Aging Characteristics and Layout Planning of Old-age Care Facilities in the Downtown Area of Nanchang City

Compared to the situation of population aging and the elderly aging, the development of oldage undertaking in Nanchang is still undeveloped in that the old-age care industry lags behind the urban renewal speed and the objective needs of aging. Apart from discussions on the composition of elderly population and the status quo of aging, this paper took the institutional old-age care in the downtown area of Nanchang for example, explored problems in the current institutional old-age care facilities through field investigation, and proposed suggestions for the layout planning of old-age care facilities in the study area.

Analysis of home care-based multi-level old-age service system

With the deepening of China＇s aging, China＇s social pension problem more obvious each day, and gradually become the focus of attention of the whole society. On the one hand, China entered the aging society, old-age needs to grow exponentially. The sixth national census shows that in our country, the population aged 60 and 13.26% of the total population over the total number of 179 million, 65 years and older the proportion of 8.87% of the total population, the absolute number of nearly 120 million. Hundreds of millions of older age groups will produce a growing demand for care services, which is the original old-age service system and the whole economic and social development is a huge pressure. On the other hand, with the economic and social transformation, the traditional model of family pension has been unable to adapt to the profound changes in modem employment, family structure, the concept of retirement, since most parts of China, ＂old before getting ricE＂ the situation, how to solve the elderly the pension problem is related to the overall situation of China＇s economic and social development, related to the overall situation of building a harmonious society in China. Under current national conditions, the emphasis on the development of a single individual body to meet the growing demand for pension service is not realistic, we must mobilize the enthusiasm of all aspects of the element, multi-service integration of resources subject to their commitment to a different responsibilities and tasks provide a full range of care services according to different types, different levels of the actual needs of the older age groups. On the aging problem is that the whole community to face, you need to multi-government body, families, communities, institutions combine effectively starting from the actual needs of the elderly population, according to the financial assistance, life care, spiritual consolation three set the specific needs of services, through a government-led, home-based care services, community care services for the core and supplementary services for institutions focused on pension and other means to provide a full range of pension services.

Construction of Xi'an ecological old-age care community in the new urbanization

The new urbanization is an important carrier of ecological civilization construction, and ecological old-age care is the concrete manifestation of the perfect combination of the two, the proper meaning of the new urbanization connotation and an inevitable trend of its development. Based on the analysis of the connotation and relationship between the new urbanization and ecological old-age care, together with the current situation and existing problems of the current nursing institutions and ecological old-age care in Xi'an area, this paper discusses the major issues that should be noticed when constructing the ecological old-age care community in Xi'an and three main construction modes.

The Experience and Enlightenment of the Development of Old-age Care Services in Russia

Through the analysis of the history and current situation of Russia＇s old-age care services system, this paper analyzes and studies the old-age care services system in Russia. By means of law and social policy, Russia can promote the active participation of the elderly in politics, economy, culture and other activities to promote the positive image of the elderly. The active aging policy in Russia and the development trend of the old-age care service to promote the social adaptation and re-employment of the elderly are of positive significance to the development of our country＇s old-age care service.

Neurocritical Care Training for the Neurosurgery Resident

Introduction: Recent data has associated favorable outcomes in patients who were treated in a “semi-closed” intensive care unit and attended to by a devoted team of neurointensivists as opposed to the neurosurgeons. This has led many to question the need for dedicated critical care education in the neurosurgical residency training program. Our aim was to determine what current neurosurgery residents and program directors/chairman thoughts were on NCC education in neurosurgical resident training, and to discuss possible methods to allow for collaboration between the NCC team and the neurosurgeons. Methods: Surveys were sent out electronically to all residency programs. Thirty-nine responses from junior residents, 36 responses from senior/chief residents, and eight responses from program directors/chairman were obtained. Results: No statistical difference between the majority responses of the different level residents, and between program directors/chairman and combined resident responses. Conclusions: Clearly, neurosurgery residents of all levels and program directors/chairman value NCC education and see a valuable role for this knowledge in their future. Most residents however do not want to spend an additional year of fellowship training to become certified neurointensivists. We discuss the role of NCC education in residency training and possible solutions to allow collaboration between the NCC team and the neurosurgical team.

Improvement of the Legal System for Addressing the Issue of Elderly Care in China in the Context of Population Aging

Rapid population aging is a social reality facing China at present,and the issue of elderly care has become a hot topic of social concern.Legislation to address the issue of elderly care in the context of population aging should follow systematic concepts to achieve“vertical and horizontal integration.”In terms of content,it is necessary to formulate specific legal approaches around“the elderly and children,”with a focus on guaranteeing the livelihood and protection of the rights of the elderly while taking into account childbirth,employment and other issues.the laws should not only safeguard the social participation and labor rights of the elderly,but also effectively respond to the social challenges brought about by the aging of the population.It is also necessary to optimize the family planning policy to ease the burden of child-raising,improve the population structure and promote the long-term balanced development of the population,thus fundamentally solving the problem of population aging.the effort to improve the legal system to deal with the issue of elderly care in the context of population aging will better advance Chinese modernization.

呼吸与危重症医学科住院医师胜任力评价体系的构建

目的 构建适合中国国情的呼吸与危重症医学科住院医师胜任力评价体系。方法 本研究于2022年8月至2023年7月进行,采用文献综述结合德尔菲法,包括2轮专家函询,筛选、优化呼吸与危重症医学科住院医师胜任力评价指标。结果 两轮函询的有效问卷回收率均为100%,专家权威系数分别为0.905和0.914,专家咨询的肯德尔和谐系数分别为0.193(χ^(2)=237.561,P<0.001)和0.157(χ^(2)=212.459,P<0.001)。研究构建了胜任力评价体系,包括一级指标8项,二级指标38项。结论 本研究初步构建了呼吸与危重症医学科住院医师胜任力评价体系,更加适用于我国呼吸与危重症医学科住院医师规范化培训的实践临床环境,为规范化培训和教学提供了简单可行的胜任力评价方式。

以问题为导向的基层医疗机构超声专业住院医师培养与探索

超声医学专业住院医师的培训总体目标是以六大核心胜任力为导向,培养具有良好的职业素养、专业能力、病人管理、沟通合作、教学能力和学习能力,能够独立、规范地从事临床常见病多发病诊疗工作的超声医师。超声医学专业住培学员来源有多个层次,其中基层医疗机构委派的住院医师培养需求及目标有其自身特点,本文旨在探索有针对性培养基层医院来源的住院医师,使其将来在基层工作岗位中更好地发挥应有的作用。

慕课联合翻转课堂在呼吸与危重症医学科规范化培训中的应用

目的:探讨慕课结合翻转课堂在呼吸与危重症医学科住院医师规范化培训中的应用价值。方法:选取在安徽医科大学第二附属医院呼吸与危重症医学科参加住院医师规范化培训的84名内科学员,随机分为观察组和对照组。对照组给予常规教学方式,观察组在常规教学方式的基础上,录制慕课教学视频交住培学员自主学习,让住培学员利用自由时间学习慕课资源,随后通过翻转课堂进行实践、交流互动。比较两组出科理论考试成绩、临床技能成绩及住培学员对于教学的满意度。结果:观察组住培学员理论考试和临床技能成绩均优于对照组,且观察组学员对教学的满意度高于对照组(P<0.05)。结论:慕课联合翻转课堂在呼吸与危重症医学科住院医师规范化培训中有着积极意义。

城乡居民养老保险对家庭双代经济流动的影响——基于中国健康与养老追踪调查数据

利用“中国健康与养老追踪调查”(CHARLS)数据,通过构建多元线性模型,实证分析城乡居民养老保险对家庭内部亲子代经济流动的影响。结果发现,“经济面向”的城乡居民养老保险挤出了子代向亲代提供的经济支持,但对亲代的经济“逆反哺”并无显著影响;双代婚姻状况、受教育水平和亲代家庭资产均正向显著影响家庭代际经济的双向流动;子女之间存在“攀比效应”和“示范效应”;子代家庭收入正向影响向上代际经济支持。因此,老年人养老水平的提高需要从国家、社会和家庭层面共同着力:国家提高城乡居民养老保险的保障水平,鼓励老年人隔代照料孙子女;市场进一步完善养老服务;家庭发挥情感保障作用,关照独子女失能老人。

基于《住院医师规范化培训内容与标准(2022年版)》的实践应用——以重症医学科住院医师规范化培训为例

探讨《住院医师规范化培训内容与标准(2022年版)》在住院医师规范化培训中的应用效果。结果表明,《住院医师规范化培训内容与标准(2022年版)》在住院医师规范化培训中应用,能收到较好的教学效果和满意度。

中美重症医学科专科医师规范化培训体系的差异及启示

医学是终身学习不断提高的科学,毕业后教育是医学重要的延续。近年各种公共卫生事件突发,国家层面对危重患者诊疗需求与日俱增,培养高水平重症医学科医师乃大势所趋。住院医师规范化培训(简称作住培)近年来已经逐渐完善成熟,然而专科医师规范化培训(简称专培)仍处于初步探索阶段,培训基地较少,管理及培养目标尚不明确,考核评价机制单一,且专科医师综合能力水平参差不齐。本文旨在分析中美两国重症医学科专培的差异,拟从准入制度、培训目标、培养体系、评价体系、基地管理、师资培训、临床胜任力发展等多方面提出切实可行措施,为我国重症医学科培养卓越医师提供参考。

住院医师人文关怀能力与情绪智力水平的相关性研究

目的调查住院医师的人文关怀能力与情绪智力水平现状,了解两者的相关性。方法采用横断面调查法,使用人口学特征问卷、人文关怀能力量表和情绪智力量表,于2022年9月对三甲综合医院的住院医师进行调查。采用皮尔逊相关分析和多元线性回归分析法,分析住院医师人文关怀能力与情绪智力水平的关系。结果住院医师人文关怀能力量表平均得分为(188.82±20.80)分,情绪智力量表平均得分为(87.08±13.49)分,情绪智力水平与人文关怀能力显著相关,自我情绪评价、他人情绪评估、情绪控制、情绪运用、学校社团工作经历是人文关怀能力的独立预测因子。结论住院医师人文关怀能力处于较低水平,情绪智力影响因素众多、发展水平不同,两者呈正相关关系。培养单位在制订、实施和评估人文关怀能力干预措施时,情绪智力水平是重要考虑因素。要加强人文素养教育,提高住院医师的情绪智力水平,促进社会的总体健康。

床旁即时超声教学现状及其在住院医师规范化培训中的初步探索

随着超声医学的不断进步,超声在临床的应用越来越广泛,常规的超声检查主要由超声医生在检查室进行,但近年来随着超声便携机的研发,床旁即时超声(point-of-care ultrasonography,POCUS)越来越受到临床医生的欢迎。POCUS是由临床医生在床旁进行超声检查并解释结果,以临床问题为目标导向,用于指导临床诊断、治疗及操作。POCUS的优势在于帮助临床医生快速有效地解决急危重症的临床问题,但是由于目前缺乏对住院医师开展系统性、规范化的相关培训,导致国内POCUS在临床实际应用和教学方法中均存在诸多问题和困难。上海交通大学医学院附属新华医院超声科对POCUS的教学现状和目前存在的问题进行总结,初步探索其在超声医学科专业基地住院医师规范化培训中的方法和作用。

河北省老年人中医养生保健文化现状及对策研究

[目的]了解河北省60—85岁老年人中医养生保健文化现状,分析影响因素,并提出对策。[方法]采用整群随机抽样方法,随机抽取河北省11个地级市的常住老年居民2800人进行问卷调查。[结果]回收有效问卷2538份,有效率90.64%。河北省老年人中医养生保健理念和知识的具备率偏低,仅为17.34%,情志养生、时令养生和体质养生具备率较低,分别为28.80%、25.53%、20.96%,城镇老年人各项养生保健具备率均高于乡村老年人;在经穴养生和体质养生方面,女性老年人高于男性老年人;在年龄分布上,60—69岁老年人具备率最高;未患慢性病老年人高于患慢性病老年人。[结论]河北省老年人中医养生保健文化水平仍待提高,乡村老年人、80岁以上老年人及患慢性病老年人是河北省开展老年人中医药健康知识宣传和普及的重点人群。

基于ISBAR的医护一体化查房在儿科住院医师规范化培训中的探索

为探讨医护一体化查房模式在儿童重症医学科进行住院医师规范化培训中的应用效果及思政教育意义,选取2022年1月至2023年5月至我院儿童重症监护室(Pediatric Intensive Care Unit,PICU)轮转的住培医师40名,随机分为观察组和对照组,观察组采用基于ISBAR的医护一体化查房模式,对照组采用传统查房模式,培训结束后对所有住培医师进行出科考试以及专业技能水平评估,同时调查学员对两种培训模式的满意度,最后对两组培训结果进行对比分析。结果显示,采用基于ISBAR的医护一体化查房模式可有效提升住院医师的沟通意识及沟通能力,全面提高出科成绩及专业技能水平,有助于培养其团结协作精神及健康心理,是思政教育与医学专业培训有机结合的独特方式。

“村改居”社区居家养老服务的内在逻辑与路径——基于发展型社会政策视角

在城镇化和老龄化的双重因素驱动作用下,“村改居”社区老人日益增多。如何提高这一特殊区域老年人群体的养老服务品质,从而保障其合法权益,是经济社会发展中应有的题中之义。基于发展型社会政策视角,“村改居”社区居家养老服务存在供需错位、人才匮乏、资金断层和主体单一等困境,从顶层设计+资源整合,推进“村改居”社区居家养老服务功能化;政府引导+社会参与,推进“村改居”社区居家养老服务社会化;技能培训+人才培养,推进“村改居”社区居家养老服务专业化;科技赋能+转变观念,推进“村改居”社区居家养老服务品质化等方面提出了“村改居”社区居家养老服务的新路径。

基于岗位胜任力的主题式晨间报告在重症医学科住院医师规范化培训中的探索

目的探讨在重症医学科住院医师规范化培训带教中开展基于岗位胜任力的“主题式晨间报告”的作用。方法收录自2020年1月至2022年12月某院重症医学科参加住院医师规范化培训的住培医师共60名,随机分试验组和对照组,每组30人。试验组采用基于岗位胜任力的主题式晨间报告的互动教学方式,对照组采用传统带教方式。比较两组住培医师在不同带教方式下临床理论知识、操作实践技能考核成绩,采用360环评的方式收录患者或家属、护士、同事以及带教老师对住培医师岗位胜任力(自主学习能力、团队协作能力、有效沟通能力、学习兴趣)的多方位评价。结果试验组带教后的临床理论知识、操作实践技能考核得分均高于对照组,差异有统计学意义(理论考核:t=2.101,P<0.05;实践考核:t=9.647,P<0.05)。规培1月后无论护士、同事、带教老师对住培医师的各项岗位胜任力评分试验组均高于对照组,差异均有统计学意义(护士评价自主学习能力:t=3.182,P=0.002,团队协作能力:t=3.978,P<0.05,有效沟通能力:t=2.180,P=0.0335,学习兴趣:t=3.884,P<0.05;同事评价自主学习能力:t=2.888,P=0.005,团队协作能力:t=6.816,P<0.05,有效沟通能力:t=3.833,P<0.05,学习兴趣:t=4.086,P<0.05;带教老师评价自主学习能力:t=3.429,P=0.001,团队协作能力:t=3.086,P=0.003,有效沟通能力:t=3.493,P=0.001,学习兴趣:t=3.126,P=0.003)。患者或家属对两组规培医师的满意度评分对比差异有统计学意义(t=3.126,P=0.003)。结论对重症医学科住院医师规范化培训学员临床带教中采用基于岗位胜任力的主题式晨间报告的互动教学,不仅可以提高住培医师的理论实践以及病例分析的考核成绩,还能提升岗位胜任力,以及患者和家属的满意度。

社区老年人照护需求现状及影响因素研究:基于三省的基线调查

背景人口老龄化背景下对老年人照护的研究逐渐成为热点。以往对老年人照护需求率的调查存在较大差异(8.54%~53.15%),缺乏大样本的研究证据。目的了解我国社区老年人照护需求现状及其影响因素。方法调查对象来自国家重大公共卫生专项“老年期重点疾病预防和干预”项目2019年的基线调查,该调查采用多阶段分层整群随机抽样方法,在辽宁省、河南省和广东省的16个区(县)共抽取16199名60岁及以上老年人开展问卷调查,问卷内容主要包括基本人口学特征(性别、年龄、城乡、婚姻状况、文化程度、职业、体质量、居住情况)、照护需求现状、患慢性病情况、病人健康问卷抑郁自评量表(PHQ-9)、简易智能精神状态检查(MMSE)量表、老年人日常生活活动能力调查(ADL)量表、自评健康状况、每天锻炼身体和跌倒情况(过去1年)等。采用PHQ-9评定老年人的心理状况、MMSE量表评估老年人的认知功能,老年人照护需求评估采用ADL量表(存在BADL或IADL失能)或自报需要照护。采用Logistic回归分析探讨老年人照护需求的影响因素。结果收集有效样本数据16193份,社区老年人照护需求率为14.57%(95%CI=14.02%~15.11%),随着年龄增加照护需求率逐步上升,女性的照护需求率高于男性(P<0.05)。多因素Logistic分析结果显示,年龄每增加一岁照护需求风险增加7%(OR=1.07,95%CI=1.06~1.08);与文盲相比,文化程度在小学、初中、高中及以上老年人照护需求OR(95%CI)分别为0.33(0.29~0.37)、0.24(0.20~0.28)、0.17(0.12~0.22);与每日锻炼身体相比,每日不锻炼老年人照护需求OR(95%CI)为1.17(1.05~1.30);与不患慢性病人群相比,患1~2种和患3种及以上慢性病老年人照护需求OR(95%CI)分别为1.29(1.10~1.51)、1.57(1.35~1.82);与认知功能正常相比,认知功能异常老年人照护需求OR(95%CI)为2.02(1.79~2.27);与自评健康状态好相比,自评健康状况一般和自评健康状况差老年人照护需求OR(95%CI)分别为1.29(1.14~1.46)、2.68(2.27~3.16);与没有摔倒过相比,摔倒1~2次和3次及以上老年人照护需求OR(95%CI)分别为1.23(1.06~1.43)、2.00(1.59~2.52);与心理状况良好相比,轻度和中重度抑郁老年人照护需求OR(95%CI)分别为1.14(1.21~1.65)、2.05(1.69~2.48)。结论我国三省社区老年人照护需求率较高,且高龄、身体及心理健康状况差、跌倒次数多的老年人照护需求率更高。

标准化课程建设应用于重症医学科住院医师规范化培训教学的效果探索

目的 探讨标准化课程建设是否能够提高重症医学科住院医师规范化培训(简称住培)的质量和满意度。方法 选取首都医科大学附属北京安贞医院重症医学科住培基地2021级、2022级共24名学员。将研究对象按照专业化课程建立授课前后分组,进行自身对照比较。采用历史性对照方法,将2022级学员(第一年即接受标准化课程)一年住培结束后的成绩与2021级(无标准化课程)一年住培结束后的成绩进行对比分析。并根据标准化课程设立的不同的系统内容,进行相关成绩分析。360°评估量表对住培学员及指导医师等进行多角度和全方位的综合性评估。通过满意度调查评估住培学员满意度。结果 标准化课程授课一年后住培学员自身的考核成绩得分显著高于授课前(P<0.05),按年级分层比较也显示标准化课程后住培学员考核成绩高于之前(2022级P<0.05)。以住培第一年为节点,比较无标准化课程的学习成绩与接受标准化课程的学习成绩,后者有显著提高(P<0.05)。标准化课程建立后,学员成绩较标准化课程建立前的各系统成绩有提高,且掌握各系统内容更均质、全面。360°评价发现,住培学员与带教老师的相互评价提高。满意度调查发现学员满意度有所提升。结论 标准化课程建立对重症住培质量和满意度有明显提升作用。标准化课程的建设和实施可能为重症医学科住培提供范本,培养出可造之才。