Nationwide Trends in Catheter-Directed Therapy Utilization for the Treatment of Lower Extremity Deep Vein Thrombosis in Medicare Beneficiaries

PurposeTo determine overall and provider specialty trends in the use of catheter-directed therapy for lower extremity deep vein thrombosis (DVT) treatment in the Medicare population.Materials and MethodsUsing data obtained from 2007–2017 Centers for Medicare & Medicaid Services 5% research identifiable files, all claims associated with acute and chronic lower extremity DVT were identified. The annual volume of 2 services—venous percutaneous transluminal thrombectomy (current procedural terminology [CPT] code 37187) and venous infusion for thrombolysis (CPT code 37201 from 2007 to 2012 and CPT code 37212 from 2013 to 2017)—was examined for trends in DVT intervention. Utilization rates based on region and the place of service were calculated. The results were further categorized based on primary operator type (radiology, cardiology, surgery, and other).ResultsThe total number of DVT interventions increased over time, with 4.27 service counts per 100,000 beneficiaries in 2007 increasing to 13.4 by 2017, a growth rate of 12.09%. Radiologists performed the majority of interventions each year, except in 2013, in which they performed 46.6% of interventions, whereas surgeons and cardiologists combined performed the other 53.4%. In 2017, radiologists performed 7.56 services per 100,000 beneficiaries, which was 56.8% of the total count, more than those performed by surgeons, cardiologists, and unspecified providers combined.ConclusionsCatheter-directed therapy is increasingly being used for the treatment of DVT, with its use undergoing a nearly 12-fold increase from 2007 to 2017 in the Medicare population. Radiologists remained the dominant provider of these services throughout the majority of study period, with a relative reduction in market share from 72% in 2007 to 57% in 2017.     

国际康复政策架构与核心内容研究：基于世界卫生组织康复政策文件的内容分析

目的 运用世界卫生组织(WHO)健康服务构成要素的理论,从健康服务体系视域,对WHO有关康复服务的政策架构与行动战略进行系统的内容分析,探讨WHO国际康复政策的理论基础与方法、康复政策架构以及行动战略的核心内容。方法 WHO发布的康复相关政策文件包括《健康服务体系中的康复》《健康服务体系中的康复：行动指南》《康复指标清单：康复监测和评估架构配套的工具》和《康复现状系统评估配套工具(STARS)：康复信息收集模板(TRIC)》,形成国际康复政策体系。本研究运用内容分析方法,根据WHO健康服务构成的六大要素,即领导力和治理能力、筹资、健康人力资源、服务提供、医药技术、健康信息系统,详细分析国际康复政策的理论基础与方法、政策架构以及行动战略的核心内容与康复服务优先发展领域。结果 现代康复服务政策核心依据WHO有关构建以人为本的健康服务、关注健康的社会决定因素的理论,依据《国际功能、残疾与健康分类》的功能、残疾和健康理论,明确发展康复是实现联合国可持续发展目标三,确保健康的生活方式,促进各年龄段人群的福祉,即“全民健康覆盖”的重要路径。系统分析了领导力和治理能力、筹资、健康人力资源、服务提供、医药技术、健康信息系统六大领域,WHO的国际政策架构、行动战略以及发展内容与优先领域。WHO倡导制定国家康复规划,建立与完善康复治理结构并发展康复治理能力,采取多种途径为发展康复服务筹资。将康复融入现代健康服务体系,在健康服务连续体中提供不同层次的康复服务,在健康服务体系中构建康复服务体系,培训专业人员,建立服务信息网络,提升服务质量和服务覆盖率,关注重点领域和优先项目,以满足不同人群的多样化需求,实现全民健康覆盖。将辅助技术作为医药技术领域纳入康复服务体系。在健康信息系统中,收集有关功能和康复需求的信息以及康复服务结果和影响的数据,并开展基于循证的康复政策系统研究。结论 基于健康服务体系六大构成要素,从宏观、中观和微观三个层面,系统研究了国际康复政策架构。现代康复发展的理念是要实现全民健康覆盖。发展康复必须建立以人为中心的现代健康服务体系,并且关注社会决定因素。发展康复是实现联合国2030年可持续发展目标的重要举措。国际康复的政策体系围绕康复领导力和治理、康复筹资、康复人力资源、康复服务提供、康复相关医药技术以及康复与健康信息六大领域,从理论与政策、政策行动、实施工具和路径(评价指标体系和实施效果评估)三个层级,构建了康复发展的政策和行动战略以及具体的实施方法与工具的体系。实施WHO康复政策,需要采取如下行动：加强康复服务领导力、治理、规划和协调能力;构建合理的康复筹资机制,为康复筹措必要资金;健全康复人力资源培养与保障机制;提升康复人员专业能力,提升康复服务提供能力并改善服务质量;提高辅助产品和辅助技术服务的质量与可及性;建立涵盖功能、残疾和康复的健康信息系统并开展康复科学研究。     

Ethical global health in nursing education: An integrative review

AimThe purpose of this integrative review is to provide a comprehensive review of ethical considerations for host communities and nursing programs in planning, implementing and evaluating global health experiences for nursing students.BackgroundGlobal health experiences for nursing students are proliferating rapidly across university settings while at the same time decreasing the average time spent in the host country engaged with local communities. Global health experiences are an area where students can experience ethics as it is applied across varied contexts including resource limited international settings. As nursing education expands its global programming, exploring the ethical implications of designing, implementing and evaluating GHEs becomes pivotal to build respectful, sustainable relationships with global partners and best prepare nursing students for ethical professional practice in an interconnected world.DesignWe conducted an integrative review to examine ethical considerations in development of ethical global health experiences that benefit, rather than harm, host communities and participating nursing student guests.MethodsThe search included articles published in English language, peer-reviewed journals between 1998 and 2021 that discussed ethics in the context of nursing students traveling internationally for global health experiences. Eighteen articles met criteria for review.ResultsOverall, findings demonstrate relatively little research specific to ethical engagement in global health experiences. The articles in this integrative review discussed a range of ethical attributes including reciprocity or collaboration, respect, sustainability or commitment, justice and openness. Recommendations based on research and non-research articles are provided.ConclusionsEthical comportment in global health experiences requires careful planning, implementation and evaluation to assure an equitable and sustainable partnership between host community, faculty and nursing student guests.     

乳腺癌患者“一站式”服务模式体验的质性研究

目的深入了解乳腺癌患者对"一站式"服务模式的评价,分析其服务需求,以采取针对性措施,进一步提高患者满意度、促进其身心康复。方法选取我中心乳腺外科医生5名、乳腺专科护士5名,以及在我中心接受诊疗的乳腺癌患者18例、家属9例,采取半结构访谈法,全程录音记录,随后将声音资料整理录入后运用现象学的方法编码分析。结果据访谈结果提炼出对于一站式服务模式的体验包括:让患者及家属感到规范、便捷,体现了护理的连续性和医护的合作性;同时对患者的心理社会支持有待加强、健康教育有待深入、延伸护理有待完善。结论"一站式"服务虽在一定程度上满足了患者的诊疗需求,但在制度流程、服务细节等方面仍有待改善和提高。     

中俄院校卫勤演习的比较研究

介绍了我校和俄罗斯基洛夫军事医学院的卫勤演习情况,然后针对卫勤演习的构成要素,如演习类型、演习课目、参演对象、演习导调和保障基地等进行了对比分析。在此基础上,从调整参演对象、改变演习时机、改革演习导调、加强基地建设等方面,对我军院校卫勤演习提出了建议。     

优化早交班内涵的实践与成效

目的 探讨早交班内涵的优化与实践成效。方法 评估传统早交班内涵, 对传统早交接内涵进行优化、培训, 使责任护士掌握并应用于临床实践, 对优化前、后的早交班内涵的相关护理指标进行评价。结果 早交班内涵优化后的护理质量及患者对责任护士的满意度较优化前有显著提高, 差异有统计学意义(P<0.05)。结论 早交班内涵的优化提高了护理工作的质量及效率, 体现了优质护理的人性化、连续性、整体性、专业化。     

The changing role of dental auxiliaries: A literature review

A review of the literature on dental auxiliaries and their utilization in the dental workforce is presented, and their future role is examined in the light of broader issues relating to changing disease patterns and service delivery. Legislative factors, productivity, quality assurance and the potential scope for dental auxiliaries in both the public sector and private practice setting are discussed. A strategy for adopting a team approach in the delivery of dental services is suggested, which would necessitate the dentist taking on the role of team leader and maintaining responsibility for overall treatment planning and quality assurance. Dental auxiliaries could provide basic preventive and restorative dental services, allowing dentists to concentrate on providing more complex high-technology treatment. Implications for the future training of dental auxiliaries are presented.