住院病人和护士对护理行为关怀性认知比较

目的比较住院病人和护士对护理行为关怀性的认知和评价,为更好地实施护理关怀提供科学的依据。方法采用修改后的关怀行为评价量表对205例住院病人和75名护士进行调查。结果住院病人和护士都认为＂提供专业能力＂类的护理行为（技术熟练、密切观察病情等）最具有关怀性;病人认为＂人道、利他主义价值观＂方面的护理行为较有关怀性,而护士认为＂健康教育＂方面的护理行为较有关怀性（P〈0.05）。结论护士和住院病人对护理行为关怀性的认知有一致性,但也存在较多差异。医院护理管理和临床护士应调整护理行为,使护理更能体现人性关怀,促进病人早日康复,从而提高病人的满意度,取得更好的社会效益。     

Hospital Utilization as a Function of Social Deprivation: Diabetes vs Non-Diabetes

We tested the hypothesis that a relationship between ill health and deprivation exists for patients with diabetes, distinct from that experienced by the non-diabetic population. Age standardized admission and appointment rates and proportion of total activity for patients with and without diabetes were determined by electoral ward and correlated with the Townsend index of social deprivation for the health district of South Glamorgan (population 408000). Both diabetic (r = 0.78, p < 0.001) and non-diabetic (r = 0.74, p < 0.001) in-patient admissions were positively correlated with social deprivation. This relationship also existed for attended out-patient appointments (r = 0.67, p < 0.001 and r = 0.45, p < 0.01, respectively). The proportion of diabetic to non-diabetic admissions by ward also showed a positive correlation for in-patients (r = 0.47, p < 0.001). This remained true for IDDM (r = 0.23, not significant) and NIDDM (r = 0.62, p < 0.001) diabetes, for admissions for coronary heart disease (r = 0.50, p < 0.001) and cerebrovascular disease (r = 0.29, p < 0.05), elective admissions (r = 0.30, p > 0.05), and emergency admissions (0.46, p < 0.001). Our results suggest that secondary care utilization is positively correlated with social deprivation and that this relationship is stronger in the diabetic population. This may be due to different prevalence rates or increased complications requiring hospital treatment in different social circumstances. Further research is required to examine these factors more closely. © 1997 John Wiley & Sons, Ltd.     

Indicators of quality of in-patient psychiatric treatment: the patients' view.

OBJECTIVES: The object of this study was to find out from psychiatric in-patients which aspects of care and treatment they considered important and how satisfied they were with these. DESIGN: One hundred and ninety-four in-patients were asked to rate the importance of, and their satisfaction with, 22 different aspects of in-patient care and treatment. The questionnaire, developed for the purpose of the study after a pilot phase including professional care givers and patients, contained 92 items and was returned by 52% of all discharged patients from the Psychiatric university hospital during a 3-month period. RESULTS: Patients made a clear distinction between aspects of treatment they considered important and aspects they were satisfied with. Ranked of highest importance were various therapeutic relationships, and respect for their rights and privileges. They were satisfied with their relationships with clinical staff but dissatisfied with medication. CONCLUSION: A well differentiated assessment of importance and satisfaction has implications for the evaluation of the quality of psychiatric care, for specific methods of treatment, and for the improvement of in-patient psychiatric care.     

探讨医疗改革对医院医疗营运的影响因素

目的探讨医疗改革对医院医疗营运的主要影响因素,为加强医院管理提供依据.方法运用灰色关联分析法和ICD国际疾病分类法,对五年间影响医院医疗营运的因素进行分析.结果影响的主要因素为平均开放病床数、业务收入、医技检查数、和疑难危重病人数.结论必须抓住机遇适应医疗市场需求,坚持以"优质、高效、低耗"的就医模式,真正做到病人至上,质量第一,服务第一,以优质的医疗信誉赢得市场.     

Is in-patient treatment justified for alcohol dependence?

Three lines of argument support the use of in-patient treatment for alcohol dependence. The first of these is that of natural justice. People ailing from their dependence on alcohol have a right to as full a range of treatment options as other people have for other disorders. Alcohol dependence is a disorder with a substantial morbidity and mortality. We should not forget that. Secondly, a variety of in-patient treatments have been shown to have a place in the treatment armamentarium. Some in-patient treatment is better than others, and treatment matching produces better results. Thirdly, the cost of in-patient treatment for alcohol dependence has repeatedly been shown to produce a worthwhile economic benefit.     

Suicide,ethnicity and psychiatric in-patient care: A case-control study

Abstract

This study compares patients with controls concerning sociodemographic variables and describes Swedish and foreign-born patients concerning psychiatric disorders. suicide risk. history of attempted suicide, suicide method, number of parasuicides and time from discharge to suicide. It is based on 59 psychiatric in-patients who had committed suicide, of whom 46 were native Swedes and 13 foreign-born, and on a random sample of 630 controls living in the same area of Stockholm, Sweden. There was an excess suicide risk for being foreign-born with a crude odds ratio of 1.94 (CI = 1.01?3.76) in an unconditional logistic regression. In the final model, single living, having a somatic disease and being unemployed were major risk factors for committing suicide. There were no differences between Swedes and those of foreign birth concerning distribution of certain background variables (i.e., suicide risk, diagnoses and quality of care assessed via clinical records). Only 39% of the patients were classified as high risk by the doctor-in-charge at admission. This is significantly lower p<0.001) than the retrospectively rated risk. Planned aftercare was considered as satisfactory for about half of the patients. About two-thirds of the patients did not participate in aftercare or almost immediately discontinued the contact. More attention is necessary in order to motivate the patients to take part in aftercare and there is a need for better co-operation between hospital and out-patient clinics.     

Medicinal plants used with Thai Traditional Medicine in modern healthcare services: a case study in Kabchoeng Hospital, Surin Province, Thailand

Ethnopharmacological relevance

Thai Traditional Medicine (TTM) is available in many modern hospitals in Thailand. However, there have been difficulties in integrating TTM, particularly the practices of the use of herbal medicines, into modern healthcare services. Kabchoeng Hospital is one hospital that has been able to overcome these difficulties. Thus, this study aimed to document the successful utilization of herbal medicine at Kabchoeng Hospital. The documentation focused on both the knowledge of medicinal plants and the success factors that facilitated the utilization of herbal medicine in the context of a modern hospital in Thailand.

Materials and methods

Kabchoeng Hospital was intentionally selected for this case study. Participatory observation was used for the data collection. There were six groups of key informants: three applied Thai Traditional Medicine practitioners (ATTMPs), a pharmacist, two physicians, two folk healers, the head of an herbal cultivation and collection group, and 190 patients. The plant specimens were collected and identified based on the botanical literature and a comparison with authentic specimens; these identifications were assisted by microscopic and thin layer chromatography (TLC) techniques.

Results

Eighty-nine medicinal plants were used for the herbal preparations. The ATTMPs used these plants to prepare 29 standard herbal preparations and occasional extemporaneous preparations. Moreover, in this hospital, seven herbal preparations were purchased from herbal medicine manufacturers. In total, 36 preparations were used for 10 groups of symptoms, such as the treatment of respiratory system disorders, musculo-skeletal system disorders, and digestive system disorders. Four success factors that facilitated the utilization of herbal medicine at Kabchoeng Hospital were determined. These factors included a proper understanding of the uses of herbal medicines, the successful integration of the modern and TTM healthcare teams, the support of an herbal cultivation and collection group, and the acceptance of the local people.

Conclusions

The practices that support the use of herbal medicine at Kabchoeng Hospital illustrated the successful application of TTM and also represented a model for the integration of TTM, and particularly the use of herbal medicine, into modern hospitals. This integration will be beneficial for sustainable healthcare systems in Thailand and in other countries where modern medicine is the mainstream medical system.     

An exploration of the social identity of mental health inpatient service users

Social identity theory proposes that a threatened social identity can impact on self-concept and well-being. As a low-status minority group, mental health service users face the possibility of a threatened social identity compounding existing mental health problems. This may be further complicated by an inpatient admission where the context in which social identity is maintained has changed from a community setting. We use a qualitative approach to explore the salient social identity of mental health inpatient service users using semi-structured interviews. Analysis showed that the salient in-groups and out-groups mainly centred around the inpatient context but were somewhat influenced by non-mental health service group membership. Participants also talked of their unique characteristics as group members. How these findings relate to social identity theory and, particularly how they relate to mental health service users within changing contexts is explored.     

In-Hospital Patient Falls After Total Joint Arthroplasty : Incidence,Demographics, and Risk Factors in the United States

In-hospital falls (IFs) increase morbidity, cost, and may result in litigation. We analyzed the Nationwide Inpatient Sample to quantify the incidence of IFs in patients who underwent hip and knee arthroplasty and to define trends, patient's demographics, risk factors, complications, and hospital cost. Patients operated on between 1998 and 2007 were identified and grouped depending on the presence of a diagnosis of IF. Of those, 0.85% had an IF, representing 2.1 falls per 1000 inpatient days. The incidence of IF increased from 0.4% to 1.3% during the study period. Independent risk factors included revision surgery, advanced age, male sex, minority race, and the presence of comorbidities. Patients having IF had a longer hospital stay and were less likely to be discharged to their primary residence. In-hospital mortality, complications, and cost were higher in patients sustaining IF. Given the associated morbidity, mortality, and increased cost, resources should be allocated to minimize the risk of IF in this population.