部队医院文职人员管理的探索与研究

随着部队医疗机构人事编制的调整,军队医院及疗养院为缓解人员严重短缺的问题,通过公开考核面向社会招聘具有专业资格的非现役文职人员。文职人员作为军队疗养院的聘用制人员已成为医护工作的主要力量。因此,完善文职人员的管理工作是提高医院医疗质量的重点。本文通过分析文职人员聘用、教育、生活福利待遇及公务事业、社会保险等文职人员管理制度,探讨各项管理制度的特点及作用,提出适合我院推行的文职人员管理制度,即充分利用社会人才资源,建立健全文职人员管理评价体系,提高文职人员献身部队、服务军队的积极性和创造性。     

军队疗养院非现役文职人员工作满意度及职业需求调查

目的:非现役文职作为军队疗养院的聘用制人员已成为医护工作的主要力量。本文通过调查军队疗养院非现役文职人员的工作满意度,分析其对自身职业的潜在需求,为提高医疗服务质量提出可行对策。方法:采用问卷调查的方式对我院聘用的100名非现役文职人员调查该群体工作满意度及对自身职业的潜在需求。结果:非现役文职人员对管理制度、工作环境、团队合作及人际关系等方面表示满意,其中最满意的是工作环境;而对工作压力、工资福利、奖惩制度、职称晋升及个人发展等方面表示不满,其中最不满意的是工资福利。非现役文职人员对优化人事编制、提高福利待遇及减轻工作负荷的需求度较高,而对职业情感、临床带教及军事知识的需求度较低。结论:军队疗养院的管理人员应完善管理机制,充分了解非现役护理队伍对职业的潜在需求,积极的为其创造良好的晋升政策和发展平台,建立绩效考核制度以提高该群体的工作满意度,进而提升军队疗养院护理服务的质量。     

新形势下军队医院卫生技术人员的稳定与思考

目的 分析在新形势下军队医院卫生技术人员的稳定性及影响因素。方法 对某省5家军队医院现役卫生技术人员进行问卷调查,采用卡方检验进行统计学分析。结果 有21.4％的现役卫生技术人员有转业倾向,其中医疗岗位占93.5%。与地方比福利待遇偏低、职称晋升困难、改非现役文职人员的不确定性显著影响人员的稳定性。结论 通过组织谈心和政策约束,稳定医疗岗位人才。对于选择提前退休或自主择业人员,积极创造条件返聘,通过各种途径稳定卫生技术人员,确保军队医院稳步转型。     

生理驱动高仿真模拟技术在心肺复苏培训中的应用

目的:探讨生理驱动高仿真模拟技术对于提高医护人员心肺复苏能力的效果及必要性.方法:对126名新入院医护人员进行基本急救知识摸底测试,然后使用简单急救技能操作模拟器和生理驱动高仿真模拟人,应用"简短理论讲授+分项技术练习+综合模拟演练+录像回放分析"方法进行急救技能培训,分析培训效果,总结反馈意见.结果:培训前心肺复苏理论成绩45.81±5.23,心肺复苏操作技能及格率仅为11.36%.经短期培训后,再次以同等难度试卷测试,平均理论成绩为92.85±6.25,心肺复苏操作测试合格率为100.0%,与培训前平均成绩比较有显著的提高(P<0.01);对接受培训者的反馈意见进行分析,认为有必要加强急救培训者占95.2%;认为高仿真模拟急救培训对今后医疗工作中处理紧急突发事件或急危重病人有重要帮助者占98.4%.结论:生理驱动高仿真模拟培训对提高急救意识和实际应急能力有重要帮助作用,有必要对医护人员定期进行急救知识和技能培训.     

新型战伤急救止血剂体内抗菌活性的实验研究

目的:探讨新型战伤急救止血剂对家兔急性感染伤口的抗菌作用。方法:选用兔感染创面模型,分新型战伤止血剂、5A沸石、Quiclot和空白对照组对创面进行治疗,通过组织学观察、组织内细菌计数等方法对各组抗菌性能进行研究。结果:肉眼和组织学观察新型战伤急救止血剂治疗组动物模型伤口,炎症反应均小于其他各组;新型战伤急救止血剂治疗组织内细菌计数为104,比其他3组显著减少(P<0.01)。结论:新型战伤急救止血剂具有良好的体内抗菌性能。     

ECS结合情景模拟教学在社区医师急救技能培训中的应用效果分析

目的:探讨应用急救模拟人(Emergency Care Simulator,ECS)结合情景模拟教学法对社区医师进行急救技能培训的效果。方法:应用ECS结合情景模拟对27名社区医师按照2010年美国心肺复苏指南标准进行急救技能培训,急救技能内容包括心肺复苏,气管插管和4项技术(止血、包扎、固定、转运),比较培训前后成绩的区别;调查社区医师对ECS结合情景模拟教学法的认可程度。结果:社区医师胸外按压培训前后的成绩分别为59.61±12.35和81.42±13.26(P<0.05),气管插管的成绩分别为64.18±15.21和85.49±18.17(P<0.05),4项技术的成绩分别为62.15±12.28和89.32±15.34(P<0.05);96.2%认为该教学方法可以提高学习兴趣和团队合作精神。结论:应用ECS结合情景教学对社区医师进行培训可以提高急救技能,有利于培养团队精神和临床思维能力。     

高仿真模拟支气管镜在支气管镜操作训练中的应用

目的:探讨高仿真模拟支气管镜模拟技术在呼吸科专科医师支气管镜操作训练中的作用.方法:对20名呼吸科医生(支气管镜检查术的初学者)作为观察对象,采用美国生产的Simbionix GI Mentor Simulator高仿真模拟支气管镜操作系统进行培训.由2名熟练进行支气管镜检查术的呼吸科医生进行指导,比较培训前后在高仿真模拟支气管镜操作的速度、灵活性和准确性方面差异.结果:20名初学者均完成了支气管镜的操作培训.在模拟训练后,操作的灵活性、准确性和速度都明显提高.与训练前相比视野清晰可见时间由(30.0±2.0)％增加到(75.0±5.0)％:段支气管检查到达由(74.0±5.1)％提高到(89.3±4.0)％;通过咽喉及声门时间由(00.01.28±00.00.54)h缩短到(00.00.36± 00.00.09)h,操作用时由(00.07.27± 00.01.23)h缩短到(00.06.24± 00.00.54)h.误入食道次数由(6.0±2.0)缩短到(2.0±0.5),培训前机器给予自动评分为(30.8±6.6)分,培训后(70.8±6.6)分.结论:高仿真模拟支气管镜在初学气管镜呼吸专科医师培训中起到重要的作用.     

全科医师急救技能调查分析

目的:了解全科医师对急救技能掌握情况和对培训的态度。方法:对在我院参加培训28名社区全科医师急救技能进行调查,对心肺复苏中的胸外心脏按压频率、电除颤功率等问题进行理论和技能考核,并对4项技术(止血、包扎、固定和转运)进行技能考核。根据职称分为初级和中级2组,比较2组成绩差异;发放调查问卷,了解对急救技能培训的需求情况。结果:社区全科医师急救技能掌握普遍较差,心肺复苏技能平均合格率为14.2%,4项技术合格率为17.8%;初级与中级职称组成绩无差别(P>0.05);89.2%的社区全科医师认为急救技能非常重要,92.8%希望定期得到急救技能培训。结论:社区全科医师急救技能普遍掌握较差,应定期进行对他们急救技能培训。     

系统化康复护理促进脑卒中患者有效康复

为了探讨系统化康复护理对脑卒中患者有效的康复效果,本研究选取132例脑卒中患者,采用随机数字表法将患者随机分为观察组(n=68)和对照组(n=64),观察组给予系统化康复护理,对照组给予常规护理,采用简易智能状态检查量表(MMSE)和洛文斯顿作业疗法认知评定量表(LOTCA)评估患者认知功能,采用Barthel指数(BI)评估患者日常生活能力,采用抑郁自评量表(SDS)评估患者抑郁情况。MMSE评估结果表明,观察组干预后定向力、注意力和计算力、语言能力以及MMSE总分分别为(9.24±1.31)分、(4.54±0.97)分、(7.86±1.22)分和(25.57±2.03)分,明显高于对照组(p0.05);LOTCA结果表明,观察组干预后定向力、知觉、视运动、思维能力以及LOTCA总分分别为(5.30±1.24)分、(13.24±1.90)分、(17.41±2.55)分、(18.16±1.80)分和(55.64±4.56)分,明显高于对照组(p0.05);观察组干预后BI评分为(76.82±10.46)分,明显高于对照组(p0.05);观察组干预后SDS评分为(42.15±6.41)分,明显低于对照组(p0.05)。初步的研究表明,系统化康复护理对脑卒中患者康复有较好的促进作用,明显改善了患者认知功能、日常生活能力以及抑郁状态,值得临床上推广使用。     

HoLEP对良性前列腺增生的疗效及安全性观察

目的:探讨以尿道钬激光前列腺剜除术(HoLEP)治疗良性前列腺增生(BPH)的临床疗效和安全性。方法:选取我院102例以HoLEP术治疗的BPH患者的临床资料,分析BPH患者的年龄、切除腺体的大小、手术出血量、手术前后的最大尿流率(Qmax)、最大尿流率时逼尿肌压(Pdet/Qmax)、国际前列腺症状评分表(IPSS)评分和生活质量评分(QOLS)等。再选取我院100例以尿道前列腺电切术(TURP)治疗的BPH患者的临床资料,对比两组患者并发症的发生情况。结果:102例BPH患者的年龄为(71.58±9.74)岁,切除腺体为(84.32±36.39)g,手术出血量为(146±24.68)mL,手术前的最大尿流率(8.37±5.28)mL/s,最大尿流率时逼尿肌压为(72.93±26.49)cm H_2O,IPSS评分为(28.8±5.98)分,QOLS评分为(5.8±0.46)分;手术后的最大尿流率(24.77±5.89)mL/s,最大尿流率时逼尿肌压为(42.35±10.37)cm H_2O,IPSS评分为(9.4±1.28)分,QOLS评分为(2.8±0.28)分。手术后的Qmax明显升高(P0.05),而Pdet/Qmax、IPSS评分和QOLS均显著降低(P0.05)。HoLEP术治疗的BPH患者并发症发生明显低于尿道前列腺电切术(TURP)治疗的患者(P0.05)。结论:HoLEP是一种安全有效的治疗BPH的微创手术。     

部队疗养院非现役文职护理人员的现状分析

目的:分析部队疗养院非现役文职护理人员的现状并给出相应对策。方法:采用不记名问卷形式对92名非现役文职护理人员进行调查。结果:部分非现役文职护理人员在业务能力、军事素质、身心健康等方面存在不足。结论:应采取有效措施提升非现役文职护理人员的综合素质,提高护理质量。     

部队疗养院非现役文职护理人员的现状分析

目的：分析部队疗养院非现役文职护理人员的现状并给出相应对策。方法：采用不记名问卷形式对92名非现役文职护理人员进行调查。结果：部分非现役文职护理人员在业务能力、军事素质、身心健康等方面存在不足。结论：应采取有效措施提升非现役文职护理人员的综合素质,提高护理质量。     

Transformation of health services from civilian to wartime medical corps--example from Bosnia and Herzegovina

In the multiethnic Bosnia and Herzegovina, Croats and Muslims, attacked by the Yugoslav army and Serbs, had to employ rationally their poorly provisioned civilian health services so that they could respond to the extremely numerous and prompt needs of war conditions. The health services in the areas controlled by Croats and Muslims had to be reorganized twice because of sudden changes of wartime conditions. With further development of the situation, when all three sides participated in the conflict, the number of wounded increased rapidly. In the meantime, a large-scale population shift on an ethnic basis occurred in all parts of Bosnia and Herzegovina, thus giving rise, along with a greater number of the wounded, to a severe humanitarian crisis. Civilians were therefore another heavy burden to the wartime health services. This created enormous problems for the inadequately provisioned health services of Bosnia and Herzegovina in the area under the control of Croats and Muslims. However, poorly equipped with personnel as well as everything else, the health services in the area controlled by Croats and Muslims, through appropriate reorganization, successfully accomplished their task in the wartime medical corps. Besides this correctly executed transformation from civilian health services into a wartime medical corps, high motivation of medical staff also greatly contributed to successful operation of the medical corps in the war zone despite the long duration of the war. In the majority of cases, the wounded were within 30-40 minutes from the moment of injury in the hands of a surgical team and within the next ten minutes were already in the operating theater. After primary wound dressing, the wounded were sent to one of the well-organized main war hospitals for further treatment. This resulted, along with secure evacuation routes, in a minimum number of lifelong invalidity among the wounded.     

The long shadow of the Kargil War: The effect of early-life stress on education

The paper examines the long-term impact of the India-Pakistan war of 1999 on the educational attainment of children born to families of soldiers who survived the war. Based on the assumption that military families faced higher levels of psychological stress than civilian families during the war period, the paper uses a difference-in-difference methodology with household fixed effects to show that the education of military children exposed to the war during their formative years suffered significantly. An examination of the consumption expenditure pattern of military and civilian households suggests that the effect was unlikely to be via resource-related channels. The improbability of other direct pathways through which the war could affect these families suggests that the negative effect might have resulted from the psychological stress that the war generated for the affected families.     

医学研究生灾难医学知识的初步调查及对策

目的了解医学研究生对灾难医学相关知识的认知情况。方法通过发放调查问卷,对我校2008-2011年入学的458名医学研究生进行灾难医学相关知识调查分析。结果医学研究生对灾难医学的基本概念、基本急救技术、灾后心理援助以及传染病的预防及处理相关知识掌握较好,但对灾难伤员的检伤分类、灾难医学管理相关知识掌握明显不足。结论医学研究生掌握灾难医学相关知识已明显提高,但仍存在不足,应加强医学研究生急救技能培训、开设灾难医学选修课,以提高我国灾难医学救援整体水平。     

New tools for systematic evaluation of teaching qualities of medical faculty: results of an ongoing multi-center survey

Background

Tools for the evaluation, improvement and promotion of the teaching excellence of faculty remain elusive in residency settings. This study investigates (i) the reliability and validity of the data yielded by using two new instruments for evaluating the teaching qualities of medical faculty, (ii) the instruments'' potential for differentiating between faculty, and (iii) the number of residents'' evaluations needed per faculty to reliably use the instruments.

Methods and Materials

Multicenter cross-sectional survey among 546 residents and 629 medical faculty representing 29 medical (non-surgical) specialty training programs in the Netherlands. Two instruments—one completed by residents and one by faculty—for measuring teaching qualities of faculty were developed. Statistical analyses included factor analysis, reliability and validity exploration using standard psychometric methods, calculation of the numbers of residents'' evaluations needed per faculty to achieve reliable assessments and variance components and threshold analyses.

Results

A total of 403 (73.8%) residents completed 3575 evaluations of 570 medical faculty while 494 (78.5%) faculty self-evaluated. In both instruments five composite-scales of faculty teaching qualities were detected with high internal consistency and reliability: learning climate (Cronbach''s alpha of 0.85 for residents'' instrument, 0.71 for self-evaluation instrument, professional attitude and behavior (0.84/0.75), communication of goals (0.90/0.84), evaluation of residents (0.91/0.81), and feedback (0.91/0.85). Faculty tended to evaluate themselves higher than did the residents. Up to a third of the total variance in various teaching qualities can be attributed to between-faculty differences. Some seven residents'' evaluations per faculty are needed for assessments to attain a reliability level of 0.90.

Conclusions

The instruments for evaluating teaching qualities of medical faculty appear to yield reliable and valid data. They are feasible for use in medical residencies, can detect between-faculty differences and supply potentially useful information for improving graduate medical education.     

A policy management game for mass casualty incidents: an experimental study

The number of complex and unique mass casualty incidents has increased due to natural and technological disasters as well as man-made disasters such as political instabilities, economic recession, and terrorism. Thus, health care policy-makers such as the Austrian Samaritan Organization have been continuously improving the training of emergency staff to enable them to quickly evacuate an emergency site, to minimize the number of fatalities at the incident site, and to decrease the patients’ waiting time for treatment. We developed a policy management game to provide a training tool for emergency staff to support such policy-makers. In addition, with this game students can be educated on scheduling and planning techniques such as simulation, queuing theory, and resource allocation. To investigate the potential of our policy management game, we conducted an experimental study with 96 participants including students, practitioners from health care services, and researchers. They acted as incident commanders to decide on sending medical staff to triage, to different treatment rooms for care and to on-site transportation, as well as to transportation to hospitals during three game runs. The participants rated the general structure and organization of the experiment as high. The performance was also improved by many participants during the experiment. We found differences in performance among the different participant groups.     

THE NEW MILITARY MEDICAL ETHICS: LEGACIES OF THE GULF WARS AND THE WAR ON TERROR

United States military medical ethics evolved during its involvement in two recent wars, Gulf War I (1990–1991) and the War on Terror (2001–). Norms of conduct for military clinicians with regard to the treatment of prisoners of war and the administration of non‐therapeutic bioactive agents to soldiers were set aside because of the sense of being in a ‘new kind of war’. Concurrently, the use of radioactive metal in weaponry and the ability to measure the health consequences of trade embargos on vulnerable civilians occasioned new concerns about the health effects of war on soldiers, their offspring, and civilians living on battlefields. Civilian medical societies and medical ethicists fitfully engaged the evolving nature of the medical ethics issues and policy changes during these wars. Medical codes of professionalism have not been substantively updated and procedures for accountability for new kinds of abuses of medical ethics are not established. Looking to the future, medicine and medical ethics have not articulated a vision for an ongoing military‐civilian dialogue to ensure that standards of medical ethics do not evolve simply in accord with military exigency.