The importance of social comparisons for high levels of subjective quality of life in chronic schizophrenic patients

In schizophrenic patients, quality of life (QoL) studies often find high levels of general life satisfaction and satisfaction in various life domains despite deprived living conditions. Therefore, the usefulness of QoL as an outcome indicator has been questioned. Since social comparison processes have been postulated to be related to the level of satisfaction, this hypothesis was analysed empirically by the present study in schizophrenic patients. Satisfaction and social comparisons of 148 schizophrenic inpatients and 66 mentally healthy controls were examined with regard to the domains ‘health’ and ‘family’ by means of a standardised interview. The schizophrenic patients had a history of either long-term (n = 75) or short-term (n = 73) restricted and deprived living conditions. Long-term patients showed significantly higher satisfaction levels than short-term patients. They compared themselves predominantly laterally or downwards with fellow inpatients. Significant relationships between the direction of social comparisons and satisfaction ratings were found in all three samples. Social comparisons proved to be important for the level of satisfaction in schizophrenic patients. Results indicate that experiences of restricted and deprived living conditions induce accommodation processes and response-shifts that should be taken into account in the interpretation of quality-of-life data. This revised version was published online in June 2006 with corrections to the Cover Date.     

Factors affecting WHOQOL-26 in community-dwelling patients with schizophrenia

OBJECTIVE: Schizophrenic patients' quality of life (QOL) has become increasingly important due to shift of mental health care from hospitals to communities. This paper describes a longitudinal study conducted to clarify relationships among the QOL, self-esteem, depressive mood, and uncooperativeness of schizophrenic patients identified in the authors' previous crosssectional study. METHODS: Subjects were 61 schizophrenic patients attending day care at mental hospitals. They were assessed initially, and again after a 12-month follow-up. The assessment was carried out using the Rosenberg Self-Esteem Scale, WHOQOL-26 Scale, and the Brief Psychiatric Rating Scale, and included personal characteristics. Covariance structure analysis (Synchronous Effects Model) was conducted to clarify the relationships between self-esteem and the WHOQOL-26 Scale, and between psychiatric states (depressive mood and uncooperativeness) and self-esteem, while controlling for subjects' individual characteristics and use of antipsychotics as confounding factors. RESULTS: The results indicated that self-esteem had a significantly positive effect on the WHOQOL-26 Scale while depressive mood and uncooperativeness were without significant effects. CONCLUSIONS: The results provide evidence that the enhancement and maintenance of self-esteem may be an effective method of improving WHOQOL-26 in schizophrenic patients.     

The influence of institutional characteristics on length of stay for psychiatric patients: A national database study in South Korea

The institutionalization of psychiatric patients has put a tremendous burden on many societies, but few studies have examined the effects of institutional characteristics on patient length of stay (LOS). This paper investigated the association between institutional characteristics and LOS for 160,517 psychiatric patients in South Korea by applying a two-level modeling technique to administrative claims databases covering the entire patient population. Patient LOS, expressed in terms of days, was analyzed by taking account of institutional type, ownership, location, inpatient capacity, staffing, and patient demographics. The characteristics of inpatients were used as control variables and consisted of gender, age, sub-diagnosis, and the type of national health security program. The main findings of this study are: (1) patient LOS was 69% longer at psychiatric hospitals than at tertiary-care hospitals; (2) neither location nor inpatient capacity was associated with LOS; (3) larger staffs reduced LOS; and (4), LOS increased with a higher proportion of male inpatients, inpatients ≥65 years old, or inpatients diagnosed with organic or schizophrenic disorders, possibly through contextual effects. The results of this study suggest that researchers and policy makers could improve their assessment of psychiatric patient LOS and its association with health outcome by taking into account institutional characteristics and using multi-level analyses.     

住院康复期精神分裂症患者心理健康状况与社会支持的调查

目的:探讨住院康复期精神分裂症患者心理健康状况与社会支持的相关性。方法:采用症状自评量表和社会支持量表对住院康复期137例精神分裂症患者进行问卷调查。结果:患者的心理健康状况较常模差;患者的社会支持度较常模低(P<0.01)。结论:社会支持与住院康复期精神分裂症患者的心理健康密切相关,护士在患者住院治疗的同时,应充分评估和利用患者的社会支持,促进身心康复。     

综合医院住院结核病患者特征与治疗转归的对应分析

目的 了解中国综合医院结核病住院病例的治疗效果，探索不同属性特征的结核病患者住院期间的治疗转归。方法 对南充地区综合医院2003年结核病住院病例进行回顾性研究，采用x^2检验确定对住院转归具有统计学意义的属性变量，在此基础上，再采用对应分析方法揭示结核病患者不同属性特征与不同住院转归之间的内在联系。结果 x^2检验结果显示，住院结核病例的性别、年龄、入院时病情、伴随病（其他疾病或并发症）及住院天数对住院转归具有统计学意义；对应分析图进一步显示患者属性特征与住院转归的关系：（1）住院期间死亡的结核病患者与治愈、好转的结核病例属性特征差别较大；（2）年龄在15岁以上、入院时病情急的男性结核病患者住院期间容易出现好转的治疗结局；（3）入院时病情一般、没有伴随病、住院时间超过8天的女性：结核病例相对容易出现治愈的结局；（4）住院治疗效果较差的结核病例在年龄〈15岁、入院病情危重两方面表现出一定的一致性。结论 （1）如何从病案繁杂的信息中提取出有用的信息，对应分析提供了一种新的思路；（2）综合医院结核住院患者特征与住院转归间存在一定的对应关系，应针对不同特征的结核住院患者制定相应的防治策略，以强化完成抗结核病治疗提高治愈率。     

非手术住院患者出院带药状况分析

目的：揭示非手术住院患者出院带药状况及其影响因素,为药品费用的环节控制提供依据。方法：采用Visual Fox-Pro6．0对数据库进行整理,SPSS11．0统计软件对观察对象的出院带药状况及影响因素进行统计分析。结果：非手术住院患者出院带药发生率为50．4％,其日均药费及例均药费（P〈0．01）均高于无出院带药的患者;治愈者与好转者出院带药率无显著性差异（P〉0．05）;Logistic回归分析结果显示,出院带药的影响因素为患者的年龄和费别,而非疾病有关因素。结论：非手术住院患者出院带药的发生率较高,是导致药费增高的因素之一,应作为合理用药和药费控制的重要环节点。     

165所医院住院患者抗菌药物临床应用横断面调查

目的了解我国医院住院患者抗菌药物临床应用现状。方法所有参加调查的医院采用横断面调查的方法调查一天的住院患者中抗菌药物的使用种类及用药量。结果165所医院115143名住院患者中,55755人使用抗菌药物,使用率为48.42%。总DDD s为282775.55,使用指数为245.59。抗菌药物使用指数排在前3位的科室为综合ICU（592.97）,其次为其他科（453.81）和妇产科（445.27）。抗菌药物中喹诺酮类的使用指数最高76.75,其次为林可类（63.46）和头孢菌素类（46.05）。结论使用指数能较准确反映抗菌药物利用情况,总的抗菌药物使用情况偏高。     

参保精神分裂症患者住院费用及影响因素分析

目的了解天津市参保精神分裂症患者住院费用构成及其影响因素,为控制住院费用提供参考依据。方法从天津市2003-2007年参保住院患者资料库中随机抽取精神分裂症患者18 182例,对其住院费用情况进行回顾性分析。结果天津市2003-2007年参保精神分裂症患者人均住院费用为(3 014.59±745.31)元;其中一级医院为(1 986.94±538.79)元;二级医院为(2 181.92±503.85)元;三级医院为(3 861.22±738.29)元;参保精神分裂症患者的住院费用中床位费、药品费、检查费、治疗费、材料费和其他费用依次占15.41%、5.04%、22.60%、52.37%、0.27%和4.31%。多元线性回归分析结果表明,年龄大、医院级别高、住院天数多、治疗费和材料费比重大,精神分裂症患者住院费用越高;曾住院次数多的患者住院费用越低。结论年龄、医院级别、住院天数、曾住院次数、治疗费和材料费比重是天津市参保精神分裂症患者住院费用的主要影响因素。     

Gearing service quality into public and private hospitals in small islands: empirical evidence from Cyprus

PURPOSE: The purpose of this research is to develop and compare some determinants of service quality in both the public and private hospitals of Northern Cyprus. There is considerable lack of literature with respect to service quality in public and private hospitals. DESIGN/METHOD/APPROACH: Randomly, 454 respondents, who have recently benefited from hospital services in Famagusta, were selected to answer a modified version of the SERVQUAL Instrument. The instrument contained both service expectations and perceptions questions. FINDINGS: This study identifies six factors regarding the service quality as perceived in both public and private Northern Cyprus hospitals. These are: empathy, giving priority to the inpatients needs, relationships between staff and patients, professionalism of staff, food and the physical environment. Research results revealed that the various expectations of inpatients have not been met in either the public or the private hospitals RESEARCH IMPLICATIONS/LIMITATIONS: At the micro level, the lack of management commitment to service quality in both hospital settings leads doctors and nurses to expend less effort increasing or improving inpatient satisfaction. Hospital managers should also satisfy their employees, since job satisfaction leads to customer satisfaction and loyalty. Additionally, hospital administrations need to gather systematic feedback from their inpatients, establish visible and transparent complaint procedures so that inpatients' complaints can be addressed effectively and efficiently. ORIGINALITY/VALUE: The hospitals need to organize training sessions based on the critical importance of service quality and the crucial role of inpatient satisfaction in the health care industry. Future studies should include the remaining regions in Cyprus in order to increase research findings' generalizability. Additionally, including other dimensions such as hospital processes and discharge management and co-ordination may provide further insights into understanding inpatients' perceptions and intentions.     

三级医院就餐住院病人膳食满意度分析

目的调查三级医院就餐住院病人的膳食满意度及影响因素,为医院膳食管理提供参考依据。方法采用现况研究方法对徐州市6所三级医院就餐住院病人进行膳食满意度问卷调查。结果病人对医院膳食整体服务质量的评价情况显示:认为满意的占34.36%,认为一般的占49.08%,而不满意的占16.56%。各有25.46%的病人对膳食价格和品种不满意,24.23%的病人对餐具卫生情况不满意,21.78%的病人对膳食口味不满意,17.79%的病人对工作人员服务态度不满意等。单因素分析显示:不同年龄层、文化程度、婚姻状况对膳食满意度的影响具有统计学差异,P<0.05。多因素分析显示:文化程度为小学及以下、初中以及高中/中专,婚姻状况已婚和未婚对满意和比较满意的判定有统计学差异,P<0.05。结论三级医院的病人膳食满意度较低,医院应当加强膳食管理工作,为病人提供优质的膳食服务。     

社区脑卒中患者的日常生活能力与长期照料需求研究

目的了解脑卒中患者的日常生活能力与长期照料需求．为进一步在社区开展脑卒中患者的长期照料提供理论依据．方法选取经医院确诊为脑卒中、虹口区户籍的脑卒中存活患者作为对象,采用问卷调查的方法收集资料。结果共调查脑卒中患者1300名,17．08％的患者完全依赖,6．62％的患者严重依赖,8．08％的患者显著依赖。8．62％的患者功能有限独立,59．60％的患者功能完全独立。日常生活能力越好的患者对生活越满意,完全独立的患者39．19％对生活表示满意．有限独立的患者19．59％表示满意,显著依赖的患者15．22％表示满意,严重依赖的患者8．79％表示满意．生活完全依赖的患者5．67％对生活表示满意。日常生活能力情况和长期照料需求情况密切相关,生活能力独立情况越差,长期照料需求越高。结论脑卒中患者对生活满意度较低,长期照料需求与日常生活能力有关。应当根据患者生活能力情况提供相应的生活服务。     

Balance outcomes from two small rural hospitals

Objectives: To describe predicted and measured balance changes in patients receiving physiotherapy in two rural hospitals, and to explore the relationship among balance at discharge, carer availability and patients' discharge destination. Design: Prospective measurement study. Setting: Two rural Australian hospitals. Participants: Eighty‐nine inpatients with a median age of 84. Main outcome measures: Berg Balance Scale (BBS) on admission and the treating physiotherapist's estimate at admission of individual patient's discharge BBS. Follow‐up measures included discharge BBS, carer availability after discharge and patient discharge destination. Results: Although change in measured balance of study participants had wide variability, balance measured by the BBS displayed a statistically and clinically significant improvement. A strong relationship was found between balance scores and discharge destination. However, no relationship was found between carer availability and discharge destination. Physiotherapists' estimates of discharge BBS displayed an average error of 7/56. Conclusions: The strong relationship between measured balance and discharge destination in these elderly study participants suggests that maximising their balance might minimise admissions to nursing home. The high variability of measured balance change suggests outcomes are difficult to predict. The study results suggest that premature assessment of patient's suitability for nursing home placement should be avoided. The accuracy of physiotherapist's estimates of discharge BBS suggests that greater weight might be placed on their input to facilitate the discharge planning process.     

新疆基层医院住院患者间接医疗费用分析?

目的:分析新疆基层医院住院患者日间接医疗费用情况,为卫生资源的合理配置提供科学依据。方法:对新疆福海、阜康、富蕴、洛浦4个样本县市,调查日所有住院患者日间接医疗费用情况进行现场问卷调查研究。结果 :(1)县级医院住院患者日间接医疗费用高于乡级医院患者(P﹤0.001)。(2)县级医院不同科室住院患者日间接医疗费用水平不同(P<0.05)。(3)县乡基层医院前5位系统性疾病中,不同系统疾病患者日间接医疗费用水平不同(P<0.05)。结论:不同级别基层医院、不同疾病系统住院患者日间接医疗费用不同,且县级医院不同科室住院患者日间接医疗费用不同。     

Experiences of elderly patients regarding independent community living after discharge from hospital: a longitudinal study.

OBJECTIVE: To describe the reported experiences of elderly patients regarding their transition from an acute hospital to independent community living. DESIGN: Observational longitudinal study based on semi-structured interviews conducted monthly for 6 months following discharge from hospital. SETTING: Four South Australian acute hospitals. Patients. One hundred elderly patients who faced a long-term change in health status and/or in their ability to manage practical aspects of daily living. MAIN OUTCOME MEASURES: Experiences in managing change in health status, social circumstances and independent community living. RESULTS: Few patients believed that discharge plans made in hospital had assisted their return to independent community living. Discharge planning addressed mainly formal health services rather than practical aspects of daily living. Many patients implemented innovative solutions when formal services were unavailable or inadequate. Pain, tiredness, loss of mobility, and grief over loss of previous abilities were frequent, long lasting sequelae to illness, and few discharge plans prepared patients to deal with this. CONCLUSIONS: Elderly patients who have left hospital to face a permanent change in health status often regret that they have not been better prepared for what lies ahead in terms of more specific information about their condition, linked with practical discharge plans that prepare them for their period of convalescence. We suggest that the underlying problem is a disjunction between the multiple systems involved in hospital discharge planning, primary medical care, disability-oriented community health services, and informal community services.     

Nursing interagency referral forms are important for cooperation within the nursing profession upon patient transfer from hospital to home care]

The purpose of this study was to clarify factors concerning hospital discharge notification in Shizuoka. The subjects, nurses at 146 hospitals and 93 public health centers or municipal health centers, were surveyed by means of a questionnaire. The data were analyzed by the chi-squared test and multiple logistic linear regression analysis. The results showed that hospital discharge notification was provided by 92.6% of hospitals having a hospital discharge notification form, but only 7.4% of hospitals without such a form. There was a significant difference in hospital discharge notification between hospitals with and without a nursing interagency referral form, indicating that the latter is an important factor in provision of information on transfer of patients from the care of hospital nurses to that of public health nurses (p < 0.001). There were no significant links between providing hospital discharge notification and the number of beds, the existence of a visiting nurse room, the MSW, the examination of nursing assistance methods after discharge, or the notification of hospitalization. These results indicated that the nursing interagency referral form to be important for notification purposes.     

采用EQ-5D量表进行严重急性呼吸道感染住院病例生命质量的探索性研究

目的了解严重急性呼吸道感染住院病例的生命质量变化及其影响因素。方法对住院的严重急性呼吸道感染病例,在入院前后,利用自行设计的问卷和EQ-5D量表进行调查,并采用多因素的多元线性回归方法分析EQ-5D评分的影响因素。结果共纳入81例住院病人,其中流感病例12例,非流感病例69例。入院时的评分低于出院前评分。入院时回答有困难的维度中,疼痛/不舒服最高(73%),其次为日常活动(62%)。出院前所有五个维度回答有困难的比例均下降,其中,疼痛/不舒服降至25%,日常活动降至35%。多因素分析结果提示年龄、入院时的自我评分和地区是可能的影响因素。结论严重急性呼吸道感染住院病例的生命质量受到入院时健康状况的影响。EQ5D量表可作为评价传染病生命质量、评估疾病无形负担的方法之一。     

7 074例精神疾病患者住院费用影响因素分析

目的了解精神科住院病人医疗费用的影响因素，以控制医疗成本，降低医药费用。方法对2003～2005年出院的7 074例精神疾病患者进行费用构成分析，并对影响医疗费用的因素进行单因素方差分析和多因素逐步回归分析。结果住院费用构成中，药品费比例逐年上升，住院床日费亦呈上升趋势。影响平均床日费的主要因素，按其对床日费作用由大渐小依次为：住院日、出院原因、入院病情、支付方式、年龄和疾病分类。不同支付方式对床日费的影响作用不同。结论建议住院床日费的核定标准应结合住院日核定综合制定。同时，建议利用医院信息系统，对临床药品使用进行实时监控，以及时遏止药品费用的过速增长。     

脑卒中病人住院费用构成及影响因素分析

目的:分析脑卒中住院病人的住院费用构成及影响因素。方法:采用描述性统计方法对云南省两个县级医院2003—2007年脑卒中住院病人的住院费用构成及趋势进行分析,并采用多元线性回归方法对影响其住院费用的因素进行多因素分析。结果:2003—2007年期间,在脑卒中患者住院总费用中药费所占的比重最大,且呈逐年增加的趋势;脑卒中患者的人均住院费用也呈逐年增加趋势。影响脑卒中住院费用的因素主要有入院状态、住院天数、抢救次数和主要出院情况。结论:应合理调整医疗机构的收费结构,缩短平均住院日,减轻脑卒中患者的经济负担。     

甘肃省农村慢性病住院患者疾病及费用分析

目的通过分析甘肃省农村慢性病住院患者情况,掌握农村居民慢性病防治重点,为卫生适宜技术筛选提供依据。方法抽取甘肃省兰州市皋兰县、张掖市临泽县2007年基层医疗机构住院患者病例资料,获取疾病、费用等信息,并分析其构成情况。结果农村慢性病住院患者在县、乡级医疗机构住院患者中所占比例为37.78%;常见的慢性病为循环系统、消化系统、呼吸系统疾病;县、乡医疗机构日均住院费用分别为(216.15±1.88)(、87.03±1.66)元,差异有统计学意义(P<0.05);县、乡医疗机构例均住院费用分别为(2 342.39±2.38)(、680.74±1.79)元,差异具有统计学意义(P<0.05);县级医疗机构慢性病住院费用以手术费、西药费、诊疗费为主,占76.25%;乡级以西药费、手术费、床位费为主,占70.02%。结论农村医疗机构住院患者中以慢性病患者为主,手术费和药费是慢性病患者住院费用的主要影响因素,应推广针对慢性病治疗的农村卫生适宜技术。