竹溪县降低孕产妇死亡率和消除新生儿破伤风项目分析

为实施“降低孕产妇死亡率和消除新生儿破伤风项目”,通过培训乡村产儿科技术服务人员,以改善乡镇卫生院产儿科服务条件,提高育龄妇女住院分娩安全意识,降低孕产妇死亡率和消除新生儿破伤风。开展了人员培训、健康教育、设备配置、贫困救助、监督指导等活动。孕产妇死亡率、新生儿破伤风等重点指标达到终期目标。提出贫困地区妇幼卫生事业建设与发展必需有可行性项目支持。     

不同地区孕产妇死亡率的比较

近年来,我国在降低孕产妇死亡率方面取得了令人瞩目的成绩,1994年我国孕产妇死亡率为1 500/10万,2005年已下降到47.7/10万,正在逐步实现联合国提出的"千年发展目标"[1].但我国妇幼保健状况仍存在许多问题,如地区差异和城乡差异还很大.     

投入不足对基层孕产妇保健服务提供的影响

投入不足是影响我国孕产妇保健服务提供的重要因素。通过对项目县的服务提供者和妇幼卫生关键知情人访谈资料的分析,描述服务提供网络及现有资源状况,认为投入不足通过乡镇卫生院院长的重视和支持程度、妇幼专干和村医的工作积极性、人力资源的改善以及设备和设施的改进等六个方面阻碍了孕产妇保健服务的提供。     

孕产妇意向对新生儿疾病筛查可及性的影响评价

采用问卷调查的方法对244名孕产妇进行了意向调查,通过了解需方对新生儿疾病筛查的认知、满意度等,对其可及性的作用,寻找潜在的促进和阻碍新生儿疾病筛查开展的种种影响因素,为我国今后更好地开展疾病筛查提供借鉴.     

从高危妊娠救治现状探讨三级综合医院产科发展模式

产科一直以来被大家公认为高危科室,三级综合医院产科收治的疑难危重孕产妇更多。自全面两孩政策实施以来,全国孕产妇死亡率出现升高趋势,比去年同期增长30.6%,母婴安全保障形势十分严峻。随着分娩人数的增加,各地妇幼服务机构工作量激增、工作压力加大,特别在高危妊娠的管理、救治等方面存在的问题日益突出。本文通过剖析高危妊娠救治现状,探讨三级综合医院产科发展模式,旨在为新形势下综合医院产科危重症救治方面提供新的思路。     

混沌理论对优化临床管理模式的启示——以孕产妇管理为例

围绕混沌理论与妊娠及分娩之间的联系,结合实践,提出可行的优化孕产妇管理工作的建议。强调医务人员应应用线上及线下多种方式,于孕前、孕期、产时、产后各阶段,针对孕产妇身心各方面,对其实施系统化的管理;应重点把握与孕妇首次接触的时机,建立信任关系以保证其良好的遵医行为;管理过程中应尊重孕产妇的个体差异,为其提供个性化的指导,同时应重视其支持系统的建立,医疗机构、社区、家庭应为孕产妇提供切实的支持。旨在为孕产期保健工作提供新思路,从而更好地为广大孕产妇服务。     

上海市某三级医院57起产科纠纷赔偿案例分析

产科是医疗纠纷发生概率最高的科室之一。随着国家二胎政策的全面实施,高危孕产妇的比例在不断升高,一旦出现医疗过错,极易导致医疗损害后果的发生。回顾性分析了上海市某三级医院57起产科医疗赔偿案例,分析其成因及分布特点。通过分析可知,造成产科医疗纠纷争议事由为胎儿或新生儿损害、孕产妇损害、意外事件等,医务人员在诊疗过程中存在助产及手术操作不当、胎儿监护不当、抢救治疗措施不力等过错。建议产科医务人员提高医疗技术水平和责任心,加强医患沟通,增强防范意识,以提高产科医疗质量,降低医疗纠纷的发生。     

综合医院开展临床预防服务的可行性

临床预防服务是预防医学的重要组成部分,也是临床医学的重要内容.鉴于慢性非传染性疾病对社会、家庭及个人的负担越来越重,在各级医院尤其综合医院开展临床预防服务,对预防慢性病的发生、发展,降低死亡率、减轻社会、家庭负担,将起到事半功倍的作用,产生深远影响.     

医患互动与新生儿先天性HCMV感染的诊疗

在新生儿先天性巨细胞病毒感染的诊疗中,乃至儿科疾病的防治中,应注重调节好医患矛盾的两方面.医患双方处理好知情同意,避免诊疗中的医疗纠纷,对于建立积极主动的、和谐信任的医患互动模式非常重要.这也体现了双方对新生命的最大的珍惜和尊重.     

关于低出生体重儿生长模式的思考

低出生体重儿发生率是衡量社会发展和妇幼保健状况的重要指标.低出生体重不仅直接增加新生儿死亡率和儿童早期的患病率,而且与儿童的远期预后密切相关.本文从低出生体重儿的生长特点、生长追赶的利弊以及营养管理等方面,探讨适于低出生体重儿的最佳生长模式,以求改善这一特殊群体的近期健康和远期生活质量.     

伊斯兰教临终关怀与癌性疼痛心理治疗的探讨

如何利用伊斯兰教的信仰关怀、情感关怀和死亡关怀“三关怀”,提高癌症患者临终关怀质量和癌性疼痛心理治疗效果,作者根据在宁夏回族地区癌症患者中开展临终关怀的五年实践体会,从临终关怀的宗旨和目的出发,探讨了伊斯兰教的临终关怀之信仰关怀、情感关怀和死亡关怀三种形式和内容,解释了癌性疼痛的原因、疼痛的主观和客观影响因素及心理治疗的常用方法和原则,总结了在宁夏回族地区开展临终关怀应用伊斯兰教的信仰关怀、情感关怀和死亡关怀”三关怀”与癌性疼痛心理治疗之间的关系。     

宁夏临终关怀现状及实践

在宁夏回族地区如何开展临终关怀工作和提高临终关怀工作的质量,根据在宁夏回族地区开展临终关怀工作五年的实践体会,分析了宁夏主要由于社会老龄化的压力、家庭结构的变化和宁夏疾病死因顺位变化原因开展临终关怀的必要性。探讨了目前宁夏临终关怀面临的七个主要问题,即热心从事临终关怀的专业人员少、临终关怀机构缺乏、社会重视度低、心理治疗严重不足、社会义工资源短缺、医院与外界对临终关怀医护人员的关怀少和患者及家属对临终关怀治疗的期望值高。总结了在宁夏开展临终关怀实践的六点体会。     

儒释道与改善癌症患者临终关怀的关系

随着中国肿瘤患病率的不断上升,社会对临终关怀的需求也逐渐增大。由于我国基本国情、文化背景和价值观念与西方不同,援引自西方基督教的临终关怀理念与实践方法在中国的发展出现了许多问题。本文旨在从中国传统的儒释道文化中汲取智慧和经验,针对当前的问题,从死亡教育的开展、医护人员的培训、临终关怀机构的发展与社会支持等方面,提出相应的完善策略,促进我国临终关怀的本土化、体系化、制度化与社会化,希望为构建具有中国特色的临终关怀体系提供新的思路。     

Spiritual distress at life's end: finding meaning in the maelstrom

Recent trends in social research indicate a decline in church attendance and a corresponding increased interest in spirituality. With the aging of the population, attention to end of life care, with its corresponding spiritual concerns and distress, has become a prominent issue. Spiritual distress can be difficult to distinguish from psychological and physical distress and indicates the need for differential diagnostic markers to distinguish between genuine spiritual experience and psychosis related to the physical death process. Further, for hospice patients who are in genuine need of amelioration through pharmacologic suppression, the question of when and how to medicate becomes paramount as the distinction between spiritual process and physchosis becomes less evident. This article is an exploratory attempt to encourage dialogue across interdisciplinary lines and foster participation from alternative therapies representing the spiritual context of the patient. Anecdotal data from hospice professionals representing a variety of disciplines are presented to illustrate and emphasize the need for continued dialogue and research in this important area.     

1例晚期肿瘤患者宁养服务浅谈

通过提供居家宁养护理指导和心理疏导的方法,为晚期癌症患者提供身、心、灵全方位的照顾,从而提高晚期癌症患者的生活质量。通过对1例晚期肿瘤患者进行症状控制、护理指导、心理疏导、灵性沟通,该晚期肿瘤患者及家属的自身照顾能力提高,晚期肿瘤患者在生命末期的生活质量有所提高,最终达到善终。身心灵的照顾在宁养服务中起重要作用,有利于患者生活质量的提高,但仍要根据患者的个体特点并掌握一定技巧。     

Creative Supervision for Counselors Working in a Hospice Setting

The number of individuals receiving hospice care in the United States is on the rise. Many individuals who suffer from debilitating health issues use the care of helping professionals in a hospice environment. Supervision approaches for counselors who encounter grief, loss, death, and bereavement issues in hospice settings are needed. The authors introduce three creative interventions for use with supervisees in one of the four stages of the integrative developmental model of supervision. One intervention, the “Rock Talk,” is more thoroughly explained and then demonstrated in a case illustration of a supervisee using the intervention to say goodbye to a hospice client.     

关于我国临终关怀发展策略的思考

随着人口的老龄化,疾病谱和死因顺位的改变,恶性肿瘤等慢性疾病的患病过程和死亡过程明显延长,加上晚期恶性肿瘤患者昂贵的医疗费用与低质量的生存状态,这些都使得临终关怀成为一种迫切的需求.为此探讨我国临终关怀服务存在的主要问题和对策.     

Wisdom at the end of life: Hospice patients’ reflections on the meaning of life and death

The processes of aging and confronting mortality are often accompanied by unique psychological challenges. From the perspective of positive psychology, such challenges can yield opportunities for growth, including increased wisdom. This qualitative study explored 15 terminally ill hospice patients’ perspectives on wisdom, the dying process, and the meaning of life using consensual qualitative research methods. Most participants cited humility as a key component of wisdom, emphasizing that “Wisdom is when we realize ‘I don’t really know much’.” Other components of wisdom included self-knowledge, rationality, experiential learning, listening to and learning from others, and sharing knowledge with others. Participants also suggested that the process of facing illness and death presents opportunities for positive growth, including changing priorities and learning to appreciate life more fully in the present moment. In considering the sources of meaning in their lives, participants emphasized relational connections, personal growth, spirituality, vocational fulfilment, and living a full life. Participants also shared their reflections on important past experiences and regrets. Lastly, participants offered advice to others based on their experiences facing illness and mortality. Implications for psychological care of the dying and future research are discussed.     

Lessons We Learned: Stories of Volunteer–Patient Communication in Hospice

As our population ages, the questions of how to care for and communicate with the dying have become increasingly important areas for research. This study identifies hospice volunteers as both important members of the hospice team and as an underresearched source of wisdom regarding end-of-life communication. This article presents preliminary findings from a longitudinal, ethnographic study of volunteer–patient relationships in hospice. Three themes related to volunteer–patient communication are described using stories from hospice volunteers. The article concludes with reflections on end-of-life communication as experienced by the volunteers, and suggests that narrative ethnography is an appropriate and effective research method for the study of hospice and end-of-life care.     

临终关怀护理的现状与分析

随着医疗卫生水平的不断提高,人们对临终关怀的需求亦处于增长之中。纵观国内外临终关怀的发展,在不断发展中尚存在诸多的问题。本文从临终关怀的现状着手,分析启动时间、关怀内容、社会支持和服务的机构与模式四方面存在的问题,为以后的研究指明方向。