急诊应用抗生素情况的调查分析

目的了解我院急诊应用抗生素的情况,促进合理用药。方法采取回顾性调查方法,随机抽取我院2008年4月～6月份急诊处方2 186张,统计急诊应用抗生素的综合情况,分析抗生素应用中存在的不合理现象。结果成人应用抗生素以氟喹诺酮类和克林霉素居首位,其次是头孢菌素类,儿童主要应用头孢菌素类。给药方式绝大部分为静脉给药,达八成以上。不合理用药问题主要有:给药方法不合理、指征不明确、配伍不合理等。结论我院急诊抗生素应用仍有部分偏高,存在不合理应用现象。改变现状需要广大医务人员的共同努力,临床药师应发挥积极的作用。     

SCREENING FOR PSYCHIATRIC COMORBIDITY AMONG FEMALE ALCOHOLICS: THE USE OF A QUESTIONNAIRE (SCL-90) AMONG WOMEN EARLY IN THEIR TREATMENT PROGRAMME

The use of a questionnaire, Symptom Check List-90 (SCL-90),as a screening instrument for psychiatric disorders was studiedin 60 women attending their first treatment for alcohol abusein Stockholm, Sweden. A global SCL-90 index, the General SymptomaticIndex (GSI), measuring the total level of recent self-reportedpsychological distress, showed a high efficacy in distinguishing‘psychiatric cases’ from ‘non-cases’in the present sample. Psychiatric cases were defined as subjectssatisfying the criteria for any current DSM-III-R disorder otherthan substance abuse. The psychiatric diagnoses were obtainedindependently by use of the Structured Clinical Interview forDSM-III-R (SCID-I). Psychiatric disorders, especially depressionand anxiety disorders, frequently antecede or develop secondaryto alcohol abuse among women. The use of structured interviewsto diagnose these disorders is, however, time-consuming. Findingsfrom the present study indicate that SCL-90 can be used to detectpsychiatric comorbidity among female alcoholics, thus enablingclinicians to be aware of concomitant psychiatric disordersamong a subgroup of patients.     

使用核心讨论组方法研究肺结核病人生存质量的构成领域和方面

[目的]目前国内外尚未发现成熟的肺结核病人生存质量专用量表,本研究采用核心讨论组方法,探讨肺结核病人生存质量的构成领域和方面.[方法]深圳市龙岗区和宝安区41名肺结核病人、家属及医务人员按照不同类型分为6个核心讨论组,使用半结构化的形式开展核心讨论.讨论过程进行书面记录和录音,并采用定性分析方法对讨论结果进行分析.[结果]肺结核病人的生存质量主要由4个领域、8个方面构成,分剔为:生理机能(包含一般生理、疾病生理)、心理机能(包含消极心理、治疗心理、歧视感)、社会机能(包含治疗经济、社会支持与环境)及健康教育领域.[结论]肺结核病人生存质量的构成领域和方面除了普适性问题外,还包含了体现肺结核病人特异性的问题,诸如疾病的心理负担、被歧视感、治疗的经济负担及健康教育的需求等.核心讨论组方法有助于构建肺结核病人生存质量测定量表的领域和方面.     

THE RELATIONSHIP BETWEEN HELPING ALLIANCE AND OUTCOME IN OUTPATIENT TREATMENT OF ALCOHOLICS: A COMPARATIVE STUDY OF PSYCHIATRIC TREATMENT AND MULTIMODAL BEHAVIOURAL THERAPY

During the last decades, a positive relation between a goodalliance and a successful therapy outcome has been demonstratedacross a variety of different therapeutic modalities. The relationshipbetween alliance and drinking outcome in long-term treatmentof alcoholics (12 months or more) has not, as far as we know,been presented. In the present study, alcoholics were randomizedto two outpatient treatment programmes; multimodal behaviouraltherapy (MBT) and psychiatric treatment based on a psychodynamicapproach (PT). As part of the study, analyses were performedconcerning differences in alliance between the two treatmentmodels (MBT, n= 17; PT, n= 18), and concerning the relationshipbetween alliance and treatment outcome. A Swedish version ofthe Helping Alliance Questionnaire was used to measure alliance.All therapy sessions were tape-recorded. An independent researcherrated the patient's and therapist's contribution to the allianceat the third session (early alliance). Early patient and therapistalliances were not related to sociodemographic data or initialmeasures of alcohol severity, psychiatric symptoms, or personalitystructure in either therapy. Early therapist alliance was betterin MBT in comparison with PT. For MBT patients, a significantpositive correlation was found between early patient allianceand mood dimensions at 6 months. There were no significant positivecorrelations between early alliance and drinking outcome duringthe course of treatment and in the third year after start oftreatment. Mood and drinking outcome also showed low correlations.In conclusion, an initial positive alliance seems insufficientto reduce alcohol misuse. The relationship between early allianceand improvement in alcohol misuse needs to be further investigated.     

THE PATHWAY TO PSYCHIATRIC ADMISSION

Little information is available about the pathway along which psychiatric admissions move from the community to residential care. A cohort of one year's admissions has been analysed in a Queensland provincial city recording the community situation in which their referral starts and the various agencies involved en route to the hospital bed. Those whose initiation process was started by self, by family members, by neighbours or significant others in the patient's life seemed to find the pathway easier. Others already in some contact with the non-family professionals, welfare and other agencies, or who have no family resources, experienced more difficulties.     

四手操作对根管预备中辅助设备的使用效果与保养的意义

目的探讨四手操作在根管预备中辅助设备使用与保养的意义。方法回顾分析、总结628例在根管预备过程中电子根尖定位仪、机用镍钛器械、超声根管治疗仪和牙科显微镜辅助设备的合理使用和正确保养的临床资料。结果 628例根管预备治疗获得满意的效果,上述辅助设备功能正常、保养良好。结论四手操作在根管预备中辅助设备的合理使用和正确保养方面起到积极作用,可延长辅助设备的使用寿命、减少因设备原因造成的并发症。     

NEW WAYS TO USE BIOCHEMICAL INDICATORS OF ALCOHOL ABUSE TO REGRANT LICENCES IN A FAIRER MANNER AFTER DRUNKEN DRIVING IN GERMANY

The failure of medical-psychological examination to provideconvincing recommendations concerning the regranting of licencesin a significant number of cases illustrates the need for objectivelaboratory testing. Experience in Germany shows that blood-alcoholconcentration alone could lead to misleading recommendations,and suggests that laboratory testing is best done on samplestaken at the time of the offence, rather than subsequently atmedical-psychological investigation.     

头皮撕脱伤治疗方法的回顾与探讨

头皮撕脱伤是一种骤然发生的意外创伤，伤情重、出血多，常伴休克、颅脑外伤等，其发生率有逐年增加的趋势。文献报告的处理方法各异，处理方法方式的选择直接关系到头皮撕脱伤的疗效和后遗畸形的程度。笔者对1993年10月-2005年6月收治的21例头皮撕脱伤的临床资料进行了回顾分析，总结经验教训，以期为今后的临床工作提供借鉴，现报道如下。