精神科工作场所暴力防范对策探讨

精神科工作场所暴力相较于其他医疗科室工作场所暴力而言,具有发生频率高、危害程度重、防范难度大的特点。在科学界定精神科工作场所暴力内涵的基础上,分析了我国精神科工作场所暴力防范中存在的现实困境,在借鉴美国精神科工作场所暴力防范相关理论的基础上,提出构建完备的防范体系、引入并推广有效评估工具、建立系统化应急措施的防范对策,以期对我国精神科工作场所暴力防范提供有益参考。     

医护人员遭遇医院工作场所暴力情况及影响因素分析

目的 了解医护人员遭受医院工作场所暴力现状,分析影响医院工作场所暴力发生的因素,探寻易遭受医院工作场所暴力医护人员的特点。 方法 采用整群抽样方法选择研究对象,利用自行设计问卷对研究对象2013年6月至2014年6月遭受医院工作场所暴力情况进行调查,采用SAS9.3进行数据分析。结果 医院工作场所暴力事件的发生率为66.1%,急症科室、年龄31～40岁、已婚、中级职称、在院工作时间11～20年、与患者接触时间长与医院工作场所暴力事件的发生显著相关。结论 医护人员在医院工作场所遭受暴力的风险性高,对医护人员心理和职场行为均会产生不良影响。应从个体层面、医院层面及社会制度层面采取预防措施,构建和谐的医疗环境。     

县级医院工作场所暴力现状及影响因素分析

目的 了解县级医院医生遭受医院工作场所暴力的流行特征并分析原因,提出相应的防范策略,降低医院工作场所暴力事件的发生。方法 使用自拟问卷对我国东、中、西部地区共90所县级医院进行问卷调查,其中有效问卷5842份,有效收回率为81.91%。结果 县级医院医生暴力总发生率为69.38%;logistic回归分析结果显示,医生的性别、年龄、教育程度、月平均收入、所在科室与工作年限是医院工作场所暴力的影响因素。结论 暴力的发生率偏高（主要特征）,建议相关部门加大对医院工作场所暴力的干预,维护医院正常秩序,为医生提供良好的工作环境。

     

公立医院工作场所患者暴力对护士职业倦怠的影响

目的 探讨公立医院工作场所患者暴力对护士职业倦怠的影响以及可能的机制。方法 采用横断面问卷调查法收集数据,采用多元阶层线性回归分析法进行数据统计分析。结果 公立医院工作场所暴力的发生频率由高到低的次序是语言侵犯、苛刻刁难、妨碍工作、诋毁声誉、威胁恐吓、躯体攻击、性骚扰类,样本护士的职业倦怠总体发生率为68.9%,遭受暴力对护士职业倦怠具有积极的预测作用（β=0.379,P＜0.01）。结论 大多数护士遭受到过不同类型的患者暴力,职业倦怠在护士群体中也较为普遍。减少患者暴力并构建和谐的护患关系将有利于缓解护士的身心疲惫状态,进而提高护理服务质量。     

论医疗暴力的预防和处理对策

医疗暴力是一种违法行为,已得到了越来越多的人关注。目前医疗暴力事件的频繁发生,不断降低医患相互的信任感,而且引发了恶性的医患暴力冲突事件,影响医疗行业正常发展,成为影响社会稳定的问题之一。本文从整体的角度出发,分析我国目前医疗暴力现状、诱因及对策。深度剖析医患矛盾的缘由,在社会大环境下,就如何缓解医患矛盾的问题也提出了几点建设性的对策。     

医疗冲突与暴力的缘起、发展与消弭 ——互动视域下医患权利（力）运作形式三

医疗冲突和暴力频繁发生而备受关注。从内涵、性质、特点等阐述二者之间的关系,并将冲突和暴力分为前期、中期和后期三个阶段,从医患双方权力运作的新视角,力求化解冲突、遏制暴力。     

依法治国视域下防治暴力伤医的法律途径

依法治国的核心是依宪治国,国家尊重和保障人权,暴力伤医是对宪法所保护的公民权利和法益的侵害。暴力伤医直接侵犯的是医务人员生命健康权、人格尊严权和财产安全权,严重破坏了医疗机构正常的医疗秩序,间接侵犯其他病患的就医权。由于相关立法滞后、医疗风险保险机制缺失等因素导致暴力伤医案件逐年增多,给和谐医患关系造成严重破坏。从立法角度提出建议,依法处理暴力伤医,是保障医患双方权益的有效途径。     

医务人员遭受医院暴力及对媒体作用的认知研究

目的 对医务人员遭受暴力事件的周期、类型、场所进行分析;对媒体医患报道行为方式进行评价,为规范媒体行为,减少医院暴力提供政策依据。方法 通过问卷星软件收集某省医务人员医院暴力发生情况及对媒体作用的认知情况等相关数据。结果 暴力发生频率相对较低,多发生在内科,以语言暴力为主;医务人员有60%以上对媒体的医患报道采取不可信和负面态度,且职称越高这一趋势越明显。结论 应在医患间建立良好的沟通机制,做好医患暴力应急,规范媒体行为,缓和紧张的医患关系。     

导诊服务台对患者咨询问题分析及对策

门诊作为医院的重要窗口,是对病人进行早期有效诊治的重要场所,是确保医疗和护理质量的首要环节,同时门诊也是各种病人高度集中的场所。门诊的环境嘈杂、拥挤,人流动性大,且以患者为主。由于患者有病痛,行动不便,环境不熟悉,对医疗工作程序不了解等原因,均会加重就诊过程中的不便和精神负担。因此做好导医工作,为患者提供咨询服务,方便患者就诊是门诊护理工作的重要环节之一。现就本院患者对导诊服务台所咨询的问题进行随机统计分析,并提出相应对策。     

集体行为理论视角下暴力伤医现象诱发因素的研究

暴力伤医现象是我国医患矛盾尖锐的具体表现,不仅严重干扰了医院正常诊疗秩序,更对医疗人员的人身安全造成威胁。探讨其诱发因素并进一步提出抑制策略对减少暴力伤医事件、构建和谐的医患关系具有重要的理论意义。文章以集体行为理论框架为视角,阐释暴力伤医事件的诱发因素并提出相应的抑制策略。     

Physical Violence against General Practitioners and Nurses in Chinese Township Hospitals: A Cross-Sectional Survey

Purpose

The purpose of this study is to identify risk factors of physical violence in Chinese township hospitals.

Methods

A cross-sectional survey was used in a sample of 442 general practitioners and 398 general nurses from 90 township hospitals located in Heilongjiang province, China (response rate = 84.8%).

Results

A total of 106 of the 840 (12.6%) respondents reported being physically attacked in their workplace in the previous 12 months. Most perpetrators were the patients’ relatives (62.3%), followed by the patient (22.6%); 73.6% of perpetrators were aged between 20 and 40 years. Of the physical violence incidents, about 56.6% (n = 60) resulted in a physical injury, and 45.4% of respondents took two or three days of sick leave. Reporting workplace violence in hospitals to superiors or authorities was low (9.4%). Most respondents (62.8%) did not receive training on how to avoid workplace violence. Logistic regression analyses indicated that general nurses, aged 35 years or younger, and with a higher-level professional title were more likely to experience physical violence. Healthcare workers with direct physical contact (washing, turning, lifting) with patients had a higher risk of physical violence compared to other health care workers. Procedures for reporting workplace violence were a protective factor for physical violence; when in place, reporting after psychological violence (verbal abuse, bullying/mobbing, harassment, and threats) was more protective than waiting until an instance of physical violence (beating, kicking, slapping, stabbing, etc.).

Conclusions

Physical violence in Chinese township hospitals is an occupational hazard of rural public health concern. Policies, procedures, and intervention strategies should be undertaken to manage this issue.     

Morbid Jealousy and Sex Differences in Partner-Directed Violence

Previous research suggests that individuals diagnosed with morbid jealousy have jealousy mechanisms that are activated at lower thresholds than individuals with normal jealousy, but that these mechanisms produce behavior that is similar to individuals with normal jealousy. We extended previous research documenting these similarities by investigating sex differences in partner-directed violence committed by individuals diagnosed with morbid jealousy. The results support some of our predictions. For example, a greater percentage of men than women diagnosed with morbid jealousy used physical violence, attempted to kill, and actually killed their partners, and used their hands rather than an object to kill their partners. These results replicate results generated for individuals with normal jealousy. Discussion addresses implications of the current research and highlights directions for future research on the psychology of morbid jealousy.

Deep Learning and Its Applications in Biomedicine

Advances in biological and medical technologies have been providing us explosive volumes of biological and physiological data, such as medical images, electroencephalography, genomic and protein sequences. Learning from these data facilitates the understanding of human health and disease. Developed from artificial neural networks, deep learning-based algorithms show great promise in extracting features and learning patterns from complex data. The aim of this paper is to provide an overview of deep learning techniques and some of the state-of-the-art applications in the biomedical field. We first introduce the development of artificial neural network and deep learning. We then describe two main components of deep learning, i.e., deep learning architectures and model optimization. Subsequently, some examples are demonstrated for deep learning applications, including medical image classification, genomic sequence analysis, as well as protein structure classification and prediction. Finally, we offer our perspectives for the future directions in the field of deep learning.     

帕累托法则在企业医院医疗人力资源管理中的应用

目的 探索帕累托法则在企业医院医疗人力资源管理中的应用。方法 应用帕累托法则对医院关键成员进行管理,在重点培养科室管理群体和系统培训专长医疗群体的基础上,提升全院医疗整体实力。结果 在床位数逐年增加、床位使用率不断增长、工作量日益攀升以及医疗人员缺编较严重的情况下,医疗工作安全有序运转,取得了良好的社会效益和经济效益。结论 帕累托法则应用于基层医院护理人力资源管理行之有效。     

HIV/AIDS epidemic in Eastern Europe: Recent developments in the Russian Federation and Ukraine among women

Background: The Russian Federation and the Ukraine are among the Eastern European countries with the fastest growing number of cases of HIV. According to data from the Joint United Nations Program on HIV/AIDS, nearly 90% of newly reported HIV diagnoses in Eastern Europe in 2006 were from the Russian Federation (66%) and the Ukraine (21%). A growing number of women are infected with HIV. The impact of gender on HIV/AIDS is an important factor in understanding the development and evolution of the HIV/AIDS epidemic in Eastern Europe.Objective: The aim of this study was to assess the importance of integrating gender consideration into the creation of HIV programs and to examine the effect of gender on HIV/AIDS.Methods: Reported HIV/AIDS cases from the official epidemiological register of the Ukrainian Centre for AIDS Prevention alongside data from the Russian Federal AIDS Center were analyzed. Joint United Nations Program on HIV/AIDS country fact sheets were reviewed and analyzed, and this information was supplemented with published HIV prevalence and sexually transmitted disease case reporting information, unpublished reports, and expert evaluations.Results: Of the newly registered cases of HIV, the proportion of women rose from 13.0% in 1995 to 44.0% in 2006 in the Russian Federation, and from 37.2% in 1995 to 41.9% in 2006 in the Ukraine. There has also been a considerable increase in mother-to-child transmission of HIV since 1995. Between 1987 and 1994, the proportion of children among the people newly infected with HIV in the Ukraine was 2.2%; in 2006 it was 17.6%. In 2006, 16,078 new HIV cases were registered in the Ukraine and 39,652 new HIV cases in the Russian Federation. Large increases in the number of HIV-infected women were reported from both countries.Conclusions: The data examined in this study suggest subregional differences in the magnitude of the HIV/AIDS epidemic in the Russian Federation and the Ukraine and the importance of the impact of gender on the rapid spread of the HIV/AIDS epidemic among women and women of child-bearing age. To protect women from HIV infection, it is important to find ways to empower them by implementing policies and specific prevention measures that increase their access to knowledge about HIV/AIDS; the empowerment of women is vital to reversing the HIV/AIDS epidemic.     

Female sex workers and the social context of workplace violence in Tijuana, Mexico

Gender-based violence in the workplace impacts the physical and emotional wellbeing of sex workers and may lead to other health problems, such as PTSD and depression, drug abuse, and a greater likelihood of sexually transmitted infections. This study examines the social context of workplace violence and risk avoidance in the context of legal regulations meant to reduce harms associated with the industry. Ethnographic research, including 18 months of extended field observations and interviews with 190 female sex workers, is used to illustrate how sex workers in Tijuana, Mexico, experience and manage workplace violence. Multiple subthemes emerge from this analysis, including deciding where to work, working with a third party, avoiding theft, and dealing with police. These findings support the idea that the risk of violence is part of a larger "hierarchy of risk" that can result in a "tradeoff" of harms.     

Plants for Peace? Conflict Management in the Development of Ten South African Outreach Nurseries

Conflict is inherent to development, but the intensity of conflicts over small-scale projects is often severely underestimated. Effectively managed conflict can strengthen relationships and enhance productivity, but unresolved conflict undermines relationships, morale and projects. This paper examines conflict management during the development of ten South African outreach nurseries situated within communities experiencing high levels of poverty. Sources of conflict included: (1) Contestations over scarce or limited resources, or (2) ownership; (3) Disputes over accountability; (4) Struggles over social boundaries or (5) individual or collective identities; (6) Deteriorating interpersonal relationships; (7) Power struggles between community participants and (8) Structural imbalances between implementing organisations and community stakeholders. Conflicts spiraled into violence or near-violence in two cases, with threats of violence in two others. Fostering cooperative relationships and operational environments requires concerted effort from the outset, including the development of effective institutions. Development fundamentals cannot be exchanged for expediency; adequate time, staff, and resources have to be allocated to projects.

非医疗技术因素对门诊患者满意度的调查与分析

?????? 目的 了解门诊患者对于非医疗技术服务的满意度现状,探讨影响门诊患者满意度的非技术因素。方法 对广州市某三甲医院2012年3—6月就诊的208名门诊患者进行问卷调查。结果 与“等候时间”、“诊疗费用”相关的满意度水平显著低于“服务态度”、“环境设施”类,且满意度水平存在着社会人口学差异。结论 医院应注重非医疗技术服务的改进,可从营造舒适就诊环境、加强医患沟通、降低医疗费用及合理门诊布局等方面入手。同时,优化门诊预约服务可有效提高门诊患者满意度。     

The Evaluation of Incidentally Discovered Adrenal Masses

Objective: The objective of this Disease State Clinical Review is to provide clinicians with a practical approach to the evaluation of incidentally discovered adrenal masses.Methods: A case-based clinical approach to the evaluation of adrenal masses is presented. Recommendations were developed using available prospective and randomized studies, cohort studies, cross-sectional studies, anecdotal observations, and expert opinions.Results: Incidentally discovered adrenal masses are common. The approach to the patient with an adrenal mass should involve assessment of malignant potential via imaging characteristics and adrenal hormone excess via clinical and biochemical features. The roles of biopsy, surgical or medical therapy, and longitudinal surveillance are also important to consider and are influenced by case-specific factors. Inappropriate or inadequate evaluations may put patients at increased risk for developing preventable adverse cardiometabolic outcomes or cancer.Conclusion: Incidentally discovered adrenal masses require a multimodal assessment that involves interpretation of multiple imaging characteristics, dynamic and static hormonal measurements, and a nuanced approach to considering interventional diagnostics, treatments, and longitudinal surveillance. Herein, we review these evaluations and provide a practical approach for clinicians.Abbreviations: ACTH = adrenocorticotropic hormone; CS = Cushing syndrome; CT = computed tomography; DHEAS = dehydroepiandrosterone sulfate; HU = Hounsfield units; MRI = magnetic resonance imaging; UFC = urinary free cortisol     

Paléopathologie : à propos de squelettes humains découverts à Poitiers (Vienne,France)

Palaeopathology: remarks about skeletons discovered in Poitiers (Vienne, France). Age, sex and stature of human fossils from a population decimated during an epidemic period are estimated. The prevalence of abnormalities and pathologies is compared with those of today’s population. Osteoarthritis is the most frequent pathology and this at different stage development. Osteoporosis and vertebrae compression are studied. The cases of important scoliosis are numerous. An abnormal vertebra is presented. A strange lesion on the ilium of the left coxa is discussed. Some hypotheses are formulated concerning the mode and the hygiene of life of this population. To cite this article: O. Boeuf, P. Alberti, C. R. Palevol 2 (2003) 169–180.