陕西省精神卫生资源现状分析

目的：了解陕西省精神卫生机构、床位和人员资源分布现状,为制定全省精神卫生服务资源配置规划提供参考依据。方法采用描述性分析的方法对全省精神卫生机构的数量、分布情况、机构类型、主办单位、床位数、医生和护士数等指标进行分析。结果截至2013年全省共有71家精神卫生机构,精神科床位数5406张,主要分布在精神病专科医院中,占总床位数的72.1%。主办单位包括政府部门、企业和个人等,以政府部门主办为主,占总床位数的67.3%。全省精神科床位密度平均为1.45张/万人,医生密度平均为2.44/10万,护士密度平均为3.75/10万。结论全省精神卫生机构主办部门众多,精神卫生床位资源不足,地域分布不合理。     

辽宁省第三人民医院

辽宁省第三人民医院始建于1950年,原名为辽宁省精神病防治院,1995年经省卫生厅批准,更名为辽宁省精神卫生中心、辽宁省第三人民医院。是省直惟一的一所承担全省精神疾病医、教、研、防、司法精神医学鉴定为一体的神经精神病专科医院,是全省精神科医生继续教育基地,目前已发展成为以精神科为主、综合科为辅的大型医院。医院占地4.6万平方米,固定资产总值3599万元,开放床位650张,两个门诊部,一个住院部,医疗、医技科室25个。并设分院一个,床位400张。目前拥有螺旋CT、彩色超声、醒脉通治疗仪、眼科AB超、美国麻醉心脏监护仪、远程心脏监护仪…     

综合性医院多学科协作诊治急性肺血栓栓塞447例分析

急性肺血栓栓塞(PTE)是临床常见的危重症,起病急,临床表现缺乏特异性,误诊率及病死率均较高.本院是开放床位1 250张的综合性医院,近年来进行多学科协作,采用规范化诊疗程序诊治急性PTE,取得了满意的疗效,现报告如下.     

国外精神医学考察报告(2)

1日本精神病院简况日本千叶市距东京约 2 0公里 ,沿东京湾有一个新开发区 ,是千叶市的文化、科技、行政办公区域。 1993年 8月 2 3日至 8月 2 7日世界精神医学学术会议就在这里召开。在日本 ,精神卫生医疗的收益是非常可观的。据 1990年的统计 ,日本共有 16 5 5个医疗机构和35 82 5 1张床位 (88.6 %为私立 ) ,构成了 2 3种精神病的防治网。笔者所参观的日本浅井医院是日本条件最好的一所私立精神病医院 ,位于千叶县东部 ,东临太平洋 ,距东京 75公里 ,在国内外享有盛誉。该院建于 194 6年 ,目前床位 4 41张 (其中精神科病床 35 4张 ,一般病床…     

慢性粒细胞白血病急粒-急淋双重变1例报告

慢性粒细胞白血病(慢粒)急性淋巴细胞白血病(急淋)-急性粒细胞白血病(急粒)或急粒-急淋双重变均较少见。近年国内相继报道3例,其中2例为急淋变完全缓解后发生急粒变,另1例则在较短时间内先急粒变后转急淋变。我院1986年收治1例慢     

慢性髓系白血病急淋变继而急髓变1例

<正>慢性髓系白血病(CML)简称慢粒,在我国年发病率为0.39-0.99/10万,在疾病终末期易进展为急性白血病。大多数为急性髓系白血病(AML)变,简称急髓变,只有少数为急淋(ALL)变或急单(AMOL)变,偶有巨核细胞及红细胞等类型的急性变。慢性粒细胞白血病(CML)转化为ALL,之后     

HOAP方案治疗成人急性非淋巴细胞白血病50例观察

我们自1976年以来,以HOAP方案治疗急性非淋巴细胞白血病(简称急非淋),其中资料较完整,治疗在两疗程以上者50例,包括初治者42例,完全缓解(CR)后复发者1例,经其它化疗方案治疗一疗程以上无效改用HOAP方案治疗者6例,慢性粒细胞白血病急粒变(慢粒急粒变)1例。所有     

CT平扫在急、慢性阑尾炎中的诊断价值

[目的]探讨CT平扫在急、慢性阑尾炎中的诊断价值.[方法]回顾性分析28例临床可疑急、慢性阑尾炎并经CT平扫检查患者资料,分析其诊断准确率、特异性与敏感性等.[结果]CT检查示28例患者中有24例诊断为急、慢性阑尾炎,与病理对照漏诊4例急性阑尾炎,误诊2例,其中1例附件囊肿CT诊断为阑尾脓肿,1例小肠管壁增粗CT诊断为急性阑尾炎,敏感性为85％(22/26),特异性为50％(1/2),准确性为82％(23/28),阳性预测值为92％(22/24),阴性预测值为25％(1/4).CT平扫分级与病理分级Kappa=0.0625.[结论]CT平扫诊断急、慢性阑尾炎敏感性、准确性较好,特异性及阴性预测值较低,提示CT平扫对于发现急、慢性阑尾炎是一种较好的手段,但对于急、慢性阑尾炎分级作用较差.     

江西省精神疾病患者的治疗率及卫生资源利用现状

目的了解江西省精神疾病治疗情况及全省精神卫生机构床位现状,为政府决策提供参考依据。方法资料来自江西省11个地市精神疾病流行病学调查,采用概率样本法,按初级单位容量比例分层、整群,随机抽样,对精神疾病治疗情况及精神卫生机构床位进行调查。结果各类精神疾病患者中未接受任何治疗占38.43%,治疗达6个月以上者仅占18.96%,坚持持续治疗的患者占13.57%。全省有精神卫生机构17所,病床3342张,各级精神卫生机构总床位使用率70.05%,县乡镇级精神卫生机构床位使用率不到50%,各级精神卫生机构入不敷出较为突出。结论江西省精神疾病治愈率低,病残率高,精神科病床低于全国的比例,造成这种现象的主要原因有精神卫生资源投入严重不足,精神病患者家庭经济困难,精神卫生知识普及和宣传力度不够,对精神病缺乏有针对性的防治措施和手段,这些应引起政府有关部门的重视。     

青岛市城市人口老龄化对医疗资源配置影响及对策

目的研究青岛市人口老龄化对卫生资源配置的影响。方法通过整群抽样调查法获取老年人口医疗需求的相关资料,并应用卫生服务需求法测算出老年人群对床位配置、卫生人力的需求量。结果青岛市未来20年人口老龄化程度不断加剧,由于老年人口增加导致的医疗资源需求量增加显著。结论卫生资源配置需要考虑人口老龄化因素。     

Nurse staffing, bed numbers and the cost of acute psychiatric inpatient care in England

The aim of this analysis was to describe the composition, variability and factors associated with nurse staffing costs in acute psychiatric inpatient care. Numbers of acute inpatient beds in England have fallen, creating an occupancy crisis. Numbers of acute inpatient nursing staff are linked to quality of care. Variance in staffing and beds has considerable resource implications, but little is known about how these costs are structured. The sample comprised survey data from 136 wards in 26 NHS Trusts, matched with nationally available data on service levels, population and outcomes. The cost of providing acute inpatient care varied fivefold between different Trusts. This variation comprised of numbers of beds/population, numbers of nurses/beds and the proportion of nurses qualified. These variations were not fully accounted for by differing levels of social deprivation. Although service provision levels in London were higher, wide variation in costs existed in every region. Associations between nursing cost per bed and performance indicators were found. As investment in acute inpatient care varies widely, we need to know much more about the relationship of inputs to outputs, so that empirically based standard service levels can be defined.     

江苏省“十三五”期间康复医疗资源的发展

目的 调查江苏省“十三五”期间康复医疗资源配备的情况及其发展。方法 通过卫生健康委系统对江苏省13个地级市医疗卫生机构统一发放电子版调查表,回顾性调查2015年至2019年康复资源的发展。结果 与2015年相比,2019年末江苏省设置康复医学科的二级及以上综合医院占比提高3.42个百分点;开展康复服务的基层医疗机构占比提高5.67个百分点;每百万人口拥有康复科编制床位数增加127张,实有床位数增加142张;临床早期康复介入每百万人口增长4 326人次;每百万人口拥有康复专业技术人员增加91人,其中康复医师增加25人,康复治疗师增加31人,康复护士增加29人,其他康复行业从业人员增加6人;康复从业人员中,副高级及以上职称比例增高1.65个百分点,硕士及以上学历比例增高1.27个百分点。结论 “十三五”以来,江苏省各类康复资源配置均有所提高。     

The effects of an ambulatory collaborative practice model on process and outcome of care for bipolar disorder

Background: Bipolar disorder is a chronic mental illness that affects 1% of the population. Persons with bipolar disorder have substantial rehabilitative potential, although research has shown that such mood disorders are undertreated.Objectives: The objective was to determine the effect of a high-intensity collaborative practice ambulatory program on process and outcome of care: specifically, patient satisfaction, intensity of medication treatment, and the amount and patterns of service use.Study Design: The Bipolar Disorders Program was structured for easy patient access by assigning clinical nurse specialists as primary caregivers to each patient supported by psychiatrist backup. The first 76 patients enrolled in the Bipolar Disorders Program who completed 6 months served as the sample. A quasiexperimental study was used. A mirror image design was used where relevant measurements before admission to the Bipolar Disorders Program were compared with data during the first 6 months of enrollment.Results: Patients showed significant increases in satisfaction with care, increases in intensity of medication treatment, and trends toward decreases in neuroleptic exposure. Annualized service use data revealed significant decreases in emergency department use, psychiatric triage use, and psychiatric hospitalization days.Conclusions: These data indicated that high-intensity ambulatory treatment for bipolar disorder may have increased both treatment intensity and patient satisfaction and decreased use of costly mental health services.     

Clinical Characteristics and Service Use of Incarcerated Males with Severe Mental Disorders: A Comparative Case-Control Study with Patients Found Not Criminally Responsible

Since the drop in the bed capacity of civil psychiatric hospitals, an increase in the bed capacity of forensic psychiatric care and prison units has been reported in the United States and Europe. However, in Canada, a decrease in the number of people with severe mental illness (SMI) during the last two decades in penitentiaries has been reported. At the same time, an increase in individuals found not criminally responsible on account of mental disorder (NCRMD) was observed in forensic hospitals. The aim of this study is to compare incarcerated severely mentally ill (I-SMI) individuals with forensic-hospitalized SMI individuals in terms of their clinical profiles and service use in the province of Quebec (Canada). A case-control study design was selected using a sample of 44 I-SMI individuals and 59 forensic-hospitalized SMI individuals. Important findings include the following: I-SMI persons had less schooling; they more often reported suicide attempts and violent and non-violent crimes; and they had a higher level of comorbidity involving Cluster B personality disorders and substance-use disorders. Forensic-hospitalized SMI persons were more likely to have been receiving psychiatric follow-up before hospitalization. The final logistic regression model showed that lifetime suicide attempts, non-violent crimes, and psychopathic traits were higher among I-SMI individuals than among forensic-hospitalized SMI individuals. In contrast, receiving regular psychiatric follow-up was associated with forensic-hospitalized SMI individuals. Differences in psychopathological characteristics and the use of mental health services were found for I-SMI persons. More research is needed to determine which new initiatives might be efficacious in addressing the mental health needs of I-SMI individuals.     

"快乐医疗"护理文化建设的实施与体会

目的精神病患者疾病慢性迁延、易复发、住院时间长,以封闭式管理为主,娱乐活动较少,建设“快乐医疗”护理文化,提高护理质量,促进患者康复。方法①确立“仁爱为怀,诚信为本”的护理理念。②建设“快乐医疗”护理文化。③完善护理规章制度。④服务流程再造,延伸快乐链,把整个护理服务流程分为导医、待医、就医、问药、医后等环节。结果住院患者的满意度从90.2%上升到97.6%,健康教育知晓率达到了96.2%,未发生护患纠纷和精神科意外事件。结论“快乐医疗”护理文化是提高护士素质、护理质量和护理服务的有效途径。     

Opening of Psychiatric Observation Unit Eases Boarding Crisis

Objectives

The objective of this study was to evaluate the effect of a psychiatric observation unit in reducing emergency department (ED) boarding and length of stay (LOS) for patients presenting with primary psychiatric chief complaints. A secondary outcome was to determine the effect of a psychiatric observation unit on inpatient psychiatric bed utilization.

Methods

This study was a before‐and‐after analysis conducted in a 1,541‐bed tertiary care academic medical center including an adult ED with annual census over 90,000 between February 2013 and July 2014. All adult patients (age > 17 years) requiring evaluation by the acute psychiatry service in the crisis intervention unit (CIU) within the ED were included. Patients who left without being seen, left against medical advice, or were dispositioned to the pediatric hospital, hospice, or court/law enforcement were excluded. In December 2013, a 12‐bed locked psychiatric observation unit was opened that included dedicated behavioral health staff and was intended for psychiatric patients requiring up to 48 hours of care. The primary outcomes were ED LOS, CIU LOS, and total LOS. Secondary outcomes included the hold rate defined as the proportion of acute psychiatry patients requiring subsequent observation or inpatient admission and the inpatient psychiatric admission rate. For the primary analysis we constructed ARIMA regression models that account for secular changes in the primary outcomes. We conducted two sensitivity analyses, first replicating the primary analysis after excluding patients with concurrent acute intoxication and second by comparing the 3‐month period postintervention to the identical 3‐month period of the prior year to account for seasonality.

Results

A total of 3,501 patients were included before intervention and 3,798 after intervention. The median ED LOS for the preintervention period was 155 minutes (interquartile range [IQR] = 19–346 minutes), lower than the median ED LOS for the postintervention period of 35 minutes (IQR = 9–209 minutes, p < 0.0001). Similar reductions were observed in CIU LOS (865 minutes vs. 379 minutes, p < 0.0001) and total LOS (1,112 minutes vs. 920 minutes, p = 0.003). The psychiatric hold rate was statistically higher after intervention (before = 42%, after = 50%, p < 0.0001), however, coupled with a statistically lower psychiatric admission rate (before = 42%, after = 25%, p < 0.0001).

Conclusions

Creation of an acute psychiatric observation improves ED and acute psychiatric service throughput while supporting the efficient allocation of scare inpatient psychiatric beds. This novel approach demonstrates the promise of extending successful observation care models from medical to psychiatric illness with the potential to improve the value of acute psychiatric care while minimizing the harms of ED crowding.

     

Primary Care for Mentally Ill Adults in Acute Residential Treatment Facilities

Psychiatric bed capacity has decreased nationally with an impact on the number and the types of patients admitted to acute in-patient units. Acute residential programs provide alternatives to hospitals for patients with problems that do not meet criteria for admission. However, these settings may not have resources to respond to the medical co-morbidities associated with severe mental illness. To understand the medical needs of patients in these settings, this research examined data from a nurse-managed primary care outreach service. Prevalent problems included acute issues and chronic disorders associated with severe mental illness. In multivariate analyses, demographic and substance related factors contributed to all chronic illness. However, age was the over-riding predictor of cardio-metabolic disorders. Drug abuse consistently predicted HIV/AIDS and HCV risk. Findings demonstrate that patients diverted to alternative forms of acute psychiatric care are no less in need of medical services than those admitted to hospitals. This underscores the importance of primary care that is provided at the site of acute residential treatment and integrated with overall care.