The evolution of today's hospital emergency departments —Current problems and challenges

The announcement of the National Heart Attack Alert Program by the National Heart, Lung and Blood Institute in June of 1991 prompted leaders of the Florida Chapter of the American College of Cardiology to develop a statewide program to reduce the morbidity and mortality from acute myocardial infarctions within Florida. It became apparent that the success of such a program would require the prompt institution of thrombolytic agents or other revascular-ization procedures in appropriate patients. No longer could the decision regarding institution of therapy await discussion by telephone and/or the arrival at the emergency department (ED) of the patient's primary care physician or cardiologist. Efforts to establish appropriate protocols for therapy revealed that many of the 25,000 or more physicians currently staffing the 5,600 or so EDs in this country were moonlighting residents or practitioners from a variety of specialties or subspe-cialties with limited or no formal EM training. Furthermore, it was learned that there were in the entire country only about 800 postgraduate, year-one Council for Graduate Medical Education accredited training positions. There were only 21 such training positions in the entire state of Florida. The reasons for these deficiencies are discussed and a challenge to correct this person power crisis is issued, not principally to the leadership of EM, but to the entire medical profession.     

试论门诊管理

结合门诊管理的实践,对如何加强门诊管理进行了论述。主要为:①掌握门诊特点,确定门诊管理重点;②做好工作计划,实施目标管理;③充分发挥门诊部办公室的作用,承上启下,及时协调;④健全门诊管理组织,完善门诊管理规定;⑤抓好服务质量,方便病人就医;⑥加强质量考核,确保门诊工作质量。     

STRESS IN THE RURAL EMERGENCY ROOM

ABSTRACT: This study identifies stress-producing factors reported by registered nurses (RNs) attending serious incidents in an Australian rural hospital's emergency room. A Delphi approach was used to determine the six most significant stress-producing factors, and these factors were then ranked by two groups of nurses. The rankings were compared using the Spearman Rank Order Coefficient of Correlation and were found to be dependent on years of nursing experience of the RNs taking part in the study. The more experienced group nominated 'anxiety about nursing a family member or close friend' as the most significant stress-producing factor, while the less experienced group reported 'concerns about nursing a child' as the most important stress-producing factor. Possible reasons for the variation in rankings are discussed, and recommendations are made in the light of the study's findings.     

目标教学结合Roy适应式情景教学在急诊科护理教学中的应用研究

目的 探讨目标教学结合Roy适应式情景教学在急诊科护理教学中的应用效果。方法 将分配到空军军医大学第一附属医院西京医院急诊科实习的护生110人作为研究对象,按进科先后顺序分为对照组和观察组,每组55人。对照组采用传统教学,观察组采用目标教学结合Roy适应式情景教学。评估两组实习护生情景模拟演练考核成绩和急诊急救能力。采用SPSS 22.0进行t检验和卡方检验。结果 观察组实习护生情景模拟演练考核教学目标,理论知识目标、技能目标、态度目标考核平均成绩分别为（9.09±1.21）分、（13.98±1.87）分、（9.32±0.95）分,对照组理论知识目标、技能目标、态度目标考核平均成绩分别为（8.41±1.17）分、（12.43±1.72）分、（8.72±0.83）分,观察组教学目标（理论知识目标、技能目标、态度目标）的掌握程度均优于对照组,差异有统计学意义（P<0.05）。观察组实习护生急诊急救能力优于对照组,差异有统计学意义（P<0.05）。结论 目标教学结合Roy适应式情景教学应用于急诊科护理教学,有助于提升实习护生的理论和实践技能,有助于培养实习护生的急诊急救能力。     

基于ISD模型的突发公共卫生事件全员培训设计与应用分析

目的 北京市某三级医院为提升全员应对突发公共卫生事件的应急处置能力,最大限度保障职工职业安全,实现所有工作人员零感染,开展全员职业培训与考核。方法 采用ISD（instructional system design）模型进行培训课程的系统设计,对全院人员在线学习、电子试卷考核和现场培训、考核结果使用Excel、SPSS 22.0进行分析。结果 参加培训人员经培训后平均得分由84升至100,答题时间由平均308 s缩短为179 s,不同职称人员培训前后考核分数存在差异,不同部门间人员培训前后的考核分数存在差异。结论 在突发公共卫生事件发生时,全员培训及考核是必要的,应用ISD模型有助于快速制定培训方案。在线学习考核的应用是应急全员培训的首选有效方式。     

神经内科临床实习生临床思维能力培养实践

目的 探讨提高神经内科临床医学实习生临床思维能力的方法。方法 选择2017年至2018年临床医学实习生为研究对象,2018年为试验组（98人）,2017年为对照组（95人）。试验组实施临床思维能力培养,对照组采用传统常规的方法培养。实习结束前,采用自制的《临床医学实习生临床思维能力调查问卷》进行调查,评价教学效果。使用SPSS 14.0进行t检验和卡方检验。结果 试验组与对照组均存在临床思维的片面性、表像性、定势性、被动性、懒惰性、简化性、混乱性等问题,试验组存在的临床思维方面问题较对照组明显下降（P<0.001）,其中试验组的临床思维的片面性、表像性、定势性、被动性、懒惰性方面与对照组比较差异有统计学意义（P<0.05）。除语言沟通与表达能力外,试验组的其他临床思维能力自评得分与对照组比较差异都有统计学意义（P<0.05）。试验组的出科考核成绩与对照组比较差异也有统计学意义（P<0.05）。结论 临床医学生在神经内科实习阶段实施临床思维训练,有利于培养学生的临床思维能力,提高人才培养质量。     

应用CBL与RadiAnt DICOM Viewer在临床本科生放射科实习线上教学的实践

临床本科生在放射科实习普遍存在轮转时间短、积极性不高、教师采用传统教学模式、影像阅片软硬件设施不足等问题。本研究应用RadiAnt DICOM Viewer和CBL模式在临床本科生放射科实施线上实习教学。经过实践取得了良好的效果。研究结果显示,临床本科生临床技能阅片测验结果显示及格率达91.18%（124/136）。随堂测验平均成绩为（85.71±10.99）分,及格率达91.91%（125/136）。满意度调查结果显示,84.56%（115/136）的学生更加认可应用RadiAnt DICOM Viewer进行临床阅片教学;80.88%（110/136）的学生通过本次课程培训后,表示对影像学更加感兴趣;90.44%（123/136）的学生认为本科生影像学线上实习教学是可行的。     

急诊科护士对新发传染病知信行调查问卷的编制

目的 编制急诊科(emergency department,ED)护士对新发传染病(emerging infectious diseases,EID)知信行(knowledge attitude practice,KAP)调查问卷,并进行信效度检验。方法 以KAP理论为基础,通过文献回顾、德尔菲专家函询形成问卷初稿;于2021年5月方便抽样上海市3所三级甲等综合医院293名ED护士进行预调查,完成问卷条目筛选和信效度检验。结果 形成含有34个条目的ED护士对EID知信行调查问卷,其中知识维度12个条目、态度维度10个条目、行为维度12个条目。问卷整体Cronbach's α系数为0.926,各维度Cronbach's α系数为0.617~0.968;问卷整体分半信度为0.846,各维度分半信度为0.614~0.958。问卷水平内容效度指数(scale-level content validity index,S-CVI)为0.99,条目水平内容效度指数(item-level content validity index,I-CVI)为0.99~1.00;探索因子分析显示,知识、态度、行为3个维度分别提取公因子4个、1个、2个,累计方差贡献率分别为50.192%、78.319%、73.341%,问卷整体累计方差贡献率67.242%;验证因子分析显示,问卷整体及各维度拟合度较好。结论 EID知信行调查问卷具有良好的信效度,可作为ED护士对EID KAP的评估工具。     

Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma

BACKGROUND: Regular use of inhaled corticosteroids (ICSs) can improve asthma symptoms and prevent exacerbations. However, overall adherence is poor among patients with asthma. Objective To estimate the proportion of poor asthma-related outcomes attributable to ICS nonadherence. METHODS: We retrospectively identified 405 adults age 18 to 50 years who had asthma and were members of a large health maintenance organization in southeast Michigan between January 1, 1999, and December 31, 2001. Adherence indices were calculated by using medical records and pharmacy claims. The main outcomes were the number of asthma-related outpatient visits, emergency department visits, and hospitalizations, as well as the frequency of oral steroid use. RESULTS: Overall adherence to ICS was approximately 50%. Adherence to ICS was significantly and negatively correlated with the number of emergency department visits (correlation coefficient [ R ] = -0.159), the number of fills of an oral steroid ( R = -0.179), and the total days' supply of oral steroid ( R = -0.154). After adjusting for potential confounders, including the prescribed amount of ICS, each 25% increase in the proportion of time without ICS medication resulted in a doubling of the rate of asthma-related hospitalization (relative rate, 2.01; 95% CI, 1.06-3.79). During the study period, there were 80 asthma-related hospitalizations; an estimated 32 hospitalizations would have occurred were there no gaps in medication use (60% reduction). CONCLUSIONS: Adherence to ICS is poor among adult patients with asthma and is correlated with several poor asthma-related outcomes. Less than perfect adherence to ICS appears to account for the majority of asthma-related hospitalizations.     

Prevalence of viral infection markers by polymerase chain reaction amplification and interferon-alpha measurements among patients undergoing lumbar puncture in an emergency department

Aseptic meningitis is a frequent diagnosis in emergency departments. Nevertheless, viral investigations are not carried out currently and the viral etiology in adult population has not been studied extensively. We conducted a prospective study including all consecutive patients undergoing lumbar puncture during a 15 months period in an adult emergency department. Bloody and purulent cerebrospinal fluid (CSF) were excluded. The main tests undertaken were: CSF genomic amplification by the polymerase chain reaction (PCR) for neurotropic viruses and serum and CSF interferon-alpha (IFN-alpha) measurements. Among 194 patients included, 45 had and 149 did not have aseptic meningitis. Of 45 patients with aseptic meningitis, 10 had alternative non-virological final diagnosis, and 35/45 were presumed to have neurological disorders of viral origin. Patients (27/35) completed virological analysis: 21/27 (78%) had either positive viral PCR (enterovirus: 8 patients, Varicella zoster virus (VZV): 5, Epstein-Barr virus (EBV): 2, herpes simplex virus (HSV): 1, human herpes virus 6: 1) or only raised serum or CSF IFN-alpha (4 patients). Overall, 59% of patients with a positive viral PCR had either CSF or serum raised IFN-alpha. Twentyone patients without meningitis had either positive viral PCR (enterovirus: 3 patients) or only high serum IFN-alpha level (18 patients). In the setting of aseptic meningitis diagnosed in an adult emergency department, viruses are the most common agents encountered, with enterovirus and VZV as the two main etiological agents. Current CSF viral genome amplification and IFN-alpha measurement are informative and could be useful to confirm the viral origin of various neurological disorders, although the sensitivity and specificity of IFN-alpha measurement for the diagnosis of viral infection need further confirmation.