军队医院中患者对医护工作的评价及需求调查

目的：本文通过调查部分军队医院患者对护理工作的评价及需求,为提高军队医院的护理服务质量提供有利资料。方法：随机抽取四所三级甲等军队医院的380名住院患：考进行问卷调查,调查患者对护理工作的满意程度及需求。结果：患者对护理服务技术满意度为43．2％,对态度满意度为37．3％,对环境和健康教育满意度分别为59．5％和55％;患者最需要的知识为康复知识,占46．1％;患者对护理人员热情工作态度的期许和需求最高,达到38．2％;其次为熟练工作技能,占28．4％。结论：从患者角度出发,真正落实以民文本的原则,切实为患者服务,改善护理服务质量已经成为护理领域的核心内容,应得到各个军队医院的重视,落实优质护理服务工作。     

Systematic Monitoring of Male Circumcision Scale-Up in Nyanza,Kenya: Exploratory Factor Analysis of Service Quality Instrument and Performance Ranking

Background

Considerable conceptual and operational complexities related to service quality measurements and variability in delivery contexts of scaled-up medical male circumcision, pose real challenges to monitoring implementation of quality and safety. Clarifying latent factors of the quality instruments can enhance contextual applicability and the likelihood that observed service outcomes are appropriately assessed.

Objective

To explore factors underlying SYMMACS service quality assessment tool (adopted from the WHO VMMC quality toolkit) and; determine service quality performance using composite quality index derived from the latent factors.

Study design

Using a comparative process evaluation of Voluntary Medical Male Circumcision Scale-Up in Kenya site level data was collected among health facilities providing VMMC over two years. Systematic Monitoring of the Medical Male Circumcision Scale-Up quality instrument was used to assess availability of guidelines, supplies and equipment, infection control, and continuity of care services. Exploratory factor analysis was performed to clarify quality structure.

Results

Fifty four items and 246 responses were analyzed. Based on Eigenvalue >1.00 cut-off, factors 1, 2 & 3 were retained each respectively having eigenvalues of 5.78; 4.29; 2.99. These cumulatively accounted for 29.1% of the total variance (12.9%; 9.5%; 6.7%) with final communality estimates being 13.06. Using a cut-off factor loading value of ≥0.4, fifteen items loading on factor 1, five on factor 2 and one on factor 3 were retained. Factor 1closely relates to preparedness to deliver safe male circumcisions while factor two depicts skilled task performance and compliance with protocols. Of the 28 facilities, 32% attained between 90^th and 95^th percentile (excellent); 45% between 50^th and 75^th percentiles (average) and 14.3% below 25^th percentile (poor).

Conclusion

the service quality assessment instrument may be simplified to have nearly 20 items that relate more closely to service outcomes. Ranking of facilities and circumcision procedure using a composite index based on these items indicates that majority performed above average.     

Improved fine needle aspiration (FNA) cytology results with a near patient diagnosis service for breast lesions

This study is a review of the quality of FNA cytology results for breast lesions approximately 18 months before and 10 months after a change from a rapid diagnosis FNA service with consultant pathologist aspirators to a conventional FNA service with clinician aspirators of varied experience. The setting was symptomatic breast clinic in a large hospital in rural New Zealand acting as a tertiary referral centre for a population of 550,000. The results were collected retrospectively and prospectively. The quality of results for pathologist aspirators (total 810) and clinician aspirators (total 403) was compared using the definitions of the NHS Breast Screening Program Guidelines for Cytology Procedures and Reporting in Breast Cancer Screening. There were statistically significant differences in specificity (biopsy cases only) with 73% for pathologists and 49% for clinicians, specificity (full) with 74% and 56%, inadequate rate with 23% and 37%, and complete sensitivity with 76% and 67%. The use of pathologist aspirators allowed the specimens to be reported in a few minutes. Specimens taken by clinicians took at least 30 min to report. The financial aspects of the two approaches are discussed. When compared with clinician aspirators, pathologist aspirators obtained better quality results and these were reported more quickly.     

Correlates of female sterilization regret in the southern states of India

This study analyses factors associated with the incidence of sterilization regret in the four south Indian states of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. Using data from the National Family Health Surveys, in all four states the incidence of regret was found to be less than 10% and the factors significantly associated with it were child loss experience and quality of services. Hence, there is a need to improve the quality of services, both in terms of counselling and service provision, and women need to be counselled about the permanent nature of sterilization in order to avoid future regret.     

Cost-Effectiveness Analysis of a Mobile Ear Screening and Surveillance Service versus an Outreach Screening,Surveillance and Surgical Service for Indigenous Children in Australia

Indigenous Australians experience a high rate of ear disease and hearing loss, yet they have a lower rate of service access and utilisation compared to their non-Indigenous counterparts. Screening, surveillance and timely access to specialist ear, nose and throat (ENT) services are key components in detecting and preventing the recurrence of ear diseases. To address the low access and utilisation rate by Indigenous Australians, a collaborative, community-based mobile telemedicine-enabled screening and surveillance (MTESS) service was trialled in Cherbourg, the third largest Indigenous community in Queensland, Australia. This paper aims to evaluate the cost-effectiveness of the MTESS service using a lifetime Markov model that compares two options: (i) the Deadly Ears Program alone (current practice involving an outreach ENT surgical service and screening program), and (ii) the Deadly Ears Program supplemented with the MTESS service. Data were obtained from the Deadly Ears Program, a feasibility study of the MTESS service and the literature. Incremental cost-utility ratios were calculated from a societal perspective with both costs (in 2013–14 Australian dollars) and quality-adjusted life years (QALYs) discounted at 5% annually. The model showed that compared with the Deadly Ears Program, the probability of an acceptable cost-utility ratio at a willingness-to-pay threshold of $50,000/QALY was 98% for the MTESS service. This cost effectiveness arises from preventing hearing loss in the Indigenous population and the subsequent reduction in associated costs. Deterministic and probability sensitivity analyses indicated that the model was robust to parameter changes. We concluded that the MTESS service is a cost-effective strategy. It presents an opportunity to resolve major issues confronting Australia’s health system such as the inequitable provision and access to quality healthcare for rural and remotes communities, and for Indigenous Australians. Additionally, it may encourage effective health service delivery at a time when the healthcare funding and workforce capacity are limited.     

新形势下加强医疗服务质量监管的路径选择

卫生服务质量包括公共卫生服务质量和医疗服务质量。其中,医疗服务质量直接关系到患者的生命与健康,是卫生服务的核心工作。目前,医疗服务市场”信息不对称”,因此,如何有效的监管医疗机构的服务质量成为政府的重要职责之一。本文在明确医疗服务质量监管内涵的基础上,结合我国监管现状,指出我国医疗服务领域所存在的监管主体单一、监管力量薄弱、监管法规有待完善、监管过程缺乏常态化、监管结果未能及时公开等方面的不足,并针对上述不足之处,提出四点政策建议：一是以政府为核心,培育多元监管主体;二是以信息化建设为平台,创新监管手段;三是以法规建设为重点,完善监管体系;四是加强监管结果的运用。     

国土空间生态修复与保护空间识别——以北京市为例

构建国土空间修复与保护识别体系可以有效实现区域生态系统修复与保护,然而,当前国土空间生态修复与保护研究和规划缺乏从系统性和完整性的角度识别关键生态修复与保护区。因此构建了系统的生态修复与保护空间识别方法,以实现区域协调发展、保障区域生态安全。基于该方法,以北京市为例,通过评估生态系统服务、生态系统质量和生态问题,构建生态修复与保护空间格局。研究结果表明：(1) 2000—2015年生态系统服务和质量退化区主要集中在平原区和密云水库北部,面积为760.4 km~2;生态系统质量低下区主要分布在西南部山区和东北部山区,面积为4925 km~2;水土流失问题区零星分布在山区,面积为130.1 km~2;基于以上三者的北京生态修复建议区总面积5606 km~2。(2)建议北京生态保护区6391 km~2,主要分布在北部山区和西南部山区,保护了79.63%的水源涵养功能,74.97%的土壤保持功能,58.79%的洪水调蓄功能和60.3%的自然栖息地。本研究构建的生态修复与保护空间识别方法体系,为北京生态修复和保护规划与生态安全格局构建提供科学依据,还可以为其他地区的生态修复与保护规划提供参考。     

Performance Evaluation of Resource Management in Cloud Computing Environments

Cloud computing is a computational model in which resource providers can offer on-demand services to clients in a transparent way. However, to be able to guarantee quality of service without limiting the number of accepted requests, providers must be able to dynamically manage the available resources so that they can be optimized. This dynamic resource management is not a trivial task, since it involves meeting several challenges related to workload modeling, virtualization, performance modeling, deployment and monitoring of applications on virtualized resources. This paper carries out a performance evaluation of a module for resource management in a cloud environment that includes handling available resources during execution time and ensuring the quality of service defined in the service level agreement. An analysis was conducted of different resource configurations to define which dimension of resource scaling has a real influence on client requests. The results were used to model and implement a simulated cloud system, in which the allocated resource can be changed on-the-fly, with a corresponding change in price. In this way, the proposed module seeks to satisfy both the client by ensuring quality of service, and the provider by ensuring the best use of resources at a fair price.     

Pollinator service affects quantity but not quality of offspring in a widespread New Zealand endemic tree species

Human-mediated introductions of predatory mammals to New Zealand have led to massive bird extinctions and population declines. This reduction in bird abundance could have a variety of negative effects on the plants they pollinate, and this has led to recent management efforts to eliminate predatory mammals in some areas. In this study, we utilized variation in management efforts to determine the effects of pollinator service on progeny quantity and quality of an endemic New Zealand tree species, Fuchsia excorticata. Due to its gynodioecious breeding system (separate hermaphroditic and female plants), we were able to estimate effective pollination by scoring pollen deposition on females as a proxy for pollinator service, which we used to examine the effect of pollinator service on both the quantity of fruits produced and the quality of fruits, as measured by the selfing rate of hermaphrodites. We found that increased pollinator service increased progeny quantity, with a stronger effect in females, but had no effect on the quality via selfing rates. The combined effects of pollen limitation and loss of seeds due to inbreeding depression led to hermaphrodites having an estimated 24–80% reduction in the number of offspring reaching reproductive age, even in the highly managed populations. Our results suggest management efforts can have substantial impacts on progeny quantity, but progeny quality is likely influenced by more difficult to manage population or species-specific traits such as tree size, plant sex ratio, and pollinator behavior.     

读者服务中图书馆员的语言调适

阐述了服务语言在高校图书馆工作中的重要性,提出了馆员应利用亲切、礼貌、诙谐的语言来提升服务语言的质量;并通过使用微笑服务,合理调适语气、语调,提高自身的专业知识和文化修养来优化服务语言。     

陕北黄土高原植被恢复与生态系统服务的时空关系

陕北黄土高原作为退耕还林还草核心区域,是地表格局及植被显著变化的区域之一。评估植被恢复成果及其对生态系统服务的影响,对促进区域生态环境提升具有重要作用。本研究选择植被覆盖度作为指标评估区域植被恢复状况,以碳固定服务、土壤保持服务、生境质量及产水服务作为指标表征区域生态系统服务,分析权衡协同关系及不同尺度的时空变化,同时运用双变量空间自相关分析植被恢复对生态系统服务的影响。结果表明: 2000—2020年,陕北黄土高原植被覆盖度呈波动上升趋势,年均值由31.7%升至47.1%,植被改善显著;研究区碳固定服务、土壤保持服务呈明显上升趋势,生境质量几乎保持不变,产水服务先升后下降总体呈上升趋势,各生态系统服务时空变化存在明显的尺度效应;4种生态系统服务间的关系主要为协同;植被覆盖与生态系统服务之间存在显著的空间依赖性,相关程度存在一定差异,植被覆盖度对土壤保持服务影响最明显,其次为碳固定服务,而植被覆盖增强条件下林草耗水增多则导致区域产水量下降,造成一定的负效应。总的来说,陕北黄土高原地区植被建设已取得显著成效,生态环境得到明显改善。     

Evaluating municipal solid waste management performance in regions with strong seasonal variability

The evaluation of municipal solid waste (MSW) services using management systems (ISO 9001, ISO 14001, and OHSAS 18001) is important for improving the quality of such services. In this study, we prioritize and select performance indicators (PIs) for MSW service evaluation and organize them in a Balanced Scorecard (BSC) tool. The tool is applied for the period 2008–2011 to the public administration organization responsible for waste management in Loulé Municipality, Portugal, a region characterized by strong tourist seasonality. MSW management priorities are well established through EU directives and the application of PIs should allow service objectives to be quantified, including reducing the production of waste, increasing the quantity of recyclables, improving clients’ satisfaction with the service, improving workers’ motivation, decreasing the quantities of waste in landfills, and reducing service costs. The results indicate that the use of indicators and BSC tool can assess the strategic objectives of the organization and monitor its performance over time. The overall BSC assessment ratings were 51.7%, 66.1%, and 70.1% for 2009, 2010, and 2011, respectively, indicating an improvement in overall service performance over time. The results demonstrate that monitoring seasonal variations of PIs in tourist regions is important since these variations can help to explain annual changes in the factors affecting waste services management, their impacts on overall service quality, and the best time for measures to be applied. Based on this case study, the BSC can effectively contribute to improvements in the quality and cost of MSW services in areas characterized by strong seasonal variations in population and waste.     

School-age involvement in sport and perceived quality of sport services

Creating an active and healthy lifestyle starts in infancy and adolescence. A number of individual and collective factors affect whether or not sport is taken up and continued, which is an essential element in achieving a healthy lifestyle in adolescence and extending this into adult life. This study sets out to determine the perceived quality of the sport service provided by schools with organised physical activities, and whether the most positively assessed public organisations have a higher percentage of participation than those with a more negative assessment. The study population was 1109 adolescents from 28 towns comprising part of a sport provision system. A self-devised questionnaire with all the necessary properties, validity and reliability was conducted. The results showed that 42% of the adolescents take part in organised physical sport, and give the service provided a positive assessment. It was found that in organisations with a more positive assessment, the town has a higher rate of involvement in sporting activities.     

A study of the impact of oral health on the quality of life of older people in the UK- findings from a National Survey.

Objectives The aim of this study was to was to determine whether older adults perceive oral health as affecting their life quality and to identify variations in impacts in relation to socio-demographic factors, dental service utilisation and method of payment. Design This study formed part of the Office for National Statistics Omnibus Survey, which utilised a random probability sample of addresses from the British Postcode Address File (PAF). Setting 3,000 homes were selected from one hundred post sectors across Britain. Respondents were interviewed in their homes about how oral health affects their quality of life. Subjects 454 older people (aged 65 and over) took part in the survey. Main outcome measures The study group perceived oral health as impacting on their quality of life in general (negative and/or positive impact) (70%, 318), enhancing (53%, 241) and detracting (44%, 199) from their life quality. The most frequently perceived way in which oral health affects life quality was its effect on eating and comfort. Older people from higher socio-economic groups reported that oral health had a greater impact on their quality of life in general (positive and/or negative impacts), (OR=1.77,95% CI= 1.22,2.78) and specifically, enhancing their quality of life (OR=1.52, 95% CI=1.01,2.30). Those who reported attending the dentist within the last year perceived that their oral health enhanced their life quality (OR=1.55, 95% CI=1.01,2.38). Conclusions Socio-economic background and dental attendance pattern are associated with how older people perceived oral health as affecting quality of life. These findings may have implications for promoting regular dental attendance and auditing dental services for older people.     

分层管理对大面积烧伤患者早期康复治疗的临床意义

目的：重度烧伤早期易合并多种并发症且病情复杂、死亡率高,严重影响患者的生存周期和生活质量。本研究分析并探讨不同干预措施对重度烧伤患者早期并发症的效果,为临床研究提供可借鉴的方法。方法：选取2011年1月．2012年11月我院收治的重度烧伤患者66例,随机分为常规护理组和分级管理组,每组各33例。常规组采取基本护理模式对患者进行康复期护理,分级管理组根据病情对患者进行分级,分配不同专业技能等级的护理人员进行护理。观察并比较两组患者的临床效果及对护理服务的满意度。结果：分层管理组患者并发症发生率为42.3％,明显低于常规护理组69．7％（P〈0．05）;分层管理组的护理质量、患者依从性及对护理服务的满意度均显著高于常规护理组,差异具有统计学意义（P〈0．05）。结论：对大面积烧伤患者实施分层管理的护理模式具有积极的作用,不仅有效降低并发症发生率,而且能够合理分配护理人员,优化服务质量,提高患者满意度,值得在临床护理实践中推广应用。     

UK-based real-time lymphoproliferative disorder diagnostic service to improve the management of patients in Ghana

The objective of the study was to evaluate the feasibility of a UK-based real-time service to improve the diagnosis and management of lymphoproliferative disorders (LPDs) in Ghana. Adult patients reporting to hospital with a suspected LPD, during a 1 year period, were prospectively enrolled. Bone marrow and/or lymph node biopsies were posted to the Haematology Malignancy Diagnostic Service (HMDS), Leeds, UK and underwent morphological analysis and immunophenotyping. Results were returned by e-mail. The initial diagnoses made in Ghana were compared with the final HMDS diagnoses to assess the contribution of the HMDS diagnosis to management decisions. The study was conducted at the two teaching hospitals in Ghana—Komfo Anokye, Kumasi and Korle Bu, Accra. Participants comprised 150 adult patients (≥12 years old), 79 women, median age 46 years. Bone marrow and lymph node biopsy samples from all adults presenting with features suggestive of a LPD, at the two teaching hospitals in Ghana, over 1 year were posted to a UK LPD diagnostic centre, where immunophenotyping was performed by immunohistochemistry. Molecular analysis was performed where indicated. Diagnostic classifications were made according to international criteria. Final diagnosis was compared to the initial Ghanaian diagnosis to evaluate discrepancies; implications for alterations in treatment decisions were evaluated. Median time between taking samples and receiving e-mail results in Ghana was 15 days. Concordance between initial and final diagnoses was 32% (48 of 150). The HMDS diagnosis would have changed management in 31% (46 of 150) of patients. It is feasible to provide a UK-based service for LPD diagnosis in Africa using postal services and e-mail. This study confirmed findings from wealthy countries that a specialised haematopathology service can improve LPD diagnosis. This model of Ghana–UK collaboration provides a platform on which to build local capacity to operate an international quality diagnostic service for LPDs.     

Evaluation of a primary care adult mental health service: Year 2

Aims This study aimed to examine the effectiveness of a primary care adult mental health service operating within a stepped care model of service delivery.Methods Supervised by a principal psychologist manager, psychology graduate practitioners provided one-to-one brief cognitive behavioural therapy (CBT) to service users. The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) was used to assess service user treatment outcomes. Satisfaction questionnaires were administered to service users and referring general practitioners (GPs).Results A total of 43 individuals attended for an initial appointment, of whom 19 (44.2%) completed brief CBT treatment. Of the 13 service users who were in the clinical range pre-treatment, 11 (84.6%) achieved clinical and reliably significant improvement. Of the six service users who were in the non-clinical range pre-treatment, three (50%) achieved reliably significant improvement. Both service users and GPs indicated high levels of satisfaction with the service, although service accessibility was highlighted as needing improvement.Conclusion The service was effective in treating mild to moderate mental health problems in primary care. Stricter adherence to a stepped care model through the provision of low-intensity, high-throughput interventions would be desirable for future service provision.     

结合生态系统服务供需和人类福祉的区域规划

生态系统服务与人类福祉的和谐关系是区域规划的基石。现有的区域规划较少同时考虑生态系统服务的供需和流域居民的福祉差异。以城市化流域——官厅水库流域为例,应用改进后的CASA模型、IPCC清单法、SolVES模型和问卷调查量化食物供给、碳固持和文化服务以及人类福祉,再结合服务的供需关系及人类福祉水平开展聚类分区,并针对各区情况提出规划建议。结果显示,官厅水库流域内食物供给和文化服务供大于求,而碳固持服务供不应求。流域福祉位于中等水平,分值为3.44(满分5分)。其中,居民的基本物质需求分值最高(3.64),收入分值(3.00)明显低于流域整体水平。除此之外,居民认为供水、医疗条件和收入这些福祉要素仍有待改善。流域可分为城市发展区、城郊休闲区、生态涵养区和文化建设区。在各区需采用因地制宜的方式,通过增大植被覆盖面、开展文旅产业和推动冰雪项目等形式,提高居民生活质量和维持区域可持续性。     

信息时代高校图书馆读者服务工作的发展对策研究

介绍了信息时代高校图书馆读者服务工作的发展趋势,分析了当前这项工作中存在的一些问题,并提出了解决这些问题的相应对策,如转变服务观念、加强图书馆技术设备建设、加强馆藏信息资源建设、创新读者服务内容、实行开放服务方式以及提高读者服务人员素质等。