综合医院以联络为主的联络会诊模式资料分析

近年来,会诊-联络精神病学不断发展.在国外,会诊-联络精神病学已成为精神病学的一个重要分支[1].会诊-联络精神病学的工作范畴包括两方面:会诊和联络.联络可视为会诊-联络的简便形式,另一个理解是指联络精神科医师和内外科或特殊部门的医务人员进行定期接触,精神科医师为治疗小组成员;会诊则不然,精神科医师只是应邀对某些问题提出建议或意见,并不被视为治疗小组成员[2].而目前我国在综合医院中开展的联络会诊精神病学工作,主要以会诊为主,而缺少与非精神科医生的联络交流.针对这一情况,本院从2009年起,制定以加强与各科医务人员联络为主的联络会诊模式,取得良好效果,现分析如下.     

思茅地区会诊联络精神病学的10年应用

目的 探讨会诊联络精神病学在思茅地区综合医院的临床应用前景，促进临床科研工作。方法 对我院为综合医院提供精神科会诊280例，310次会诊资料进行统计.结果综合医院精神科会诊以内科、老干科、综合科最多，疾病以器质性精神障碍，神经症、精神分裂症，精神活性物质所致精神障碍为主，经会诊处理后76.3％的患者达临床痊愈。结论 会诊联络精神学在综合医院有其特殊地位，应在思茅地区积极开展会诊联络精神病学工作。     

内科患者合并精神障碍36例会诊体会

目的:分析内科患者的精神障碍的诊断和治疗.方法: 对会诊的36例内科患者精神障碍进行临床分析.结果:内科患者中躯体疾病合并精神障碍者,应及时请精神科医生会诊,明确诊断和治疗.结论: 加强会诊联络精神病学的精神医学服务,提高临床医疗服务质量.     

综合医院110例伴发精神障碍患者院际会诊治疗的回顾性分析

目的：探讨联络会诊精神病学在综合医院中的作用。方法：回顾性分析5年内综合医院向我院邀请的110次精神科会诊。结果：会诊后的诊断主要为器质性疾病所致精神障碍23.6%、神经症20%、精神分裂症和分裂样精神病38%、抑郁症13.6%、应急相关障碍4.5%。结论：综合医院内精神科会诊可及时发现和治疗精神障碍,并拓展精神病学业务,建立联络会诊精神病和双向转诊很有必要。     

综合医院申请精神科会诊172例回顾性分析

目的：探讨综合医院会诊-联络精神病学的开展现状。方法：对我院2006年至2008年住院患者申请精神科会诊172例的临床资料进行回顾性分析。结果：近3年来申请精神科会诊的病例数呈逐年上升趋势;申请会诊的科室以神内科为最多;会诊后精神疾病分类,以神经症为多见。结论：开展会诊-联络精神病学,有利于提高非精神科医生对精神障碍的识别能力,更大程度减少误诊率及漏诊率。     

精神科327例院际会诊情况分析

目的 了解综合医院精神科会诊服务需求的特点.方法 对2008年1月～2011年6月期间我院为成都市综合医院提供的327例次院际会诊患者进行回顾性分析.结果 内科科室会诊比率占63.4％,其中神经内科最高;会诊后精神科诊断以器质性精神障碍为主占36.4％,对多数会诊患者(75.5％)给予了精神科药物处理.结论 综合医院对精神卫生服务的需求逐年增加,精神科应加强会诊-联络精神病学的工作.     

综合医院会诊-联络精神病学临床研究

探讨综合医院住院病人精神科急会诊与普通会诊的待征差异。方法：就1997年度197例连续精神科会诊，分析其申请会诊科室、原发病、申请理由及精神障碍诊断处理。结果：非精神科医师对精神科疾病的诊断率为33．1％，其中与会诊医师诊断一致的为48．2％。急会诊中主要为脑器质性精神障碍及躯体疾病所致精神障碍（63％），普通会诊以神经症（27．4％）、躯体疾病所致的精神障碍（26．6％）、抑郁症（20．2％）为主。结论：急会诊与普通会诊的诊断差异有助于在精神科会诊中作临床鉴别诊断；会诊一联络精神病学工作亟待加强。     

综合性医院22例会诊患者的临床分析

目的:分析会诊患者精神障碍的诊断和治疗。方法:对22例会诊患者的精神障碍进行临床分析。结果:精神障碍在住院患者中被识别率低、治疗率低、治疗不规范。结论:加强会诊联络精神病学的精神医学服务,提高临床医疗服务质量。     

48例内科病人合并精神障碍会诊分析

目的分析内科病人的精神障碍的诊断和治疗。方法对会诊的48例内科病人的精神障碍进行临床分析。结果内科病人中躯体疾病合并精神障碍者,应及时请精神科医生会诊,明确诊断及时治疗。结论加强会诊联络精神病学的精神医学服务,提高临床医疗服务质量。     

会诊-联络精神病学在综合医院应用分析

通过回顾性分析,得出结论:会诊--联络精神病学在综合医院的应用有重要价值,对促进医院的发展及非精神科医生了解精神科知识、全方位提高医院诊治水平有重要意义.     

临床科室点对点远程医学业务模式建立与应用

国内医院间开展远程业务大都采取“会诊中心”模式,参与远程医学业务双方医生都要去会诊中心.这种模式不便于远程业务工作的开展,也不利于双方医生的交流,对急诊和疑难重症患者也无法做到及时响应.为克服以上缺点,探索建立了临床科室“点对点”远程医学模式,把远程医学服务延伸到科室和患者床边,能够及时快速响应会诊和急救,有利于双方医生的交流与合作.     

在线问诊环境下医患交流行为模式研究

采集18 664条医患在线交流对话信息,运用描述性统计分析、主题挖掘等方法从交流行为和内容两方面对医患交流行为模式进行研究分析,得出在线问诊环境下患者更具有主导性等结论,以期为管理和推广在线问诊服务提供一定理论与实践指导。     

Psychiatric comorbidities in cancer patients: acute interventions by the psychiatric consultation liaison service

Wiener Medizinische Wochenschrift - The aim of this study was to explore the psychiatric comorbidities in cancer patients examined by the psychiatric consultation liaison services (CLP) in...     

综合医院238例精神科会诊的临床分析

通过住院病人精神科会诊238例分析,发现内科请会诊最多,为172例(72.3%).精神科诊断中,以症状性精神病最多,其精神症状的发生可与基础疾病不平行,且无意识障碍者较多.误诊原因等分析,反映了综合医院中目前会诊形式已不能满足现代医学发展的需要,应当在综合医院中建立精神科并有必要发展会诊一联络精神病学.     

Physicians' Perception of Palliative Care Consultation Service in a Major General Hospital in China

Objective s The in-hosptial palliative care consultation (PCC) is emerging as a routine service in some medical center in China. The current study evaluated how physicians in primary care team and consultation team perceive the PCC service for the purpose of investigating the effectiveness of this consultation model in a general hospital. Methods In-hosptial palliative care consultations have been carried out at Peking Union Medical College Hosptial by a dedicated consultation team, and 37 consultations were completed in 2016. A questionnaire was designed for physicians in terms of its benefits to patients,their family as well as the primary care team. Physicians who applied for consultation in 2016 formally (requested from the department other than the Geriatrics) and informally (by rotating residents and unemployed visiting doctors in geriatric department) were invited to participate in the survey by scanning a two dimentional code on social networking platform. Results There were 103 physicians participated in the survey, including primary care physicians from the department of Internal Medicine (n=8), Gynaecology (n=16) and Surgery (n=13), rotating residents (n=30), visiting doctors (n=16) in Geriatric department, and PCC team members (n=20). 94.0% of the non-PCC physicians agreed that PCC relieved the suffering of patients; 89.2% thought PCC improved the quality of patients’ life; there were 91.6%, 95.2%, 90.4% physicians who felt it relieved the anxiety of patients, of family members and of care providers, respectively. There were 96.4% physicians who felt it could ease the tension in physician-patient relationship; 97.6% felt it lower the risk for medical negligence, and 96.4% of doctors who applied for PPC felt satisfied with PCC service in terms of process and achieving objectives of consultation. More primary-team physician agree “PCC service helps the physicians better understand palliative care” than PCC members (97.6% vs. 80%, P<0.05), while both were interested in learning more on palliative medicine (100% vs. 96.4%, P>0.05). Conclusion Palliative care consultation service in a general hospital is efficacious and acclaimed.The primary care physicians and the PCC members hold positive attitudes to the benefits that the PCC services bring to patients, family members, and physicians themselves. PCC for terminal patients in a general hospital may serve as a good modle for promotion of palliative care in China.     

Doctors' unawareness of the drugs their patients are taking: a major cause of overprescribing?

We studied the accuracy of both hospital and general practitioners' records of current drug treatment in consecutive patients who attended a general medical review clinic. Either the hospital or the general practitioner's records (obtained in a questionnaire), or both, were inaccurate for over 70% of 59 patients interviewed with their medicine. Most of the errors were due to patients taking drugs in addition to those shown in their records. Some of these were inappropriate, and many seemed unnecessary. It appears that neither hospital doctors nor general practitioners are fully aware which drugs their patients are taking, and this may contribute to overprescribing. We believe that considerable financial savings might be made if patients brought all their medicines to every consultation.     

精神病患者与家属就诊行为及心理分析

目的：调查精神病患者与家属就诊行为及心理状况.方法：完成对110例精神病患者及家属调查,包括人口学资料、非精神病专科就诊情况、延迟至精神科就诊原因、精神科求医途径及原因、精神病未治疗期病程、患者及家属的心理状况.结果：非精神科主要求助方式为宗教迷信和非专科医生;精神科就诊方式主要为家属意愿;精神病未治疗期病程平均为（9.04±13.32）月;精神病患者家庭存在严重的功能障碍,家属存在不同程度的心理问题.结论：在精神卫生服务方面需进一步加强精神卫生知识的普及宣传,加强社会支持系统的作用,以改善家属的心理问题和患者疾病的预后.     

Guidelines reduce time to consultation for a liaison psychiatry service in an Irish teaching hospital

Background

Timeliness of response from referral to consultation is necessary to provide best standards of care to inpatients in the general hospital setting.

Aims

To measure the length of time from referral to consultation in a liaison psychiatry service, and improve service delivery by introducing guidelines for time to consultation.

Methods

Time to consultation was measured on all patients presenting to a liaison psychiatry consultation service over an initial 6-month period, with subsequent repeat measurement following the introduction of guidelines.

Results

There were significant reductions for time to consultation in the service for the second cycle of the audit (??²?=?43.84, P?Conclusions Introduction of guidelines for time to consultation, may improve response times, leading to improved quality of service for inpatient consultation services.     

Psychiatry in General Practice

Psychiatrists should include the family doctor in their plans for future psychiatric services. The general practitioner now treats most of the patients who seek help for psychiatric disorder and he could not give up his psychiatric practice even if he wanted to. Furthermore, there are not now nor will there ever be enough psychiatrists to take over all patients with mental ills. Most emotionally disturbed patients can be better handled by their family physicians than by a specialist.

To provide the best care for emotionally disturbed people the communication between family doctors and psychiatrists must be improved. The specialist must acknowledge the importance of the general practitioner's role in psychiatric diagnosis and treatment and give him more help. Medical schools must provide better undergraduate and postgraduate psychiatric training for the students who will become family doctors. Health plans and other prepayment agencies should properly compensate the general practitioner for giving psychiatric treatment. The specialist in psychiatry should consult more readily with the general practitioner and help him carry out some of the therapy. General hospitals should permit family doctors to admit mental patients to psychiatric wards in a general hospital and to carry out psychiatric treatment with the help of the specialist in psychiatry.