临床医生信息需求调查及对策

采用自行设计的调查问卷,对四川省三级医院、二级医院、基层医疗卫生机构临床医生医学信息的需求情况进行调查,结果显示四川省临床医生医学信息服务的需求较高,可以采用多种继续教育培训和服务满足临床医生的医学信息服务需求。     

Social scientists and patient safety: Critics or contributors?

Patient safety has been high on the national and international agenda in healthcare for almost a decade. It is proving to be a tough problem; tough in cultural, technical, clinical, and psychological terms and because of its massive scale and heterogeneity. While many of the challenges and problems of patient safety are social and organisational, few social scientists are involved in patient safety. Clinicians and clinical researchers are for the most part open to other perspectives, but that they may not fully appreciate the potential contribution of the social sciences. Social scientists can, for instance, assist in drawing attention to the need to take an account of the social and cultural context of patient safety interventions, by drawing on narratives and stories to illuminate organisational processes and by encouraging greater use of ethnographic and observational research. However, if social scientists are to have a real impact they need to do more than simply offer critiques of patient safety and move to active engagement with clinicians and patient safety researchers.     

浙江省医生资源的分布及其宏观配置效率分析

通过对浙江省各地市千人医生数的比较,分析浙江省医生资源分布的状况和特征,认为目前浙江省医生资源存在地区分布、城乡分布不均衡的情况;又进一步从各县区医保基金的支付流向及宏观角度分析浙江省医生资源的配置效率,认为医生资源配置缺乏系统的人力资源配置和导向机制,是造成医疗卫生服务公平性,乃至看病难问题的根本原因之一.     

Innovation and the English National Health Service: a qualitative study of the independent sector treatment centre programme

Over the past two decades, an international trend of exposing public health services to different forms of economic organisation has emerged. In the English National Health Service (NHS), care is currently provided through a quasi-market including 'diverse' providers from the private and third sector. The predominant scheme through which private sector companies have been awarded NHS contracts is the Independent Sector Treatment Centre (ISTC) programme. ISTCs were designed to produce innovative models of service delivery for elective care and stimulate innovation among incumbent NHS providers. This paper investigates these claims using qualitative data on the impact of an ISTC upon a local health economy (LHE) composed of NHS organisations in England. Using the case of elective orthopaedic surgery, we conducted semi-structured interviews with senior managers from incumbent NHS providers and an ISTC in 2009. We show that ISTCs exhibit a different relationship with frontline clinicians because they counteract the power of professional communities associated with the NHS. This has positive and negative consequences for innovation. ISTCs have introduced new routines unencumbered by the extant norms of professional communities, but they appear to represent weaker learning environments and do not reproduce cooperation across organisational boundaries to the same extent as incumbent NHS providers.     

临床医师参与院前急救轮岗工作的利与弊

目的分析临床医师参与院前急救轮岗工作的利与弊。方法通过首批37名临床轮岗医师的院前轮岗情况及调查问卷,分析院前急救轮岗制度的有利因素与不利因素。结果首批37名轮岗医师完成了急救转运出车14582车次,占出车总数的31．3％。并使得院前急救平均反应时间由13．8min缩短到12．5min。回车率由5．7％降到2．5％,急救迟缓放车率由14．6％降到6．5％,平均迟缓放车率由23.3％降到12．0％。轮岗医师调查问卷中,对“急救医师工作强度”一项的评分最高为7．7分,对“急救医师福利待遇”一项的评分最低为3．2分。“对院前急救知识和技能培训是否满意”及“对自己应急能力的培养是否有帮助”两项的平均分均为7．5分。结论临床医师院前急救轮岗制度既存在有利因素,又存在不利因素,未能从根本上解决急救医师紧缺的问题。     

医防融合背景下临床医师的公共卫生知识与技能要点研究

目的 构建临床医师的一般公共卫生知识和技能体系,为培养临床医师的公共卫生知识和技能提供参考。方法通过文献研究、深度访谈、焦点小组访谈等方法归纳提炼临床医师的公共卫生知识和技能要点,并邀请16位专家采用德尔菲法对临床医师的一般公共卫生知识和技能进行筛选,根据专家咨询结果确立知识与技能要点。结果 经过两轮的专家咨询,建立了临床医师的一般公共卫生知识与技能体系,包含有7个一级维度、22个二级维度和99个三级维度。结论 构建了临床医师需掌握的一般公共卫生知识技能体系。     

临床医生主观幸福感与疲劳、睡眠质量及心理安全感的相关性

目的：探讨临床医生主观幸福感与疲劳、睡眠质量及心理安全感的关系。方法采用总体幸福感量表、疲劳量表、匹兹堡睡眠质量指数量表和心理安全感量表对山东省滨州医学院烟台附属医院280名临床医生施测。结果男女医生在脑力疲劳、睡眠总分、心理安全感总分、人际安全感和确定控制感比较差异有统计学意义（P＜0．01）;幸福感总分与心理安全感总分、人际安全感、确定控制感呈正相关（P＜0．01）,与疲劳总分、躯体疲劳、脑力疲劳、睡眠总分、主观睡眠质量、使用睡眠药物、睡眠潜伏期、睡眠持续性、习惯性睡眠效率及睡眠紊乱呈负相关（P＜0．05）;疲劳总分与睡眠总分、主观睡眠质量、使用睡眠药物、睡眠潜伏期、习惯性睡眠效率及睡眠紊乱呈正相关（P＜0．05）;人际安全感、确定控制感、主观睡眠质量、使用睡眠药物、习惯性睡眠效率、睡眠持续性、睡眠潜伏期、躯体疲劳对主观幸福感有预测作用。结论临床医生的主观幸福感与疲劳、睡眠质量及心理安全感具有密切的关系。     

四川省临床医生对医学信息的认知及需求

问卷调查显示,四川省临床医生对医学信息的认知情况较好,信息需求意愿较强,但需采取措施缓解其信息需求和获取能力之间的矛盾,为其提供价廉优质的医学信息服务。     

少数民族地区临床医生糖尿病防治知识水平调查

目的：评价甘肃省少数民族地区临床医生对糖尿病防治知识的掌握程度,分析存在原因,制定培训计划和对策。方法：以甘肃省甘南藏族自治州和临夏回族自治州为中心,抽取该地区临床内科和全科医生321人进行问卷调查,用不记名笔试的方法,在规定时间内完成答题,调查问卷当场收回,调查后集中审查、整理。结果：少数民族地区基层医务人员对糖尿病发病机理及诊断掌握情况糖尿病诊断标准掌握率41.7%,对1型及2型糖尿病鉴别要点的掌握57.6%,对Hb A1c检测意义的知晓率42.8%,对糖尿病急性并发症诊断知晓率56.9%;对糖尿病慢性并发症治疗原则了解率仅47.9%,对眼底视网膜病变分期准确率34.8%,糖尿病肾病分期知晓率43.6%,糖尿病神经病变知晓率42.6%,低血糖临床表现认知率62.8%;对糖尿病饮食计算方法掌握率仅47.6%;糖尿病患者如何进行运动治疗知晓率61.4%;对糖尿病降糖药物了解率低,使用知识欠缺。结论：结果表明：甘肃省少数民族基层医务人员糖尿病防控知识欠缺,尤其是在民族地区糖尿病防治技术亟待普及与提高,糖尿病防治整体状况堪忧。