脑血管病患者实施健康教育的积极意义

脑血管病是临床上极为常见的危重症,其发病率、复发率和病死率均高.本文对我院神经内科住院的120例脑血管病人进行科学系统的疾病预防健康教育,探讨正规的健康教育在脑血管疾病防治中的积极作用,取得了满意效果,现报道如下.     

中国精神科住院服务的现状调查

目的了解目前的精神科住院服务现状,为提高精神病院的结构性调整和质量提高提供依据.方法采用问卷形式调查了全国不同性质不同级别的36家精神卫生机构的门诊服务情况.结果年均入院702.0±614.3人次,不同系统和不同级别医疗机构间的出入院病例数有显著性差异.医疗保险支付的总体比例低.平均住院日69.4天;平均周转率4.6±3.8张,卫生系统高于民政系统.住院病种仍以精神分裂症居首位,占62.1%,其次为情感性障碍(9.3%)和神经症(7.2%).病种构成比在不同系统机构间有显著性差异.结论本次调查反映了精神科住院资源绝对不足和相对闲置的矛盾.住院时间过长是精神科长期存在的一个问题,与医院管理模式和整个精神卫生服务模式有关.住院患者还是以精神分裂症为主.     

烧伤患者并低渗性脑病30例临床分析

血液电解质紊乱引起低渗血症在临床上甚为常见,而烧伤科患者出现血液电解质紊乱引起低渗血症并出现神经系统症状,临床上偶有发生.作者总结我院烧伤科住院患者并发低渗性神经系统障碍30例,现报告如下.     

我院住院患者用药状况研究

目的 研究住院患者的药物利用情况和药品费用.方法 对2007-10～2008-03我院出院的1324例患者的药物使用情况和住院期间的药品费用进行统计分析.结果 1324例患者在住院期间共使用药物9010种,人均用药6.8种,使用最多的药物分别是抗感染药物、抗肿瘤药物、血液系统用药和消化系统药物.给药方式以口服和注射给药为主,其中注射药品的消耗金额占药品总金额的90%.患者在住院期间的用药金额平均为7234元.结论 住院患者的用药品种数较多,药品费用负担较重.减少用药品种、采取口服用药方式、选择合适的治疗药物可望促进药物利用水平的提高,减轻患者的经济负担.     

某综合医院精神科开放病房4年病例资料分析

目的 了解某综合医院精神科开放病房4年病例的临床特点.方法 抽取2006年10月～2010年12月在广东省人民医院开放式管理和综合治疗模式的精神科病房住院的2723例精神障碍患者,对其临床特征、疗效和住院天数等资料进行总结与分析.结果 2723例住院患者中,排在前三位的疾病分别是抑郁症（20.49%）、双相障碍（15.57%）和广泛性焦虑症（14.69%）;治愈率前3位的精神障碍分别为焦虑症90.3%,双相障碍87.7%,抑郁症84.6%,平均住院天数较短.结论 综合医院精神科病房开放式管理模式可能有利于精神疾病的治疗和缩短住院周期.     

精神分裂症药物维持疗法中的一些问题(文献综述)

抗精神病药物的广泛使用,在治疗中改变了精神分裂症的某些临床病象,但没有从根本上解决治疗问题.因之,在一个阶段充分治疗之后仍须进行长时期的药物维持疗法,借以巩固疗效,减少复发或再住院.一、适应指征和病人选择一般认为住院或非住院的慢性精神分裂症病人以及大部急性病人皆需进行抗精神病药物维持疗法.有人则认为,维持疗法对预后良好的精神分裂症或对病情极其严重者价值不大.对这两者之间的各类型则有价值.     

临床路径在急性脑出血治疗中的应用

目的 评价临床路径在急性脑出血治疗中的应用效果.方法 将实施临床路径前后患者的住院天数、医疗费用、健康知识评分、满意度进行比较并对出现的变异进行分析.结果 实施临床路径加强了医患沟通,降低了医疗费用、住院天数,提高了健康知识掌握情况和满意度.实施过程中的变异主要来自患者方面.结论 临床路径作为一种新型的医疗管理模式,值...     

支气管哮喘患儿的舒适护理

目的 对住院的支气管哮喘患儿实施全方位的舒适护理,使患儿在生理、心理、社会、心灵上达到最佳状态,降低不愉快的程度.方法 选择6岁以上的支气管哮喘患儿,在治疗、护理过程中全方位实施舒适护理.结果 通过舒适护理的实施,患儿对疾病的恐惧感和焦虑情绪明显减轻,对疾病的应激能力和适应水平明显提高.结论 舒适护理应用于支气管哮喘患儿的治疗中,提高了患儿对疾病的应激能力及适应水平.     

长期住院精神分裂症患者伴发代谢综合征的调查

目的 研究长期住院精神分裂症患者的代谢综合征患病情况.方法 以长期住院的精神分裂症患者为研究对象,进行一般资料问卷调查和实验室检查,包括血糖和脂代谢相关指标.结果 资料完整的421例长期住院精神分裂症患者,伴发代谢综合征者131例,占31％,女性高于男性,精神分裂症合并代谢综合征患者生活质量明显下降.结论 长期住院的精神分裂症患者易合并代谢综合征,应重视相关代谢高危因素并及早进行干预.     

脊柱硬膜外脓肿的诊断和外科治疗

概述 脊柱硬膜外脓肿(spinal epidural abscess,SEAs)在临床上较少见[1],发病率约在(0.2～1.3)/1万个住院患者.它通常可导致严重的脊髓功能损伤.滥用静脉药品和脊柱手术等是发病的重要因素.SEAs的典型症状是发热、局限性的背部疼痛和进行性的神经体征.     

The involuntary treatment of adolescent psychiatric inpatients--a nation-wide survey from Finland

This national cross-sectional study investigates the prevalence rates, regional differences and factors associated with the involuntary inpatient treatment of adolescents in Finland on a chosen day in 2000. The proportion of inpatients with involuntary legal status was 29.5% (n=82) giving a prevalence rate of 2.5 per 10,000/12-17 years old inhabitants. Forty-eight per cent of involuntarily inpatients were 16-17 years old and 62% had psychotic disorders. Twenty-six per cent of inpatients with involuntary legal status were voluntarily admitted. Regional differences of involuntary treatment were rather modest. Psychotic disorders, suicidal acts, and substance use disorders were independently associated with involuntary legal status. There is a need for further studies to investigate the long-term effects of involuntary treatment on the adolescents' subsequent well-being. Further studies on alternatives methods for involuntary treatment are warranted, likewise the clinical guidelines for involuntary treatment practices.     

Involuntary first admission of patients with schizophrenia as a predictor of future admissions.

OBJECTIVE: The extent to which the legal status of a first psychiatric admission-voluntary or involuntary-predicted the legal status and number of future admissions was examined among patients with schizophrenia. METHODS: Data on all patients in Israel who had a nonforensic first admission between 1978 and 1992 and a diagnosis of schizophrenia (N=9,081) were extracted from the national psychiatric hospitalization case registry. Also obtained from the registry was information about the patients' subsequent hospitalizations through 1995, demographic data, and diagnosis. Analyses adjusted for time since first admission, age at first admission, country of origin, and religion. RESULTS: The first admission of 12.9 percent of the patients was involuntary. The legal status of the first admission was not related to the number of readmissions. However, female patients whose first admission was involuntary were 4.1 times more likely to have an involuntary second admission than female patients whose first admission was voluntary; these odds were 3.4 for males. Further analysis examined the percentage of involuntary admissions among all hospitalizations of the 3,420 patients who had four or more admissions (chronic patients). Among the chronic patients who had an involuntary first admission, 41 percent of subsequent admissions were involuntary. This figure was significantly lower among the chronic patients who had a voluntary first admission-13 percent. The percentage of involuntary admissions was not related to the number of admissions. CONCLUSIONS: The strong association of involuntary legal status at first admission with involuntary status at second admission and with the number of involuntary admissions over time suggests that involuntary first admission might be an important factor in assessing whether patients are likely to be readmitted involuntarily.     

Repetitive involuntary movement associated with episodic cerebral ischemia

Clinical characteristics of 12 patients with carotid occlusive disease who experienced episodes of repetitive involuntary movement were analyzed and correlated with laboratory findings. The majority of patients had rhythmic involuntary movements of one or both extremities on one side, which were characteristically precipitated by standing, walking, or hyperextension of the neck and were promptly alleviated by assuming a sitting or supine position. Six patients had a history of a prior transient ischemic attack or stroke. Electroencephalograms contained no epileptiform activity at rest or during sleep in any patient or during the involuntary movements in 2 patients. Cerebral angiography revealed either occlusion or high-grade stenosis of the internal or common carotid artery on the side opposite the involuntary movement in all patients. We conclude that the repetitive involuntary movements result from transient hemodynamic ischemic episodes rather than partial (focal) epilepsy.     

Phenomenology of abnormal movements in stuttering

BACKGROUND: Stuttering is often accompanied by involuntary movements, abnormal gestures or changes in facial expression. OBJECTIVE: To describe the incidence and phenomenology of abnormal movements (AMs) in stuttering patients. MATERIALS AND METHODS: Eighty-five consecutive patients with stuttering and 119 normal controls videotaped and subsequently reviewed, in which AMs were classified as voluntary or involuntary, and as concurrent or unrelated to speech. Movement phenomenology was correlated with disease severity. RESULTS: Of 85 stuttering patients studied, 51.7% had AMs and 22 more than one AM. Sixty-six different AMs were identified, of which 83.3% occurred during speech, 72.7% were classified as involuntary, and 27.2% as voluntary. Of 38 involuntary movements concurrent to speech, 25 were originally perceived as voluntary, but had since become involuntary through repeated use during stuttering. All involuntary movements not concurrent to speech fulfilled criteria for tics. CONCLUSION: AMs occurring during stuttering were not always involuntary; movements not concurrent with speech clearly fulfilled clinical criteria for tics and were similar in incidence to normal controls. Inverse correlation was found between conscious control of movement during speech and stuttering severity. Many involuntary movements occurring during speech were clearly referred by patients as initially voluntary early on in the development of their speech disorder (starters or unblockers), underlining the importance of repetitive use of complex motor sequences as a source for putative involuntary movement genesis.     

Involuntary Detention: Do Psychiatrists Clinically Justify Continuing Involuntary Hospitalization?

To elucidate disparities in clinical and legal documentation for patients admitted involuntarily to a county psychiatric hospital in Texas. The study sample comprised of 89 randomly selected patients, involuntarily hospitalized to our facility in September 2011. All patients met criteria for involuntary detention based on the legal documents filed by admitting psychiatrists. Electronic medical records were reviewed to assess if the clinical documentation from the same date when legal documents were filed; demonstrated criteria for involuntary detention (harm to self, harm to others, inability to care for self). A logistic regression model was used to assess the predictors of concordance between legal and clinical documentation of involuntary detention criteria. Of 89, 6 patients were made voluntary, while two were discharged within 24 h, thus removed from the analysis pool. Of 81, 31(38.2 %) patients lacked sufficient clinical documentation on medical records required for involuntary hospitalization. Patients, for whom detention was justified in clinical notes, were more likely to have single marital status, longer duration of hospitalization and they were more likely to undergo commitment for further inpatient mental health treatment. Our study found that involuntary detention of many patients based on the legal documents filed by admitting psychiatrists was not justified by the clinical documentation. This indicates that appropriate standards are not maintained when completing the medical certificates for involuntary detention. Maintaining appropriate standards may reduce the need for involuntary hospitalization, increase patient autonomy, and reduce resource utilization.     

Are there Different Tendencies in the Ordering of Care and Confinement between Urban and Rural Areas?

Objective: To compare long-term trends in legal guardianship policy and involuntary psychiatric admissions in urban and rural areas for people suffering from mental illness.Method: New and current legal guardianships as well as involuntary admissions according to Guardianship Law and also to Commitment Law were examined from 1998 to 2010.Results: All investigated variables (new and current legal guardianships as well as involuntary admissions) increased significantly along assessed period of time. Current guardianship rates are lower in urban area. On the other hand, rates of involuntary admissions according to Guardianship Law are in urban area 3fold higher and those according to Commitment Law doubled. New and current guardianships' ratio as well as ratio between involuntary admissions according Commitment Law and Guardianship Law remained quite stable.Discussion: The large differences in legal guardianship policy and involuntary treatment between urban and rural regions cannot be explained on the basis of available data. The role of community-based care networks in the process of reducing involuntary admissions should be further examined.     

Symptomatology of the involuntary movement

Actual phenomena of various types of involuntary movements listed below were demonstrated by moving pictures, which were followed by comments on symptomatology, in particular the fundamental characteristics of an individual involuntary movement. These characteristics are the essence of each involuntary movement, and it is necessary to recognize both its phenomenon itself and its accumulated knowledge in order to realize and interpret the involuntary movement. The following involuntary movements are treated: (1) typical tremor-at-rest in paralysis agitans, (2) atypical parkinsonian tremor, (3) essential tremor, (4) chorea, (5) ballism, (6) athetosis, (7) choreoathetosis, (8) dystonia, (9) spontaneous myoclonus at rest, (10) intention or action myoclonus, (11) intention tremor and (12) hyperkinesis.     

Involuntary psychiatric hospital treatment among 12- to 17-year-olds in Finland: A nationwide register study

Information on involuntary psychiatric hospital treatment of all 12- to 17-year-old minors in 1990 and 1993 in Finland was collected from the national hospital discharge register. Involuntary treatment was associated with older age, psychosis diagnosis, and treatment in adult psychiatric ward. Treatment year, sex, and having previous psychiatric hospital treatment were not associated with involuntary treatment. Considerable differences were found when different health care districts were compared. In 12 of 22 districts there were no minors in involuntary treatment in 1993. For ethical and legal reasons the involuntary treatment of minors in adult settings can hardly be justified.     

Involuntary medication in psychiatric inpatient treatment.

The aim of this study was to examine involuntary medication in psychiatric inpatient treatment. A retrospective chart review of 1543 consecutive admissions of working aged civil patients from well-defined catchment areas to three psychiatric centres were evaluated regarding events of involuntary medication. 8.2% of the admissions included involuntary medication episode(s). Involuntary medication was associated with a diagnosis of schizophrenia, involuntary legal status and having previously been committed. One of the studied centres used less involuntary medication than the other two, even if patients with schizophrenia were over-represented in that centre. Although involuntary medication mainly takes places in the treatment of patients who are conceptualised most ill and perhaps resist treatment most, treatment culture obviously also plays a role. In future, it is important to study the aspects of treatment culture to fully understand the use of involuntary medication in psychiatry.     

Peculiar involuntary movements in premature babies with specific cerebellar injuries

We observed characteristic involuntary movements in premature babies during early infancy. These movements consisted of asymmetrical irregular banging of the extremities, similar to chorea, ballisms, or jitteriness. We investigated the clinical characteristics and neuroimaging findings of the patients with these peculiar involuntary movements to clarify their pathophysiological mechanisms and to find a treatment. In our sequential follow-up study on 90 premature infants with various pre-and perinatal brain insults, we found various types of cerebellar injuries in 28 patients. In 19 of these, the prominent injuries were observed in the inferior cerebellar hemispheres. These cerebellar injuries were often observed in patients born before the gestational age of 27 weeks. Fourteen of the 28 patients with cerebellar injuries displayed the above-mentioned characteristic involuntary movements. Twelve of these 14 patients with both cerebellar injury and involuntary movements were born before the gestational age of 27 weeks. On the contrary, 10 patients with cerebellar injury born after the gestational age of 27 weeks did not display these peculiar involuntary movements. It is noteworthy that cerebral injuries were not associated with the occurrence of these involuntary movements. Two patients with asymmetrical cerebellar deformity caused by compression due to a cystic lesion did not show these involuntary movements. The movements appeared around the corrected age of 3 months, and they disturbed the patients' acquisition of sitting ability. Nine patients with these involuntary movements developed severe athetotic cerebral palsy. These movements showed drug resistance, however, benzodiazepines had a partial effect in some patients. Recently, cerebellar injury in premature infants has received a lot of attention. We believe that the peculiar involuntary movements we observed in the present patient group may be caused by a particular type of cerebellar damage specific to premature infants born before 27 weeks of gestational age.