Impact of Non-Clinical Years on Surgery Residents’ Technical Skills: Evaluation of a Technical Skills Refresher Curriculum

We ascertained the opinions of residents and faculty regarding technical skills decay during non-clinical training years and evaluated the effectiveness of a technical skills refresher curriculum (TSRC) offered to residents in the month prior to rejoining clinical training years. 32 faculty and 14 residents completed surveys which gleaned opinions regarding technical skills decay during non-clinical years. Six residents completed a TSRC during the month prior to rejoining clinical training. We compared clinical evaluations of the residents who completed the TSRC to residents who rejoined clinical training prior to the implementation of the curriculum. Surveys indicated that residents and faculty believe that non-clinical years have a slightly negative impact on technical skills and residents who completed dedicated research years would require up to 4 months for technical skills to return to the level of their non-research peers. Residents who completed the TSRC reported having significantly higher comfort levels with their technical skills after the curriculum

How Marie Sklodowska-Curie Doctoral Networks Can Support European Refractory Ecosystem in Context of The European Green Deal

The movement of the Iron&Steelmaking(I&S)industry towards Net-Zero emissions and digitalized processes through disruptive,breakthrough technologies will be achieved through the use of Hydrogen.The biggest challenge for the refractory industry is to continue to meet the performance expectations while,at the same time,moving to a more sustainable production direction.The complexity and urgency of these technological changes,highlighted by the European Green Deal,requires ambitious,international,interdisciplinary and intersectoral projects,bringing together institutes from across the global value chain,to carry out cutting edge research.The European Union,through its flagship doctoral training program,MSCA,has,and continues to support research and development as well as the promotion of the refractory industry in Europe.An introduction to two MSCA projects and some of the results achieved are highlighted within this article.

Knowledge towards Physical Medicine and Rehabilitation among Training Doctors and Medical Students at the Mohammed VI University Hospital of Marrakech

The aim of our study is to evaluate the knowledge regarding physical medicine and rehabilitation among physicians in training and medical students at the Mohammed VI University Hospital in Marrakech, to approach the knowledge, attitudes, and practices of doctors regarding physical medicine and rehabilitation and evaluate the knowledge in theoretical training related to PRM among the students. We conducted a monocentric cross-sectional analytical study, using a web-based anonymous survey, carried out among 558 undergraduate student and training doctors, randomly selected in the form of a survey on the knowledge towards Physical Medicine and rehabilitation. We received 558 survey duly completed by students of the Faculty of Medicine and Pharmacy of Marrakech (62.4%) and training doctors (37.6%). The mean age of the participants was 24.53 ± 3.9 years, with extremes ranging from 17 to 39 years. 52.7% of the participants were from the former educational reform, The predominance of participation was remarkable among pediatricians 23%, The population who knew PRM was the majority (79.3%), 40.7% of the participants were unaware of the availability of a PRM department at Mohamed VI University Hospital, 0.5% of all training doctors and medical students questioned strongly agreed with the sufficiency of their training in disability management were belonging to the new reform, 84.1% of participants had never attended or referred a patient to the PRM department. 23.2% of training doctors affirmed the referral of patients to PRM for further management. Despite the essential role of PRM in the management of diseases, it remains little known by training doctors and medical students. This lack of knowledge of PRM reflects the lack of the undergraduate and postgraduate of the medical education in the field of rehabilitation.

基于“DOCTOR”模型的公立医院采购管理评价体系构建

目的:基于"DOCTOR"模型构建公立医院采购管理评价体系,以客观评价公立医院采购管理品质,强化医院采购成本控制。方法:应用德尔菲法明确采购管理评价体系的指标,运用层次分析法确定各指标所占权重,最终建立公立医院采购管理评价体系。结果:公立医院采购管理评价体系共包含6项一级指标、24项二级指标。结论:公立医院采购管理评价指标体系有助于医院管理者全面了解医院采购工作情况,帮助医院改进、提升采购管理工作,为医院长期健康发展提供必要保障。

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。

农村地区高血压患者服药情况及影响因素研究:基于家庭医生签约服务

背景高血压是心血管疾病主要的危险因素,降压用药不仅要考虑患者血压特征,也要考虑患者合并症情况。现阶段,基于家庭医生签约服务对高血压患者的服药状况及影响因素研究比较缺乏。目的调查安徽省界首市家庭医生签约服务的高血压患者服药现状,描述患者服药行为与患者特征之间的关联,探索患者用药调整的影响因素,并分析基层高血压患者用药的合理性。方法采用整群抽样的方法,于2021年7—8月从安徽省界首市随机抽取48个行政村,通过面对面调查法采用自制问卷收集患者特征和服药数据,参照《国家基层高血压防治管理指南2020版》将问卷中患者提到的降压药分为如下5类:A类为血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体阻滞剂(ARB),B类为β受体阻滞剂,C类为钙通道阻滞剂(CCB),D类为利尿剂,E类为单片复方制剂。通过科大讯飞智能语音血压计的后台获取患者上传的近1年血压数据,分析不同特征患者的服药行为。采用多因素Logistic回归分析探讨高血压患者用药调整的影响因素。本研究中联合用药是指服用复方制剂或2种以上降压药,用药调整是指患者过去服用其他降压药。结果本研究共纳入高血压患者3005例,其中男1291例(43.0%)、女1714例(57.0%),平均年龄为(65.5±9.8)岁,高血压服药率为79.1%,联合用药率为40.2%。2376例服用降压药的患者中,不同类型降压药服用率从高到低依次为(部分患者存在联合用药):E类(39.6%)、C类(35.1%)、D类(20.3%)、A类(20.1%)、B类(3.7%);服用最多的降压药为复方利血平(33.7%)。对于年均血压≥160/100mm Hg的患者,仍有12.2%和4.9%未服用降压药。患者联合用药以E类降压药为主。年均“舒张压≥100 mm Hg”且“患合并症”的患者,调整后A类和C类降压药的服用率增加相对较多,年均“收缩压≥160 mm Hg”且“未患合并症”的患者,调整后E类降压药的服用率增加相对较多。多因素Logistic回归结果显示,服药年数长(OR=1.042,95%CI=1.031~1.053,P<0.001)、初中以上文化程度(OR=1.488,95%CI=1.195~1.853,P<0.001)、合并高脂血症(OR=1.267,95%CI=1.052~1.525,P=0.013)、合并心血管疾病(OR=1.394,95%CI=1.166~1.667,P<0.001)、合并脑血管疾病(OR=1.258,95%CI=1.040~1.522,P=0.018)是患者用药调整的促进因素,高龄(OR=0.980,95%CI=0.971~0.990,P<0.001)是用药调整的抑制因素。结论界首市农村地区高血压患者的服药率较高,主要服用E类和C类降压药。服药年数长、初中以上文化程度、合并高脂血症、合并心脑血管疾病是患者用药调整的促进因素,高龄是用药调整的抑制因素。

Study on AIDS Epidemic from Unsafe Blood Handling among Rural Doctors

Objectives: This paper examines the basic knowledge ofAIDS and HIV transmission through unsafe blood collec-tion and supply among rural Chinese doctors. It also ex-plores the accessibility of AIDS intervention methods inrural area. Methods: We did Case studies, held focus group discus-sions and provided questionnaires to all rural doctors inone township where the epidemic of HIV was known to bespread through blood collection and supply. Data were col-lected and analyzed with software EPI 6.0.Results: The effective response rate to the questionnairewas 100%. The results showed that more than 95% of in-formants gave correct answers to the questions about thesexual and blood-bourne transmission of HIV as well as itscontagiousness. Half of the participants were ignorant aboutmother to child transmission of HIV and did not know thatHIV couldn’t be transmitted by saliva, sweat, mosquito bites,sharing of bathtubs or toilets. More than 80% of infor-mants were opposed to blood selling and reportedly under-stood the objective of the blood organizers in their villages,knew the peak time of blood selling by the villagers, and ,were aware of the risks of diseases being spread throughblood. . 27.3% used disposable syringes ‘once in a while’,and 15.2% discarded or sold used disposable syringes.Conclusions: The authors assert that there are severe lurk-ing perils of iatrogenic cross infection in rural areas. Ruraldoctors urgently need formal training on prevention andtreatment of HIV infection. We believe that rural doctorsshould become the key force in AIDS prevention and con-trol in rural area.

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。

我国农村家庭医生签约服务老年人健康管理实践影响因素:一项范围综述

背景以家庭医生签约服务为载体的健康管理服务是我国农村老年人实现健康老龄化的必要途径,而该项服务在实践中受到多种因素影响。目的对影响我国农村家庭医生签约服务老年人健康管理实践的因素进行范围综述,为提高该项服务的可及性和有效性提供参考依据。方法于2023年1—4月,遵循范围综述报告规范清单,于Web of Science、PubMed、Embase、Medline、CINAHL、中国知网、万方数据知识服务平台、维普网和中国生物医学文献数据库检索有关家庭医生签约服务老年人健康管理的文献,检索时限为建库至2022-12-31。根据纳入和排除标准,基于社会生态学模型审查、总结和分析影响农村家庭医生签约服务老年人健康管理实践的因素。结果共纳入27篇文献,提取了与农村家庭医生签约服务老年人健康管理相关的个人、人际、组织、社区及政策5个层面的影响因素。结论农村家庭医生签约服务老年人健康管理实践受到多层面、多因素影响,推动农村地区签约服务老年人健康管理发展需综合考虑其影响因素,明确各责任部门、主体的权利和义务,合力促进以家庭医生签约服务为载体的健康管理服务提质增效。

“DOCTOR”医院采购管理体系建立与创新

随着国家医药卫生体制改革的不断深入,医院采购管理已成为医疗卫生系统管理者关注的重点。医院的采购工作是一项系统工程,其管理体系的建立也是医疗管理领域中值得探究的重要课题。通过对秦皇岛市第一医院长期采购工作经验的总结与提炼,提出"DOCTOR"采购管理体系,包含部署、目标、成本、学习、合法、档案等6个元素,进一步适应新形势下现代医院采购要求。

“DOCTOR”医院采购管理体系实施效果研究

目的:研究分析秦皇岛市第一医院深化实施"DOCTOR"采购管理体系的效果,以促进医院采购管理精细化、科学化,进而提升医院采购管理水平。方法:采用分层随机抽样方法调查院内科室采购成本控制与采购满意度情况,运用描述性统计、秩和检验等方法进行分析。结果:深化实施"DOCTOR"采购管理体系后,院内科室的采购满意度得到显著提升,采购成本显著降低。结论:"DOCTOR"采购管理体系能够有效帮助医院进行采购成本控制,提升采购满意度,具有可推广性。

基于结构方程模型的“DOCTOR”医院采购管理体系计量验证

目的对"DOCTOR"医院采购管理体系进行计量验证。方法在两所公立医院开展问卷调查,由所获数据对理论模型进行信度和效度检验,通过构建高阶因素分析模型进行计量验证。结果 "DOCTOR"医院采购管理体系内六大要素结构清晰,相互之间适度正向相关,共同构成整体管理体系;能够显著提升采购满意度,控制采购成本;具备一定程度的推广性。结论 "DOCTOR"医院采购管理体系构建合理,六大要素相互关联,共同促进医院采购管理水平提升。

Evaluation of Need and Distribution of National Essential Medicines List in Village Clinics:A Cross-sectional Study Based on the Perspective of Village Doctors in China

This study aimed to evaluate the satisfaction of village doctors to essential medicines list (EML) and accessibility of essential medicines (EMs) distribution to improve the implementation of EML in village clinics.A total of 422 village doctors from five counties in three provinces of China were surveyed by questionnaires.Logistic regression analysis was conducted to identify the main factors associated with village doctors' evaluation of EML.The results showed that village doctors had a negative evaluation in satisfaction level of EML to village-based care and accessibility of EM distribution.The government should adjust EML regularly based on the actual health status of local villagers in China and focus on adding appropriate drugs that meet the needs of villagers with chronic disease.The local government should also attach importance to the distribution of EMs and maintain their supply in village clinics.

Standardized training for resident doctors in China

Medical graduates are not fully trained physicians when they leave medical school.Currently,standardized training for resident doctors in most hospitals in China is carried out according to the Ministry of Health guidelines.However,these guidelines provide only outline guidance,and specific resident training is managed independently by and varies with individual institutions.Therefore,it is important to study training demand to learn about the content and emphasis of training.

Reviewing the trends of nursing doctoral thesis research in Hong Kong

This review aimed to analyze the trends and contributions of nursing doctoral theses produced in Hong Kong. A total of 56 nursing doctoral theses were included in this review. The most often studied topic was cardiovascular rehabilitation care (n = 9, 16%). More recently, the most often studied topics has been health technology advancements in nursing care (n = 6, 10.7%). The common trend of study methods was to be quantitative in nature. Of the total, 35 out of 56 were quantitative studies. Half were experimental/ quasi-experimental research studies (n = 28, 50%). For theoretical foundations or applications, the majority (n = 21, 36%) of doctoral theses had no specific theoretical/conceptual models as study frameworks. This trend indicates that there is space for improving the theoretical and philosophical foundation of nursing research in Hong Kong. For the contributions of doctoral thesis research, Hong Kong nursing scholars place more emphasis on direct enhancement of clinical practice or the improvement of patient outcomes. This review provides concrete evidence of the status of nursing research and knowledge development in Hong Kong nursing.

Underlying Beliefs Influencing Vietnamese Nurses and Doctors in Screening for Victims of Domestic Violence: An Exploratory Study

Many health professionals in Vietnam have limited knowledge and experience in coordinating care for victims of Domestic Violence (DV). This qualitative study aimed to elicit the beliefs of nurses and doctors that are influencing the care of victims of DV. Data were collected by semi-structured interviews with nineteen nurses and doctors. Data were analyzed by content analysis and organized by three main themes;behavioral beliefs, normative beliefs and control beliefs. The outcomes of this study will inform the development of intervention strategies that will enable health professionals to better respond to and manage care for women who experience domestic violence in Vietnam.

Work-family conflict and job burn-out among Chinese doctors:the mediating role of coping styles

Background Burn-out among doctors threatens their own health, and that of their patients. To identify risk factors of the doctor burn-out is vital to improving their health and increasing the quality of healthcare services. This study aims to explore the relationship between work-family confict （WFC） and burn-out among Chinese doctors and the mediating role of coping styles in this relationship.Methods A cross-sectional survey was conducted in China, with a questionnaire packet which consisted of the Chinese Maslach Burnout Inventory （CMBI）, WFC Scale and the Simplifed Coping Style Questionnaire （SCSQ）. A total of 2530 doctors participated in the survey. Correlation analysis was performed to explore the relationship between CMBI, WFC and SCSQ scores. A linear regression model was set to determine the mediating role of coping styles on the relationship between WFC and burn-out.Results Doctors who had higher scores on work interfering with family confict, reported more emotional exhaustion （r=0.514, P〈0.001） and had a sense of accomplishment （r= 0.149, P〈0.001）. Simultaneously, family interfering with work （FIW） was positively associated with all dimensions of burn-out （r=0.213, 0.504, 0.088, respectively, P〈0.001）. Coping styles had partial, complete and even mediating effects on the relationship between WFC and burn-out among Chinese doctors.Conclusions WFC was correlated with burn-out, and coping style was a mediator in this relationship among Chinese doctors. Coping style was a positive resource against burn-out.

Stress and sleep quality in doctors working on-call shifts are associated with functional gastrointestinal disorders

To investigate the role of sleep quality and psychosocial problems as predictors of functional gastrointestinal disorders (FGIDs) in doctors that work 24 hour-on-call shifts.METHODSIn this cross-sectional observation study, using the Rome III Questionnaire and Pittsburgh Sleep Quality Index (PSQI), we analyzed 170 doctors with 24 hour-on-call shifts.RESULTSAmong the participants that had experienced a 24 hour-on-call shift within the last 6 mo, 48 (28.2%) had FGIDs. Overall prevalence of irritable bowel syndrome (IBS) and functional dyspepsia (FD) were 16.5% and 17.1%, respectively, with 5.3% exhibiting both. Sleep scores (PSQI) (8.79 ± 2.71 vs 7.30 ± 3.43, P = 0.008), the presence of serious psychosocial alarm (83.3% vs 56.6%, P = 0.004), and the proportion of doctors who experienced over two months of recent on-call work (81.2% vs 68.9%, P = 0.044) were significantly different between individuals with or without FGIDs. Multivariate analysis revealed that presenting serious psychosocial alarm was an independent risk factor for prevalence of FD (OR = 5.47, 95%CI: 1.06-28.15, P = 0.042) and poor sleep quality (PSQI ≥ 6) was a predictor of IBS (OR = 4.17, 95%CI: 1.92-19.02, P = 0.016).CONCLUSIONPhysicians should recognize the role of sleep impairment and psychological stress in the development of FGIDs and a comprehensive approach should be considered to manage patients with FGIDs.

Satisfaction of Village Doctors with the Township and Village Health Services Integration Policy in the Western Minority-inhabited Areas of China

Township and Village Health Services Integration Management（TVHSIM） is an essential form of China＇s two-tiered health service integration plan at the township and village level. Its main purpose, also one of the target goals in China＇s new healthcare reform, is to gradually integrate rural health services and appropriately allocate rural health resources. This study aims to assess the village doctors＇ satisfaction with the TVHSIM and provide scientific base to further improve TVHSIM. A cross-sectional study was carried out in which 162 village doctors from Qinghai, Inner Mongolia and Xinjiang in western China were interviewed. Descriptive analysis, independent t-test, one-way ANOVA, Spearman rank correlation and multiple linear regression were used to analyze the difference and relevance between village doctors＇ personal characteristics and their satisfaction with TVHSIM and six subscales. Village doctors with different years of practice, social insurance status and essential medical knowledge level showed statistically significant differences in their satisfaction levels（all P〈0.05）. Age（P〈0.05） and years of practice（P〈0.01） were negatively correlated with Drug and Medical Device Management and Financing Management. Essential medical knowledge level（P〈0.05） was negatively correlated with Operations Management as well. However, social insurance status（P〈0.05） was positively correlated with Human Resources Management and Drug and Medical Device management. Gender, age and years of practice respectively had significant influence on village doctors＇ satisfaction with TVHSIM（P〈0.01）. In conclusion, in order to further promote TVHSIM policy in rural China, a well-rounded social insurance model for village doctors is urgently needed. In addition, the development of TVHSIM is regionally imbalanced. Efficient and effective measures aiming at rationalizing gender and age structure and enhancing essential medical training should be carefully considered.

Jean-Pierre Abel-Rémusat:Doctor and Sinologist

1 Introduction Throughout his life,Jean-Pierre Abel-Rémusat(1788-1832)(Fig.1)was in contact with the medical art,through his family,through his studies,through a few moments of practice,through his various interests and in many of his written.