深圳地区社区健康服务中心院上转前急救患者病种病情分析

<正>深圳市社区卫生服务工作自1996年开展以来,各个方面发展较快,社区卫生服务工作发展水平处于我国前列,特别是宝安区已建立起"医院-社康中心"患者双向转诊的基本模式,形成"绿色通道"[1]。本课题以宝安区开展双向转诊工作较好的西乡人民医院及其所属38家社区健康服务中心(社康中心)为研究对象,在调查其双向转诊工作现状的基础上,回顾性分析了2009—2013年医院急诊科院前急救出车,社康中心接回经院前急救患者     

深圳市劳务工门诊常见病及用药情况分析

目的:了解深圳市劳务工"医保"用药现状。方法:采用多中心、随机、平行试验方法,对我院本部和社区康复服务中心(简称"社康中心")2006年4~9月劳务工"医保"处方进行统计、分析。结果:劳务工"医保"门诊接诊总病种达230种,接诊频率排序列前6位的依次为上呼吸道感染、胃炎、支气管炎、宫颈炎、肺炎、阴道炎;本部与社康中心人均费用分别为94.8、36.8元.人-1,全身性抗菌药物应用率分别为50.1%、73.1%,平均用药品种数分别为2.88、3.25种。结论:社康中心合理用药水平较低,本部"医保"目录内药品应用比例偏低,人均费用偏高,有待规范。     

社区护理在居家养老保健服务中的作用模式和流程探讨

目的探讨分析社区护理在居家养老保健服务中的作用模式和流程。方法随机选取深圳市西乡街道3家社康中心居家养老的老年人,分别设为A社区、B社区和C社区,每家社康中心选取100例老年人作为研究的对象,对社区居民和社区内常住老人的摸底调查,分析近年来这3家社康中心辖区内常住老人的自我健康行为和社区护士对其的管理状况,采取问卷调查的方式对社区护理在居家养老保健服务中的作用模式和其流程进行总结分析。结果 A社区老人和社区居民对社康中心满意度为60%,B社区老人和社区居民对社康中心满意度为80%,C社区老人和社区居民对社康中心满意度为98%,C社区老人和社区居民对社康中心满意度大于A社区老人和社区居民对社康中心满意度和B社区老人和社区居民对社康中心满意度。三组社区居民对社康中心满意度进行比较,P<0.05,有统计学意义。结论居家养老保健服务中的社区护理更应该结合社区老年人的心理、生理以及社会活动进行护理,加强社区护理护理人员的培养,对社区进行综合性的管理,可提高社区居民对社康中心满意度,进而保证社区老年人的和谐健康发展。     

中医药服务现状调查与分析

目的了解沙井街道社区健康服务中心中医药资源配置与中医药服务功能在社区的开展情况。方法采取结构式问卷调查的方法,调查沙井街道21家社康中心中医药资源配置与服务开展情况。结果发放问卷21份,回收有效问卷21份,回收有效率为100%。结论社区健康服务中心普遍开展了中医药服务,但开展率低,目前社区中医药服务存在中医药业务用房面积小、中医药科室设置不全、中药品种配备及中医常用器械不足等问题,上述问题必须引起各级政府部门的高度重视,进一步完善中医药社区的各项配套制度,加大支持力度与资金投入,保障中医药社区卫生事业的可持续发展。     

国家中医药管理局副局长马建中赴南京调研指导社区中医药工作

<正>本刊讯2011年8月19日,国家中医药管理局副局长马建中在江苏省、南京市卫生行政部门有关领导陪同下,赴南京市调研指导社区中医药工作。马建中先后前往秦淮区秦中社区卫生服务中心和白下区止马营社区卫生服务中心调研。调研中,他深入诊室,详细了解社区中医药工作开展情况,并向就诊群众仔细询问对社区中医药工作的了解和感受。     

社康中心与药店合作新路径

<正>零售药店在基层医疗的价值被广泛认可,越来越多的力量正在敦促社康中心和药店发挥各自优势,从竞争走向合作,向基层医疗一体化方向深度融合。在医药分家、处方流转、门诊统筹等政策的不断推进之下,基层医药机构的两大主力,社区卫生服务中心（以下简称“社康中心”）和零售药店在承接外流处方、争夺慢病客源等方面展开“博弈”。对处方流转不畅或拿不到国谈药品的药店来说,尽管有诸多利好政策明确鼓励零售药店发展,但真正执行政策并享受政策红利的药店屈指可数。相比之下,社康中心拥有较高的报销比例（不少城市社区门诊的报销比例高达80%）、处方资源优势,     

医疗联合体对社区卫生服务中心运行效益的影响

目的:通过对武汉市第五医院直管的6家社区卫生服务中心与非直管的社区卫生服务中心的运行和经济效益进行比较,研究医疗联合体对社区卫生服务中心运行效益的影响。方法:收集汉阳区8家社区卫生服务中心的运行数据,用重复测量资料方差分析方法对直管和非直管社区卫生服务中心的服务提供和经济效益进行比较分析。结果:①直管社区卫生服务中心平均门诊人次年平均增长率为12.77%,出院人次年平均增长率为19.81%;非直管社区卫生服务中心平均门诊人次年平均增长率为2.83%,平均出院人次年平均下降率为-11.01%。②重复测量方差分析:门诊人次、出院人次、人均业务收入和人均门诊费用4个指标组间效益的差异均有统计学意义(P0.05),药品收入占业务收入比例的组间效应的差异没有统计学意义(P0.05)。结论:直管后社区卫生服务中心服务提供明显增加,经济效益也提高,但是,需要完善对社区的监管机制,促进社区公益性的回归。     

深圳市社区卫生服务机构基本药物制度实施现状调查

目的 了解深圳市社区卫生服务机构基本药物制度实施现状,为国家基本药物制度的落实提供参考意见.方法 采用普查方式,对深圳市所有社区卫生服务机构进行为期5年(2007年～2011年)连续性调查.结果 至2011年,已建成社区健康服务中心611家,社区健康服务中心门急诊服务呈稳步发展趋势,社区卫生财政投入力度逐年加大.国家基本药物制度、药品零差率、纳入医保定点机构的实施范围明显增加,但医药分开或医药托管、实行两条线管理的机构比例仍不高.社区健康服务中心配备药物437.4种(西药285.9种,中成药151.5种),实施零差率/低差率西药184.1种,中成药91.0种.结论 深圳市社区基本药物制度实施总体取得初步成效,各项基本药物关键政策均呈向好趋势,但仍有提升空间.     

山西：鼓励中医药走进社区

据新华社信息，山西省日前出台社区卫生服务有关政策明确规定，到2010年全省各级社区卫生服务机构慢性病防治和保健康复的中医药参与率应不低于80％，基本满足社区居民对中医药服务的需求。据山西省卫生厅中医局局长文渊介绍，社区卫生服务中心应设立中医科、中药房及配备相应的中医诊疗设施设备，配备不少于250种的中药饮片和50种中成药；社区卫生服务站应配备不少于50种的中成药，有条件的可配备一定数量的中药饮片，并配置常用的中医药诊疗设备；社区卫生服务要能提供针灸、推拿、拔罐、熏蒸等安全有效、便捷经济的中医药适宜技术。     

糖尿病社区分级管理模式的探讨

目的 评价以社区为基础的糖尿病管理模式在糖尿病控制中的作用,探讨适合中国国情的糖尿病社区分级管理模式.方法 对深圳市光明新区公明办事处社康中心、深圳市宝安区海华札区及布心社区社康中心登记在册的189例糖尿病患者进行分级管理,依据血糖水平将患者分为常规管理级及强化管理级分别进行管理.社康中心负责糖尿病患者的基本管理工作,综合医院负责患者的治疗方案制定及技术指导,管理模式的评价指标包括社康中心全科医师的专业技能及遵从管理方案意愿、患者对治疗的依从性、患者的血糖控制水平.结果 通过对糖尿病患者进行分级管理后,社康中心全科医师对糖尿病患者的专业管理技能合格率、遵从管理方案意愿率及患者对治疗的依从率分别从分级管理前的75.5%、36.7%、26.5%提高到分级管理后的98.0%、95.9%、47.6%,三个评价指标的提高均具有显著的统计学差异（χ^2=8.29、39.75、38.60,P〈0.01）.患者的空腹血糖、餐后2小时血糖及糖化血红蛋白从分级管理前的（8.49±3.35）mmol/L、（12.67±5.37）mmol/L、（8.45±2.22）%降至分级管理后的（6.99 4±1.47）mmol/L、（9.12±2.75）mmol/L、（6.76±0.72）%,患者三个血糖参数均显著降低（t=-5.64、8.09、9.94,P〈0.01） .糖尿病患者社区分级管理后,患者空腹血糖、餐后2小时血糖及糖化血红蛋白的达标率分别从分级管理前的25.9%、20.0%、14.8%提高到分级管理后的48.2%、38.5%、40.7%,三个血糖指标达标率的提升均有显著的统计学差异（χ^2=20.49、12.08、32.31,P〈0.01）.结论 以社区为基础的糖尿病管理模式易为社康中心全科医师掌握,患者对治疗的依从性较高,患者的血糖控制效果较好,可在社区推广.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Polymorphisms in genes involved in neurotransmission in relation to smoking

Smoking behavior is influenced by both genetic and environmental factors. The genetic contribution to smoking behavior is at least as great as its contribution to alcoholism. Much progress has been achieved in genomic research related to cigarette-smoking within recent years. Linkage studies indicate that there are several loci linked to smoking, and candidate genes that are related to neurotransmission have been examined. Possible associated genes include cytochrome P450 subfamily polypeptide 6 (CYP2A6), dopamine D₁, D₂, and D₄ receptors, dopamine transporter, and serotonin transporter genes. There are other important candidate genes but studies evaluating the link with smoking have not been reported. These include genes encoding the dopamine D₃ and D₅ receptors, serotonin receptors, tyrosine hydroxylase, trytophan 2,3-dioxygenase, opioid receptors, and cannabinoid receptors. Since smoking-related factors are extremely complex, studies of diverse populations and of many aspects of smoking behavior including initiation, maintenance, cessation, relapse, and influence of environmental factors are needed to identify smoking-associated genes. We now review genetic polymorphisms reported to be involved in neurotransmission in relation to smoking.     

Genotoxic effects of chlorophenoxy herbicide diclofop-methyl in mice in vivo and in human lymphocytes in vitro

Diclofop-methyl (DM) is a chlorophenoxy derivative used in large quantities for the control of annual grasses in grain and vegetable crops. In this study, the genotoxic effects of DM were investigated by measuring chromosomal aberrations (CAs) in mouse bone-marrow cells and CA and the comet assay in human peripheral lymphocytes. Mice were treated with 15.63, 31.25, 62.5, and 125?mg/kg body weight of DM intraperitoneally for 24 hours, and 15.63-, 31.25-, 62.5-, 125-, and 250-µg/mL concentrations were applied to human lymphocytes for both 24 and 48 hours. In in vivo treatments, DM significantly, but not dose dependently, increased the total chromosome aberrations, compared to both negative and solvent controls. Cell proliferation was significantly, but not dose dependently, affected by all doses. In in vitro treatments, DM (except 15.63 µg/mL) significantly and dose dependently increased the frequency of chromosome aberrations. Also, 250 µg/mL of 48-hour treatment was found to be toxic. Cell proliferation was significantly and dose dependently affected by DM applications, when compared to negative control. In in vitro treatments, DM significantly decreased the mitotic index only at the highest concentration for 24 hours, and 62.5- and 125-µg/mL concentrations for 48 hours. In the comet assay, a significant and dose-dependent increase in comet-tail intensity was observed at 62.5-, 125-, and 250-µg/mL concentrations. The mean comet-tail length was significantly increased in all concentrations. Our results demonstrate that DM is genotoxic in mammalian cells in vivo and in vitro.     

2010调脂治疗领域进展

2010年在调脂治疗领域针对他汀治疗心血管病的防治又进行了许多探索。本文通过综述他汀类药物的国际大规模临床试验结果,重新评价了他汀类药物在冠心病一级预防和冠心病二级预防中的地位,阐明了强化他汀治疗的意义;对他汀的心肾保护作用和安全性新证据进行了说明。     

Tramadol concentrations in blood and in cerebrospinal fluid in a neonate

Based on blood and cerebrospinal fluid samples collected in a full-term neonate, the penetration of tramadol in the central nervous system is described. Following intravenous administration of tramadol, a lag time of about 4 h was observed until full blood–brain equilibration was achieved. This pharmacokinetic observation is in line with a recent pharmacodynamic evaluation of the central opioid effects of tramadol in adults.