山东省社会药房慢性病管理现状调查研究

目的 调研山东省内社会药房开展慢性病管理的现状,为提高管理水平提供参考。方法 选择山东省5个地市155个社会药房为研究对象,问卷调查慢性病管理的人员配备、服务项目和阻滞因素等;分地市选取1 155例慢性病患者为研究对象,调研患者对药房慢性病管理的认知、需求、参与和认可情况。结果 社会药房主要围绕高血压(90.5%)、糖尿病(87.5%)和慢阻肺(75.2%)等慢性病开展服务,管理项目主要有用药指导(90.3%)、健康教育(89%)和生化指标检测(85.8%),阻滞性因素是缺少专业管理人员(61.3%)、患者依从性差(52.9%)和对药房缺少信任(48.4%)。患者对慢性病的认知度(65.2%)低,参与药房管理的积极性低(56.5%);期望药房建立慢性病管理专区(57.7%),检测生化指标(56.2%),提供用药指导(50.8%);73.6%的患者信任药房的管理,满意度为86.7%。结论 慢性病管理在一定程度上满足了患者的疾病康复需求和健康管理需求,但仍面临多重挑战,社会药房需要利用好各类利好政策,从发展方向、发展路径和发展模式上大胆创新、不断探索。     

妊娠高血压疾病的发病因素与母婴不良结局的关系

目的 研究妊娠高血压疾病发病相关因素与母婴不良结局的关系。方法 以2013年1月至2015年6月收治的200例妊娠高血压疾病患者为研究对象,收集并整理所有患者病例资料,包括妊娠高血压严重程度、孕周、孕次、分娩方式、合并症、母婴不良结局等,单因素及多因素logistic回归分析妊娠高血压疾病发病因素及分娩方式对母婴不良结局的影响。结果 母婴不良结局:母亲不良结局55例(27.5%),胎儿不良结局48个(21.5%),新生儿不良结局47个(21.3%)。相关性:尿蛋白严重程度与妊娠高血压疾病程度正相关(P<0.05)。单因素及logistic多因素回归分析发现母婴不良结局与妊娠高血压疾病发病孕周、分娩孕周及尿蛋白有关。结论 及时发现并严格控制妊娠高血压疾病及蛋白尿程度,最大限度延长分娩孕周能有效减少母婴不良结局发生。     

周口地区糖尿病患者自我管理与健康教育状况调研

目的：了解糖尿病患者的自我管理能力以及健康教育状况,为糖尿病预防及控制提供参考。方法：采用问卷调查的方式,用Excel软件进行统计分析。对100例糖尿病患者进行关于糖尿病自我管理和健康教育情况的调查,内容包括患者基本信息、糖尿病患者血糖控制状况、影响血糖控制的因素以及接受糖尿病相关知识的途径等。以测量的空腹血糖值为目标判断糖尿病患者血糖控制的情况。从糖尿病患者对糖尿病的认识,了解相关信息的途径,患者想要获得的糖尿病知识,以及对健康教育的需求等情况进行调查。结果：在血糖控制上,血糖控制非常好的只有18人,占18.8%;饮食、运动、药物以及对于糖尿病的认识都会影响血糖控制。63个患者（65.6%）对于糖尿病有了解,但是非常了解糖尿病的只有9人（9.4%）,而且66个患者（68.8%）最想要知道的是关于糖尿病的并发症防治,说明患者对于糖尿病的知识还是缺乏的。这表明周口地区患者自我管理能力较差,健康教育情况也不佳。结论：患者更需要健康教育服务,健康教育可以提高糖尿病患者的自我管理能力。每个医院需定期开展糖尿病患者健康教育活动。     

50例高血压患者用药依从性调查及药学监护

摘 要 目的：了解住院原发性高血压患者遵医嘱用药状况,分析影响患者服药依从性的原因,并有针对性地进行用药教育和药学监护。方法: 以高血压预防指南为主要内容对50例原发性高血压住院患者进行用药教育和指导,每个患者均在入组后两个月时间内完成定期回访,收集有关患者治疗及用药有关信息并对结果进行分析。结果: 通过用药教育和药学监护,患者了解了高血压病、合理用药及治疗相关知识,完全遵医嘱进行降压药物治疗比例达86%,戒烟限酒比例达82%,优化生活方式比例达78%,82%的患者血压得到有效控制,均较刚入院时有了明显好转。结论: 临床药师对高血压患者进行用药教育和药学监护可以使患者建立良好的生活方式,提高患者对药物治疗的依从性,提高治疗效果,缓解并发症,降低药物不良反应,提高患者的生活质量。     

甘肃省榆中县夏官营镇老年高血压患者用药依从性调查分析

目的：充分了解影响农村地区老年高血压患者用药依从性的因素,为提高高血压患者用药依从性提供参考。方法：对甘肃省兰州市榆中县夏官营镇912名65岁以上居民进行健康体检,对所筛选出的高血压患者的用药依从性问题进行现场问卷调查。结果：老年高血压患者用药依从性好、尚可、差所占比例分别为36.12%、28.49%和35.04%;用药依从性不佳的主要原因为记忆力减退和家属督促不力;对药物疗效完全了解、部分了解、不了解者分别占50.52%、31.87%和17.61%。结论：甘肃省兰州市榆中县夏官营镇老年高血压患者用药依从性较差,对药物疗效等相关知识了解程度不高,不按时服药的老年高血压患者较多。提示医、药、护人员要深入社区,加强对老年高血压患者的健康教育,对患者家属加强督促,使患者认识到药物治疗对控制血压的重要性,提高用药依从性。     

互动护理模式在康复科患者健康教育中的作用

目的 探讨互动护理模式在康复科患者健康教育中的应用价值。方法 选取2013年10月至2014年5月康复科住院患者141例,按照床号单双数分为观察组和对照组,观察组73例,对照组68例,分别采取互动护理模式及传统模式对患者进行健康教育,比较两组患者对护理工作的满意度和健康教育知识掌握情况。结果 健康教育知识知晓率观察组患者为83.6%,对照组为66.2%,两组比较差异有统计学意义(P<0.05);患者对护理工作满意度观察组为98.6%,对照组为89.7%,两组比较差异有统计学意义(P<0.01)。结论 互动护理模式是一种有效的护理健康教育模式。     

急性脑梗死患者血浆同型半胱氨酸水平高血压与脑微出血的相关性分析

目的 探讨急性脑梗死患者血浆同型半胱氨酸(Hcy)水平、高血压与脑微出血(CMB)的关系。方法 选择铜陵市人民医院神经内科2011年1月至2012年1月收治的急性脑梗死患者74例, 对其临床及影像学资料进行回顾性分析。根据是否存在CMB分为CMB组和无CMB组。记录两组患者血压、血脂、血糖、血浆Hcy水平等情况, 并探讨CMB的危险因素。结果 74例急性脑梗死患者中, 男性51例, 女性23例, 平均(66.22±8.96)岁。logistic回归分析显示, CMB的发生与高血压密切相关(OR=4.67, 95% CI:1.23～17.65, P=0.02), 与血浆Hcy水平无明显相关(OR=1.01, 95% CI:0.97～1.06, P=0.38)。结论 CMB与血浆Hcy水平增高无关, 与高血压显著相关, 高血压可能为其独立危险因素。     

播客技术在临床健康教育中的应用效果

目的 探索播客技术对妇科住院患者健康教育效果的影响。方法 选择2014年11月至12月在安徽省立医院妇科住院的126例患者,分为对照组(77例)和试验组(49例)。对照组按临床护理路径进行健康教育;试验组运用播客技术按临床护理路径进行健康教育,比较两组患者健康教育知晓率、住院期间满意度。结果 试验组患者住院期间健康教育知晓率、住院期间满意度均高于对照组,差异有统计学意义(P<0.05)。结论 运用播客技术可明显提高患者住院期间健康教育知晓率、住院期间的满意度,而且可以普及医疗卫生知识,提高患者预防意识,值得推广。     

强化护理干预在社区高血压患者健康教育中的应用

目的 探讨强化护理干预对社区高血压患者护理效果的影响。方法 120例社区高血压患者随机分为干预组和对照组, 每组60例。对照组采取常规社区护理干预, 干预组采用强化护理干预措施。结果 干预组患者的健康知识知晓率、健康生活行为方式、遵医依从性、血压值变化等相比, 均优于对照组, 差异有统计学意义(P<0.05)。结论 强化护理干预能提高社区高血压患者健康知识知晓率、健康生活行为方式、遵医依从性, 并有效地控制了血压。     

安徽省结核病防治核心信息知晓率抽样调查分析

目的 评估安徽省居民结核病防治核心信息知晓率现状,为进一步加强安徽省结核病防治健康教育与健康促进工作提供科学依据。方法 采用分层整群随机抽样方法,2015年在安徽省抽取6个调查点,使用统一调查问卷对15岁以上常住居民进行面对面调查。结果 研究共完成调查对象900人,5条结核病核心信息总知晓率为75.8%。农村居民（87.0%）高于城区居民总知晓率（70.2%）,差异有统计学意义（P<0.05）;接受过宣传教育的居民核心信息总知晓率（80.4%）高于未接受过宣传教育的居民（68.4%）,差异有统计学意义（P<0.05）。5条核心信息中知晓率较低的2条是第四条“我国对肺结核患者实施部分免费政策”（48.0%）和第五条“肺结核大部分能治好”（62.3%）。结论 安徽省结核病防治知识知晓率未达到国家指导要求,有必要进一步加强结核病健康教育工作。     

The voices of community pharmacists during the COVID-19 pandemic in Puerto Rico

BackgroundCommunity pharmacists have provided health care services uninterruptedly throughout the coronavirus disease 2019 (COVID-19) pandemic. However, their public health role is often overlooked.ObjectivesThe purpose of this article is to discuss the roles and the coping mechanisms of community pharmacists working during the COVID-19 pandemic in Puerto Rico.MethodsA cross-sectional study, using an electronic survey, was conducted to assess the community pharmacists’ response during the COVID-19 pandemic in Puerto Rico. Two open-ended questions explored community pharmacists’ opinions about the pharmacist’s role and coping mechanisms during the pandemic. The responses were analyzed following an inductive thematic analysis. Two major themes emerged from their responses: professional and personal experiences.ResultsOf the 302 participants who completed the survey, 77% of them answered 1 or both open-ended questions. The answers were diverse, and the respondents went beyond the specific topics asked. In professional experiences, important roles as educators and providing continuity of care and emotional support to their patients were highlighted. They also expressed concerns and frustrations on the profession’s shortcomings, feeling overworked yet with a lack of recognition. In personal experiences, most of the respondents were concerned about the impact of having to juggle work and home life. They also reported mental health concerns, expressing feeling stressed, overworked, and worried about the constant risk of exposure and fear of exposing their loved ones.ConclusionCommunity pharmacists in Puerto Rico ensured the continuation of care, provided education, and managed anxious and stressed patients. Most relied on family members to cope with the extra burden that the COVID-19 pandemic. The lack of recognition created resentfulness among participants. It is essential to listen to our community pharmacists’ voices to support and respond to their needs and learn from their experiences as frontline health care workers.     

驻闽部队高血压患者自我管理知识与技能调查分析

目的 了解高血压患者自我管理知识与技能掌握现状,为开展健康教育提供依据.方法 以自编调查表对确诊的115名高血压患者进行问卷调查.结果 多数患者高血压基本知识欠缺.全部答对所选知识问题者仅占15.65%;自我管理基本知识与技能平均得分(67.60±9.24),不同性别、年龄差异无统计学意义(均P>0.05),不同文化程度、家族史、是否初诊间差异有统计学意义(均P<0.05).结论 高血压患者自我管理知识与技能培训非常必要.     

基于网络药理学分析宣肺败毒方治疗SARS、MERS和COVID-19的作用机制

目的 探讨宣肺败毒方对冠状病毒感染治疗作用的有效成分、作用靶点、信号通路等,从而阐释其作用机制。方法 利用Cytoscape构建了宣肺败毒方的药物–性–味–归经网络。采用TCMSP数据库、SwissADME数据库和Swiss Target Prediction数据库筛选宣肺败毒方的有效成分和相关靶点,通过GeneCards数据库和CTD数据库收集严重急性呼吸道疾病（SARS）、2012年的中东呼吸综合征（MERS）和新型冠状病毒肺炎（COVID-19）的疾病靶点,将药物靶点和疾病靶点取交集,利用Cytoscape软件构建网络;运用String数据库,对潜在靶点进行蛋白相互作用（PPI）网络模型构建;通过Metascape数据库对潜在靶点进行GO和KEGG富集分析,并且用Cytoscape构建网络。结果 宣肺败毒方中有10种药材与肺经有关。从中筛选出167个活性成分和242个潜在作用靶点,核心药物为甘草、麻黄、青蒿、马鞭草、虎杖,核心成分为槲皮素、豆甾醇、山柰酚、木犀草素、异鼠李素等,核心靶点为AKT1、IL-6、TP53、VEGFA、TNF等,可能的作用机制与PI3K-Akt signaling pathway、HIF-1 signaling pathway和TNF signaling pathway等多个信号通路有关。结论 通过网络药理学探讨了宣肺败毒方对SARS、MERS和COVID-19的潜在共同作用机制,体现了中药多成分、多靶点、多途径的作用特点。     

Frequently asked questions about dabbing concentrates in online cannabis community discussion forums

Background“Dabbing” involves vaporizing a “dab” of cannabis concentrate on a heated “nail,” passing the vapour through a water-pipe rig or portable pen device, and inhaling the vapour. While some cannabis industry media claims that this process is cleaner, safer, and more effective for getting high, medical and public health sources raise concerns about residual solvents and pesticides, unexpectedly intense effects, and rapid increases in tolerance. The aim of this study is to characterize the content of questions about dabbing posed in cannabis and dabbing-specific forums on the Reddit social media platform, as well as comment responses to these questions.MethodsWe conducted a content analysis of one year (2017) of information-seeking user-generated posts to three Reddit online cannabis community discussion forums (“subreddits”) that contained the terms “dab” and “question.” We also examined post engagement and the types and sentiment of information exchanged in the comment responses.ResultsAcross 193 dabbing question posts, the most frequently asked question content was about types and logistical use of devices and related equipment (38%) and comparisons of cannabis products (32%), followed by questions about the step-by-step process of getting high (18%), legal issues (17%), and health concerns (13%). Nearly every post had a response (98%), with a median 5 comments per post and few negative (i.e. hostile, condescending, or trolling) comments (4%). Source of advice or information was stated in about a quarter (26%) of comment responses, with the overwhelming majority of this information (89%) coming from disclosures of personal experience vs. web or commercial sources.ConclusionPeople seeking advice online about dabbing inquired most often about logistics of use, but less often about health, tolerance, and legal risks. These findings may be used to inform public health efforts and health practitioner education as cannabis becomes increasingly legal and accessible.     

Low-risk drinking guidelines to reduce alcohol-related harm: Delphi survey to explore aspects ‘beyond epidemiology’

Background: Low-risk drinking guidelines across Europe portray a wide variation. We turned to European experts to identify areas of agreement and disagreement on questions relevant to forming and communicating low-risk guidelines: need and purpose of guidelines, criterion for low risk, desired components and stratification, views over evidence base and communication aspects.

Methods: A policy Delphi survey carried out in two rounds in 2015 with public health and addiction experts (n?=?51), using the web-based eDelfoi survey tool. Both closed and open-ended questions were used and free-format comments were invited. Frequency counts are presented, and textual answers and comments were subjected to qualitative content analysis. In the second round, key questions were repeated, and new questions, formulated based first-round comments, were presented.

Results: The experts considered as the main rationale for drinking guidelines the public’s right to be informed about risks of drinking. Separate guidelines were called for regarding longer term average consumption and drinking on single occasions, and at-risk groups and high-risk situations were identified that require special attention. Scepticism arose from the complexity of alcohol-related risks and, in particular, from the need to differentiate the advice for various subgroups.

Conclusions: The Delphi survey provided insight into aspects of forming low-risk drinking guidelines that go beyond the epidemiology and will potentially help towards more aligned messages in future guidelines.     

Pharmacist eConsult service for primary care medication optimization and safety

BackgroundThere is a critical need in primary care to proactively prevent, identify, and resolve poor medication-related outcomes. However, more than 80% of primary care practices do not have clinical pharmacists as members of expanded care teams. The emergence of eConsult services in primary care settings presents an opportunity for primary care providers (PCPs) to consult with clinical pharmacists as “on-demand” pharmacotherapy specialists.ObjectivesThe objectives were to (1) determine the use of a clinical pharmacist in an existing eConsult network, (2) characterize the use and type of clinical pharmacist eConsults sent by PCPs, and (3) measure the implementation percentage of pharmacist recommendations by PCPs.MethodsThe study was conducted in a federally qualified health center using an existing eConsult platform. A clinical pharmacist was contracted to receive eConsults and was expected to respond within 2 business days. PCPs were introduced to the pharmacist eConsult service through presentations that reviewed the clinical pharmacist’s education/training, suitable pharmacist eConsult topics, and workflow for sending a pharmacist eConsult.ResultsA total of 57 eConsults containing 123 individual questions were answered. Advanced practice nurses (APRNs) sent 3 times the number of eConsults and individual questions per eConsult compared with physicians (P < 0.0001). Most eConsult questions from APRNs related to adverse drug events/drug interactions (44%), drug or dosage changes to reach therapeutic goals (18%), and renal/hepatic dosage adjustments (13%). However, physician eConsult questions were primarily targeted on patient-specific drug or dosage adjustments (62%) and comprehensive medication regimen reviews (17%). A total of 74% of the pharmacist eConsult responses had at least 50% of the recommendations implemented by PCPs.ConclusionThis study revealed the use of a pharmacist eConsult service for medication-related questions in an existing eConsult network for PCPs. As more practices enroll in value-based plans, pharmacist eConsults can improve the quality and safety of prescribing and chronic medication management.