“临床技能学”国家精品资源共享课建设的探索与实践

国家精品资源共享课是对原有国家精品课程的转型与升级。课程通过现代信息技术构建适合于网络椽笔的共享系统,向高校师生和社会学习者提供优质教育资源服务。文章结合“临床技能学”资源共享课的建设经验,从课程沿革、课程建设目标、课程内容及资源建设、师资队伍建设以及课程管理建设几方面探讨国家精品资源共享课的有效途径。     

Monitoring and Root Cause Analysis of Clinical Biochemistry Turn Around Time at an Academic Hospital

Quality can be defined as the ability of a product or service to satisfy the needs and expectations of the customer. Laboratories are more focusing on technical and analytical quality for reliability and accuracy of test results. Patients and clinicians however are interested in rapid, reliable and efficient service from laboratory. Turn around time (TAT), the timeliness with which laboratory personnel deliver test results, is one of the most noticeable signs of laboratory service and is often used as a key performance indicator of laboratory performance. This study is aims to provide clue for laboratory TAT monitoring and root cause analysis. In a 2 year period a total of 75,499 specimens of outdoor patient department were monitor, of this a total of 4,142 specimens exceeded TAT. With consistent efforts to monitor, root cause analysis and corrective measures, we are able to decreased the specimens exceeding TAT from 7–8 to 3.7 %. Though it is difficult task to monitor TAT with the help of laboratory information system, real time documentation and authentic data retrievable, along with identification of causes for delays and its remedial measures, improve laboratory TAT and thus patient satisfaction.     

临床护理教学管理工作实践与探索

临床护理教学是护生将护理理论与临床护理实践紧密结合的关键环节,是使护生获得护理专业所必需具备的态度、知识和专业技能的重要途经。高度重视临床护理教学管理机制和质量控制,树立以护理程序为指导的临床护理教学,加强临床师资队伍建设,建立临床护理带教教师资格认定制度,对提高临床护理教学质量,帮助护生尽快适应现代护理工作具有重要意义。     

口腔正畸治疗牙周病致前牙移位的应用及临床有效性分析——以黄冈市中心医院口腔科为例

目的分析口腔正畸治疗牙周病致前牙移位的应用及临床有效性。方法选择黄冈市中心医院牙周病致前牙移位患者共70例,数字表随机分2组每组35例,对照组的患者给予牙周基础治疗,观察组在该基础上增加口腔正畸治疗。比较两组患者对治疗的满意评价、治疗前后患者牙齿松动程度、前牙覆盖、牙周袋深度、总有效率、不良反应。结果观察组患者对治疗的满意评价高于对照组,治疗后患者牙齿松动程度、前牙覆盖、牙周袋深度低于对照组,总有效率高于对照组,P<0.05。两组均无不良反应,P>0.05。结论牙周基础联合口腔正畸治疗对于牙周病致前牙移位的治疗效果确切,可有效缩小前牙移位,并改善牙周袋情况,且安全性高,值得推广和应用。     

欧盟EATRIS对中国转化医学中心管理的启示

随着中国国家转化医学重大科技基础设施启用,如何盘活现有转化医学中心资源,对加速医学研究进程意义重大。研究系统梳理欧盟转化医学研究基础设施（EATRIS）的发展历史及项目情况,发现EATRIS立足于113个转化医学研究机构,成立协调办公室和科学咨询委员会,建立了以项目为中心的转化医学体系,以协调科研支持资源,在患者教育、公私合作、生物数据库建设等方面积累了丰富经验。综合中国国家临床医学研究中心快速增加,但缺乏顶层统筹协调,支持分散和协作割裂以及基础设施利用率低的现状,研究提出应立足国家转化医学基础设施,搭建统筹管理平台,设立专项发展基金,以推动患者临床价值实现为目标的发展建议,为中国转化医学中心高效率运转提供经验参考。     

浅析在新形势下如何提高骨科年轻护士临床护理能力

目的分析目前骨科年轻护士队伍中存在的主要问题,以便科室层面针对现状采取培训方法。方法制订骨科年轻护士的培训计划,从提高年轻护士综合能力入手,通过床边实境培训,培养年轻护士的护理思维能力、病情观察能力、专业知识运用能力和实际解决问题能力,变被动工作为主动工作,在深度、广度上挖掘,体现专科护理的内涵和价值。结果实施后年轻护士的个人素质提高,患者和医生满意度提升。结论这种临床实境培训方法,内容紧密联系实际,现场讲课、床边实践、即时纠正,提高了年轻护士的能力,使护士的整体技能水平有了明显的提升。     

Potential impact of the validated Predicting Abusive Head Trauma (PredAHT) clinical prediction tool: A clinical vignette study

BackgroundThe validated Predicting Abusive Head Trauma (PredAHT) tool estimates the probability of abusive head trauma (AHT) in children <3 years old with intracranial injury.ObjectiveTo explore the impact of PredAHT on clinicians’ AHT probability estimates and child protection (CP) actions, and assess inter-rater agreement between their estimates and between their CP actions, before and after PredAHT.Participants and SettingTwenty-nine clinicians from different specialties, at teaching and community hospitals.MethodsClinicians estimated the probability of AHT and indicated their CP actions in six clinical vignettes. One vignette described a child with AHT, another described a child with non-AHT, and four represented “gray” cases, where the diagnosis was uncertain. Clinicians calculated the PredAHT score, and reported whether this altered their estimate/actions. The ‘think-aloud’ method was used to capture the reasoning behind their responses. Analysis included linear modelling, linear mixed-effects modelling, chi-square tests, Fisher’s exact tests, intraclass correlation, Gwet’s AC₁ coefficient and thematic analysis.ResultsOverall, PredAHT significantly influenced clinicians’ probability estimates in all vignettes (p < 0.001), although the impact on individual clinicians varied. However, the influence of PredAHT on clinicians’ CP actions was limited; after using PredAHT, 9/29 clinicians changed their CP actions in only 11/174 instances. Clinicians’ AHT probability estimates and CP actions varied somewhat both before and after PredAHT. Qualitative data suggested that PredAHT may increase clinicians’ confidence in their decisions when considered alongside other associated clinical, historical and social factors.ConclusionsPredAHT significantly influenced clinicians’ AHT probability estimates, but had minimal impact on their CP actions.     

Implementation of routine electronic health record-based child abuse screening in General Emergency Departments

BackgroundRoutine child abuse screening is an approach to early identification of abuse. Previous studies evaluated paper-based screens; the widespread use of electronic health records suggests that screening is more likely to succeed if integrated into the electronic record.ObjectiveTo implement an electronic health record-based child abuse screen in a diverse hospital system and to evaluate the screening rate, rate of positive screens, and number of reports to Child Protective Services and assess whether hospital and patient characteristics are associated with these rates.Participants and settingChildren <13 years of age evaluated at one of 13 Emergency Departments within University of Pittsburgh Medical Center Health System.MethodsA previously validated child abuse screen was slightly modified and integrated into Cerner. Multivariable logistic regression models were used to estimate the odds of the outcomes of interest, controlling for key covariates.ResultsOf 17,163 eligible children: 68% received the screen of which 1.9% were positive. The rate of reports to Child Protective Services was higher among children who were screened (p < 0.0001). Younger children were more likely to be screened, have a positive screen, and have a report filed. There was no difference in the odds of being screened according to hospital teaching status, size or urban vs rural location.ConclusionsA child abuse screening tool can be integrated into the electronic health record in a large health-care network. The increased number of reports among children who were screened suggests that screening facilitates detection of suspected maltreatment.