老年家庭护理服务的卫生经济学评价

我国人口年龄结构已进入老年型,高速发展的人口老龄化使得卫生资源的供需矛盾日益突出.如何合理配置老年家庭护理资源,优化家庭护理成本效益,促进我国家庭护理的进一步规范和发展,须从经济学角度对老年家庭护理进行卫生经济学评价.为了使人们对老年家庭护理的卫生经济学评价有更深入的理解和认识,对国内外卫生经济学评价方法以及该方法在老年家庭护理领域的应用等进行了综述.     

药物经济学分析的基本方法

药物经济学(pharmacoeconomics，PE)是以卫生经济学为基础而发展建立的一门新型边缘学科，它是一门将经济学原理和方法应用于评价临床药物治疗过程，并以此指导临床医生制定出合理的效果处方为主要宗旨的应用科学。可见，PE研究可为临床合理用药、药品资源的优化配置、新药的研制与开发、临床药学服务、药政管理和医疗保险等提供决策依     

临床试验中的成本研究

将临床试验与经济学研究相结合,进行卫生经济学评价,已成为目前临床研究发展的热点.本文介绍了成本的定义、分类和临床试验中进行成本研究的方法,包括如何识别成本,如何系统全面地收集分析成本数据与研究中应注意的问题.     

慢性伤口专项护理服务成本的研究

目的 对慢性伤口专项护理实际成本进行核算,与现行收费标准进行对比,证实其偏差,为卫生行政部门及物价部门制定合理收费价格提供客观依据.方法 对慢性伤口护理服务各项成本构成进行测量、记录及归集,用项目成本阶梯分摊法进行核算.结果 单次慢性伤口护理的实际成本为(29.42±9.29)元,是现行收费(12元)的2.5倍.结论 慢性伤口专项护理收费标准严重偏离护理成本,不能体现护士进行专项护理的劳动价值.     

高压氧疗在慢性伤口管理中应用的最佳证据总结

目的总结高压氧疗在慢性伤口管理中应用的最佳证据, 为慢性伤口管理中高压氧的应用提供指导和参考。方法系统检索国内外数据库中高压氧疗在慢性伤口治疗中应用的相关证据, 包括指南、专家共识、系统评价、随机对照试验等, 检索时限为建库至2020年12月31日。由2名研究员进行文献质量评价, 对符合纳入标准的文献进行证据提取。结果最终纳入文献12篇, 包括2篇指南、2篇专家共识、3篇随机对照试验和5篇系统评价;从高压氧疗作用机制、应用范围、评估内容及使用建议4个方面汇总了14条最佳证据。结论本研究归纳了高压氧疗在慢性伤口管理中应用的最佳证据, 医护人员应结合慢性伤口患者实际情况, 有针对性地选择证据, 为慢性伤口患者制订科学合理且个性化的治疗方案, 提高护理质量。     

伤口护理管理的新进展

文章阐述了伤口的愈合受内在和外在因素的影响,慢性伤口的治疗需要在“伤口床准备”的原则下应用系统性的方法.伤口分为可愈合性、维持性和不可愈合性;目前,尚无证据表明压疮完全可以避免;对于慢性伤口患者要加强自我管理和社会心理干预,尤其对合并糖尿病等慢性疾病患者的管理涉及多层次干预、卫生政策修订和医疗保健机构的改革.护士是开展伤口优质护理服务的根本,要对护士进行结构化培训,以提高对急慢性伤口患者的服务质量.     

卫生经济学评价在护理不良事件管理中的应用进展

对卫生经济学评价常用方法及其在护理不良事件管理中的应用现状进行综述,为临床护理管理者改善病人结局,选择最优方案节约医疗资源并分析其特点,以及进一步研究提供参考.     

德国慢性伤口护理专家标准解读及启示

本文通过对德国慢性伤口协会更新的《慢性伤口护理的专家标准》进行解读,旨在为伤口护理人员规范临床慢性伤口护理实践提供参考。更新的慢性伤口护理专家标准由评估、计划、执行、咨询/培训和评价五个层次构成,要求临床有资质的护理人员在护理慢性伤口患者时进行准确评估,制定可行的慢性伤口护理计划,保证慢性伤口护理计划能被正确执行,在计划的制定和执行过程中强调患者的参与度,并对患者及家属进行相关知识培训,在一定时间内对整个慢性伤口护理的过程进行评价并适当修订计划。而每个层次按照结构、过程、结果三个方面的内容进行管理,以保证伤口护理达到最佳效果。     

基于“互联网+”全程信息化慢性伤口管理系统的构建与应用

目的构建基于"互联网+"全程信息化慢性伤口管理系统并探讨其应用效果。方法借助互联网技术,组建专业化的慢性伤口管理团队,搭建慢性伤口信息化管理系统平台。比较系统应用前后医疗联合体成员单位护理人员处理慢性伤口的能力、患者伤口愈合程度及患者满意度之间的差异。结果应用全程信息化慢性伤口管理模式后,患者伤口愈合程度高于应用前,满意度显著提高,医联体护理人员处理慢性伤口的能力高于应用前(P 0. 05)。结论基于"互联网+"全程信息化慢性伤口管理系统的构建,可进一步优化慢性伤口诊疗流程,提高慢性伤口治愈率和护士处理慢性伤口的能力,提高患者对医疗护理的满意度,实现区域内慢性伤口的同质化管理。     

护理经济学的发展

护理经济学是研究护理服务过程中资源配置及行为的一门新兴边缘学科,属于护理学的范畴,也是卫生经济发展过程形成的分支学科之一,它应用卫生经济学的理论和方法,分析评价护理服务过程中的需求供给及成本效益,合理评价护理服务的经济价值,以加强护理服务过程中的经济体系、经济规律的认识,最终达到合理配置护理资源的目的[1]。20世纪70年代,英国和法国《医疗经济学》杂志的出版标志着卫生经济学分支学科的开始,在其各分支学科诸如药学经济学、临床经济学、医院经济学蓬勃发展进程中,产生了护理经济学[2]。1979年,美国著名卫生经济学家保罗.J…     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.