早期康复训练对脑卒中偏瘫患者功能恢复的影响

目的:探讨康复训练对早期脑卒中偏瘫患者功能恢复的影响。方法:60例早期脑卒中偏瘫患者随机分为康复组和对照组各30例,均接受常规神经科治疗和早期良肢位摆放,康复组同时进行包括头、颈、肩、躯干、臀、足部的运动及床上运动训练。治疗前后采用Brunnstrum评价肢体功能;Barthel指数评价ADL。结果:治疗3个月后,2组患者肢体功能和ADL与治疗前比较均有提高,康复组疗效优于对照组(P<0.01)。结论:本文拟定的康复训练计划为脑卒中偏瘫患者的功能恢复提供了一套有效的训练方法。     

Racial disparities in family-provider interactions for pediatric asthma care

Objective: Black and Latino children experience significantly worse asthma morbidity than their white peers for multifactorial reasons. This study investigated differences in family-provider interactions for pediatric asthma, based on race/ethnicity. Methods: This was a cross-sectional study of parent surveys of asthmatic children within the Population-Based Effectiveness in Asthma and Lung Diseases Network. Our study population comprised 647 parents with survey response data. Data on self-reported race/ethnicity of the child were collected from parents of the children with asthma. Outcomes studied were responses to the questions about family-provider interactions in the previous 12 months: (1) number of visits with asthma provider; (2) number of times provider reviewed asthma medications with patient/family; (3) review of a written asthma treatment plan with provider; and (4) preferences about making asthma decisions. Results: In multivariate adjusted analyses controlling for asthma control and other co-morbidities, black children had fewer visits in the previous 12 months for asthma than white children: OR 0.63 (95% CI 0.40, 0.99). Additionally, black children were less likely to have a written asthma treatment plan given/reviewed by a provider than their white peers, OR 0.44 (95% CI 0.26, 0.75). There were no significant differences by race in preferences about asthma decision-making nor in the frequency of asthma medication review. Conclusion: Black children with asthma have fewer visits with their providers and are less likely to have a written asthma treatment plan than white children. Asthma providers could focus on improving these specific family-provider interactions in minority children.     

Provider networks and primary‐care signups: do they restrict the use of medical services?

This article analyzes the effect of gatekeeper and network restrictions on use of health‐care services using simulation‐based estimation methods. Data from the Community Tracking Survey (1996–1997) show significant evidence of selection into plans with gatekeeper and/or network restrictions. Enrollees in plans with networks of physicians have fewer office‐based visits to non‐physician medical professionals, but more emergency room visits and hospital stays. Individuals in plans that require signups with a primary‐care provider have more visits to non‐physician providers of care, more surgeries and hospital stays but substantially fewer emergency room visits. Enrollees of plans that do not pay for out‐of‐network services have more office‐based and emergency room visits, but less surgeries and hospitalizations. Copyright © 2008 John Wiley & Sons, Ltd.     

浅谈移动平均法在医院药品采购计划生成中的应用

目的:为医院药品采购计划的科学、合理生成提供一种方法。方法:根据影响药品采购计划的主要因素,通过移动平均法数学原理建立医院药品采购计划模型计算公式,并加以实践。结果:由该模型计算得到的预测用量能较快地跟踪实际使用量,采用该模型可以自动调整库存,动态预测药品采购数量。结论:该模型有助于实现医院药品采购计划的科学、合理生成,可保障临床绝大部分用药需求。     

独生与非独生儿童心理发展的纵向分析:南京的十年追踪研究

目的： 纵向探讨家庭计划生育对独生与非独生儿童的心理发展、行为模式与性格特征有何长期性的影响，方法：采用中文版Ａｃｈｅｎｂａｃｈ 行为量表对同一群体的儿童作纵向观察，在十年期间按心理发展阶段作四次调查与分析。对所得资料就行为问题总分及个别项目作检验。结果： 行为问题随年龄增大而减少，独生与非独生男孩原有的差异到了青少年期大致消失。但独生女孩的内向性行为问题与非独生女孩比较，并没因时间的延长而减少，到青少年时仍有差异。本研究提示独生与否对心理发展上的长期影响有性别上的不同。     

Search costs and Medicare plan choice

There is increasing evidence suggesting that Medicare beneficiaries do not make fully informed decisions when choosing among alternative Medicare health plans. To the extent that deciphering the intricacies of alternative plans consumes time and money; the Medicare health plan market is one in which search costs may play an important role. To account for this, we split beneficiaries into two groups – those who are informed and those who are uninformed. If uninformed, beneficiaries only use a subset of covariates to compute their maximum utilities, and if informed, they use the full set of variables considered. In a Bayesian framework with Markov Chain Monte Carlo (MCMC) methods, we estimate search cost coefficients based on the minimum and maximum statistics of the search cost distribution, incorporating both horizontal differentiation and information heterogeneities across eligibles. Our results suggest that, conditional on being uninformed, older, higher income beneficiaries with lower self‐reported health status are more likely to utilize easier access to information. Copyright © 2009 John Wiley & Sons, Ltd.     

Standardized care plans in Swedish health care: their quality and the extent to which they are used

Objectives:  To investigate the quality of standardized care plans and the extent to which they are used within Swedish in-hospital somatic care. Further, to examine the quality of the knowledge summaries on which existing standardized care plans were supposed to be based.
Design:  Submitted documents were reviewed with study-specific protocols.
Setting:  A national survey, based on a structured selection of Swedish hospitals.
Participants:  A total of 25 Swedish hospitals participated, and were asked to submit all documents in use that were labelled standardized care plan.
Results:  Only 4% (34 out of 782) of the reviewed documents fulfilled the criteria for being a standardized care plan. None of the 34 knowledge summaries (an accompanying document with a compilation of scientific facts and reliable experience) was evidence-based.
Conclusions:  There is a lack of knowledge regarding what a standardized care plan is, and how such a document should emanate from evidence-based knowledge. Our results raise the question of how recent developments in research are used to create standardized care plans for the best possible care. In the process of developing standardized care plans it is important to acknowledge that staff who develop these plans need scientific training and experience. Standardized care plans are in the early stages of development, and at this stage it seems appropriate to initiate a discussion regarding possible cooperation at national level when developing standardized care plans for certain large groups of patients suffering from specific diseases, or undergoing the same treatment.     

DWJ—SXI型实芯滴丸机设计方案

DWJ-SXI型实芯滴丸机以脉冲液强制将药液流切断,落入冷却液成形,通过控制脉冲周期来控制药液流的长度,达到控制丸重;可使操作简便,易于机构调试,减少滴头品种,提高成品率,降低成本。     

The challenge of using the low back pain guidelines: a qualitative research

PURPOSE: Current low back pain (LBP) clinical guidelines have helped to summarize the scientific evidence and research, but have failed to provide tools and guide family physicians (FPs). The purpose of this study is to identify barriers and facilitators for the implementation of LBP guidelines from family FPs' perspective. METHODS: A qualitative focus group study of FPs in the north of Israel. Purposeful sampling was used to recruit participants, all of them board-certified FPs. Four focus groups were created, and discussions were taped, transcribed and analysed for major themes. RESULTS: Focus groups findings have expanded the understanding of the intellectual and mental challenges faced by Israeli FPs caring for LBP patients and highlighted the many obstacles to implementing LBP guidelines. Physicians' decision-making, pertaining to LBP, functions on three levels simultaneously: the physicians' agenda based on familiarity with the guidelines; their need to remain grounded in the context of the specific patient-doctor relationship; and the constraints and demands of the physician's workplace, medical system and environment. CONCLUSIONS: Despite an overall positive attitude towards LBP guideline implementation, FPs found it hard to come to terms with the conflicting dimensions of LBP patient care. The patient-doctor interaction determined the outcome of the encounter, whether it complied with the guidelines and whether the encounter leads to a healing process or to a vicious circle of unnecessary utilization of services.