军队精神病患者518例入院情况分析

我科从1998年4月～2001年3月共收治部队男性精神病518例.现将这些患者入院情况作一分析,旨在提高部队对精神病的早期发现、早期治疗、防止复发及预防的能力,从而保持部队战斗力.     

精神障碍患者的入院方式调查探析

目的调查精神障碍者的入院方式。方法 91例精神病患者,以问卷调查方式了解其入院方式。结果 91例患者中,自愿入院患者18例,占19.78%;医疗保护入院患者51例,占56.04%;强制入院患者22例,占24.18%。同时,≤55岁、未婚、高中及以下学历、家庭收入中低等收入患者所占比例较高(P<0.05)。结论精神障碍者以非自愿入院方式为主,且以低收入、低学历、未婚、中青年患者为主。     

慢性心力衰竭患者出院前血浆NT-proBNP水平与再入院率的关系

目的探讨N末端B型脑钠肽(NT-pro BNP)水平在评价慢性心力衰竭(CHF)患者出院后再入院率中的应用价值。方法选择该院2010年2月至2012年4月CHF患者86例,随机分为两组,其中出院前血浆NT-pro BNP水平小于或等于400 pg/m L为对照组(42例),出院前血浆NT-pro BNP水平大于或等于600 pg/m L为研究组(44例)。两组患者在出院前抽取肘静脉血,用酶联免疫吸附试验法测定BNP,观察患者出院后第1、3、6、12个月再入院率。结果两组患者在出院后6、12、24个月NT-pro BNP水平比较,差异均有统计学意义(P<0.01)。在再入院率方面,两组患者出院后1、3个月再入院率比较,差异均无统计学意义(P>0.05),出院后6、12、24个月再入院率比较,差异均有统计学意义(P<0.05或0.01)。结论 CHF患者出院时NT-pro BNP水平是预测再入院率的重要指标,对CHF患者中长期预后判断有重要价值。     

精神障碍患者的入院方式调查分析

目的：对精神障碍患者的入院方式进行调查,并分析影响入院方式的重要因素。方法选择165例精神障碍患者作为研究对象,对所有患者的入院资料进行分析,并对其发放《精神障碍患者入院方式及相关因素研究问卷》进行调查。结果32例自愿入院,占19.4%,98例医疗保护入院,占59.4%,35例强制入院,占21.2%;自愿入院、医疗保护入院以及强制入院的精神障碍患者的年龄、婚姻状况、文化程度以及家庭收入等方面对比,差异有统计学意义(P<0.05)。结论我国精神障碍患者入院方式主要为非自愿入院,其入院方式受到多种因素影响。     

情感性精神障碍患者再次住院原因分析

目的 探讨情感性精神障碍患者再次住院相关原因。方法 采用回顾性分析的方法 ,分析情感性精神障碍患者再次住院临床资料及相关原因。结果 患者服药依从性差是其复发率增高较重要的因素之一。结论 针对情感性精神障碍复发再住院原因,采用加强精神卫生知识宣传,增强医患沟通,坚持长期维持治疗,提高服药依从性是预防复发的重要手段。     

入院介绍的落实程度对患者满意度的影响

目的 探讨入院介绍的落实程度对患者满意度的影响.方法 对该科住院患者满意度调查结果进行分析.结果 2011年1-3月患者对病房护士服务质量总满意度约为85％左右,其中入院介绍对护士接待满意和较满意者占77％；2011年4月后患者对病房护士服务质量总满意度为97％～100％,其中入院介绍对护士接待满意和较满意者占100％.结论 入院介绍的有效落实对提高患者满意度有着重要的作用.     

80例躁狂症患者再入院的临床资料分析及预防策略

躁狂症是精神科常见病。经治疗后，绝大多数患者能恢复正常的工作、学习和生活。但仍有相当一部分患者反复发作，多次住院。为探索其复发原因及规律，本文调查了2000年～2003年首次复发第二次住院的躁狂症患者80例，均符合CCMD-3的诊断标准。将其资料进行分析和总结。报告如下：     

军队患者病种住院日及医疗费用例析

为了解卫生资源的使用效率及经费情况,并为各级卫生行政管理部门制定改革政策提供依据,本研究分析了某中心医院2001-01～2003-12的2681例患者医疗信息库有关病种住院日和住院费用的信息,结果提示单病种管理应成为医院管理的基本内容,医疗工作效率受医院经济政策调控,应加强公共卫生和疾病的预防控制工作。     

某部军人心理卫生知识知晓率调查

目的 了解部队军人心理卫生知识知晓率,为部队有效开展心理卫生服务提供依据. 方法 采用匿名法对某部921名军人进行问卷调查. 结果 本组平均统计项正确率为46.8%,知晓率为12.4%.在平均正确率方面,干部高于士兵和士官,本科>大专>高中>初中.79.9%的军人关注心理健康;60.7%的军人将学校或部队教育作为接受心...     

构建军人心理健康预警监测防控体系的初步探讨

为了对官兵心理问题能做到早预防、早发现和早干预,我们提出构建集心理健康预警信息收集报告、预警监测、信息核实以及干预处理于一体的心理预警监测防控网络体系,该体系包括心理健康及其危险因素的预警指标的选择,预警信息的有效采集,心理健康的七级预警,预警监测机构的建设,预警监测规范的制定,预防干预措施的有效实施。此体系的建立和运行对维护部队安全稳定、合理配置战斗力和卫勤保障力量具有重要意义。     

酒精所致精神障碍患者的社会支持及身心健康水平的相关分析

目的:探讨酒精所致精神障碍患者的社会支持状况及身心健康水平的相关关系。方法:运用症状自评量表(SCL-90)和社会支持评定量表(SSRS)对37名酒精所致精神障碍的患者进行问卷调查。结果:①酒精所致精神障碍患者SCL-90各项因子分均显著高于1986年全国常模。②酒精所致精神障碍患者社会支持总分、客观支持、主观支持和支持利用度均显著低于对照组。③酒精所致精神障碍患者的身心健康水平与社会支持存在相关性。结论:酒精所致精神障碍的患者心理、生理及社会功能有不同程度的损害,大力宣传过度饮酒的危害性,加强社会支持,做好心理卫生工作,进行早期干预。     

饮酒致精神障碍住院患者68例分析

目的:探讨饮酒所致精神障碍患者的临床特征.方法:对68例住院的饮酒所致精神障碍患者的临床资料进行分析.结果:城乡饮酒所致精神障碍患者在受教育程度方面有显著性差异(P＜0.05);城镇患者饮酒原因主要为工作需要,而农村患者主要因劳累而饮酒;城镇患者精神症状中抑郁情绪发生率明显高于农村组(P＜0.01).结论:了解城乡因饮酒所致精神障碍患者在临床特征方面各自不同的特点,对预防城镇和农村酒精所致精神障碍的发生有一定意义.     

Effect of a Medical Toxicology Admitting Service on Length of Stay,Cost, and Mortality Among Inpatients Discharged with Poisoning-Related Diagnoses

There are no published studies that have compared quality outcomes of hospitalized poisoned patients primarily under the care of physician medical toxicologists to patients treated by non-toxicologists. We hypothesized that inpatients primarily cared for by medical toxicologists would exhibit shorter lengths of stay (LOS), lower costs, and decreased mortality. Patients discharged in 2010 and 2011 from seven hospitals within the same health care system and greater metropolitan area with Medicare severity diagnosis-related groups for “poisoning and toxic effects of drugs” with and without major comorbidities or complications (917 & 918, respectively) were identified from a Premier® database. The database contained severity-weighted comparisons between expected and observed outcomes for each patient. Outcome parameters were differences between expected and observed LOS, cost, and percent mortality. These were then compared among groups of patients primarily admitted and cared for by (1) medical toxicologists at one hospital (Banner Good Samaritan Medical Center, BGS), (2) non-toxicologists at BGS, and (3) non-toxicologists at six other hospitals. Records of 3,581 patients contained complete data for assessment of at least one outcome measure. Patients cared for by medical toxicologists experienced favorable differences in LOS, costs, and mortality compared with other patient groups (p < 0.001). If patients cared for by non-toxicologists had experienced similar differences in observed over expected values for LOS, cost, and mortality as those cared for by medical toxicologists, there would have been a median savings of 1,483 hospital days, $4.269 million, and a significant decrease in mortality during the 2-year study period. Differences between observed and expected LOS, cost, and mortality in patients primarily cared for by medical toxicologists were significantly better than in patients cared for by non-toxicologists, regardless of facility. These data suggest that significant reductions in patient hospital days, costs, and mortality are possible when medical toxicologists directly care for hospitalized patients.     

不同职业入伍的新兵社会状况及心理素质的研究

目的 研究不同职业入伍新兵的社会状况和心理素质特点.方法 整群抽取某部2630名集训新兵进行社会状况分析,并应用症状自评量表(SCL-90)、艾森克成人个性问卷(EPQ)、自我和谐量表(SCCS)、简易应对方式问卷(CSQ)、社会支持量表(SSRS)进行心理调查.结果 收回有效问卷2599份,城镇入伍、双亲家庭、高中以上文化、主动入伍、要求进步的新兵中入伍前职业是学生者较多;农村入伍、单亲家庭、初中以下文化、被动入伍的新兵中其他职业入伍者较多(P<0.05).SCL-90:学生新兵强迫、人际关系敏感、抑郁、焦虑、敌对、精神病性因子得分低于其他职业新兵(P<0.05,P<0.01);EPQ:学生新兵内外向因子得分高于其他职业新兵,而神经质和精神质得分低于其他职业新兵(P<0.01);SCCS:学生新兵自我不和谐、自我刻板性因子得分低于其他职业新兵,而自我灵活性得分高于其他职业新兵(P<0.01);CSQ:学生新兵积极应对得分高于其他职业新兵(P<0.01);学生新兵SSRS各因子得分均高于其他职业新兵(P<0.01).结论 学生新兵心理素质较好,可塑性强,入伍前职业是影响新兵心理素质的重要因素之一;新兵入伍后应结合入伍动机、目的、家庭状况,从自我和谐、积极应对、主动寻求支持等方面加强新兵的个性塑造.     

Association between Total Daily Doses with duration of hospitalization among readmitted patients in a multi-ethnic Asian population

Increased length of stay (LOS) in the hospital incurs substantial financial costs on the healthcare system. Multiple factors are associated with LOS. However, few studies have been done to associate the impact of Total Daily Doses (TDD) and LOS. Hence, the aim of this study is to examine the association between patients’ LOS upon readmission and their TDD before readmission. A retrospective cross-sectional study of readmission cases occurring from 1st January to 31st March 2013 was conducted at a regional hospital. Demographics and clinical variables were collected using electronic medical databases. Univariable and multiple linear regressions were used. Confounders such as comorbidities and drug related problems (DRP) were controlled for in this study. There were 432 patients and 649 readmissions examined. The average TDD and LOS were 18.04 ± 8.16 and 7.63 days ± 7.08 respectively. In the univariable analysis, variables that were significantly associated with the LOS included age above 75 year-old, race, comorbidity, number of comorbidities, number of medications, TDD and thrombocytopenia as DRPs. In the multiple linear regression, there was a statistically significant association between TDD (β = 0.0733, p = 0.030) and LOS. Variables that were found significant were age above 75 year-old (β = 1.5477, p = 0.008), Malay (β = −1.5123, p = 0.033), other races (β = −2.6174, p = 0.007), depression (β = 2.1551, p = 0.031) and thrombocytopenia as a type of DRP (β = 7.5548, p = 0.027). When TDD was replaced with number of medications, number of medications (β = 0.1487, p = 0.021), age of 75 year-old (β = 1.5303, p = 0.009), Malay (β = −1.4687, p = 0.038), race of others (β = −2.6499, p = 0.007), depression (β = 2.1951, p = 0.028) and thrombocytopenia as a type of DRP (β = 7.5260, p = 0.028) were significant. In conclusion, a significant relationship between TDD and number of medications before readmission and the LOS upon readmission was established. This finding highlights the importance of optimizing patients’ TDD in the attempt of reducing their LOS.     

Association between rivaroxaban use and length of hospital stay,treatment costs and early outcomes in patients with pulmonary embolism: a systematic review of real-world studies

Background: In the EINSTEIN-Pulmonary Embolism (PE) trial, subjects randomized to rivaroxaban versus enoxaparin bridging to vitamin K antagonist (VKA) therapy experienced a reduced index hospital length of stay (LOS). We sought to conduct a systematic review of real-world studies comparing LOS, costs and early outcomes among patients treated with rivaroxaban or parenterally bridged VKA in routine practice.

Methods: We searched Medline and Scopus from 1 January 2011 to 30 November 2016 to identify observational studies comparing acute PE patients anticoagulated with rivaroxaban or parenterally bridged VKA and reporting data on index hospital LOS, costs and/or early post-PE outcomes. Studies not using appropriate methods for minimizing confounding bias or not published in English were excluded.

Results: Five studies met inclusion criteria. Rivaroxaban use was associated with decreased index hospital LOS (range: 1.36–1.70 days) and treatment costs (range: $1818–$2688) during an index stay compared to parenterally bridged warfarin. No differences in early readmission for recurrent thrombosis were noted between anticoagulation strategies. Readmission for major bleeding was rare in both cohorts. Similar reductions in LOS (range: 0.23–4.3 days) and costs (range: $251–$7094) were observed with rivaroxaban in studies restricted to patients deemed low risk for early complications by clinical gestalt or by a clinical- or claims-based risk stratification tool.

Conclusions: Regardless of patient predicted risk of post-PE complications, real-world studies suggest that rivaroxaban is associated with a reduced hospital LOS and costs versus parenterally bridged warfarin, without increasing readmission.     

文拉法辛联合心理干预治疗躯体化障碍临床疗效对照研究

目的 评价文拉法辛联合心理干预治疗躯体化障碍患者的临床疗效和副作用.方法将符合CCMD－3诊断标准的44例躯体化障碍患者随机分为治疗组和对照组各22例.两组病例均给予文拉法辛,起始剂量75 mg·d^-1,1周后増至150 mg·d^-1,并维持此剂量,疗程6周.治疗组同时联合心理干预治疗.采用汉密顿抑郁量表（HAMD）、不良反应量表（TESS）评定疗效及不良反应. 结果 经6周治疗后,治疗组显效率为86.4%,对照组为59.1%（P<0.05）, 两组间HAMD减分率于第2,4,6周末比较差异均有显著性或极显著性（P<0.05或P<0.01）,治疗组起效明显快于对照组.两组各时间点TESS评分差异无显著性（P>0.05）.结论 文拉法辛联合心理干预治疗躯体化障碍的疗效优于单用文拉法辛.     

Opioid Dependence as a Chronic Disease: The Interrelationships Between Length of Stay,Methadone Dose,and Age on Treatment Outcome at an Urban Opioid Treatment Program

ABSTRACT

Data looking at the impact of length of stay in treatment, methadone dose, and age for treatment of opiate dependence have been evaluated separately, but the relative impact of these variables has not been examined. For this report, regression analyses of length of stay, methadone dose, and age were compiled to determine the relative effect of each variable on opiate toxicology results, which was the primary outcome measure. Regression analysis yielded statistical significance for length of stay (P < .001) and methadone dose (P < .05) but not for age. Comparing length of stay in treatment, methadone dose, and age to opiate toxicology results indicated that length of stay was the most important factor. These comparisons impact treatment strategies for opiate dependence, particularly when using a chronic disease model as a strategy for delivering care.