新医改背景下武汉市医学院校大学生医疗保障认知和评价状况分析

目的:分析在校大学生对医疗保障的认知和评价状况,探讨完善该人群医疗保障相关制度的策略。方法:在武汉市采用分层随机抽样的方式确定3所院校,对在校大学生进行问卷调查和半结构访谈。结果:在校大学生中知晓城镇居民医保政策的比例为11.5%,经历过商业医保理赔的在校大学生对理赔"很不满意"和"较不满意"的比例为34.0%,在校大学生对现有医疗保障待遇满意程度评分的得分率为57.0%。结论:应在该群体中加大医疗保障相关信息的宣传工作力度,保险公司亟需对在校大学生商业医保重新定位并改进相关服务工作,在校大学生医疗保障相关制度仍应在细节上加以完善。     

Psychosocial mediators and moderators of the effect of peer‐victimization upon depressive symptomatology

Background: Intervention strategies and developmental models of stress have been criticized for failing to integrate social psychological variables. This study investigates both self‐referential cognitive mediators (perceived threat and control) and a social psychological moderator (ethnic/religious identity) of the effect of peer‐victimization upon depressive symptomatology. Methods: Self‐report questionnaires were completed by 924 students (46% female), aged 8 to 12 years. Experiences of discriminatory and non‐discriminatory peer‐victimization, threat and control appraisals, depressive symptoms, and strength of main identity were assessed. Results: Perceived threat partially mediated the effect of peer‐victimization (regardless of whether it was discriminatory or not) on depressive symptoms. Perceived control partially mediated the effect of non‐discriminatory peer‐victimization on depressive symptoms. Strength of ethnic/religious identity buffered the effect of peer‐victimization on depressive symptoms. Victimization perceived to be discriminatory in nature was more strongly associated with depressive symptoms than non‐discriminatory victimization. Conclusions: Findings support calls for a greater emphasis to be placed on social psychological variables in explaining depressive symptomatology. For clinical, counseling and intervention purposes, it is important to examine whether victims perceive peer‐victimization as discriminatory and whether their own strength of identity affects symptomatology.     

药物经济学在国家基本药物遴选中的应用

目的 在我国基本药物目录遴选过程中引入药物经济学评价方法,提高遴选过程科学性和临床用药合理性,保证基本药物质优价廉,切实满足公众用药需求.方法文献研究法.结果 药物经济学在我国基本药物遴选中的参与不够,缺少专业人才和研究机构,现有评价资料科学性不高,保障制度不完善.结论 针对遴选方法中存在的问题,开展药物经济学评价方法学研究,建设专业人才队伍及机构,建立药物经济学数据库,制定相应法规确保实际应用.     

医院科室绩效考核体系建设研究

公立医院建立以“公益性”为核心的绩效评价体系势在必行.公立医院必须通过绩效考核,提升医院核心竞争力,强化医院管理者经营意识以实现医院长期战略目标,满足医院进一步发展需要和员工需求.医院发展必须建立在服务质量、医疗水平、成本控制等方面,如何将影响医院运营的指标在绩效考核体系中全面完整地体现,并通过指标的重要程度构建合理的评价考核体系是我们绩效考核工作的重点.对绩效考核设立原则、绩效考核体系建立步骤、绩效考核指标选择、绩效考核反馈制度等方面进行了讨论.     

以三维绩效结构理论构建军队医院护士长绩效考核指标体系

目的 建立一套科学、客观、全面的军队医院护士长绩效考核指标体系.方法 以三维绩效结构理论为基础,应用质性研究法、专家小组讨论及德尔菲(Delphi)专家咨询法,定量分析各指标的权重,建立军队医院护士长绩效考核指标体系.结果 建立了医院病区护士长绩效考核指标体系,包含任务绩效、关系绩效、适应性绩效3部分内容的Ⅰ级指标3条、Ⅱ级指标10条、Ⅲ级指标68个条目池.结论 以三维绩效结构理论构建的军队医院护士长考核指标体系,为全面实施有效、充分量化、真实地评估病区护士长的绩效管理提供依据.     

The reliability and validity of the Japanese version of the Appraisal of Diabetes Scale for type 2 diabetes patients

Aims

An appropriate questionnaire for measurement of the psychological burden of self-management or behavior modification in type-2 diabetes patients has yet to be developed in Japan. This study was conducted to test the reliability and validity of the Japanese version of the Appraisal of Diabetes Scale (ADS).

Methods

The study enrolled 346 Japanese patients with type 2 diabetes: 200 men and 146 women who were 63.2 ± 10.1 and 62.2 ± 11.9 years of age and had HbA1c levels of 6.9 ± 1.2% and 7.3 ± 1.9%, respectively.

Results

The questionnaire was divided into three components: “Psychological impact of diabetes”, “Sense of self-control”, and “Efforts for symptom management”. Cronbach's alpha was 0.746-0.628. Significant correlations were observed between “Sense of self-control” and self-managed dietary and exercise behaviors and HbA1c levels; between “Psychological impact of diabetes” and various treatments, symptoms causing anxiety, and HbA1c levels; and between “Efforts for symptom management” and dietary and nutritional behaviors. The questionnaire showed better evidence of internal consistency, test-retest reliability and validity.

Conclusion

Our results suggested that the Japanese version of ADS may be a useful tool for the quick assessment of common anxieties and motivation toward treatment in patients with type 2 diabetes.     

局部解剖学的改革初探

局部解剖学是以尸体解剖为主的实践性极强的一门课程。随着医学教育教学改革的发展,传统的考核评价方法越来越不能满足现代医学生的培养要求。为了进一步保障和提高教学质量,增强学生的动手能力、分析问题和解决问题的能力,我室在局部解剖学的教学改革中逐步改进考核评价,取得了满意的教学效果。     

Breast reconstruction after therapeutic or prophylactic mastectomy for breast cancer: A comparison of guideline recommendations

BackgroundThe purpose of this article is to illuminate differences in published clinical practice guideline recommendations for breast reconstruction after prophylactic and therapeutic mastectomy.MethodsTen guidelines were identified through a systematic search of websites and databases of reputable oncology guideline developers, and key differences and gaps in recommendations were noted. Quality assessment of the guidelines was conducted by three reviewers using the AGREE II tool, focusing on breast reconstruction specific documents rather than the general breast cancer guidelines.ResultsThe most comprehensive guidelines were published by Alberta Health Services, Cancer Care Ontario, the American Society of Plastic Surgeons, and the Association of Breast Surgery/British Association of Plastic Reconstructive and Aesthetic Surgeons. AGREE II scores in the domains of “Scope and Purpose” and “Clarity and Presentation” were ranked relatively high for all four guidelines while “Applicability” and “Editorial Independence” were ranked relatively low. The Alberta and Ontario guidelines were the overall highest ranked guidelines across all domains.ConclusionOverall, these guidelines provide consistent recommendations on who should receive breast reconstruction education, who is a candidate for postmastectomy breast reconstruction, and the appropriate timing of reconstruction and extent of mastectomy. Future updates from all should focus on expanding to include alloplastic and autologous forms of reconstruction and should include a broad scope of relevant questions.