上海市恶性肿瘤死亡患者临终期住院行为分析

目的:分析恶性肿瘤患者临终期诊疗行为,总结其特点及发现存在的可能问题,为调整、优化资源配置提供循证依据,从而更好地满足患者需求。方法:收集2016年上海市住院期间因恶性肿瘤死亡居民的临终期住院记录,分析其临终前住院服务量、机构构成、转院情况以及机构流向等特点,采用Gephi绘制可视化图直观反映转院情况和区域分布情况。结果:临终期内住院次数和住院服务需求的增长趋势近似指数形式,尤其是临终前最后一季度。住院主要集中在三级医院,但比非临终期患者较临终期患者的三级医院住院的构成比低。分析患者的住院机构选择,约一半患者固定在1家机构住院,90%的患者住院机构数量在3家以内。转诊具有明显的区域性,郊区患者在区域内就诊比较明显,市区患者主要集中在市区三级医院。结论:根据恶性肿瘤患者临终期住院服务特点,建议从资源配置与服务利用两方面进行优化。在资源配置上,加强区域医疗中心和基层建设,缓解三级医院住院服务压力,方便患者就诊。在服务利用方面,加强上下转诊标准建设,合理引导患者分流;对医疗机构管理及考核根据临终期的特点来调整标准。     

对临终患者实施医疗服务的实践与探讨

临终关怀是对无治愈希望病患的积极与整体性的照顾。通过成立以收治肿瘤晚期患者为 主的关爱病房，对临终患者实施医疗服务进行有益的尝试与探析，对发展临终关怀事业提出建议。     

恶性肿瘤患者的临终护理

临终护理是满足晚期患者生理、心理、社会需求的全面照顾,延长患者生存时间,提高生存质量,维护其人格生命的尊严,切实做到让患者在最后生命历程中面对死亡保持安详.现将临终患者的临床资料及综合护理体会介绍如下: 1 临终患者心理需求及心理调整     

恶性肿瘤病人临终期营养支持治疗体会

目的探讨恶性肿瘤病人临终期营养支持治疗体会。方法研究对象为2008年6月——2013年6月我院收治的372例恶性肿瘤患者,其中156例经患者及家属要求实施临终期营养支持治疗（设为干预组）,其余216例患者仅实施常规的治疗及护理（设为对照组）,比较分析两组并发症发生率、住院15 d以内死亡率及血糖、血脂、肝功能、肾功能、尿酮等相关指标。结果干预组并发症发生率及住院15 d以内死亡率分别为20.5%及11.5%,显著少于对照组的45.4%及28.7%（P〈0.05）。入院后第1天两组无显著区别（P〉0.05）,而入院后第10 d,干预组血糖、血脂、肾功能、肝功能等相关指标均显著优于对照组（P〈0.05）,且尿酮阳性率显著少于对照组（P〈0.05）。结论针对恶性肿瘤病人实施临终期营养支持治疗,可显著降低并发症发生率,延缓死亡时间,并改善患者临终期身体健康指标,值得推广应用。     

照料模式对老年人临终期医疗服务利用的影响

目的 研究照料模式对老年人临终期医疗服务利用的影响,为完善老年人临终照护政策提供依据。方法 利用中国老年健康影响因素跟踪调查2014—2018年追踪数据筛选出2 226名临终期老年人,应用logistic回归模型和Heckman样本选择模型分析照料模式对老年人临终期医疗服务可获得性和医疗费用的影响。结果 正式照料（OR=6.931,P <0.1）和非正式照料（OR=3.479,P <0.1）能够显著提高老年人临终期医疗服务的可获得性,然而高额照料花费对医疗服务可获得性起抑制作用（OR=0.392,P <0.05）。同时,接受正式照料老年人的临终医疗费用低于无人照料（β?=-0.973,P <0.05）和接受非正式照料（β?=-0.633,P <0.05）的老年人。结论 临终照料显著影响老年人医疗服务利用,正式照料能够提高老年人临终期医疗服务可获得性并降低医疗费用支出。建议进一步规范和促进照护行业发展,充分发挥正式照料与医疗服务的协同作用,并建立以长期护理保险为主的正式照料筹资机制,以完善老年人临终健康保障体系。     

危重患者实施临终医疗的研究现状

随着社会老龄化问题的日益突出,近年来医院中收治的危重患者明显增加,先进的生命支持技术可以使患者存活的更长久,但与此同时,人们也逐渐认识到持续、高强度和积极的治疗并不都是有益的.尽管重症监护病房(ICU)拯救生命,但仍有很多严重损伤和疾病的患者死于医院,其中20%死于ICU.对危重患者如何实施临终医疗一直是重症医学需要思考的伦理问题.现将重症监护室危重患者实施临终医疗的研究综述如下,总结目前存在的问题并对其应用前景进行展望.     

晚期恶性肿瘤患者的临终全方位护理

近年来，恶性肿瘤病人不断增多，2005年4月～2007年3月我院内科共收治晚期恶性肿瘤患者23例，作者对其实行全方位护理。宗旨是减少临终病人的痛苦，增加其舒适程度，提高病人的生存质量，维护临终病人的尊严，同时给予病患家属精神上的支持，给予他们承受所有事实的力量，进而坦然地接受一切即将面临的问题。     

临终期医疗的经济学和伦理学探讨

对临终期患是采取强化治疗还是放弃治医，即对这类患的继续治疗是否有意义，这不仅是卫生经济学的研究内容，也是医学伦理不的研究课题，本以卫生经济学与医学伦理学相结合，对国际学术界和舆论界的观点动态进行了分析探讨，可供我国读参考。     

贫弱人群医疗救助基本服务包的设计

一、设计基本服务包的一般程序和原则 在表1中我们列举了决策空间和决策原则,表明在界定基本服务包时应作出什么类型的决定。     

支付方式改革与医疗服务综合管理协同机制研究

医疗保险支付方式改革作为医药卫生体制改革中的重要举措,应该处理好与医疗服务价格调整、公立医院薪酬绩效改革、成本核算的优化、卫生信息化建设、医疗服务质量控制等医疗服务综合管理政策的衔接问题,充分发挥协同作用,形成政策合力,从而更充分地发挥支付机制改革的作用。     

医疗介护模式对晚期消化道肿瘤患者生活质量的影响

目的通过实施医疗介护模式,延伸医院的医护服务,提高晚期消化道肿瘤患者的生活质量。方法入选2010年5月至2011年5月我院肿瘤科病房出院的晚期消化道肿瘤患者162例,其中对照组78例,观察组84例,所有患者随访2个月。分别在出院时及出院后1个月、2个月,采用KPS量表、癌症疼痛综合治疗生存质量量表及巴氏指数量表对患者进行测评。结果出院后1个月及出院后2个月,观察组的KPS评分明显高于对照组(P<0.05),癌症疼痛综合治疗生存质量评分亦明显高于对照组(P<0.05);而观察组的ADL评分在出院后1个月及出院后2个月低于对照组(P>0.05)。结论实施医疗介护模式可以减轻晚期消化道肿瘤患者的疼痛,改善患者的体能状态,提高患者的生活质量。     

临终关怀护理对晚期癌症患者生存质量的影响

目的探讨临终关怀护理对晚期癌症患者生存质量的影响。方法选取我院2018年10月至2019年5月间收治的60例晚期癌症患者作为研究对象,随机分为两组各30例。对照组患者给予常规护理,观察组患者在对照组患者基础上给予综合性临终关怀护理。比较两组患者护理后的生活质量以及护理满意度。结果护理后,观察组患者的躯体功能、认知功能、情绪功能、社会功能评分以及生活质量综合评分均显著高于对照组患者(P <0.05)。观察组患者的护理满意度为93.3%,显著高于对照组的73.3%(P <0.05)。结论晚期癌症患者采用综合性临终关怀护理可显著改善其生活质量,提高其护理满意度。     

Assessment of Anxiety and Depression in Advanced Cancer Patients and their Relationship with Quality of Life

The growing interest in the mental health and quality of life of cancer patients, has been the major reason for conducting this study. The aims were to compare advanced cancer patients’ responses to Hospital Anxiety and Depression (HAD) scale with those to European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30, version 3.0), as well as the impact of quality of life dimensions (as measured by EORTC QLQ-C30) on the levels of anxiety and depression. The analysis, conducted in 120 advanced cancer patients, showed that the most significant associations were found between emotional functioning and HAD-T (total sum of scores) (r=−0.747; p < 0.0005), HAD-A (anxiety) (r=−0.725; p < 0.0005) and HAD-D (depression) (r=−0.553; p < 0.0005). In the prediction of HAD-T, the contribution of physical, emotional, role, and social functioning along with nausea-vomiting, dyspnea, sleep disturbance and gender is high. For anxiety, the predictor variables were physical, role, cognitive, emotional, and social functioning, followed by dyspnea, sleep disturbance, and appetite loss, while depression was predicted by physical, role, emotional, and social functioning, the symptoms of nausea-vomiting, pain, sleep disturbance, constipation, as well as the variables of age, gender, anticancer treatment and performance status. Concluding, psychological morbidity, in this patient population, was predominantly predicted by the emotional functioning dimension of EORTC QLQ-C30.     

Age and Gender Differences in Medicare Expenditures and Service Utilization at the End of Life for Lung Cancer Decedents

PURPOSE: Gender and age differences in medical care are well documented. We examined age and gender differences in Medicare expenditures for lung cancer decedents in the last year of life (LYOL) through a cross-sectional study of Medicare administrative and claims data. METHODS: Participants were aged Medicare beneficiaries (>or=68) with lung cancer, who were covered by Parts A and B for 36 months before death (1996-1999; n = 13,120). Regression techniques were used to estimate age and gender differences in mean Medicare utilization and expenditures in the LYOL overall and by type of service, conditional on use: inpatient, outpatient, physician, skilled nursing facility (SNF), home health, and hospice, controlling for demographic, clinical, geographic, and supply characteristics. RESULTS: Women were more likely than men to use inpatient, SNF, home health, and hospice services. Women's average expenditures were approximately dollars 1,900 greater than men's, with differences attributed to higher average expenditures for SNF, home health, and hospice. Older cohorts used fewer inpatient and outpatient services and used more SNF and hospice services in their LYOL. Average Medicare expenditures were significantly lower in older cohorts (dollars 8,487 less for those age >or=85 at death than for those 68-74). Adjusting for age explains most of the gender differences in average Medicare expenditures. Remaining gender differences vary across age cohorts, with larger gender differences in social-supportive service expenditures among those 68-74 and 75-84 and outpatient and physician services among those 75-84 and >or=85. DISCUSSION AND CONCLUSIONS: Our findings suggest that gender disparities in expenditures are generally small at the end of life for lung cancer decedents, particularly among the older cohorts. As expected, the bigger observed differences are by age although the direction of the association is not consistent across types of service. Higher expenditures for women on social-supportive services may reflect fewer informal supports for older women compared with men.     

优质护理服务模式对晚期胃癌患者疼痛的影响效果观察

目的探讨优质护理服务模式在晚期胃癌中应用效果。方法选择2010年6月至2012年7月在我院住院治疗的200例晚期胃癌为研究对象,根据有无开展优质护理服务分为A组(n=100)和B组(n=100),A组患者给予常规护理,而B组患者则在优质护理服务模式指导下护理干预措施进行护理,比较两组患者疼痛情况。结果 A组患者疼痛程度明显高于B组,差异有统计学意义(P<0.05);B组患者基础护理合格率(99.00%)和患者对护理人员护理服务满意率(98.00%)明显高于A组(91.00%,87.00%),差异有统计学意义(P<0.05)。结论优质护理服务干预措施明显改善患者的疼痛程度,改善患者的预后,值得进一步推广。     

The Impact of Poverty,Chronic Illnesses,and Health Insurance Status on Out-of-Pocket Health Care Expenditures in Later Life

This study aims to examine poverty, chronic illnesses, health insurance, and health care expenditures, within the context of a political economy of aging perspective. Subsamples of 1,773 older adults from the Medical Expenditure Panel Survey were selected for analyses. The results showed that chronic illnesses influenced out-of-pocket health care costs. Older persons with more than one health insurance spent less on out-of-pocket health care costs. The results have implications for health care social workers concerned with the growing costs of chronic illnesses, implementing integrated care, and advocating for extending public health insurance coverage especially for our most impoverished older adults.     

Preferences of Patients and Oncologists for Advanced Ovarian Cancer Treatment-Related Health States

PurposeThe purpose of this study was to compare expected utility preferences of various health outcomes of chemotherapy treatment among ovarian-cancer patients receiving chemotherapy, ovarian cancer patients who were post-treatment (eg, under surveillance), and oncologists who treat this disease.MethodsParticipants were asked to score 6 hypothetical ovarian cancer treatment-related health states using both a rating scale and the standard gamble. Scores were obtained in the range of 0.0 (death) to 1.0 (perfect health) for each hypothetical health state, with a difference of 0.10 being practically meaningful, and were analyzed by analysis of variance.ResultsSeventy-five eligible participants were included in this study (41 ovarian-cancer patients and 34 oncologists). Patients and physicians reported similar responses in the rating scale exercise (F = 0.854, P = .43). However, when the health states were presented with an element of uncertainty via the standard gamble exercise, patients who were under surveillance reported significantly different expected utilities of the health states from physicians and from patients who were receiving treatment, demonstrating greater risk aversion than the other groups (F = 4.270, P = .018).ConclusionsThis study suggests that there are significant differences in expected utility preferences among patients who are under surveillance as opposed to oncologists or patients receiving treatment, despite similarities in rating scale values. These findings suggest a need to further evaluate these differences in expected utility preferences in the context of decision in the setting of recurrent disease, where a patient under surveillance must make decisions related to re-initiation of therapy at a time when her preferences are likely to significantly differ from those of oncologists.     

新疆医疗服务价格调整前后胆囊炎住院费用的比较分析

目的：分析新疆医疗服务价格调整前后胆囊炎费用结构的变化：方法：采用病例回顾法收集新疆8所综合性医院4年的胆囊炎出院病例住院费用信息和病例首页的基本信息，运用t检验、构成比、对数多元线性回归模型对医疗服务价格调整前后胆囊炎住院费用构成及影响因素进行比较分析；结果：医疗服务价格调整前后胆囊炎住院费用构成及影响因素均发生了变化；结论：医疗服务价格调整对胆囊炎住院费用产生了一定程度的影响。     

健康教育对晚期血吸虫病人生存质量的影响

目的探讨＂答疑.指导.交流＂健康教育模式对晚期血吸虫病患者生存质量的影响,为医院健康教育提供依据。方法对2009年5～8月我院收治的72例晚期血吸虫免费救治患者进行健康教育,用血防知识调查表和《生存质量测定简表》评估其效果。结果 72例患者健教前血防知识及格率为47.22%,健教后及格率为98.61%,差异有显著性意义;健康教育前后患者生存质量各领域及总的健康与生活评分存在差异,且有统计学意义。结论对晚期血吸虫患者进行有效的健康教育能帮助患者更好地认识所患疾病,从而改善消极行为,提高病人生存质量。