Effects of Staff Training on Nursing Home Residents’ End-Of-Life Care: A Randomized Controlled Trial

ObjectivesThis trial examines the effects of end-of-life training on long-term care facility (LTCF) residents' health-related quality of life (HRQoL) and use and costs of hospital services.DesignA single-blind, cluster randomized (at facility level) controlled trial (RCT). Our training intervention included 4 small-group 4-hour educational sessions on the principles of palliative and end-of-life care (advance care planning, adverse effects of hospitalizations, symptom management, communication, supporting proxies, challenging situations). Training was provided to all members of staff. Education was based on constructive learning methods and included resident cases, role-plays, and small-group discussions.Setting and participantsWe recruited 324 residents with possible need for end-of-life care due to advanced illness from 20 LTCF wards in Helsinki.MethodsPrimary outcome measures were HRQoL and hospital inpatient days per person-year during a 2-year follow-up. Secondary outcomes were number of emergency department visits and cost of all hospital services.ResultsHRQoL according to the 15-Dimensional Health-Related Quality-of-Life Instrument declined in both groups, and no difference was present in the changes between the groups (P for group .75, adjusted for age, sex, do-not-resuscitate orders, need for help, and clustering). Neither the number of hospital inpatient days (1.87 vs 0.81 per person-year) nor the number of emergency department visits differed significantly between intervention and control groups (P for group .41). The total hospital costs were similar in the intervention and control groups.Conclusions and ImplicationsOur rigorous RCT on end-of-life care training intervention demonstrated no effects on residents’ HRQoL or their use of hospitals. Unsupported training interventions alone might be insufficient to produce meaningful care quality improvements.     

抗抑郁药临床应用的进展

抗抑郁药是治疗抑郁症和抑郁症状的主要药物,近10余年来,从药物作用机制到药物的疗效和安全性得到了飞快地发展。使得治疗抑郁症和抑郁症状的药物具有更多的选择,为临床提高疗效、减少药物不良反应和减少疾病复发提供更多的手段。     

唇腭裂病因学研究的新进展

先天性唇腭裂是一种常见的多基因遗传病,是遗传因素和环境因素综合作用的结果,随着人类基因组计划的完成,先天性唇腭裂易感基因的研究已成热点,国外许多学者已进行了大量的研究,并取得了初步的成果。本文回顾近年来在唇腭裂病因学研究方面的进展,包括易感基因定位、相关信号分子流行病学及动物模型等方面的研究。     

黄连碱药理活性研究进展

黄连碱是一种天然的原小檗碱型生物碱季铵盐,存在于毛茛科和罂粟科的多种植物中,资源丰富。尽管有关黄连碱的药理研究还不深入,但已有文献报道其有抑制A型单胺氧化酶、选择性抑制和双重抑制血管平滑肌细胞增殖、抑制破骨细胞分化和功能、选择性调节血管平滑肌细胞中的多药耐药蛋白质、抗真菌、胃黏膜保护、细胞毒、心肌保护等一些药理活性。鉴于目前缺少对黄连碱研究的系统回顾和综述,该文对近年来发表的黄连碱药理活性研究文献进行整理和分析,为深入开展以药理活性为基础的黄连碱创新药物研究提供信息。     

自拟壮骨方治疗绝经后骨质疏松症的疗效及作用机制研究

目的：探讨自拟壮骨方治疗绝经后骨质疏松症的疗效及作用机制。方法：将纳入研究的240例绝经后骨质疏松症患者随机分为2组,每组120例。治疗组采用口服自拟壮骨方治疗,对照组采用口服尼尔雌醇片治疗。比较2组患者的骨密度及血清中钙、磷、碱性磷酸酶、雌二醇的水平,同时比较2组患者治疗后的疼痛改善情况。结果：①骨密度。治疗前2组患者腰椎和股骨颈骨密度比较,组间差异均无统计学意义[（0．73±0．26）g·cm-2,（0．71±0．29）g·cm-2,t＝3．296,P＝0．110;（0．84±0．03）g· cm-2,（0．85±0．02）g·cm-2,t＝3．114,P＝0．201]。治疗组治疗前后腰椎骨密度的差值大于对照组[（0．20±0．15）g·cm-2,（0．18±0．12）g·cm-2,t＝4．012,P＝0．021];2组患者股骨颈骨密度的差值比较,差异无统计学意义[（0．60±0．24）g·cm-2,（0．16±0．14）g·cm-2,t＝1．062,P＝0．080]。②血生化指标。治疗前2组患者血清中钙、磷、碱性磷酸酶、雌二醇浓度比较,组间差异均无统计学意义[（2．24±0．16）mmol·L-1,（2．22±0．14）mmol·L-1,t ＝5．659,P＝0．431;（1．19±0．21）mmol·L-1,（1．18±0．22）mmol·L-1,t ＝3．314,P＝0．158;（109．50±13．41）U·L-1,（108．71±20．42）U·L-1,t ＝1．354,P＝0．762;（40．86±18．26）pmol·L-1,（41．14±19．04）pmol·L-1,t＝1．918,P＝0．656]。治疗组血清中钙和磷浓度治疗前后的差值均大于对照组[（1．61±0．46）mmol·L-1,（0．31±0．25）mmol·L-1,t ＝5．618,P＝0．000;（0．60±0．24）mmol·L-1,（0．30±0．14） mmol·L-1,t＝7．012,P＝0．000];碱性磷酸酶和雌二醇浓度治疗前后的差值与对照组比较,差异均无统计学意义[（20．21±12．16）U·L-1,（16．11±10．12）U·L-1,t＝1．368,P＝0．612;（19．26±10．23）pmol·L-1,（16．76±9．67）pmol·     

黄酮类化合物药理活性及其构效关系研究进展

总结黄酮类化合物在抗氧化、抗炎、抗肿瘤作用方面的研究近况,在阐述黄酮类化合物的生物活性和药理作用的同时,对其构效关系研究进展进行了评述,并对黄酮类化合物药理作用的研究提出进一步的展望.     

新型冠状病毒肺炎疫情防控常态化下临床试验用药品规范化应用的策略与实践

目的 分析福建医科大学附属协和医院在新型冠状病毒肺炎疫情防控常态化下临床试验用药品应用情况，优化管理策略，为其他药物临床试验机构提供参考。方法 对试验用药品全流程中的关键环节和存在问题进行探讨分析，制定疫情相关防控措施并优化流程，对比优化前后1年间的试验用药品应用情况、差错事件数和工作效率。结果 影响试验用药品应用的主要因素是人员、环境、流程，通过明确职责、加强培训和健全制度进行了流程优化。优化后2020年药物临床试验药房承担160项临床试验的药品管理工作，涉及随访受试者总数897名，负责应用259种临床试验用药品，工作量与2019年（128项）相比增长显著，工作服务能力有效提高，药品相关的差错事件发生频次显著下降（P<0.01），获得了研究者、申办方、监管部门等的高度认可。结论 新型冠状病毒肺炎疫情未对该院临床试验用药品应用造成持续影响，专人专职采用优化后的流程使疫情下试验用药品的应用更为规范，可保障受试者的用药安全，提高药物临床试验质量。     

利培酮治疗抽动秽语综合征25例

目的 了解利培酮治疗抽动秽语综合征（Tourettesyndrome,TS)的临床疗效。方法 对25例TS患者应用利培酮治疗，其中20例临床疗效。方法 对25例TS患者应用利培酮治疗，其中20例完成了该项试验，在治疗前及治疗4wk后进行耶鲁综合抽动严重程度量表（YGTSS）评分，用减分率来评估治疗效果。结果 治疗后YGTSS的总的运动抽动分数，总的发声抽动分数，全部损伤率及总的严重程度分数均小于治疗前，经检验有统计学意义，将资料进行相关回归分析发现减分率同总的运动抽动分数及总的严重程度分数的变化相关更大，标准回归系数分别为0．539，0．513（P＜0．01），而与总的发声抽动分数及全部损伤率的变化 明显（P＞0．05）。结论 利培酮治疗TS症状明显改善，疗效肯定，副作用轻微。     

Who Is Responsible? A Man With Dementia Wanders From Home,Is Hit by a Train,and Dies

The impact of dementia and Alzheimer's disease extends far beyond the healthcare needs of the person with dementia. As the disease progresses, individuals with dementia often require ongoing formal or informal care for their basic daily routine because of behavior changes and continuing loss of cognitive function. Most of the care for people with dementia takes place at home, and the unpaid, informal caregivers are often spouses or other relatives. Providing long-term informal care at home for someone with dementia is psychologically, physically, and financially draining. The tragedy described in this case elucidates the far-reaching societal impact of dementia care and the implicit health policy considerations.In 2007, a 91-year-old Japanese man with dementia was in the care of his wife when he wandered from home, was hit by a train, and died, immediately affecting the Central Japan Railway Company operations and, subsequently, legal practice as well as Japanese elder care policy. The railway sued the man's wife and son for negligence and lost revenue, winning both trials at the local and district courts. This ruling shocked families and caregivers in Japan, where care for elderly parents traditionally falls on the oldest son, and brought attention to the complex issues related to dementia care. A decade later, we revisit this case to provoke a renewed dialogue about the matrix of responsibilities and liabilities associated with caregiving; to illuminate the unmet needs of the person with dementia, as well as his or her informal caregivers; and the financial implications related to long-term care policy. We close with 2 practical suggestions which preserve the dignity of the individual and provide reassurance for caregivers.     

养老机构预立医疗照护计划研究进展

介绍预立医疗照护计划的概念内涵,综述养老机构开展预立医疗照护计划的必要性、实践现状（包括介入预立医疗照护计划讨论的时机、讨论牵涉人员及内容、干预策略及效果）、影响因素,以期为今后在我国养老机构中开展预立医疗照护计划提供参考。