患者对医生与护士社会地位认知情况的调查研究

目的 调查患者对医生与护士社会地位的认知情况及医护社会地位差异的影响因素.方法 采用自编的医生护士社会地位问卷对286例患者进行调查.结果 多数患者认为护士的社会地位在我国社会中处于中等及以上水平.大部分患者认为医生的社会地位高于护士的社会地位(认同率75.5%).经济待遇方面,护士职业的经济待遇较医生职业低(认同率62.2%);职业声望方面,在15个项目中,有14个项目均是医生职业的认同率高于护士职业,仅有对职业劳动强度的认同率护士职业高于医生职业.患者认为医护社会地位产生差异的影响因素有职业经济待遇、职业的重要程度、职业本身所具有的权力、对专业技术的要求4个方面.结论 深入研究医护社会地位问题形成的影响因素,有助于我们从对策上研究提高护士社会地位的方法,以落实国家的科学发展观,促进护理队伍的可持续发展,创建和谐的医护关系.     

Do Standardized Patients Have Concerns About Students Not Captured by Traditional Assessment Forms?

Construct: Traditionally, standardized patients (SPs) assess students' clinical skills principally through numerical rating forms—an approach that may not fully capture SPs' concerns. SPs are students' closest approximation to real patients. To maximally benefit students' clinical training and evaluation it is important to find ways to give voice to the totality of SPs' perspectives. Background: SPs have been shown to be a reliable and valid means to assess medical students' clinical skills in clinical skills examinations. We noticed, however, that SPs often express “off the record” concerns about students, which they do not include on traditional assessment forms. Approach: To explore these “off the record” concerns, we designed a Concerns item and added it to the traditional assessment form for an end-of-3rd-year clinical skills examination shared by three medical schools. We asked SPs to use this Concerns item to identify students about whom they had any “gut-level” concerns and provided them with a narrative opportunity to explain why. SPs were informed that the purpose of the item was to help students with difficulties and was not part of the student's grade. Results: We analyzed the concerns data using quantitative and qualitative methods. Of 551 students at three schools, 223 (～40%) had concerns recorded. Seventy students received two or more concerns. Qualitative analysis of SPs' comments revealed 3 major categories of concern: communication and interpersonal skills, history taking, and physical exam. Grouped under each were several subcategories. More than half of the written comments from the SPs related to the communication/interpersonal skills category and included subcategories commonly addressed in communications courses: lack of empathy, good listening skills, and lack of connection to the patient. They also included subcategories that in our experience are less commonly addressed: odd or off-putting mannerisms, lack of confidence, unprofessional behavior, domineering behavior, and biased behavior. Another 47% of concerns identified deficiencies in history taking and physical examination. Of the students with concerns noted by two or more SPs, SPs' narrative comments on 84%, 42%, and 48% of the students in the domains of communications, history, and physical exam respectively indicated potential problems not identified by scores on the traditional assessment form. Conclusion: The Concerns item is a narrative assessment method that may add value to traditional quantitative scoring by identifying and characterizing problematic student performance not captured by the traditional assessment form. It may thus contribute to giving fuller voice to the totality of SPs' perspective.     

Pain coping skills training un-locks patient-centered pain care during the COVID- 19 lockdown

BackgroundIn 2020, the COVID-19 virus sparked a crisis constituting a nationwide public health emergency that rapidly altered the provision of healthcare services for all Americans. Infectious disease mitigation led to widespread lockdowns of perceived nonessential services, programs, and non-emergent healthcare interventions. This lockdown exacerbated the public health dyad of uncontrolled pain and the opioid epidemic, which was already in a crisis state. Current literature supports the management of uncontrolled pain with a biopsychosocial approach, empowering patients to explore self-care to enhance activities of daily living. Pain Coping Skills Training (PCST) delivers real-life strategies that improve quality of life and strengthen self-efficacy. Self-efficacy has been identified as a patient outcome measure that demonstrates improved patient-perceived function and quality of life despite pain intensity. Studies have shown that nurse practitioners (APRN) are well-positioned to provide PCST to chronic pain sufferers.MethodsA pretest-posttest design was utilized for this project to enhance pain self- efficacy through an APRN-led community-based intervention.InterventionCommunity-dwelling adults treated in a specialty pain management practice were self-selected to participate in a 6-week telehealth delivered PCST Program. This APRN delivered program presented basic pain education and a broad range of evidence-based nonpharmacologic pain management self-care tools. The primary outcome was improved Pain Self-efficacy measured with the pain self-efficacy questionnaire (PSEQ), with secondary outcomes of improved perceived pain intensity and function measured with the pain, enjoyment, and general activity (PEG) scale tracked weekly.ResultsBaseline PSEQ and weekly PEG scores were obtained and compared to scores after the program. Collateral data points included confidence in using complementary and alternative nonpharmacologic interventions, satisfaction with the program, and a qualitative patient statement regarding pre-and post-intervention participation.ConclusionsThis project concluded that a Nurse Practitioner delivered PCST program via telehealth technology could provide community-dwelling adults with an intervention that improves pain self-efficacy, enhances self-reported PEG measures, and meets the social distancing requirements that continue to impact patients during the COVID-19 pandemic.     

重症急性胰腺炎与肝损害关系的临床研究

目的探讨重症急性胰腺炎（SAP）与肝损害的关系及发生机制。方法回顾分析162例AP病例,对其中104例AP合并肝损害的病例进行分析。结果半数以上的AP患者发生肝损害。结论SAP与肝损害的发生存在关联,联系呈正相关。肝损害可作为独立指标预测AP严重程度,并可研判预后。     

精神科教学培训中“角色扮演”及“巴林特小组”的应用

精神科医师与患者的沟通内容多涉及患者隐秘的心理活动,应有较强的医学伦理学意识,而患者对于谈论自身心理活动又可能有所避讳,因此建立良好的医患关系极为重要,而对于精神科医师的培训更应注重提高建立良好医患关系的能力。“角色扮演”及“巴林特小组”是两种有效的教学方式。     

医患关系的关怀性及其对医学教育的启示

关怀与关怀行为是医学人道性的本质展现。医疗关怀行为的发生机制、医患关系的关怀特征以及非选择伦理关怀,启示医学教育应创建关怀性师生关系,培养关怀型教师并进行生命教育,以满足临床医学实践中患者对关怀的强烈需求。     

急诊科医护人员合作不良的影响因素调查

目的:调查急诊科医护人员合作不良的主要影响因素,并比较医生和护士对医护人员合作不良影响因素的认识程度差异。方法:采用自制问卷对长春市4所三级甲等医院急诊科医护人员进行调查。结果:医生对影响因素项目的确认评分在人员因素方面评分较高,而护士在沟通因素、社会因素评分较高。医生和护士对人员因素、态度与认知因素、沟通因素、社会因素及制度与管理因素的确认评分差异具有统计学意义(P<0.01)。结论:医生和护士认为医护合作不良影响因素主要表现在人员因素和社会因素。     

在传承中超越 努力探索新时期中医人才培养新模式

首都医科大学附属北京中医医院是一所临床优势突出的大型综合中医院,名医荟萃,专科特色突出,形成了北京中医医院的服务品牌。近年来在工作中院党委发现随着名老中医的故去,医院原有的一些特色优势有弱化的趋势。2007年医院党委确定了由党委书记为第一责任人,组织实施"新名中医培养战略工程"。采用"团队带团队"的方式,发挥第一、二、三批全国老中医药专家学术经验继承工作的滚动效应,集中医院内可以利用的中医药资源,通过多种形式的培养方法,利用三年的时间,在教学相长的过程中打造一批具有中医临床特长的中青年名医队伍。新的人才培养模式有力地促进了我院中医人才队伍建设。本项目同时获得北京市委组织部、北京市人事局的资助。     

广州市5757例手足口病肠道病毒与气候因素的相关性

目的探究气候因素对手足口病肠道病毒感染的影响。方法收集2009～2011年广州市的气候及某医院实验室诊断手足口病病例数据,应用单因素相关、多元线性回归检验气候因素与各肠道病毒报告例数之间的关联,并应用亚组分析探索影响的滞后作用。结果单因素分析结果表明周平均气温、湿度和露点与EV71、Cox A16和其他肠道病毒周报告例数存在正相关性,气压成负相关（P〈0.05）。控制其他气候因素后,湿度、气温分别与EV71、Cox A16和其他肠道病毒例数有显著性联系,且亚组分析证实与2～3周后的例数关联最强（P〈0.05）。结论气候因素,尤其湿度、气温可影响手足口病肠道病毒感染,在高热高湿度的季节,预防控制措施更可减少感染手足口病肠道病毒的危险性。