The Relationship between Personality Disorder Features and Symptom Improvement at an Inpatient Treatment Program for Posttraumatic Stress Disorder

This study examined the association between personality disorder (PD) features and symptom improvement among adult survivors of childhood trauma in an inpatient program for posttraumatic stress disorder (PTSD). Participants completed questionnaires at admission, discharge, and six months following discharge. Multiple regression analyses were used to assess the combined effects of personality features on symptom improvement. Results indicated that improvement in trauma-related symptoms was not related to PD features. By contrast, the PD features were associated with change in other Axis I symptoms often comorbid with PTSD. Overall, results suggested that PD features do not impede improvement in trauma-related symptoms; however, specific accommodations might be needed to address comorbid disorders among individuals with PTSD.     

探讨三级综合医院基于信息交互体系的双向转诊

建立基于信息交互体系的双向转诊信息平台,通过大连市某三级综合医院与社区卫生服务中心双向转诊研究,着重于探索临床路径这一研究方向对双向转诊的意义。用同期非随机对照试验,收集大连市黄河路社区上转患者人次和医院下转患者人次,以及分别比较转诊费用和医患转诊认知度。结果,上转患者402人,下转患者179人,上转服务明显好于下转,试验组和对照组患者医疗费用（除诊疗费）差异有统计学意义（P〈0．05）,双向转诊认知度差异有统计学意义（P〈0．05）。目前双向转诊还处于单向流动状态,上转率明显高于下转率,双向转诊节省了医疗费用,在医患对其认知度方面,前者明显高于后者,制度上的支持是双向转诊顺利实施的关键。     

脑梗死的溶栓治疗——离我们到底有多远？

急性脑梗死是我国的常见病、多发病,目前最有效的药物治疗手段是进行溶栓治疗.但我国的溶栓率还比较低,与发达国家相比仍有很大差距.主要原因为老百姓知晓率低、院前延误、城市急救系统运力不足、卒中中心的建设不够及医源性因素等几个方面,以后应该加强溶栓宣传、加强城市急救中心建设、加强卒中中心建设及对各级医院的神经科医生进行相关培训,提高接受溶栓患者的比例,从而让更多的患者受益.     

Do hospital treatments represent a ‘teachable moment’ for quitting smoking? A study from a stage-theoretical perspective

Hospital treatments are assumed to be a ‘teachable moment’. This phenomenon, however, is only poorly conceptualised and untested. A stage-theoretical perspective implies that a cueing event such as hospital treatments is a teachable moment if a stage progression, change of cognitions, or both occur. This concept is examined in a cross-sectional study by comparing smokers in two treatment settings, an emergency department (ED) and inpatient treatment after elective surgery, with smokers in a control setting. Setting differences were hypothesised in stage distribution, and levels of and stage differences in social-cognitive factors under control for possible confounders. Stage, social-cognitive factors and possible confounders were assessed in 185 ED smokers, 193 inpatient smokers and 290 control smokers. Compared to control smokers, ED and inpatient smokers were in higher stages; they perceived fewer risks and cons; inpatient smokers reported more concrete plans. Stage differences in self-efficacy among ED and inpatient smokers differed from those among control smokers, but the former corresponded more strongly to the theoretical stage assumptions. The results suggest that hospital treatments lead to a stage progression and change of corresponding cognitions, and thus represent a ‘teachable moment’. Stage-matched interventions should be provided but consider differences in cognitions to be effective.     

寻绎我国医院文化建设的逻辑路径

国家新一轮医疗体制改革,将引起医疗市场格局的新变动.加强文化建设将成为医院寻求竞争优势行之有效的一种战略.分析当前我国医院文化建设中普遍存在的问题,并对其发展脉络和运行机理进行有序的梳理,探索性地提出我国医院文化建设的发展路径:实现人性化与制度化的统一;普遍性与特殊性的统一;继承性与时代性的统一.     

医院文化的作用机制研究

医院文化作用机制有内外两种.在医院文化内部,以价值观为主体的精神层医院文化通过制度层医院文化作用于以行为为主体的外显层医院文化.对外部,医院文化的适应性、方向性、参与性、一致性分别对医院绩效体系中患者满意度、学习与成长、财务、流程四个维度产生影响.公立医院改革应发挥医院文化的作用机制,加强文化管理.     

非识字高龄患者住院中的需求对策相关性研究

探讨患者的需求与对策。应用会谈法收集资料,教育患者认知所患疾病相关知识、帮助患者和家属适应住院环境、支持家属对患者的生活护理、缓解患者心理紧张情绪、协助患者遵从医疗护理服务行为、照顾患者口服用药过程、满足患者治疗过程中的需求、加强护理操作周边作业的督导,进而提出了满足需求对策的依据。     

The deChristianization of Christian hospital chaplaincy: some bioethics reflections on professionalization, ecumenization, and secularization.

The traditional roles of Christian chaplains in aiding patients, physicians, nurses, and hospital administrators in repentance, right belief, right worship, and right conduct are challenged by the contemporary professionalization of chaplaincy guided by post-Christian norms located in a public space structured by three defining postulates: the non-divinity of Christ, robust ecumenism, and the irrelevance of God's existence. The norms of this emerging post-Christian profession of chaplaincy make interventions with patients, physicians, nurses, and hospital administrators in defense of specifically Christian bioethical norms and goals unprofessional, because the chaplain is now directed as a professional to support health care services held to standards articulated within a secular morality. These changes are exemplar of the profound recasting of the dominant moral culture with wide-ranging implications for bioethics.     

To Be With Them: A Hospital Chaplain's Reflection of the Bedside Ministry to Terminally III and Dying People

The author, an ordained Lutheran pastor, reflects upon his experiencesas chaplain at a small hospital in southwestern Germany (Tropenklinik– Paul Lecher Krankenhaus, Tübingen). Besides itsexpertise in the treatment of tropical diseases this 100 + bedhospital serves as the referral hospital for terminally illand dying patients from the local University hospitals and thesurrounding area. The experiences at the bedside of such patientswith various denominational and religious backgrounds challengedthe chaplain to go beyond the confines of any fixed theologicalsystem or counseling technique. They made him to discover threeessentials as the very basis of such ministry, which he sharesin this article. He identifies these as (1) the necessity torealize the situation sober mindedly, (2) the desire to becomea companion, and (3) the venture of confident faith, where holdingon to any genuine perspective of life is deemed ridiculous.     

缺位与越位的思考——医疗保健体制改革的定位

政府的缺位和医院的越位是目前医疗体制改革的症结所在。政府将医院推向市场,意味着政府放弃医疗的社会保障职能。医院失去政府的约束和支持,逐利将成为其必然行为。平价医院只是缓和矛盾的一时之计,只要医院不退出市场,看病难、看病贵就难有灵丹妙药,医患关系也将难以和谐。