Changing patterns of cervical cancer rates.
Changing patterns of cervical cancer rates.
复制标题
宫颈癌发病率的变化模式。
DOI：
10.1136/bmj.287.6391.510
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发表时间：
1983
期刊：
影响因子：
--
通讯作者：
G. Cook
中科院分区：
文献类型：
--
作者：
G. Draper;G. Cook
麻醉师们听说有个主要部门正在试验使用性格问卷和一位训练有素的心理学家来挑选该专业的新入职人员。一些本可以避免的悲剧发生在实习生的手中，多年来，麻醉师学院的考试障碍与该专业的自然培训秩序不相适应，这已经形成了一种挥之不去的不安。将于1985年生效的改革旨在将第一年受训人员的注意力集中在安全和工艺能力上，然后鼓励他学习病理生理学、药理学和物理科学等更详细的方面，这些方面是经过全面培训的专家所必需的因此，需要重新评估国民保健服务等级对考试障碍时间安排的影响。需要进一步注意的一个突出主题是麻醉部门的管理和行政质量的影响以及有效安排工作和培训的重要性。例如，当一个动作缓慢的外科医生或过多的手术清单威胁到其他预定的承诺时，无论是专业的还是社会的，都需要缓解紧张局势。有趣的是，麻醉学是第一个专门为其成员开设管理课程的专业。部门组织对护理质量可能产生影响的另一个方面是，需要重新考虑紧急麻醉师在等待紧急情况时可以做些什么。考虑到可靠的通信，他能不关注术后疼痛缓解的质量吗？这通常被认为是现代医疗实践中的一个主要弱点。事实上，可能对安全或护理质量产生直接影响的全新想法相对较少。也许这是因为，就通常的指标而言，我们目前的差距非常小。可避免的死亡人数只占麻醉总人数的很小一部分，而且可能无法通过一般教育努力来减少。今天，这句话可能仍然是正确的，就像第一次写的那样：“在绝大多数（死亡）中，严重偏离了普遍接受的安全做法。”英国航空公司飞行员协会最近提出的紧急事故报告制度可能会发挥更重要的作用在这个范围的另一端，为了其他好处，许多轻微的发病率被故意接受。从病人的角度来看，术前的同情和安慰，术后良好（和安全）的疼痛控制，以及不受麻醉不良影响是唯一可能的质量衡量标准。与我们目前关注的指标相比，这些指标的衡量难度要大得多。这一专业，无论是集体还是个人，都在努力解决这些问题，这也许仅仅是取得迅速进步的困难的反面。无论如何，尽管存在问题，在这次会议上编写（和重写）的这本书有望成为追求高质量麻醉护理的里程碑。
anaesthetists6 and heard how one major department is experimenting with the use of personality questionnaires and a trained psychologist in the selection process for new entrants to the specialty. Some easily avoidable tragedies occur at the hands of trainees, and over the years there has developed a nagging unease that the examination hurdles of the Faculty of Anaesthetists are inappropriate to the natural order of training in the specialty. The changes which will come into effect in 1985 are designed to focus the attention of the first year trainee on safety and craft competence before encouraging him to learn the more detailed aspects of pathophysiology, pharmacology, and the physical sciences necessary for the fully trained specialist.7 The consequent need to reappraise the influence of National Health Service gradings on the timing of examination hurdles was also touched on. A topic that was highlighted for further attention was the effect of the quality of management and administration in anaesthetic departments and the importance of efficient scheduling of both work and training. For example, there is a need to mitigate the tensions created when a slow surgeon or an over running operating list threatens to impinge on some other scheduled commitment, whether professional or social. Interestingly, anaesthetics is the first specialty in which a course on management has been specifically designed solely for its members. Another aspect of the possible influence of departmental organisation on the quality of care is the need to rethink what the emergency anaesthetist could be doing while waiting for the emergency. Given reliable communications, could he not be attending to the quality of postoperative pain relief, generally acknowledged to be a major weakness in modern medical practice ?8 In fact, relatively few totally new ideas emerged that might have a direct impact on safety or on the quality of care. Perhaps this is because in terms of the usual indicators we are now working on a vanishingly small margin. The number of avoidable deaths is a very small proportion ofthe total number of anaesthetics given and may not be reducible by general educational efforts. It is probably still as true today as when first written that: "In the great majority [of deaths] there was a serious departure from generally accepted safe practice."9 Critical incident reporting, recently introduced by the British Airline Pilots Association, may have a more relevant part to play.10 At the other end of the range much minor morbidity is knowingly accepted for the sake of other benefits.1" From the patient's point of view, empathy and reassurance before the operation, good (and safe) pain control after it, and freedom from the ill effects of anaesthesia are his only possible measures of quality. These are a good deal less easy to measure than the indices on which we currently focus. The vigour with which the specialty, both corporately and individually, is addressing itself to these problems is perhaps merely the obverse of the difficulty of making rapid progress. At all events, and despite its problems, the book which was written (and rewritten) at this meeting promises to be a milestone in the pursuit of high quality care in anaesthesia.