健康素养在脑卒中患者积极度与自我管理行为间的中介效应

目的 探讨脑卒中患者健康素养、患者积极度和自我管理行为的现状,明确三个变量间关系,并探讨健康素养在患者积极度与自我管理行为间的中介效应。方法 采用一般资料问卷、慢性病健康素养调查量表、患者积极度量表、脑卒中自我管理行为调查问卷对河南省4所三级甲等医院就诊的223名脑卒中患者进行调查。结果 脑卒中患者健康素养得分为（82.30±15.28）分,自我管理行为得分为（40.89±9.74）分,患者积极度得分为（45.21±11.30）分。脑卒中患者健康素养、自我管理行为与患者积极度三个变量间呈正相关（r值分别为0.622、0.479、0.457,且均P<0.01）;且健康素养在患者积极度与自我管理行为间起显著部分中介效应,中介效应占总效应的53.79%。结论 脑卒中患者健康素养、患者积极度可预测其自我管理行为,且患者积极度既可直接影响自我管理行为,也可通过健康素养间接影响自我管理行为。     

Dose to patients through nuclear medicine procedures in a department in northern Greece

Diagnostic nuclear medicine procedures in a large hospital in northern Greece during 1984–1988 have been surveyed in order to estimate the radiation burden to the patients. The mean effective dose equivalent (EDE) was found to be 1.96 mSv/examination and 2.46 mSv/patient, allowing for the fact that a number of patients underwent more than one examination. Apart from EDE, absorbed dose has been calculated for bone marrow, thyroid, gonads, kidneys and bladder. Patients undergoing multiple examinations have been used to calculate true patient dose distribution as well as patient time-weighted dose distribution. Because of the predominance of renal examinations, 8.5 fatal renal malignancies are expected per 100000 patients.     

穴位体表电刺激对术后PCEA的强化效应

目的　观察穴位体表电刺激对术后患者硬膜外自控镇痛（PCEA）效果、镇痛药用量、血清皮质醇浓度和不良反应的影响。方法　 选择经腹全宫切除术患者40例（ASAⅠ～Ⅱ级）,随机分成二组,每组20例。A组：于术后第4,8小时 Han's各刺激30 min,术后行PCEA。B组：单纯行术后PCEA（对照组）。术后随访镇痛效果、镇静评分、布氏舒适评分（BCS）,分段记录24 h镇痛药用量及总按压次数/实进次数（D1/D2）比值,血清皮质醇含量,肛门恢复排气时间和不良反应情况。结果　两组镇痛效果满意,A组BCS评分高于B组（P＜0.05）。A组镇痛药用量为（31.7±1.9）ml,与对照组（34.2±2.1）ml相比差异有显著性（P＜0.01）。血清皮质醇浓度两组均较术前下降,但A组术后8 h的下降幅度大于对照组。A组恢复肛门排气时间快于B组,而且恶心、呕吐与对照组相比有所减少。结论　术后患者硬膜外腔自控镇痛（PCEA）复合应用穴位体表电刺激,可增强镇痛效果,减少用药量,降低不良反应,是安全有效的复合镇痛方法。     

对当前医患关系的再认识

医患关系在是规范浪潮冲击下出现了一些新的特征,同时也为医患双方提出了新的要求,作为医务人员一方应主动建立以病人为中心,充分新生病人权力的医疗服务体系,用主尚的医德医风去缔结医患关系。     

分娩镇痛的临床观察

目的 探讨布比卡因硬膜外自控镇痛和罗湃卡因蛛风膜下腔－硬膜外自控镇痛用于分娩的效果及对产程、母婴的影响。方法 ９０例初产妇分为３组,布比卡因硬膜外自控镇痛组（Ａ组,ｎ＝３０）、罗哌卡因蛛网膜下腔－硬膜外自控镇痛组（Ｂ组,ｎ＝３０）和对照组（Ｃ组,ｎ＝３０,未行分娩镇痛）,观察各组镇痛效果、产程时间、分娩方式血清皮质醇及新生儿Ａｐｇａｒ评分情况。结果 Ａ,Ｂ组镇痛效果满意,以Ｂ组为佳两组 产程未血清     

The role of carbon dioxide and atmospheric air in double-contrast barium enema

Background Patient discomfort 0–24 h after double-contrast barium enema (DCBE) was investigated in two ways.Methods In part 1, 139 patients, not previously informed, were contacted by telephone to assess symptom rates without bias. In part 2, designed as a prospective randomized double-blind trial, the effect of carbon dioxide (CO₂) as an insufflating gas was compared with conventional atmospheric air (AA).Results Part 1: 10% experienced severe abdominal pain, and 18% severe abdominal distention. Part 2: Low discomfort rates were found for both severe pain (7% for AA vs. 2% for CO₂) and severe distention (13% for AA vs. 8% for CO₂); the differences were not significant. In both parts of the study, female patients with a history of abdominal discomfort of colon irritabile type were significantly overrepresented in the severely symptomatic groups. Equal numbers of patients experiencing severe abdominal distention for the first time were found in both the AA and CO₂ groups, ruling out AA as the sole cause of these symptoms.Conclusion Abdominal post-DCBE discomfort seems to be less frequent than previously reported and is not effectively eliminated by CO₂. We still find the use of AA in DCBEs justified.     

病人图书馆是医院图书服务的新领域

建立病人图书馆,以“图书治疗”、“图书护理”为患者提供服务,是现代医学模式转变的需要。国外病人图书馆的发展对病人治疗康复已起到了积极的作用。我国应根据国情建立不同模式的病人图书馆,为患者提供多种多样的服务。     

Impact of Generalist Care Managers on Patients with Diabetes

Objective. To determine how the addition of generalist care managers and collaborative information technology to an ambulatory team affects the care of patients with diabetes.
Study Setting. Multiple ambulatory clinics within Intermountain Health Care (IHC), a large integrated delivery network.
Study Design. A retrospective cohort study comparing diabetic patients treated by generalist care managers with matched controls was completed. Exposure patients had one or more contacts with a care manager; controls were matched on utilization, demographics, testing, and baseline glucose control. Using role-specific information technology to support their efforts, care managers assessed patients' readiness for change, followed guidelines, and educated and motivated patients.
Data Collection. Patient data collected as part of an electronic patient record were combined with care manager-created databases to assess timely testing of glycosylated hemoglobin (HbA1c) and low-density lipoprotein (LDL) levels and changes in LDL and HbA1c levels.
Principal Findings. In a multivariable model, the odds of being overdue for testing for HbA1c decreased by 21 percent in the exposure group ( n =1,185) versus the control group ( n =4,740). The odds of being tested when overdue for HbA1c or LDL increased by 49 and 26 percent, respectively, and the odds of HbA1c <7.0 percent also increased by 19 percent in the exposure group. The average HbA1c levels decreased more in the exposure group than in the controls. The effect on LDL was not significant.
Conclusions. Generalist care managers using computer-supported diabetes management helped increase adherence to guidelines for testing and control of HbA1c levels, leading to improved health status of patients with diabetes.     

Inadequate pre-operative evaluation and preparation: a review of 197 reports from the Australian incident monitoring study

The Australian Incident Monitoring Study database was examined for incidents involving inadequate pre-operative patient preparation and/or evaluation. Of 6271 reports, 727 had appropriate keywords, of which 197 (3.1%) were used for subsequent analysis. All surgical categories were represented. In 10% of reports the patient was not reviewed pre-operatively by an anaesthetist, whilst in 23% the anaesthetist involved in the operating theatre had not performed the pre-operative assessment. Death followed in seven cases, major morbidity in 23 cases, admission to a high-dependency unit or intensive care unit in 17 cases, and surgery was cancelled in nine cases. Poor airway assessment, communication problems and inadequate evaluation were the most common contributing factors. Respondents indicated that the incident was preventable in 57% of cases. Proposed corrective strategies include improved communication, quality assurance activities, development of protocols and additional training. A structured assessment of the airway, along with improvements in information exchange, patient assessment, and use of clearly defined patient management plans and pathways would prevent most of the incidents reported.