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.     

Memory rehabilitation for older adults: preserving independent living / Rehabilitación de la memoria para adultos mayores: preservación de la autonomía de vida

Abstract

Episodic memory problems are the hallmark of cognitive ageing in normal elderly people. Learning of new material is worse in pathological cognitive ageing, such as dementia and its preliminary states (mild cognitive impairment). Because episodic learning is crucial to preserve independent living in the elderly, rehabilitation programmes for everyday memory problems are welcomed. The scope of scientific interest has switched from treatment to prevention. We claim that lifestyle interventions are the most direct way to preserve cognition. We summarize evidence for changes in nutrition and exercise. In addition, psychological interventions for elderly people with normal or pathological cognitive ageing are available. Recent meta-analyses found lacking evidence of transfer to everyday life and long-term effects. We critically assess these meta-analyses. We propose theoretically derived experimental interventions relying on spared learning mechanisms. As an example we report visual-imagery training showing positive effects in a randomized control trial, using individual memory diaries on memory improvement.     

Letting Go: Conceptualizing Intervention De‐implementation in Public Health and Social Service Settings

The discontinuation of interventions that should be stopped, or de‐implementation, has emerged as a novel line of inquiry within dissemination and implementation science. As this area grows in human services research, like public health and social work, theory is needed to help guide scientific endeavors. Given the infancy of de‐implementation, this conceptual narrative provides a definition and criteria for determining if an intervention should be de‐implemented. We identify three criteria for identifying interventions appropriate for de‐implementation: (a) interventions that are not effective or harmful, (b) interventions that are not the most effective or efficient to provide, and (c) interventions that are no longer necessary. Detailed, well‐documented examples illustrate each of the criteria. We describe de‐implementation frameworks, but also demonstrate how other existing implementation frameworks might be applied to de‐implementation research as a supplement. Finally, we conclude with a discussion of de‐implementation in the context of other stages of implementation, like sustainability and adoption; next steps for de‐implementation research, especially identifying interventions appropriate for de‐implementation in a systematic manner; and highlight special ethical considerations to advance the field of de‐implementation research.     

Student Service Members/Veterans’ Mental Health: Who Is at a Greater Risk for Posttraumatic Stress Symptoms on College Campuses?

Using a cross-sectional design, this study surveyed 144 students on campus who are service members and veterans to determine whether posttraumatic stress (PTS) symptoms are significantly correlated with demographic factors (e.g., age, race and marital status), risk factors (e.g., military branch and combat exposure), and resources (e.g., social support and religiosity). The results confirm previous findings on correlates of PTS symptoms, provide new information about service members on campus that are at a greater risk for PTS and highlight resources that are associated with reduced PTS symptoms. These findings not only give institutions of higher learning insight into identifying specific demographics that are at a greater risk for PTS symptoms on college campuses, but also point to ways of supporting student service members/veterans by accurately targeting existing resources to the most affected populations.     

The Community Psychologist as Critical Friend: Promoting Critical Community Praxis

Community‐engaged researchers have a responsibility to community partners to get beyond the traditional researcher stance to take on the active role of critical friend. On the basis of my own community research experiences in the USA, in this article, I argue that there is added value in taking on the practice of critical friendship to encourage a higher degree of critical reflection and critical practice in our partners and in our work together. In the context of long‐term, trusting relationships with community partners, researchers can play the role of critical friend working together to shape critical community praxis on the basis of critical theorizing, critical reflection, and a shared commitment to working for social justice. Those trying to make a difference in communities are often isolated and can benefit from opportunities for dialogue with other community practitioners within a critical frame of reference. Although not without risks and challenges, stepping into this role allows us to put into sharper relief the gap between community practice that challenges injustice and practice that maintains it. Copyright © 2014 John Wiley & Sons, Ltd.     

医保DIP改革与医疗服务供给的伦理思考：冲突与对策

区域点数法总额预算下的按病种分值支付（diagnosis-intervention packet,DIP）是当前国内医保支付方式改革的最大热点,但尚需完善。对医疗服务供给侧结构性改革的主要目标进行了梳理,以此为基础对DIP改革的潜在伦理问题进行了分析,认为DIP多劳多得的激励机制不利于机构间协作,控费导向支付机制不利于服务行为规范,等级系数设置和低费用偏好机制不利于机构服务能力提升。从制定连续服务支付策略、提高病种分组精细程度、统一各类医保支付政策及构建能力导向支付机制等方面提出了DIP改革的优化策略。

     

论当前我国医疗市场对医患关系的影响

解读目前紧张的医患关系是一个迫切的社会课题。医疗服务是一种商品 ,医疗市场是客观存在的 ,它是导致医患关系紧张的深层次原因。     

技术创新对提高医疗服务质量驱动力的探析

技术创新在人类发展史上起着里程碑式的作用,同样推动现代医学快速进展和持续进步。医疗技术是医疗质量的核心,技术创新能够全方位提升医疗服务质量。结合国内外医疗相关技术创新的现况和医院实践,剖析了技术创新在提升医疗服务质量中的驱动作用,结合自身实践,从医疗设备技术创新、医学信息技术创新、医学技术创新思维和理念这三个方面,对技术创新促进医疗服务质量提升的实现途径进行探讨,为持续改进和不断完善医疗服务质量提供新的思路和手段。     

A Minister's Information-Handling

ABSTRACT

One of the roles which ministers perform is that of “caregiver.” Caregiving functions include such activities as visiting parishioners, hearing confessions, and counselling people. These functions are carried out within a legal context. In this paper, two aspects of the parish minister's information handling in respect to his/her role as caregiver are examined. Specific attention is given to the pastor's vulnerability, while carrying out pastoral duties, to civil lawsuits for malpractice and to her/his expectation of privilege against testifying in criminal proceedings. It is observed that in North America, considerable confusion exists over who actually owns and who can control the information a minister acquires and disseminates.