关于加快转变我军卫勤保障能力生成模式的探讨

卫勤保障能力是军队战斗力的重要组成部分,着眼于提高我军卫勤保障能力,加快卫勤保障能力生成模式从数量规模型卫勤向质量效能型卫勤转变,本文以卫勤保障能力生成模式的本质内涵为基础,对我军卫勤保障能力生成模式转变的必要性进行分析,提出了推进新生卫勤力量建设、加快新型保障模式转变、加强卫勤信息综合集成、深化卫勤训练和管理改革等方法途径。     

Levels of satisfaction of 'low-risk' mothers with their current health visiting service

AIMS AND OBJECTIVES: To assess the expressed levels of satisfaction of 'low-risk' mothers with the current health visiting service. Setting Sheffield, England, Autumn 1997. METHODOLOGY: Self-completion, postal questionnaire (initial postcard reminder followed by a second letter and questionnaire) to a sample of 403 mothers assessed as 'low priority' by their health visitor. Questions largely related to maternal opinion of the adequacy of the health visiting service delivered during the first 9-12 months. The local research ethics committee approved the study. RESULTS: A corrected response rate of 75% with little evidence of significant bias. A high proportion (86%) of women stated that they were either 'fairly' or 'very' satisfied with the service they had received from their health visitor with regard to their baby. A lower proportion (72%) was equally satisfied with the service they had received in respect of their own health. Despite an average number of approximately 10 contacts in relation to infant health with the health visitor during the first year of life, some 6% of women wanted more frequent contacts, particularly in the first few weeks. Study limitations The questionnaire was designed specifically for the study and validation was limited. The study population comprised a selected, 'low-risk' group. CONCLUSIONS: The number of reported contacts with the health visitor seemed to greatly exceed those indicated by a basic child health surveillance programme. The overall level of maternal satisfaction is high, though a minority of women would like more support. Dissatisfaction was expressed with the lack of an appointment system for clinics, poor punctuality in home visits, and inappropriate or inadequate advice.     

Untreated Hypertension and the Emergency Department: A Chance to Intervene?

Objectives:  Untreated hypertension (HTN) is a major public health problem. Screening for untreated HTN in the emergency department (ED) may lead to appropriate treatment of more patients. The authors investigated the accuracy of identifying HTN in the ED, the proportion of ED patients with untreated HTN, patient characteristics predicting untreated HTN, and provider documentation of untreated HTN.
Methods:  The authors performed a retrospective cross-sectional study on a random sample of 2,061 adults treated at an urban academic ED. The validity of six candidate definitions of HTN in the ED was assessed in a subsample using outpatient clinic records as the reference standard. "Untreated HTN" was HTN without a HTN medication listed in the ED history. "Documentation of untreated HTN was documentation of HTN as a visit problem, specific referral for HTN, or ED discharge with a HTN" information sheet or a HTN medication. Multivariable logistic regression was used to determine associations.
Results:  The preferred definition of HTN in the ED had sensitivity of 86% (95% confidence interval [CI] = 80% to 90%), specificity of 78% (95% CI = 69% to 85%), and accuracy of 83% (95% CI = 78% to 87%). Of the 42% (95% CI = 40% to 44%) of ED patients with HTN, 43% (95% CI = 39% to 46%) had untreated HTN. Patients who were younger and male, without primary care physicians, with fewer prior ED visits, and without cardiovascular comorbidities, had higher odds of untreated HTN. Of those with untreated HTN, 8% (95% CI = 5% to 11%) had their untreated HTN documented.
Conclusions:  Untreated HTN was common in the ED but rarely documented. Providers can use ED blood pressures along with patient characteristics to identify those with untreated HTN for referral to primary care.     

无陪护模式病房不同能级护理人员承担工作项目调查

目的了解山东省三级综合性医院无陪护模式病房不同能级护理人员承担工作项目情况,为实现护理人力资源优化管理提供基础和依据。方法自行设计无陪护模式病房临床护理人员能级对应相关情况调查表,对山东省6所三级医院无陪护模式病房551名护理人员承担部分工作项目情况进行调查。结果不同能级护理人员承担各护理工作项目有所侧重(均P<0.01),但均承担所有工作项目;基础护理、执行治疗是主要的临床护理工作,分别占23.81%、22.00%;临床教学及科研所占的比重最少,分别占8.17%、2.51%;无陪护模式病房护理工作的主力是大专学历、初级职称及工龄不足3年的护士。结论护理人力资源配置的不合理及利用低效率并存,护理管理者应制定科学的护理人力资源配置标准,并根据不同岗位的专业技术要求配备相应能力的护士,从而优化护理人力资源管理。     

优质护理服务中有限人力资源最大化利用探索

目的在有限的人力资源条件下,探索使现有人力资源达到最大化应用的管理方法。方法对内科片15个优质护理服务示范工程试点病房进行排班模式改革及分层使用,优化工作流程,采用部分工时制发挥病休、产休人员人力作用,建立内科片统一调配的用人制度,采用"文化魅力"影响护士心态及激励其工作热情,专业及医德医风培训常规化。实施5个月后评价效果。结果患者对护理服务的满意率平均为97%,护理事故发生数为零,护理投诉为零,护理差错共发生4起。结论人力资源的最大化利用可在有限的人力资源条件下,提高工作效率及护理质量。     

优质护理服务供需平衡的扎根理论研究

目的探索优质护理服务运行规律,为发展完善优质护理服务模式奠定基础。方法采用参与式观察与深度访谈收集资料,通过开放编码、主轴编码和核心编码方式进行分析。结果优质护理服务需要护理服务、护理支持系统与患者需求、患者支持系统之间的平衡,支点为基于经济社会发展、疾病谱和人口老龄化制定的国家政策。结论优质护理服务的开展,可促进临床护理服务质量和患者满意度的提升,但需强化护理支持系统,以提高护理人员满意度。     

Investigating Geographic Variation in Mortality in the Context of Organ Donation

Organ procurement organizations (OPOs) report a nearly fourfold difference in donor availability as measured by eligible deaths per million population (PMP) based on hospital referrals. We analyzed whether mortality data help explain geographic variation in organ supply as measured by the number of eligible deaths for organ donation. Using the 2007 National Center for Health Statistics’ mortality data, we analyzed deaths occurring in acute care hospitals, aged ≤ 70 years from cerebrovascular accidents and trauma. These deaths were mapped at the county level and compared to eligible deaths reported by OPOs. In 2007, there were 2 428 343 deaths reported in the United States with 42 339 in‐hospital deaths ≤ 70 years from cerebrovascular accidents (CVA) or trauma that were correlated with eligible deaths PMP (r²= 0.79.) Analysis revealed a broad range in the death rate across OPOs: trauma deaths: 44–118 PMP; deaths from CVA: 34–118 PMP; and combined CVA and trauma: 91–229 PMP. Mortality data demonstrate that deaths by neurologic criteria of people who are likely to be suitable deceased donors are not evenly distributed across the nation. These deaths are correlated with eligible deaths for organ donation. Regional availability of organs is affected by deaths which should be accounted for in the organ allocation system.     

Transplant Organizational Structures: Viewpoints From Established Centers

This personal viewpoint report summarizes the responses of a survey targeting established transplant programs with a structured framework, such as center, institute, or department, and stability of leadership to assure valuable experiential observations. The 18‐item survey was sent to 20 US institutions that met inclusion criteria. The response rate was 100%. Seventeen institutions had a distinct transplant governance structure. A majority of respondents perceived that their type of transplant structure was associated with enhanced recognition within their institution (85%), improved regulatory compliance (85%), transplant volume growth (75%), improved quality outcomes (75%) and increased funding for transplant‐related research (75%). The prevailing themes in respondents’ remarks were the perceived need for autonomy of the transplant entity, alignment among services and finances and alignment of authority with responsibility. Many respondents suggested that a dialogue be opened about effective transplant infrastructure that overcomes the boundaries of traditional academic department silos.     

Community psychiatric nursing: focus on effectiveness

The focus for provision of mental health services is now the community in most developed countries. Different ways of organizing community mental health services are evident in the literature. Community psychiatric nurses (CPNs) have a key role to play in these services but the literature indicates that the CPN role varies from area to area within different models of service provision. This paper presents the findings of a study in which 13 service users and 15 CPNs in five focus groups discussed the effectiveness of mental health service. Selected staff and service users were chosen from a representative range of community mental health services across Northern Ireland. Service users expressed concern at the variety of CPN and other professional roles within multidisciplinary teams and some CPNs expressed dissatisfaction with their role and with role boundaries within teams. These findings suggest that further work is needed within community mental health services to ensure the role of the CPN remains effective and develops to meet the needs of service users.     

Comparing emergency medical service systems--a project of the European Emergency Data (EED) Project

Aim

The aim of this prospective study was the comparison of four emergency medical service (EMS) systems—emergency physician (EP) and paramedic (PM) based—and the impact of advanced live support (ALS) on patients status in preclinical care.

Methods

The EMS systems of Bonn (GER, EP), Cantabria (ESP, EP), Coventry (UK, PM) and Richmond (US, PM) were analysed in relation to quality of structure, process and performance when first diagnosis on scene was cardiac arrest (OHCA), chest pain or dyspnoea. Data were collected prospectively between 01.01.2001 and 31.12.2004 for at least 12 month.

Results

Over all 6277 patients were included in this study. The rate of drug therapy was highest in the EP-based systems Bonn and Cantabria. Pain relief was more effective in Bonn in patients with severe chest pain. In the group of patients with chest pain and tachycardia ≥120 beats/min, the heart rate was reduced most effective by the EP-systems. In patients with dyspnoea and S_pO₂ < 90% the improvement of oxygen saturation was most effective in Bonn and Richmond. After OHCA significant more patients reached the hospital alive in EMS systems with EPs than in the paramedic staffed (Bonn = 35.6%, Cantabria = 30.1%; Coventry = 11.9%, Richmond = 9.2%). The introduction of a Load Distributing Band chest compression device in Richmond improved admittance rate after OHCA (21.7%) but did not reach the survival rate of the Bonn EMS system.

Conclusions

Higher qualification and greater training and experience of ALS unit personnel increased survival after OHCA and improved patient's status with cardiac chest pain and respiratory failure.