深圳市观澜街道老年人社区护理服务的需求及影响因素分析

[目的]探讨深圳市宝安区观澜街道老年人社区护理服务需求及其影响因素,为开展社区老年护理服务提供参考.[方法]对观澜街道辖区居民开展深入访谈和问卷抽样调查.[结果]调查对象的慢性病患病率和两周患病率随年龄呈增长趋势,老年慢性病防治咨询、社区急救护理、健康教育、传染病宣教、社区慢性病护理是前5位护理需求,年龄、文化程度、慢性病情况和居住情况是影响老年人社区护理需求的影响因素.[结论]观澜街道社区老年人护理需求较多,应注重完善慢性病防治咨询、健康教育等服务,引导老年人充分利用社区护理服务,并根据实际情况建立老年人社区护理服务示范点.     

城乡老年人社区居家养老服务需求及影响因素分析

目的分析成都市城乡老年人社区居家养老服务需求现状及影响因素。方法采用问卷调查的形式,对成都市178名城乡老年人进行调查。结果城乡老年人社区居家养老服务需求总分为(138.86±39.63)分,排在前3位的依次是社会福利、社会参与及医疗保健需求。多元线性回归分析结果显示,健康状况、文化程度、养老倾向是城乡老年人养老服务需求的影响因素(P0.05)。结论政府与相关人员应以城乡养老服务需求为基础,为老年群体提供多元化、个体化、高水平的养老服务,使其真正享受高质量的晚年生活。     

深圳市观澜街道老年人社区护理服务的需求及影响因素分析

[目的]探讨深圳市宝安区观澜街道老年人社区护理服务需求及其影响因素,为开展社区老年护理服务提供参考。[方法]对观澜街道辖区居民开展深入访谈和问卷抽样调查。[结果]调查对象的慢性病患病率和两周患病率随年龄呈增长趋势,老年慢性病防治咨询、社区急救护理、健康教育、传染病宣教、社区慢性病护理是前5位护理需求,年龄、文化程度、慢性病情况和居住情况是影响老年人社区护理需求的影响因素。[结论]观澜街道社区老年人护理需求较多,应注重完善慢性病防治咨询、健康教育等服务,引导老年人充分利用社区护理服务,并根据实际情况建立老年人社区护理服务示范点。     

社区老年慢性病患者护理需求调查分析

目的通过调查了解社区老年慢性病患者的健康状况及护理需求情况。方法选择2010年9—12月上海市徐汇区华泾社区的老年慢性病患者498例进行健康现状及护理需求调查。结果社区老年慢性病患者中,疾病谱排列前5位依次为高血压、脑卒中、冠心病、糖尿病和泌尿系统疾病。对社区护理服务需求主要集中在慢性病用药、康复、饮食及运动指导等方面。影响社区护理需求服务的相关因素依次为文化程度、患病种类、照顾者角色、收入状况和医疗费来源。结论老年慢性病患者有较高的护理服务需求,针对老年慢性病特点开展有针对性的社区护理服务对提高老年慢性病患者的生存质量有积极的促进作用。     

西安市养老机构老年慢性病患者的医疗护理需求现状调查

目的 调查西安市养老机构老年慢性病患者的医疗护理需求现状.方法 选择在西安市市区10所各级各类养老服务机构入住的老年慢性病患者500例进行调查,调查内容包括一般人口学资料、生活质量及医疗护理需求.结果 500例老年人的生活质量加权平均分为(77.43±2.12)分;对于医疗护理中的心理沟通、行为干预、饮食护理、清洁卫生、户外活动的需求都比较多.多元回归统计分析结果表明影响老年慢性病患者生活质量的因素包括家庭经济状况、自理能力、职业地位与疾病状况(P＜0.05).结论 西安市养老机构老年慢性病患者的医疗护理需求都比较多,要根据影响其生活质量的因素积极加强对症干预,从而建立具有西安特色的养老机构服务模式.     

社区老年护理中的现存问题与发展方向

目的 探讨我国社区老年护理中目前存在的问题及现状,同时分析未来的发展方向.方法 自制问卷调查表,于2009年4月至2011年3月对随机选取10个社区689例老年人的人口学资料、健康状况、社区护理需求等问题进行调查.然后对7个社区卫生服务中心进行实地调研,统计分析调查结果.结果 本组689例社区老年人中很多均患有慢性病,高血压患病率居首,且居住在农村社区的老年人所患疾病与城市社区老年人相比,很多疾病患病率有所提升.城市组和农村组社区老年人对社区护理和疾病护理需求程度比较接近;而在基础护理需求中城市组需求较多的为口腔护理,农村组需求较多的为注射和测量体温、血压.结论 随着中国步入老龄化社会,对社区老年护理需求逐年增高,因此,我国必须大力发展和健全社区医疗与护理体系,根据社区老年人的需求建立社区护理服务网络,使得社区老年人能够老有所医,真正提高晚年的生活质量.     

成都市社区老年人群健康护理服务项目需求的调查

目的 了解老年人对健康护理服务项目的需求情况,以期为老年护理人才的培养提供参考依据.方法 采取整群抽样方法抽取成都市某区一家养老机构和两个社区中的60岁以上老年人98例为研究对象,采用自制问卷进行调查.分析老年人群健康状况和健康护理服务项目需求.结果 在收回的98份有效问卷中,患有1种慢性病的老年人为42.9%,2种及以上的为26.5%;在老年人中所患慢性病的前5位是:高血压、糖尿病、心脏病、骨关节疾病、慢性阻塞性肺疾病.在健康护理服务需求中,自我健康监测指导、慢性病及常见疾病的护理、老年人常见慢性疾病的健康教育、提供娱乐活动得分最高.结论 在进行老年护理教育时,应结合区域老年人群的健康护理服务需求和国家相关意见及政策有针对性地培养老年护理人才.     

社区居家老年人综合健康状况与养老意愿分析

[目的]通过分析居家老年人综合健康状况、护理需求和养老意愿,从而科学地分配老年护理资源,提高老年居民的生活质量。[方法]采用随机抽样方法抽取乌鲁木齐市水磨沟区的3个社区,每个社区采用便利抽样方法抽取300位居家老年人,共计900位老年人,对其进行健康状况问卷调查及养老服务需求、养老意愿调查。[结果]乌鲁木齐市水磨沟区老年人健康状况总分为(16. 79±3.28)分,老年人综合健康状况与年龄、疾病状况和居住类型相关,躯体健康、年龄是老年人养老意愿的影响因素。[结论]躯体健康、年龄、居住类型是老年人综合健康的影响因素,老年人的日常生活能力与居家养老服务需求有关。     

武汉市某社区老年人慢性病情况及护理需求的调查分析

目的 调查社区老年人的健康状况、慢性病情况及老年人的社区护理需求。 方法 采用问卷调查的方法对528名老人的一般情况、健康状况、慢性病情况及社区护理需求进行调查。 结果 78.2%的老年人患有老年性慢性病。在社区护理需求方面,社区老年人需求比较高的主要是生病时护士上门护理(85.9%)、老年慢性病预防宣教与护理(86.0%)和社区紧急事故的救护(79.0%)等。 结论 社区卫生服务机构在老年人聚居的小区,应以老年慢性病的预防宣教,护理、生病时护士上门护理和社区紧急事故的救护等为重点开展老年人的社区护理。     

深圳市福田区老年人慢性病患病现状及护理需求调查分析

目的 探讨深圳市社区老年慢性病患病状况与家庭护理需求.方法 采用深圳市老年人家庭护理需求调查问卷随机对福田区8个社区的792名60岁以上常、暂住老年人进行调查.结果 老年慢性病患病率为64.1%,患病率前5位依次为高血压(29.6%)、糖尿病(14.2%)、心血管疾病(10.1%)、颈和腰椎疾病(8.1%)、高血脂(7.0%).常、暂住老年慢性病患者在文化程度、居住状态、经济来源、个人收入、医疗费来源方面具有显著性差别(P<0.05).影响患者家庭护理需求服务的主要因素是就医指导、照顾者角色、个人经济状况、医疗费、患病种类(P<0.05).结论 老年慢性病患者对家庭护理服务需求量大,最需要的服务内容是血压、血糖监测、健康咨询、心理护理、服药指导、家庭病床等.     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.