开展社区药学服务的体会和工作方法探讨

本研究回顾了我中心药师开展社区药学服务的情况,总结其具体内容和方法,为促进社区药学服务的发展提供参考。基层医院药师只有深入临床和社区,从用药咨询、用药教育、处方评价、药物相互作用和不良反应监测、医药和药患沟通等方面开展工作,才能切实做好社区药学服务。     

Transitional care following a skilled nursing facility stay: Utilization of nurse practitioners to reduce readmissions in high risk older adults

This quality improvement project's goal was to identify older adults who were at high risk for readmission following a skilled nursing facility (SNF) admission and evaluate the impact of a nurse practitioner (NP) visit within 72 hours of SNF discharge. The aims of this project were to reduce 30-day readmissions, identify gaps in care, and address care needs for patients recently discharged from a SNF. High readmission risk was estimated through use of readmission risk prediction and frailty tools. Results of the project revealed several gaps in care including medication discrepancies, delays in start of home health services, and lack of follow up with a primary care provider. Of the patients seen for a transitional care visit (TCV), none were readmitted. Project findings indicate there is value in seeing patients in their home soon after SNF discharge. Further work is indicated to improve care transitions in this area.     

Back pain and treatment seeking among community-dwelling older adults: Findings from a population-based survey

This study explores the prevalence and factors associated with back pain and treatment seeking of older people. We used data from the Longitudinal Aging Study in India (LASI), 2017-18. A sample of 31,464 older adults aged 60 years and above was considered for this study. Chi-square test was used to find the significance level for bivariate associations. Additionally, Heckprobit selection model was employed to fulfill the objectives. Among 34% of the participants suffering from back pain, 46.2% used external application, followed by analgesics (40.8%) and therapy (6.6%). Older adults with higher education had a higher probability of seeking therapy than those with no or primary education [β:0.25; CI:0.03,0.48]. Participants from the highest wealth quintile had higher probability of seeking therapy than those from the lowest [β:0.41; CI:0.23,0.58]. The use of therapy, which is globally recommended first line of management for back pain, was least utilized and must be promoted.     

Effects of square-stepping exercise on motor and cognitive function in older adults — A systematic review and meta-analysis

ObjectivesTo document the effects of square-stepping exercise (SSE) on motor and cognitive function in older adults.MethodsFive online databases were searched in May 2021. Controlled studies published from 2006 to May 2021 were included. The experimental group received SSE alone or SSE combined with other exercise(s), whereas the control group received no training or other exercise(s). Motor and cognitive outcomes included balance, fall risk, agility, endurance, gait speed, flexibility, muscle strength, reaction time, global cognitive function, memory, and executive function.ResultsTen articles with a total of 920 participants were included. Static balance (p=0.0009), dynamic balance (p=0.0008), fall risk (p<0.00001), and agility (p=0.02) improved more in the intervention group than in the control group. However, SSE did not seem to exert beneficial effects on cognitive function.ConclusionIn older adults, SSE provided beneficial effects on motor function, including static and dynamic balance, risk of falls, and agility. However, positive effects on cognitive function were not observed and require further investigation.     

638颗老年人牙髓炎患牙一次根管治疗术的临床疗效观察

目的：探讨一次性根管治疗术的临床疗效。方法：在门诊患者中选择60岁以上老年牙髓炎患者。共计638颗患牙,对其进行一次性根管治疗术。术后1年回访446颗患牙,检查根管治疗的效果。结果：446颗经过一次性根管治疗的患牙,成功424颗,成功率为95．07％,失败22颗,失败率为4．93％。结论：一次性根管治疗术可取得满意的临床疗效,值得推广使用。     

同型半胱氨酸检测在脑卒中高危人群筛查中的应用价值

目的：探讨同型半胱氨酸（Hcy）检测在脑卒中高危人群筛查中的应用价值。方法检测3组（脑卒中组、脑卒中高危组、对照组）人群 Hcy、血脂、血糖水平,进行组间比较,分析其相关性。结果脑卒中组和脑卒中高危组血清 Hcy水平与对照组比较,差异有统计学意义（P＜0．05）。结论 Hcy检测在脑卒中高危人群筛查中有重要价值,高 Hcy血症是脑卒中的独立危险因素之一。     

社区2型糖尿病视网膜病变风险预测模型的构建与验证

背景　糖尿病视网膜病变（DR）发病率高,危害性大,是导致成人失明的主要原因,但社区实施眼底筛查较为困难,而DR风险预测模型可帮助全科医生早期识别DR高危人群。目的　探讨社区门诊就诊的2型糖尿病患者发生DR的危险因素,构建并验证DR风险预测模型,进一步提高DR患者筛查效率。方法　收集2018年6月-2019年6月于方庄社区卫生服务中心门诊就诊的421例2型糖尿病患者,采用随机数字表法分为模型组336例,检验组85例。收集患者的一般资料,血压以及空腹血糖（FBG）、餐后2 h血糖、糖化血红蛋白（HbA1c）、血肌酐、尿素氮、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）及尿蛋白,均行非散瞳眼底彩色照相（NMFCS）。模型组采用单因素Logistic回归分析计算出发生DR的相关因素,得出的相关因素用多因素Logistic回归分析进一步探讨,在此基础上构建DR风险预测模型,并由检验组评估DR风险预测模型的可行性。结果　在421例2型糖尿病患者中DR患者共87例,其中模型组69例,检验组18例。多因素Logistic回归分析结果显示,DR的危险因素有病程（β=0.196,OR=1.217,P<0.001）,收缩压（SBP）（β=0.028,OR=1.028,P=0.038）,FBG（β=0.409,OR=1.506,P=0.003）,HbA1c（β=0.594,OR=1.811,P=0.001）,LDL-C（β=0.360,OR=1.434,P=0.038）。据此,构建的DR风险预测模型为Y=1/〔1+e-（0.196X1+0.028X2+0.409X3+0.594X4+0.360X5-16.482）〕,其中,Y指DR发生概率,X1指病程,X2指SBP,X3指FBG,X4指HbA1c,X5指LDL-C。DR风险预测模型预测模型组发生DR的ROC曲线下面积是0.884,诊断临界值是0.192。DR风险预测模型预测检验组发生DR的ROC曲线下面积是0.803,灵敏度为72.2%,特异度为79.1%。结论　糖尿病患者的病程、SBP、FBG、HbA1c、LDL-C与DR显著相关,DR风险预测模型对DR有一定的预测价值。     

社区团队服务中脑卒中双向转诊模式的探索与实践

目的 探索社区团队服务中脑卒中双向转诊模式.方法 以社区脑卒中管理为突破口,积极探索北京市方庄社区卫生服务中心与市卫生局指定的对口支援医院--天坛医院之间实施脑卒中双向转诊模式.结果 社区脑卒中有效管理率达到92.7%,失访率下降了20.6%;社区居民卒中知识知晓率达到88.5%.结论 通过社区团队服务中脑卒中双向转诊模式的探索与实践,有力的提高了社区卫生服务中心的医疗质量和慢性病管理水平,提升了社区卫生服务工作的内涵.     

既往脑梗死人群生活方式、用药情况及中医证候要素分析

目的:分析既往脑梗死人群的生活方式及用药情况,探讨其中医证候特点,为脑梗死的防治提供依据。方法:采用临床横断面流行病学调查研究的方法,于2012年12月至2013年12月在北京市丰台区方庄、花乡社会卫生服务中心收集既往脑梗死含短暂性脑缺血发作患者447例,记录其人口学特征、生活方式、用药情况及中医证候量表。结果:目前仍在吸烟男性占46.71%,女性占7.46%,经常饮酒的男性占28.95%,女性占2.71%,仍在吸烟、经常饮酒的男性数量明显大于女性(P0.01);口味偏油的男性占17.11%,女性占9.15%,男性数量明显大于女性(P0.05);常喝牛奶或酸奶的男性占29.61%,女性占43.39%,男性数量明显小于女性(P0.01);筛查人群合并高血压病的人群占72.71%,合并血脂异常的男性占54.61%,女性占68.81%,男性数量明显小于女性(P0.01),合并糖尿病的人群占31.54%;服用降压药人群与患高血压病的人群比率为85.85%,服用降脂药人群与患血脂异常的人群比率为40.56%,服用降糖药人群与患糖尿病的人群比率为84.40%;既往脑梗死人群中医证候要素分布情况:痰湿70.25%,气虚39.82%,阴虚21.25%,内火15.21%,内风8.95%,血瘀6.71%。结论:既往脑梗死人群生活方式、用药情况需要改进,存在药物使用不合理的现象。     

社区卫生服务机构抗感染药物合理应用情况分析

目的：了解我中心抗感染药物的使用情况,并进行合理性分析。方法：以限定日剂量（DDD）及药物利用指数（DUI）为指标,对我中心2008-2009年抗感染药物处方统计学处理和分析。结果：抗感染药物的用量比较平稳,DDDs排序居前4位依次是氟喹诺酮类、青霉素类、大环内酯类、头孢菌素类。结论：我中心抗感染药物的应用总体基本合理,但存在用药不合理现象,仍需加强对抗感染药物合理使用的监控,通过干预措施,促进临床合理用药。