2010 年-2013 年 6928 例远程会诊病例统计分析

目的 对喀什地区第一人民医院6928例远程会诊咨询病例进行统计和分析,为我院更好地开展远程会诊工作总结经验,为制定远程医疗长远发展规划提供参考依据.方法 利用EXCEL软件对数据进行归类、整理,计算2010年至2013年该院会诊病例的临床分类和会诊结果的构成比.利用SPSS 13.0统计分析软件进行统计分析.以转诊治疗费用做参考,计算会诊病例属地治疗人均结余费用.结果 远程会诊咨询例数呈逐年递增又下降的趋势,会诊病例主要为外科病例5061,占73.05％;其次为内科病例1698,占24.51％;会诊病人属地治疗占94.01％;属地治疗人均结余费用6726元.结论 通过远程医疗服务手段,可提高医院的收治能力和医疗技术水平,不仅可取得良好的社会效益,还能给本地区老百姓减轻很大的经济负担.     

医院内部会诊管理系统的构建探讨

本文介绍了在医院会诊管理工作中构建和使用会诊管理系统的必要性,重点从医生状态显示层、会诊关系建立层、会诊工作记录层、会诊结果评价层和会诊纠纷处理层5个层面,论述了院内会诊管理系统的设计方法,并对系统构架和未来的使用提出了合理的建议。     

Chronic hepatitis C in the state prison system: insights into the problems and possible solutions

The prevalence of chronic hepatitis C virus (HCV) within the correctional system is estimated to be 10–20-times greater than that which is reported in the general population. High-risk behavioral patterns probably account for the greater estimates in this population. Recent observations of more than 780 patient-inmates infected with HCV within the California Department of Corrections suggest a very high prevalence of advanced fibrosis in this population. Observational studies performed in Texas have shown that the rates of chronic liver disease-related deaths have increased significantly between 1989 and 2003, especially among Hispanic patient-inmates. Viral hepatitis accounts for a significant number of these chronic liver disease-related deaths. Identification of high-risk patient-inmates infected with HCV, as well as appropriation of funds for their treatment, should result in a decreased rate of liver-related complications. This should translate into reduced morbidity and cost to correctional institutions, as well as to improved public health and safety.     

Training and maintaining motivational interviewing skills in a clinical trial

Motivational interviewing (MI) is an evidence-based practice that is being implemented in a wide range of settings. Research supports the importance of ongoing coaching and feedback sessions following initial training in MI to implement and sustain MI-adherent competencies. This article describes the development and preliminary testing of a group feedback and consultation process where clinicians code each others’ clinical samples of MI sessions and provide feedback to each other regarding the level of adherence to MI fidelity measures. Preliminary results suggest that group feedback may help clinicians develop and sustain MI skills.     

Empowering patients or general practitioners? A randomised clinical trial to improve quality in reproductive health care in Belgium

Background?Evidence-based clinical guidelines on contraceptive use were developed and distributed among all Flemish general practitioners (GPs) in Belgium.

Objectives?To evaluate the effectiveness of two strategies for implementing a guideline on oral contraceptives in order to enhance the quality of the first contraception consultation in general practice, by either empowering patients or by introducing a computer decision support system (CDSS).

Method?A random sample of 45 GPs was distributed among three study groups. One group was visited by an ‘empowered patient’, one group's electronic medical record was supplemented with a CDSS, and one group served as the control group. Simulated patients (SPs) assessed the performance of GPs in daily practice before and after the interventions, using a validated 48-point checklist.

Results?The baseline mean score of the 43 GPs was 26.16 (SD?=?5.76). The SPs received sufficient information about correct pill usage, but not concerning factors associated with pill failure and drug interaction. After the intervention, the GPs' mean score was 26.39 (SD?=?6.86). Only the intervention group with the ‘empowered patient’ scored significantly better (29.92 [SD?=?7.11]). The computer group and control group scored lower (24.36 [SD?=?6.60] and 24.82 [SD?=?5.65], respectively).

Conclusion?Developing and distributing an evidence-based guideline did not change GPs' behaviour. However, empowering patients to participate more proactively significantly improved GPs' performance during a contraception consultation. A CDSS did not.     

The triage-function of a psychosomatic liaison-service for gynecological patients

The psychosomatic psychotherapeutic consultation liaison (CL)-service for gynecological patients at the Vienna University has been evaluated. Research interest focused on success and failure of the initial interview, conceptualized for a specific clientele. The interview has a triage function for treatment planning. By the type of treatment that was applied, patients were divided into three groups: Group A, patients with one single contact with the unit; Group B, patients who were referred to external psychotherapy; Group C, patients who were treated with short-term psychoanalytic psychotherapy as offered by the service unit. The drop-outs figured as Group D. The questionnaires completed by the patients at the first consultation and 6 months after their final contact with the clinic covered socio-demographic data, ego functions; the motivation for psychotherapy, a complaints list and finally, at the second contact only, an individual retrospective judgement concerning personal consequences of the consultation. Patients needs in CL-seruices call for quick decisions, which therapeutic measure would be most adequate. An experienced clinician's decision is based on several circumstances: individual feeling of suffering therapy-motivation and ego-strength, as well as social and demographic facts. Comparing groups with different therapeutic recommendations showed that the psychometric tests discriminated well between these four groups and thus the validity of the clinical recommendation has been confirmed.     

神经症患者就医情况调查

目的：了解神经症患者发病后的在情况。方法：对１９９８年７月～１９９９年８月前来门诊咨询,符合ＣＣＭＤ－２Ｒ神经症诊断标准的患者１００例,了解其发病后的就医情况。结果：有４８例首诊于精神科‘４７例首诊或反复长期就诊于综合医院内科等,尤以焦虑症和凝症症患者为多;５例癔症发作时求助于迷信活动。结论：约有半数神经症患者发病后去综合医院治疗,因此在综合医院普及精神医学知识,设立心理咨询或精神科门诊,开展联络