康复医院残疾患者医疗欠费状况的研究

目的：分析康复医院残疾患者住院欠费的情况，为减少或杜绝医疗欠费提供资料。方法：112例脊髓损伤、脑卒中、脑瘫出院的康复患者欠费个案作为调查研究对象进行统计分析。结果：康复残疾患者拖欠医疗费用总金额为1231829．82元，人均欠费10998．48元。欠费人员多为外地国有中小企业职工、农民工，欠费方式因经济困难无力支付费用占总欠费用的78．0％，逃费占12．9％，医疗纠纷占9．1％。结论：康复医疗机构应加强医疗欠费的管理；政府部门应建立并完善医疗法制管理制度和社会救助基金制度，切实维护医患双方合法权益。     

关于“问题患者”的特征和成因的质性研究

目的了解问题患者的特征以及成因,探讨问题患者的应对方法。方法以质性研究方法对20名临床护士进行半结构式、面对面的深度访谈以收集资料。结果 问题患者的特征包括攻击性行为、行为和症状前后不一致、要求过多过高、不寻常的求医行为、依从性差、不信任医务人员、自认为是专家、坏消息的传播者以及多种复杂的社会问题,其成因包括患者因素、医护人员因素和其他因素。结论及时识别问题患者表现,分析问题患者的特征以及成因,针对问题患者成因采取不同的应对方法,有助于减少护患矛盾。     

浅谈药房药品差错原因及防止措施

药品的安全关系到患者的健康,做好医院药房药品的监管工作对于维护医院声誉,保障患者各项权利有着重要的意义。笔者将从药房药品的差错分类出发,分析出药品差错的原因,从而探索出相关的防治措施。     

个案管理模式应用于特发性中枢性性早熟患儿及其主要照护者的效果分析

目的探讨个案管理模式应用于特发性中枢性性早熟(ICPP)患儿及其主要照护者的效果,为特发性中枢性性早熟患儿及其主要照护者提供更加专业的、有效的临床护理及延伸服务,从而进一步提高满意度,降低特发性中枢性性早熟患儿主要照护者焦虑的发生。方法选取我院2014年3-9月确诊的96例ICPP患儿及其主要照护者为研究对象,将96例ICPP患儿及其主要照护者随机分为观察组和对照组,研究过程中,对照组4例患儿失访退出。最终完成研究的患儿为对照组44例,观察组48例。观察组接受个案管理,对照组接受常规护理,分别于确诊当日和接受治疗1年后,比较患儿主要照护者的焦虑发生率、患儿治疗依从性及患儿主要照护者满意度。结果两组患儿主要照护者焦虑程度、满意度前后对比以及患儿治疗依从性差异有统计学意义(P0.05)。结论应用个案管理模式能够减少患儿主要照护者的焦虑发生、提高患儿治疗依从性,从而提高患儿及主要照护者的生活质量,还可提高患儿主要照护者的满意度,改善护患关系。     

Endoscopic ultrasound elastography for small solid pancreatic lesions with or without main pancreatic duct dilatation

Background/Objectives: Endoscopic ultrasound elastography (EUS-EG) is useful for diagnosis of small solid pancreatic lesions (SPLs), particularly in excluding pancreatic cancer (PC), but its dependence on main pancreatic duct dilatation (MPDD) has not been examined. We aimed to investigate EUS-EG for diagnosis of small SPLs with and without MPDD.MethodsPatients with pathologically diagnosed SPLs of ≤20 mm were included and retrospectively analyzed. Using the blue:green ratio, an EUS-EG image was classified as blue-dominant, equivalent, or green-dominant. Using multiple EUS-EG images per patient, a lesion with a greater number of blue-dominant than green-dominant images was classified as stiff, and the others as soft. EUS-EG images in random order were judged by three raters. Considering stiff SPLs as PC, diagnostic performance of EUS-EG was examined for SPLs with and without MPDD.ResultsOf 126 cases analyzed, 65 (52%) were diagnosed as PC, and 63 (50%) had MPDD. A total of 1077 EUS-EG images were examined (kappa coefficient = 0.783). Lesions were classified as stiff in 91 cases and soft in 35 (kappa coefficient = 0.932). The ratio of stiff to soft lesions was significantly higher in PC than in non-PC (62:3 vs. 29:32, P < 0.001). The sensitivity, specificity, and negative predictive value of a stiff lesion with vs. without MPDD for diagnosis of PC were 94%, 23%, and 50% vs. 100%, 60%, and 100%, respectively.ConclusionsUsing the EUS-EG stiffness classification for small SPLs, PC can be excluded with high confidence and concordance for a soft lesion without MPDD.     

结核病管理策略对复治原因的影响研究

目的　研究结核病不同管理策略对造成结核病复发原因的影响。方法 使用调查表方法,对结核病复治病人进行入户调查。结果 1993—1997年结核病三类不同管理策略地区结核病复发人数总体呈下降趋势,但是ITP地区逐年下降幅度大,NTP和CTT地区下降幅度平缓。造成复发的原因主要是“未按医嘱坚持治疗”、“用药不合理”与“治疗不正规”,CTT地区结核病复发的最主要原因是“未按医嘱坚持治疗”人数达70%。结论 加强对初治TB病例规范治疗,减少TB复治病例产生。     

Final results of a long-term,clinical follow-up in fatty liver patients

Objective. There is increasing focus on non-alcoholic fatty liver disease (NAFLD). The aim of the present study was to conduct a long-term clinical follow-up of patients with biopsy-confirmed fatty liver without inflammation or significant fibrosis (pure fatty liver), to analyse for potential risk factors at the time of index liver biopsy important for survival and the development of cirrhosis and to describe the causes of death. Material and methods. Patients were linked through their personal identification number to the Danish National Registry of Patients and the Register of Causes of Death. All admissions, discharge diagnoses and causes of death during follow-up were collected. All surviving patients were invited to a clinical follow-up. Results. The follow-up period was 20.4 and 21.0 years, respectively, for the NAFLD and alcoholic fatty liver disease (AFLD) groups. Two NAFLD patients (1.2%) developed cirrhosis during the follow-up period versus 54 (22%) AFLD patients. Sixty-four percent of 178 surviving patients out of an original cohort of 417 patients attended the clinical follow-up. In NAFLD patients, none of the risk factors studied was significant in relation to the risk of death. Patients with AFLD died primarily from cirrhosis and other alcohol-related disorders, whereas in patients with NAFLD the main causes of death were cardiovascular disease and cancer. Conclusions. For patients with pure non-alcoholic fatty liver, survival was good and independent of the histological, clinical and biochemical characteristics at the time of biopsy; the main causes of death were cardiovascular disease and cancer.     

离休干部172例在院死亡疾病谱分析

目的：探讨在长海医院住院去世的上海军队离休干部的死亡原因及其变化趋势。方法选取1985年3月至2013年1月上海军队干休所死亡离休干部172例及其死亡登记表,分析死因顺位及死因构成比。结果1985年1月～2013年1月,该队列人群前5位死因构成比分别为：肿瘤（41.9%）,神经系统疾病（16.9%）,循环系统疾病（15.7%）,呼吸系统疾病（10.5%）和内分泌、营养与代谢疾病（7.6%）。前5位死亡病种分类构成比分别为：肿瘤（42.4%）,冠心病（12.8%）,慢性阻塞性肺疾病（8.7%）,脑梗死（8.1%）和2型糖尿病（7.6%）。肿瘤死亡顺位及构成比前8位分别为：肺癌（35.6%）,胰腺癌（9.6%）,直肠癌和胃癌（均为8.2%）,前列腺癌和肝癌（均为5.5%）,淋巴瘤和多发性骨髓瘤（均为4.1%）。结论肿瘤是老年患者最主要的致死原因,心脑血管疾病也是老年患者住院死亡的主要原因之一,应加强肿瘤与心脑血管疾病的防治工作。     

经络综合导引治疗仪的研制

经络综合导引治疗仪是根据祖国医学的经络学说和养气功理论，应用呼气启动导引，视觉模型提示和穴位电刺激的多因素共同作用，导引气血沿经络运行。主要用于强化瘫痪肢体的康复。该治疗仪以单片微机为程控中心，通过硬件设计和软件开发，实现了呼气触发，视觉提示和位电刺激同步发，１６和电极依次选通和数字化幅度调节等多种功能。     

《诸病源候论》对皮肤病学的贡献

对《诸病源候论》在皮肤病方面的成就进行了较为系统的整理总结 ,该书着重讨论了皮肤病的命名、分类、病因病机 ,并阐发了《内经》“邪之所凑 ,其气必虚”理论和预防为主的思想。