Determinants of the Frequency of Prenatal Consultations among Women Giving Birth in the Maternity Wards of the Commune of Agbangnizoun (Zou), Benin

Antenatal care is a safe way to prevent pregnancy-related health problems, difficult deliveries and even further to anticipate low birth weight [1]. But pregnant women, especially in Africa, do not attend antenatal clinics as recommended by the WHO. The general objective of this study was to study the norm in terms of Antenatal Consultation (ANC) frequency as well as the determinants of the frequency among women who gave birth in the maternity hospitals of Agbangnizoun. Our research was a cross-sectional, descriptive, retrospective and quantitative type, which was carried out among 335 women in Agbangnizoun, Benin from 1 February to 3 April 2020 (3 months), in order to find out the general or specific characteristics of women that we associate with the frequency of prenatal consultation. At the end of the study, we found that 60%, 68% and 15% of the surveyed population had received ANC in the first, second and third trimesters, respectively. Ethnicity, income level of spouses over the three trimesters as well as the level of their knowledge and overall practice of ANC are determinants of the frequency of prenatal consultation.

基于Consultant Climate导向与斯维尔验证的烟台某售楼处节能改造研究

以烟台某售楼处节能改造项目为例,通过Consultant Climate分析帮助设计者快速找到主要能耗矛盾并进行节能改造,再利用斯维尔进行改造后的评价。结果显示:Consultant Climate能够快速找到地区气候缺陷并提出量化策略,斯维尔能够准确合理给出节能率。结合两者可以帮助设计者快速准确地找到适应气候的设计策略,提高工作效率,避免因气候调节能力不佳导致重新改造所带来的资源浪费。

基于Climate Consultant的现代民居被动式优化策略分析——以豫北地区为例

为改善豫北地区现代民居室内热环境状况,提高民居气候适应能力。采用Climate Consultant软件分析豫北地区的气候数据,得出了适用于该地区的被动式建筑策略组合及各策略有效时间比。结合冬夏两季现代民居室内外的热环境实测数据,针对夏季炎热和冬季寒冷问题分别提出了被动式优化策略:民居功能分区设计采用“向心性”的空间布局、冬季在一层檐廊处增设阳光间、改善围护结构保温隔热设计;夏季疏通建筑自然通风的路径、增设遮阳设施、改善庭院绿化。通过以上适宜性被动式优化策略,提高现代民居室内热舒适性,为豫北地区现代民居的建设和改造提供了重要的理论依据和有价值的参考。

Inter-hospital transfers and door-to-balloon times for STEMI: a single centre cohort study

Background Key performance indices such as door-to-balloon times have long been recognized as quality metrics in reducing time to care for patients with acute coronary syndromes(ACS). In the situation where patients do not present to a facility capable of 24/7 percutaneous coronary interventions(PCI) delays in time to therapy can exceed the recommendation of 90 min or less. This study aimed to evaluate the impact of transfers on performance indices for patients diagnosed with ST-segment elevation myocardial infarction(STEMI). Methods Over a seven month collection period, all patients presenting with symptoms suggestive of ACS and admitted for PCI were studied. Patients were divided into dichotomous groups of direct presentations or transfers from a secondary non-PCI capable hospital with key times recorded, including symptom-onset, first hospital and PCI-capable hospital arrival and balloon inflation times to evaluate time of treatment for STEMI patients. Results Of the 87 patients diagnosed with STEMI, transferred patients experienced statistically significant delays in symptom-onset to the PCI-capable hospital(PCI-H) arrival(215 vs. 95 min, P < 0.001), symptom-onset to balloon inflation(225 vs. 160 min, P = 0.009) and first hospital arrival to balloon inflation times(106 vs. 56 min, P < 0.001). Only 28%(n = 9) of transferred patients underwent balloon inflation within 90 min from first hospital arrival, while 60%(n = 19) did within 120 min, although all received balloon inflation within 90 min from arrival at the PCI-H. After controlling for confounding factors of socio-economic status, presentation date/time and diagnostic category, transferred patients experienced an average 162% longer delays from symptom-onset to PCI-H door arrival, and 98% longer delays in symptom-onset to balloon inflation;compared to patients who present directly to the PCI-H. No statistically significant differences were noted between transferred and direct patients when measured from PCI-H door-to-balloon times. Conclusions This study shows that transferred patients experience a greater overall system delay, compared to patients who present directly for PCI, significantly increasing their time to treatment and therefore infarct times. Despite the majority of transfers experiencing pre-hospital activation, their treatment hospital arrival to balloon times are no less than direct presenters after controlling for confounding factors, further compounding the overall delay to therapy.

Patient Education Level and Utilization of Internet Resources by Patients in Orthopedic Hip and Knee Consultations

Introduction: Internet has become an increasingly popular source of reference for patients to learn about their medical problems. It is easily accessible, and a large number of uncensored information is available online written from various sources and perspectives. However, the role of internet and its impact on patient’s care and understanding of the disease remains unclear. The purpose of this study is to evaluate the role and effect of internet use for patients seeking consultation for hip and knee arthritis. More specifically, the relationship between patient’s education level, internet use, motives for doing background readings, perception of internet information, and reactions to the available information will be studied. Method: Patients seeking orthopaedic consultation for knee or hip arthritis at the Toronto Western Hospital were identified and invited to fill out a questionnaire on their first visit. The questionnaire was designed to assess the patients’ pre-consultation reading habits, their use of internet, and their reaction to what they have read on the internet. The questionnaire also included questions about the respondent’s background.Results: In comparing patients holding college/university degree (CU) with patients having no college/university education (NoCU), the CU group were associated with increased internet use (CU vs. NoCU: 71.0% vs. 48.3%;p 0.01) and background reading (CU vs. NoCU: 82.2% vs. 17.8%;p 0.001) prior to consultation;fewer incidence of anxiety following internet use (CU vs. NoCU: 29.9% vs. 53.6%;p 0.05);and higher rates of decisions influenced by internet use (CU vs. NoCU: 20.8% vs. 3.6%, p 0.05). Internet users demonstrated a higher confidence in gathering and understanding medical information (Internet users vs. non-internet users: 6.59 ± 2.05 vs. 5.03 ± 2.78;p 0.001) and rated the accuracy of information on internet at 7.18 ± 2.01 (max = 10). Conclusion: Internet use can influence patient’s treatment decision, anxiety level, and understanding of their disease. Caregivers must recognize the growing trend of internet use and should counsel and educate their patients appropriately based on what they have read to help them accurately appreciate the nature of their disease.

Use of Analogy by Public Health Nurses in Problem Solving for Individual Consultations in Japan: A Multiple Case Study

Aim: Nurses must develop good problem-solving skills (PSS) to work in the complex health care environment. This study explored PHNs’ use of analogy in PSS development. The purposes of the study were to clarify how PSS developed in one area (i.e., mental health) could be applied to another area (i.e., maternal health) and whether new PSS could develop in response to PSS gained in another area. Methods: A multiple case study was conducted using interviews. We interviewed 27 consultations from eight Japanese PHNs who consulted in mental health departments before transferring to maternal health departments. The data on how PHNs applied PSS in the selection, mapping, evaluation, and learning stages of the analogy process were extracted from transcribed interviewed data and compared. Results: PHNs provided 59 PSS used in 27 consultations. All PHNs applied past mental health PSS to solve new problems in maternal health. They tended to select past PSS based on structural similarity and to apply PSS via low-level abstraction in serious situations or preventively to avoid causing the current situation to worsen. Notably, PHNs developed maternal health PSS by using past mental health PSS;these new PSS were derived through analogy from various failures and successes. Conclusions: PSS developed in one area can be applied in another area, and new PSS can develop through applying these previous PSS. Identification of structural similarities and preventive analogies must be included in nursing education, especially for nurses working in public health fields.

基于Climate Consultant的天水传统民居气候适应性分析

天水传统民居建筑由于受到自然环境以及建筑文化的影响导致施工过程中存在较大的盲目性和自主性,缺乏相应的理论支持,同时建筑设计缺乏气候数据的量化设计。采用Climate Consultant分析软件将大量气候数据转化成便于理解的图示,同时得到改善天水传统民居舒适度的被动优化策略,并结合现阶段传统民居建筑特点,对实际气候环境进行检测分析,从而针对天水地区冬季寒冷、夏季炎热的问题分别提出相对应的设计优化策略:冬季增设附加阳光间、加强外墙保温设计、优化门窗节能设计;夏季增设自然通风设计、遮阳措施设计、庭院绿化设计。通过改进传统民居的适宜性技术与设计措施,从而提高民居的热舒适性,为天水地区乃至整个西北地区传统民居的建设和更新提供了相应的理论依据和参考价值。

Hello,can you hear me?Orthopaedic clinic telephone consultations in the COVID-19 era-a patient and clinician perspective

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has resulted in seismic changes in healthcare delivery.As a result of this,hospital footfall required to be reduced due to increased risk of transmission of infection.To ensure patients can safely access healthcare,we introduced orthopaedic clinic telephone consultations in our busy district general hospital.AIM To investigate patients’and clinicians’perspective of telephone consultations during COVID-19,and whether this method of consultation could be a viable option in the post-pandemic future.METHODS This is a single centre,prospective study conducted in a busy National Health Service district general hospital.In May 2020,100 non-consecutive adult patients were contacted by independent investigators within 48 h of their orthopaedic clinic telephone consultation to complete a telephone satisfaction questionnaire.The questions assessed satisfaction regarding various aspects of the consultation including overall satisfaction and willingness to use this approach long term.Satisfaction and perspective of 25 clinicians conducting these telephone consultations was also assessed via an online survey tool.RESULTS 93%of patients were overall satisfied with telephone consultations and 79%were willing to continue this method of consultation post-pandemic.Patients found telephone consultations to reduce personal cost and inconvenience associated with attending a hospital appointment.72%of clinicians reported overall satisfaction with this service and 80%agreed that telephone consultations should be used in the future.The majority found it less laborious in time and administration in comparison to face to face consultations.Patients and clinicians expressed their desire for video consultations as a method of further improving their experience with remote consultations.CONCLUSION Our study has shown that telephone consultations are a safe and rapid method of adaptation to the COVID-19 pandemic,achieving the aim of reducing hospital footfall.This method of consultation has resulted in immense clinician and patient satisfaction.Our findings suggest that this tool has benefits in post pandemic healthcare delivery.It has also highlighted that telephone consultations can act as a steppingstone to the introduction of the more complex platform of video consulting.

The Effect of Consultations on the Cost of Pre-Anesthetic Assessment

Background: In our study, researching the distribution of the consultations other than anaesthesia in compliance with the disciplines and ages of the patients and its effect on the assessment cost has been aimed. Methods: Our study has been conducted during 8 months by the retrospective assessment of the records of 3844 cases on which an elective surgical procedure was planned in the anesthesiology polyclinic of Firat University Hospital. The records of patients have been obtained through examining their files from the hospital record system. Results: The total number of patients whose consultations have been demanded was 367 (9.5%) and the number of male/female was 192/175. The number of cases about which more than one consultation has been demanded was determined as 87 (2.2%). The number of cases on which a method change for the anaesthesia was applied was 21 (5.7%), and the number of cases whose surgery was cancelled was 3 (0.81%). Requested consultation for each patient, the consultations of cardiology, chest diseases and internal medicine bring an additional cost on the total sum respectively as 37.2 TL (28.61 $), 29.8 TL (22.92 $) and 19.9 TL (15.30 $). Conclusions: We suggest that the cost analysis should be absolutely taken into consideration during the pre-anaesthetic assessment for the requirement of routine examinations.

Medical consultation in ulcerative colitis:Key elements for improvement

Ulcerative colitis(UC)is a chronic inflammatory disease with a high impact.In order to improve patient outcomes,the clinician-patient relationship in daily practice is critical.Clinical guidelines provide a framework for UC diagnosis and treatment.However,standard procedures and the medical content focused upon medical consultations in UC patients has not yet been defined.Moreover,UC is a complex disease,given that patient characteristics and patient needs have been proven to vary during clinical consultation since establishing the diagnosis and upon the course of the disease.In this article,we have discussed the key elements and specific objectives to consider in medical consultation,such as diagnosis,first visits,follow-up visits,active disease patients,patients on topical therapies,new treatment initiation,refractory patients,extra-intestinal manifestations,as well as challenging situations.The key elements have been mentioned to comprise effective communication techniques,motivational interviewing(MI),as well as information and educational aspects,or organizational issues.The key elements to be implemented in daily practice were reported to comprise several general principles like duly prepared consultations,in addition to honesty and empathy with patients,as well as effective communication techniques,MI,information and educational points,or organizational issues.The role of other healthcare professionals such as specialized nurses,psychologists,or the use of checklists was also discussed and commented on.

基于专家咨询法的公立医院门诊药学服务评价体系构建研究

目的:构建门诊药学服务的三级评价指标体系,并确定各级指标的权重。方法:通过文献回顾、运用结构-过程-结果(SPO)模型、德尔菲专家咨询法,研究公立医院门诊药学服务评价指标。结果:最终入选的15名咨询对象均为各自领域的专家,两轮专家咨询结果趋于一致,咨询专家意见集中,结果可信度高,专家积极程度达93.33%(14名专家提出各自的修改意见),权威系数为0.880,指标重要性赋值均数均>3.5分,而变异系数则<0.25。结论:经过两轮专家咨询,建立了公立医院门诊药学服务三级评价指标体系,其中,一级指标3个,二级指标10个,三级指标39个,并赋予各指标权重。

A-Kano模型下全过程工程咨询业主需求实证研究

我国全过程工程咨询实践正处于多种模式并存、咨询内容差异较大的探索性阶段。以业主需求为导向,合理确定咨询服务内容,提升全过程工程咨询企业服务能力,是推进全过程工程咨询健康发展的关键。通过梳理相关文献,识别出12种全过程工程咨询业主需求,进而借助A-Kano模型开展正、负向满意度与重要度问卷调查,并计算出各类需求的优先级。实证分析结果表明:工程监理和造价咨询属于基本型需求;项目管理、设计及勘察属于期望型需求;招标代理、前期策划和BIM咨询为兴奋型需求;后期运营、建筑节能与绿色建筑咨询、工程检测服务以及工程保险咨询为无差异需求。基于上述结果为工程咨询企业提出转型建议,使其更好地满足业主集成化、个性化的咨询需求。

MDT联合PBL+CBL模式在临床肝癌教学中的应用

目的探讨多学科会诊(multiple disciplinary team,MDT)联合问题导向教学法(problem based learning,PBL)+案例教学法(case based learning,CBL)教学模式在肝癌临床教学中的应用效果。方法选择2019年10月—2022年6月入院实习的128名临床医学专业学生为研究对象,采用抽签法将其分为对照组64名和观察组64名,对照组采取传统教学模式,观察组采取MDT联合PBL+CBL教学模式。对比两组学生考核成绩、对教学效果的认同度、教学满意度。结果观察组考核成绩得分[理论知识(89.01±6.39)分、病例分析(84.16±5.04)分、技能操作(85.19±6.08)分]均高于对照组[理论知识(80.14±5.63)分、病例分析(76.69±5.60)分、技能操作(75.93±5.47)分],差异有统计学意义(P<0.05)。观察组对MDT联合PBL+CBL教学模式能激发学习兴趣(95.31%)、加深对理论知识的理解(100.00%)、提升临床思维能力(93.75%)和临床分析能力(96.88%)、提高理论联系实践的能力(100%)、提升自学能力(96.88%)和团队协作能力(95.31%)的认同度均高于对照组(56.25%、60.94%、39.06%、62.50%、43.75%、35.94%、35.94%),差异有统计学意义(P<0.05)。观察组对教学的满意度(92.19%)高于对照组(51.56%),差异有统计学意义(P<0.05)。结论MDT联合PBL+CBL的肝癌临床教学模式能提高教学质量,提升学生的综合素质。

基于德尔菲法构建护理专业学位研究生与肿瘤专科护士核心能力联合培养方案

目的:构建护理专业学位研究生与肿瘤专科护士核心能力联合培养方案,为推动我国护理专业学位研究生教育的发展提供参考。方法:通过文献分析法及半结构化访谈初步形成护理专业学位研究生与肿瘤专科护士核心能力联合培养方案条目池,制定专家函询问卷,并采取德尔菲专家函询法对15名专家进行专家函询,最终形成护理专业学位研究生与肿瘤专科护士核心能力联合培养方案。结果:3轮函询专家积极性系数均为100.0%,专家权威系数分别为0.838,0.880和0.880。经过咨询最终形成包括理论知识掌握能力、临床综合实践应用能力、组织管理能力、教学及科研能力、发展能力5个一级指标、17个二级指标、96个三级指标的护理专业学位研究生与肿瘤专科护士核心能力联合培养方案。结论:构建的护理专业学位研究生与肿瘤专科护士核心能力联合培养方案具有良好的可靠性与科学性,对肿瘤护理方向专科人才培养提供参考。

乡村振兴中村级协商民主的提升路径探析——基于浙江省小古城村“众人的事由众人商量”的经验分析

村级协商民主是基层协商民主的重要组成部分,发展村级协商民主能够保障农民的合法权益,调动其参与村庄公共事务的热情。在乡村振兴时期为发挥农民的主体作用,提升乡村治理效能,需要构建起村级协商民主的新路径。通过对浙江省小古城村协商民主实践进行经验总结发现,该村通过实行党建引领促进村级协商民主开展、多元主体参与实现决策的科学化、协商程序规范确保协商活动有序、监督落实到位展现村级协商民主成效等制度,真正实现了“众人的事由众人商量”。因此,在乡村振兴的新时期以小古城村的经验作为参考,发展村级协商民主需要坚持党的领导,为村级协商民主提供根本保障;培育村民权利主体意识,营造民主开放的协商氛围;完善相关制度设计,促进村级协商民主高质量发展;利用数字技术赋能,构建数字化协商平台;发挥村级协商议事组织功能,提升协商主体能力。

全过程工程咨询项目咨询方行为风险因素间影响关系研究

全过程工程咨询是建筑业未来的发展趋势,但其顺利推行存在一定的阻碍,如何实现风险的有效管控是目前亟需解决的问题之一。项目风险由客观风险和主体行为风险构成,工程项目主体的不当行为将会对项目产生重大影响。本文针对主体行为风险中全过程工程咨询单位带来的风险,从项目全生命周期角度出发,运用文献研究法、专家访谈法和因子分析法对咨询方行为风险因素进行系统识别,构建了包含6个阶段、13项一级风险和34项二级风险的全过程工程咨询项目咨询方行为风险因素体系,运用FUZZY-DEMATEL-ISM模型对风险因素间相互影响关系和风险传导路径进行分析,发现可行性研究不到位、前期规划咨询不当、项目评估不达标是其中的关键风险因素,并提出了相应的风险管理建议。

数字经济时代管理咨询行业情报工作胜任力模型优化研究

[目的/意义]随着新一轮科技革命和产业变革不断深入,管理咨询行业日益受到重视,尤其在当前数字经济背景下,根据管理咨询行业目前的发展情况,急需对情报工作胜任力模型优化升级,为我国对管理咨询行业情报工作的有效管理提供科学参考。[方法/过程]梳理目前管理咨询企业中情报工作者胜任力不明确而造成的人才流失严重、高学历与复合型人才稀缺、人才选择与培养机制不完善等问题,在研究中通过词频统计法确定胜任特征、问卷调查法验证胜任力模型,并采用灰色关联度法对胜任力模型进行优化得出最终的情报工作胜任力模型。[结果/结论]针对情报工作者胜任力不明确这一根本原因,以优化后的胜任力模型为基础,从个人、企业、政府三个方面对管理咨询行业情报胜任力提升给出科学建议。

我院中医师与中药临床药师联合会诊工作模式建立及实践

目的为医疗机构选择和建立适用于自身临床特色的中药临床药学服务模式提供参考。方法结合临床案例,介绍我院中医师与中药临床药师联合会诊模式的工作流程、服务内容,并进行成效分析。结果我院联合会诊药学服务模式的工作流程分为评估患者用药情况,会诊查房、制定给药方案,床旁教育,药学监护,药学查房和药学延伸服务6个环节。该模式的服务内容主要包括会诊前充分收集临床信息,评估患者药物治疗方案;会诊中针对患者个体化情况,中药临床药师与中医师一起制定给药方案;会诊后开展床旁用药教育,保障患者正确用药;会诊后制定并执行药学监护计划;会诊后监测患者病情变化,及时反馈至会诊中医师以调整给药方案;会诊后提供药学延伸服务,开展药物咨询、药学门诊、联合门诊。该模式建立后,每年服务住院患者近1000人次,服用中药饮片患者的医嘱审核率为100%;个体化用药教育占比达到78.80%,患者满意度为100%;病区中药饮片处方合格率由联合会诊工作开展前的89.33%提高至开展后的97.08%;每年为1000余例患者提供中药相关咨询,为医护人员整理、提供药学资料近百份。结论通过建立中医师与中药临床药师联合会诊工作模式,开展中药临床药学服务,提高了中药饮片的合理使用水平,体现了中药临床药师价值。

药学门诊对儿童疱疹性咽峡炎用药干预分析

目的总结药学门诊参与儿童疱疹性咽峡炎用药管理的经验。方法选取2020年1月—2022年12月共832例就诊于我院药学门诊及儿科门诊的疱疹性咽峡炎病例,就诊于药学门诊的病例为干预组,就诊于儿科门诊的病例为对照组,干预组按照循证医学原则进行用药建议与指导,对照组不进行干预,所有患儿随访病情直至痊愈。结果832例患儿全部康复,无重症住院病例。干预组与对照组在发热、疼痛、疱疹愈合等时长及血液检查结果均差异无统计学意义(均P>0.05),干预组与对照组在药物使用方面差异有统计学意义(P<0.001),干预组不良反应数量(5例)及治疗费用[(44.30±5.23)元]均显著低于对照组[23例,(178.20±71.40)元](P<0.001)。结论疱疹性咽峡炎属于自限性病毒感染,应按照循证的原则予以对症支持,过度用药并未给儿童带来显著获益,反而增加不良反应风险,增加治疗费用。

新时代发展社会组织协商的逻辑进路

社会组织协商是社会主义协商民主的重要渠道,是基层协商的重要组成部分。党的二十大提出“坚持党的领导、统一战线、协商民主有机结合”的战略部署,为发展社会组织协商提供更为宏阔的创新空间,三者“有机结合”形成推动社会组织协商的强大动力源。党的领导为社会组织协商提供根本政治保证,统一战线为社会组织协商画出最大“同心圆”,协商民主为社会组织协商规定本质内容。社会组织要以加强自身建设为起点,积极融入坚持党的领导、统一战线、协商民主有机结合的伟大实践之中,在坚持三者“有机结合”的坐标系和动力场内积极参与、发展协商民主。