对乳腺癌患者焦虑抑郁情绪的研究及心理伦理干预

目的探讨乳腺癌患者焦虑抑郁情绪和正常人群焦虑抑郁情绪的差别,为心理伦理治疗提供依据。方法随机选取乳腺癌患者100例和正常对照组患者100例,采用心理问卷和心理量表测试,分别对两组研究对象进行一次性完成症状自评量表（SCL290）、抑郁自评量表（SDS）、焦虑自评量表（SAS）的测试及评定,然后对两组患者进行比较,并提出伦理对策。结果乳腺癌患者焦虑抑郁情绪明显的高于正常人群（P〈0．05）,焦虑抑郁情绪得分分别为89％和18％（P〈0．05）,心理伦理治疗势在必行。结论乳腺癌患者具有更高的焦虑抑郁情绪发生率,对乳腺癌患者进行治疗时,要加强心理咨询和心理治疗等心理伦理方面的干预,以减轻焦虑抑郁情绪的发生率,提高病人的生活质量。     

云南省级某综合医院精神科联络-会诊现状及其相关因素

目的 探讨云南省级某综合医院住院患者精神科联络会诊现状及相关因素.方法 收集某三甲医院1a内向精神科请求会诊服务的487名患者,对患者人口学资料、申请会诊科室、精神障碍病种、会诊后精神科处理情况等进行统计分析.结果 在接受精神科会诊服务的患者中,平均年龄为(57.14±16.59)岁,最大92岁,其中以40 ～ 70岁居多,女性(52.4％)稍高于男性(47.6％).申请会诊较多的科室依次为消化、神内、创伤、心内、呼吸.常见精神障碍为情绪障碍、神经症、器质性精神障碍、睡眠障碍等.会诊后精神科的处理主要有抗抑郁/焦虑药、抗精神病药、抗抑郁药合用抗精神病药、镇静催眠药、心理干预.结论 综合医院普通临床科室有较大的精神科会诊需求,但非精神科医生的对精神障碍的识别、处理能力及生物-心理-社会医学模式的意识还有待提高.     

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.     

原发性甲状腺功能减低症与垂体腺瘤的鉴别诊断

目的探讨原发性甲状腺功能减低致垂体增生的临床特点和诊治方法,避免误诊。方法9例患者各经X线平片、CT、MRI等影像检查发现鞍内鞍上占位性病变,但因影像学及临床特点不典型,经内分泌检查、骨龄检查等确诊为原发性甲状腺功能减低导致垂体增生,遂采用激素替代治疗。结果9例患者均口服甲状腺片治疗,随访4~18个月,内分泌检查除TSH仍高于正常,其余均恢复正常,症状均有不同程度减轻,其中2例患者复查MRI发现病变明显缩小。结论原发甲状腺功能减低,易误诊为垂体腺瘤,应进行内分泌检查、骨龄检查等明确诊断,治疗采用激素替代治疗。     

"I want more time with my doctor": a quantitative study of time and the consultation

BACKGROUND: Although consultations have increased in length, patients still express dissatisfaction with how much time they spend with their doctor. OBJECTIVES: This study aimed to explore aspects of consultation time and to examine the correlates of patients' desire for more time. METHODS: A quantitative cross-sectional design was used. General practice patients from eight UK practices (n = 294) completed a questionnaire following a consultation regarding their satisfaction with the consultation, their beliefs about how long the consultation lasted (perceived time) and how long they would have preferred it to last (preferred time). The actual consultation length (real time) was recorded by the doctor. RESULTS: The majority of patients underestimated how long the consultation took, and a large minority stated that they would have preferred more time. When controlling for both real time and perceived time, a preference for more time was correlated with a dissatisfaction with the emotional aspects of the consultation and a lower intention to comply with the doctors recommendations. It was unrelated to satisfaction with the information giving and examination components of the consultation. CONCLUSION: Patients' dissatisfaction with consultation length could be managed by making consultations longer. Alternatively, it could also be managed by changing how a given time is spent. In particular, a doctor who listens and tries to understand their patient may make the patient feel more satisfied with the consultation length and subsequently more motivated to follow any recommendations for change.     

The harmful consequences of elevating the doctor-patient relationship to be a primary goal of the general practice consultation

Introduction In the UK, it has been estimated that an ‘average’GP will undertake 8000 face to face clinical interactions annually.¹The consultation has come to be identified as the cornerstoneof general practice,² and to be seen more than an occasion forthe medical work of diagnosis and treatment.³ Beginning withthe work of Balint,⁴ it has also come to be seen as a ‘meeting’of individuals in which (often undifferentiated) symptoms areexpected to be understood and accommodated in relation to theirsocial and psychological contexts. Much effort in educationand research has been invested in giving the consultation thisdeeper meaning and wider range of potential practice.⁵ Thus,whilst the doctor–patient relationship is a given in today'sprimary care, achieving a satisfactory doctor–patientrelationship has also been elevated to be an outcome or goalof every consultation. In many ways, exploring that     

综合医院精神科会诊临床分析

目的 对综合性医院精神科会诊情况进行分析研究.方法 回顾性分析我科会诊的718例住院病人的临床资料,包括请会诊科室、会诊病人的诊断和处理等.结果 申请会诊科室共19个,其中针灸科（神经内科）会诊的人数最多,占43.3%.会诊的疾病前三类是：器质性精神障碍（71%）、心境障碍（8.6%）和神经症（6.0%）.所选的药物以苯二氮类（67.8%）、新型抗抑郁药（51.8%）和非典型抗精神病药（27%）应用较多.结论 我综合性医院会诊有年会诊率更高、患者年龄更大、以器质性精神障碍多见以及多选用新型药物治疗为主等特点.     

1150例神经内科会诊病例分析

目的了解神经内科会诊病例的科室分布、申请会诊方式以及疾病种类特点,探讨神经系统疾病与其他系统疾病的关系。方法对申请神经内科会诊病例的一般情况、疾病诊断以及神经系统疾病与其他系统疾病的关系等进行统计分析。结果会诊患者总数1150例,其中男性485例,女性665例,年龄分布7～95岁;平均年龄59.5±6.8岁。申请会诊科室以内科最多,共655例(56.9%)。急会诊例数285例(24.8%),常规会诊例数865例(75.2%)。531例(46.2%)继发于申请会诊科室所属的系统疾病,89例(7.7%)为医源性神经系统损害,75例(6.5%)为精神障碍性疾病。常规会诊以头晕/眩晕最多共243例,占常规会诊的25.5%;急会诊以急性脑血管病最多,共79例,占急会诊总数的39.9%。结论会诊病例神经系统损害多数与其他系统疾病有关;急会诊最常见的病种为急性脑血管病,常规会诊最常见的病种为头晕;部分神经系统损害与医源性因素有关;外科会诊主要目的为手术风险评估,内科会诊主要目的为脑血管病二级预防。