气温变化与心脑血管疾病急诊关系的病例交叉研究

目的 探讨北京市日平均气温与心脑血管疾病急诊(ICD-10:I00～I99)的关系,研究气温变化对心脑血管疾病的影响.方法 收集北京大学第三医院急诊科心脑血管疾病急诊资料、北京市气象资料和北京市大气污染物数据,应用时间分层的病例交叉设计研究方法分析春季(3-5月)、夏季(6-8月)、秋季(9-11月)、冬季(12-2月)日平均气温与心脑血管疾病急诊的关系.结果 在控制二氧化硫(SO2)、二氧化氮(NO2)及大气可吸入颗粒物(PM10)影响的情况下,春季、夏季、秋季、冬季当日平均气温对心脑血管疾病急诊的影响最大,平均气温每升高1℃与心脑血管疾病急诊的OR值分别为1.282(95%CI:1.250 ～1.315)、1.027(95% CI:1.001～1.055)、0.661(95% CI:0.637～0.687)、0.960(95%CI:0.937～0.984),关联有统计学意义(P<0.05).当同时调整相对湿度、风速、大气压强的影响时,春季、夏季、秋季、冬季平均气温与心脑血管疾病急诊的OR值分别为1.423(95%CI:1.377～1.471)、1.082(95%CI:1.041～1.124)、0.633(95%CI:0.607～0.660)、0.971(95%CI:0.944～1.000).关联有统计学意义(P<0.05).结论 春季、夏季日平均气温升高可以导致心脑血管疾病急诊人次增加,说明春夏季气温升高对心脑血管疾病患者是危险因素,应注意防暑;秋季、冬季气温升高可以导致心脑血管疾病急诊减少,说明秋冬季气温升高对心脑血管疾病患者是保护性因素,应注意保暖.     

Impact of quality circles for improvement of asthma care: results of a randomized controlled trial

Rationale and aims Quality circles (QCs) are well established as a means of aiding doctors. New quality improvement strategies include benchmarking activities. The aim of this paper was to evaluate the efficacy of QCs for asthma care working either with general feedback or with an open benchmark. Methods Twelve QCs, involving 96 general practitioners, were organized in a randomized controlled trial. Six worked with traditional anonymous feedback and six with an open benchmark; both had guided discussion from a trained moderator. Forty‐three primary care practices agreed to give out questionnaires to patients to evaluate the efficacy of QCs. Results A total of 256 patients participated in the survey, of whom 185 (72.3%) responded to the follow‐up 1 year later. Use of inhaled steroids at baseline was high (69%) and self‐management low (asthma education 27%, individual emergency plan 8%, and peak flow meter at home 21%). Guideline adherence in drug treatment increased (P = 0.19), and asthma steps improved (P = 0.02). Delivery of individual emergency plans increased (P = 0.008), and unscheduled emergency visits decreased (P = 0.064). There was no change in asthma education and peak flow meter usage. High medication guideline adherence was associated with reduced emergency visits (OR 0.24; 95% CI 0.07–0.89). Use of theophylline was associated with hospitalization (OR 7.1; 95% CI 1.5–34.3) and emergency visits (OR 4.9; 95% CI 1.6–14.7). There was no difference between traditional and benchmarking QCs. Conclusions Quality circles working with individualized feedback are effective at improving asthma care. The trial may have been underpowered to detect specific benchmarking effects. Further research is necessary to evaluate strategies for improving the self‐management of asthma patients.     

对老年支气管哮喘缓解期患者行家庭访视的效果观察

目的 探讨家庭访视对老年支气管哮喘缓解期患者疾病认知、遵医行为及复发率、复诊率的影响。方法将社区89例老年支气管哮喘缓解期患者分为观察组46例和对照组43例，对照组实施常规健康教育，观察组在此基础上每月2—3次进行家庭访视并予护理指导。结果随访1年后，观察组的疾病认知优于对照组，遵医行为明显高于对照组，差异有统计学意义；观察组哮喘复发率低于对照组，复诊率高于对照组。结论对老年支气管哮喘缓解期患者进行家庭访视，有利于提高患者的疾病认知水平及遵医行为，能有效降低哮喘复发率，提高复诊率。     

Efficacy and safety of rolapitant for prevention of chemotherapy-induced nausea and vomiting over multiple cycles of moderately or highly emetogenic chemotherapy

ObjectiveRolapitant, a novel neurokinin-1 receptor antagonist (RA), was shown to protect against delayed chemotherapy-induced nausea and vomiting (CINV) during the first cycle of moderately emetogenic chemotherapy (MEC) or highly emetogenic chemotherapy (HEC) in randomized, double-blind trials. This analysis explored the efficacy and safety of rolapitant in preventing CINV over multiple cycles of MEC or HEC.Patients and methodsPatients in one phase III MEC, one phase II HEC, and two phase III HEC clinical trials were randomized to receive oral rolapitant (180 mg) or placebo in combination with a 5-hydroxytryptamine type 3 RA and dexamethasone. Regardless of response in cycle 1, patients could continue the same antiemetic treatment for up to six cycles. On days 6−8 of each subsequent chemotherapy cycle, patients reported the incidence of emesis and/or nausea interfering with normal daily life. Post hoc analyses of pooled safety and efficacy data from the four trials were performed for cycles 2–6.ResultsSignificantly more patients receiving rolapitant than control reported no emesis or interfering nausea (combined measure) in cycles 2 (p = 0.006), 3 (p < 0.001), 4 (p = 0.001), and 5 (p = 0.021). Over cycles 1−6, time-to-first emesis was significantly longer with rolapitant than with control (p < 0.001). The incidence of treatment-related adverse events during cycles 2–6 was similar in rolapitant (5.5%) and control (6.8%) arms. No cumulative toxicity was observed.ConclusionsOver multiple cycles of MEC or HEC, rolapitant provided superior CINV protection and reduced emesis and nausea interfering with daily life compared with control and remained well tolerated.     

术前访视小组的流程管理与实施效果

目的探讨术前访视小组的流程管理及实施效果。方法成立术前访视小组，并对其进行技能培训，按规范化的流程对术前患者进行访视，评估访视效果。结果解决了护理人力资源紧张造成的矛盾，提高了患者及医生的满意度和术前访视质量及效率：结论术前访视小组的流程管理是一种科学、高效的管理方法，有利于提高访视质量。     

A Program Evaluation of Postpartum/Newborn Home Visitation Services in Aiken County, South Carolina

ABSTRACT Objective: Home visiting programs for very young children seek to promote their health and development. We conducted a process and outcome evaluation of the Postpartum/Newborn Home Visit (PPNBHV) service in 1 county.
Design: A retrospective study of Aiken County Health records of live infant births in 2004 was conducted.
Sample: A random sample of 176 infants who were born in 2004 and enrolled in the women, infants, and children's (WIC) program in the same year was selected.
Measures: Process measures include timeliness of the home visit, and appropriateness of revisits. Outcome measures include age at WIC enrollment and immunization status at 6/9 months.
Results: Of the 176 infants, 76 (43%) received a home visit. Of these, 13 (17%) received the visit within the stipulated time frame. After controlling for potential confounders, infants who received a home visit were 4 times (95% CI 1.92–8.36) as likely to enroll early in the WIC program compared with those who did not.
Conclusion: The PPNBHV service may contribute to early enrollment in the WIC program. Improvement in the timeliness of the visits is needed. Program monitoring and evaluation are necessary to ensure adherence, measure outcomes, and provide feedback for continuous quality improvement.     

在社区开展产后访视保障母婴安全

目的　提高围产期保健质量。方法　深圳市妇幼保健院泥岗社区健康服务中心 (社康中心 )在辖区开展了 1年的产后访视工作 ,在访视过程中使用访视套卡 (A、B卡 ) ,并在辖区内对有 1岁以下儿童的母亲进行问卷调查。结果　泥岗社区 2 0 0 0年的产后访视率为 97 2 2 % ,辖区内有 1岁以下儿童的母亲对保健知识的知晓率在访视前与访视后差别有显著性的意义 (P <0 0 0 1)。结论　社康中心开展产后访视工作 ,提高了访视率和有 1岁以下儿童的母亲对保健知识的知晓率 ,及时处理了产妇及新生儿出现的异常情况 ,保障了母婴安全     

加强术后访视工作,提高患者对护理工作满意度

目的了解术后访视工作中存在的问题,进行有针对性的学习和改进,提高术后访视效果。方法通过向患者发放问卷,了解患者对访视者仪表、服务态度、理论知识的满意度以及对手术室护理工作的意见和建议。结果100%的患者认可访视者的服务态度,对手术室护理工作满意度达99%。结论不断征求患者的意见和建议,及时进行改进,可以提高手术患者对手术室护理工作的满意度。     

Association between patient engagement in HIV care and antiretroviral therapy medication adherence: cross-sectional evidence from a regional HIV care center in Kenya

Consistent individual effort in engagement in HIV medical services has been associated with positive health outcomes in people living with HIV (PLHIV). However, whether these benefits are facilitated by improved medication adherence has not been widely studied. This study aimed to investigate the marginal effect of engagement in HIV care on medication adherence at a public health facility in Kenya. Between February and April 2013, 392 patients on HIV care at Nyeri Provincial General Hospital participated in this study. Data were collected using a self-administered health survey questionnaire assessing health and sociodemographic statuses. A manual stepwise general linear model was specified to measure the effect of engagement in HIV and other associated predictors on medication adherence. Engagement in HIV care was significantly associated with log-transformed medication adherence in the sample (100·β = 9.2%, 95% CI 3.2–15.1) irrespective of gender and other selected predictors. Longer duration on antiretroviral therapy was also a significant predictor of better medication adherence (100·β = 3.2%, 95% CI 2.3–4.1). Despite inter-gender differences in adherence and engagement determinants, gender's independent effect on medication adherence and engagement in care were not statistically significant. Poor medication adherence was associated with lower patient engagement in HIV care services, suggesting that interventions which remove obstacles to regular observance of scheduled clinic appointments and eventual retention may have a beneficial impact on medication adherence and, accordingly, health outcomes in PLHIV.