Treatment Decision Making and Its Discontents

Patient participation in treatment decision making is held as a virtue in clinical contexts, and has much to recommend it. Yet important questions have been raised about the assumptions underlying models of patient participation. Debates have arisen about the significance of medically defined risks and outcomes of treatment; the adequacy and relevance across social groups of the concept of autonomy; and the emphasis on the professional–patient dyad. This article contributes to the debate about treatment decision making with reference to a study focused on older women with cancer. Interviews with patients and cancer care professionals highlighted the salience to patients' treatment choices of experiential knowledge, social roles and responsibilities, and the health policy context. It appears that prevailing models of decision making may obscure patients' more typical decision processes as well as the social determinants of those choices.     

城市社区医疗及其就诊影响因素调查

以广州市三个具有代表性的社区卫生服务中心为研究对象，通过访谈、座谈、现场观察、查阅资料等方法对城市社区卫生服务中心的基本建设是否达标、医疗服务和就诊状况及其影响因素、制度构成等进行调查。分析总结社区医疗基本建设令人堪忧、就诊仍然受到冷落以及影响社区医疗就诊的因素和制度构成。指出政府要加大对社区医疗投入力度；新医改对社区医疗的支持有待于进一步深化；社区首诊和双向转诊及其配套政策亟待建立健全；要从政策制度层面做好城市社区医疗就诊的制度设计与安排。     

Treatment of lateral epicondylitis in general practice

Mechanical low back pain creates a significant economic burden in the industrial world. The costs of treating mechanical back pain in terms of sickness absenteeism and compensation claims are increasing rapidly.^1-3 There is robust evidence that staying active and continuing or resuming ordinary activities is more effective than rest in the management of mechanical back pain.⁴ This evidence in the international literature has been incorporated in a set of Clinical Guidelines produced by the Royal College of General Practitioners (RCGP).⁵ These guidelines recommend that early investigation and referral to a specialist for simple mechanical back pain are unwarranted in most cases. Positive advice to stay active and continue ordinary activities is emphasised. The RCGP guidelines recommend the use of educational material for patients in the form of The Back Book, to reinforce positive messages.⁶ This book has been shown to be clinically effective in a randomised, controlled trial.⁷ A comparative study from Australia⁸ showed that a public education campaign based on The Back Book had a positive effect on GP management of mechanical back pain and related morbidity.     

颅脑外伤治疗中的人文关怀

人文关怀是对人的生存状况的关怀、对人的尊严与符合人性的生活条件的肯定,在医疗服务中具有重要意义。目前在颅脑外伤治疗中注重疾病本身而人文关怀不够。由于大部分颅脑外伤疾病起病急、住院时间长、并发症后遗症多、伤残率高再加上治疗费用高,患者社会角色转变快,容易使患者产生焦虑、抵触、恐惧、抑郁、绝望等心理问题,并影响医患关系及患者的康复。人文关怀有助于缓解患者的心理问题,促进良好医患关系的建立,加速疾病的康复,提高患者的生存质量,转变患者的社会角色。     

构建城市社区医疗就诊机制的理论思考——城市社区医疗及其就诊问题系列研究

运用新制度经济学的制度理论，提出完善城市社区医疗就诊制度，不仅要完善制度本身，更重要的是完善和设计好社区医疗就诊制度的实施机制；进而运用社会学的社会运行机制理论，提出社区医疗就诊机制概念和构建城市社区医疗就诊机制体系理论，为社区医疗就诊制度及其实施机制的建设提供理论指导和方法指引。     

Integration of Medical and Psychological Treatment within the Primary Health Care Setting

ABSTRACT

Integrated care entails the provision of behavioral health services within the primary care setting and emphasizes a collaborative approach between mental health professionals and primary care providers (Kenkel, Deleon, Orabona Mantell, Steep, 2005 Kenkel, M., Deleon, P., Orabona Mantell, E. and Steep, A. 2005. Divided no more: Psychology's role in integrated health care. Canadian Psychology, 4(3): 189–202.  [Google Scholar]). Research was collected to highlight the history, development, and implementation of integrated care within primary care facilities. The authors performed a comprehensive literature review of collaborative care and summarized the program design of the site where they work. It is hypothesized that integration will improve patient access to health care, increase the rate of evidence based practice, improve patient health and satisfaction, and reduce long-term costs.     

Predictors of Adequate Depression Treatment among Medicaid-Enrolled Adults

Objective. To determine whether Medicaid-enrolled depressed adults receive adequate treatment for depression and to identify the characteristics of those receiving inadequate treatment.
Data Source. Claims data from a Medicaid-enrolled population in a large mid-Atlantic state between July 2006 and January 2008.
Study Design. We examined rates and predictors of minimally adequate psychotherapy and pharmacotherapy among adults with a new depression treatment episode during the study period ( N =1,098).
Principal Findings. Many depressed adults received either minimally adequate psychotherapy or pharmacotherapy. Black individuals and individuals who began their depression treatment episode with an inpatient psychiatric stay for depression were markedly less likely to receive minimally adequate psychotherapy and more likely to receive inadequate treatment.
Conclusions. Racial minorities and individuals discharged from inpatient treatment for depression are at risk for receiving inadequate depression treatment.     

探讨ICU监护及治疗在临床救治中的作用

目的探讨ICU监护及治疗在临床危重病抢救治疗中的作用。方法2004年3月~2005年12月共经ICU监护和治疗的患者78例(治疗组),非ICU监护和治疗的患者52例(对照组),两组患者从年龄、性别、病种、治疗效果、住院时间、昏迷与输氧、血象检测分别进行分析统计。结果治疗组的治疗效果、血象恢复情况均优于对照组;而治疗组的住院时间、昏迷患者的昏迷时间、输氧时间均少于对照组。结论建立ICU是时代发展的必然。     

内镜辅助下治疗胃出血的临床护理体会

目的：探讨内镜辅助下治疗胃出血的有效护理对策。方法：回顾性分析本院2009—2011年收治的54例行内镜辅助下治疗的胃出血患者，总结临床护理经验。结果：本组54例胃出血患者经内镜辅助下治疗和护理后，显效48例，有效3例，无效3例，治疗总有效率为94．4％，术后2例患者出现再出血，1例患者出现胃穿孔，术后并发症发生率为5．6％，经对症处理后痊愈出院。结论：对行内镜辅助下治疗的胃出血患者实施有效的护理，能够提高临床治疗效果，降低术后并发症发生率。     

晚期恶性肿瘤的姑息治疗与临终关怀

姑息治疗是在临终关怀基础上发展起来的更现代、更科学的医学分支学科，它是对那些对治愈性治疗无反应的病人的积极整体照顾，需在多学科综合治疗组各成员共同协作下完成，其目的是帮助患者达到和维持其躯体、情感、精神及社会行为能力的最佳状态，使患者及其家属获得尽可能好的生活质量。本文对姑息治疗的策略和摸式亦进行了探讨。     

Medicare Managed Care Spillovers and Treatment Intensity

Evidence suggests that the share of Medicare managed care enrollees in a region affects the costs of treating traditional fee‐for‐service (FFS) Medicare beneficiaries; however, little is known about the mechanisms through which these ‘spillover effects’ operate. This paper examines the relationship between Medicare managed care penetration and treatment intensity for FFS enrollees hospitalized with a primary diagnosis of AMI. I find that increased Medicare managed care penetration is associated with a reduction in both the costs and the treatment intensity of FFS AMI patients. Specifically, as Medicare managed care penetration increases, FFS AMI patients are less likely to receive surgical reperfusion and mechanical ventilation and to experience an overall reduction in the number of inpatient procedures. Copyright © 2015 John Wiley & Sons, Ltd.     

Adolescent Drug Treatment,a Family Affair

This paper describes a day care program for treating youth drug abuse. Day care treatment is situated in the middle, between outpatient care and the full-time alternatives such as residential therapeutic communities. Day care is structured to treat youth drug abuse as a family problem and requires behavioral change in all family members. Some social work interventions aimed at effecting family changes are outlined and illustrated. Follow-up research indicates that this approach is a viable one in treating youth drug abuse.     

经胃镜止血钛夹治疗上消化道出血患者的护理观察

目的：探讨经胃镜止血钛夹治疗上消化道出血患者的护理效果。方法：选取本院2012年2月-2013年1月收治的62例经胃镜止血钛夹治疗的上消化道出血患者,按照随机数字表法将其分为对照组和治疗组各31例。对照组给予常规护理干预措施,观察组给予综合护理干预措施,观察比较两组患者并发症发生率与患者满意度。结果：两组患者经过临床护理之后,对照组并发症发生率为16.13%,明显高于治疗组的0,且患者满意度80.65%明显低于治疗组的100%,差异均有统计学意义（P〈0.05）。结论：经胃镜止血钛夹治疗上消化道出血的患者采用综合护理干预措施后,其临床护理效果明显优于常规护理,不仅降低了患者并发症的发生率,而且提高了患者满意度,值得临床推广应用。     

Religion,Spirituality and Health Care Treatment Decisions: The Role of Chaplains in the Australian Clinical Context

This paper summarizes the views of Australian health care chaplains concerning their role and involvement in patient/family health care treatment decisions. In general terms the findings indicated that the majority of chaplains surveyed believed that it was part of their pastoral role to help patients and their families make decisions about their health care treatment. Differences in involvement of volunteer and staff chaplains, Catholic and Protestant, male and female chaplains are noted, as are the perspectives of chaplaincy informants regarding their role in relation to health care treatment decisions. Some implications of this study with respect to quality patient centered care, chaplaincy utility, and training are noted.     

急性一氧化碳中毒的急救与护理

目的探讨急性一氧化碳（CO）中毒有效的抢救和护理措施。方法收治急性CO中毒30例,其中重度中毒10例,中度中毒15例,轻度中毒5例。均采用综合抢救和积极的护理,并使用高压氧舱治疗。结果治愈24例,显效5例,无效1例,总有效率96．7％。结论CO中毒后,如能采取综合抢救和积极护理,及时使用高压氧舱治疗,可以明显提高治愈率。     

我国计划生育机构开展生殖道感染防治的现状

目的了解我国目前计划生育服务机构生殖道感染(RTIs)防治工作的现状。方法利用文献回顾法、知情人定性访谈和县级计划生育服务机构问卷调查,收集相关资料并整理分析。结果国家和地方政策支持RTIs防治工作,98·3%的地区计划生育服务机构已从预防、医疗、宣教等多个角度参与此项工作。我国计划生育服务网络完善,人力资源丰富,开展RTIs防治可充分利用现有资源达到社会效益最大化。然而专项经费不足、技术人员RTIs医疗水平不高、部门间缺乏协调等问题有待解决。结论计划生育服务机构现有的硬件设备和技术力量为开展RTIs防治提供了可能性和可行性,但仍需加强服务人员RTIs技能培训和协调部门间的合作。     

前后联合入路手术治疗严重胸腰椎骨折的护理

目的总结前后联合入路手术治疗严重胸腰椎骨折的护理方法。方法 2008年4月至2011年3月行前后联合入路手术共治疗60例胸腰椎骨折患者,根据患者病情,制定出针对性的、个体化的护理措施并予以实施。结果个性化护理组患者恢复情况及患者生活质量改善情况明显优于常规护理组患者（P〈0.05）。结论实施针对性的、个体化的护理措施,能避免胸腰椎骨折术后并发症,减轻病人痛苦,最大程度恢复神经功能、肢体运动功能,提高病人的生活质量。