先天性心脏病患儿围手术期心理护理程序研究

为提高先天性心脏病患儿围手术期护理质量,应用心理评估和临床实验方法,对４～１２岁无陪护患儿的心理特点和心理护理程序进行了系列研究。结果发现,先天性心脏病患儿性格较正常儿童内向．情绪不稳定,其智力和适应能力都明显低于正常儿童,根据上述特点确定了围手术期心理护理目标和行为训练等护理方法．通过对１０６例患儿的实验对比观察,提出建构围手术期少理护理程序的理论依据和基本模式．     

内固定治疗老年股骨粗隆间骨折

老年股骨粗隆间骨折的手术治疗正在逐步被接受,手术方法也因为骨折具体情况有多种选择,本文对老年股骨粗隆间骨折的临床特点、内固定选择、围手术期注意事项进行阐述,为临床治疗提供帮助.     

老年髋部骨折围手术期医疗风险的分析与对策

髋部骨折是老年人的常见病之一,髋部骨折对老年人生命的危害最大。随着人口老龄化,老年髋部骨折发病率呈逐年上升趋势。老年骨质疏松髋部骨折围手术期的医疗风险临床较常见,如何降低老年骨质疏松髋部骨折围手术期的医疗风险,是临床骨科需要解决的问题。分析存在的风险问题,明确各种风险因素,尽可能降低老年髋部围手术期的医疗风险。     

老年髋部骨折围手术期医疗风险的分析与对策

髋部骨折是老年人的常见病之一,髋部骨折对老年人生命的危害最大.随着人口老龄化,老年髋部骨折发病率呈逐年上升趋势.老年骨质疏松髋部骨折围手术期的医疗风险临床较常见,如何降低老年骨质疏松髋部骨折围手术期的医疗风险,是临床骨科需要解决的问题.分析存在的风险问题,明确各种风险因素,尽可能降低老年髋部围手术期的医疗风险.     

围手术期医疗质量管理策略

围手术期是手术患者在医院诊疗过程中的最重要时期,隐患多、风险大,历来是医疗质量管理的重点和难点。本文介绍了中国医科大学附属盛京医院加强围手术期管理的措施,只有加强对手术全程的监管,促进围手术期抗菌药物的合理使用,提供术后规范化的护理,加强质量教育和培训,才能确保围手术期的医疗质量。     

ERAS理念在老年股骨转子间骨折围手术期的应用

探讨与传统的围手术期干预方式相比,ERAS理念在老年股骨转子间骨折围手术期的应用效果。取自2017年1月～2018年1月,12个月内我院60例老年股骨转子间骨折经PFNA内固定手术治疗患者。经签署知情同意书,利用随机数表将患者随机分成试验组和对照组,每组30例,并做术前疼痛指标的评估笔记。随后对两组分别采用ERAS指导下的围手术期干预以及传统理念下的围手术期干预。两组患者术后6小时、24小时、3天、5天的疼痛情况进行VAS评分。对出院的患者进行术后为期1年的随访,评价髋关节的功能,并记录相关的数据信息。结果,试验组术后6小时、24小时、3天的VAS疼痛评分明显优于对照组(P0.05),5天的VAS评分两组无明显差距。试验组的术后卧床时间、住院时间、住院费用均明显少于对照组(P0.05),试验组术后一年髋关节Harris显著高于对照组评分(P0.05),ERAS理念指导下的围手术期干预术后效果优于传统方法,对减少患者术后痛苦,减轻患者及社会医疗负担有一定的意义。     

康复队伍建设对实现残疾人康复服务的影响

老年股骨颈骨折是常见的骨科病,但其治疗方案的选择并没有统一的标准。本文回顾了骨折治疗原则的发展历程和股骨颈骨折现有的治疗方法,旨在从系统论的最优化原则角度,初步讨论治疗老年股骨颈骨折的最优方案,认为应结合患者的生理年龄、预期寿命、骨的质量、骨折情况和经济条件等因素来选择治疗方案。     

有关治疗老年股骨颈骨折最优方案的思考

老年股骨颈骨折是常见的骨科病,但其治疗方案的选择并没有统一的标准.本文回顾了骨折治疗原则的发展历程和股骨颈骨折现有的治疗方法,旨在从系统论的最优化原则角度,初步讨论治疗老年股骨颈骨折的最优方案,认为应结合患者的生理年龄、预期寿命、骨的质量、骨折情况和经济条件等因素来选择治疗方案.     

围手术期综合管理新理念

手术是医疗服务的重要措施,近年来对围手术期管理的研究日益深入。随着加速康复理念、手术安全核查表、日间手术等围手术期管理的日益改进、更新,手术质量逐步提高,康复效率逐渐加快。随着对围手术期认识的加深,笔者认为应进一步拓展围手术期定义范畴,将其结束节点进一步延伸至恢复日常生活工作。同时,从手术质量、康复效率及治疗成本三方面设定相应指标,全面、统一评价围手术期管理措施的合理性、可行性,逐步提高患者围手术期体验。     

青壮年肝癌患者围手术期心理特征与人文关怀

青壮年患者因其在家庭、社会生活中的重要角色,其在治疗阶段情绪波动较大,而围手术期患者紧张、悲观、焦虑和恐惧等心理反应会对其生理功能产生巨大的不良影响,限制了对患者诊疗过程中配合,尤其是对围手术期影响明显。为了降低围手术期患者心理应激产生的不良影响,同时适应生理一心理一社会医学模式的转变,管床医生在围手术期必须对手术患者...     

Counselors and Physicians Providing Mental Health Services: An Integrated Approach

The authors argue that there is a clear link between mental and physical health issues. A wellness‐based approach to integrated health care, such as the one described in this article, may allow older clients to be empowered to make lifestyle changes that can improve the quality of their lives and reduce physical illness.     

实施单病种临床路径缩短患者平均住院日

为研究单病种临床路径应用效果,对宫颈癌患者39例、输卵管妊娠患者29例实施,临床路径。结果显示,手术并发症发生率降低,平均住院日和住院费用、药品费、药占比均下降,并具有统计学意义（P〈0．05）。因此,应用单病种临床路径,能降低患者住院日和费用、提高医护工作效率、增加医院竞争力。     

The Unmet Educational Agenda in Integrated Care

One of the reasons integrated care has not become a dominant service delivery model is the unmet training agenda. This article argues that the typical mental health professional is not trained to adequately address the challenges of integrated care. To insure competency both a macro and clinical training agenda are needed. At the macro-level, mental health professionals need to understand healthcare economics and basic business principles as any integrated care service delivery system is embedded and driven by economic forces. Integrated care practitioners also need some basic business skills to understand these forces and to create and manage a financially viable system, given the future flux of the system. Traditional mental health professionals also do not have the clinical skills to implement integrated care. Integrated care is not simply placing a traditionally trained mental health professional and letting them practice specialty mental health in a medical setting. Thus, the special skills needed in integrated care are enumerated and discussed. Finally, a new degree program is described as it is time given the huge need and advantages of integrated care to develop specialty training in integrated care.     

中西医结合脑卒中治疗新模式的探讨

卒中是危害人类健康最严重的疾病之一,其发病率高、死亡率高、致残率高,已成为世界范围内的健康问题。卒中单元已被证实是目前治疗卒中最有效的方法,组织化卒中医疗作为卒中单元的进一步发展,成为脑卒中治疗模式新的趋势;中医强调整体观念和辨证论治,将中西医结合起来,建立和实施中西医结合脑卒中治疗新模式,有助于降低脑卒中患者的死亡率,减少并发症,提高生活质量。通过探讨一种中西医结合脑卒中治疗模式的特点和运作方式,为脑卒中治疗模式的发展提供新的思路。     

Interprofessional Education: Preparing Psychologists for Success in Integrated Primary Care

Rapidly occurring changes in the healthcare arena mean time is of the essence for psychology to formalize a strategic plan for training in primary care settings. The current article articulates factors affecting models of integrated care in Academic Health Centers (AHCs) and describes ways to identify and utilize resources at AHCs to develop interprofessional educational and clinical integrated care opportunities. The paper asserts that interprofessional educational experiences between psychology and other healthcare providers are vital to insure professionals value one another’s disciplines in health care reform endeavors, most notably the patient-centered initiatives. The paper highlights ways to create shared values and common goals between primary care providers and psychologists, which are needed for trainee internalization of integrated care precepts. A developmental perspective to training from pre-doctoral, internship and postdoctoral levels for psychologists in integrated care is described. Lastly, a call to action is given for the field to develop more opportunities for psychology trainees to receive education and training within practica, internships and postdoctoral fellowships in primary care settings to address the reality that most patients seek their mental health treatment in primary care settings.     

The Challenge of Integrated Care for Mental Health: Leaving the 50 minute hour and Other Sacred Things

A growing body of research has demonstrated the effectiveness of integrating mental/behavioral healthcare with primary care in improving health outcomes. Despite this rich literature, such demonstration programs have proven difficult to maintain once research funding ends. Much of the discussion regarding maintenance of integrated care has been focused on lack of reimbursement. However, provider factors may be just as important, because integrated care systems require providers to adopt a very different role and operate very differently from traditional mental health practice. There is also great variability in definition and operationalization of integrated care. Provider concerns tend to focus on several factors, including a perceived loss of autonomy, discomfort with the hierarchical nature of medical care and primary care settings, and enduring beliefs about what constitutes “good” treatment. Providers may view integrated care models as delivering substandard care and passively or actively resist them. Dissemination of available data regarding effectiveness of these models is essential (e.g. timeliness of treatment, client satisfaction). Increasing exposure and training in these models, while maintaining the necessary training in traditional mental health care is a challenge for training at all levels, yet the challenge clearly opens new opportunities for psychology and psychiatry.     

Application of the APA ethics code for psychologists working in integrated care settings: Potential conflicts and resolutions

ABSTRACT

Increasingly, there is evidence of the potential benefits of an integrated care model. In fact, the American Psychological Association (APA) supports the role of psychologists in integrated healthcare given the positive outcomes for patients in primary care settings such as increased access to mental health services, reduced mental illness stigma, and improved health associated with recognizing the impact of psychosocial factors on physical wellbeing. Less attention has been paid, however, to ethical dilemmas that may arise for psychologists working in integrated healthcare. This paper explores considerations for resolving potential ethical conflicts that may arise for psychologists working in integrated care settings.     

Implications of Healthcare Payment Reform for Clinical Psychologists in Medical Settings

Health reform, post the passing of the Patient Protection and Affordable Care Act, has highlighted the need to better address critical issues such as primary care, behavioral health, and payment reform. Much of this need is subsequent to robust data showing the seemingly uncontrollable growth of healthcare costs, and the exacerbation of these costs for patients with comorbid behavioral health and medical conditions. There is increasing recognition that incorporating behavioral health in primary care leads to improved outcomes and better care. To address these problems, primary care will play critical roles across the healthcare system, especially in the delivery of behavioral health services. Psychologists are uniquely positioned to take advantage of this propitious moment and can help facilitate the integration of behavioral and primary care by developing competencies in integrated care, training a capable workforce, and advocating for integrated care as the status quo.     

Integrating Systems of Care in California for Youth with Severe Emotional Disturbance IV: Educational Attendance and Achievement

Empirical results are presented from school-based interventions in three California counties that are pioneering participants in a carefully evaluated effort to create an innovative system of care for youth with severe emotional disturbance. Data are presented about the educational attendance and achievement of youth enrolled in clinical and academic programs designed to provide collaborative mental health and education services. Attendance levels were uniformly high. The youth were below expected grade level as measured by standardized tests at program admission. Across programs, two counties demonstrated grade level increases of one year or more for one year in school on all subscales of established measures of educational achievement. The third county demonstrated increases of slightly less than one year on two of three subscales of the educational achievement measures. These results are the first from a multisite demonstration of integrated education and mental health programs embedded within a broader system of care for youth. The findings, combined with those from our prior studies, illustrate that is possible to reduce and control placements in restrictive levels of care while improving the academic performance of a vast majority of the youth enrolled in specialized programs within the care systems.