CLINICAL CONTRIBUTIONS TO ADMINISTRATIVE PRACTICE

No abstract available for this article.     

Strategies of Intervention with Families of Pediatric Leukemia Patients

As part of a longitudinal research study, families of children with leukemia were provided with a psychosocial intervention program over a two-year period. This paper describes the approaches used at specific times during the illness: diagnosis and initial treatment, early outpatient treatment, later outpatient treatment, remission, relapse, and death. the goals of the intervention strategies were to facilitate: an understanding of the realities of the illness; management of emotional distress; and utilization of resources to care for the child, attend to other responsibilities, and support and communicate with one another.     

中国公立医院资源配置思路与测算

目的:加强对公立医疗资源的调控,明确公立医疗资源配置标准,提高利用效率.方法:分析公立医院循环扩张模型,在以病床数为标准的完善医疗资源调控思路下,通过趋势外推法预测我国病床需求总量及结构.结果:2020年我国千人口病床数为5.7张,社会办医床位占比达到30％,基层公立医疗机构、二、三级公立医院病床比例稳定在目前的3∶4∶2.结论:在确定医疗资源配置标准后,还需要从投入政策、治理模式和决策权划分3个角度完善医疗资源配置机制.     

高值耗材在医院大量使用的影响及对策

解决看病贵是我国医改的重点,更是广大民众的企盼.但当前在政府、医院及有关部门千方百计降低药费的同时,由于高值耗材在医院不规范的大量使用,造成患者的经济负担依旧很重,看病贵的难题没有得到实际意义上的破解.文章从分析高值耗材在医院使用的现状入手,就加强医院内控制度建设和有关行政部门如何规范、指导等方面提出了对策.     

The Impact of Hospital Quality on Profits,Volume, and Length of Stay

Using 2006–2007 data from a sample of 6,082 U.S. hospitals, quality of care measures developed by the Hospital Quality Alliance (HQA) are applied to heart attack, heart failure, pneumonia, and surgery. Quality of care for these was related to both higher profits per case and increased number of cases. Length of stay was inversely related to quality of care for preventative (surgical and heart attack) care.     

Transient loss of consciousness with and without injuries

Objectives: Transient loss of consciousness (LOC) is a fairly common phenomenon and frequently carries a risk of injury. The aim was to study the occurrence of injuries and causes of emergency referrals versus later specialist consultation in association with LOC in the primary healthcare setting.

Methods: A four-month survey was carried out in the Primary Healthcare Emergency Department of the City of Tampere, Finland (198,000 inhabitants). The subjects comprised consecutive patients aged at least 15 years, attending a primary healthcare emergency department because of LOC. The type of LOC was determined (seizure, syncope and uncertain) and the type and site of all injuries associated with LOC were registered. All referrals to hospital or specialist consultation because of LOC were also registered and the predictors of admission were analysed by logistic regression modelling.

Results: Injury was associated with 43 (20%) out of 220 visits because of LOC; in 12/72 (17%) cases with syncope, in 24/118 (20%) with seizures and in 7/30 (23%) with an uncertain cause of LOC. Most of the injuries were minor. Emergency referral was required in 45/220 (20%) cases of LOC. Coronary heart disease and injury were the main predictors of emergency referral to hospital.

Conclusions: Injuries are as frequent in patients with syncope as in those suffering seizures. Most patients with LOC in primary healthcare emergency departments do not seem to require emergency admission to hospital.     

Impact of the sustained control of cardiovascular risk factors on first episode heart failure: The relevant role of primary care

Background: The role of cardiovascular risk factor control in the development of heart failure (HF) has not yet been clearly established.

Objective: To determine the effect of cardiovascular risk factor control on the occurrence of a first episode of hospital admission for HF.

Methods: A case-control study using propensity score-matching was carried out to analyse the occurrence of first hospital admission for HF taking into account the degree of cardiovascular risk factor control over the previous 24 months. All patients admitted to the cardiology unit of the Hospital del Mar between 2008 and 2011 because of a first episode of HF were considered cases. Controls were selected from the population in the hospital catchment area who were using primary care services. Cardiovascular risk factor measurements in the primary healthcare electronic medical records prior to the first HF episode were analysed.

Results: After the matching process, 645 participants were analysed (129 HF cases and 516 controls). Patients suffering a first HF episode had modest increments in body mass index and blood pressure levels during the previous two years. Adjusted odds ratio for experiencing a first HF hospital admission episode according to systolic blood pressure levels and body mass index was (OR: 1.031, 95% CI: 1.001–1.04), and (OR: 1.09, 95% CI: 1.03–1.15), respectively.

Conclusion: Increased levels of body mass index and systolic blood pressure during the previous 24 months may determine a higher risk of having a first HF hospital admission episode.     

加快转型转变 推动全面发展 为能打胜仗提供强有力的卫勤保障

本文回顾总结军区医院疗养院十年来的建设成绩和问题,分析建设发展形势,提出到2020年医院建设目标任务,探讨加快军区医院疗养院建设发展的对策措施。     

Impotence: Etiology and Management

There has never been a more favorable outlook for the patient with impotence. In the current climate of growing interest and candor regarding human sexuality, patients Eire more inclined to seek help, and physicians and other therapists are better informed. Improved understanding of pathophysiology and psychosexuality has enhanced the effectiveness of new approaches to treatment.