Evaluation of Attending Medical Teams and Their Impact on the DRG Components of Cholecystectomy

Objective:This study assessed the role of the attending medical team in the cost control of the cholecystectomy DRG components.Methods:The association between team structure,workflow,and treatment outcomes was analyzed using a mixed-methods approach combining quantitative data and qualitative interviews from 628 patients.Results:Inter-professional teamwork significantly affected length of stay,treatment costs,and recurrence rates,with experienced teams performing better in terms of emergency response and collaborative efficiency.Patient satisfaction was generally high,indicating that good teamwork enhances treatment outcomes.Significance:The study highlights the importance of optimizing team configuration to improve the quality,efficiency,and cost control of healthcare.

Sources and symptoms of stress among nurses in the first Chinese anti-Ebola medical team during the Sierra Leone aid mission: A qualitative study

Objective: This study investigated the sources of stress,corresponding symptoms,and stress relief among nurses of the first Chinese anti-Ebola medical team during the Sierra Leone aid mission.Method: A purposive sampling method was used and 10 nurses were selected from the first Chinese anti-Ebola medical team that was dispatched to Sierra Leone.Data were collected via phone and semistructured interviews,then analyzed using Colaizzi's seven-step method.Results: The data showed three major themes: (1) The causes of stress during the Sierra Leone aid mission mainly related to unsafety,responsibility,and unfamiliarity;(2) Physical,cognitive,emotional,and behavioral symptoms were documented;(3) Nurses experienced relief from stress after the mission.Conclusion: Targeted measures,proper responses and good community support can effectively lower stress among nurses on anti-Ebola missions.

The Training and Performance of Emergency Physicians as Anesthetists for International Medical Surgical Response Teams: The Emergency Physician’s General Anesthesia Syllabus (EP GAS)

Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians (EPs) possess skills in airway control, management of moderate and deep sedation, and ventilator management, we propose that with proper training in general anesthesia, EPs can serve as anesthetists for IMSuRT with anesthesiologist supervision. Methods: During a 10-week period, a board-certified EP administered general anesthesia to 60 patients prior to a surgical medical mission trip. The breakdown of surgical cases was: 11 orthopedic, 2 genitourinary, 20 ear, nose, and throat, 8 obstetrics and gynecological, 13 general surgery, and 6 vascular. A simplified protocol for induction, maintenance, and emergence was adhered to for all cases. Results: Fourteen orthopedic cases using general anesthesia were performed in a one-week period in Haiti. These cases involved open reduction and internal fixation (ORIF), hemiarthoplasty, hardware removal, tendon transfer and external fixation of fractured bone. Conclusion: We demonstrate the feasibility of a model curriculum to train EPs in the basics of anesthesia. The EP can safely and effectively deliver general anesthesia for major cases on surgical medical mission trips under the auspices of an anesthesiologist in an austere environment.

The Medical Care of Multiple Disciplinary Team Reduces the Risks of Complications in Patients after Arteriovenous Fistula Operation

Introduction: Arteriovenous fistula (AVF) operation is recognized a gold standard of hemodialysis for end-stage renal disease. Because various complications may occur during perioperative period, medical care plays an important role in improving the possibility of AVF operation. The objective of the study was to explore the effect of the mode of multiple disciplinary team (MDT) medical care on the patients with end-stage renal disease treated by arteriovenous fistula (AVF) operation. Method: 98 patients with end-stage renal disease under the AVF operation were divided into observation group and control group. The control group was performed with regular medical care and for the observation group was treated under the mode of MDT medical care. Complications after operation, hospitalized time and medical satisfaction were comprehensively compared between the both groups. Results: The overall complications including swelling, bleeding, infection and thrombosis in observation group accounted for 5%, however, 19% of patients suffered different complications in the control group. The total complications significantly decreased in the observation group compared with control group (P < 0.001). The hospitalization time was shortened to 9.8 ± 5.6 days in the observation group, and the average hospitalization in control group was 17.8 ± 8.9 days. The medical satisfaction was increased by 20.83 percent in the observation group compared with the control group (P < 0.001). 75% patients in control group were satisfied with medical care, and 98.53% patients were satisfied for observation group. Conclusion: The mode of MDT medical care was beneficial for patients with end-stage renal disease after AVF operation, which could significantly reduce complications, hospitalized time and improve patients’ degree of satisfaction. Thus, it should be recommended in the clinical work.

Implement the Palliative Care in Medical Practice of a Tertiary Comprehensive Hospital in China

The locations and modalities of palliative care services to patients with severe/end-stage illness can be diverse,ranging from general hospitals to home-based care.The concept of palliative care hasn't been fully applied to medical practice by care providers in China's Mainland,where the seriously ill or terminal patients mainly receive medical care in hospitals.The implementation of palliative care in medical practice has developed greatly in Peking Union Medical College hospital in terms of clinical patient care,education,and research.This article gives an overview of it,and the experiences in team building,promotion,support seaking and fund raising were also discussed in this article.We hope to explore an effective dilivering model of palliative care for end-stage patients that is adaptive to Chinese culture and social environment.

Medical care delivery at the Beijing 2008 OlympicGames

BACKGROUND： Beijing successfully hosted the 2008 Olympic Games, and the servicesincluding medical services were widely appreciated by both participants and visitors. Weretrospectively analyzed the quality of the medical services provided to athletes, spectators, VIPs,and the workforce during the Beijing 2008 Olympic Games. The information thus gathered would beuseful for planning strategies for managing mass gatherings.METHODS： Medical encounter forms filled during the Beijing 2008 Olympic Games wereretrospectively reviewed. Descriptive statistics was used to characterize the data by accreditation anddiagnostic categories.RESULTS： A total of 22 892 medical encounters were documented during the Beijing 2008Olympic Games. Among them, 10 549 （46.08%） involved the workforce, 3 365 （14.70%） athletes,3 019 （13.19%） spectators, 585 （2.56%） members of the media, 1 065 （4.65%） VIPs, and 4 309（18.82%） others. Of the 22 892 cases, physical injury accounted for 27.90% （6 386）, respiratorydisease 18.21% （4 169）, and heat-related illnesses 2.68% （615）.CONCLUSIONS： Preparations of the medical service for the Beijing 2008 Olympic Gameswere made for 7 years, and the service provided has been praised worldwide. This study providesvaluable information that may be useful for planning medical services for upcoming Olympic Games,including the London 2012 Olympic Games and other mass gatherings.

基于Team STEPPS的出院准备护理对股骨头缺血性坏死术后患者的影响

目的:研究基于提高医疗质量和患者安全的团队策略和工具包(team strategies and tools to enhance performance and patient safety,Team STEPPS)的出院准备护理对股骨头缺血性坏死(ANFH)术后患者的影响。方法:选取清远市人民医院2022年1—8月收治的76例ANFH术后患者为研究对象,采用随机数字表法分为观察组和对照组,各38例。对照组实施术后常规护理,观察组在对照组基础上实施基于Team STEPPS的出院准备护理。对比两组自我管理能力、遵医行为情况。结果:护理后,两组运动锻炼、认知性症状管理与实践、与医生交流得分及总分升高,观察组高于对照组(P<0.05);护理后,两组功能锻炼、工作活动、日常起居、定期复查得分及总分升高,观察组高于对照组(P<0.05)。结论:基于Team STEPPS的出院准备护理可以提高ANFH患者术后居家自我管理能力及遵医行为。

TBL(Team-based learning)教学法在局解教学中的设计与评价

为适应现代医学发展的要求,在日益增多的医学教学改革尝试中,TBL教学法引起人们的关注。本文通过在局部解剖学教学中开展TBL教学,并且和传统教学方法做了对比研究。结果提示在局部解剖学教学中采用TBL教学法有利于提高学生学习兴趣及解决问题的能力,有利于动态评价学生的学习状态。

县域医共体下家庭医生团队知识共享现状及影响因素研究

背景县域医共体下家庭医生团队知识共享是县乡村三级机构之间互动的重要方式,对于提升区域医疗卫生服务质量、改善居民健康水平等起重要作用。目的了解县域医共体下家庭医生团队的知识共享现状,探讨其影响因素,为促进家庭医生团队内部知识管理和能力提升提供科学依据。方法于2022年10—12月,采用方便抽样法在湖北省抽取2个县域医共体,经多阶段抽样选取医共体下的381个家庭医生团队为研究对象。采用自编团队知识共享调查问卷调查团队的知识共享水平,包括显性知识共享、隐性知识共享两个维度。采用多元线性逐步回归分析探讨家庭医生团队知识共享的影响因素。结果县域医共体下家庭医生团队知识共享总得分为(27.84±3.84)分,显性知识共享、隐性知识共享维度的平均条目水平得分分别为(5.51±0.79)、(5.61±0.77)分。多元线性逐步回归分析结果显示,学历异质性指数、团队长作用、团队沟通强度、平台载体使用水平、团队活动强度、成员学习积极性是县域医共体下家庭医生团队知识共享总得分的影响因素(P<0.05)。结论县域医共体下家庭医生团队内部知识共享处于良好水平,但仍有提升空间。建议通过增加家庭医生团队活动频次,提高团队沟通能力,采取相关激励措施,拓展知识共享渠道等促进家庭医生团队成员知识共享。

县域医共体下家庭医生团队管理现状及相关因素研究

背景县域医共体下家庭医生团队效能不高,团队管理现状尚不明确,不同特征成员的团队管理感知情况亦不明晰。目的了解县域医共体下家庭医生团队管理现状,为进一步完善家庭医生团队管理提供依据。方法于2022年10—12月,采用课题组自行设计的问卷对湖北省内县域医共体下429个家庭医生团队的1724名主要成员进行调查,调查内容包括团队配置管理、团队互动管理及团队管理结果等。采用χ2检验、单因素方差分析对不同特征家庭医生团队成员的团队管理感知差异进行分析,采用Pearson相关分析探讨团队互动管理因素与团队管理结果因素的相关性。结果1724名调查对象中,62.9%(1084/1724)的成员感知团队考核激励措施为有效,88.7%(1530/1724)的成员感知拥有合理的家庭医生团队人员配置;对团队互动管理的感知方面,团队内部互动强度得分为(22.3±5.3)分,团队外部互动强度得分为(22.0±5.3)分;对团队管理结果的感知方面,团队目标实现(即团队任务绩效)得分为(33.1±7.4)分(总分为0~36分),团队满意度得分为(22.3±4.9)分(总分为0~24分),团队发展潜力得分为(27.9±6.3)分(总分为0~30分)。不同岗位、不同职称、不同年龄段家庭医生团队成员团队配置管理、团队互动管理、团队管理结果感知情况比较,差异有统计学意义(P<0.05)。团队互动管理因素与团队管理结果因素之间存在线性正相关关系(P<0.05)。结论家庭医生团队成员感知团队配置管理情况相对良好,团队考核激励措施仍有改善空间;家庭医生团队互动管理较佳,团队互动对团队管理结果提升具有重要作用;家庭医生团队成员对团队管理结果感知较好,感知任务绩效低于满意度和发展能力;不同岗位、职称、年龄段的家庭医生团队成员对团队管理感知差异较大。

长学制传染病教学中TBL(Team-Based Learning)模式的应用和改进

目的:研究TBL教学在八年制学生传染病教学中的应用成效及存在的问题,为改进和推广该教学方法提供参考依据。方法:对2006级八年制学生部分理论课采用TBL教学,进行闭卷考试及问卷调查。结论:与传统教学模式相比,TBL教学对提高学生学习兴趣,培养学分分析问题、解决问题、沟通能力和团队协作精神以及提高考试成绩均有帮助。

神经源性肠道功能障碍患者基于Team STEPPS的出院准备

目的探讨脊髓损伤致神经源性肠道功能障碍患者基于Team STEPPS出院准备的实施效果。方法将78例脊髓损伤致神经源性肠道功能障碍患者按照住院时间顺序分为对照组和观察组各39例;对照组实施常规出院准备,观察组实施基于Team STEPPS的出院准备。结果观察组出院准备度及出院指导质量得分除需要的内容维度外,总分和其他维度得分显著高于对照组,患者对护理工作满意度显著优于对照组(均P<0.01)。结论基于Team STEPPS构建和实施出院准备,可提高脊髓损伤致神经源性肠道功能障碍患者出院准备度和出院指导质量,提高患者满意度。

科教兴国背景下高校医学实验技术队伍建设新思路

目前,国家对实施科教兴国战略、强化现代化建设人才支撑作出重大部署。为了加强高校医学实践教学质量与实验技术队伍建设,通过对医学实验技术队伍现状进行分析,提出了科教兴国背景下高校医学实验技术队伍建设的新思路,即深化实验技术队伍与教师队伍的交叉融合,以专业能力培养为导向,建设实验技术队伍评价体系与职称晋升体系,以教学改革项目为突破,明确实验技术队伍定位及建设目标,以工科领域为参考,放宽医学实验技术队伍职能权限,为当前高校医学实验队技术伍建设提供参考。

Entry-Level Forward Surgical Team Training Is Associated with Increased Confidence of Primary Combat Surgeons

Background: In recent years, we have established an entry-level Forward Surgical Team (FST) training program in a Chinese military medical university for the 5th grade undergraduates, who would be deployed to different military medical services as primary combat surgeons. This study aimed to assess the role of this pre-service training in improving their confidence with combat medical skills, after several years since they received the training. Methods: We conducted a nationwide survey of 239 primary combat surgeons who have ever participated in an entry-level FST training program before deployment between June 2016 and June 2020, which was for evaluating on a 5-point Likert scale the benefits of entry-level FST training and conventional surgery training in improving their confidence with combat medical skills. The difference in scores was compared using the student t-test. Significance was considered as P Results: The total score was significantly higher for entry-level FST training than that for conventional surgery training (30.76 ± 4.33 vs. 28.95 ± 4.80, P There was no significant difference between the training for surgical skills confidence scores (18.03 ± 8.04 vs. 17.51 ± 8.30, P = 0.098), but for non-technical skills, the score of entry-level FST training was significantly higher than that of conventional surgery training (12.73 ± 5.39 vs. 11.44 ± 5.62, P The distributions of confidence scores were different under various subgroups by demographics. There were no significant differences in scores between the two training in all specific surgical skill sets except “life-saving surgery” (P = 0.011). Scores of all 4 non-technical skill sets were significantly higher for entry-level FST than those for conventional surgery training (P Conclusions: The training should be considered as an essential strategy to improve confidence in combat medical skills, especially life-saving surgery and non-technical skills, for primary combat surgeons.

多学科诊疗门诊现状与质量控制——以广西某三甲医院为例

多学科诊疗(MDT)门诊广泛应用于肿瘤、疑难危重复杂疾病及多病共存的患者诊疗。文章旨在研究在三级医院开展MDT门诊一站式就诊模式和诊后闭环管理,在实现医疗资源整合、优化就医流程、改善患者就医体验、保障医疗质量与安全方面起到重要作用。针对MDT门诊管理中职能部门重视不足、临床医师积极性不高、患者就诊主动性不强、MDT门诊信息化建设不完善、质量改进效果不佳等薄弱环节及质量控制难点,采取核心成员引领、配套激励考核机制、定期通报质量情况、完善信息化建设、延伸服务范围、加大宣传力度等有效管理手段持续改进,在提升病例病种数量、扩大品牌影响力、提高会诊质量方面取得了明显成效。

医学基础与临床融合发展教学团队建设现状分析与初步实践

全面加强医学类师资队伍建设对提升医学人才培养质量具有重要意义,也是推动医学基础与临床融合发展的关键路径。分析目前医学类师资队伍建设过程中面临的困境与挑战,以地方院校医学师资队伍建设为切入点,聚焦基础与临床融合发展的教学团队建设,探讨加强基础与临床融合发展教学团队建设的实现路径,总结加强基础与临床融合发展教学团队建设的实践经验,以期通过教学团队建设,为持续提升医学专业人才培养质量提供经验与支持。

“新医科”视域下基础医学教师素养内涵的解构分析

“新医科”建设承担着为健康中国培养医学创新人才的使命,推进着医学教育的深刻变革。基础医学是医学教育中的重要组成和医学创新的前沿阵地,高素质的师资队伍是医学创新人才培养的关键。通过文献检索及经验总结,对“新医科”视域下基础医学教师素养的内涵从三个方面进行了解构和分析。首先明确了品格素养的内涵是以教育家精神、科学家精神和医学人文精神为其内核;其次从学科知识、数字信息知识和教育理论知识三个方面分析了知识素养的内涵;最后,以教学能力、科教融合能力、创新能力、人才培养能力和管理能力这几个方面解构基础医学教师能力素养。在此基础上,结合现状,针对内涵制定相应措施,“引”“育”并行、科教并重,构建“一中心三结合四维度”的基础教师素养培养提升体系应用于师资队伍建设,在师德师风建设、知识结构优化、科研创新能力提升等方面取得一定成效,意在打造一支政治过硬、管理科学、育人水平高超、具有创新活力的高质量基础医学师资队伍。

多元教学法在医学影像学教学中的应用

目的探讨案例教学法(case-based learning,CBL)、以团队为基础的学习(team-based learning,TBL)联合基于医学影像存档与传输系统(picture archiving and communication system,PACS)、思维导图的多元教学法在医学影像学教学中的应用价值。方法选取2022年1月—2023年12月广州医科大学附属第一医院放射科36名本科实习生为研究对象,2018级实习生为对照组,2019级实习生为试验组,对照组采用传统教学法,试验组采用多元教学法,对比2组出科理论知识考核平均成绩和实践技能考核平均成绩。结果试验组实习生出科理论知识考核、实践技能考核和总成绩分别是(44.78±2.44)分、(39.50±2.43)分和(84.28±4.78)分,均高于对照组的(39.72±3.36)分、(34.50±3.13)分和(74.22±6.42)分,差异有统计学意义(P<0.001)。试验组实习生的整体成绩等级优于对照组,差异有统计学意义(P<0.05)。结论CBL、TBL联合PACS、思维导图多元教学法可以满足当前医学影像学实习教学目标,促进实习生自主学习并提升教学效果。

湖北省医疗机构护工队伍建设现状调查

目的调查湖北省医疗机构护工队伍建设现状,以促进护工行业的规范化发展。方法2023年8-9月,以便利抽样方法,抽取湖北省17个地市州医疗机构的护理管理者及护工,采用由中华护理学会决策咨询工作委员会编制的医疗机构调查问卷及护工调查问卷进行调查。结果有效调查1398所医疗机构,其中仅395所医疗机构配备有护工。护工队伍人员结构以女性、年龄≥50岁、初中及以下文化程度、<5年工作年限为主;工作模式偏向一对一服务、24 h制、非固定休息;应聘渠道主要为通过他人介绍,以患者自聘和社会化管理为主;管理机构主要是第三方中介公司(62.62%);培训覆盖率达78.27%,以岗前一次性培训为主,考核率为49.62%;薪资水平以2000~5000元为主;53.78%的护工没有缴纳或由自己缴纳保险;近60%的医疗机构对护工服务态度及服务质量满意。结论医疗机构的护工管理制度待完善,人员结构待调控,协调机制待优化,队伍建设续航能力待保障,劳动保障待健全。有必要建立护工管理体系,统一准入标准,构建科学化工作模式,创新培训与考核制度,构建科学合理的劳动保障制度,以促进优质护理服务。

中华人民共和国初期卫生工作与基层治理重构──以防疫医疗队为视角

卫生工作是国家治理的重要组成,是维护国民健康,促进经济发展和社会稳定的关键因素。中华人民共和国初期,新政权以“防疫医疗队”的组织形式深入广大基层地区开展卫生工作,通过推动“情感认同的激发(疫病防治)—思想文化的改造(教育宣传)—队伍体系的壮大(干部培养)—社会秩序的稳定(组织建立)”的实践,促进国家力量向基层下沉,为基层社会治理的重构提供了充分保障。从防疫医疗队的工作开展来看,卫生工作推动基层治理的重构具体表现在:理念治理层面关系导向的树立,技术治理层面内生动力的生成,情感治理层面政治认同的推进,以及文化治理层面现代观念的塑造。