, and the competencies identified in this study present a broad framework underpinning these behaviours. The identified competencies have the potential to inform public health initiatives, practice, and policy, empowering individuals to optimise their health.     

The Safe Care Framework™: A practical tool for critical thinking

Safe, effective and ethical clinical decision-making in nursing depends on critical thinking, yet there is no consensus on the educational strategies that are most effective in developing and refining this foundational skill. A qualitative inquiry among graduating Bachelor of Science in Nursing students sought to determine whether one such educational strategy, an operationalized critical thinking framework, would assist nursing students to better understand acute care patients' complex profiles. The Safe Care Framework™, consisting of the ‘Concept Map Template’ and the ‘Priority Setting Tool Template’, was developed using a constructivist pedagogical approach. The framework illustrates and operationalizes the systematic critical thinking processes that expert nurses use to provide safe, comprehensive care. Thematic analysis of qualitative survey results revealed the following three main themes; (1) greater organization and understanding of patient data; (2) guiding of assessments and priorities of care; (3) better communication with others, and several subthemes. Thus, the Safe Care Framework™ may be a practical operational tool that can support novice nurses in developing critical thinking skills. This framework adds to the literature on innovative pedagogy for nurse educators.     

大数据理念下医保报销循证决策框架设计

通过专家咨询探讨基于大数据理念的医保报销循证决策框架,明确决策的维度,结合大数据资源分析医保报销的循证决策步骤,围绕医保决策实践就如何充分利用大数据资源提出建议。     

面向元数据服务的国防科技管理大数据资源体系架构设计

在研究参考《美国国防部体系结构框架》（DoDAF）2.0版数据规划技术基础上,理清了国防科技管理大数据的需求线和数据结构,设计了国防科技管理大数据资源的总体框架体系。借鉴DoDAF 2.0版中的元模型构建思想,重点研究了国防科技管理大数据的元数据技术及元数据交换规范,以推进我国国防科技大数据体系的建设,提高我军基于数据的精准管理和决策能力。