基于医院信息系统的设备使用数据查询程序的设计

目的:医疗设备效益分析是基于医疗设备的使用数据,传统的数据收集方法费时、费力,且数据不完全准确。通过设计数据查询程序,以方便准确的获得医疗设备使用数据。方法:医院信息管理系统(HIS)对医疗设备的计价收费有着详细的记录,可以通过调用设备计价情况来获取设备使用数据。在HIS数据库的基础上,通过设计有针对性的数据查询程序,可轻松实现设备使用数据的查询。结果:该程序查询得到的数据通过EXCEL导出并加以整理即可获得设备的使用数据。结论:该程序的编写,极大减少了医疗设备使用数据统计所需的人力、物力,提高了数据的准确性,可做到对任意时间段的数据进行实时查询。     

A critical examination of the role of appreciative inquiry within an interprofessional education initiative

Appreciative inquiry (AI) is a relatively new approach to initiating or managing organizational change that is associated with the ‘positiveness’ movement in psychology and its offshoot positive organizational scholarship. Rather than dwelling upon problems related to change, AI encourages individuals to adopt a positive, constructive approach to managing change. In recent years, AI has been used to initiate change across a broad range of public and private sector organizations. In this article, we report findings from a subset of 50 interviews gathered in a wider study of interprofessional education (IPE) in which AI was employed as a change agent for implementing IPE in a number of health care institutions in a North American setting. A multiple case study approach. (Yin, 2002) was employed in the wider study and semi-structured interviews were undertaken with participants both before their IPE programs and directly afterwards to obtain a detailed understanding of their expectations and experiences of IPE. Interviews were analyzed in an inductive thematic manner in order to produce key emergent themes from each of the IPE programs. A process of re-analysis provided a set of themes which offered an understanding of the role of AI within this IPE initiative. Our findings identify a strong resonance and fit for AI both among the health and social care professionals who participated in this initiative. Numerous individuals commented on the enthusiasm and energy AI engendered, while praising its ability to enhance their working lives and interprofessional relationships. Yet a number of difficulties were also reported. These focused on problems with the translation of the AI process into achievable structural level (e.g. professional, cultural) changes. Based on these findings, the article goes on to argue that the use of AI can overlook a number of structural factors, which will ultimately limit its ability to actually secure meaningful and lasting change within health care.     

Physiotherapists' stories about professional development

Abstract

Introduction: A professional career may extend over a period of 40 years. Although learning is a feature of professional competence, little is known about learning and development after professional entry education. Methods: Narrative inquiry was used to understand how physiotherapists learned and developed over time, and stories from a purposeful sample of 12 physiotherapists were collected. Stories were thematically analyzed with regard to key elements related to learning and development, and common themes were identified across stories. Findings: Four themes emerged from the analysis where physiotherapists learned and developed in working life: (1) facing challenges; (2) contrasting perspectives; (3) drawing on hundreds of educators; and (4) building on personal experience. Conclusion: Non-formal ways of learning in working life may help physiotherapists learn and develop confidence, communication strategies and different approaches to treatment. Besides reflection on personal experience and patient encounters, learning and development may be promoted and supported by taking on challenges and changing settings.     

Weaving a fabric of moral meaning: how nurses live with suffering and death

Nursing has a long and rich history of caring for those who are sick and suffering, as well as for those who are dying. The threat of death, and/or the reality of suffering till death, for patients, is a reality in the lives of nurses. The purpose of this study was to examine how nurses live with patients who are suffering and dying. Founded on notions of relationship and embodiment, naturalistic inquiry was used to generate and analyse qualitative data from nine nurses who, at the time of the study, were working with patients whom they described as suffering or dying. Findings reflected how the nurses used the dilemmas of their patients' lives to inform their own personal and professional lives through a process of 'weaving a fabric of moral meaning'. Findings are discussed in terms of practice, research and education.     

通过问诊运用方证对应“快捷键”——祝肈刚谈更年期综合征治疗心得

"快捷键"的本质其实就是方证对应。其背后有很深厚的中医辨证理论、以及大量的临床实践观察在此基础上提炼方药的使用规律、对应的临床症状,才能以简驭繁,快速把握临床用药思路,并保证疗效的稳定。文章通过还原祝肇刚在问诊中,运用"快捷键"进行更年期综合征方证对应的过程,整理其更年期综合征辨治经验,以期指导临床实践。     

Improper use of child restraint seats as a sleeping environment: Two cases of childhood death

A child restraint seat (CRS) is designed to keep infants safe inside motor vehicles while in motion. However, there have been a growing number of reports of injuries sustained as a result of CRS use outside the vehicle. These injuries commonly result from a fall from an elevated surface or an overturning of the CRS. The incidence of death from these events, however, is not well documented. The present report retrospectively analyzed the British Columbia Coroner Service Database to identify deaths involving CRS use outside the vehicle. Two such fatalities were identified. In both instances, infants had been placed in a CRS overnight and, in both cases, the CRS was found overturned, resulting in asphyxiation. The history and pathological findings of both cases are summarized.     

基于隐结构模型分析的心血管疾病中医问诊证候分类研究

目的探讨心血管疾病的中医问诊证候分类特征,为中医证候诊断标准的建立提供客观依据。方法利用中医心系问诊采集量表,采集大样本心血管疾病临床病例,根据问诊信息的＂有、无＂分别赋值＂1、0＂,建立问诊数据库;基于隐结构分析,找出规律,建立隐结构模型;人机结合,对部分隐变量进行综合聚类分析和类的细分;基于模型结果,分析心血管疾病的临床中医问诊证候分类特征。结果心血管疾病中医问诊证候以心气虚、心阳虚、气阴两虚、痰湿、血瘀、气滞、心火亢盛、津液亏虚为主,并兼见胃气上逆、肾气不固、脾胃虚寒等证,其出现率依次为46%、23%、34%、18%、19%、39%、14%、1.7%、19%、27%、25%,并提示了这些证候与关系密切的各问诊症状之间的相关性（包括出现的概率和互信息）。结论隐结构分析方法能为中医证候的分类提供定性定量依据,并提示综合聚类分析和类的细分方法的应用能进一步明确隐变量与变量之间的定量关系,从而为临床中医证候标准的建立提供依据。     

Evaluating motivational deficits in individuals with mental illness: the Chinese General Causality Orientations Scale

The study examined the adequacy of the Chinese version of the General Causality Orientations Scale in measuring motivational deficits among clients with mental illness. The scale was part of a motivational frame of reference designed to evaluate and resolve motivational deficits. The study was carried out in Taiwan, and data were collected at multiple psychiatric facilities. Based on a sample of 353 participants, the translated version was found to be internally consistent and valid. To make the scale more suitable for clinical use, a mixed category was added to the three previously suggested typological categories. It is concluded that the scale can be used in this patient population. Further research is needed to investigate temporal stability and other validity traits of the scale. Copyright © 2000 Whurr Publishers Ltd.     

采用询检法确定血吸虫病化疗对象的研究

目的为提高血吸虫病高度流行区人群化疗依从性 ,比较询检法化疗与全民化疗控制血吸虫病的效果、费用。方法选择湖沼垸外型的三浃、芦洲两个高度流行村 ,分别采用询检法化疗和全民化疗 ,纵向比较两种化疗方法的效果及费用等。结果通过两年实施 ,询检法化疗人群覆盖率及受治率均明显高于全民化疗 (P<0 .0 0 1 ) ,控制血吸虫病效果两方法差异无显著性 (P>0 .0 5 )。询检法每 1 0 0人化疗费用较全民化疗费用低 4.2 0元。结论询检法化疗控制血吸虫病的效果与全民化疗差异无显著性 ,但具有人群覆盖率高、费用低等特点 ,优于全民化疗