医院后勤服务社会化实践中的几点思考

就医院后勤服务社会化的实际操作中的几个问题进行了论述,指出实行后勤社会化服务,必须有相应的外部环境;后勤部门实行企业化管理,必须有相配套的政策作保障;实施商品化服务,必须有对等的经济意识;加大后勤服务化的力度,必须有果敢超前的决策意识。     

Does injury claim status and benefit status predict low back pain outcomes?

Background

In New Zealand the Accident Compensation Corporation (ACC) is a state-funded insurance agency that accepts claims for accidental injuries, including lumbar spine injuries. It is unknown whether ACC claim status (accepted, not accepted) affects low back pain (LBP) outcomes, or whether benefit status (e.g., sickness, disability) further affects outcomes in patients without ACC cover

Aims

This study aimed to determine whether ACC claim and benefit status are likely to influence a range of outcomes for people with LBP in New Zealand.

Methods

A prospective survey of low back pain patients was performed (April 2008–October 2010). ACC claim status was recorded, and individuals without accepted claims indicated benefit status. Surveys were sent at multiple time points; pain, functional limitation, psychological factors, and general health were assessed. Statistical analysis was undertaken using ANCOVA and ANOVA (p<0.05).

Results

In total, 168 patients completed the study. Six-month measures showed individuals with no ACC claim for LBP to overall have poorer outcomes (mental health, p=0.039; pain, p=0.045; functional limitation, p=0.049); sub-group analysis (no ACC claim) between those with or without a benefit showed those on benefits to have significantly higher functional limitation (p<0.001), poorer physical health (p=0.002), greater pain (p=0.027), and stronger fear avoidance behaviours for both work (p=0.047) and physical activity (p=0.35).

Conclusion

Findings indicate individuals with accepted ACC claims for LBP have significantly better outcomes than those without, and patients on benefits with no accepted ACC claim for LBP have even poorer outcomes.     

Coping and Management Techniques Used by Chronic Low Back Pain Patients Receiving Treatment From Chiropractors

ObjectivesThe purpose of this study was to describe coping strategies (eg, mechanisms, including self-treatment) that a person uses to reduce pain and its impact on functioning as reported by patients with chronic low back pain who were seen by doctors of chiropractic and how these coping strategies vary by patient characteristics.MethodsData were collected from a national sample of US chiropractic patients recruited from chiropractic practices in 6 states from major geographical regions of the United States using a multistage stratified sampling strategy. Reports of coping behaviors used to manage pain during the past 6 months were used to create counts across 6 domains: cognitive, self-care, environmental, medical care, social activities, and work. Exploratory analyses examined counts in domains and frequencies of individual items by levels of patient characteristics.ResultsA total of 1677 respondents with chronic low back pain reported using an average of 9 coping behaviors in the prior 6 months. Use of more types of behaviors were reported among those with more severe back pain, who rated their health as fair or poor and who had daily occurrences of pain. Exercise was more frequent among the healthy and those with less pain. Female respondents tended to report using more coping behaviors than men, and Hispanics more than non-Hispanics.ConclusionPersons with chronic back pain were proactive in their coping strategies and frequently used self-care coping strategies like those provided by chiropractors in patient education. In alignment with patients’ beliefs that their condition was chronic and lifelong, many patients attempted a wide range of coping strategies to relieve their pain.     

Understanding Hispanic Patient Satisfaction with Telehealth During COVID-19

BackgroundRecent studies have described the use of telehealth for pediatric surgical care during the COVID-19 pandemic. We aimed to evaluate equity in telehealth use by comparing rates of utilization and satisfaction with pediatric surgical telemedicine among Hispanic patients.MethodsWe conducted a retrospective cohort study of patients seen by a surgical subspecialty provider in the outpatient setting at a quaternary pediatric hospital between April 1 and June 30, 2020. Patients evaluated in the same three-month period in 2019 were analyzed as a historic control. Differences in Family Experience Survey (FES) responses based on race and ethnicity and preferred language of care were assessed using univariable and multivariable generalized linear modeling.ResultsThe pandemic cohort included fewer patients of Hispanic ethnicity and fewer Spanish-speakers. After controlling for visit type, comparison of Spanish-speaking and English-speaking patients revealed that Spanish-speaking families had significantly lower scores for FES items that evaluated healthcare provider explaining (IRR 0.74, 95% CI: 0.61–0.90), listening (IRR 0.76, 95% CI: 0.63–0.92), and time spent with the family (IRR 0.73, 95% CI: 0.60–0.89). There were no differences in FES responses based on insurance status or degree of medical complexity.ConclusionsTelehealth services were less commonly used among Hispanic and Spanish-speaking patients. Language may differentially affect family satisfaction with healthcare and telehealth solutions. Strategies to mitigate these inequities are needed and may include strengthening interpreter services and providing language-concordant care.Level of evidenceLevel IV.     

Metabolic formation of pyrenequinones as enhancing agents of mutagenicity in Salmonella

Pyrene and 1-methylpyrene in the pyrolysis product of cellulose, which enhances mutagenicity of 2-acetylaminofluorene, must be metabolized to expose enhancing activity. 1,6-Pyrenequinone and 1,8-pyrenequinone, having high enhancement activity, were first isolated and identified in the metabolites of pyrene by rat liver microsomal fraction.     

Effects of Acupressure on Sleep Quality and Psychological Distress in Nursing Home Residents: A Randomized Controlled Trial

ObjectiveTo compare the efficacy of acupressure with sham acupressure in older-adult nursing home residents presenting with poor sleep quality and psychological distress.DesignProspective, randomized, double-blind, sham-controlled trial.Setting and participantsSixty-two nursing home residents with poor sleep quality and psychological distress participated in this study. Participants were randomly assigned to an experimental group (n = 31) receiving acupressure at true acupoints (Baihui, Juque, Neiguan, Tianzhu, and Yongchung) or control group (n = 31) receiving acupressure at sham points. All participants received 20 minutes of acupressure before sleeping 3 times a week for 8 weeks. All participants were blinded to group allocation.MeasuresSleep quality and psychological distress were measured using the Pittsburgh Sleep Quality Index and the Kessler Psychological Distress scale, respectively. Both groups' outcomes were assessed by assessors blinded to group allocation at the baseline, the end of the intervention, and 1 month after the intervention.ResultsThe experimental group demonstrated significantly more improvement in sleep quality than did the control group at the end of the intervention (10.5 vs 13.3) and 1 month after the intervention (8.3 vs 14.2; both P ≤ .001). Moreover, the experimental group had lower psychological distress levels than did the control group at 1 month after the intervention (14.6 vs 17.9, P = .05). Furthermore, significant differences in mean sleep quality (F = 60.8, P < .001) and psychological distress (F = 24.6, P < .001) were observed in the experimental group between the measurements at baseline and after the intervention.ConclusionsAcupressure at true acupoints improves sleep quality, reduces psychological distress, and provides more clinically beneficial effects compared with that at sham points. Future studies should examine whether these effects are maintained in the long term.     

Becoming an eCoach: Training therapists in online cognitive-behavioral therapy for chronic pain

Objective

Online cognitive-behavioral therapy (iCBT) is effective in supporting patients’ self-management. Since iCBT differs from face-to-face CBT on several levels, proper training of therapists is essential. This paper describes the development and evaluation of a therapist training based on theoretical domains that are known to influence implementation behavior, for an iCBT for chronic pain.

Dominant lethal study of the antiandrogen alpha, alpha, alpha-trifluoro-2-methyl-4'-nitro-m-propionotoluidide: a comparison of statistical methods

The antiandrogen α,α,α-trifluoro-2-methyl-4′-nitro-m-propionotoluidide (SCH 13521) was given orally in a single dose of 500 or 1000 mg/kg to adult male rats. Triethylenemelamine (TEM) was given ip in a single dose of 0.25 or 0.50 mg/kg as a positive control. Placebo was given po or ip as a negative control. Males were mated sequentially with 2 untreated virgin females each week for 8 weeks. Near mid-pregnancy, the number of implantation sites and fetal deaths were measured. For comparative purposes, 4 methods of statistical analysis were used to evaluate genetic damage; with one of these, fetal deaths were expressed as a function of the sire. Compared with values from the negative controls, females that were mated with males from the 4 treatment groups had fewer implantation sites after the first posttreatment mating period. The results of the 4 analyses did not indicate that treatment with SCH 13521 induced dominant lethal mutations, although 3 of the 10 rats given 1000 mg/kg died. In contrast, data from the analyses indicated that TEM induced lethal mutations and, by inference, primarily affected mitotic and postmeiotic spermatocytes.     

Disposition of radioactivity following intravaginal administration of 3H-miconazole nitrate

With the use of specimens obtained by induced abortion, the relationships between crown-rump length on the one hand and body weight and menstrual age on the other were investigated in 43 twin fetuses with menstrual ages between 8 1/2 and 21 weeks. This study indicates that the body weight of twins in comparison with length is the same as that of singletons, an indication of the fact that they are not growth retarded. On the other hand, the average crown-rump length when compared with menstrual age is somewhat less than that of singleton fetuses. The possible implications of these findings are discussed in the light of prevailing concepts concerning the growth of twins.