基层医院临床药师在抗菌药物专项整治活动中的作用

目的探讨药师在基层医院专项整治活动中的作用。方法抽取了基层医院2012年2月至4月份的用药数据,以用药频度（DDDs）排序出前20位药品。结果用药频度均得到了明显的减少,对于I类切口手术预防用药出现了较大的变化,合格率由2.13%上升至54.12%。结论药师应充分发挥自身优势,为抗菌药物专项整治活动和合理应用抗生素提供重要药学服务     

临床医生情绪调节效能感:在共情疲劳与抑郁间的中介效应研究

目的 探讨情绪调节效能感在临床医生共情疲劳与抑郁间的中介效应。方法 采用方便抽样的方法调查385名临床医生,运用情绪调节效能感量表(SRESE)、救助人员生活质量-共情疲劳分量表(ProQOL-CF)和健康问卷抑郁分量表(PHQ-9)进行评估。结果 本调查中临床医生SRESE总分(64.80±8.53)分,ProQOL-CF总分(44.77±9.36)分,PHQ-9总分(11.29±3.10)分。(情绪调节效能感与共情疲劳、抑郁呈负相关(P＜0.05),共情疲劳与抑郁呈正相关(P＜0.05);(情绪调节效能感中介模型拟合良好,表达积极情绪效能感在医生共情疲劳与抑郁之间的中介效应无统计学意义,但管理消极情绪效能感在其中的部分中介效应有统计学意义,中介效应解释总效应的百分比为48.8%。结论 良好的情绪调节效能感可以有效应对共情疲劳产生的冲击,减轻其对临床医生可能带来的抑郁不良情绪,尤其应注重培养临床医生管理消极情绪的技能和自信心。     

The role of perceptions of clinicians in their adoption of a web-based antibiotic approval system: do perceptions translate into actions?

PURPOSE: Computerized Decision Support Systems have been shown to improve clinicians' performance. Clinicians' adoption of these systems is crucial for their success. Studying clinicians' perceptions can provide an insight into the determinants of clinicians' adoption of such systems. The aim of this study was to measure clinicians' perceptions of ease of use and usefulness of a web-based antibiotic approval system, and to investigate the relationship between the reported perceptions and use of the system. METHODS: Potentially identifiable coded surveys were sent to a total of 70 senior and 150 junior medical staff, and 30 pharmacists all working at a tertiary care referral teaching hospital of Melbourne, Australia. Clinicians' perceptions of ease of use and usefulness of the antibiotic approval system; clinicians' general computer use; and clinicians' usage of the antibiotic approval system were measured. RESULTS: The overall response rate from the clinicians was 53.4%. The majority of the participants (70% and above) found it easy to obtain antibiotic approval using the system. More than 80% of the participants believed that the system will decrease the inappropriate use of antibiotics at the hospital. Clinicians who were more likely to use the system also found it easy to learn (Rho=0.392, p=0.001), easy to show others how to use the system (Rho=0.298, p=0.014), easy to find additional information (Rho=0.317, p=0.009), and easy to use it within their daily workflow (Rho=0.268, p=0.028). In addition, the clinicians were also more likely to use the system if they believed that it will improve their adherence to evidence-based practice (Rho=0.352, p=0.003). CONCLUSION: The majority of clinicians in an independent investigation of the antibiotic approval system found the system easy to use and useful to them. A number of clinicians' perceptions about the system were found to be correlated with the actual usage of the system by the clinicians.     

重庆市合川区医护人员心理健康状况分析

目的：调查重庆市合川区医护人员的心理健康状况。方法：以重庆市合川区570名医护人员为研究对象,应用症状自评量表（SCL-90）调查,以SCL-90总分>160分为心理症状阳性,并在躯体化、强迫、人际关系、抑郁、焦虑、敌对性、恐怖、偏执、精神病性9项因子及总均分等方面进行统计分析。结果：心理症状阳性的比例：医护人员18.95%（108/570）;临床护士23.20%（58/250）,临床医生15.63%（50/320）;区级卫生单位医护人员25.60%（75/293）,卫生院医护人员11.91%（33/277）。该地区医护人员SCL-90多项因子分与中国人常模比较有明显差异;区级单位医护人员各项因子得分及总均分均明显高于卫生院医护人员,差异有统计学意义（P<0.01）;护士在强迫、抑郁、焦虑、敌对性及总均分方面明显高于医生,差异均有统计学意义（P<0.01）,在精神病性方面差异有统计学意义（P<0.05）,而在躯体化、人际关系、恐怖及偏执等方面两者无明显差异（P>0.05）。结论：该地区医护人员的心理健康状况较差。区级医疗卫生单位医护人员的心理健康状况明显比卫生院工作人员差,临床护士心理健康状况较临床医生差。     

Effectiveness of workshop training for psychosocial addiction treatments: a systematic review

Workshop training for psychosocial substance abuse treatment has been an important part of the transfer of evidence-based approaches into larger practice. Although they are widely used, training methods such as self-study reading, internet-based courses, and educational workshops have not traditionally been the focus of empirical investigations. Based on electronic and manual searches of the literature, we summarize 17 evaluations of workshop training that describe the training program and the educational outcomes. In general, training tends to improve attendees' knowledge, attitudes, and confidence in working with clients who have substance abuse problems. Some skill improvements, when measured, are usually seen immediately after training but are less often maintained over a longer time. Extended contact, through follow-up consultation, supervision, or feedback, appears to be necessary for the long-term adoption of skills. There are also a number of institutional factors that may influence the extent to which providers adopt new practices. Given the popularity of this training format, the role of workshop training needs to be a focus of future evaluative research.     

一个值得关注的问题：医生疲劳与患者安全

医务人员由于长时间工作及生理周期破坏所导致的睡眠剥夺，使患者不能得到高质量的医疗服务，这在我国医患关系比较紧张的客观实际情况下是不容忽视的。因此，关注医生疲劳与患者安全的问题在我国有其现实意义。积极采取各种策略妥善解决医生疲劳问题，保证医疗安全，建立安全、高质量的医疗保障体系，不仅直接关系到患者的治疗效果，而且对融洽医患关系，保证医疗安全都是十分重要的。     

SPIT TOBACCO PREVENTION AND CESSATION COUNSELING: STATEWIDE SURVEY OF HEALTH-CARE PROFESSIONALS AND EDUCATORS

The use of spit tobacco (ST) products is a serious public health problem in the United States. Use of ST is associated with increased risk of oral cancer, gastrointestinal neoplasms, and other deleterious effects. The prevalence of ST use among adolescents is high in many areas, especially in predominantly rural states (e.g., South Dakota, Montana). Community-wide efforts aimed at prevention and cessation of ST use among young people are needed. A total of 4089 clinicians and educators were surveyed in 1998 regarding their personal ST use and several other characteristics associated with ST prevention and cessation counseling. Educators reported significantly higher rates of ST use than did clinicians. The most prevalent barriers to ST counseling among clinicians were perceptions of patient resistance to referral to ST cessation programs and the lack of community services that effectively treat ST use. Lack of training was a major barrier to ST counseling among all educator subgroups. Although knowledge of the health effects of ST was fairly high among all subgroups, more than 10% of dentists and dental hygienists failed to report that ST use causes gum disease. Most clinicians believed that they should demonstrate leadership in efforts aimed at ST control; however, only 64% of dentists believed that repeated counseling attempts were necessary with patients who continued to use ST. Compared with clinicians, educators generally felt less obligated to provide ST counseling. Eighty percent of physicians reported counseling activities, but fewer than half of the dental professionals did. More than 75% of Drug Abuse Resistance Education (DARE) officers reported having delivered ST counseling, whereas only 4% of volunteer leaders did. Fewer than 50% of educators believed that the ST program they taught was effective. Training of various professionals in ST interventions may benefit from emphasizing different issues (reduction of personal ST use, knowledge, commitment, etc.). Our findings have implications for community-based efforts aimed at controlling ST use among young people.     

临床教学医院中循证医学的应用

对山西医科大学3所临床教学医院的157名临床医生进行问卷调查,了解临床教学医院的临床医生对循证医学的认知和应用现状,分析存在的问题,并提出建议。     

肿瘤姑息治疗状况及医务人员对肿瘤姑息治疗态度调查

目的 了解姑息治疗的现状及医务人员对姑息治疗的态度,以推动此项工作的开展。方法 采用问卷调查法对姑息治疗有关的六个方面进行调查。结果 428名被调查者来自全国22个省市自治区的44家医院,其中住院医师占34.6％,主治医师占34.6％,副主任医师占21.0％,护士占10.0％。肿瘤内科专业占大部分(66.4％)。绝大多数医院收治的Ⅲ～Ⅳ期患者占40％以上,其中半数医院甚至达80％以上。大部分患者治疗的目的是积极抗肿瘤治疗和控制症状,平均住院时间在两周至两个月内,部分肿瘤专科医院能够提供临终关怀的有关服务,对便秘、疼痛、中性粒细胞下降控制能力较强,而对厌食、抑郁或焦虑、气短控制则较为困难。城市患者(90％)更多的愿意在医院渡过生命的最后时光,而农村患者(95％)则相反,更多的愿意在家中。半数多的人(51.6％)认为对生存期只有几个月的患者的治疗意见应以姑息治疗为主,但也有近一半的人(46.5％)认为应尽量将延长生命和姑息治疗相结合。三分之一的人认为只有约50％的患者有对临终前不抢救的要求,对是否抢救的观点,多半(60.2％)的医务人员未发表意见。而对不抢救应与患者商量多数表示同意。四分之一的人曾经使用安慰剂治疗疼痛,并且多数人听说过安慰剂治疗疼痛。三分之一的人仍将成瘾看成是疼痛治疗的一个