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.

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。

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.

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.

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。

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。

医学留学生传染病见习教学中TBL模式的应用和改进

目的:研究TBL教学在医学留学生传染病见习教学中的应用及存在的问题,为改进和推广该教学方法提供参考依据。方法:选取中山大学中山医学院2012级、2013级和2014级医学留学生,将其分成实验组和对照组。实验组采用TBL教学,对照组采用传统教学法,见习结束后进行闭卷考试及问卷调查。结果:实验组在理论考核及各项能力提升方面均优于对照组,对教学模式满意度明显高于对照组(P均<0.05)。结论:与传统教学模式相比,TBL教学对提高医学留学生学习兴趣,培养分析问题、解决问题、沟通能力和团队协作精神以及提高教学效果均有帮助。

MDT联合CBL教学法在胃肠肿瘤外科临床带教中的应用

目的 探讨多学科会诊(multidisciplinary team,MDT)联合以案例为基础(case-based learning,CBL)的教学法在胃肠肿瘤外科临床带教中的应用效果。方法选择2020年1月—2021年12月在广西医科大学附属肿瘤医院进行住院医师规范化52名培训学员为研究对象,随机将其分为观察组和对照组,每组各26名。观察组采用MDT联合CBL教学法,对照组选择以授课为基础(lecture based learning,LBL)的教学法,采用考试考核及调查问卷分析对比两组学员的教学效果。结果 观察组病例分析题、理论知识总成绩及技能操作考核成绩均高于对照组,差异有统计学意义(P <0.05)。观察组在激发学习兴趣、课堂气氛活跃、提高阅读指南及文献能力、提高独立思考能力、锻炼临床思维、培养团队协作能力、继续接受该教学模式等方面的满意度均优于对照组,差异有统计学意义(P <0.05)。结论 MDT联合CBL教学法可培养学员学习兴趣,提高其阅读指南及文献、独立思考、临床思维及团队协作能力等,教学效果良好。

某省级三甲公立医院国际医疗中心护理管理团队职业化模式构建及效果评价

目的探索某省级三甲公立医院国际医疗中心护理管理团队职业化模式。方法通过文献研究、德尔菲专家咨询,在某省级三甲公立医院国际医疗中心的3个护理单元(包含门诊、一病区、二病区)分别建立3人制护理管理团队,对管理团队进行职业化培训,明确管理边界与职责任务,并在医院国际医疗中心进行实证研究,对3个护理管理团队(合计9人)实施前后的护士领导力、患者满意度、学科建设等进行比较。结果实施职业化培训后,护士领导力各维度得分均提高,且有统计学意义(P<0.05),患者满意度提高(P<0.05),护理质量、科研水平、创新能力均提升。结论通过成立护理管理团队并进行职业化培训,可有效推广职业化管理理念,提高护士领导力,培养人才梯队,带动学科和团队的整体发展,提升护理文化内涵,适合医院各临床科室推广应用。

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。

我军机动医疗救护分队阶梯式岗位评价的质性研究

目的 探索机动医疗救护分队岗位评价指标构成要素,为实现科学、合理的岗位管理提供依据。方法采用目的抽样法在军队医院、研究院所等选取8名相关领域的专家作为研究对象,采用半结构式访谈法调查机动医疗救护分队岗位评价指标要素,借助NVivo12.0软件对访谈内容进行整理、编码、分类、归纳、提炼主题。结果 归纳出岗位准入、岗位技能、岗位强度、岗位环境、岗位职责5个层面,提炼出“岗位要求—岗位特性—岗位意义”阶梯式岗位评价模型。结论 在进行岗位评价时,应注重考察分队人员的能力和素质、岗位的责任和特性,为公正评价岗位、科学管理人员提供基础。

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。

家庭医生制度下医护团队模式干预在社区高血压疾病管理中的应用效果

目的:探讨家庭医生制度下医护团队模式干预对社区高血压疾病管理的应用效果。方法:选取2021年1月—2022年1月湖北中医药高等专科学校附属三板桥医院收治的高血压患者126例作为研究对象,依据随机数字表法分为两组,各63例。对照组实施常规干预,观察组实施家庭医生制度下医护团队模式干预。比较两组血压、依从性及高血压知识知晓率。结果:干预6个月后,两组收缩压、舒张压低于干预前,且观察组低于对照组,差异有统计学意义(P<0.05);两组治疗依从性、护理依从性、自我管理依从性、预防行为依从性评分高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05);两组预防知识、危害、危险因素、高血压诊断知晓率高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:家庭医生制度下医护团队干预模式在社区高血压疾病管理中的应用效果较好,可有效控制患者血压水平,提升患者依从性及高血压知识知晓率。