A study of influencing factors related to efficient use of medical exanimation resources: the perspective of certified medical doctors in Taoyuan County, Taiwan

研究動機與問題：本研究最主要的目的希望能夠將最易被大家忽略的健保醫療檢驗資源使用問題，從實務面上探討，並指認出有效使用醫療檢驗資源的關鍵因素，針對這些因素與措施進行評估，歸納出具體明確可行的方向，提供主管機關做為費用管控的參考，為我國健保永續經營貢獻一份力量。 本研究根據研究動機與目的，設定三個研究問題：1.影響醫師有效的使用醫療檢驗資源的因素有哪些？2.藉由桃園縣執業醫師的看法了解有效使用醫療檢驗資源關鍵因素為何？3.不同執業院所、服務科別、職別的醫師對有效的使用醫療檢驗資源看法是否有差異？ 研究資料與方法：以文獻回顧法、問卷調查法、深度訪談法蒐集資料及驗證資料；研究過程分三個階段進行，第一階段為背景資料與文獻資料的蒐集，瞭解醫療檢驗資源使用現況與問題，並透過訪談實務界菁英驗證文獻與補充資料不足；第二階段依文獻分析與彙整內容設計問卷與訪談大綱；第三階段將回收的問卷編碼、整理後以Excel/2003版與SPSS for window12.0版套裝軟體進行資料分析；深度訪談資料透過內容分析法予以歸納整理分析。獲得研究答案，達成研究目的。 研究結果與建議：量化研究部分，本研究共分送488份問卷，回收318份，回收率為65.1％。並以卡方檢定樣本與母群體並無差異，可代表母群體。質化研究部分，深度訪談三位年資10年以上實務界菁英，建構本研究實務上的概念。歸納研究結果：醫療檢驗資源有效使用的關鍵影響因素有「醫療風險」、「病人就醫行為」與「照護之連續性」3項。根據研究結果，為有效使用醫療檢驗資源，必需減少醫療風險、規範病人就醫行為與進行照護流程改造。Background:The purpose of this research is to find out the influencing factors related to the usage of resources for medical examinations under the Taiwanese National Health Insurance (NHI). From the practical point of view, this research focuses on, the first, defining the efficient use of medical test and then finding out the critical factors effecting the efficient usage from medial practitioners’ viewpoints in Taoyuan County, Taiwan. It is expected to provide advisory values to improve the global budget system of NHI. Research Questions: 1.What are the factors influencing doctors to utilize medical examination efficiently? 2.What are the certified medical doctors of Taoyuan County thinking about these factors? 3.Concerning the above factors, do there exist systematic differences among medical doctors from different hospitals, rank of medical doctors and fields of profession? Methods: In this study, author utilizes literature review, questionnaires, and in-depth interview. The survey was divided into three stages. First, related information was collected to clarify the problems of medical examination usage in present situation from both interviewing medical practitioners and literature review. In the 2nd stage, a general questionnaire was designed to administrate to selected medical doctors in Taoyuan County in mid-2008. The last stage was data coding and analyzing by using Excel/2003 and SPSS for Windows. The return rate was 65% (318/488) and there is no difference between population and sample after consistency test. Results and Suggestions The results show that the key factors of efficient medical examination usage are medical risk-aversion of doctors, clinical shopping of patients, and the need to medical care continuity. These exist a greater viewpoint differences between different level of hospital than different ranks or specialties of doctors. These results will lead the author to suggest that the Bureau of NHI needs to promote adequate mediation mechanism to reduce medical risk, to promote inter-hospital patient information sharing system, and to improve the logistic of continuity care

對國小四年級數學低成就學童在分數學習的迷思概念/錯誤類型與其成因之探討

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順丁烯二酐∕丙三醇處理材之機械強度、膠合性及塗裝性

本研究以順丁烯二酐(maleic anhydride)及丙三醇(glycerol)之混合液(MG)對杉木、紅櫟木及紅柳桉等木材進行酯化之化學改質，探討MG處理材之機械強度、膠合性及塗裝性。由其結果得知，MG處理材經180℃、3 hr加熱反應者之硬度較未處理材提高，然較短時間或較低溫度加熱反應之℃處理材之硬度則較未處理材降低。各不同條件MG處理材之MOR均較未處理材降低，其降低程度同時受樹種、WPG值及處理條件所影響。MOE則依樹種而異，紅櫟木及紅柳桉之MG處理材MOE均提高，杉木以180℃加熱2 hr及3China fir (Cunninghamia lanceolata), red oak (Quercus sp.) and red lauan (Shorea sp.) were chemical modified with the mixture of maleic anhydride(M) and glycerol(G) by esterification. The mechanical strength, adhesion property and coating property of MG

順丁烯二酐/丙三醇處理材之尺寸安定性

本研究以順丁烯二酐（maleic anhydride）及丙三醇（glycerol）之混合液（MG）對杉木、紅櫟木及洪柳桉等試材進行酯化之化學改質處理，探討改質處理時加熱反應之溫度、時間，及MG混合液中酸與醇莫耳比等對木材尺寸安定性之改良效果。MG處理時高溫長時間之加熱處理條件對木材尺寸安定性之改良效果較佳，加熱溫度180℃，加熱時間2?3hr者有較低浸水重量損失、吸水率、吸水體積膨脹率，其ASE值可達72.7％。加熱溫度140℃及160℃之MG處理材對吸水率降低之效果不明顯，140℃者且有高的重量損失。吸China fir (Cunninghumia lanceolata), red oak (Quercus rubra) and Red Iauan (Shorea spp.) were chemically modified with the mixture of maleic anhydride (M) and glycerol (G) by esterification. The effects of reaction temperature, reaction time, and molar

Attitudes and Behaviors towards Family Meetings in Nursing Staff

[[abstract]]目的：本研究目的為探討護理人員對家庭會議之態度及行為。方法：本研究採橫斷式研究設計，於2016年09月01日至10月30日進行結構式問卷調查，研究對象為北部某區域醫院護理人員285位，變項包括社會人口學、自擬家庭溝通會議量表及家庭溝通行為量表。以獨立樣本t檢定及單因子變異數分析進行分析。結果：護理人員對家庭會議之態度平均總分為5.18分、行為平均總分為5.66分。結果發現年齡、教育程度、護理工作總年資、職別、安寧訓練、宗教信仰與家庭會議態度達顯著差異。家庭會議行為在背景變項方面，除宗教信仰外達顯著差異。結論：護理人員認同家庭會議所帶來的正面效果，建議持續辦理安寧訓練並鼓勵參與，提升護理人員對家庭會議之相關知識、態度與技能。 Objectives: This study explored the attitudes and behaviors of nursing personnel towards family meetings. Methodology: This was a cross-sectional study involving a structured questionnaire survey conducted from September 1 to October 30, 2016. The participants were 285 nursing personnel of a regional hospital in northern Taiwan. The variables included demographic characteristics and items in self-designed measuring scales for family communication meetings and scales for family communication behaviors. The independent samples t test and one-way analysis of variance were used for statistical analyses. Results: The mean score for attitudes of the nursing personnel towards family meetings was 5.18, and that of behaviors was 5.66. The findings revealed that age, educational attainment, years of professional nursing experience, job position, hospice training, and religious beliefs generated significant differences in attitudes toward family meetings. Behaviors towards family meetings also exhibited significant differences among all sociodemographic variables except for religious beliefs. Conclusion: Be in agreement with family meetings among nursing personnel brought positive effects. We recommend regular hospice training to encourage personnel's participation while enhancing their knowledge and skills and improving their attitudes in relation to family meetings

建構E化更年期健康篩檢系統之信、效度探討

[[abstract]]背景更年期正值健康與疾病的過渡階段，過去傳統的更年期照護偏向更年期症狀困擾的評估與衛教，缺乏從預防慢性疾病的整合性照護。目　的提供婦女一套整合更年期症狀困擾程度、骨質疏鬆風險因子、心血管風險因子、糖尿病風險因子之可信賴、有效的E化更年期健康評估工具。方　法本研究分為四個階段，分別為評估與分析期、設計期、發展期與前驅測試期，來檢視E化更年期健康篩檢系統的開發成效。結　果E化更年期健康篩檢系統的信、效度顯示，專家效度為.97–.99與使用者評鑑內容效度為.99；且兼具良好的再測信度：Pearson’s correlation介於.80–.96及組內相關係數（intraclass correlation）介於.79–.96。結　論／實務應用本研究結合護理、醫學與資訊工程等跨領域共同合作，建立一套適用於更年期婦女的E化健康風險評估系統，並通過信效度考驗。透過E化系統提供立即性與便利性的資料分析與專屬個人量身訂作之衛教建議，有助於提供護理人員衛教諮詢的依據與醫師診療的輔助參考