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71.
Interventions are needed to improve the quality of care for schizophrenia. However, in designing these interventions it would be helpful to understand better which patients are at highest risk for poor-quality care and why care for this disorder is often of poor quality. We study the extent to which patient and treatment factors are associated with poor-quality care in 224 patients randomly sampled from two mental health clinics. Quality of medication management is evaluated using an established method based on national treatment recommendations. Multivariate regression is used to study the effect of patient and treatment factors on treatment quality, controlling for provider. Risk for poor-quality care was greater for patients who were more severely ill, older, and less compliant with treatment recommendations. There were trends toward poor management of symptoms in men and substance abusers, and poor management of side effects in Black patients. Provision of poor-quality care was associated with failure to document symptoms and side effects in the medical record. Interventions to improve care for schizophrenia should attend to the need for accurate clinical assessment and strategies for managing challenging clinical situations. 相似文献
72.
Peskett MJ 《Anaesthesia》1999,54(12):1143-1149
Clinical indicators and complications occurring in the recovery room or post anaesthetic care unit were recorded for patients who had an anaesthetic procedure during 1995, 1996 and 1997 (n = 13 266). Clinical indicators measured were those developed by the Australian Council on Healthcare Standards in conjunction with the Australian and New Zealand College of Anaesthetists, and three other indicators. All patients were assessed and positive data were collected by nursing staff on a standardised form which was checked and collated by the anaesthetist responsible for the recovery room (the author). The rates for some indicators were higher than the Australian Council on Healthcare Standards 1997 rates, but the overall rates of complications were comparable with, or lower than, those in published series. Clinical indicator data are seen as a valuable quantitative tool for quality assurance, particularly if collected as part of a more comprehensive programme. 相似文献
73.
40所军队医院病种病例分型质量评价结果分析 总被引:17,自引:2,他引:15
应用病例分型质量费用监控管理软件和SAS6.12统计软件包,对40所军队医院50万份病例样本资料进行深入分析,结果显示:病例分型组合数据稳定,分析结果合理。 相似文献
74.
Sophie D. Fosså M.D. Clare Moynihan M.Sc. Said Serbouti M.Sc. 《Supportive care in cancer》1996,4(2):118-128
Patient-based questionnaires were designed with the aim to identify and rank long-term somatic and psychosocial morbidity in patients with low-stage testicular cancer. A further intention was to compare patients' assessments with experienced doctors' general opinion on quality of life items in cured testicular cancer patients. In pilot study I, 103 tumour-free patients ranked items of physical and psychosocial morbidity after having had various kinds of treatment. Though the ranking procedure appeared to cause some difficulties amongst the patients and subsequently was abandoned, the results indicated considerable differences between the patients' and doctors' evaluations. In pilot study II patients were asked to score the different items. The questionnaire of pilot study II was completed by 107 patients from the Norwegian Radium Hospital (NRH) and 99 relapse-free patients from the Royal Marsden Hospital (RMH) with testicular cancer stage I at least 1 year after infradiaphragmatic radiotherapy (n = 94) or adjuvant chemotherapy (2 cycles,n=26), or patients who had been followed on the surveillance program (n = 86). A total of 93 doctors completed a similar questionnaire, thereby expressing their general opinion on long-term morbidity in comparable testicular cancer patients as seen during routine clinical follow-up. Both the irradiated patients and those on the surveillance program reported slight degrees of Raynaud-like phenomena, neurotoxicity and ototoxicity, most probably representing background morbidity in an age-matched general male population. Doctors tended to underestimate their patients' somatic morbidity, but often overestimated the degree of psychological distress, in particular in patients on the surveillance program. Significant differences between RMH and NRH patients with regard to sexual problems and to leisure time activity may be explained by cultural differences in the two countries. The items presented in the questionnaire used identify important issues for patients cured of testicular cancer which may be used in future multicentre trans-cultural studies assessing these patients' quality of life. This will provide sufficient data for psychometric testing and, together with the findings from patients' free comments, support the final design of a testicular cancer quality of life module. 相似文献
75.
The validity of the Cognitive Coping Strategy Inventory (CCSI; Butler et al., 1989) was tested in a prospective fashion. Subjects were randomly assigned to one of three conditions. Some were matched to a strategy for which they received a high CCSI score, some were mismatched to a strategy for which they received a low CCSI score, and some were given a choice of strategies. Those subjects using a matched strategy obtained better threshold and tolerance times on the cold pressor than subjects who used a mismatched strategy. Despite clear differences in exposure to the cold pressor these conditions did not differ from each other in self-reported levels of pain. It was concluded that the CCSI appears to be a valid and useful tool for selecting a coping strategy to help particular individuals manage acute pain. Though the CCSI is relatively easy to administer and score, the comparative costs and benefits of using it must be weighed against the somewhat more efficient approach of simply offering the subject a choice of treatments. Subjects given a choice of strategies performed as well as subjects matched to a strategy on the basis of CCSI scores. 相似文献
76.
Edward M. Carroll David W. Foy Brooke J. Cannon Gail Zwier 《Journal of traumatic stress》1991,4(1):25-40
This paper reviews the empirical literature on the clinically significant problems found within families containing a member with post-traumatic stress disorder. Recommendations are made regarding specific instruments that can be useful for evaluating marital and familial adjustment. Assessment issues concerning the need to weigh historical relationship factors vis-á-vis the influences of a traumatized family member are discussed. A multiple-gating model is presented for assessing different aspects of family dysfunction, and suggestions for future research and clinical directions are offered. 相似文献
77.
Catherine S. Fichten Rhonda Amsel Kristen Robillard Vicki Tagalakis 《Cognitive therapy and research》1991,15(5):345-369
This study explores three issues: thoughts and feelings of individuals with and without physical disabilities concerning encounters in different situations, ways of grouping self-statements into valenced categories, and use of states-of-mind (SOM) ratios as an alternative to positive and negative thought frequencies. Data from 127 able-bodied and 46 physically disabled college students indicate that, in everyday social encounters, nondisabled individuals' thoughts and feelings were more negative, while those of disabled individuals were more negative when helping was involved and when encounters centered on the impairment. Thus, problematic encounters between people with and without disabilities may be due to the reactions of individuals with disabilities in situations which involve help, and to reactions of able-bodied persons in everyday contexts. The data also confirm the utility of SOM ratios as an alternative to valenced frequencies in cognitive assessment: SOM scores discriminated groups when situational demands were manipulated and scores were linearly related to criterion measures. However, SOM ratios differed dramatically, depending on the attentional focus of thoughts. The findings illustrate types of thoughts which occur during interaction between people with and without disabilities, demonstrate a simple technique for grouping thoughts into valenced categories on an empirical basis, and highlight the relative contribution of cognitive and affective elements to overall valenced scores. Implications for research on assessment of self-statements are discussed and recommendations are made concerning programming to facilitate the social integration of people with disabilities.This research was supported by grants to the first author from the Social Sciences and Humanities Research Council of Canada and from Fonds F.C.A.R. pour l'aide et le soutien à la recherche. Thanks are due to Meribah Aikens, Maria Barile, Leo Bissonette, Bosco Daude, Jim Dubois, Lillian Fox, Evelyn Gold, Naomi Goodz, Darlene Judd, André Leblanc, John Martos, Sue McKenzie, Irwin Slopak, and Joan Wolforth for their assistance with various stages of this investigation. 相似文献
78.
中西医结合对重症脑外伤昏迷病人促苏醒疗效观察 总被引:14,自引:0,他引:14
目的 :探讨醒脑开窍疗法对治疗重症颅脑损伤患者促苏醒作用以及对预后的影响。方法 :将 80例颅脑损伤患者 (GCS≤ 8)随机分成 2组 ,治疗组 4 0例 (在常规治疗基础上加用中药针刺疗法 ) ;对照组 4 0例。两组于伤后 1月按GCS预后评分评定预后 ,两组在促醒后 1月内意识好转率作一比较。结果 :治疗组预后恢复良好为 87 5 % ,显著高于对照组 6 2 5 % ,P <0 0 1;两组病死率差异无显著性意义 (P >0 0 5 )。治疗组 1月内清醒 32例 ,对照组 2 0例 ,P <0 0 1。结论 :中西医结合疗法在治疗重症脑外伤昏迷患者时 ,能加速促醒和提高生存质量。 相似文献
79.
1314例育龄妇女缺铁性贫血发病现状调查 总被引:2,自引:0,他引:2
目的 :研究育龄妇女缺铁性贫血 (IDA)的发病现状及营养状况与IDA的关系。方法 :检测青岛市城市及农村 1314例妊娠期和非妊娠期育龄妇女的外周血红蛋白浓度 (Hb)、平均红细胞体积 (MCV)、平均红细胞血红蛋白量 (MCH)、血清铁蛋白 (SF) ,并进行个人问卷调查 ,应用营养计算软件评价膳食营养。结果 :1314例育龄妇女IDA发病率为 2 0 .4 0 % ,其中非孕妇的发病率高于孕妇。农村育龄妇女的发病率明显高于城市。孕妇中孕≥ 2 8周组发病率最高 (4 0 % ) ,与其他孕周组相比差异有高度显著性 (P <0 .0 1)。营养评价结果显示非孕妇组热量、维生素A、E、B1、B2 、PP、C的缺乏率高于孕妇组(P <0 .0 0 1)。结论 :农村育龄妇女及孕 2 8周以上的孕妇为IDA高发人群。应加强对农村育龄妇女的膳食营养宣教及指导 ,对孕晚期的孕妇及时采取有针对性的干预措施。 相似文献
80.
Prevalence of Personality Disorders Among Combat Veterans with Posttraumatic Stress Disorder 总被引:5,自引:0,他引:5
Many combat veterans with PTSD have co-occurring symptoms of other forms of psychopathology; however, there have been limited studies examining personality disorders among this population. The few extant studies typically have assessed only two or three personality disorders or examined a small sample, resulting in an incomplete picture and scope of comorbidity. This study assessed all DSM-III-R personality disorders in 107 veterans in a specialized, inpatient unit. Using the Structured Clinical Interview for DSM-III-R Personality Disorders, 79.4% of the participants were diagnosed with at least one personality disorder: 29.9% received only one diagnosis, 21.5% had two, 15.9% had three, and 12.1% had four or more. The most frequent single diagnoses were Avoidant (47.2%), Paranoid (46.2%), Obsessive-Compulsive (28.3%), and Antisocial (15.1%) personality disorders.(116B)(116B-2)(323-E112) 相似文献