就医老年患者的营养状况

目的了解老年就诊患者临床营养就医需求,为优化医疗服务模式提供依据。方法选取医院门诊就诊、住院治疗的老年患者发放调查问卷200份,调查老年就诊患者营养状况、营养影响因素以及对医疗机构医疗服务的需求,根据调查结果优化医疗服务模式。结果 200例老年患者中,98%患有一种或以上慢性疾病,94%的老年患者认为营养指导可以辅助治疗疾病,并能通过多种渠道获得营养知识,78.5%的老年患者认为自我营养状况不佳,100%的住院老年患者希望获得一对一的营养咨询指导及个性化食谱,71%的老年患者希望医院设立营养门诊。结论进一步优化流程,建立一站式多学科综合诊疗服务模式,充分发挥临床营养师职能,加强老年患者健康管理,提升患者满意度。     

一站式服务在整形外科门诊的应用研究

目的探讨一站式服务在整形外科门诊的应用效果。方法选取2017年1月-2017年9月在我院整形外科门诊开展一站式服务工作后接诊的求美者315例为观察组,以2016年4月-2016年12月实施一站式门诊服务模式前接诊的320例求美者为对照组,比较两组的满意度。结果实施一站式门诊服务模式后门诊环境的满意度为98.7%,对门诊流程的满意度为96.5%,对门诊服务的满意度为97.2%,实施后门诊满意度较实施前显著提高,P0.05,差异具有统计学意义。结论实施"一站式"服务模式简化繁琐的服务流程,缩短就诊前时间,提升患者满意度,值得各医院推广应用。     

多学科协作诊疗模式对老年重症急性胰腺炎合并肾衰竭患者预后的影响

目的 观察多学科协作诊疗模式对老年重症急性胰腺炎(SAP)合并肾衰竭(RF)患者的干预效果及对预后的影响.方法 选择2018年3月至2019年3月收治的70例老年SAP合并RF患者,采用随机数表法分为两组各35例.对照组实施传统干预及治疗,观察组在对照组基础上实施多学科协作诊疗.记录并比较两组康复时间(少尿期持续时间、...     

肺结核住院患者全程护理服务模式的建立与实施

目的为结核病患者提供温馨、便捷、优质的服务,建立入院前-入院时-出院后全程人性化护理服务模式。方法入院前,病房护士到门诊接患者;入院时,实行首接负责制;住院期间,护理服务的每个环节尽显人性化理念;出院时,帮助患者回归家庭与社会;出院后,情系患者。结果所有病人在住院期间均享受到高质量的护理服务,出院后还得到护士的康复指导。结论全程护理服务模式的建立与实施不仅为医院赢得了信誉,也对患者的治疗和康复起了很大的促进作用。     

老年医学多学科整合团队工作模式的进展

老年人常同时患有多种慢性疾病及老年综合征,相比传统的专科就诊模式,以患者整体为中心,实施个体化的综合治疗、康复和护理服务,从而最大限度地维持和恢复老年患者的功能状态和生活质量的老年医学多学科整合团队(GIT)模式成为老年患者的重要诊疗模式。现就GIT模式国内外现状进行研究分析。     

晚期血吸虫病多学科综合治疗的价值与评价

晚期血吸虫病病情复杂,并发症多,严重威胁患者生命健康。本综述通过对晚期血吸虫病临床分型、辅助检查与治疗的主要手段(包括手术类型等)进行综合分析与评价,认为根据患者具体情况制定的个体化多学科综合治疗方案是晚期血吸虫病最合理的治疗模式。建议今后要设立多学科协作的诊疗制度,定期组织多学科病例讨论,形成稳定的治疗团队,以提高晚期血吸虫病的诊疗水平,减少误诊,提高疗效。     

多学科团队协作模式在养老机构老年慢性病患者长期护理服务中的应用

目的探讨多学科团队协作护理模式在养老机构老年慢性病患者长期护理服务中的应用效果。方法选取泸州社会福利院老年慢性病患者120例为研究对象。组建多维度、多机构、跨专业的多学科团队,采用多学科团队协作模式进行3个月的长期护理服务。分别在实施多学科团队协作模式前后,采用问卷调查评估患者满意度,采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评定患者心理状态,采用日常生活能力Barthe指数评估量表评估患者日常生活能力,采用美国医学结局研究组健康状问卷(MOSSF-36)评估患者生活质量情况。结果多学科团队协作模式实施后,老年慢性病患者的满意度评分、日常生活能力评分和生活质量评分均高于实施前(P均<0.05),患者心理状态评分均低于实施前(P均<0.05)。结论多学科团队协作模式可以提高养老机构老年慢性病患者的满意度,改善患者的心理状态,提高患者的日常生活能力和生活质量,值得推广应用。     

晚期多原发结直肠癌多学科治疗一例报道

近年来,结直肠癌的发病率显著上升,随着多学科共同参与的多学科团队（multidisciplinary team,MDT）模式的建立,结直肠癌患者特别是晚期结直肠癌患者的生存时间得到明显延长,生活质量得到有效改善。此例晚期多原发结直肠癌患者带瘤生存已达7年,在多学科协作模式下进行的综合治疗使患者病情得到较好控制,生活质量保持较高水平。本文就此例患者诊疗过程中的一些经验和体会与大家一起来分享。     

多学科整合式治疗管理模式在老年患者医疗管理中的应用研究

目的探讨多学科整合式治疗管理模式在老年患者医疗管理中的应用价值。方法采用前瞻、随机对照实验的设计方法,对202例老年患者在医疗工作中采用多学科整合式治疗管理模式并与传统医疗模式进行对比。分析多学科整合式管理模式对患者的医疗、转归、并发症发生率、日常生活力的改善及患者和家属对治疗的满意度等因素。结果多学科整合式治疗管理模式较传统医疗模式可明显提高患者的医疗质量、减少医疗缺陷,控制减少并发症的发生,提高患者日常生活能力,减轻了患者对社会及家庭的经济负担,提高了家庭和社会对医院的满意度。结论多学科整合式治疗管理模式可以作为为老年患者提供临床医疗服务的新模式进行推广。     

重视外科在肝硬化门静脉高压症治疗中的作用

门静脉高压症的治疗一直被认为是复杂、多样的,随着理念与技术的革新,其治疗模式已经从单一学科诊疗模式过渡到多学科协作诊疗模式。在多学科诊疗模式下,门静脉高压症外科治疗并不是即将消失的治疗方式,而是多学科诊疗模式下不可或缺的治疗手段之一,并且将扮演越来越重要的角色。外科医生应该在新的理念影响下,发展个体化、规范化、微创化的...     

精神疾病患者日间康复治疗与就业探讨

目的探讨日间康复治疗与就业对社区精神疾病患者的康复作用。方法医院、残联、公司三方建立日间康复中心,残联负责组织贫困及无业患者和部分医疗费用的补贴,医院免费为精神疾病如精神分裂症、抑郁症、焦虑症、癫痫伴精神障碍康复者进行康复治疗、社交技能训练;督促、看护病人服药;提供手工劳动技能训练同时,公司按患者劳动付酬。结果日间康复中心集康复治疗和就业为一体,有别于其他治疗。结论通过自身的劳动获取适当的报酬,解决就业和生活问题,减轻家庭、社会和国家的部分负担;使精神疾病康复者看到自己存在价值,消除自卑感,增强自信心。     

Post-stroke rehabilitation. A review of the guidelines for patient management

A comprehensive, intense rehabilitation program is key to successful convalescence for patients who have experienced stroke. A guideline on post-stroke rehabilitation published by the Agency for Healthcare Research and Quality provides clinicians with detailed recommendations for managing patients who have sustained a brain attack. Rehabilitation should begin following diagnosis and after any life-threatening issues have been effectively managed. The key steps include patient management during the acute phase, screening for rehabilitation and choice of setting, managing rehabilitation, and facilitating the patient's transition back into the community. The timeliness of rehabilitation interventions and the intensity of rehabilitation services are important factors in maximizing a patient's functional outcome at hospital discharge and on follow-up.     

Possibilities of rehabilitation in the geriatric hospital (author's transl)

Rehabilitation is with medicine and nursing care an inseparable part of the modern geriatrics. In opposition to other medical subjects there is no certain direction. Generally joy of life, self-confidence and independence should be the aim of geriatric rehabilitation. In the geriatric hospital a particular classification has been proved: Rehabilitation with the most serious sick, reduced and bedridden aged patient and actual rehabilitation-generally and at special diseases. A special care of the rehabilitated patients after discharge from hospital has to be wished.     

Experience with WHO-recommended multidrug therapy (MDT) for multibacillary (MB) leprosy patients in the leprosy control program of the All Africa Leprosy and Rehabilitation Training Center in Ethiopia: appraisal of the recommended duration of MDT for MB patients.

During 1981 a World Health Organization Study Group recommended that multibacillary (MB) leprosy patients should be given multidrug therapy (MDT) for at least 2 years and, wherever possible, until skin-smear negativity. This paper reports on the experience with MDT for MB patients under routine field conditions in the leprosy control program of the All Africa Leprosy and Rehabilitation Training Center (ALERT) in the Shoa Region of Ethiopia. The period of MDT to reach skin-smear negativity was evaluated for 348 new MB patients. Only 31.6% of these patients could be released after 26 four-weekly doses of MDT, and 19.8% needed over 5 years of MDT. The average period of MDT to reach skin-smear negativity was estimated at about 4 years. Of 3343 patients of cohorts which, almost exclusively, consisted of patients treated with dapsone before MDT, 72.8% were released after 26 four-weekly doses of MDT; whereas of 712 patients of cohorts which mainly included new patients, only 23.5% were released. It was estimated that if MDT would be stopped, regardless of skin-smear results, after 26 four-weekly doses of the drugs collected within a period of 3 years, about 80% of the patients would complete treatment. The operational problems with continuation of MDT until skin-smear negativity are discussed. Although as yet it has not been proven by study results that after 2 years of MDT the relapse rate will be low, the available knowledge indicates that this is likely to be the case. Based on a) probability, b) the finding that 2 years of MDT can be maintained in the majority of the patients, and c) the operational difficulties with the continuation of MDT until skin-smear negativity, it is recommended that MDT should be limited to 2 years. MDT of limited and fixed duration will facilitate the implementation and expansion of the treatment in parts of the world where most patients are not yet benefitting from this treatment.     

急诊创伤中心多学科综合治疗建设现状

多学科综合治疗(multi-disciplinary treatment,MDT)是一种通过整合多学科专家资源进行疾病诊疗的模式,在包括肿瘤在内部分疾病临床诊疗中经常采用,并取得了较好效果.急诊创伤中心收治的患者大多需要多个学科的医生共同合作才能完成救治工作.为了更好救治收治的患者,急诊创伤中心近年来开始积极进行MDT...     

Global therapy management of chronic heart failure during cardiac rehabilitation

Heart failure is a complex syndrome, whose treatment associates diet, medicine, educational sessions, exercise training, psychological and social help. During cardiac rehabilitation, heart failure patients start exercise training against reconditioning and wasting muscle tissues: segmental rehabilitation, steady state exercise or interval training, breathing physiotherapy, swimming pool, low frequency electric muscle stimulation, according to individualized training program, in association with salt free diet and fight against cardiovascular risk factors. Rehabilitation also helps to increase the dose of drugs according to international recommendations, looking after clinical and biological parameters, and allows including patients in educational sessions. These two last points seem to be a key role of rehabilitation. Thanks to these many actions, hold by multidisciplinary team trained to take care of chronic heart failure patients and to lead therapeutic education, cardiac rehabilitation is very useful for chronic heart failure patients, to help hospital and liberal management therapy of chronic heart failure and reduce medical cost. Rehabilitation counsels should be carried on in home-based program.     

Qualitätssicherung und Leitlinien in der Rehabilitation bei muskuloskelettalen Krankheiten

Diseases of the musculoskeletal system are among the most common and most costly diseases in Germany. They are also associated with a considerable burden for those affected. As a result these disorders also dominate the utilization statistics with respect to medical rehabilitation measures paid for by the statutory pension insurance. In the last 10 years, quality assurance programs have been developed for rehabilitation--initiated and financed by the rehabilitation sponsors--that are characterized by a comprehensive, perspective, pronounced scientific basis, region-wide implementation, and strong patient orientation. The development of guidelines for rehabilitation began later than for acute medicine. In addition to the formulation of guidelines for rehabilitation by medical organizations and professional associations, the German pension insurance has developed so-called process guidelines containing framework requirements for the treatment of defined indication groups rather than support for decision-making in the rehabilitation of individual patients. By planned control of adherence to the process guidelines in the quality assurance programs of the pension insurers prompt implementation of the guidelines can be anticipated.     

Evaluation of a multidisciplinary care program for stroke patients in a day care center.

With funds received by the Rehabilitation Center at Martin Place Hospital East from the Michigan Association of Regional Medical Programs, a Rehabilitation Day Care Center was established. Initially it was called the Stroke Day Care Center (SDCC). Its purpose was to provide comprehensive care to patients with disabilities due to stroke and related diseases according to the "day at the hospital, night at home" concept. A complex of medical and allied services was furnished, based upon the patient's attendance at the SDCC from one to five days a week. The goal was to promote for the patient an earlier return of functional vocational, social and home activities by effectively providing him and his family with multidisciplinary care. In this SDCC program the main emphasis was on testing the feasibility of lowering the cost of stroke-patient care by: a) shortening the hospital stay; b) reducing the need for in-patient care in facilities for non-acute illness; c) shortening the stay in extended care facilities; d) returning younger stroke victims earlier to the labor force; e) identifying the number of stroke patients who could live at home if provided with a modified day care program; and f) assessing the need for purely recreational and social activities in future programs. The evaluation was based on a comprehensive study of 108 patients during the period February 1972 to June 1973. This project is offered as a model for the development and expansion of rehabilitation-recreation day care centers for the handicapped of all ages.     

Rehabilitation in haemophilia — options in the developing world

Summary. Musculoskeletal care is provided in many different settings by many different providers [ 1 , 2 ]. Physicians are better prepared to treat acute diseases, acute manifestations and have problems in following chronic patients and to preventing losses of functional independence. Haematoma affecting muscles and joints is the most common musculoskeletal finding in haemophilic patients [ 3 ]. Proper treatment is fundamental to prevent disability. Treatment aims at restoring the original muscle trophism and strength because joint stability is dependent on the uniform distribution of muscle power over different joint surfaces. Physical rehabilitation continues until complete anatomical and functional recovery is achieved. Coordination and proprioceptive stimulation complement the exercises to recover original muscle strength. Recurrent haemorrhages usually progress to chronic synovitis, the leading cause of motor disability and joint degeneration in haemophilic patients [ 6 , 9 ]. Moreover, chronic synovitis is a predisposing factor for repetitive episodes of haemarthrosis, a leading cause of joint deformities and severe muscle atrophy. At this point, an efficient treatment alternative should be put into effect to restrain bleeding and prevent synovitis-related joint degeneration, which is synovectomy. Synovectomy is an effective alternative, less costly and easier to perform. Rifampicin synovectomy is advantageous because it is safe, not aggressive to the patient, can be repeated if necessary, and it does not prevent the use of either radiotherapy or surgery after, if necessary [ 6 ]. Once the sequelae have set in, treatment tends to be conservative, and it aims at giving the patient functional independence for gait and other activities [ 3 , 6 ]. The most common limb deformities seen in these patients are knee and elbow flexion, but the patient should also be assessed for compensatory scoliosis, hyperlordosis and lower limb length discrepancies. Chronic joint pain is a rather common complaint in this patient population with early arthrosis, and special drugs and physical treatment must be put into action. Rehabilitation is often inexpensive and very efficient.     

Rehabilitative und ambulante physikalisch-medizinische Versorgung von Rheumakranken

Rehabilitation and outpatient physiotherapy were investigated from the perspectives of patients suffering from rheumatoid arthritis (RA) or ankylosing spondylitis (AS) and of rheumatologists. In 2007, 204 outpatients with RA and 47 with AS at the Arthritis Center in Halle, Germany, and 117 rheumatologists from all over the country participated in two questionnaire surveys. Patients and rheumatologists gave predominantly positive judgements of physiotherapy, psychological interventions, and patient education programs. However, outpatient care including these interventions was judged to be mainly limited by fixed budgets and other formal restrictions. Even though these therapeutic options are part of (primarily inpatient) rehabilitation programs, the estimate of the need for multidisciplinary rehabilitation programs varied widely among the rheumatologists. Significant objections against rehabilitation include reluctance of the patients, administrative burden for the physicians, payers' rejections, and limited choice of rehabilitation clinic. Despite major functional limitations, a substantial portion of the patients received no multidisciplinary medical rehabilitation, outpatient physiotherapy, psychological interventions, or patient education. Recommendations for the improvement of care are derived from these data.