“磁性医院”管理理念在聘用护士管理中的应用

目的：探讨“磁性医院”管理理念在聘用护士管理中的应用效果。方法自2014年3月至2015年3月,对某医院聘用护士实施“磁性医院”管理方法,措施包括：合理配置护理人力资源,分层使用护理人员;建立有效的激励机制,激励护士成长;重视护士专业发展,加快专科护士的培养;营造良好的工作环境,提高护士工作满意度。比较实施前后的护士工作满意度。结果实施“磁性医院”管理后,与同事的关系、被表扬和认可、与社会或专业交流的机会、工作的控制与决策权、排班制度、职业发展机会六项护士工作满意度指标及整体工作满意度平均得分均明显高于实施前,P＜0．01,差异有统计学意义。结论“磁性医院”管理模式能增强医院的凝聚力与吸引力,调动护士的积极性,提高工作满意度,降低离职率。     

Fidaxomicin versus oral vancomycin for severe Clostridium difficile infection: a retrospective cohort study

ObjectivesThis study was conducted to compare clinical outcomes of fidaxomicin versus oral vancomycin in the management of severe Clostridium difficile infection (CDI).MethodsThe investigation was a retrospective, multicentre, propensity score-matched analysis using a national clinical administrative database. Veterans treated for severe CDI from any Veterans Affairs Medical Center between 1 June 2011 and 30 June 2017 were included if they received fidaxomicin or an oral vancomycin regimen for treatment. The two groups were matched by the nearest-neighbour method from a propensity score derived from independent variables associated with the selection of a fidaxomicin course.ResultsPropensity score matching resulted in two well-matched cohorts consisting of 213 fidaxomicin and 639 oral vancomycin courses. No statistically-significant difference was found for the primary outcome of combined clinical failure or recurrence (68/213 (31.9%) versus 163/639 (25.5%), respectively, p 0.071). Additionally, no statistically significant differences were found for the secondary outcomes of 30-day (23/213 (10.8%) versus 75/639 (11.7%), respectively, p 0.71), 90-day (48/213 (22.5%) versus 140/639 (21.9%), respectively, p 0.85), and 180-day mortality (62/213 (29.1%) versus 186/639 (29.1%), respectively, p 1.0) between the two treatment groups.ConclusionsCourses of fidaxomicin or oral vancomycin for severe CDI resulted in similar treatment outcomes. Study findings are consistent with current treatment guideline recommendations for the use of either agent in the management of severe CDI.     

Combination therapy with ciprofloxacin and third-generation cephalosporin versus third-generation cephalosporin monotherapy in Escherichia coli meningitis in infants: a multicentre propensity score–matched observational study

ObjectivesEscherichia coli is the second cause of bacterial meningitis in neonates. Despite the use for 35 years of third-generation cephalosporins (3GCs), high morbidity and mortality rates with E. coli meningitis continue to occur. Because ciprofloxacin has good microbiologic activity against E. coli and good penetration in cerebrospinal fluid and brain, some authors have suggested adding ciprofloxacin to a 3GC regimen. The objective of this study was to assess combining 3GCs with ciprofloxacin versus 3GCs alone in a cohort of infants with E. coli meningitis.MethodsWe included all cases of E. coli meningitis diagnosed in infants <12 months of age that were prospectively collected through the French paediatric meningitis surveillance network between 2001 and 2016. The main outcome was the proportion of short-term neurologic complications with versus without ciprofloxacin. The analysis was conducted retrospectively by multivariable regression and propensity score (PS) analysis.ResultsAmong the 367 infants enrolled, 201 (54.8%) of 367 had ciprofloxacin and 3GC cotreatment and 166 (45.2%) of 367 only a 3GC. Median age and weight were 15 days (range, 1–318 days) and 3.42 kg (range, 0.66–9.4 kg). A total of 86 (23.4%) of 367 infants presented neurologic complications (seizures, strokes, empyema, abscesses, hydrocephalus, arachnoiditis); 57 received ciprofloxacin cotreatment. Complications were associated with ciprofloxacin cotreatment on multivariable analysis (odds ratio (OR) = 1.9; 95% confidence interval (CI), 1.1–3.4) and PS analysis (OR = 1.9; 95% CI, 1.1–3.3). Mortality rate did not differ with and without ciprofloxacin: 22 (10.9%) of 201 versus 16 (9.6%) of 166 deaths (OR = 0.7; 95% CI, 0.3–1.6; PS analysis).ConclusionsCiprofloxacin added to 3GCs at least offers no advantage for neurologic outcome and mortality in infants with E. coli meningitis.     

Fear and Anxiety: A Simultaneous Concept Analysis

TOPIC. A simultaneous concept analysis of fear and anxiety.
PURPOSE. To develop a process model that reflects distinct characteristics of fear and anxiety.
SOURCES. Existing biopsychology empirics and theory from peer review with and external to nursing literature.
CONCLUSIONS. Fear and anxiety are distinct diagnoses guided by separate brain mechanisms. The author offers a process model for further critique by peers and clinical populations.     

Evaluating the progress of deep learning for visual relational concepts

Convolutional neural networks have become the state-of-the-art method for image classification in the last 10 years. Despite the fact that they achieve superhuman classification accuracy on many popular datasets, they often perform much worse on more abstract image classification tasks. We will show that these difficult tasks are linked to relational concepts from cognitive psychology and that despite progress over the last few years, such relational reasoning tasks still remain difficult for current neural network architectures. We will review deep learning research that is linked to relational concept learning, even if it was not originally presented from this angle. Reviewing the current literature, we will argue that some form of attention will be an important component of future systems to solve relational tasks. In addition, we will point out the shortcomings of currently used datasets, and we will recommend steps to make future datasets more relevant for testing systems on relational reasoning.     

Health promotion at Swedish Child Health Centres

Effective health promotion intervention is understood to modify appropriate risk and protective factors. The relevance of such interventions for the Child Health Service (CHS) was examined in three steps. In the first step, the six most important public health problems in the target group that might be affected by CHS interventions were identified. The health problems include sudden infant death syndrome (SIDS), mental health problems, injuries, infections, asthma and allergic and nutritional disorders. In the second step, three groups of modifiable determinants were identified: risk and protective factors for (i) SIDS, asthma and allergic disorders and airway tract infections (determinants: breastfeeding, environmental tobacco smoke, sleeping non-prone and lacking indoor ventilation), (ii) injuries and (iii) mental health problems. In the third step, evidence for the preventive measure's ability to alleviate the effects of these risk factors was scrutinized. Evidence was found for effectiveness of CHS interventions aiming at decrease of environmental tobacco smoke. Evidence was also found for injury prevention provided that the intervention is a part of a wider community effort, and possibly also if it is very focused. Requirements for mental health promotion are also at hand.
Thus, effective health promotion via CHS interventions is feasible.     

妇女对产后访视服务的体验与需求

为了深入了解产后妇女对社区提供的产后访视服务的看法及对此项服务的需求 ,并由此提出改进现有产后访视服务的可能做法 ,在上海某中心城区的 2个街道深入访谈了 5 3名在 1998年 12月～ 1999年 7月期间接受过产后访视服务的妇女 ,并进行了 2组产后妇女的专题小组讨论。结果 :产后访视覆盖率达 10 0 % ,其中 9%的对象接受过 1次、32 %的对象接受过 2次、5 9%的对象接受过 3次产后访视。大多数产妇接受了产后访视常规中问诊、检查和宣教。在产妇所遇的问题中有关小儿护理的问题占第 1位 ,其次是产后妇女本人的情绪问题。产后妇女对与婴儿健康成长有关的服务内容需求最大 ,希望能从专业医护人员处获取可靠信息 ,有多种媒体的健康教育教材可供家庭选用 ,同时还呼吁在社区内有形式多样的面对面教育活动 ,如咨询、父母学校和母亲俱乐部等。研究结果提示产后访视服务现已有较满意的覆盖率 ,但其内容、形式和服务质量尚有待以服务对象需求为导向 ,在条件具备的情况下不断改善。     

坚持“以人为本”,建立医院管理的长效机制

通过医院管理年活动，从树立现代质量观念，提升医疗服务水平；强化基础管理，保障医疗安全；改善医院服务，构建和谐医院等方面进行了论述，并指出要树立以人为本的管理理念，构建和谐的工作氛围；优化就医流程和医疗环境，处理好医患矛盾，弘扬白求恩精神。     

Carrier testing in fragile X syndrome: Effect on self‐concept

The purpose of the study was to explore self‐concept in women at risk for inheriting the fragile X mutation. Time 1 measures were obtained prior to carrier testing and Time 2 measures were collected approximately 5 months after learning carrier status. The sample consisted of 42 women from 17 families. Measures included the Tennessee Self‐Concept Scale (TSCS), the fragile X Visual Analog Scale (VAS), and a structured interview. The TSCS provided a global measure of self‐concept and the fragile X VAS and structured interview provided a contextual measure of self related to carrier status. Results indicated that there were no differences initially between carriers and noncarriers and no change from Time 1 to Time 2 on the TSCS. Analysis of the Time 1 fragile X VAS means for the total sample found a reduction in positive feelings about self. Analysis of the Time 2 fragile X VAS found that noncarriers reported improvement in feelings about self, with no change in feelings about self found in the carriers. Responses from the structured interview indicated that the feelings regarding self in the context of genetic testing are not related to global self‐concept, but result from concerns regarding the implications of a positive carrier test for themselves and their families. This information highlights areas related to carrier testing that warrant further investigation and may ultimately result in modifications to the genetic counseling. Am. J. Med. Genet. 92:336–342, 2000. © 2000 Wiley‐Liss, Inc.     

转变护理服务理念的做法与体会

总结了近几年护理管理工作实施护理服务理念转变的做法:(1)医院要我做什么的传统服务理念转变为病人需要我做什么的服务理念。(2)单纯依赖制度管理的传统管理模式转变为以人为本的现代管理模式。(3)单纯完成操作的传统工作模式转变为人性化工作模式。实践证明实施护理服务理念转变推动了护理队伍的建设、发展和护理质量的提高。