从医疗质量安全到患者安全：医疗风险治理的观念更新与政策优化

在现代医疗风险治理中,患者安全的理念和相关制度逐渐引起重视。与医疗质量安全相比,患者安全更强调权利导向、伦理照护、社会协同,有其独特价值。目前,我国患者安全相关制度发展迅速,但仍存在专门政策法规缺少、有效伦理制约机制不足、医患沟通机制不完善等问题。应当进一步树立患者安全观念,通过完善患者安全相关政策法规、构建不良事件报告制度、设立医师道歉制度、设立患者安全组织和数据库等措施,优化医疗风险治理政策,实现医患共赢。     

Variations in the evaluation of colorectal cancer risk

OBJECTIVES: To test the variability in estimating cancer risk and demonstrate the consequences that subjectivity has on patient care. SUBJECTS AND METHODS: Forty-three clinicians were each asked to assess 40 symptomatic colorectal referrals. Each clinician was provided with a comprehensive history on the 40 patients. The clinicians graded the referral according to a malignancy risk score, decided on the required first line investigation and the priority of that investigation. The main outcome measures used was accuracy in cancer detection and appropriateness of investigations selected. RESULTS: There was a wide degree of variation among all clinicians grading both benign and malignant disease with the overall correct classification of 54% (P-value of <0.001). On average, the clinicians correctly diagnosed 71.3% of the cancer patients as compared to 44% of the benign patients. Of the cancer patients, 47% were correctly classified as an urgent referral whilst 52% of the benign patients were over classified and graded as an urgent referral. The mean number chosen by clinicians to have a flexible sigmoidoscopy as the appropriate first investigation was 13 (of 40 patients); this was despite the diagnosis being possible in all cases with a flexible sigmoidoscopy. The choice to use full colonic investigation was seen throughout all disciplines. Junior doctors demonstrated the highest tendency choosing full colonic investigation in 92.3%. Consultants and senior grades showed the least tendency to choose full colonic imaging although even here colonoscopy or barium enema represented 48.5%. CONCLUSION: Subjective assessment of cancer referrals is a significant problem that needs to be confronted. Improvements are needed to resolve the inherent problems of subjectivity and operator bias if uniform quality of patient care and best use of resources is to be achieved.     

照顾者参与的谵妄评估工具研究进展

照顾者参与谵妄评估是谵妄评估与管理的重要环节,有助于早期识别谵妄,制定针对性干预措施,以预防或减少患者谵妄并改善预后。照顾者参与的谵妄评估工具包括单条目与多条目谵妄评估工具,分别汇总、分析和比较两类工具的内容、特性、测量学性能和应用,以期为照顾者参与患者谵妄评估工具的完善、本土化及临床实践提供参考。     

幼年特发性关节炎患儿报告结局评估工具研究进展

对国内外开发的幼年特发性关节炎患儿报告结局评估工具进行综述,概述幼年特发性关节炎患儿普适性和特异性自我报告结局评估工具的主要内容、应用范围、应用效果及局限性,旨在为我国幼年特发性关节炎患儿报告结局评估工具开发、患儿症状管理、精准评估以及临床决策的实施提供参考。     

An evaluation of osteoporosis screening tools for the osteoporotic fractures in men (MrOS) study

SUMMARY: No large-scale evaluations of osteoporosis screening tools have been done in men. OST and MOST were examined among 4658 US Caucasian and 1914 Hong Kong Chinese men. Both tools have high negative predictive values, accurately screening out men with low risk, and saving a third of DXA tests. INTRODUCTION: Prior investigations have studied the performance of osteoporosis screening tools in women, but no large-scale evaluations have been done in men. METHODS: This study examines the performance of the Osteoporosis Self-assessment Tool (OST), the Male Osteoporosis Screening Tool (MOST), quantitative ultrasound index (QUI), and body weight as screening tools. Osteoporosis was defined by a dual-energy X-ray absorptiometry (DXA) measured bone mineral density (BMD) T-score < or =-2.5. Four thousand six hundred and fifty-eight US Caucasian and 1914 Hong Kong Chinese men, aged > or =65 years and community-dwelling, were included in the analysis. Receiver operating characteristic (ROC) analysis was used to compare the area under the ROC curve (AUC) between different screening tools. RESULTS: MOST had a significantly larger AUC (> or =0.8) than OST, QUI, and body weight in detecting osteoporosis. Using the second tertile as cutoff, OST and MOST yielded sensitivities of around 90% and negative predictive values (NPVs) of >97%, accurately screening out Caucasian and Chinese men with low risk of osteoporosis. CONCLUSIONS: OST and MOST can effectively rule out osteoporosis for both Caucasian and Chinese men, and compared to referring men 65 years and older for BMD DXA testing, they save a third of DXA resources.     

口腔潜在恶性疾病相关生存质量评估工具的研究进展

口腔潜在恶性疾病作为有癌变风险的一类疾病,不仅会损害身体功能,而且会严重影响患者的心理、家庭、社交等。作为新医学模式发展的产物,口腔健康相关生存质量评估得到了越来越多的关注与应用,但是纵观国内外研究,很少将口腔健康相关生存质量评价体系应用于口腔潜在恶性疾病的诊疗过程。本文就口腔潜在恶性疾病的分类及流行现状、生存质量的定义及评估重要性、口腔潜在恶性疾病相关生存质量评估工具以及OHRQoL在口腔潜在恶性疾病中的应用等方面内容进行综述,以探讨口腔潜在恶性疾病相关生存质量的发展方向。     

我国中央层面家庭医生签约服务政策量化评价：基于PMC指数模型

背景 我国人口老龄化形势日益严重,家庭医生签约服务对助推分级诊疗制度建设、建立合理有序就医秩序发挥着重要作用,目前学者对家庭医生签约服务政策的研究主要集中于定性评价,较少有学者利用工具聚焦代表性政策对各篇进行定量评价。目的 定量评价我国中央层面的6篇家庭医生签约服务相关政策,分析政策优劣,在此基础上,提出促进我国家庭医生签约服务高质量发展的对策和措施,助力健康中国战略实施。方法 于2022-04-30,以“家庭医生”为关键词在北大法宝数据库进行全文检索,并在国务院网站进行相关内容检索,检索时限为2015-01-01至今。采用ROSTCM 6.0软件进行文本挖掘,然后以其结果为依据选择其中具有代表性的中央层面家庭医生签约服务相关政策,并基于政策一致性评价（PMC）指数模型对其进行量化评价。结果 依据纳入与排除标准检索获得相关政策32篇,家庭医生签约服务领域排名前5位的高频关键词为“签约服务”（274次）、“健康”（272次）、“医疗”（264次）、“家庭医生”（225次）、“签约”（180次）,以其为依据共选择中央层面有代表性的家庭医生签约服务相关政策6篇,分别标记为P1～P6。政策量化...     

The outcome measures for loss of functionality in the activities of daily living of adults after stroke: a systematic review

Objective: To provide clinicians and researchers information regarding (1) the existing outcome measures to assess the loss of functionality in the activities of daily living (ADLs) of patients with stroke and (2) the presence of these assessment tools in the Italian context.

Study Design and Setting: For this Systematic Review Medline, CINAHL, and PsycINFO were searched for articles published up to 4 July 2017. Two authors independently identified eligible studies on the basis of prede?ned inclusion criteria and extracted data. Study quality and risk of bias were assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results: Of 370 publications identified and screened, 46 studies fell within the inclusion criteria and were critically reviewed. The most commonly used tools were: the Frenchay Activities Index and the Functional Independence Measure.

Conclusion: This review has emphasized the need for agreement among researchers as to which tool must be studied in depth or adapted to other national contexts in order to develop universal norms and standards.     

Comparison of a Web-Based Dietary Assessment Tool with Software for the Evaluation of Dietary Records

Background

Dietary assessment in clinical practice is performed by means of computer support, either in the form of a web-based tool or software. The aim of the paper is to present the results of the comparison of a Slovenian web-based tool with German software for the evaluation of four-day weighted paper-and-pencil-based dietary records (paper-DRs) in pregnant women.

Methods

A volunteer group of pregnant women (n=63) completed paper-DRs. These records were entered by an experienced research dietitian into a web-based application (Open Platform for Clinical Nutrition, OPEN, http://opkp.si/en, Ljubljana, Slovenia) and software application (Prodi 5.7 Expert plus, Nutri-Science, Stuttgart, Germany, 2011). The results for calculated energy intake, as well as 45 macro- and micronutrient intakes, were statistically compared by using the non-parametric Spearman’s rank correlation coefficient. The cut-off for Spearman’s rho was set at >0.600.

Results

12 nutritional parameters (energy, carbohydrates, fat, protein, water, potassium, calcium, phosphorus, dietary fiber, vitamin C, folic acid, and stearic acid) were in high correlation (>0.800), 18 in moderate (0.600–0.799), 11 in weak correlation (0.400–0.599), while 5 (arachidonic acid, niacin, alpha-linolenic acid, fluoride, total sugars) did not show any statistical correlation.

Conclusion

Comparison of the results of the evaluation of dietary records using a web-based dietary assessment tool with those using software shows that there is a high correlation for energy and macronutrient content.     

Essential Medicines: An Indian Perspective

The concept of defining essential medicines and establishing a list of them was aimed to improve the availability of affordable medicines for the world''s poor. Access to essential medicines is a major determinant of health outcomes. Several countries have made substantial progress towards increasing access to essential medicines, but access to essential medicines in developing countries like India is not adequate. In this review we have tried to present the Indian scenario in respect to availability and accessibility of essential medicines over last one decade. To enhance the credibility of Indian healthcare system, procurement and delivery systems of essential medicines have to be strengthened through government commitment, careful selection, adequate public sector financing, efficient distribution systems, control on taxes and duties, and inculcating a culture of rational use of medicines in current and future prescribers.