颛桥社区儿童保健服务模式效果评价

目的探讨现阶段社区儿童保健工作服务模式,以进一步提高社区儿童保健服务质量和管理水平。方法建立以颛桥社区卫生服务中心为主体的儿童保健三级管理网络,实施团队式和信息化的服务管理模式,比较调整模式前后两年管理指标和健康指标的变化情况。结果采用团队式和信息化的服务管理模式能提高7岁以下儿童保健覆盖率、3岁以下儿童系统管理率、高危儿管理率和疑难病例转诊率等主要管理指标和降低贫血患病率、营养不良发生率和肥胖发生率等主要健康指标。结论基于团队式和信息化的社区儿童保健服务管理模式对进一步提高儿童保健的服务质量和工作效率具有良好的推动作用。     

社区老年人认知功能及相关因素调查

目的了解社区老年人认知功能及相关影响因素,为促进老年保健提供依据。方法对上海市卢湾区某社区601名60岁及以上老年人,采用简易智能状态量表（mini—mental status examination,MMSE）评定认知功能,采用日常生活能力量表（activities of daily living scale,ADL）调查认知功能相关因素。结果年龄与MMSE评分呈负相关,与ADL评分呈正相关;MMSE评分与ADL评分呈负相关。单因素统计分析结果显示,性别、年龄、文化程度、职业、婚姻状况影响老年人认知功能。多元线性回归分析显示,文化程度、年龄、心脏疾病影响MMSE评分。结论增龄、文化程度低、女性、无业或工人、心脏病可能对老年人认知功能产生不良影响。对其中的可干预因素进行干预,有利于提高老年人的认知功能和生活质量。     

老年脑梗塞患者社区早期家庭康复模式分析

目的为了探索老年脑梗塞患者恢复期的社区综合康复整体方案,评估其在提高生活质量,降低复发率,有效控制复发危险因素,降低医疗费用的效果。方法随机选取老年脑梗塞恢复期患者共80例,分为社区卫生服务中心病房与社区家庭两组,疗程均为1个月,采用统一的药物治疗、手法康复及功能锻炼康复措施,以病房组为对照组,社区组增加日常生活心理疏导,家庭成员配合,社区作业等综合措施,采用ADL（Barthel指数评定）和Brunn Strom运动功能评定两组患者康复疗效;选用90项症状自评量表（SCL-90）、汉密尔顿抑郁量表（HAMD）,评定患者的心理状态及情绪状况,并对两组相关医疗费用进行比较。结果患者经过药物及康复治疗后,肢体功能有明显改善,病房组与社区组之间无统计学意义（P〉0．05）;病房组抑郁量表分明显高于社区家庭干预组;在与脑梗塞康复治疗相关费用上社区组明显优于病房组。结论脑梗塞恢复期社区康复治疗模式是安全、有效的,在对患者的心理疏导及降低费用上产生的社会效益有显著的优越性。     

Independent Community Pharmacists' Perspectives on Compounding in Contemporary Pharmacy Education

Objectives

To identify compounding practices of independent community pharmacy practitioners in order to make recommendations for the development of curricular objectives for doctor of pharmacy (PharmD) programs.

Methods

Independent community practitioners were asked about compounding regarding their motivations, common activities, educational exposures, and recommendations for PharmD education.

Results

Most respondents (69%) accepted compounding as a component of pharmaceutical care and compounded dermatological preparations for local effects, oral solutions, and suspensions at least once a week. Ninety-five percent were exposed to compounding in required pharmacy school courses and most (98%) who identified compounding as a professional service offered in their pharmacy sought additional postgraduate compounding education. Regardless of the extent of compounding emphasis in the practices surveyed, 84% stated that PharmD curricula should include compounding.

Conclusions

Pharmacy schools should define compounding curricular objectives and develop compounding abilities in a required laboratory course to prepare graduates for pharmaceutical care practice.     

Pharmacists’ and Pharmacy Students’ Ability to Identify Drug-related Problems Using TIMER (Tool to Improve Medications in the Elderly via Review)

Objective

Determine the effectiveness of TIMER (Tool to Improve Medications in the Elderly via Review) in helping pharmacists and pharmacy students identify drug-related problems during patient medication reviews.

Methods

In a randomized, controlled study design, geriatric patient cases were sent to 136 pharmacists and 108 third-year pharmacy students who were asked to identify drug related-problems (DRPs) with and without using TIMER.

Results

Pharmacists identified more tool-related DRPs using TIMER (p = 0.027). Pharmacy students identified more tool-related DRPs using TIMER in the first case (p = 0.02), but not in the second.

Conclusion

TIMER increased the number of DRPs identified by practicing pharmacists and pharmacy students during medication reviews of hypothetical patient cases.     

中老年临界高血压社区干预护理模式探讨

目的探讨临界高血压干预护理效果。方法将318例临界高血压患者随机分成2组,实验组160例,指导其合理膳食,运动锻炼,控制纳盐,劝戒烟酒,调节情绪。对照组158例,只做一般宣教、不强调性干预。结果经干预后患者对健康知识的掌握,血压控制,饮食结构等指标较对照组均有显著变化。结论临界高血压实施干预护理,可有效控制高血压的发生,值得推广。     

盐城市社区居民药学服务需求的调查

目的 了解社区居民对药学服务的态度和需求,获得实证资料,为实施药学服务提供科学依据。方法在盐城市5个社区进行药学服务的问卷调查,对有效回收229份问卷进行统计分析,同时组织药学服务志愿者进行用药知识宣传。结果被调查者对药学服务概念的知晓率为32．3％;在药店购药的居民为468％;根据医生指导用药的仅为567％;产生不良反应的占6o％;有45．8％的家庭未能定期清理过期药品;954％的居民希望通过不同的途径获得药学相关知识。结论社区药学服务的工作迫切需要进一步开展,以更好地保障居民合理、安全和有效的用药,满足公众自我保健和自我药疗的需求。     

大医院帮扶社区医疗工作的探索与实践

通过与社区卫生服务中心开展医疗帮扶工作,总结了成立社区医疗服务中心、签订帮扶协议书、开展人才培养、实施专科技术延伸、建立双向转诊关系、医院品牌传播等六个方面的做法与成效。指出了存在着认识不足、双向转诊不畅、帮扶效果难以评价等主要问题。体会到开展医疗帮扶工作,必须依靠卫生行政部门的指导和支持、必须是“三方”受益和政府满意、必须成立专门的机构、必须立足于提升社区卫生服务机构的医疗服务能力和水平等。     

县级医院融入社区卫生服务的探索与尝试

社区卫生建设是世界卫生组织倡导的服务模式,是我国新医改的重要组成部分。本文通过介绍诸城市人民医院在融人社区卫生服务中的做法和效果,阐述了县级医院融入社区卫生建设,是发展和完善社区卫生服务网络的有效形式;县级医院与社区医院建立集团化的协调机制,是解决三级医疗网内服务功能冲突的有效途径;县级医院的最大舞台在社区卫生服务,最大市场在农村。     

Knowledge generation and utilisation in occupational therapy: Towards epistemic reflexivity

Aim:  The purpose of this article is to consider the ways in which theory generation, and hence knowledge generation, in occupational therapy is a complex social process, and therefore carries (often hidden) responsibilities for those who are part of our epistemic community. An epistemic community is a knowledge-producing community, who apply their standards of credibility, and epistemic values, to theory choice. In occupational therapy this community is comprised of a worldwide group of scholars and practitioners.
Methods:  We propose that epistemic reflexivity can be used to critique and contribute to our disciplinary knowledge and to critically consider 'who' makes epistemological choices in our profession, and the consequent implications for the theories we adopt. The purpose of this article is to make these relations explicit so that scholars and therapists can become increasingly conscious and empowered with respect to their contributions to occupational therapy's epistemic community. To demonstrate an application of epistemic reflexivity, we critically consider a theoretical construction that has been widely adopted by the international occupational therapy community: evidence-based practice.
Results:  As authors, we engage in epistemic reflexivity to critically consider the challenge posed by evidence-based practice. We propose a conception of practice knowledge that is informed by evidence yet based on a conception of wise practice.
Conclusion:  Our intention is to stimulate discussion and debate in occupational therapy's epistemic community, a number of approaches for fostering epistemic reflexivity in occupational therapy are suggested.