签署知情同意书有助于改善医患关系

当前医疗活动中由于缺乏人文关怀、患者对医务人员信任度下降以及医患之间信息不对称,导致现阶段医疗投诉以及医疗纠纷逐年上升,投诉和纠纷内容多样且性质趋于严重复杂。在签署医疗知情同意书时,适时给予病人情感上的关爱,重视病人心理需求,采取医学技术与人文关怀相结合的医疗活动,有助于在现代医学模式基础上构建和谐的医患关系。     

实施社区首诊制必先做好条件准备

为了解决群众“看病难,看病责”的问题,国家大力发展社区卫生事业。社区首诊制作为其中一项重要的制度被各地纷纷响应,然而由于我国现阶段社区卫生事业基础尚很薄弱,开展社区首诊制的条件还不具备,因此开展起来困难重重。所以现阶段应以完善社区首诊制的基础条件为工作重心。     

香港医疗制度与改革

香港的医疗制度由一个"二元医疗体系"组成,在体制模式、融资制度及服务规管三方面的安排都有其独特之处,为香港七百多万人提供了一个全民医疗安全网,能够达到公平、有效、可及性高及质素佳的要求。但是这个医疗系统也存在不少问题和隐忧,需要有效的改革,包括管治、管理、服务安排和融资模式改革等。     

Maternal and paternal infant representations: A comparison between parents of term and preterm infants

Objective

Research on parental attachment representations after preterm birth is limited and inconclusive. The present study is the first in which maternal and paternal attachment representations after term, moderately and very preterm birth are compared. In addition, special attention was directed toward disrupted attachment representations.

Method

Mothers and fathers of term infants (≥37 weeks of gestational age, n = 71), moderately preterm infants (≥32–37 weeks of gestational age, n = 62) and very preterm infants (<32 weeks of gestational age, n = 56) participated in the present study. Attachment representations (balanced, disengaged, distorted) about their infants were evaluated with the Working Model of the Child Interview (WMCI). To asses disrupted representations the coding of the WMCI was extended with the disrupted scale (WMCI-D).

Results

The three main classifications of attachment representations were not affected by preterm birth. In addition, there were no gender differences in the rate of balanced representations. In case of non-balanced representations however, maternal representations were more often distorted, whereas fathers showed more often disengaged representations. Results further revealed that maternal disrupted attachment representations were marked by role/boundary confusion or disorientation, whereas paternal disrupted attachment representations were characterized by withdrawal.

Conclusion

Given the gender differences it is essential to tailor interventions according to the attachment representations of the parent, in order to be able to alter their non-balanced and/or disrupted attachment representations.     

Nonmaternal care hours and temperament predict infants’ proximity-seeking behavior and attachment subgroups

Using the NICHD Early Childcare dataset (N = 1281), this study examined whether infant temperament and the amount of time infants spend in nonmaternal care independently predict (1) the likelihood that they seek comfort from their mother when needed and (2) placement in a particular subgroup of infant-mother attachment patterns. Mothers reported the number of hours their infant spent in nonmaternal care each month and their infant's difficulty adapting to novel stimuli at 6 months. The degree to which 15-month-old infants seek comfort from their mother during reunion episodes in the Strange Situation was observed using two behavioral scales (“proximity seeking” and “contact maintaining”). Their average score forms the outcome variable of “proximity-seeking behavior.” The other outcome variables were the subgroups of infant-mother attachment patterns: two subgroups for insecure babies (resistant and avoidant) and four subgroups for secure babies (B1, B2, B3, and B4). Easy adaptability to novel stimuli and long hours of nonmaternal care independently predicted a low level of proximity-seeking behavior. These predictors also increased the likelihood of an insecure infant being classified as avoidant (vs. resistant). A secure infant with these same predictors was most likely to be classified as B1, followed by B2, and then B3, with B4 being the least likely classification. Although previous studies using the NICHD dataset found that hours of nonmaternal care had no main effect on infants’ attachment security (vs. insecurity), this study demonstrates that hours of nonmaternal care predict the subcategories of infant-mother attachment.     

区域卫生规划与卫生资源配置

区域卫生规划与卫生资源配置的关系密不可分,同时也是解决医疗保健供需平衡的重大举措和主要手段。首先提出了区域卫生规划的现实意义和基本理论,并分析了建立区域卫生规划对解决以上问题怎样产生积极的影响。     

People with severe and profound intellectual disability: Nurse carer experiences in a South African setting

We explored nurse carer experiences with people with severe and profound intellectual disability in a care and rehabilitation centre in South Africa. Informants were a convenience sample of 10 nurses (females = 7; males = 3; mean years of service = 7.8, SD = 4.8 years). They completed an unstructured interview on their care provision experiences. The data were thematically analysed using Tesch’s method of open coding. Findings resulted in the following three themes to characterise the nurse carer experiences: compassion, person-centred care, and importance of parent involvement. Compassionate and person-centred care is fundamental to the establishment of a therapeutic relationship between nurse carers and people with severe and profound intellectual disability.