肝硬化门脉高压并上消化道出血治疗方法探讨

目的探讨肝硬化门脉高压并上消化道出血的治疗方法。方法回顾性分析128例肝硬化门脉高压并上消化道出血患者的临床资料,对不同出血类型患者予以不同治疗。结果治疗后,2周内未出现活动性出血117例,出血症状持续11例,其中因医治无效死亡3例,治疗有效率为91.4%。128例患者出血诱因分别为药物38例(29.7%),饮酒36例(28.1%),过劳20例(15.6%),精神压力21例(16.4%),诱因不明13例(10.2%)。结论肝硬化门脉高压并上消化道出血治疗时要及时明确患者的出血病因,探寻出血诱因。质子泵抑制剂(PPI)适用于治疗消化性溃疡出血患者;介入治疗适用于门脉高压性胃出血患者;生长抑素及其衍生物有助于降低门静脉压,适用于治疗食管胃底曲张静脉破裂出血患者。     

Who benefits from extended continuing care for cocaine dependence?

The goal of this study was to determine which cocaine dependent patients engaged in an intensive outpatient program (IOP) were most likely to benefit from extended continuing care (24 months). Participants (N = 321) were randomized to: IOP treatment as usual (TAU), TAU plus Telephone Monitoring and Counseling (TMC), or TAU plus TMC plus incentives for session attendance (TMC +). Potential moderators examined were gender, stay in a controlled environment prior to IOP, number of prior drug treatments, and seven measures of progress toward IOP goals. Outcomes were: (1) abstinence from all drugs and heavy alcohol use, and (2) cocaine urine toxicology. Follow-ups were conducted at 3, 6, 9, 12, 18, and 24 months post-baseline. Results indicated that there were significant effects favoring TMC + over TAU on the cocaine urine toxicology outcome for participants in a controlled environment prior to IOP and for those with no days of depression early in IOP. Trends were obtained favoring TMC over TAU for those in a controlled environment (cocaine urine toxicology outcome) or with high family/social problem severity (abstinence composite outcome), and TMC + over TAU for those with high family/social problem severity or high self-efficacy (cocaine urine toxicology outcome). None of the other potential moderator effects examined reached the level of a trend. These results generally do not suggest that patients with greater problem severity or poorer performance early in treatment on the measures considered in this report will benefit to a greater degree from extended continuing care.     

Breast pumps as an incentive for breastfeeding: a mixed methods study of acceptability

Increasing breastfeeding rates would improve maternal and child health, but multiple barriers to breastfeeding persist. Breast pump provision has been used as an incentive for breastfeeding, although effectiveness is unclear. Women's use of breast pumps is increasing and a high proportion of mothers express breastmilk. No research has yet reported women's and health professionals' perspectives on breast pumps as an incentive for breastfeeding. In the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study, mixed methods research explored women's and professionals' views of breast pumps as an incentive for breastfeeding. A survey of health professionals across Scotland and North West England measured agreement with ‘a breast pump costing around £40 provided for free on the NHS’ as an incentive strategy. Qualitative interviews and focus groups were conducted in two UK regions with a total of 68 participants (pregnant women, new mothers, and their significant others and health professionals) and thematic analysis undertaken. The survey of 497 health professionals found net agreement of 67.8% (337/497) with the breast pump incentive strategy, with no predictors of agreement shown by a multiple ordered logistic regression model. Qualitative research found interrelated themes of the ‘appeal and value of breast pumps’, ‘sharing the load’, ‘perceived benefits’, ‘perceived risks’ and issues related to ‘timing’. Qualitative participants expressed mixed views on the acceptability of breast pumps as an incentive for breastfeeding. Understanding the mechanisms of action for pump type, timing and additional support required for effectiveness is required to underpin trials of breast pump provision as an incentive for improving breastfeeding outcomes. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.     

106例小儿药物中毒发生情况及危险因素分析

目的 探讨引起小儿药物中毒发生情况并分析其诱因.方法 以2016年9月至2019年9月本院收治的106例药物中毒小儿为研究对象,采用横断面研究模式,分析中毒患儿中常见药物及临床表现,同期以160例非药物中毒患儿为对照组,两组均发放问卷调查,分析影响患儿中毒的危险因素.结果 (1)106例患儿中34.91％ 为3～6岁,...     

Behavioural pharmacology of food, water and salt intake in relation to drug actions at benzodiazepine receptors

Drugs which are agonists at benzodiazepine receptors produce many interesting behavioural effects, and amongst these are the stimulation of food, water and salt intake. This review examines the evidence for benzodiazepine effects on these forms of ingestion, and makes tentative proposals about their modes of action. The recent advent of putative benzodiazepine antagonists and inverse agonists provides important new pharmacological tools for the analysis of factors which control ingestion. Preliminary data on examples of such drugs are considered. Anorectic effects of inverse agonists are described. It is clear, though, that the categorization of a drug in one test situation may not apply to another. For example, the compound Ro15-1788 appears as a specific antagonist in one test, a partial agonist in another, and apparently lacks effect in a third. We are not yet sufficiently forward in our understanding of drug actions at benzodiazepine receptors, and their interactions with particular test circumstances, to predict and account for divergent effects of this kind.     

Nursing shortages and evidence-based interventions: a case study from Scotland

In this report, key aspects of change in the labour market for nurses in Scotland are examined, and an integrated policy framework intended to improve nurse recruitment, retention and utilization is outlined. The purpose of this article is to provide an overview of the dynamics of the nursing labour market in Scotland and to draw some more general messages from the evidence base on the effectiveness of interventions to improve recruitment and retention of nursing staff. The paper has three main elements: it provides a backdrop of key trends in the Scottish nursing labour market; it summarizes issues related to planning and nursing shortages, including an assessment of the utility of current indicators of recruitment and retention difficulties; and it reviews the main potential interventions to address nurse recruitment and retention difficulties, drawing from key research/evidence from UK and other English language sources. Five main interventions are examined: integrating the planning of the healthcare workforce; improving recruitment; incentives to improve retention; improving staff deployment; and improving utilization/skill mix.     

Has Pay-for-Performance Decreased Access for Minority Patients?

Objective. To examine whether the CMS and Premier Inc. Hospital Quality Incentive Demonstration (PHQID), a hospital-based pay-for-performance (P4P) and public quality reporting program, caused participating hospitals (1) to avoid treating minority patients diagnosed with acute myocardial infarction (AMI), heart failure, and pneumonia and (2) to avoid providing coronary artery bypass graft (CABG) to minority patients diagnosed with AMI.
Data Sources. One hundred percent Medicare inpatient claims, denominator files, and provider of service files from 2000 to 2006.
Study Design. We test for differences in the conditional probability of receiving care at PHQID hospitals for AMI, heart failure, and pneumonia before and after implementation of the PHQID between white and minority patients. We also test for differences in the conditional probability that white and minority patients diagnosed with AMI receive CABG in hospitals participating, and not participating, in the PHQID before and after the implementation of the PHQID.
Data Extraction Methods. Data were obtained from CMS.
Principal Findings. We find little evidence that the PHQID reduced access for minority patients: only "Other Race" beneficiaries had a significant reduction in adjusted admissions to PHQID hospitals in the postperiod, and only for AMI. Only marginally significant (  p <.10) evidence of a reduction in CABG was found, also occurring for Other Race beneficiaries.
Conclusions. Despite minimal evidence of minority patient avoidance in the PHQID, monitoring of avoidance should continue for P4P programs.     

The search for good compliance: economic aspects of a conveyed combination pharmaco-therapy,exemplified by an osteoporosis therapy

The discussion of adequate compliance in health care often refers to a lack of information between patients and physicians. In our setting, we show that contract arrangements as well as the distribution of information are important for an adequate alignment of the interest of patients and physicians. The analysis emphasises the benefit of organised pharmaco-therapy enhancing the concomitant compliance. Therefore, the results can work as a proxy for the need of good economic-based approaches discussing compliance in chronic diseases.     

Internet-based group contingency management to promote abstinence from cigarette smoking: a feasibility study

Background

In contingency management (CM) interventions, monetary consequences are contingent on evidence of drug abstinence. Typically, these consequences are contingent on individual performance. Consequences contingent on group performance may promote social support (e.g., praise).

Methods

Thus, to combine social support with the monetary incentives of CM, we integrated independent and interdependent group contingencies of reinforcement into an Internet-based intervention to promote smoking abstinence. Breath carbon monoxide (CO) measures were compared between treatment conditions and a baseline control condition. Thirteen participants were divided into 5 groups or “teams” (n = 2-3 per team). Each participant submitted video recordings of CO measurement twice daily via the Internet. Teammates could monitor each other's progress and communicate with one another through an online peer support forum. During a 4-day tapering condition, vouchers exchangeable for goods were contingent on gradual reductions in breath CO. During a 10-day abstinence induction condition, vouchers were contingent on abstinence (CO ≤ 4 ppm). In both treatment conditions, concurrent independent and interdependent group contingencies were arranged (i.e., a mixed contingency arrangement).

Results

Less than 1% of CO samples submitted during baseline were ≤ 4 ppm, compared to 57% submitted during abstinence induction. Sixty-five percent of participants’ comments on the online peer support forum were rated as positive by independent observers. Participants rated the intervention favorably on a treatment acceptability questionnaire.

Conclusion

The results suggest that the intervention is feasible and acceptable for promoting abstinence from cigarette smoking.