社区安宁疗护服务发展

借鉴国内外社区安宁疗护服务经验,探讨中国本土化社区安宁疗护服务发展,提出建立并完善社区安宁疗护相关政策和法律制度;提高社区安宁疗护服务的综合能力;加大安宁疗护在社区的推广与宣传,以促进和加快中国社区安宁疗护服务更快更好地发展。     

重庆主城区老年健康状况和社区护理需求调查

目的：了解重庆主城区社区老年人健康状况和社区护理需求,为今后开展社区老年护理提供依据。方法采用简明健康状况调查量表（S F‐36）和自行设计的问卷,对重庆市主城辖区内3个街道（社区）1005名老年人的健康状况及社区医疗护理需求进行调查分析。结果社区老年人慢性病的发病率为79．69％,S F‐36总得分为（71．76±12．85）分,生理健康（72．46±17．56）分,心理健康（73．29±16．87）分。多元回归表明不健康状况的影响因素分别为慢性病患病数量、经济状况、年龄、生活方式。社区护理需求排名前5位依次是定期检查、社区专家护理、高质量的社区护士、健康讲座、急救护理知识。老年人社区护理需求多因素Logistic回归分析显示,性别（X1）、职业（X2）、经济状况（X3）、检查情况（X4）、社区护理了解情况（X5）为其影响因素,回归预测模型为：P＝1／[1＋Exp∑（－2．155＋0．612X1－0．121X2＋0．173X3＋0．211X4＋1．107X5）]。结论社区需要对老年人加强定期身体检查,对男性老年人应引起重视,投入更多的关怀,加强慢性病管理、养老养生、营养保健的宣传,加强社区老年护理人才的阶梯培养,改变社区护理模式。     

Diabetes management in Australian rural aged care facilities: A cross--sectional audit

Background

There is gap in the literature regarding the current practice of diabetes management of the elderly in Australia and its compliance with available Australian diabetes practice guidelines.

Aims

The aims of this study were to describe the pharmacological management of elderly residents with diabetes living in aged care facilities and to identify areas for improvement in the current management as recommended by the current diabetes management guidelines in Australia.

Method

Residents with diabetes from three rural aged care facilities were identified by nursing staff. A cross-sectional medical record audit was carried out to obtain data of residents diagnosed with diabetes.Thirty-four medical records were audited from three aged care facilities.Data including demographics, medical histories and medications were collected and analysed.

Results

This study had two key findings; Firstly, it showed that about a third of residents with type 2 diabetes are managed with diet only. Secondly, of the residents who are managed with medications, less than half of those audited (41%) were managed according to the current diabetes guidelines in terms of pharmacological treatment which included anti- hypertensive, lipid lowering and anti- platelet therapies. Of those patients with a history of CVD, all were receiving an antihypertensive medication, 71% were not managed for their lipids and 20% were not on any prophylactic anti- platelet therapy.

Conclusion

Management of patients with diabetes living in rural aged care facilities is inconsistent with the current management guidelines. Educational interventions targeting health professionals and patients might be beneficial to increase compliance with the current diabetes guidelines.     

Evidence-Based Guidelines for the Treatment of Thrombosis

Thrombosis disease since the majority of doctors who agree to be harmful, increasing emphasis on the application of antithrombotic drugs. However, the organization always treatment, the dose of medication and treatment method based only on the efficacy of clinical experience and observation, it is not comprehensive enough and precise, and the breadth and depth of their use is restricted. 1986 American Thoracic physician College （Americin College of Chest Physicians. ACCP） has released guidelines for antithrombotic therapy, the use of antithrombotic treatment of rapid growthpopular guide clinicians of the importance of treatment, patients also benefited. The sixth meeting since the 2001 ACCP （ ACCP - 6 ）, antithrombotic treatment guidelines by their own national experts agree, and the widespread use of that technology into the international guidelines. Canada HIRSH. J professors to compile the ＂ Guide to the treatment of thrombosis,＂ fifth edition （ 2005 ）, a book reflects ACCP - 7 session （ September 2004） and more than 500 proposals of the international classification of antithrombotic therapy ： a meta - analysis of many experts, so thromboembolic disease was recommended treatments for a wide range of the level of evidence, identify the various antithrombotic treatment in a variety of situations and the pros. thus guiding physicians to make the best choice of treatment for patients. My understanding and treatment of thrombosis implemented late start, the fields where the lack of randomized trial data. develop more treatment programs rely on clinical experience may deviate from the principle of evidence - based medicine.     

上海市社区卫生服务机构编制与人力资源配置研究

本研究结合上海实际,以服务人口、工作量和单位工作时间等因素为依据,应用"排队论模型",结合"卫生服务需求法"进行社区卫生服务机构编制和人力配置测算与研究,旨在为政府出台相关政策提供科学依据.     

我国老年长期照护的现状及未来发展的思考

我国老龄化形式日益严峻,老年长期照护已然成为我国重要的公共卫生问题。笔者通过回顾分析,从照护需求、照护体系、照护模式、照护人力等方面梳理我国老年长期照护的现实问题,并提出展望,明确老年长期照护未来发展的机遇,以期为老年护理学科的发展提供参考。     

310例育龄妇女孕前保健社区常态化管理模式

目的:探讨创立社区卫生孕前保健常态化管理模式,提高孕产妇生活质量,降低母婴并发症。方法:利用属地卫生保健专业卫技人员结合社区居委公干、义工、慈善关爱团队等机构人员对社区育龄妇女建档、复档"一对一"入户调研孕前保健,孕产妇咨询、体检、服务和关爱、问卷调查,对有生育要求的310例育龄妇女进行社区定期围产保健监测和孕期营养指导咨询,追踪服务至产后,同期设立对照组310例,比较产后结局。本组育龄妇女孕前保健至产后,追踪2年,均在社区内完成。结果:2组产后24 h出血量、阴道分娩例数、剖宫产例数、新生儿出生体重、妊娠糖尿病例数、产褥期感染例数的差异有统计学意义(均P<0.05);两组孕妇女生活质量评定显示,生活质量整体评价、健康状况整体评价、生活领域评价、自我评价总分等方面研究组均优于对照组(P<0.05)。结论:创立社区卫生孕前保健常态化管理模式,可以提高围产期管理水平,降低母婴并发症。     

我国社区安宁疗护现状及发展策略

通过梳理中国社区安宁疗护的发展模式和经验,分析社区安宁疗护发展存在的主要问题,为社区安宁疗护发展提出合理化建议,如加大支持保障力度、加强人才队伍建设、树立正确的生死观等,以促进国内社区安宁疗护服务更快更好地发展。     

开设安宁疗护课程在医学院校教育中的意义

近几年,政府主导下的安宁疗护在中国大陆地区逐步兴起,安宁疗护学术组织、学术会议逐渐增多,试点单位陆续启动,促进了安宁疗护的蓬勃发展。安宁疗护的核心思想是强调人本主义、身心社灵整体观和科学的死亡观,是最贴近医学本质的临床学科。因此,很有必要在医学院校开设安宁疗护的相关课程,并把它作为专业素养教育的一个重要组成部分。医学生通过学习和实践安宁疗护相关理念和知识,才能在未来更好地为患者提供高品质的医疗健康服务。通过梳理安宁疗护现状和需求以及医学院校开设安宁疗护相关课程的国内外现状,为中国开展安宁疗护医学教育,培养专业人才提供参考。     

居家养老服务的研究现状

本文主要就我国居家养老服务的现状进行综述,总结了居家老年人的护理服务需求内容,介绍了我国正在试行开展的两种居家养老模式,并对该模式在开展中存在的问题及改进对策进行探讨,以期为我国居家养老服务事业的发展提供借鉴.     

Screening for palliative care needs in the community using SPICT

BackgroundThe Worldwide Hospice Palliative Care Alliance has recommended integration of palliative care into primary health care. Diminished capacity to provide palliative care is a barrier for integration. The purpose of this study was to screen for palliative care needs in the community.MethodsA cross-sectional study was conducted in two rural communities of Udupi district. Supportive and Palliative Care Indicators Tool – 4ALL (SPICT-4ALL) was used to identify the palliative care needs. Purposive sampling was used to collect the individual information from the households for identifying the palliative care need. Conditions requiring palliative care and the sociodemographic factors associated with it were explored.ResultsOut of 2041 participants, 51.49% were female, and 19.65% were elderly. Less than a quarter of them (23.08%) had at least one chronic illness. Hypertension, diabetes, and ischemic heart disease were commonly found. 4.31% had satisfied the requisite SPICT criteria, which indicated a need for palliative care. Diseases of cardiovascular system followed by dementia and frailty were the most common conditions requiring palliative care. Univariate analysis showed that age, marital status, years of education, occupation, and the presence of morbidities were significantly associated with the need for palliative care. Being unemployed and having one or more morbidities were factors independently associated with requirement of palliative care.ConclusionsThe estimated palliative care need in the community survey exceeds the perceived need. Although palliative care is traditionally identified with cancer, the proportion of people with noncancer palliative care needs were significantly higher than cancer palliative care.     

关于社区卫生服务人力资源开发的思考与探讨

基于北京市朝阳区大力发展社区卫生服务３年多的实践,就发展社区卫生服务的关键所在－人力资源开发,在配置卫生资源,实施全科医学培训工程,制定相应政策保障,充分展示社区卫生服务功能等方面的现状及其对策进行了充分的论述和有益的探讨。     

General practice and residential aged care: A qualitative study of barriers to access to care and the role of remuneration

Background

More than 169,000 people live in residential aged care facilities (RACFs). As people age they use health services, particularly general practitioner (GP) services, more frequently but many GPs do not attend patients in RACFs.

Aims

To examine GPs’ perceptions of barriers to providing care to patients in RACFs.

Methods

This study was conducted in June 2014 in the Bayside Medicare Local (BML) region in Victoria, Australia; all participants were drawn from this region. Two focus groups (FGs) were conducted. One was for GPs (n=5) that have a specific interest in practicing in RACFs, the other with RACF staff (n=8) representing public, private, and not-for-profit aged care providers. Results were presented to the Royal Australian College of General Practitioners (RACGP) National Standing Committee for General Practice Advocacy and Support for feedback and validation of the findings against national perspectives of the effect of remuneration on the provision of GP services in RACFs.

Results

Remuneration problems are a barrier to the provision of GP services to patients in RACFs. These problems can be grouped into: direct remuneration, opportunity cost, additional administrative burden, and unremunerated work. GPs’ perceptions of the effects of these problems on willingness to practice in RACFs are described.

Conclusion

Innovative models of remuneration for GPs attending RACFs are needed to ameliorate the problems identified. Such models need to capture and pay for activities that are time consuming but often unremunerated.     

社区老年人营养支持对生命质量的影响

目的 为提高社区老年人的健康水平，寻求有效的社区营养干预措施。方法 本次调查选择社区300名老人作为研究对象，将其分为实验组与对照组，并对实验组进行一系列营养保健知识健康教育。结果 实验组的营养保健知识知晓率有明显的提高，特别是对米面的加工、我国的膳食指南、膳食宝塔结构的知晓率以及戒除烟酒对保健的意义均有明显的改善，但部分饮食习惯改善不明显。结论 社区营养健康教育干预是一项长期性的持续性的工作。但必须根据社区及老人的实际情况。因地制宜地采取多种手段进行有效干预。真正提高社区老人的生活质量及健康质量。     

社区卫生服务在老年保健中的作用

目的：探索社区老年人预防、治疗、保健、康复一体化的服务模式。方法：对社区老年慢性病患者实施社区整体护理,并进行健康干预。结果：对老年人健康干预后,不良生活习惯纠正率为66%,91.8%的居民对社区医疗护理满意;超过70%的老年慢性病人选择社区卫生服务的家庭治疗。结论：社区卫生服务为老年人提供了全面、连续、专业的医疗服务,提高了老年人生活质量。     

社区养老与家庭养老的老年人心理健康状况调查

目的：调查社区养老与家庭养老的老年人心理健康状况。方法：随机抽取70岁以上，不与子女同住的家庭养老的老人220名；；随机抽取社区养老院或敬老院中70岁以上，自筹费用的老人220名，用SCL-90评价。结果：社区养老与家庭养老的老年人在强迫、人际敏感、抑郁、焦虑、敌对、偏执因子分上具有显著性差异。结论：社区养老与家庭养老的老年人需要更多的关爱。改善心理健康。     

人口老龄化背景下医养结合养老模式

随着人口老龄化程度不断加深,中国养老服务需求与日俱增,传统养老模式已无法适应当代老龄化社会发展,因此,探索和推进医养结合新型养老模式的任务迫在眉睫。通过查阅大量文献,对中国人口老龄化现状、国外养老运营体系的成功经验、中国传统养老模式及医养结合养老模式的发展现状进行分析,探究制约中国医养结合养老模式发展的主要问题,为更好地推进中国养老事业提供依据。     

"Please, I want to go home": ethical issues raised when considering choice of place of care in palliative care

Many palliative care patients would prefer to receive care, and to die, at home. Despite this many die in institutions. In response to this, politicians and charities have adopted policies aimed at increasing the opportunities for care and death at home. The need to discuss plans for discharge with most inpatients reinforces expectations of a choice of place of care. However, many palliative patients do not have a choice of care at home. This article will explore the circumstances in which patients are unable to choose home care and consider changes in clinical practice that can help to maximise choice. We shall argue that there is a distinction between the preferences of patients and the choices actually available to them. In attempting to make this distinction we advocate consideration of the balance between the ethical principles relevant to each case.     

某三甲医院老年专科病房护士对缓和医学认知情况的调查分析

目的 总结某三甲综合医院老年专科病房护士对缓和医学知识的掌握情况并根据调查结果分析其影响因素.方法 采用问卷调查法对某医院老年专科病房护士210名进行调查.调查问卷是在参考相关文献的基础上自行修改而成.主要涉及调查对象的一般资料、对死亡的态度及照顾终末期患者的经历、对缓和医学的了解情况等.结果 发放问卷210份,回收有效问卷194份,有效回收率92.4％.结果显示,仅有24.2％调查对象能很公开和家人讨论死亡,55.7％未参加过死亡教育或临终关怀相关的课程或培训,57.2％的研究对象没有阅读过有关死亡的文章或书籍,仅有27.8％通过毕业后医院的继续教育获得有关死亡或临终关怀的相关知识.29.4％知道缓和医学的概念,94.3％未接受过缓和医学方面的教育培训.结论 应加强关于缓和医学的继续教育,采取有效措施促进老年专科病房护士对缓和医学知识的掌握,进而促进缓和医学在老年终末患者中实施以提高患者及家属的生活质量.