三级综合医院护士在社区护理中的角色与作用

笔者分析了三级综合医院开展社区护理的必要性和可行性；阐述了三级综合医院护士在开展社区护理中承担的教育者和咨询者、服务者、协调者和合作者、观察和研究者多种角色；并提出三级综合医院护士在开展社区护理中所发挥的作用，包括：(1)向社区提供经验丰富的专科护士，提高社区护理质量；(2)为社区护士的培养提供师资队伍和培训基地；(3)开设日间病房，为病人提供方便的治疗及护理；(4)建立双向转诊的社区卫生服务网络，为社区提供持续的优质服务；(5)开展社区护理研究。     

医学微生物学"项目-导师制"实验教学改革初探

目的:探讨"项目-导师制"实验教学改革效果及其在医学微生物学实验教学中应用价值.方法:采用"项目-导师制"法对2001级学生进行医学微生物学实验教学,以无记名问卷调查和专家评议方式了解实验教学效果,以现场操作了解学生实验技能,以相对标准化试卷综合测试学生成绩,并与2000级学生医学微生物学实验教学效果、实验技能、考试成绩进行回顾性和对比分析.结果:2001级和2000级学生实验教学效果不满意、满意、很满意率分别为0%(0/180)、25.00%(45/180)、75.00%(135/180)和55.38%(72/130)、34.62%(45/130)、10.00%(13/130),差异有显著性(P＜0.01).实验技能考核及格、良好、优秀率分别为0%(0/180)、22.22%(40/180)、77.78%(140/180)和56.92%(74/130)、35.38%(46/130)、7.69%(10/130),差异有显著性(P＜0.01).综合考试成绩不及格、及格、良好、优秀率分别为0%(0/180)、17.78%(32/180)、47.22%(85/180)、35.00%(63/180)和154%(2/130)、38.46%(50/130)、52.31%(68/130)、7.69%(10/130),差异有显著性(P＜0.01).结论:"项目-导师制"实验教学是一种新型实验教学模式,可显著增强实验教学效果,帮助学生快速掌握实验技能,提高学生综合考试成绩,克服传统实验教学存在的一些弊端,具有应用推广价值.     

社区高血压病患者的群体干预效果

目的根据"以病人为中心、以家庭为单位、以社区为范围"的全科理念对高血压病患者进行群体干预,以达到更为理想的治疗效果。方法将社区中303名高血压病患者作为一个群体统一管理。结果群体干预效果明显优于针对某一患者治疗的专科模式,有显著性差异(P0.01)。结论高血压病患者群体干预效果显著,在慢性病管理中,全科模式有明显优越性,值得提倡。     

To market! To market! A new dawn for community care?

The public sector in Britain has been subjected to over a decade of major reform aimed at breaking up public service monopolies, at containing costs while at the same time opening services up to greater consumer choice. Health and social services have not been exempt from this revolution in the organization and management of public sector services. The long-standing policy of care in the community is being subjected to market principles and the introduction of a ‘contract culture’ very similar to the NHS reforms introduced in 1991. This paper reviews the origins of these developments in the doctrines of ‘new public management’, a movement which has proved attractive to policy-makers in many countries. Local authority social services departments have been identified as the lead agency for the development of a mixed economy of care following a review of community care policy by the government's health adviser, Sir Roy Griffiths, and a subsequent white paper. This paper examines the limited empirical evidence available on how managers and providers are meeting the challenge bestowed upon them, and concludes that most authorities are moving ahead cautiously if at all. Only a handful of authorities studied have embraced the reforms with any degree of enthusiasm. The paper concludes with an assessment of the reforms from two perspectives: a pessimistic one and an optimistic one. There are many worrying features of the reforms, not least among these being a lack of clarity over their intended purpose. Tensions and contradictions are plentiful, which places in jeopardy the certainty of the reforms in becoming user led rather than provider driven. A more optimistic scenario is that the changes are leading to a loosening up of services and practices which have often suffered from sclerotic tendencies, paternalism and sometimes complacency. If the reform process is skilfully handled and not rushed and if the ends are clearly established and communicated then users and carers could prove to be the principal beneficiaries.     

Determinants of decision-making in the screening procedure of a community psychiatric service

This study is a predictor analysis of the screening procedure followed by a psychiatric service for a period of 1 year preceding and a period of 1 year following the introduction of community psychiatry. Throughout this period, the psychiatric service consisted of a local service within the catchment area and a central service at a psychiatric hospital outside the area. At the time of the reorganization, the responsibility for the psychiatric service was transferred from the public health authorities to the social services. Before the reorganization, screenings were conducted on the basis of referral papers or simply as a result of telephone communication. After the reorganization, the screening procedure was intensified by means of a pre-examination. One aim of the reorganization was to ensure that the severely mentally ill take priority over patients characterized predominantly by social strain. Patients with manic-depressive psychosis and other psychoses showed a significantly increased probability of being accepted for treatment, whereas those with schizophrenia showed no significant increase, irrespective of the service reorganization. Similarly, manic-depressive psychosis and other psychoses (not schizophrenia) were significant predictors of hospitalization at the mental hospital outside the catchment area as well as hospitalization in the local facilities, irrespective of the service reorganization. Indicators of social strain were not given higher priority following the service reorganization.     

芜湖市社区高血压病人现况调查

目的　了解高血压病人的基本情况 ,为寻找社区人群高血压的防治对策提供依据。方法　应用单纯随机抽样调查某街道 5 0 1名≥ 30岁居民中的高血压病人 ,用SPSS统计软件进行分析。结果　高血压患者的知晓率为 80 .0 %,服药率为 6 8.7%,采取非药物治疗的 6 3.5 %,使血压能控制在正常范围的占 18.0 %。结论　知晓率、服药率、控制率比 1991年全国抽样调查的结果有明显提高 ,在社区广泛开展健康教育和健康促进 ,对社区高血压患者实施防治结合是很有必要的。     

Methods of Measuring Community Characteristics

There is increasing interest in the influence of community characteristics on child development and family functioning. In order to address questions on community influence, it is important to be aware of the measures available and their strengths and limitations. Useful strategies have been developed within a number of disciplines, including sociology, social and community psychology, and criminology. Methods include summarising information from existing administrative databases and census data, conducting observations, and using survey instruments with residents. The most commonly used methods are reviewed and their psychometric properties described .     

Education in family and community health: the challenge faced by a new medical school

This paper describes the efforts of the Department of Family and Community Health at Sultan Qaboos University in providing opportunities for the development of 'hands-on' problem-solving skills appropriate for Oman. The curriculum of the Department is discussed, highlighting the unusual emphasis of this discipline in both the preclinical and clinical curriculum of the College of Medicine. The importance of continuous assessment and supervision of students is discussed. Course-work in the preclinical curriculum of the Department is kept to a minimum. Field-work forms an important part of preclinical training, where application and problem-based learning are emphasized. During the clinical years the students are exposed to an integrated series of lectures and practicals covering core knowledge in clinical medicine. Practical clinical training, over a total period of 15 weeks, takes place at a variety of sites where common problems in primary health care in Oman are handled by students under supervision.