检索结果-内蒙古大学图书馆

中国全科医学 2012年第4期15卷 415-417页

作者：刘振红韩彩欣王立洋李明月唐山市工人医院社区医疗部河北省唐山市063000 河北联合大学管理学院

目的分析脑梗死住院患者不必要诊疗服务及住院费用的构成,为规范医师行为、控制住院费用不合理增长、完善医疗卫生政策等提供参考。方法随机抽取唐山市某医院137例脑梗死患者作为研究对象,结合临床路径和模糊标准法对脑梗死病例进行回... 详细信息

目的分析脑梗死住院患者不必要诊疗服务及住院费用的构成,为规范医师行为、控制住院费用不合理增长、完善医疗卫生政策等提供参考。方法随机抽取唐山市某医院137例脑梗死患者作为研究对象,结合临床路径和模糊标准法对脑梗死病例进行回顾性评判,测算和分析脑梗死患者诊疗中的过度医疗行为及产生的费用。结果脑梗死患者中过度医疗行为主要表现为不必要的药物、检查和化验项目,不必要的会诊和转诊,提高护理级别,夸大病情和增设知情同意书等。其中,药品、检查和化验项目的费用之和平均为944元,占三项实际费用的11.93%。结论过度医疗行为在脑梗死住院患者中普遍存在;导致医生过度医疗行为产生的原因包括追求经济利益和避免自身陷入不必要的医疗纠纷和诉讼两个方面;控制过度医疗行为的策略和措施包括实行预付制、推行临床路径,改革医院不合理的补偿机制,采取必要措施抑制医生的防御性医疗行为等。

关键词：脑梗死卫生服务滥用卫生保健费用

来源：评论

学校读者我要写书评

暂无评论

某高校女生滥用紧急避孕药原因分析

引用

中国学校卫生 2012年第7期33卷 805-806页

作者：谭晓红胡芬武汉工程大学校医院湖北430073

目的了解高校女生滥用紧急避孕药的原因,以便采取有效的健康教育对策。方法采用回顾性调查方法,对武汉工程大学2009年11月-2010年12月在校医院就诊女生的妇科门诊病例进行分析。结果在938例妇科病例中,202例有服用紧急避孕药史。对202... 详细信息

目的了解高校女生滥用紧急避孕药的原因,以便采取有效的健康教育对策。方法采用回顾性调查方法,对武汉工程大学2009年11月-2010年12月在校医院就诊女生的妇科门诊病例进行分析。结果在938例妇科病例中,202例有服用紧急避孕药史。对202例进行紧急避孕药知识问卷调查发现,性生活无规律与避孕知识不足(35.15%)、健康教育未广泛普及(27.72%)、作为非处方药与药品管理紊乱(29.71%)等是滥用紧急避孕药的主要原因。结论提高避孕相关知识的普及率、健康教育干预、规范药品管理、正确指导用药,均是杜绝高校女生滥用紧急避孕药的有利措施。

关键词：避孕药女用卫生服务滥用学生女(雌)性

来源：评论

学校读者我要写书评

暂无评论

Polypharmacy and hospitalization among older home care patients

引用

JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES 2000年第10期55卷 M554-M559页

作者： Flaherty, JH Perry, HM Lynchard, GS Morley, JE St Louis Univ Sch Med Div Geriatr Med St Louis MO 63103 USA Midwest Res Inst Kansas City MO 64110 USA St Louis VA Med Ctr Ctr Geriatr Res Educ & Clin St Louis MO USA

Background, One of the major goals of home care is the prevention of hospitalization. The objective of this study was to examine the relation between medication use (number, type, and inappropriateness) and hospitalization among home care patients older than 65 years., Methods, A retrospective chart review of 833 discharged older home care patients was performed. These patients were consecutive discharges from a single home care agency who either (a) returned to independent self-care or care of the family (S/F Care group) or (b) were admitted to the hospital (Hospitalized group). Medication assessment within these two groups included total number of medications (prescription and nonprescription);degree of polypharmacy (percentage of patients taking 5 or more, 7 or more, and 10 or more medications);and prevalence for different types of medications, including different types of inappropriate medications. Inappropriate medications were designated according to a list that was previously developed through a modified Delphi consensus technique by a panel of 13 experts in geriatric pharmacology and has been utilized in other studies. Student's t test was used for continuous variables and chi-square test was used for categorical variables to evaluate for differences between the S/F Care group and the Hospitalized group (p < .05). For comparisons of types of medications, p < .01 was used for significant differences, because of the high number of comparisons made. Results, Of 833 discharges, 644 (77.3%) returned to self-care or care of the Family (SIF Care group) and 189 (22.7%) were hospitalized. The Hospitalized group, compared with the S/F Care group, was taking a higher number of medications (mean +/- SD: 6.6 +/- 3.9 vs 5.7 +/- 3.4, p =.004), and had a higher percentage of patients taking 7 or more medications (46% vs 26%, p = .002) and 10 or more medications (21% vs 10%. p = .005), but not 5 or more medications. Only three types of medications were more commonly used amo

关键词：日常生活活动药物利用家庭卫生服务滥用家庭医疗保健服务住院病案医护疗养所多种药物疗法回顾性研究自我护理老年人老年人 80以上人类

来源：评论

学校读者我要写书评

暂无评论

Thyroid function tests: often justified in the acutely ill

引用

ANNALS OF CLINICAL BIOCHEMISTRY 2000年第2期37卷 158-164页

作者： Lamb, EJ Martin, J Kent & Canterbury Hosp E Kent Hosp NHS Trust Dept Clin Biochem Canterbury CT1 3NG Kent England Kent & Canterbury Hosp E Kent Hosp NHS Trust Dept Clin Audit Canterbury CT1 3NG Kent England

It is claimed that inappropriate requesting of thyroid function tests (TFTs) is common in acutely ill patients. Consecutive inpatient TFTs (n = 129) were assessed in relation to clinical history and common symptoms and signs of thyroid disease. Requests were justified in 69% of cases, most commonly on the basis of atrial fibrillation and/or tachycardia. There were no clear reasons for requesting TFTs in the remaining cases, although the yield of abnormal results in these patients was similar to that in those with justified requests. Thyroid stimulating hormone (TSH) concentration was increased (median 7.5 mU/L, range 4.8-38.6 mU/L) in 22 patients, six of whom had biochemical and/or clinical evidence of hypothyroidism (previously undiagnosed) and five of whom had pre-existing hypothyroidism. Of the remaining 11 patients with increased TSH levels, three were confirmed to have compensated hypothyroidism;non-thyroidal illness (NTI) (including the effect of drags) accounted for four cases. In four patients tone of whom died during the admission) follow-up was not possible. Of six patients with reduced TSH concentration (range <0.05-0.35 mU/L), one was thyrotoxic on carbimazole, one was receiving thyroxine for hypothyroidism, one had NTI and three were lost to follow-up (two of whom died during their admission). Manifestations of thyroid disease are protean and often subtle, and TFTs are thus clinically justified in many unwell inpatients. Although NTI contributes to some cases of abnormal TSH levels, a significant number of TFT abnormalities are consistent with underlying thyroid abnormality requiring investigation/treatment.

关键词： Health Services Misuse Thyroid Function Tests Thyrotropin 卫生服务滥用甲状腺功能试验 Thyrotropin Hypothyroidism Thyroid Function Test Health Services Misuse Thin film transistors thyroid function Thyroid Diseases

来源：评论

学校读者我要写书评

暂无评论

Antimicrobial use and bacterial resistance

引用

CURRENT OPINION IN MICROBIOLOGY 2000年第5期3卷 496-501页

作者： Monroe, S Polk, R Virginia Commonwealth Univ Med Coll Virginia Richmond VA 23298 USA

The current epidemic of bacterial resistance is attributed, in part, to the overuse of antibiotics. Recent studies have documented increases in resistance with over-use of particular antibiotics and improvements in susceptibility when antibiotic use is controlled. The most effective means of improving use of antibiotics is unknown. Comprehensive management programs directed by multi-disciplinary teams, computer-assisted decision-making, and antibiotic cycling have been beneficial in controlling antibiotic use, decreasing costs without impacting patient outcomes, and possibly decreasing resistance.

关键词：抗菌药/治疗应用决策计算机辅助抗药性微生物卫生服务滥用

来源：评论

学校读者我要写书评

暂无评论

Use of the Functional Bowel Disorder Severity Index (FBDSI) in a study of patients with the irritable bowel syndrome and fibromyalgia

引用

AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第4期95卷 995-998页

作者： Sperber, AD Carmel, S Atzmon, Y Weisberg, I Shalit, Y Neumann, L Fich, A Friger, M Buskila, D Soroka Med Ctr Dept Gastroenterol IL-84101 Beer Sheva Israel Soroka Med Ctr Dept Sociol Hlth IL-84101 Beer Sheva Israel Soroka Med Ctr Dept Epidemiol IL-84101 Beer Sheva Israel Soroka Med Ctr Dept Rheumatol IL-84101 Beer Sheva Israel Ben Gurion Univ Negev Fac Hlth Sci Beer Sheva Israel

OBJECTIVE: The purpose of this study was to evaluate the utility of the Functional Bowel Disorder Severity Index (FBDSI) as a measure of severity of disease among patients with the irritable bowel syndrome (IBS) and matched controls. METHODS: A total of 75 IBS patients and 69 matched controls completed questionnaires on bowel symptoms, health status, quality of life, psychological distress, concerns, anxiety, and sense of coherence. All participants also were tested for fibromyalgia (FS), a functional disorder of the musculoskeletal system. All participants were administered a questionnaire that included the FBDSI. On the basis of their responses to the questionnaire, the controls were subdivided as healthy controls (n = 48) or IBS nonpatients (n = 21). On the basis of the FS classification, 75 IBS patients were subdivided as IBS only (n = 50) or IBS and FS combined (n = 25). RESULTS: The mean FBDSI score was higher for the IBS patients than the controls (100.5 +/- 12.7 and 23.5 +/- 3.9, respectively;p < 0.001). IBS nonpatients had an intermediate score of 42.3 +/- 18.0. Patients with both IBS and fibromyalgia had the highest mean FBDSI score: 138.8 +/- 31.5. There was no association between FBDSI and age or gender, bur FBDSI was significantly associated with other measures of health status. CONCLUSIONS: An association was found between the FBDSI and IBS patient status: IBS nonpatients. patients with IBS only, and patients with both IBS and fibromyalgia had increasingly severe scores. The results provide support for the validity of FBDSI as a measure of illness severity in functional gastrointestinal disorders. (C) 2000 by Am. Cell. of Gastroenterology.

关键词：结肠疾病功能性/诊断结肠疾病功能性/心理学共病现象纤维肌痛/诊断纤维肌痛/心理学卫生服务滥用生活质量疾病角色疾病影响状态调查成年人女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Symptom expression in pain-predominant functional bowel syndrome: Is visceral hyperalgesia the whole truth?

引用

AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第4期95卷 862-863页

作者： Shapiro, MS Olden, KW Mayo Clin Scottsdale Div Gastroenterol & Hepatol Scottsdale AZ USA

Ever increasing socioeconomic pressures have elevated cost-effective management of patients with irritable bowel syndrome (IBS) and related functional disorders as a high priority in gastroenterology practice. The illness of these patients produces an enormous cost to society related to absenteeism and use of medical resources (1). Although most individuals with IBS go about their daily lives without need for medical care, about 30% of IBS sufferers seek assistance for their disorder (2). IBS patients pursue consultation mainly because of their abdominal pain (3). The severity of abdominal pain reported by patients with functional bowel syndrome to their physician often drives the aggressiveness of a workup in the attempt to identify "serious disease." This results in higher risk to the patient and greater expense. However, what is uncertain is whether, in IBS patients, painful symptoms directly reflect pathophysiological mechanisms involved in pain production such as visceral hyperalgesia, or whether they are a consequence of psychosocial factors.

关键词：腹痛/病因学腹痛/病理生理学腹痛/心理学结肠疾病功能性/病理生理学结肠疾病功能性/心理学卫生服务滥用痛觉过敏/病理生理学痛觉过敏/心理学痛阈/生理学疾病角色应激心理学/并发症人类

来源：评论

学校读者我要写书评

暂无评论

What determines severity among patients with painful functional bowel disorders?

引用

AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第4期95卷 974-980页

作者： Drossman, DA Whitehead, WE Toner, BB Diamant, N Hu, YJB Bangdiwala, SI Jia, HG Univ N Carolina Dept Med Div Digest Dis Ctr Funct GI & Motil Disorders Chapel Hill NC 27599 USA Univ Toronto Dept Med Toronto ON Canada Univ Toronto Dept Psychiat Toronto ON Canada

OBJECTIVE: For patients with painful functional bowel disorders (FBD), physicians frequently make diagnostic and treatment decisions based on the severity of the pain reported;patients with severe painful complaints may receive extensive diagnostic tests and treatments. Therefore, it would be important to determine what clinical factors contribute to the judgment of severity among patients with FBD. The aim of this study was to identify the psychosocial, behavioral, and physiological (visceral sensitivity) factors that predicted severity in patients with moderate to severe FBD. METHODS: Two hundred eleven female patients with moderate or severe FBD, as determined by the Functional Bowel Disorder Severity Index, entered a multicenter treatment trial at the University of North Carolina and the University of Toronto. Patients filled out diary cards and were given questionnaires and physiological testing (rectal sensitivity using barostat). Analysis of covariance and logistic regression adjusting for demographic factors were performed to determine which factors distinguished patients at study entry with moderate from those with severe FBD. RESULTS: Patients with severe FBD were characterized by greater depression and psychological distress, poorer physical functioning and health-related quality of life, more maladaptive coping strategies, and greater health care utilization. There was a trend for patients with severe FBD to have lower rectal sensation thresholds. Regression analysis indicated that severity was best predicted by behavioral features: poorer daily physical function, difficulties related to eating, more phone calls to the physician, and more days in bed for GI symptoms. CONCLUSIONS: We conclude that patient illness behaviors are best correlated with severity in FBD. The use of psychopharmacological agents (e.g., antidepressants) and psychological treatments to treat psychiatric comorbidity and to improve behavioral coping styles is recommended. Training to

关键词：结肠疾病功能性/病理生理学结肠疾病功能性/心理学共病现象卫生服务滥用痛觉过敏/病理生理学痛觉过敏/心理学疼痛测定痛阈/生理学疾病角色应激心理学/并发症青少年成年人老年人女(雌)性人类中年人

来源：评论

学校读者我要写书评

暂无评论

Colorectal cancer screening and surveillance practices by primary care physicians: Results of a national survey

引用

AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第6期95卷 1551-1556页

作者： Sharma, VK Vasudeva, R Howden, CW Univ Arkansas Med Sci Little Rock AR 72205 USA Univ S Carolina Columbia SC 29208 USA Northwestern Univ Chicago IL 60611 USA

OBJECTIVE: Screening for colorectal cancer reduces its morbidity and mortality and is cost-effective. Screening is usually the responsibility of primary care physicians who may be unsure about its implementation. We aimed to assess primary care physicians' knowledge and practice regarding colorectal cancer screening, and to compare their responses with those of three national experts and with published guidelines. METHODS: We mailed a postal questionnaire to 2310 primary care physicians regarding demographics, nature of practice, use of screening tests, and six hypothetical patients who may have been candidates for screening or surveillance. We used published national guidelines and the collective opinions of the three external experts as the so-called "gold standard." RESULTS: Of all respondents, 85.1% offered colorectal cancer screening. Most used suitable tests, starting at an appropriate age;49.8% continued screening indefinitely irrespective of patients' age and 43.6% performed fecal occult blood testing without appropriate dietary advice to patients. Also, respondents frequently performed this test for inappropriate indications. Only 51.8% would follow a positive fecal occult blood test with colonoscopy. CONCLUSIONS: Colorectal cancer screening practices by primary care physicians vary considerably from those recommended. Many offer screening to individuals in whom it is not appropriate, and continue it into advanced age. Frequent, inappropriate use of fecal occult blood tests will produce many false positives. Primary care physicians often do not appropriately follow a positive test. Further educational efforts are needed in an attempt to improve practice and further reduce the morbidity and mortality from colorectal cancer. (Am J Gastroenterol 2000;95:1551-1556. (C) 2000 by Am. Cell. of Gastroenterology).

关键词：结直肠肿瘤/诊断数据收集卫生服务滥用医师人群监测初级卫生保健/标准专业业务卫生保健质量问卷调查人类

来源：评论

学校读者我要写书评

暂无评论

The rise in acute medical admissions

引用

AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 2000年第2期30卷 252-260页

作者： Hider, P O'Hagan, J Bidwell, S Kirk, R Christchurch Sch Med Dept Publ Hlth & Gen Practice NZHTA Christchurch New Zealand

来源：评论

学校读者我要写书评

暂无评论

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案：

请选择收藏分类：

通借通还

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：