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5th INTERNATIONAL CONGRESS 第五届国际大会
Pub Date : 2017-07-13 DOI: 10.5750/IJPCM.V7I1.627
C. Woodhead
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引用次数: 0
Impact of Tracking Trends in Patients’ Hospital Experiences 跟踪趋势对患者住院经历的影响
Pub Date : 2017-07-13 DOI: 10.5750/IJPCM.V7I1.621
E. Kumah
Background : Capturing patients’ experiences of care and using the results to improve service quality is one of the key approaches to building person-centered care in healthcare organizations. Studies have suggested that systematic gathering of patients’ feedback through surveys may lead to improvements in care experiences across health systems and within organizations. While trends in patient experience have been considered at the national level, there is little evidence of systematic analyses of long-term trends at the local or organizational level. Objective : The purpose of this study was to determine whether an upward trend in patients’ reported positive experiences could be established in organizations that have a long history of surveying their patients. Methods : The study was a 12-year (2004-2015) trend analysis of overall experience scores reported by patients in three English hospital trusts: Oxford University Hospitals, University College London Hospitals and Central Manchester University Hospitals. Results : The analysis could not establish an upward trend in patients’ overall reported experiences of care over the 12 years. Whereas scores for both Oxford University and University College London Hospital Trusts were non-linear and more erratic, scores for Central Manchester University Hospitals Trust showed a downward trend, with no statistically significant year-on-year changes in scores. Discussion : The observation is consistent with the suggestion that healthcare organizations may not be fully using patient experience data to inform quality improvement. The present study also contrasts national level longitudinal studies, which have shown small improvements in patient reported experiences of care. Conclusion : More policy-level actions and effective organizational leadership are required for the goal of promoting person-centered care through care experiences to be fully realized.
背景:获取患者的护理体验并利用其结果来提高服务质量是医疗机构建立以人为本的护理的关键方法之一。研究表明,通过调查系统地收集患者反馈可能会改善整个卫生系统和组织内部的护理体验。虽然在国家一级考虑了患者体验的趋势,但很少有证据表明在地方或组织一级对长期趋势进行了系统分析。目的:本研究的目的是确定在有长期调查患者历史的组织中,是否可以建立患者报告积极体验的上升趋势。方法:对英国三家医院信托机构:牛津大学医院、伦敦大学学院医院和曼彻斯特大学中心医院的患者报告的总体体验评分进行了12年(2004-2015)趋势分析。结果:分析不能确定患者在12年内总体报告的护理经历呈上升趋势。牛津大学和伦敦大学学院医院信托基金的得分都是非线性的,而且更加不稳定,而曼彻斯特中心大学医院信托基金的得分则呈下降趋势,得分在统计上没有显著的逐年变化。讨论:观察结果与医疗保健组织可能没有充分利用患者体验数据来通知质量改进的建议是一致的。目前的研究还对比了国家层面的纵向研究,这些研究显示病人报告的护理经历有了小的改善。结论:通过护理体验促进以人为本的护理目标的全面实现,需要更多的政策层面的行动和有效的组织领导。
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引用次数: 2
Engagement and Empowerment in Person Centered Medicine 以人为本的医学的参与和授权
Pub Date : 2017-07-13 DOI: 10.5750/IJPCM.V7I1.624
J. Mezzich, J. Appleyard, M. Botbol
Engagement and empowerment are important concepts in Person Centered Medicine (PCM). Engagement refers to the act or state of personal interaction that is often crucial as part of thinking and implementing a medicine and health that are person-centered. Empowerment refers to the enablement of a person to fulfill his or her rights and responsibilities. These concepts are usually inter-related as empowerment tends to be carried out as part of an engagement process. While both concepts are relevant to human activities and human relations in general, they certainly have a major significance in the health field. Their place in PCM is related to both its principles and strategies. As such they have often being part of the institutional journey of PCM [1], now ten years old. Their conceptual place and implications in PCM are reviewed briefly next.
参与和授权是以人为本的医学(PCM)的重要概念。参与是指个人互动的行为或状态,通常是思考和实施以人为本的医学和健康的关键部分。授权是指使一个人能够履行他或她的权利和责任。这些概念通常是相互关联的,因为授权往往是作为参与过程的一部分进行的。虽然这两个概念一般都与人类活动和人际关系有关,但它们在卫生领域肯定具有重大意义。它们在PCM中的地位与其原则和战略有关。因此,它们经常成为PCM b[1]的制度旅程的一部分,目前已有10年历史。下面将简要回顾它们在PCM中的概念地位和意义。
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引用次数: 2
Latin American Experience and Responses in Disasters: Person-centered Perspectives 拉丁美洲在灾害中的经验和反应:以人为本的观点
Pub Date : 2017-07-13 DOI: 10.5750/ijpcm.v7i1.623
N. R. M. Soto
Background : Disasters affect people intensely, with people always at the center as victims or as protagonists of the event. The poorest groups suffer the greatest damages, and if the disasters recur, such groups may get trapped into persistent poverty. Objectives : This work sought to elucidate patterns of Latin American experiences on disasters and responses to them focusing on human elements along the lines of person centered medicine and health (PCM). An effort was made to explore the effects and long-term impact of disasters on health, economy and social life. Method : The relevant literature was reviewed, especially data from the Pan American Health Organization, the Regional Centre for Emergency and Disaster Documentation, the United Nations Economic Commission for Latin America and the Caribbean, and the Centre for Research on the Epidemiology of Disasters. Reciprocal relationships between disasters and urban and social vulnerability were examined. Results : It was noted that people have been always surrounded by natural and man-made threats and that emergencies involving massive destruction have affected populations in relation to multiple causes and sometimes leading to grave social deterioration and precariousness. Indicators of person centered medicine appeared to be present in much of the reviewed Latin American disasters literature. Discussion : Disasters have social and cultural backgrounds and contexts and represent high economic and social burdens for low-resource countries. Disasters and their impact tend to correlate with social disorganization and deficient status of prevailing health policies. Feelings of helplessness undermine political confidence and threaten governance and development. The Latin American region is beginning to express high interest on PCM and on its implementation, in relation to renewed concern for ethics and human values. The promising value of person-centered educational exercises to enhance disaster preparedness was illustrated.
背景:灾难对人的影响很大,人们总是处于事件的中心,作为受害者或主角。最贫穷的群体遭受的损失最大,如果灾难再次发生,这些群体可能会陷入持续的贫困。目的:这项工作旨在阐明拉丁美洲在灾害方面的经验模式和对灾害的反应,重点放在以人为本的医学和保健方面的人的因素。努力探讨灾害对健康、经济和社会生活的影响和长期影响。方法:审查了相关文献,特别是来自泛美卫生组织、紧急情况和灾害文件区域中心、联合国拉丁美洲和加勒比经济委员会以及灾害流行病学研究中心的数据。研究了灾害与城市和社会脆弱性之间的相互关系。结果:会议指出,人们一直受到自然和人为威胁的包围,涉及大规模破坏的紧急情况由于多种原因影响到人口,有时导致严重的社会恶化和不稳定。以人为本的医学指标似乎出现在许多审查过的拉丁美洲灾害文献中。讨论:灾害具有社会和文化背景和背景,对资源匮乏的国家来说是沉重的经济和社会负担。灾害及其影响往往与社会混乱和现行卫生政策的不足有关。无助感削弱了政治信心,威胁到治理和发展。拉丁美洲区域开始对PCM及其执行表示高度兴趣,因为它重新关注道德和人类价值。说明了以人为本的教育演习对加强备灾的潜在价值。
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引用次数: 1
THE CHAPERONE IN A THERAPEUTIC RELATIONSHIP: A CRITICAL DISCUSSION 治疗关系中的伴侣:批判性的讨论
Pub Date : 2017-07-13 DOI: 10.5750/IJPCM.V7I1.608
C. Thuraisingham, S. Nalliah, D. Sinniah
A chaperone is encouraged to be present in any medical consultation especially when an intimate examination is required. This impartial attendant could be reassuring to the patient especially when gender is an issue and avoids any perceived conflict that may arise in the patient-physician relationship. Situations in which a chaperone is not available or declined by the patient present unique ethical problems and need to be avoided. When a chaperone is declined doctors are in a dilemma in proceeding with an intimate examination. This critical discussion explores the noble relationship between doctor and patient and how circumstances may change when both parties independently or otherwise deviate from established guidelines in affording treatment to the patient.
在任何医疗咨询中,特别是在需要进行亲密检查时,鼓励有监护人在场。这种不偏不倚的护理人员可以让患者放心,特别是当性别是一个问题时,并避免任何可能出现在医患关系中的感知冲突。当患者没有陪伴或拒绝陪伴时,会出现独特的伦理问题,需要避免。当监护人被拒绝时,医生在进行亲密检查时处于两难境地。这一关键的讨论探讨了医患之间的崇高关系,以及当双方独立地或以其他方式偏离既定的指导方针时,情况如何变化。
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引用次数: 2
Caring Conversation Framework to promote person centred care: synthesising qualitative findings from a multi- phase programme of research 促进以人为本的关怀对话框架:综合多阶段研究项目的定性结果
Pub Date : 2017-05-29 DOI: 10.5750/IJPCM.V7I1.619
B. Dewar, C. Sharp, K. Barrie, Tamsin MacBride, Julienne Meyer
Background Little is known about how to support practitioners to enhance their interpersonal conversations to be more compassionate, person centred and relational with others. The Caring Conversations (CC) framework was empirically derived to address this issue and comprises seven attributes (be courageous, connect emotionally, be curious, consider other perspectives, collaborate, compromise and celebrate). Objective This paper synthesises the qualitative findings from a multi-phase programme of research, which implemented the CC framework across a variety of health and social care settings (acute hospitals, community, and residential care). It explores the perceived impact of the CC framework on staff and their practice. Methods Secondary analysis was conducted on the qualitative findings in the final reports of 5 studies, involved in the implementation of the CC framework. Results The analysis showed consistent positive outcomes for staff in their interactions with patients, families and others; including greater self-awareness during interactions, development of stronger relationships, and more open dialogue that supports relational practice. The secondary analysis confirmed the applicability of the framework across a number of different settings, strengthened confidence in its value, generated fresh insights to inform further research, and developed a deeper insight into the attributes of the framework and its application. Conclusions Policy and research advocate compassionate care and relational practice, but do not state how this can be delivered in practice. By synthesising the findings from 5 studies undertaken in a variety of different settings, we can be more confident in the value of the CC framework to ensure best practice.
关于如何支持从业者加强他们的人际对话,使他们更富有同情心,以人为本,与他人建立关系,人们知之甚少。关怀对话(CC)框架是根据经验得出的,旨在解决这个问题,它包括七个属性(勇敢、情感联系、好奇、考虑其他观点、合作、妥协和庆祝)。本文综合了一个多阶段研究项目的定性结果,该项目在各种卫生和社会护理环境(急性医院、社区和寄宿护理)中实施了CC框架。它探讨了CC框架对工作人员及其实践的感知影响。方法对参与CC框架实施的5项研究的最终报告的定性结果进行二次分析。结果分析显示,工作人员在与患者、家属和其他人的互动中取得了一致的积极成果;包括在互动中更强的自我意识,发展更牢固的关系,以及支持关系实践的更开放的对话。二次分析证实了该框架在许多不同环境中的适用性,增强了对其价值的信心,产生了新的见解,为进一步的研究提供了信息,并对框架的属性及其应用有了更深入的了解。政策和研究提倡同情关怀和关系实践,但没有说明如何在实践中实现这一点。通过综合在各种不同环境下进行的5项研究的结果,我们可以对CC框架的价值更有信心,以确保最佳实践。
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引用次数: 3
5TH INTERNATIONAL CONGRESS OF PERSON CENTERED MEDICINE IN OCTOBER 2017 IN ZAGREB 第五届以人为本的国际医学大会将于2017年10月在萨格勒布举行
Pub Date : 2017-02-02 DOI: 10.5750/IJPCM.V6I4.617
C. Woodhead
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引用次数: 0
Person-Centered Medicine: An Existential Outline beyond the Biopsychosocial Model 以人为本的医学:超越生物心理社会模式的存在主义大纲
Pub Date : 2016-10-26 DOI: 10.5750/IJPCM.V6I3.594
R. Ruiz-Moral
Starting from the idea that “medical problems” are always “problems of living” that reflect the existence of a “vital dimension” that is different from the biological, psychological and sociocultural dimensions, this article describes central features of this dimension. From this viewpoint, its inescapable importance in the clinical act is highlighted, an importance that shapes the tasks that are inherent to it – diagnosis and decision making – but also the very process of the doctor-patient relationship. It is argued that “the subjective truth” implicit in the “vital dimension” (in the “existential self”) can only be approached through reflection and interpretation in the context of a dialogue between the professional and the patient/family with the objective of deciding on the action(s) that can better lead to reaching some concrete wishes or desires (values), that in turn require the participants to take on obligations and responsibilities. This relational perspective defines the “person centered ” clinical approach as a practice based on dialogue , importantly involving deliberation and collaboration (“ collaborative deliberation ” ). In this dialogue, the emotions, integral elements of the life dimension of its protagonists, play a decisive role both in attaining clinical effectiveness and in building and maintaining the relational process (encouraging or reducing trust) that is indispensable in a clinical activity that is an eminently moral act. Finally, the main challenges that doctors face when implementing this clinical focus and the educational challenges it entails are outlined.
从"医疗问题"始终是"生活问题"这一观点出发,反映了不同于生物、心理和社会文化层面的"生命层面"的存在,本文描述了这一层面的主要特征。从这个角度来看,它在临床行为中不可避免的重要性得到了强调,这种重要性塑造了它固有的任务——诊断和决策——以及医患关系的整个过程。作者认为,隐含在“生命维度”(“存在自我”)中的“主观真理”只能通过专业人员与患者/家属之间对话的背景下的反思和解释来接近,对话的目的是决定能够更好地实现某些具体愿望或欲望(价值观)的行动,这反过来要求参与者承担义务和责任。这种关系视角将“以人为本”的临床方法定义为一种基于对话的实践,重要的是涉及审议和协作(“协作审议”)。在这段对话中,情感是主角生活维度的组成部分,在获得临床效果和建立和维持关系过程(鼓励或减少信任)方面发挥着决定性作用,而关系过程是临床活动中不可或缺的,是一种卓越的道德行为。最后,概述了医生在实施这一临床重点和教育挑战时面临的主要挑战。
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引用次数: 2
Patient-Centered Care and People-Centered Health Systems in Sub-Saharan Africa: Why So Little of Something So Badly Needed? 撒哈拉以南非洲:以病人为中心的护理和以人为本的卫生系统:为什么如此急需的东西却很少?
Pub Date : 2016-10-26 DOI: 10.5750/IJPCM.V6I3.591
J. Man, R. Mayega, Nandini D. P. Sarkar, Evelyn Waweru, Mart Leys, J. V. Olmen, B. Criel
Patient–centered care (PCC) is increasingly recognized as a key dimension of quality healthcare, but unfortunately remains poorly implemented in practice. This paper explores the current state of PCC in sub-Saharan Africa and potential barriers to its implementation, with a focus on public first line health services. We develop an analytical framework based on expert knowledge, field experience, and a conceptual literature review. Factors contributing to the (lack of) implementation of PCC are structured in three distinct but interacting layers. The first layer encompasses factors that influence and shape the performance of providers.  The training of health workers is key in that respect. Training models remain dominated by a biomedical perspective, with little attention for psychosocial dimensions of the illness experience. The second layer of determinants relates to the structural and organizational features of the health system. The emphasis in many African health care systems on specific programmatic outputs, and the subsequent pressure this creates on health workers,  jeopardize the delivery of PCC. The third layer is related to the broader socioeconomic environment in which health workers operate. Noteworthy is the gap between the “official” norms in the public sector and the actual behavior of providers. We then propose  possible avenues for change for each of these three layers. We conclude by arguing the need for further fine-tuning of the framework outlined in this paper, investing in the contextual validation of measurement tools for PCC, and testing solutions in a participatory action research framework.
以患者为中心的护理(PCC)越来越被认为是高质量医疗保健的一个关键方面,但不幸的是,在实践中实施不力。本文探讨了撒哈拉以南非洲地区PCC的现状及其实施的潜在障碍,重点是公共一线卫生服务。我们在专家知识、实地经验和概念性文献综述的基础上开发了一个分析框架。促成(缺乏)PCC实现的因素分为三个不同但相互作用的层。第一层包括影响和塑造供应商绩效的因素。在这方面,培训保健工作者是关键。培训模式仍然以生物医学视角为主,很少关注疾病经历的社会心理层面。第二层决定因素与卫生系统的结构和组织特征有关。许多非洲卫生保健系统对具体方案产出的强调,以及由此对卫生工作者造成的压力,危及了pccc的实施。第三层与卫生工作者工作的更广泛的社会经济环境有关。值得注意的是,公共部门的“官方”规范与提供者的实际行为之间存在差距。然后,我们为这三层中的每一层提出可能的改变途径。最后,我们认为有必要对本文中概述的框架进行进一步微调,投资于PCC测量工具的上下文验证,并在参与性行动研究框架中测试解决方案。
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引用次数: 63
The Role of Culture and Experience in Person Centered Medicine 文化和经验在以人为本的医学中的作用
Pub Date : 2016-10-26 DOI: 10.5750/IJPCM.V6I3.596
J. Mezzich, M. Botbol, I. Salloum
a Editor in Chief, International Journal of Person Centered Medicine; Secretary General, International College of Personcentered Medicine; Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA. b Board Director, International College of Person-centered Medicine; Chair, World Psychiatric Association Section on Psychoanalysis in Psychiatry; Professor of Child and Adolescent Psychiatry, University of Western Brittany, Brest, France. c Board Director, International College of Person-centered Medicine; Chair, Section on Classification, Diagnostic Assessment and Nomenclature, World Psychiatric Association; Professor of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA
国际以人为本医学杂志主编;国际以人为本医学学院秘书长;美国纽约西奈山伊坎医学院精神病学教授。b国际以人为本医学学院董事会主任;世界精神病学协会精神分析科主席;法国布雷斯特西布列塔尼大学儿童与青少年精神病学教授。c国际以人为本医学学院董事;世界精神病学协会分类、诊断评估和命名科主席;美国佛罗里达州迈阿密市迈阿密大学米勒医学院精神病学教授
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引用次数: 1
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the International Journal of Person-Centered Medicine
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