摘要：Background: As professionals, family physicians are obliged to remain current on advances and trends in medicine and health care delivery. This is usually achieved through engagement in continuing professional development. Instructional design is a systematic method of development of education and training programs for improved learner performance. ADDIE is an instructional systems design model for building effective education and training in five phases: analysis, design, development, implementation and evaluation. Purpose: The purpose of this study was to introduce a professional development program for primary care physicians using the ADDIE instructional design model. Methods: Program requirements were defined using a needs assessment questionnaire and consultation observations. Interactive sessions were designed and developed based on the analysis results. The sessions were evaluated with interim and final feedback forms, a final problem-based questionnaire, a self-assessment questionnaire, and focus groups. Results: Scores on the final knowledge assessment were lower than expected. However, at least 50% of participants self-reported their learning improvement as “great” for 16 out of 23 topics. Focus group feedback was generally positive but also identified areas for improvement. Conclusion: Applying a structured instructional design model for creating professional development program for physicians is a fruitful, relevant experience in primary healthcare. 1) Continuing professional development (CPD) is an essential method to help physicians maintain and further develop knowledge and expertise;2) The ADDIE (analysis, design, development, implementation, evaluation) model provides an established and useful structure for creating effective CPD programs;3) The ADDIE process ensures that physicians’ appropriate learning needs are met effectively;4) The evaluation phase of the ADDIE process provides feedback that can lead to improvement in the CPD program’s future

摘要：Objectives:Effective and efficient communication is a core element in healthcare systems,especially between healthcare providers and *** study aimed to identify communication barriers be-tween nurses and patients in primary healthcare centers in ***:This is a cross-sectional study conducted across primary healthcare centers in *** hundred and two patients were recruited using convenience sampling.A self-administered question-naire comprising 29 items on communication barriers was ***:A total of 402 patients consented to *** majority of participants reported the following statements had large effects on communication:“shortage in the number of nurses compared to the large number of patients”(254/401,63.3%),“lack of desire of nurse to communicate with patients”(246/402,61.2%),and“negative attitude of the nurse toward the patient”(238/401,59.4%).Further,“difference in language between nurses and patients,”“lack of self-confidence by nurses,”and“nurses overwhelmed by work”were ranked as top three statements with a significant influence on commu-nication between nurses and ***:Communication between healthcare providers and patients is pivotal for an optimal healthcare *** on the findings of this study and the literature,we recommend formal training of health care workers in improving communication skills and including this not only in medical cur-riculum but also in the form of continuing medical education(CMEs)1.

摘要：Objective:Mental disorders of the elderly population in China deserve *** health is significantly associated with *** study aimed to evaluate the rate of depressive symptoms and to test the relationships between social health and depressive symptoms among a large sample of community-dwelling elderly ***:We conducted a cross-sectional study among community-dwelling adults aged 60 years or above in Zhejiang Province,***-to-face interviews were used to complete a structured questionnaire for all *** used the Social Health Scale for the Elderly(SHSE)to evaluate social health status and used the short form of the Geriatric Depression Scale to evaluate depressive *** logistic regression was used to evaluate the asso?ciation between social health status and depressive ***:Of the total of 3757 participants included,1887(50.23%)were female,and the mean±standard deviation(SD)age was(70.0±8.3)*** rate of depressive symptoms was 25.92%.The social health score was higher in non?depressed participants than in depressed participants(raw score 50.7 vs.48.3,P<0.001).Participants with"moderate”or"good”social health had a significantly lower risk of depressive symptoms than those with“poor"social health(odds ratio(OR)=0.55,95%con fide nee interval(Cl):0.46-0.66 for moderate social health;OR=0.45,95%Cl:0.35-0.60 for good social health).The association between social health and depressive symptoms was con sistent across several *** clusi ons:Social health is signify cantly inversely associated with depressive *** SHSE may serve as an efficient screener to identify those elderly adults with social health deficits,but systematic assessment to guide intervention merits further investigation.

摘要：课程开发是医学教育领域每个人都会遇到的话题。由于全科医学提供照护的类型广泛、人群年龄跨度大,所以全科医学教师尤其需要为医学生、住院医师、研究员和师资发展灵活开发有效的课程。在医学教育领域中,不断变化和演变的学习环境以及不断发展的要求,需要全新且创新的课程来满足。开发医学教育课程的过程看起来令人生畏,但如果将其分解,就可以变得非常简单易行。本文侧重于采用六步法介绍课程开发流程:需求评估、确定内容、编写目的和目标、选择教育策略、实施课程、评估课程。这个流程可以为全科医学教育者以及所有希望设计(或重新设计)自己医学教育课程的医学教育者提供模板。

摘要：Background: Promoting breastfeeding support by public health nurses (PHN) requires first that the support which they currently provide to be assessed. However, there is no assessment tool for this purpose. The aim of this study was therefore to develop a scale to assess breastfeeding support currently provided by PHN. Methods: We developed the Practice of Breastfeeding Support Scale (PBSS) for PHN based on the results of a previous study. The content validity of the PBSS was established through discussion with three other researchers. A pilot study was conducted to confirm face validity. To confirm reliability and validity, an anonymous, self-reported questionnaire was sent to PHN working in municipal offices. The statistical analyses included the Kaiser-Meyer-Olkin (KMO), Barlett’s Test of Sphericity, exploratory factor analysis (EFA), Cronbach’s alpha and correlation coefficient. Results: 768 PHN participated in this study. Cronbach’s alpha of PBSS was 0.85. The KMO measure was 0.892, and Bartlett’s Test of Sphericity was p Conclusion: The reliability and validity of PBSS were confirmed. These findings suggested that the PBSS has the potential to help promote breastfeeding support by PHN by clarifying their current breastfeeding support practices and related factors.

摘要：Background: The promotion of family nursing by public health nurses (PHN) presupposes an accurate assessment of the family nursing support they already provide. However, as there is no assessment tool for this purpose, this study aimed to develop a scale to assess family nursing currently provided by PHN. Methods: We developed the family Nursing Practice Scale (FNPS) for PHN based on the results of a previous study. The content validity of the FNPS was established through discussion with three other researchers. A pilot study was conducted to confirm face validity. To confirm reliability and validity, an anonymous, self-reported questionnaire was sent to PHN working in municipal offices. The statistical analyses included the Kaiser-Meyer-Olkin (KMO), Barlett’s Test of Sphericity, exploratory factor analysis (EFA), Cronbach’s alpha, correlation coefficient and t-test. Results: Seven hundred fifty-four PHN participated in this study. Cronbach’s alpha of FNPS was 0.94. The KMO measure was 0.948, and Bartlett’s Test of Sphericity was p < 0.01. Two factors together accounted for 63.2% of the variance in EFA. No items were excluded because of low loadings. Construct validity was confirmed through comparison with categories from a previous study. The correlation coefficient of FNPS and selected items of the Practice of Breastfeeding Support Scale was r = 0.56 (p < 0.01). The result of the t-test showed that the FNPS score of PNH who had received training in family nursing was significantly higher than that of PHN who had not (t = -2.0;p < 0.05). Conclusion: The reliability and validity of the FNPS were confirmed. The FNPS comprised 15 items and two factors. The score for “Active support for the family” was lower than “Support given with awareness of the family’s situation.” The findings of this study strongly suggested that the FNPS would be effective in clarifying the current state of family nursing provided by PHN and factors related to this activity and thus greatly ass

摘要：本文的目的是向家庭医学研究者介绍案例研究,是一种在社会和健康科学中常用的严谨研究方法,与临床病例报告相差较大。本文首先概述了社会和健康科学中的案例研究,包括其定义、潜在应用、历史背景和核心特征。然后通过一个教学计划的案例研究,介绍实施案例研究项目过程的10个步骤,该教学计划旨在教授国际家庭医学住院学习者敏感检查的技能。进行案例研究的步骤包括:进行文献综述、制定研究问题、确保案例研究合适、确定案例研究设计的类型、界定案例的界限并选择案例、准备数据收集、收集和组织数据、分析数据、撰写案例研究报告、评估质量。案例研究是一种高度灵活和强大的研究工具,对家庭医学研究者来说应用广泛。

摘要：实施科学是一门研究方法的学科,旨在实践和政策中促进循证干预措施的系统实施,进而改善健康。尽管实施研究需要高质量的证据,但实施策略的随机试验往往存在较为严重的局限性。这些局限性包括存在偏倚风险、缺乏理论运用、缺乏描述实施策略标准术语、局限于实施结局以及不充分报告。本文旨在对实施策略随机试验的设计、实施和报告提供指导,以提升循证实施科学。由研究人员、卫生政策制订者和实践者组成的国际小组整合了构建随机试验方法的重要文献和实施科学的最新进展。本文为实施策略随机试验的主要内容提供指导,包括试验目的阐明、试验中人员招募和保留策略、随机设计的选择、实施科学理论和框架的使用、测量(结局指标)、样本量计算、伦理审查和试验报告。本文也关注了实施试验中需要特别重视或调整的主题。为了推进实施策略随机试验的严格开展和报告,我们建议将本指南作为研究人员、卫生保健和公共卫生政策制订者或实践者、研究资助者和期刊编辑的参考资料。

摘要：背景:鼻咽癌是我国南方重点防治的恶性肿瘤之一,探讨天然草本菊花活性成分在NPC化学预防的作用,对建立现代康复体系具有重要意义。目的:研究菊花活性成分倍半萜烯内酯(SLs)对人鼻咽癌细胞中线粒体功能和半胱天冬酶活化途径的影响。设计:完全随机对照分组设计。地点和对象:由中山大学公共卫生学院预防医学系完成,对象为低分化CNE2细胞株。干预:对parthenolide(PN)进行剂量-反应和时间效应作用观察,采用噻唑蓝(MTT)颜色反应检测细胞线粒体功能,底物荧光光谱法测定细胞内caspase-9和-3活性,蛋白免疫印迹法检测线粒体内细胞色素C释放和caspase-3酶原降解片段;并应用特异性抑制剂进行细胞内cas-pase途径阻断实验。主要观察指标:细胞线粒体功能、细胞内caspase-9和caspase-3活性、线粒体细胞色素C的释放和caspase-3酶原的降解。结果:PN(1～100μmol/L)作用12h和24h后,MTT颜色反应抑制率随剂量显著增高,呈明显剂量依赖性(Pearson'sr=0.7322,0.7703,P<0.05),IC50分别为252.94μmol/L和49.63μmol/L;但caspase-9和-3活性未见升高,未见细胞色素C释放和caspase-3酶原降解片段形成。PN与caspase抑制剂联合作用后,caspase-9和-3活性明显低于对照和单独PN作用(t=9.146,8.280,27.325,27.450,P<0.05)。

摘要：目的汇总11个开展家庭医疗服务的专业姑息治疗团队效应。设计进行一项回顾性队列研究的汇总分析。地点加拿大，安大略省。参与者3109名在2009-2011年接受专业姑息治疗团队医疗服务的患者（暴露组）及3109名在此期间接受常规医疗服务的患者（非暴露组）。干预措施虽然这些姑息治疗团队所在地区和规模不同，但包含了相同的核心团队成员和角色分配，即能够为患者在其家中提供综合姑息治疗的姑息治疗专科医师、护士和家庭医生，团队任务包括全天候的管理症状、给予医疗信息和治疗措施以及协调服务。主要结局测量指标患者（a）在死亡前最后2周在医院度过；（b）死亡前最后2周有过急诊；（c）在医院内死亡。结果暴露组和非暴露组中癌症患者约占80％，且78％患者接受临终家庭医疗护理服务的平均时间相同。在所有姑息治疗团队中，暴露组中分别有970（31．2％）和896（28．9％）名患者在生命最后2周住院治疗和有急诊经历，而在非暴露组，分别为1219（39．3％）和1070（34．5％）名患者（P〈0．001）。暴露组与非暴露组患者在生命终期住院和经历急诊的汇总相对危险度分别为0．68[95％可信区间（CI，0．61～0．76）]和0．77[95％CI（0．69～0．86）]。与非暴露组相比，暴露组患者选择院内死亡的更少[503（16．2％）比887（28．6％），P〈0．01]，且在医院内濒死的汇总相对危险度为0．46（0．40-0．52）。结论尽管社区专业姑息治疗团队的组成和地区不同，但均能有效降低患者临终时急诊及选择在医院内死亡比例。