• 【计划生育方法的用户费用:孟加拉国城市避孕药具的支付行为分析。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Routh S,Thwin AA,Kane TT,Hel Baqui A
    BACKGROUND & AIMS: The study was carried out to review the experience with the existing user-fee (pricing) strategies and examine the socioeconomic and demographic factors associated with payment behaviour among contraceptors in urban Bangladesh for selected contraceptive methods, such as injectables, pill, and condom. Data for the study were drawn from a survey of more than 5,000 married women of reproductive age in Zone 3 of Dhaka city, Bangladesh, within the sample frame of the Urban Panel Survey of the ICDDR,B's former Urban MCH-FP Extension Project. The findings of the study showed that most (80%) urban contraceptors have been paying for selected family-planning services. This indicates the existence of a notable demand for contraceptives which suggests that there is scope for improved financial sustainability of the family-planning programme through charging appropriate user-fees for contraceptives with proper analyses of willingness-to-pay among the contraceptors and price elasticities of demand. Higher socioeconomic status of households, marked by higher levels of education and house rent, and location of residence in non-slum areas, is predictive of paying for contraception. Households having 1-3 living child(ren) are also more likely to make payment for the selected contraceptive services.

    背景与目标: 这项研究的目的是回顾现有用户收费(定价)策略的经验,并研究孟加拉国城市中避孕药的支付行为与社会经济和人口统计学因素有关,这些避孕方法包括注射剂,药丸和避孕套等选定的避孕方法。该研究的数据来自对孟加拉国达卡市3区5,000多名育龄已婚妇女的调查,该调查是在ICDDR的城市小组调查(B的前城市MCH-FP扩展项目)的样本框架内进行的。该研究的结果表明,大多数(80%)城市避孕者一直在为选定的计划生育服务付费。这表明对避孕药具的需求显着,这表明通过向避孕药具收取适当的使用者费用,并对避孕药具的支付意愿和价格弹性进行适当分析,可以改善计划生育计划的财务可持续性。要求。以较高的教育水平和房租以及在非贫民区的居住地点为特征的家庭较高的社会经济地位,可以预料要为避孕买单。有1-3个活着的孩子的家庭也更有可能为选定的避孕服务付款。

  • 【保健利用中的横向公平和卫生筹资的公平性:卢旺达的小额医疗保险和使用费的比较。】 复制标题 收藏 收藏
    DOI:10.1002/hec.1014 复制DOI
    作者列表:Schneider P,Hanson K
    BACKGROUND & AIMS: :This paper uses two methods to compare the impact of health care payments under insurance and user fees. Concentration indices for insured and uninsured groups are computed following the indirect standardisation method to evaluate horizontal inequity in utilisation of basic health care services. The minimum standard approach analyses the extent to which out-of-pocket health spending contributed to increased poverty. The analysis uses cross-sectional household survey data collected in Rwanda in 2000 in the context of the introduction of community-based health insurance. Results indicate that health spending had a small impact on the socio-economic situation of uninsured and insured households; however, this is at the expense of horizontal inequity in utilisation of care for user-fee paying individuals who reported significantly lower visit rates than the insured.
    背景与目标: :本文使用两种方法来比较医疗保险支付对保险和用户费用的影响。按照间接标准化方法计算被保险人和非被保险人的浓度指数,以评估基本医疗服务利用中的水平不平等。最低标准方法分析了自付费用的医疗支出在多大程度上加剧了贫困。该分析使用了2000年卢旺达在引入基于社区的健康保险的背景下收集的横断面家庭调查数据。结果表明,卫生支出对无保险和有保险家庭的社会经济状况影响很小;然而,这是以牺牲了看病率明显低于被保险人的用户付费个人的护理利用中的横向不平等为代价的。
  • 【医疗费。在澳大利亚如何给医生付款的历史。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Dammery D
    BACKGROUND & AIMS: :Medical fees are an important part of medical practice, yet they have always been a bone of contention. This article is the first in a series of three that will look at the way the doctor was paid. It examines the role of medical fees in early medical practice in Australia.
    背景与目标: :医疗费用是医疗实践的重要组成部分,但始终是争论的焦点。本文是三部分中的第一篇,将探讨医生的付款方式。它研究了医疗费用在澳大利亚早期医疗实践中的作用。
  • 4 The Economics of Residency Application Fees. 复制标题 收藏 收藏

    【居留申请费的经济学。】 复制标题 收藏 收藏
    DOI:10.1097/ACM.0000000000001842 复制DOI
    作者列表:Maroongroge S
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【突然取消用户费用:布隆迪一线经理的观点。】 复制标题 收藏 收藏
    DOI:10.1093/heapol/czr061 复制DOI
    作者列表:Nimpagaritse M,Bertone MP
    BACKGROUND & AIMS: :In May 2006, the President of Burundi announced the removal of user fees in all health centres and hospitals for children under 5 and women giving birth. As other studies also point out, the policy was adopted extremely suddenly, without much reflection on its ultimate aims and on the operational dimension of its implementation. From the perspective of a frontline manager, this paper provides a descriptive case study of the abolition of user fees in the Muramvya District and a first-hand account of the effects of the sudden reform in the management of a district and a district hospital. The analysis highlights the challenges that the district and hospital teams faced. The main issues were: the reduction of financial flows, which prevented the possibility of investments and caused frequent drugs stock-outs; the reduced quality of the services and the disruption of the referral system; the motivation of the health staff who saw the administrative workload increase (not necessarily because of increased utilization) and faced 'ethical dilemmas' caused by the imprecise targeting of the reform. Undoubtedly, the removal of user fees for certain groups was an equitable and necessary measure in an extremely poor country such as Burundi. However, the suddenness of the decision and the lack of preparation had critical and long-lasting consequences for the entire health system. This analysis, performed from the frontline perspective, clarifies the importance of a rigorous planning of any reform, as well as of involving peripheral actors and understanding the complex challenges that they face.
    背景与目标: :2006年5月,布隆迪总统宣布取消所有健康中心和医院的5岁以下儿童和分娩妇女的使用费。正如其他研究还指出的那样,该政策突然被采纳,而对其最终目标和实施的运作层面却没有太多的思考。从一线经理的角度出发,本文提供了有关在Muramvya区取消使用费的描述性案例研究,以及对区和区医院管理突然改革的影响的第一手资料。分析强调了地区和医院团队面临的挑战。主要问题是:资金流动减少,这阻止了投资的可能性并导致经常的药品缺货;服务质量下降和推荐系统中断;卫生人员的动力,他们看到行政工作量增加了(不一定是因为利用率提高了),并且面临着由于改革目标不明确而造成的“道德困境”。无疑,在某些极端贫困的国家(例如布隆迪),免除某些群体的使用费是一项公平而必要的措施。但是,决策的突然性和缺乏准备对整个卫生系统造成了严重而持久的后果。从前线角度进行的这一分析阐明了对任何改革进行严格规划的重要性,并需要让外围参与者参与并理解他们面临的复杂挑战。
  • 【1975年至1995年的牙科手术费:已更改了多少?】 复制标题 收藏 收藏
    DOI:10.14219/jada.archive.1998.0427 复制DOI
    作者列表:Brown LJ,Lazar V
    BACKGROUND & AIMS: A shift toward diagnostic and preventive dentistry in the last two decades is evident from the change in the number of dental procedures performed, as well as the change in the percentage of time spent performing different types of procedures. During the period 1975 through 1995, the average nominal fees for selected dental procedures increased. Once inflation was taken into account, however, the increase in the average real fees charged was more modest.

    背景与目标: 从执行的牙科程序数量的变化以及执行不同类型的程序所花费的时间百分比的变化可以明显看出,过去二十年来向诊断和预防牙科的转变。在1975年至1995年期间,某些牙科手术的平均名义费用有所增加。但是,一旦考虑到通货膨胀,平均实际收费的增加幅度就较小。

  • 【流血的心,奸商或两者皆有:不受管制的市场中的专科医生费。】 复制标题 收藏 收藏
    DOI:10.1002/hec.3317 复制DOI
    作者列表:Johar M,Mu C,Van Gool K,Wong CY
    BACKGROUND & AIMS: :This study shows that, in an unregulated fee-setting environment, specialist physicians practise price discrimination on the basis of their patients' income status. Our results are consistent with profit maximisation behaviour by specialists. These findings are based on a large population survey that is linked to administrative medical claims records. We find that, for an initial consultation, specialist physicians charge their high-income patients AU$26 more than their low-income patients. While this gap equates to a 19% lower fees for the poorest patients (bottom 25% of the household income distribution), it is unlikely to remove the substantial financial barriers they face in accessing specialist care. There are large variations across specialties, with neurologists exhibiting the largest fee gap between the high-income and low-income patients. Several possible channels for deducing the patient's income are examined. We find that patient characteristics such as age, health concession card status and private health insurance status are all used by specialists as proxies for income status. These characteristics are particularly important to further practise price discrimination among the low-income patients but are less relevant for the high-income patients. Copyright © 2016 John Wiley & Sons, Ltd.
    背景与目标: :这项研究表明,在不受监管的费用设定环境中,专科医生根据患者的收入状况实行价格歧视。我们的结果与专家的利润最大化行为一致。这些发现基于与行政医疗索赔记录相关联的大规模人口调查。我们发现,在初步咨询中,专科医生向高收入患者收取的费用比低收入患者高出26澳元。虽然这一差距意味着最贫困患者的费用降低了19%(家庭收入分配的最低25%),但不可能消除他们在获得专科护理方面面临的巨大财务障碍。各专业之间差异很大,神经科医师在高收入和低收入患者之间的费用差距最大。研究了几种推断患者收入的可能途径。我们发现,诸如年龄,健康优惠卡状态和私人健康保险状态之类的患者特征均被专家用作收入状态的代理。这些特征对于在低收入患者中进一步实行价格歧视特别重要,但与高收入患者的相关性较小。版权所有©2016 John Wiley&Sons,Ltd.
  • 【复印费和患者获取自己病历的限制。】 复制标题 收藏 收藏
    DOI:10.1001/jamainternmed.2016.8560 复制DOI
    作者列表:Jaspers AW,Cox JL,Krumholz HM
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 9 Fees in dispute. 复制标题 收藏 收藏

    【费用有争议。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Cameron A
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【通过增加FDA使用费为售后药品安全性研究提供资金的提案。】 复制标题 收藏 收藏
    DOI:10.1377/hlthaff.w5.469 复制DOI
    作者列表:Carpenter D
    BACKGROUND & AIMS: :I propose to raise funds for postapproval studies of long-term drug safety by augmenting the existing "user-fee" system. Fees would be raised by an amount deemed optimal for revenue collection, and the U.S. Food and Drug Administration (FDA) would direct the incremental funds to a combination of randomized controlled trials, epidemiological studies, and postmarketing surveillance. User-fee augmentation is an achievable, incremental reform that would subsidize information that is now undersupplied in the U.S. health care system; spread the burden of funding postmarketing safety studies among pharmaceutical sponsors; and help restore public, scientific, and professional confidence in the FDA and its user-fee system.
    背景与目标: :我建议通过增加现有的“用户费用”系统来为长期药物安全性的批准后研究筹集资金。费用将提高至最适合收税的数额,美国食品药品监督管理局(FDA)将把增加的资金用于随机对照试验,流行病学研究和上市后监督的组合。增加用户费用是一项可以实现的渐进式改革,将对目前美国医疗保健系统中供应不足的信息提供补贴;在药品赞助商之间分散进行售后安全性研究的资金负担;并帮助恢复公众,科学和专业人士对FDA及其用户费用系统的信心。
  • 【跨国比较付款方和患者分担的医疗费用:根据假设病例和报销费用对绝经后患有早期乳腺癌的妇女进行的研究。】 复制标题 收藏 收藏
    DOI:10.1159/000354249 复制DOI
    作者列表:Hamada S,Hinotsu S,Ishiguro H,Toi M,Kawakami K
    BACKGROUND & AIMS: BACKGROUND:The objectives of this study were to estimate and cross-nationally compare the medical costs shared by payers and patients and the distributions of medical costs by cost category. MATERIAL AND METHODS:We estimated the medical costs covered from definitive diagnosis to completion of treatments of early-stage breast cancer and follow-up, assuming almost identical medical care provided in Japan, the UK, and Germany. The analysis was performed from the payer's perspective. Medical costs were calculated by multiplying the unit costs by the number of units consumed, based on assumption case scenarios. The medical costs incurred by payers or patients were estimated according to the cost-sharing and the cost-bearing systems in each country. RESULTS:The total medical costs in Japan were much lower than those in the UK and Germany, and these differences were mainly caused by the low costs of surgery and radiotherapy in Japan. For the base-case scenario, the co-payment in Japan (€ 3,486) was found to be 6.4-fold higher than that in Germany (€ 548). The payers in the European countries paid 2.9-fold more than those in Japan (€ ∼25,000 vs. € 8,627). CONCLUSION:Our results will be useful for policy makers in considering how to share medical costs and how to allocate limited resources. HINTERGRUND:Ziel dieser Studie war es, die von den Kassen und Patienten geteilten Kosten sowie die Aufteilung der medizinischen Kosten auf verschiedene Kostenkategorien zu schätzen und länderübergreifend zu vergleichen. MATERIAL UND METHODEN:Wir schätzten die medizinischen Kosten, die von der definitiven Diagnose bis zur Vollendung der Behandlung von Brustkrebs sowie der Nachbeobachtung abgedeckt werden müssen, unter der Annahme, dass die medizinische Versorgung in Japan, Großbritannien und Deutschland ungefähr gleich ist. Die Analyse wurde aus der Sicht der Kassen durchgeführt. Die medizinischen Kosten wurden kalkuliert, indem basierend auf theoretischen Fallszenarien die Einheitskosten mit der Anzahl der verbrauchten Einheiten multipliziert wurden. Die medizinischen Kosten, die von den Kassen oder Patienten zu tragen waren, wurden entsprechend den Kostenteilungs- und Kostenträgersystemen in jedem Land ermittelt. ERGEBNISSE:Die medizinischen Gesamtkosten waren in Japan wesentlich geringer als die in Großbritannien und Deutschland; diese Unterschiede beruhten zum großen Teil auf den geringen Kosten für Operationen und Radiotherapien in Japan. Für das Basisfallszenario wurde in Japan (3486 €) eine 6,4-fach höhere Zuzahlung als in Deutschland (548 €) ermittelt. Die Kassen der europäischen Länder zahlten 2,9-mal mehr als die in Japan (∼25 000 € vs. 8627 €). SCHLUSSFOLGERUNG:Unsere Ergebnisse werden für Entscheidungsträger bei ihren Überlegungen zur Verteilung der medizinischen Kosten und der Zuweisung von begrenzten Ressourcen nützlich sein.
    背景与目标: 背景:本研究的目的是估计和跨国比较付款人和患者所承担的医疗费用以及医疗费用按费用类别的分布。
    材料和方法:假设日本,英国和德国提供的医疗服务几乎相同,我们估算了从明确诊断到完成早期乳腺癌治疗和随访的医疗费用。分析是从付款人的角度进行的。根据假设案例方案,通过将单位成本乘以消耗的单位数来计算医疗成本。根据每个国家的费用分摊和费用分担制度,估算付款人或患者产生的医疗费用。
    结果:日本的总医疗费用远低于英国和德国的医疗费用,这些差异主要是由于日本手术和放射疗法的费用较低所致。在基本情况下,日本的共付额(3,486欧元)比德国(548欧元)高6.4倍。欧洲国家的付款人支付的费用是日本的2.9倍(25,000欧元对8,627欧元)。
    结论:我们的结果对于决策者在考虑如何分担医疗费用以及如何分配有限资源方面将是有用的。
    HINTERGRUND:Ziel死于Studie战争,死于von den Kassen和Patienten死亡,而Aufteilung der medizinischen Kosten auf verschiedene Kostenkategorien zuschätzen和länderübergreifendzu vergleichen。
    材料和方法:德国医学博士,德国医学博士,德国医学博士,德国医学博士,德国医学博士,德国医学博士。死于西德·德·卡森·杜尔希格菲尔特。死于医学的科斯滕·伍登·卡尔库利特(Kosten wurden)杰西姆·兰德·米特(Jedem Land ermittelt)的医学博士,冯·德·卡森·德·耐特森·德·特雷根·沃伦,伍登·德·科斯滕特勒格和德·科斯滕特·雷格森系统。
    ERGEBNISSE:在日本死去的医学博士Gesamtkosten死于德国的Großbritannien和德国。在日本,您可以在操作和放射治疗上工作。日本的Fürdas Basisfallszenario wurde(3486€)德国的6,4-fachhöhereZuzahlung als(548€)ermittelt。在日本死于2,9-马尔代夫的死于欧洲的死神(约25,000欧元vs.8627欧元)。
    SCHHLUSSFOLGERUNG:在德国的医学和医学研究中心工作。
  • 【患有局部乳腺癌的老年妇女可获得的Medicare乳房手术费用和治疗。】 复制标题 收藏 收藏
    DOI:10.1111/1475-6773.00133 复制DOI
    作者列表:Hadley J,Mandelblatt JS,Mitchell JM,Weeks JC,Guadagnoli E,Hwang YT,OPTIONS Research Team.
    BACKGROUND & AIMS: OBJECTIVE:To determine whether area-level Medicare physician fees for mastectomy and breast conserving surgery were associated with treatment received by Medicare beneficiaries with localized breast cancer and to compare these results with an earlier analysis conducted using small areas (three-digit zip codes) as the unit of observation. DATA SOURCE:Medicare claims and physician survey data for a national sample of elderly (aged 67 or older) Medicare beneficiaries with localized breast cancer treated in 1994 (unweighted n = 1,787). STUDY DESIGN:Multinomial logistic regression analysis was used to estimate a model of treatment received as a function of Medicare fees, controlling for other area economic factors, patient demographic and clinical characteristics, physician experience, and region. PRINCIPAL FINDINGS:In 1994, average Medicare fees (adjusted for the effects of modifiers and procedure mix) for mastectomy (MST) and breast conserving surgery (BCS) were 904 dollars and 305 dollars, respectively. Holding other fees and factors fixed, a 10 percent increase in the BCS fee increased the odds of breast conserving surgery with radiation therapy relative to mastectomy to 1.34 (p = 0.02), while a 10 percent decrease in the MST fee increased the odds of breast conserving surgery with radiation therapy to 1.86 (p < 0.01). CONCLUSIONS:Among older women with localized breast cancer, financial incentives appear to influence the use of mastectomy and breast conserving surgery with radiation therapy. This finding is consistent with the hypothesis that physicians are responsive to financial incentives when the alternative procedures have clinically equivalent outcomes and the patient's clinical condition does not dominate the treatment choice. We also find that the fee effects derived from this analysis of individual data with more precise measurement of both diagnosis and treatment are qualitatively similar to the results of the small-area analysis. This suggests that the earlier study was not severely affected by ecological bias or other data limitations inherent in Medicare claims data.
    背景与目标: 目的:确定地区性医疗保险医师乳房切除术和保乳手术费用是否与当地乳腺癌患者的医疗保险受益人接受的治疗相关,并将这些结果与使用小面积(三位数邮政编码)进行的较早分析进行比较。观察单位。
    数据来源:Medicare索赔和医师调查数据是1994年治疗的患有局部乳腺癌的老年人(67岁或以上)医疗保险受益人的全国样本(未加权n = 1,787)。
    研究设计:采用多项逻辑回归分析来估计作为医疗保险费用函数的治疗模型,控制其他地区的经济因素,患者的人口统计和临床特征,医生的经验以及所在地区。
    主要发现:1994年,乳房切除术(MST)和保乳手术(BCS)的平均Medicare费用(根据改良剂和程序组合的影响进行调整)分别为904美元和305美元。在固定其他费用和因素的情况下,相对于乳腺切除术,BCS费用增加10%可使进行放射治疗的保乳手术的几率增加到1.34(p = 0.02),而MST费用减少10%则增加了乳腺手术的几率保留放射治疗的手术率降至1.86(p <0.01)。
    结论:在患有局限性乳腺癌的老年妇女中,经济诱因似乎影响了乳房切除术和保留乳房的放射治疗手术的使用。这一发现与以下假设是一致的,即当替代程序在临床上具有等同的结局且患者的临床状况未支配治疗选择时,医生会对经济诱因做出反应。我们还发现,从对单个数据的分析得出的费用影响,对诊断和治疗的更精确测量,在质量上与小区域分析的结果相似。这表明较早的研究并未受到医疗保险索赔数据固有的生态偏见或其他数据限制的严重影响。
  • 【分担费用和在国家计划中为体弱长者提供服务的收费的未来。】 复制标题 收藏 收藏
    DOI:10.1177/073346489201100405 复制DOI
    作者列表:Rothman MB
    BACKGROUND & AIMS: Although Congress has rejected the concept of mandatory cost-sharing under the Older Americans Act, many states already use client fee systems under state-funded home and community-based services programs. This research included a survey of actual state experiences and a review of earlier studies. States are compared on issues concerning policy and experience with fee systems, including income verification, fee schedules, termination policies, and costs of administration. Although policy and practice differ markedly across states, certain states are close to operationalizing comprehensive policies in this area. The author concludes that there is a need to conduct additional state-level demonstrations that address policy issues identified in the research. Evaluation research is needed to determine program effectiveness and efficiency, particularly concerning whether cost-sharing increases the amount of services available and ensures a high level of services to minorities.

    背景与目标: 尽管国会拒绝了《老年人法案》规定的强制性费用分摊的概念,但许多州已经在州政府资助的基于家庭和社区的服务计划下使用了客户收费系统。这项研究包括对实际状态经验的调查和对早期研究的回顾。对州进行收费政策和经验方面的比较,包括收入核查,收费表,终止政策和行政费用。尽管各州的政策和实践明显不同,但某些州已接近在该领域实施全面的政策。作者得出结论,有必要进行额外的州级示威,以解决研究中确定的政策问题。需要进行评估研究来确定计划的有效性和效率,尤其是在分担费用是否会增加可用服务量并确保为少数群体提供高水平服务方面。

  • 【处方期放松管制和修改后的医疗服务费用对药物治疗管理的影响。】 复制标题 收藏 收藏
    DOI:10.1248/yakushi.125.959 复制DOI
    作者列表:Kawazoe H,Iihara N,Doi C,Morita S
    BACKGROUND & AIMS: :The proclamation of April 2002 of a Ministry of Health, Labor and Welfare ordinance has enabled doctors to prescribe drugs for an outpatient without a limit on the length of prescription terms except for a few drugs. There is a concern that the prescription-term deregulation could cause careless drug therapy management in order to extend the interval between patient hospital visits. The purpose of this study is to make pre- and post-deregulation comparisons of two items, prescription terms and implementation of clinical examination that complied with package-insert precautions, and to discuss the approaches to increase safety. Prescription terms have lengthened progressively. In the pre-regulation period of January to March 2002, the mean prescription term was 19.9 days; in the post-regulation period of July to September 2002, it was 24.9 days; and in July to September 2003, 28.6 days. Even for anti-tumor agents, there were prescriptions over 90 days after deregulation. There was no significant difference between the pre- and post-deregulation compliance ratios for the package-insert precautions in eight drugs of investigated nine. However, one case had a delay in detection of liver dysfunction, which was caused by deviation from the once-a-month testing indicated in the package-insert precautions for prolonged prescription terms. The evidence suggested that the deregulation led to negligent drug therapy management. To assure safe therapy, the following should be addressed: first, sufficient function of a computerized prescriber order entry system and second, creation of a new framework with pharmacists' active involvement such as collaborative therapy management with physicians.
    背景与目标: :2002年4月颁布的厚生劳动省法令使医生能够为门诊病人开药,除少数药物外,对处方期限没有限制。人们担心处方期限的放松可能会导致药物治疗管理不慎,从而延长了患者就诊的间隔时间。这项研究的目的是对两种项目的处方前和处方后进行比较,包括处方条款和符合插入包装预防措施的临床检查的实施,并讨论提高安全性的方法。处方条款已逐渐延长。在2002年1月至2002年3月的预先监管期间,平均处方期为19.9天;在2002年7月至2002年9月的后监管期内,该时间为24.9天;从2003年7月到2003年9月为28.6天。即使是抗肿瘤药,放松管制后90天内也有处方。在调查的9种药物中,有8种药物的插装前预防措施的解除前和解除后合规率之间没有显着差异。但是,有1例患者的肝功能障碍检测延迟,这是由于长期处方药的包装插入注意事项中指出的每月一次检测结果的偏离所致。有证据表明,放松管制导致过失的药物治疗管理。为了确保安全的治疗,应解决以下问题:首先,要有足够的计算机处方程序输入系统功能,其次,要在药剂师的积极参与下(例如与医生合作进行治疗)创建新的框架。
  • 【床旁临床方法与吞咽光纤内窥镜检查(FEES)相比在确定急性中风患者发生误吸风险方面的准确性。】 复制标题 收藏 收藏
    DOI:10.1007/s004550000038 复制DOI
    作者列表:Lim SH,Lieu PK,Phua SY,Seshadri R,Venketasubramanian N,Lee SH,Choo PW
    BACKGROUND & AIMS: :This prospective study was undertaken to determine the accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) for detecting aspiration in acute stroke patients. Fifty patients underwent an examination of their ability to swallow 50 ml of water in 10-ml aliquots. Later their oxygen saturation levels before and after swallowing 10 ml of water were measured using a pulse oximeter. Oxygen desaturation of more than 2%, was considered to be clinically significant. All patients then underwent a FEES assessment by a speech therapist and were followed up during their inpatient stay for evidence of aspiration pneumonia. The oxygen desaturation test had a sensitivity of 76.9% and specificity of 83.3% (chi2 = 18.154, p = 0.00002), while the 50-ml water swallow test had a sensitivity of 84.6% and specificity of 75.0% (chi2 = 18.001, p = 0.00002). However, when these two tests were combined into one test called "bedside aspiration," the sensitivity rose to 100% with a specificity of 70.8% (chi2 = 27.9, p = 0.000001). Five (10%) patients developed pneumonia during their inpatient stay. The relative risk (RR) of developing pneumonia, if there was evidence of aspiration on FEES, was 1.24 (1.03 < RR < 1.49). We conclude that the oxygen desaturation test combined with the 50-ml water swallow test is suitable as a screening test to identify all acute stroke patients at risk of aspiration for further evaluation and management.
    背景与目标: :这项前瞻性研究旨在确定床旁临床方法与吞咽光纤内窥镜检查(FEES)在急性中风患者中检测误吸的准确性。五十名患者接受了以10毫升等分试样吞下50毫升水的能力检查。随后,使用脉搏血氧仪测定其在吞咽10毫升水之前和之后的氧饱和度水平。氧饱和度超过2%被认为具有临床意义。然后,所有患者均接受言语治疗师的FEES评估,并在住院期间接受随访,以了解有吸入性肺炎的迹象。氧脱饱和试验的灵敏度为76.9%,特异性为83.3%(chi2 = 18.154,p = 0.00002),而50毫升的水吞咽试验的灵敏度为84.6%,特异性为75.0%(chi2 = 18.001,p。 = 0.00002)。但是,当将这两个测试合并为一项称为“床旁抽吸”的测试时,灵敏度上升至100%,特异性为70.8%(chi2 = 27.9,p = 0.000001)。五(10%)名患者在住院期间出现肺炎。如果有吸入FEES的证据,则发生肺炎的相对风险(RR)为1.24(1.03

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