利用“师生共建科研团队”模式提高医学信息学学生的职业素养

探讨了师生共建科研团队的内涵、实施模式以及取得的成效,指出该模式是培养医学信息技术高素质创新人才的有效途径之一。     

Using Emergency Obstetric Drills in Maternity Units as a Performance Improvement Tool

ABSTRACT: Background: Obstetric drills are being used increasingly to test, improve, and maintain knowledge and skills related to obstetric emergencies as a means to improve proficiency and efficiency of practitioners. The purpose of this study was to assess the feasibility and usefulness of conducting drills to evaluate the response to obstetric emergencies using a holistic approach that tested the hospital system. Methods: A prospective trial was conducted at three hospitals (two tertiary referral centers and one small community hospital) in Beirut, Lebanon. Two different emergency obstetric drills at two points in time were conducted between April and May 2006 either in the emergency room or on the labor floor. The drills included medical and paramedical staff, a female actor (simulating a pregnant woman), a research assistant (acting as her companion), and a physician trained in obstetrics (the drill leader). Responses were recorded and critically analyzed. Results: Although overall quality of care was within standards of care, problems were identified related to hospital policies, supplies and equipment, communication, and clinical management. Some technical problems related to administration of the drills were identified. Most drill participants appreciated the exercise and found it beneficial. Conclusions: Obstetric drills provide a useful tool to identify and address deficiencies in the hospital system. This finding could have implications on improving quality of care provided to obstetric patients. (BIRTH 36:1 March 2009)     

以护士为核心的新型疼痛管理模式在临床应用研究

目的：探讨以护士为核心的新型疼痛管理模式,为术后患者疼痛的管理提供科学的经验。方法：选择2016年5月至2017年4月在我院行胸、腹微创手术的患者,共212名。随机分为干预组106例,对照组106例。对照组按常规方式进行术后疼痛管理;干预组由护士进行常规疼痛管理外,同时参与患者自控式镇痛(PCA)泵的管理。结果：各研究组中没有明显药物不良反应发生。干预组停泵率明显低于对照组。在胸部手术后行静脉镇痛的患者中干预组的镇痛效果优于对照组;其他治疗组间的镇痛效果比较虽无差异,但干预组的额外用药量却显著降低。研究证明通过以护士为核心,多学科协作的疼痛管理,使自控式镇痛泵得到了充分应用,额外镇痛药物的用药量明显减少。结论：以护士为核心的多学科协作管理模式在术后镇痛管理中具有很大的优势,起到了重要的作用。     

Clinician and manager perceptions of factors leading to ward patient clinical deterioration

Background

Improving the timely recognition and response to clinical deterioration is a critical challenge for clinicians, educators, administrators and researchers. Clinical deterioration leading to Rapid Response Team review is associated with poor patient outcomes. A range of factors associated with clinical deterioration and its outcomes have been identified, and may help with early identification of deteriorating patients. However, the relative importance of each factor on the development of clinical deterioration is unknown.

“大肠者传道之官”新识

在过去相当长的一段时期内,中医学界仅把大肠视为排泄器官。但大肠与神经传导、神经系统病变之间存在紧密联系,以"大肠主神志传导"补释"大肠者传道之官",而不使用"肠脑相通"新理论主要是因为以下2点:①中医学的发展要以经典为主线,凡是能够在原有理念下依附存在的学说,没有必要也不应该作为新的理论提出。②尚有很多周围神经病变的病位并不在中枢神经系统,无法用"肠脑相通"理论解释。"大肠主神志传导"一说旨在提出"神经系统病变从肠论治",更符合中医学整体、互联、恒动的观念。     

Development and Validation of the Primary Care Team Dynamics Survey

ObjectiveTo develop and validate a survey instrument designed to measure team dynamics in primary care.ConclusionsIt is possible to measure primary care team dynamics reliably using a 29-item survey. This survey may be used in ambulatory settings to study teamwork and explore the effect of efforts to improve team-based care. Future studies should demonstrate the importance of team dynamics for markers of team effectiveness (e.g., work satisfaction, care quality, clinical outcomes).     

A Multidisciplinary Approach to Treating Obesity in a Community Health Centre

Objectives

The aim of the study is to assess the weight loss programme with regards to the long-term effectiveness of weight reduction and weight maintenance, using completion rate and BMI, blood sugar, cholesterol and blood pressure levels as outcomes. The aim of the study also includes identifying the factors associated with adherence to the programme.

Methods

The programme was developed by a multidisciplinary team. It included 6 months of introduction and another 18 months of maintenance. The data for 397 participants was collected after 24 months.

Results

346 participants have completed the introduction and 123 have completed the programme. In the introduction, the average weight loss was 12% of the initial weight. The participants, who completed the full programme, lost 9.4% of their initial weight. The participants also significantly (p<0.05) reduced their blood sugar and cholesterol levels, as well as their blood pressure. The factors associated with adherence to the programme are: age over 50, lower educational levels, lower initial weight and higher weight loss in the introduction.

Conclusions

The multi-disciplinary approach to obesity treatment was effective for a selected group of people. The proportion of dropouts was relatively high, but still low compared to similar programmes. Group treatment and mutual support are of a great importance in bringing about and maintaining the changes.     

Nursing home staff perspectives on adoption of an innovation in goals of care communication

Nursing homes (NH) are important settings for end-of-life care, but limited implementation may impede goals of care discussions. The purpose of this study was to understand NH staff perceptions of adoption and sustainability of the Goals of Care video decision aid for families of residents with advanced dementia. Study design was a cross-sectional survey of staff at 11 NHs in North Carolina who participated in the Goals of Care (GOC) cluster randomized clinical trial. Staff perceived the GOC decision aid intervention as a positive innovation; it was perceived as more compatible with current practices by male staff, nurses, and more experienced NH staff. Perceptions were correlated with experience, implying that experience with an innovative approach may help to promote improved GOC communication in nursing homes. Nurses and social work staff could be effective champions for implementing a communication technique, like the GOC intervention.