上海郊区社区医务人员PICC导管维护知识认知调查

目的:了解社区医务人员对外周中心静脉导管(peripherally inserted central catheter,PICC)置管后日常护理相关知识的认知情况,为社区推广PICC维护技术,开展针对性培训提供依据.方法:2016年1月采用自制问卷对青浦区9家社区卫生服务中心参与团队服务的415名社区医务人员进行干预前后问卷调查.结果:社区医务人员干预前后对PICC导管维护知识知晓率从77.86％提升至95.45％,统计差异有显著性意义(P＜0.01).干预后,社区护士、全科医生与乡村医生对知识的认知情况较接近.结论:社区医务人员与居家置管患者接触最密切、最直接,通过提升社区医务人员PICC导管维护知识与技能,以及时满足置管患者的服务需求.     

社区医务人员对癌症疼痛控制认知的横断面调查

目的:了解社区卫生服务中心医务人员对癌痛控制知识掌握情况,以加强社区对癌痛患者诊疗的规范管理.方法:利用金数据平台对上海市青浦区11家社区卫生服务中心的1237名在职医师、护士、药师进行手机线上问卷调查,共采集776份有效数据,分析癌痛评估和处理、阿片类药物使用、药物不良反应的认知情况.结果:对于癌痛评估和处理、阿片类...     

上海某社区卫生服务机构归因方式与居民感受相关性分析

目的:探讨居民感受与社区卫生服务归因方式的关系,为社区卫生服务中心提升工作质量提供建议.方法:于2016年5月在上海某社区卫生服务中心门诊各科室、社区卫生服务站点,采用便利抽样的方法选取524名接受医务人员服务的社区居民进行问卷调查,内容包括被调查者基本信息和社区卫生服务归因方式,并让居民填写社区卫生服务感受量表,对调查数据进行汇总和统计分析.结果:被调查者中,女性344人,占65.6％;年龄60～80岁340人,占64.9％;388人在社区卫生服务机构就诊年限大于3年的占74.0％.在归因方式上,居民倾向于认为医务人员及整个医疗机构的服务形式是为居民利益考虑(x>4);居民对本次服务和社区卫生服务中心累计服务所呈现的内容差异性、水平一致性和态度一贯性比较认可(x>4);居民的年龄、文化程度、就诊史、社区卫生服务归因方式与其单次及累积服务感受的服务内容差别性和水平一致性呈正相关(r>0,P<0.05);居民的文化程度与其感受的累积服务态度一贯性之间的相关性无统计学意义(P>0.05).结论:社区卫生服务中心应保持公益性,注重服务内容、水平、态度的差异性、一致性和一贯性,从而提高区域医疗资源利用的成本效益及社区卫生服务的社会效益性.     

283名社区护士糖尿病知识掌握情况调查分析

目的:了解社区护士糖尿病知识存量与知识缺口。方法:随机抽取上海社区卫生服务中心护士297人,发放糖尿病知识测验卷和糖尿病知识来源的调查问卷,回收283份。结果:283名护士糖尿病知识测试平均分为23.8分(满分50分),得分率47.6%,以糖尿病药物治疗和操作管理得分率最低,分别为44.4%和41.7%。社区护士获得糖尿病知识的渠道局限于社区卫生服务中心和二级医院,少部分来源于三级医院和高校。结论:上海市社区护士糖尿病知识存量不足,获得知识的渠道不畅。需探索适合社区卫生服务特点的护士培训模式,让他们享受二、三级医院护士同质同源的知识和信息,提高慢性病管理能力。     

上海市五里桥社区医务人员改革意愿调查分析

目的:调查五里桥街道社区卫生服务中心医务人员对社区卫生服务综合改革的意愿和影响因素.方法:采用自行设计的问卷对本中心114名医务人员进行基本信息、综合改革政策的态度和知晓情况等的调查,并对调查结果进行分析.结果:医务人员中对改革政策全部知晓的占22.81％,对改革持支持态度的占68.43％,其中合理收入是医务人员最期待改善的问题.Logistic分析显示,对改革政策了解程度是改革意愿的主要影响因素.结论:应加大社区卫生服务改革的相关政策宣传力度,推进民主管理,完善绩效分配,激发医务人员参与改革的积极性,确保综合改革的顺利推进.     

四川省部分社区居民健康教育效果评估

目的:了解和评价我省社区卫生服务中心实施国家基本公共卫生服务项目的效果,促进我省基本公共卫生服务逐步均等化、推动9类国家基本公共卫生服务项目落实.方法:随机抽取四川省7个地级市14家社区卫生服务中心服务对象429人,进行面对面问卷调查.结果:居民健康知识知晓率为40.6%,Logistic回归分析显示:教师、公务员、管理人员及文化程度高者知晓率高;居民健康行为形成率为91.4%,Logistic回归分析显示:女性、年龄大和健康知识知晓者健康行为形成率较高.结论:居民健康知识知晓率还有较大提升空间,健康知识的提高有助于健康行为的形成     

居民对郑州市社区片医负责制服务模式的认知利用调查分析

目的探讨居民对社区片医负责制服务模式的认知和利用状况,为社区卫生服务可持续发展和有关政策提供科学依据。方法对片医负责制"示范中心"辖区居民323名、"非示范中心"辖区居民314名进行问卷调查,收集对社区卫生服务的认知、患病时首选、就诊首选原因、到达机构的时间,以及对社区卫生服务机构的建议等指标。结果①示范中心与非示范中心辖区居民了解社区卫生服务分别占被访者的96.28%和64.01%。②示范中心有87.92%的辖区居民在患病时首选社区卫生服务机构,而非示范中心仅有56.05%的辖区居民在患病时首选社区卫生服务机构。③对患病时首选社区卫生服务站的辖区居民进行原因调查,示范中心辖区居民因距离近、费用低、态度好、对医生熟悉的选择比例均明显高于非示范中心。④示范中心辖区居民有83.90%的人在5分钟以内能到达社区卫生服务机构;而非示范中心辖区居民仅有35.35%的人在5min以内能到达社区卫生服务机构。⑤示范中心辖区居民对社区卫生服务机构整体评价十分满意、满意、基本满意的比例分别为86.69%、7.12%、4.02%,不满意的比例仅为2.17%。非示范中心辖区居民对社区卫生服务机构十分满意、满意、基本满意的比例分别为31.43%、6.05%、30.25%,不满意的比例为31.21%,两区比较其差异有显著性意义。结论片医负责制这种新型的社区卫生服务模式,为辖区居民提供了方便快捷的医疗卫生服务,深受辖区居民欢迎。     

医疗联合体对社区卫生服务中心运行效益的影响

目的:通过对武汉市第五医院直管的6家社区卫生服务中心与非直管的社区卫生服务中心的运行和经济效益进行比较,研究医疗联合体对社区卫生服务中心运行效益的影响。方法:收集汉阳区8家社区卫生服务中心的运行数据,用重复测量资料方差分析方法对直管和非直管社区卫生服务中心的服务提供和经济效益进行比较分析。结果:①直管社区卫生服务中心平均门诊人次年平均增长率为12.77%,出院人次年平均增长率为19.81%;非直管社区卫生服务中心平均门诊人次年平均增长率为2.83%,平均出院人次年平均下降率为-11.01%。②重复测量方差分析:门诊人次、出院人次、人均业务收入和人均门诊费用4个指标组间效益的差异均有统计学意义(P0.05),药品收入占业务收入比例的组间效应的差异没有统计学意义(P0.05)。结论:直管后社区卫生服务中心服务提供明显增加,经济效益也提高,但是,需要完善对社区的监管机制,促进社区公益性的回归。     

北京市月坛社区冠心病患者管理现况调查

目的 了解北京市月坛社区冠心病患者的管理现况,分析存在的问题,并针对问题提出相应建议.方法 北京市月坛社区选择了212名冠心病患者作为此次研究对象.采用横断面调查研究方法,通过自行设计的调查问卷收集患者的基本情况、治疗情况、冠心病知识知晓率、患者满意度等资料,生活质量采用SF-36量表进行评估.通过体格检查获取生理、生化指标.结果 被调查的212名患者中,未规律进行心电图者检查者82人(38.68%),未定期检查体重指数者112人(52.83)%.冠心病一级预防知晓率为27.83%,二级预防知晓率为13.21%.患病时首选社区卫生服务机构就诊者153人(72.17%).对社区医务人员服务态度、医疗水平非常满意者188人(88.68%).结论 北京市月坛社区已得到冠心痛患者认可;患者对冠心病健康知识知晓率低.社区卫生服务机构需要制定适宜的冠心病社区防治建议或指南来规范社区冠心病管理.     

社区卫生服务中心居民的认知情况及满意度调查分析

目的：探究社区居民对社区卫生服务中心的认知及满意程度情况。方法主要方法为现场问卷调查,抽取本市各街道中距离社区卫生服务中心较近的社区居民进行随机抽样调查。结果社区健康知识普及率及健康知识知晓率分别为85.5%和73.0%,社区居民对社区卫生服务中心满意度高达91.6%。结论社区卫生服务必须进一步加强宣传力度,卫生资源需合理科学配置,同时社区卫生机构应制定服务质量改善计划并严格实施,以便全面系统的开展社区医疗服务工作。     

Nifedipine in the treatment of hypertension in the elderly

The effect of nifedipine monotherapy, retard tablets, 20 mg bid, was evaluated in 23 hypertensive patients, mean age, 79 +/- 2 years. Twenty-one patients completed an eight-week study. Blood pressure (BP) decreased to 160/90 mm Hg in 15 patients; in four additional patients diastolic BP dropped by 15% to 28%. In a subset of five patients with isolated systolic hypertension, a significant reduction in systolic BP was noted. Side effects were relatively mild and only two patients discontinued the study. The results suggest that nifedipine monotherapy offers an alternative, logic, therapeutic approach to hypertension in the elderly.     

Studies on the receptors involved in the action of the various agents in the phenylbenzoquinone analgesic assay in mice

1. Tolerance to the activity of several narcotic analgesics (morphine, levorphanol, and methadone) and several narcotic-antagonist analgesics (pentazocine, cyclazocine, and nalorphine) was studied in the mouse phenylbenzoquinone stretching test. Virtually complete tolerance was induced by chronic treatment with each of the narcotic agents, while no apparent tolerance was induced by the narcotic antagonists.2. In morphine-tolerant mice there was a high degree of cross-tolerance to the effects of not only the other narcotic drugs but also to those of the narcotic antagonists, acetylsalicylic acid, and physostigmine.3. The effects of morphine and pentazocine were antagonized by naloxone but not by atropine, while the effects of physostigmine were antagonized by atropine but not by naloxone. Neither atropine nor naloxone antagonized the effect of acetylsalicylic acid.4. The results of the tolerance study suggest that there is a fundamental difference in the consequences of receptor interaction for the narcotic and the narcotic-antagonist analgesics. Morphine-tolerant mice exhibit cross-tolerance non-specifically. The selectivity of naloxone and atropine differentiates the narcotic and narcotic-analgesics from the other two agents used in this analgesic test.     

Interactions among the cannabinoids in the antagonism of the abdominal constriction response in the mouse

The ability of ⁹-tetrahydrocannabinol (THC), cannabinol (CBN), cannabidiol (CBD), 11-OH THC and 8,11-diOH THC to antagonise the abdominal constriction response in the mouse induced by formic acid, phenylquinone, 5-hydroxytryptamine, prostaglandin E₁ (PGE₁) and bradykinin was tested. THC was an effective antagonist against all nociceptive agents with an ED₅₀ in all cases between 1.0 and 2.6 mg/kg. CBN, while also effective against all nociceptive agents, was less potent than THC, with an ED₅₀ range between 46.2 and 112.5 mg/kg. CBD in doses as high as 200 mg/kg was without effect. Using PGE₁ as the nociceptive agent, 11-OH THC was equipotent to THC while 8,11-diOH THC was inactive. Naloxone, while able to antagonise the antinociceptive effect of morphine against formic acid-induced writhing, did not reverse the antinociceptive effects of THC. There were no pharmacological interactions between THC, CBD and CBN.     

Neurotensin causes a greater increase in the metabolism of dopamine in the accumbens than in the striatum in vivo

Differential pulse voltammetry with carbon fibre electrodes was used to study the effect of central administration of neurotensin on the extracellular level of 3,4-dihydroxyphenylacetic acid (DOPAC) in the nucleus accumbens and the striatum in anaesthetised rats. Intracerebroventricular injection of neurotensin (10 micrograms) increased the peak height for DOPAC 20 min after administration in the nucleus accumbens but only after 40 min in the striatum. The maximum increase was similar in both regions, with 30% and 27% above the pre-injection basal level, respectively. Neurotensin (1 micrograms) however increased the extracellular level of DOPAC in the nucleus accumbens alone. Neurotensin (0.1, 1.0 and 3.0 micrograms/0.5 microliter), injected into the ventral tegmental area, induced a potent and long-lasting elevation of the peak height for DOPAC in the nucleus accumbens, while the same doses in the substantia nigra produced effects on the metabolism of dopamine in the striatum of smaller amplitude and shorter duration. The maximum effect of each dose was about 2.5 times greater in the mesolimbic, compared to the nigrostriatal system. Amphetamine (2 mg/kg, s.c.) decreased the extracellular level of DOPAC with a similar magnitude, both in the nucleus accumbens (52%) and the striatum (47%). Intracerebroventricular administration of neurotensin (1 micrograms), 5 min after amphetamine, did not alter the effect of amphetamine on the extracellular level of DOPAC either in the nucleus accumbens or the striatum. However, neurotensin (10 micrograms) partially reversed the effect of amphetamine in the nucleus accumbens and had a similar but smaller and delayed effect in the striatum. The results from the present study, together with previous neurobehavioural studies, suggest that neurotensin has a relatively selective action on the mesolimbic dopaminergic system in the rat.     

Role of the liver in the disposition of intravenous nitroglycerin in the rat

Previous studies have indicated that the liver is the main site of nitroglycerin (NTG) elimination when the drug is systematically infused. To examine this hypothesis, we measured the apparent systemic clearance (Cls) of nitroglycerin in anesthesized rats receiving a constant intravenous infusion at a dose of 100 micrograms per kg per min. Animals were divided into shunt and sham groups; the former had undergone a portal vein ligation 10 days prior to the study, while the latter was subjected to a sham operation. On the study day, half of the animals of each group also received probenecid at 200 mg/kg, i.v., a drug previously reported to inhibit organic nitrate ester reductase (ONER) activity in rat liver. Arterial NTG samples were obtained at 41, 43 and 45 min of infusion in all four experimental groups; Cls was 439 +/- 32 ml per kg per min (mean +/- S.E.) in sham, 460 +/- 44 in sham and probenecid, 477 +/- 39 in shunt, and 461 +/- 34 in shunt and probenecid animals. During NTG infusion, hepatic blood flow (measured with a constant infusion of indocyanine green) was decreased markedly in shunted rats as was liver/body weight, indicating hepatic atrophy. The specific activity of hepatic ONER was similar in all four groups. In spite of marked differences in hepatic blood flow and hepatic mass, the Cls was similar in all four groups. The liver does not appear to be a major site for the elimination of systemic nitroglycerin as hitherto assumed.     

抗生素在预防普外科手术切口感染中的价值分析及其预防

目的:分析抗生素在预防普外手术切口感染中的临床价值.方法:选择我院收治的100例普外科手术患者作为观察对象(2015年2～11月),采用随机分组的方式将100例普外科手术患者分成对照组与实验组,分别在术后使用抗生素及术前1h使用抗生素,观察两组手术切口感染率及患者的疼痛评分.结果:对照组切口感染率(16.00％)明显高于实验组(4.00％),两组之间对比疼痛评分存在显著差异(P＜0.05),有统计学意义.结论:针对普外科手术患者根据患者的切口类型科学、合理选择抗生素及选择适当的使用时间能有效减少术后手术切口感染,有效改善患者预后.     

女性医务人员健康状况的研究

目的探讨女性医务人员健康状况的特点。方法对2877例医院工作人员健康查体资料进行统计学分析。结果①女性医务人员中,41.0%的人员患有不同类型的疾病,略高于男性患病率（36.8%）,二者差异有统计学意义（P=0.029）;②女性医务人员高脂血症为31.9%（212/665）,低于男性（65.9%,274/416）;③脂肪肝患病率女性（32.6%,181/556）,亦低于男性（45.9%,151/329）;④女性相关疾病中,乳腺疾病和子宫肌瘤的患病率分别为4.8%和3.4%;而宫颈糜烂为20.2%;⑤女性医务人员高血糖为11.0%（77/702）,高血压为4.6%（56/1229）。结论女性医务人员中妇科与乳腺疾病是健康体检的重点,代谢性疾病也应加以关注。     

人文关怀在手术室护理中的应用

目的探讨在手术室护理中人文关怀的作用。方法将2012年5月至2012年11月200例手术患者随机分为两组,对照组100例,采取术前、术中常规护理,观察组100例,在对照组的基础上给予患者人文关怀,对比两组护理满意度及疗效。结果对照组各项指标满意度低于实验组(P<0.05),与对照组比较,实验组的住院时间明显缩短,痛苦小,并发症发生率低,P<0.05,差异均有统计学意义。结论 "以人为本"的人文关怀理念应用于手术室中,可充分提高护理质量及患者的满意度。