高职高专医学院校学分制教学管理改革初探

高职高专医学院校如何实行学分制教学管理已成为高职医学教育的热点问题。本文以高校教学管理基本内容为出发点,分析高职高专医学院校推行学分制改革过程中教学管理存在的问题,从而探索学分制背景下教学管理改革的有效对策。     

Trainee Teachers' Perceptions of the Effectiveness of the Literacy Hour in Primary Schools in England

This article presents the findings of a small scale survey comparing trainee teachers' perceptions of the effectiveness of the Literacy Hour during its first two years operation with the OFSTED evaluation of the first year of implementation published in 1999. Trainees were asked to identify, from their perspective, the strengths and weaknesses of the National Literacy Strategy, as well as indicate what their future concerns for the teaching of literacy were. As the Strategy is intended to raise standards of literacy in the future, the perceptions of these teachers at the start of their careers will be of significance, as it is in their hands that its destiny lies.     

Engagement in a cohesive group and higher-level functional capacity in older adults in Japan: a case of the Mujin

The Mujin is a traditional Japanese rotating saving and credit association (RoSCA) that provided financial aid for the lower-middle class in Japan until the postwar reconstruction period. The traditional Mujin has disappeared from most regions, and the surviving Mujin provides more of a social networking than a financial function for its members. We investigated the association between level of participation in the Mujin and the capacity for independent living in older adults. Baseline data of an ongoing cohort study of 581 self-sufficient older adults were analyzed. The Tokyo Metropolitan Institute of Gerontology Index of Competence was used to measure higher-level functional capacity, and the level of engagement in the Mujin was determined by a score derived by factor analysis. We found that a higher level of engagement in the Mujin was associated with greater functional capacity, especially social role performance, the highest-level function. We conclude that the Mujin provides a venue for community interaction that serves to increase the social capital of the community and may have psychosocial benefits for its members due to strong membership ties and mutual trust. Further investigation of the causal relationship between participation in the Mujin and functional capacity, and the psychosocial effects of similar financial mutual-aid systems in other social contexts is warranted.     

设定护士长接待时段 减少护患纠纷

通过开设护士长接待时段,与病人进行面对面的沟通,并对护士长接待时段中存在的问题进行分析,找出诱发护患矛盾的因素,针对存在的问题提出对策,以提高护理服务的质量,认为护士长接待时段为护患沟通开辟了一条新途径。     

How does the length of day shift affect patient care on older people's wards? A mixed method study

BackgroundInternationally, studies have focused on whether shift length impacts on patient care. There are also ongoing concerns about patient care for older people in hospital. The study aim was to investigate how length of day shift affects patient care in older people’s hospital wards.Objectives1) To explore how length of day shift affects patient care in older people’s wards; 2) To explore how length of day shift affects the quality of communication between nursing staff and patients/families on older people’s wardsDesignA mixed method case study.SettingsThe study was based on two older people’s wards in an acute hospital in England. One ward was piloting two, overlapping 8 h day shifts for 6 months while the other ward continued with 12 h day shifts.Participants and methodsQualitative interviews were conducted with 22 purposively recruited nursing staff (17 registered nurses; 5 nursing assistants). An analysis of patient discharge survey data was conducted (n = 279). Twenty hours of observation of nursing staff’s interactions with patients and families was conducted, using an adapted version of the Quality of Interaction Schedule (301 interactions observed), with open fieldnotes recorded, to contextualise the observations.ResultsThere were no statistically significant differences in patient survey results, or quality of interactions, between the two wards. There were three overall themes: Effects of day shift length on patient care; Effects of day shift length on continuity of care and relationships; Effects of day shift length on communication with patients and families. Nursing staff believed that tiredness could affect care and communication but had varied views about which shift pattern was most tiring. They considered continuity of care was important, especially for older people, but had mixed views about which shift pattern best promoted care continuity. The difficulties in staffing a ward with an 8 h day shift pattern, in a hospital that had a 12 h day shift pattern were highlighted. Other factors that could affect patient care were noted including: ward leadership, ward acuity, use of temporary staff and their characteristics, number of consecutive shifts, skillmix and staff experience.ConclusionsThere was no conclusive evidence that length of day shift affected patient care or nursing staff communication with patients and families. Nursing staff held varied views about the effects of day shift length on patient care. There were many other factors identified that could affect patient care in older people’s wards.     

The meaning of public health nursing: creating 24 hour care in a community in Japan

Abstract This case study describes the strategies and activities of public health nurses to increase the availability of services in a municipality of 36 000 and to transform community attitudes so that those needing services would feel free to use them. Strategies and activities are seen in the context of Japan, Minakuchi Town and the leadership of the chief public health nurse. Practicing in partnership with members of the community, strategies of public health nurses include technical activities (conducting needs assessment and framing program alternatives) and information sharing and health education (e.g. 75 meetings organized with health promoters for residents in the districts of the town). On the basis of the results of Minakuchi Town, viewed as an example of expert public health nursing practice, a general model for public health nursing practice is presented.     

老年冠心病患者无症状心肌缺血阈的动态心电图分析

目的探讨24小时动态心电图对老年冠心病无症状心肌缺血阈值的临床意义。方法对78例老年冠心病患者进行24小时动态心电图检测，以观察心肌缺血阈值（MIT）、MIT的变异（IV）：以及每阵缺血发作持续时间（TMI）和ST段最大位移以及昼夜缺血阵数（IN）。结果共检出582阵心肌缺血，92．1％在ST段压低时心率加快，夜间心肌缺血阈值较低，但缺血时间及ST段压低程度明显重于昼间。结论高心肌缺血阈与心肌耗氧增加有关；低心肌缺血阈与冠状动脉张力有关。     

以服务为导向构建医师征信平台的思考

借助信息化的手段,以医师定期考核为契机,以服务为导向构建医师征信平台,借助政府主管部门、监管机构、办医主体、医疗机构以及社会监督的力量,切实做好医师队伍的管理。     

Remaking surgical socialization: Work hour restrictions, rites of passage, and occupational identity

We examine how a policy aimed at improving patient safety by limiting residents’ work hours brought with it an unintended and unexamined consequence: altered socialization due to modified rites of passage during residency that endangered the stereotypical “Surgical Personality” and created a potential rift between the occupational identities of surgical residents who train under duty hour regulations and those who trained before they were imposed. Through participant observation occurring between June 2008 and June 2010, in-depth interviews (n = 13), and focus groups (n = 2), we explore how surgical residents training in four U.S. hospitals think about the threats that the shift from unrestricted to restricted duty hours creates for their claims of competence and professionalism. We identify three types of resident responses: (1) neutralizing statements that deny any significant change to occupational identity has occurred; (2) embracing statements that express the belief that a changed and more balanced occupational identity is needed; and (3) apprehensive statements that expressed fear of an altered occupational identity and an anxiety about readiness for individual practice.     

Developing Strategies for On-Call Staffing: A Working Guideline for Safe Practices

Effective on-call clinical staffing is critical to providing perioperative services to patients requiring emergency surgical care. Without careful monitoring of continuous work hours and hours worked per week, staffing practices can adversely affect the ability of personnel to function and provide care. Managers and perioperative personnel must carefully evaluate their on-call schedule to ensure the provision of safe medical care for their patients. Perioperative leaders at two hospitals partnered to create a safety guideline for on-call staffing practices, which includes zone guides for determining workload intensity. This guideline has served to help managers evaluate the general safety of their staffing plan and identify on-call practices that may need improvement or support in their areas of responsibility. Key recommendations from the guideline can help perioperative managers at other facilities establish clinical staffing plans and on-call practices that are safe and effective.