深圳市综合医院精神科院际会诊498例回顾分析

目的了解深圳市综合医院精神科院际会诊的现状及临床特点。方法对2009年1月~2013年12月间深圳市各级综合医院邀请深圳市康宁医院进行的498例次精神科院际会诊患者的一般人口学资料、躯体疾病情况、会诊后精神科诊断及处置情况、邀请院际会诊医院等级及患者所在科室分布情况进行回顾性分析。结果邀请精神科院际会诊的综合医院以三级医院(65.3%)居多;共涉及23个科室,其中神经内科(17.9%)、骨外科(10.2%)占前两位;会诊后精神科诊断以器质性精神障碍为主,占32.9%,其次为精神分裂症、分裂型障碍和妄想性障碍,共占28.7%,而心境障碍占16.1%,神经症、应激相关的及躯体形式障碍占13.5%。结论深圳市综合医院对精神卫生服务的需求逐年增加,三级及以上综合医院应在加强会诊-联络精神医学工作的同时,考虑开设精神卫生相关专科及配备相应的精神专科处置床位,及时处理院内各科患者的精神心理问题。     

院际精神科会诊112例分析

目的了解综合医院精神医学联络会诊的临床特点。方法统计会诊人数，对112例患者所在住院医院科室分布、精神障碍病种的分布情况，以及转院治疗情况进行分析。结果内科会诊率最高（43．8％），其次为外科（33．9％）；会诊病种情况：器质性精神障碍最多，占51．8％，其次为精神分裂症，占20．5％。结论院际精神科会诊逐年增加，与脑功能密切相关的神经内外科会诊最多，器质性精神障碍和分裂症为主要会诊诊断，转院病种主要为精神分裂症。     

早期预警评分联合标准化沟通模式在危重患者院际转运中的应用

<正>病情早期预警评分(MEWS)由收缩压、心率、呼吸、意识、体温5项参数范围赋予的分值总和判断患者的病情危重程度,具有简单易行、获取参数快速准确的优点~([1])。标准化沟通模式(SBAR)是以现状、背景、评估、建议4部分构成的以结果为导向的沟通模式,具有易掌握、表达清晰、避免遗漏等优点~([2,3])。随着分级诊疗及双向转诊制度的落实,患者院际转运在各个医院所占比例越来越大,经过对山西省危重患者院际转运现况调查显示:我省各医院患者转运存在转运前病情评估率低、准确率低、转运前与对方医院联系率低,护送医护人员能级不对应,转运过程中病情变化处理措施不得当,交接不     

主动脉瘤患者院际转运风险及对策

<正>随着我国经济的发展、生活水平的提高、医学的进步、人文理念的提升以及医疗卫生资源配置地区差异仍然十分明显,因此因各种原因有转诊要求的危重症患者在不断地增加,而主动脉瘤患者就是其中之一。在现阶段,使用救护车转运仍是淮安市急救中心(独立的院前     

院际间绩效考核结果比较方法的研究

<正>医院绩效评价是通过科学的评价方法对医院主体行为及其效率和效果进行定性和定量评价的过程,是提高医院服务能力、运营效率的重要手段[1]。自2015年军队编制体制改革以来,军队各级机关制订了一系列与军队医院运营管理相关的方针政策,如全面停止对外有偿服务、深度军民融合、停止发放超劳补贴等,对军队医院的综合管理与绩效评价工作提出了新的挑战,面向医院、科室、岗位的各层级医院绩效评价工作亟待深入研究并开展。目前,中央军委已下发关于试行军队医疗岗位津贴     

精神科院际会诊半年情况分析

随着精神心理知识的日渐普及，非精神科医院对精神科会诊的要求呈现上升趋势。为进一步了解天津市精神科院际会诊的特点，从而更好地指导精神医学联络会诊的开展，笔者将天津市安定医院2006年上半年申请院际会诊的232例患者情况分析如下。     

关于建立医院联合制剂室的探讨

提出医院之间建立联合制剂的构想,论证其必要性和必须解决的相关问题,为有关方面决策提供参考.     

浅谈办好医院院报

《广东省人民医院》报创刊于1997年8月,自开办以来,受到院领导的重视、关心和支持。从1997年6月试刊至今,共出版了近100期报纸。院报本着推进现代医院管理,促进医院内外信息交流,增强医务人员的凝聚力,树立良好医院形象的宗旨,立足于医疗、科研、教学、医院管理、卫生改革和医院精神文明建设,同时配合医院不同时期的工作中心,进行引导性宣传,在统一全院职工的思想方面发挥积极的作用。目前,该报逐渐被院内的职工所接受并成为必读报纸,也越来越受到各兄弟医院以及广大患者的关注。以下是我们近几年办报的一些体会以及办报过程中需注意的…     

店院联合孰是孰非

1999年11月,绥化市第四医院(以下简称四院)与绥化市药材公司泰华大药房成立联合门诊,地点设在了泰华大药房。四院指派了具有相关资格的临床医生、护士共28人,设科室10余个,床位24张,但不设药房;泰华大药房无偿提供医务空间800平方米。2000年11月,门诊部年纯收入24.4万元,四院职工工资同比增长了85％(原职工人均工资仅200余元);泰华大药房因门诊部的存在日增销售额近3万元。店院联手闯市场尝到甜头,引得市内其它医、药机构纷纷效仿,一时间鱼龙混杂。2001年12月25日,黑龙江省卫生厅下发《关于加强对绥化市药品零售企业非法开展医疗活动进行清理整顿》的通知,对联合门诊进行了全面“封杀”。     

某院神经外科医院感染调查

<正>为了解神经外科患者医院感染发生率,分析存在的危险因素,及时采取有效的针对性预防控制措施,进一步降低医院感染率,促进患者康复,笔者对所在医院2005-11～2007-10神经外科住院患者进行了回顾性调查与分析,并提出防控对策。1资料与方法     

Predictors of early therapeutic alliance among adolescents in Substance abuse treatment

Given the importance of the therapeutic alliance in achieving positive treatment outcomes, research is needed to illuminate the factors that contribute to the development of this important relationship. The aim of the current study was to expand upon the existing literature by examining predictors of the early therapeutic alliance among adolescents treated in two outpatient programs. Use of multilevel modeling techniques revealed that the majority of the variance in adolescents' ratings of the therapeutic alliance was due to adolescent factors (91%), while the variance in therapist ratings of alliance were nearly equally divided between adolescent and therapist factors (52% vs. 48%). Participant age was found to be the only significant predictor of therapist-rated alliance, with therapists reporting higher alliances with older adolescents. Adolescents reporting higher levels of social support, greater problem recognition, and more reasons for quitting also reported higher therapeutic alliance ratings. Future research is needed to examine if early identification of adolescents with low social support and problem recognition combined with brief treatment readiness interventions can be a promising approach to help improve therapeutic engagement and post-treatment substance use outcomes.     

综合医院心理咨询门诊93例青春期学习困难学生的智商结构分析

目的探讨综合医院心理咨询门诊青春期学习困难学生的智商特点,为制定针对性的治疗措施提供心理学依据。方法用中国修订的韦氏儿童智力量表或韦氏成人智力量表对93例青春期学习困难学生进行智力测试。结果93例学生的总智商：（97．15±13．86）,｜操作智商-言语智商｜≥15占44．10％（P〉0．05）,以平常智商最多,占49．46％（46例）。男孩在总智商和知觉组织智商均高于女孩（P〈0．05）。青春期后期学生的记忆／不分心智商较青春期前期高（P〈0．05）。结论综合医院心理咨询门诊就诊的学习困难青春期学生总体智力水平在正常范围,言语智力和操作智力发展平衡,但不同性别和年龄段在智力结构发展上有一定差异。     

上海市5家医院2011年高血压住院患者降压药物利用分析

目的分析上海市5家医院高血压住院患者降压药物的临床使用情况,并评价其合理性。方法回顾性分析上海市5家医院2011年高血压住院患者电子处方数据,通过药物利用指数（DUI）、日均药费（DDC）排序法、用药金额与用药频度（DDDs）的序号比,了解降压药物的临床利用情况。结果共计13408张降压药物电子处方,使用量最大的降压药物为钙通道阻滞剂（CCB）,占总处方量的32．3％;DDDs位居前3位的药品为苯磺酸氨氯地平片、酒石酸美托洛尔片和螺内酯片。大部分降压药物的DUI值和多数降压药物的用药金额与用药频度的序号比值均在1左右。联合用药占总处方数的27．8％。最常见的联合用药形式为钙通道阻滞剂＋血管紧张素Ⅱ受体阻断剂＋利尿剂和上述三联用药情况下加入肾上腺素B受体阻断药的四联用药形式。结论住院患者临床应用降压药以钙通道阻滞剂苯磺酸氨氯地平片占主导地位。各类降压药物的临床使用剂量基本符合推荐剂量。利尿剂类药物价格低廉患者易于接受,而血管扩张药及CCB类药物价格偏高。联合用药有利于血压控制达标,降低长期治疗费用。     

Opportunities for antimicrobial stewardship among carbapenem-treated patients in 18 North American hospitals

Here we describe the characteristics of carbapenem use at 18 hospitals across North America. Adult inpatients treated with a carbapenem for ≥24 h were included in this multicentre, retrospective, cross-sectional study. Outcomes evaluated included classification of therapy as empirical or definitive, discharge disposition and 30-day re-admission. A total of 621 patients were included in this study. Of these, 467 patients (75.2%) received a carbapenem empirically, among whom negative cultures occurred in 313 (67.0%) and 93% were eligible for de-escalation of therapy. In-hospital mortality occurred in 72 patients (11.6%) and 549 patients (88.4%) were discharged. Of the 549 patients who were discharged, 349 patients (63.6%) went home and 30-day infection-related re-admission occurred in 95 patients (17.3%). This population represents a significant need for carbapenem stewardship. Institutional guidelines should focus on four common disease states (respiratory, genitourinary, intra-abdominal and bloodstream), and diagnostic stewardship should be employed to aid in rapid de-escalation of carbapenem therapy. Additional studies aiming to identify antimicrobial stewardship techniques that may help to optimise carbapenem therapy and increase education about the importance of utilising carbapenem-sparing regimens are required.     

Prevalence and cost savings of therapeutic interchange among U.S. hospitals.

The prevalence and cost savings of therapeutic interchange (TI) among teaching, nonteaching, and investor-owned hospitals in the United States was studied. A survey was sent to all directors of pharmacy at hospitals listed in the 1999 American Hospital Association directory as having more than 100 beds; 463 (29.8%) hospitals responded. The survey elicited data about hospital demographics, the policies and personnel involved in TI, and the estimated cost savings incurred by the use of TI. Eighty-eight percent of teaching, 89% of nonteaching, and 100% of investor-owned hospitals reported having established TI policies and procedures; 88% of responding hospitals reported the use of TI as a means of formulary management. Individuals involved in the decision-making process for TI policies included physicians, pharmacists, and pharmacy and therapeutics committee members. Most responding hospitals reported having an automatic interchange procedure, and few required physician consent before the substitution was made. The most commonly substituted medication classes were histamine H2-receptor antagonists, proton-pump inhibitors, antacids, and quinolones. Differences in TI procedures and the medication classes commonly substituted were not significant between teaching and nonteaching hospitals. The annual dollar savings was estimated by 36% of teaching, 38% of nonteaching, and 50% of investor-owned hospitals and determined by record keeping in 18% of teaching, 20% of nonteaching, and 40% of investor-owned hospitals. Eighty-eight percent of teaching, 89% of nonteaching, and 100% of investor-owned hospitals have established TI policies. Significant variation in cost savings occurred when hospitals attempted to estimate the annual dollar savings, as no adequate commercially available software exists to perform this task.     

基层医院绩效考核对护士分层培训的影响

目的研究基层医院绩效考核对护士分层培训的影响。方法选择2014年7月~2016年6月期间在我院工作的护理人员200名,其中100名护士2014年7月~2015年6月期间实施分层培训作为对照组,另100名护士2015年7月~2016年6月期间在实施分层培训的同时给予各层级护士制定绩效考核方案作为研究组,观察两组护士护理水平情况。同期选取两个时间段住院患者各500例作为研究对象,分析两个时间段患者对护理的依从性和满意度情况。结果绩效考核方案实施后护理人员理论考核、操作考核以及总分均明显高于实施前(P<0.05)。绩效考核方案实施后,患者护理依从性为97.4%,明显高于实施前的86.6%(P<0.05)。绩效考核方案实施后,患者对护理满意度为95.6%,明显高于实施前的83.8%(P<0.05)。结论护士分层培训联合绩效考核对护理水平有显著提高,且提高患者护理依从性和满意度,值得临床应用及推广。     

A multifaceted intervention to reduce guideline non-adherence among prescribing physicians in Dutch hospitals

Background Despite the potential of clinical practice guidelines to improve patient outcomes, adherence to guidelines by prescribers is inconsistent. Objective The aim of the study was to determine whether an approach of introducing an educational programme for prescribers in the hospital combined with audit and feedback by the hospital pharmacist reduces non-adherence of prescribing physicians to key pharmacotherapeutic guidelines. Setting This prospective intervention study with a before–after design evaluated patients at surgical, urological and orthopaedic wards. Method An educational program covering pain management, antithrombotics, fluid and electrolyte management, prescribing in case of renal insufficiency, application of radiographic contrast agents and surgical antibiotic prophylaxis was presented to prescribers on the participating wards. Hospital pharmacists performed medication safety consultations, combining medication review of patients who are at risk for drug related problems with visits to ward physicians. Main outcome measure The outcome measure was the proportion of the admissions of patients in which the physician did not adhere to one or more of the included guidelines. Difference was expressed in odds ratios (OR) with 95% confidence intervals (CI). Multivariable logistic regression analysis was performed. Results 1435 Admissions of 1378 patients during the usual care period and 1195 admissions of 1090 patients during the intervention period were included. Non-adherence was observed significantly less often during the intervention period [21.8% (193/886)] as compared to the usual care period [30.5% (332/1089)]. The adjusted OR was 0.61 (95% CI 0.49–0.76). Conclusion This study shows that education and support of the prescribing physician can reduce guideline non-adherence at surgical wards.     

恩丹西酮、思密达和氟西汀联合治疗难治性腹泻型肠易激综合征疗效观察

难治性腹泻型肠易激综合征(腹泻型IBS)是一种病因尚不明确的慢性功能性肠道疾病，以腹泻为主要表现，常伴有明显的精神心理障碍。患者病程长，就诊频繁，严重影响正常工作和生活。我们对31例难治性腹泻型IBS采用恩丹西酮、思密达和氟西汀联合治疗，取得了较好的疗效，报告如下。     

Prevalence of plasmid-mediated AmpC β-lactamases among Enterobacteriaceae in Algiers hospitals

The aim of this study was to investigate the prevalence and diversity of plasmid-mediated AmpC cephalosporinases (PAcBLs) in clinical isolates of Enterobacteriaceae collected between 2003 and 2007 from three Algiers hospitals. Antibiograms were determined on Mueller–Hinton agar plates using the disk diffusion method, and minimum inhibitory concentrations were determined by Etest. Isolates resistant to cefoxitin or ceftazidime were screened for bla_CMY, bla_DHA, bla_FOX and bla_ACC as well as extended-spectrum β-lactamase (ESBL) genes by polymerase chain reaction (PCR). PCR products were sequenced by the Sanger method. Plasmid incompatibility grouping was conducted by PCR-based replicon typing. The prevalence of PAcBLs was 2.18% (11/505), comprising 8 CMY-2 and 3 DHA-1 enzymes. CTX-M-15 was co-produced with CMY-2 in three isolates and with DHA-1 in one isolate; the two remaining DHA-1-producers co-expressed SHV-12 ESBL. This is the first report of plasmid-mediated AmpC from Algeria, with the first detection of DHA-1 in Enterobacter cloacae.