全科医疗质量评价指标体系的研究

本研究采用改进的Delphi法，经过两轮专家咨询，建立一套合理的全科医疗质量评价指标体系。两轮咨询专家的权威程度较高，其平均值分别为0．7634，0．7378。专家意见的协调系数分别为：0．122，0．231。最终确定全科医疗评价指标体系共有指标146项，其中一级指标4项，二级指标30项，三级指标112项。其中服务内容、服务满意度、效果效益、卫生经济4项一级指标的权重系数分别为0．2416、0．2646、0．2453、0．2485。     

The Hampshire Depression Project: development and piloting of clinical practice guidelines and education about depression in primary health care

This paper describes the development and piloting of a comprehensive educational programme about recognition and management of depressive illness in primary care. Full evaluation of the effectiveness of the programme is currently underway in a randomized controlled trial, the Hampshire Depression Project (HDP), involving 56 general practices. The programme consists of clinical practice guidelines, practice-based seminars and follow-up sessions. Each part of the programme has been designed to be flexible, clinically oriented and relevant to all members of the multidisciplinary primary care team. The pilot study established the need for a systematic approach to the access of practices and practice teams, and the organization and process of the seminars. Application of this approach was associated with excellent attendance in the main programme.     

Introducing expert systems to medical students using esta, Expert System Teaching Aid

Medical students are allocated little curriculum time for exposure to expert systems. ESTA, a computer model of an expert system, was developed to make best use of this time. The nature of the students' interaction with ESTA is described, and their reactions to the expert system concepts and the place of expert systems in medicine are presented. A discussion of these reactions draws some conclusions about teaching expert systems in particular, and computers in general, in the basic medical course.     

Empowering practice nurses in the follow-up of patients with established heart disease: lessons from patients' experiences

This paper reports on the views of patients with established heart disease of a structured programme of follow-up care provided by practice nurses (PNs) in general practice in England. It is based on in-depth interviews with 22 patients receiving an integrated primary and secondary care intervention being developed and piloted for patients following heart attack or diagnosis of angina. Patients identified the important features of follow-up care to be easy access to a health professional who possessed knowledge and social and emotional skills. A range of views about the ability of PNs to provide such care emerged from patients' accounts. patients' perceptions about the seriousness of their condition and the way PN follow-up care was provided in practices emerged as important issues affecting patients' views. In addition, perceptions about the practice nurse's role, status and knowledge, existing relationships with general practitioners, and issues of communication were also important factors. It is concluded that in order to develop high-quality PN-led services for patients with established heart disease, four issues need to be taken into account: practice nurse training; continuity of follow-up care; the integration of the primary and secondary care interface; and development of the practice nurse's status within the primary health care team.     

Treatment approaches for clients with a stroke‐affected upper limb: Are we following evidence‐based practice?

Stroke rehabilitation is an area of practice that many occupational therapists encounter during their career. The literature promotes a wide range of management techniques and support devices for people who have a stroke-affected upper limb, but little is known about the validity of those that occupational therapists actually use in practice. A questionnaire was sent to occupational therapists working in Queensland and northern New South Wales facilities (n = 35), in which adults with a stroke were likely to be treated. Eighteen respondents answered questions about the management techniques and support devices used in their facility, and their perception of the benefit of these devices in the reduction of hemiplegic shoulder pain. Results are discussed with reference to evidence-based practice and indicate an urgent need for the collation and dissemination of the best current evidence available for the management techniques and support devices used in this area, as well as further research to extend this evidence.     

Independent learning among general practice trainees: an initial survey

Self-directed learning is a natural way for adults to learn. Vocational training for general practice is a preparation for unsupervised clinical work that will be supported, in the main, by continuing medical education. This study uses the Self-Directed Learning Readiness Scale to investigate factors influencing readiness for such learning among a sample of general practice trainees. Three principal factors emerged from analysis: enjoyment and enthusiasm for learning; a positive self-concept as a learner and a factor suggesting the possibility of a 'reproducing' orientation to learning. These factors may reflect approaches to learning in general rather than these adopted for professional learning, but offer helpful pointers for the development of both vocational training and of continuing medical education.     

北京、广州、上海城市居民营养知识、态度、行为的调查

对北京、广州和上海三大城市随机抽取的９６５名年龄在２０～５０岁的城市居民进行有关营养知识、态度和行为（Ｋ－Ａ－Ｐ）的调查。结果显示，三地区调查对象的营养知识水平不高。营养知识的得分与其自身受教育程度有相关性（ｒ＝０．３０１１，Ｐ＜０．０１）。年龄在３５岁以上的对象，营养知识的得分高于年轻人；三地区调查对象对营养知识的获取，合理的膳食模式，卫生的饮食习惯均持有积极、肯定的态度。食物消费频度调查结果表明，米／面、肉／禽、蔬菜、水果、奶及奶制品的消费量较高。此外，８９．５％，７８．８％和４７．８％的调查对象分别选择报纸、电视、广播作为其主要营养信息来源。本次调查为将来的营养宣教的内容和方法提供依据。     

涉外护理专业学生社区毕业实习效果评价

目的 探讨涉外护理专业学生社区毕业实习模式。方法 随机设定实验组(36人),参加慢性疾病调查、建立健康档案和进行相应的健康教育,结束时与不参加社区毕业实习的对照Ⅰ组(31人)、对照Ⅱ组(38人)的实习生同时接受基础知识和能力闭卷测试。然后统计调查问卷和健康档案的正确率,并将三组测试成绩进行比较。结果 实验组调查问卷和健康档案的正确率≥95％。实习生基础知识得分实验组(43.14±2.78)、对照Ⅱ组(42.53±1.96)与对照Ⅰ组(40.65±2.47)比较;能力得分实验组(47.00±2.34)与对照Ⅰ组(41.61±3.41)、对照Ⅱ组(41.42±3.52)比较;总分实验组(90.14±4.30)与对照Ⅰ组(82.26±5.33)、对照Ⅱ组(83.95±4.13)比较,均P<0.01,差异有极显著性意义。结论 社区毕业实习强化了实习生社区护理的基本知识,培养了实习生社区护理的相关能力。但有待于规范化。     

Signs of ocular disease: A prevalence study in optometric practice

Data on the prevalence of all ocular conditions seen in 1500 consecutive optometric patients were obtained during an investigation into the effectiveness of routine visual field screening. In many instances, these are the first prevalence figures for optometric patient populations. Some of the estimates of prevalence are compared with other optometric and general population surveys. Many disorders were observed, the most frequent being slight to moderate increases in retinal arterial reflex and attenuation, optic cup/disc ratio of 0.4, shallow anterior chambers and family history of glaucoma. The occurrence of some conditions was sporadic, resulting from the relatively small sample. However, this survey may serve as an audit of ocular disease detection for other practitioners.