如何降低ICU费用——规范ICU的建设和管理

ICU收费高的主要症结在于ICU的建设和管理需要规范化,包括在中国制定ICU的收治和转出指征规范,减少过度医疗和延迟医疗;积极配备ICU人力资源,提高监护质量,培训ICU专业医师上岗,掌握并运用专业知识施救,保证治疗的恰当性。允许恰当的家属陪护,对患者给予情感支持,或可降低镇静药物等的使用,缩短住院日;对于脑死亡、植物状态以及癌症晚期或其他晚期疾病的临终患者,提倡放弃治疗,避免无益救治造成卫生资源的浪费,对家属造成巨大的精神压力和经济负担。但是医生主动放弃治疗的决定尚需要政策的支持和法律的保障。     

英国养老护理人员培训对我国的借鉴与启示

本文介绍了英国养老护理人员培训概况,分析了其培训特点,在此基础上思考了对我国养老护理人员培训的借鉴：满足老年人的疾病护理的需求,丰富护理内涵;不断壮大养老护理队伍,吸引高技能人才;借鉴NVQ制度,促进我国养老护理人员分层培训体系的建立;改善养老护理员工的福利与奖惩制度;完善养老机构的规章制度,确保持证上岗比例。     

中国当代医疗语言学研究综述

中国当代医疗语言学研究可分为两大方面,一是理论构建,二是具体研究。对于前者,学者初步建立了理论框架,但未能充分融合沟通学和语言学的理论,较少客观分析患者的语言特点和贡献,未能深入讨论相关的语用、社会、心理、认知等因素。从研究路径来说,具体研究又可分为语言学方法、医学视角和人文视角三个方面,各自有不同的特点和优势。中国当代医疗语言学研究在医疗语言互动的语旨、语场、语式以及理论基础等方面还存在较多值得开拓的空白和课题。     

A Review of: “Barkley,R. A., & Robin,A. L. (2008). Your Defiant Teen: 10 Steps to Resolve Conflict and Rebuild Your Relationship.”

We report a study that addressed behavior data recording by direct-care staff at a child services program. In response to a decreasing percentage of daily data recording in two community-based group homes, a supervisory intervention was implemented, consisting of a revised data recording form and providing performance feedback to the direct-care staff. The intervention increased and maintained the percentage of daily data recording each month across the two group homes and seven sets of child behavior data. The study represents one approach toward staff performance improvement within child services programs.     

ICU医务人员在心脏死亡器官捐献中面临的伦理问题及对策

心脏死亡器官捐献是目前解决器官移植工作器官短缺的关键性举措,参与器官捐献过程的ICU的医务人员需要直接面临对潜在捐献者的治疗照护、临终护理、死亡判定等诸多伦理问题.应加强ICU医务人员器官捐献伦理知识的普及教育并完善相关法律制度,以保证器官捐献工作的健康、可持续发展.     

Through a glass darkly Some reflections on psychiatric nursing

Abstract

This paper is about ways of understanding some of the behaviour and events that occur in psychiatric wards. It is argued that a psychodynamic understanding of these events would help both staff and patients see some ‘meaning in madness’.     

The Association Between Delirium and Cognitive Decline: A Review of the Empirical Literature

Delirium is a common neurobehavioral syndrome that occurs across health care settings which is associated with adverse outcomes, including death. There are limited data on long-term cognitive outcomes following delirium. This report reviews the literature regarding relationships between delirium and cognitive impairment. Psych Info and Medline searches and investigation of secondary references for all English language articles on delirium and subsequent cognitive impairment were carried out. Nine papers met inclusion criteria and documented cognitive impairment in patients following delirium. Four papers reported greater cognitive impairment among patients with delirium than matched controls. Four papers reported higher incidence of dementia in patients with a history of delirium. One study found 1 of 3 survivors of critical illness with delirium developed cognitive impairment. The evidence suggests a relationship between delirium and cognitive impairment, although significant questions remain regarding the nature of this association. Additional research on delirium-related effects on long-term cognitive outcome is needed.     

Training staff to conduct a paired-stimulus preference assessment

Three staff members were trained to conduct stimulus preference assessments using a paired-stimulus format with 8 children with autism. Staff were trained to mastery level using brief instruction, a video model, and rehearsal with verbal feedback. Training took about 80 min per staff member. Results demonstrated that staff rapidly learned to correctly perform paired-stimulus preference assessments with children.