PREVALENCE OF ALCOHOL PROBLEMS AMONG ADULT SOMATIC IN-PATIENTS IN NAPLES

The aim of this cross-sectional study was to determine the prevalenceof alcohol problems among adult somatic in-patients in urbanhospitals of Naples. The patients were screened with a structuredquestionnaire regarding life style. After discharge, the patientrecords were examined and the hospital discharge diagnoses wereregistered. A patient was considered having an alcohol problemif one or more of the following criteria were fulfilled: (1)a Michigan Alcoholism Screening Test score at or above five;(2) a self-reported daily consumption for at least 2 years ofat least 60g of ethanol for males and 36g for females; (3) analcohol-related discharge diagnosis. The prevalence of patientswith alcohol problems was significantly (P < 0.01) higheramong male (43.8%, 95% confidence limits. 37.6–50.2%)than among female patients (14.8%, 95% confidence limits. 9.6–21.4%).There were no significant differences among the different typesof somatic departments regarding the prevalence of alcohol problemswhen gender was considered. Patients with alcohol problems differedsignificantly from those without alcohol problems regardinga number of variables: the former drank significantly more alcohol,smoked for more years, and had a higher prevalence of alcoholproblems in the family. It is concluded that alcohol problemsamong in-patients are as prevalent in Naples as in other industrializedcountries, that it is often not registered among discharge diagnoses,and that the problems are more prevalent in males than in females,irrespective of the type of department.     

SLEEP PATTERNS AND PROBLEMS IN ELDERLY GENERAL PRACTICE ATTENDERS: AN AUSTRALIAN SURVEY

During 1983, interviews were conducted with 348 consecutive general practice patients, mean age 74 years, attending 31 practices in city and country areas of New South Wales, Australia. Disturbances in initiating and maintaining sleep were experienced by one-third to one-half of respondents. Twenty per cent of respondents felt they had a problem with sleeping at night and a further seventeen per cent felt they would have a problem if they did not take tablets. Those with a sleep problem were more often depressed, or disturbed by a noisy neighbourhood or a recent upset or crisis than those without. Sleeping tablets were taken by twenty-four per cent of respondents. The desirability of a detailed sleep history prior to prescribing sleeping tablets is emphasised.     

地级市综合性医院健康教育的实践与体会

介绍地级市综合性医院开展健康教育工作的做法:包括健全网络,落实经费;加强培训,全员参与;积累资料,总结提高;拓宽渠道,形式多样。认为开展医院健康教育是一种医患双赢的良性工作;解决医院领导者对健康教育工作的认识以及开展健康教育的“人”和“钱”问题,是搞好医院健康教育的重要前提;对改进医院健康教育方法提出建议。     

临床药师在普外科的工作实践

目的总结临床药师在普外科开展药学服务的经验,探索临床药师参与药物治疗实践、开展药学服务的模式。方法通过分析药学服务的实例,阐述普外科临床药师的具体工作内容。结果临床药师深入临床的工作得到医务人员的认同和肯定,在药物的选用、药敏试验结果的解读、不良反应的识别与处理、用药宣教及咨询等多方面发挥了临床药师的作用。结论临床药师干预与指导临床合理用药的工作,及时纠正不合理用药现象,给医务人员和患者提供多种形式的药学服务,为临床药师树立了全新的专业形象。     

PREVALENCE OF ALCOHOL PROBLEMS AMONG ADULT SOMATIC IN-PATIENTS OF A COPENHAGEN HOSPITAL

The adult patients of somatic departments of a Copenhagen hospitalwere screened on a randomly selected day during a 14 day periodby interviewers who examined them using a stnictured questionnaireregarding life-style. A patient was considered having an alcoholproblem if one or more of the following criteria was fulfilled:(1) a self-reported daily alcohol consumption for at least 2years of at least 60 g of ethanol in men and 36 g in women,(2) a Michigan Alcoholism Screening Test (MAST) score of orabove 5, (3) an alcohol-related discharge diagnosis. In total,692 patients fulfilled the enny critena, but 181 patients (26.2%)had to be excluded owing to predeflned exclusion criteria (terminalillness, dementia, etc.), and 74 patients (14.5%) refused toparticipate. Among the 437 interviewed patients, 125 patients(28.6%; 95%-confidence limits 24.4–33.1%) fulfilled oneor more of the diagnostic criteria for an alcohol problem. Only14 patients (3.2%; 95%-confidence limits 1.8–5.3%) hadan alcohol-related discharge diagnosis. The prevalence of patientswith alcohol problems was significantly (P < 0.05) higheramong male patients (82 of 171 men (48.0%; 95%-confidence limits40.3–55.7%)) than among female patients (43 of 266 women(16.2%; 95%-confidence limits 12.0–21.2%)). The prevalenceof patients with alcohol problems was 32.4% (95%-confidencelimits 25.5–39.8%) in internal medicine departments, 28.5%(95%-confidence limits 21.3–36.6%) in surgical departments,and of female patients 22.2% (95%-confidence limits 13.7–32.8%)in the department of gynaecology and obstetrics.     

INVITED REVIEW: MANAGEMENT OF ALCOHOL PROBLEMS: THE ROLE OF THE GENERAL PRACTITIONER

Some 23% of men and 8% of women in the United Kingdom are consumingalcohol at levels that are of risk to their health, or are experiencingsome problems related to their alcohol use. Traditionally, generalpractitioner efforts have focused on diagnosing and treatingpatients with a substantial history of dependence, and relativelylittle attention has been given to early intervention, withat-risk drinkers identified in general practice through screeningor case finding programmes. Evidence indicates that early interventionsby general practitioners are effective in reducing alcohol consumptionamong at-risk patients. Further work is still needed on themost effective ways of supporting general practitioners in thistask.     

THE MEDICAL PROFILE OF UNIDENTIFIED PROBLEM DRINKERS IN GENERAL PRACTICE: TEST OF AN HYPOTHESIS

In order to facilitate general practitioner (GP) detection ofproblem drinkers the Dutch College of General Practitionersdeveloped a standard specifying the differences in medical profilebetween problem drinker and non-problem drinkers. The standardmentions 35 Reasons for Encounter (RFEs) and OP Evaluations(Es) that are thought to be specific for problem drinkers. Thestudies referred to in the standard base their conclusions aboutdifferences in medical profile upon a comparison of problemdrinkers already identified by the GP with other patients. Thisstudy tests the hypothesis that the medical profile specifiedby the standard also applies to unidentified problem drinkers.All known problem drinkers in the practices of 16 GPs, as wellas a one in 10 random sample of patients considered to be non-drinkerswere admitted to the study at their first surgery visit duringa 1-year period. Hidden problem drinkers were detected by meansof a screening questionnaire, although the results were notconveyed to the GP until the study was completed. Over the 1-yearstudy period the GPs then registered all RFEs and Es of thestudy population. RFE and E sum scores were then constructedbased on the Alcohol Standard. The estimated population prevalenceof problem drinking, corrected for the one in 10 sample fractionwas 7%. We found 6% problem drinkers (n = 78) in the categoryregarded by the GPs as non-problem drinkers (n = 1254). Differencesin RFEs and Es between hidden problem drinkers and those regardedas non-problem drinkers were significant for irregular heartbeatand psychological problems. Sexual problems were significantat the RFE level, social problems at the E level. When identifiedproblem drinkers are compared with non-problem drinkers moredifferences in the medical profile are found (four times bothRFE and E; twice RFE and once E). We conclude that most of thepublished differences in the medical profile between problemdrinkers and other GP patients are not found for unidentifiedproblem drinkers. The observed differences between unidentifiedproblem drinkers and non-problem drinkers are too small to behelpful to the GP to detect problem drinkers.     

SCREENING ALCOHOL & DRUG USE IN A GENERAL PRACTICE UNIT: COMPARISON OF COMPUTERISED AND TRADITIONAL METHODS

Systematic screening of patients for areas of health risk in their lifestyle has much potential for primary health care clinicians as a cost-effective and time saving means to identify ‘at risk’ individuals. In the area of alcohol and drug problems, such early identification increases the likelihood of successful intervention. The present study, conducted at a general practice unit, compared the use of a computer to screen for alcohol and drug use with the two more traditional assessment methods of face-to-face interview and paper and pencil questionnaire. It was found that levels of reported consumption were similar across assessment methods. Although the interview method was strongly preferred overall, patients' preference for the computer increased significantly after use. The computer was also found to be more acceptable to patients reporting non-medical drug use, a potentially threatening and sensitive issue. There was a low refusal rate and most patients were willing to allow their doctor to see the assessment results. This indicates that screening for alcohol and drug use is acceptable to general practice patients, and that the computer can play a useful role as a prevention aid.     

医疗谈话制度在医疗实践中的应用体会

随着《医疗事故处理条例》及相应配套规章的出台，患方的知情权、选择权尤为强调，而要充分体现患方的知情权、选择权，作为医院应建立一系列健全、符合法律法规的医疗谈话制度。其实，在《医疗事故处理条例》出台前，像“手术同意书”、“病危通知单”、“麻醉同意书”均属医疗谈话制度之列，但已不适应形势发展的需要，不符合规范的要求。浙江省卫生厅根据部颁《病历书写基本规范》出台了“浙江省病历书写规范”，对其中的医疗谈话作了详细的规范，结合个人在医疗实践中的应用，分类谈谈体会。     

SCREENING FOR ALCOHOL RELATED PROBLEMS IN THE ANTENATAL CLINIC; AN ASSESSMENT OF DIFFERENT METHODS

This paper assesses different methods of asking about alcoholconsumption in the antenatal clinic. Reliable screening methodsare essential if appropriate intervention is to be accuratelytargeted. Women attending antenatal clinic for the first time were questionedabout their alcohol consumption in the period immediately beforeconfirmation of pregnancy. Quantity-frequency questions, a questionabout bingeing and the Cage Questions were asked as part ofthe routine clinical history by the interviewing doctor. Inaddition, the women were given a further self-completed questionnairewhich contained more detailed questions about the usual quantityand frequency of drinking beers, wines and spirits, the CageQuestions again and the Brief Michigan Alcoholism ScreeningTest (BMAST). Asking simple quantity-frequency questions coupled with a questionabout bingeing during the clinical history was shown to be aquick and efficient method of estimating alcohol intake. Self-administeredquestionnaires were shown to be unnecessary and although theCage Questions performed better than the BMAST, these alcoholismscreening tests were found to be unreliable in this populationin which drinking was generally at a low level.     

PREVALENCE OF ICD-10 HARMFUL USE OF ALCOHOL AND ALCOHOL DEPENDENCE AMONG THE RURAL POPULATION IN UDMURTIA

A sample of 855 rural adult inhabitants in Udmurtia was interviewedby the Composite International Diagnostic Interview 1:1 (CIDI)to investigate the incidence and prevalence of alcohol-relateddisorders. Harmful use of alcohol and alcohol dependence affected37.1% of the population according to ICD-10 and DSM-III-R ina lifetime period. The incidence of alcohol dependence in theprevious year was 0.8% (1.4% in men, 0.4% in women). Alcohol-relateddisorders were more common in men (72.6%) than in women (10.3%).Correlates of alcohol dependence were sex (69.3% in men, 3.7%in women), lower education (40.1%) and being divorced in men(77.8%). Alcohol dependence had a high comorbidity with socialphobia in Udmurt men and with depression in Russian men.     

开展临床药学实践的几个问题

<正> 随着制药工业现代化进程的加快,药品分类管理和商品化程度的提高,药品价格政策的规范,医疗保险制度的建立,医院补偿机制的理顺,我国已经加入世界贸易组织,医院制剂日渐萎缩,给医院药房带来了挑战,同时随着合理用药方面的需求增加,也带来了机遇。本文旨在谈谈医院药房的发展趋势。1 开展临床药学实践卫生部张文康部长曾指出:"医和药是左右手的关系。医院的功能不仅仅是卖药,更加重要的是指导临床合理用药。"并明确指示医院要开展临床药学。临床药学是药师联系临床,探讨药物应用规律,促进临床用药合理化的一门新兴综合性交叉学科,其研究对象是个体化的患者,任务是保证患者用药的安全有效经济,因而研究合理用药是其核心。在美国已经发展到药学监护的模式,临床药师参与察看患者,制订治病方案,接受用药咨询已成日常工作,且体现医院的药学水平。1.1 药师下临床参与用药,提供药物咨询     

护士长竞争上岗的做法与体会

<正> 引入竞争机制是卫生人事制度改革的中心内容。根据三部委《关于深化卫生事业单位人事制度改革的实施意见》的精神,我院对护士长任用制度改革作了积极的探索,所有护士长全出竞进,竞争上岗。这次护士长竞聘上岗的尝试使我院用人制度发生了根本性转变,在一定意义上代表了医院干部人事制度改革的方向,使广大干部群众经历了一次改革实践的教育和洗礼,其影响力已超过这次护士长竞聘上岗的本身,对整个医院改革和发展产生了巨大震撼。     

医学本科实习中儿科带教的几点体会

临床实习是医学生理论联系实际的重要途径,是临床医生走向工作岗位的准备阶段,临床实习的好坏直接影响今后、甚至一生工作的走向。因此带教医生必须千方百计做好临床带教工作。通过实践我深深体会到必须做好以下八个方面的工作。     

THE GOOD PRACTICE OF THE POLICE: AN ALTERNATIVE APPROACH IN DEALING WITH OFFENDERS WHO ABUSE/MISUSE ALCOHOL

The office of constable is taken by declaration and specificallysays ‘... prevent all offences against the persons andproperties...’. The police service, like many hospitalsand particularly casualty units, comes into initial contactwith a high proportion of society's problems, including thoserelated to people who cannot handle alcohol. This results directlyor indirectly in a significant number of issues affecting sociallife detrimentally and at a tremendous cost to the public purse.These points at some time or another have been adequately illustratedby articles or television documentaries. The police servicehas a duty to prevent crime. The author maintains that, throughthe collaboration of the criminal justice agencies and healthservices, and using a simple approach, behaviour could be alteredsignificantly enough to contribute towards a reduction in repeatoffending and a consequent decline in the use of public funds.The author believes that a great number of people, too largeto even contemplate quantifying, would have a better qualityof life, a goal sought by many, and that the police serviceis well placed to participate constructively in the rehabilitationof offenders who have a ‘drink’ problem.