Hypoactive Sexual Desire Disorder: International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel Review

The objective of the International Society for the Study of Women's Sexual Health expert consensus panel was to develop a concise, clinically relevant, evidence-based review of the epidemiology, physiology, pathogenesis, diagnosis, and treatment of hypoactive sexual desire disorder (HSDD), a sexual dysfunction affecting approximately 10% of adult women. Etiologic factors include conditions or drugs that decrease brain dopamine, melanocortin, oxytocin, and norepinephrine levels and augment brain serotonin, endocannabinoid, prolactin, and opioid levels. Symptoms include lack or loss of motivation to participate in sexual activity due to absent or decreased spontaneous desire, sexual desire in response to erotic cues or stimulation, or ability to maintain desire or interest through sexual activity for at least 6 months, with accompanying distress. Treatment follows a biopsychosocial model and is guided by history and assessment of symptoms. Sex therapy has been the standard treatment, although there is a paucity of studies assessing efficacy, except for mindfulness-based cognitive behavior therapy. Bupropion and buspirone may be considered off-label treatments for HSDD, despite limited safety and efficacy data. Menopausal women with HSDD may benefit from off-label testosterone treatment, as evidenced by multiple clinical trials reporting some efficacy and short-term safety. Currently, flibanserin is the only Food and Drug Administration–approved medication to treat premenopausal women with generalized acquired HSDD. Based on existing data, we hypothesize that all these therapies alter central inhibitory and excitatory pathways. In conclusion, HSDD significantly affects quality of life in women and can effectively be managed by health care providers with appropriate assessments and individualized treatments.     

Outcomes After Intensive Rehabilitation for Mechanically Ventilated Patients: A Nationwide Retrospective Cohort Study

ObjectiveTo examine the effects of intensive rehabilitation on mortality and liberation from mechanical ventilation among patients with mechanical ventilation in intensive care units.DesignRetrospective cohort study using the Diagnosis Procedure Combination inpatient database.SettingPatients discharged from acute care hospitals from April 2010 to March 2016.ParticipantsPatients (N=46,438) aged 20 years and older who were admitted to intensive care units and who started rehabilitation within 3 days of starting mechanical ventilation.InterventionIntensive rehabilitation in intensive care unit in the first 5 days after admission. Amount of rehabilitation was defined as the average number of units per day in the first 5 days after admission and was dichotomized as intensive (≥1.0 unit/d) or nonintensive (<1.0 unit/d) rehabilitation.Main Outcome MeasuresThe primary outcome was in-hospital mortality. The secondary outcome was liberation from mechanical ventilation.ResultsWe identified 29,982 eligible patients, including intensive (n=7745) and nonintensive (n=22,237) rehabilitation groups. In the propensity score-matched analysis, the intensive rehabilitation group had significantly lower in-hospital mortality (risk difference: ?3.4%; 95% CI, ?4.9% to ?1.9%) and a higher proportion of liberation from mechanical ventilation (subdistribution hazard ratio, 1.08; 95% CI, 1.03-1.13) compared with the nonintensive rehabilitation group.ConclusionsPatients receiving a higher amount of rehabilitation in intensive care units were less likely to die and more likely to be liberated from mechanical ventilation.     

Psychometric properties of the Chinese Behavior Problems Inventory-01 in children and adolescents with or at risk for intellectual disabilities

As the world's most populous country, China is likely to have the highest number of people with intellectual disabilities (ID) in the world. As many people with ID are susceptible to serious and persistent behavior problems, research by Chinese scientists on this public health issue is needed. However, there are only very few reliable Chinese-language behavior assessment instruments for problem behaviors. To fill this gap we translated the Behavior Problems Inventory-01 (BPI-01; Rojahn, Matson, Lott, Esbensen, & Smalls, 2001) into Chinese. The BPI-01 is an informant-based behavior rating instrument that was designed to assess self-injurious behavior (SIB), stereotyped behavior, and aggressive/destructive behavior in individuals with ID. We then assessed the behavior of 222 children and young adults (age range 1.5–21.5 years) with or at risk for ID from three special needs service programs in mainland China. Teachers or staff members, respectively, served as respondents. The Chinese version of the BPI-01 showed good reliability (internal consistency) and good factor validity tested by confirmatory factorial analysis. We conclude that the Chinese version of the BPI-01 can be used for research and clinical evaluation of Chinese children and adolescents with ID.     

肿瘤患者跌倒常见因素中的病房设施缺陷与改进措施

目的前瞻性对造成住院肿瘤患者跌倒的常见设施配备缺陷进行改进,以降低跌倒发生率。方法统计分析病房设施缺陷致肿瘤住院患者跌倒的原因,提出科学的住院环境与基础设施改进方法。结果所有跌倒病例均与病房环境、设施缺陷有关联性。结论安全文化、综合治理,改进肿瘤病房存在的设施缺陷,能够有效减少肿瘤住院患者跌倒的几率。     

我国卫生技术现存问题分析

利用卫生统计年鉴数据,通过比较分析我国卫生技术的现状,找出我国卫生技术评估存在的问题。建立权威性的卫生技术评估机构,发挥药物经济性评估在卫生技术中的意义,从而合理配置卫生技术资源,解决当前问题,有利于更好的开展卫生技术的改革与发展。     

如何提高专家门诊的资源效应

以某大型综合性医院专家门诊为例,指出专家门诊存在号源稀缺,计划外停诊,出诊科室与门诊部沟通不畅,患者认识误区等问题。提出了以下建议:落实专家团队接诊,完善同资历专家替诊制度,取消点名挂号方式,优化专家诊室管理,改进专家请假流程,加强对患者的引导等。     

Personality, family history, and alcohol use among older men: the VA Normative Aging Study

BACKGROUND: We examined personality traits (Sociability, Impulsivity, Neuroticism) as mediators of the effects of family history on alcohol outcomes. METHODS: A sample of 485 men reported on family history of alcohol problems in 1973, completed the Eysenck Personality Inventory in 1976, and responded to a survey on alcohol use in 1982. RESULTS: Using structural equation modeling, family history was found to have direct effects on number of drinks per day and on the number of alcohol problems, as well as indirect effects mediated through Neuroticism. There were no effects of Sociability or Impulsivity on either alcohol outcome. CONCLUSIONS: In this sample of older men, family history had both direct and indirect effects, and personality traits found to affect alcohol outcomes were different from those that have been found in younger men.     

病案复印常见的问题及改进措施简

从患者、临床医师、病案管理人员三个方面分析病案复印中的常见问题,主要有患者证件携带不齐全、患者信息不全或错误、病案归档不及时或病案资料不完整、病案管理人员的工作压力增大.从而提出通过建立院内宣传系统、提高病案质量、提高病案管理人员自身素质等办法,快捷、方便、高效地为患者提供病案复印.     

内科系统医疗谈话记录存在的问题和管理策略

目的 分析医疗谈话记录存在的问题,探讨管理策略。方法 对5 个科室2013 年8 月-2013 年11 月的203 份谈话记录存在的问题进行分类统计。结果 谈话记录存在问题共39 份,问题发生率19.2%（39/203）,其中存在一项问题29 份,发生率14.3%（29/203）,存在两项及两项以上问题10 份,发生率4.9%（10/203）。所有谈话记录中共存在问题54 项,平均每份1.4 项（54/39）,69.2%（27/39）有沟通无完整的记录。结论 医务工作者充分履行告知义务,认真做好医疗谈话并形成文字记录,提高病历记录质量,减少医疗纠纷。