自我效能感与糖尿病患者血糖控制情况的研究

目的探讨糖尿病患者自我效能感对糖尿病控制情况的影响。方法选择我院80例门诊糖尿病患者分为两组,观察组给予临床路径干预,评测两组患者自我效能感和糖尿病控制情况。结果观察组自我效能感、空腹血糖、餐后血糖和糖化血红蛋白控制方面都优于对照组。结论患者自我效能感的提高,改善了患者的糖尿病控制情况,满足了患者的健康需求。     

临床路径干预糖尿病患者自我效能感和糖尿病控制情况临床研究

目的探讨临床路径对糖尿病患者自我效能感的影响。方法选择本院80例门诊糖尿病患者分为两组,观察组实施临床路径干预,评测两组患者自我效能感和糖尿病控制情况。结果观察组自我效能感、空腹血糖、餐后血糖和糖化血红蛋白控制方面都优于对照组。结论临床路径提高了患者的自我管理能力,改善了患者的糖尿病控制情况,满足了患者的健康需求,增进了医患关系,是患者易于接受的一种诊疗模式。     

护理干预对2型糖尿病患者自我血糖监测依从性的影响

目的探讨护理干预对2型糖尿病患者自我血糖监测依从性的影响效果。方法选择2014年7月~2015年7月在我院治疗的2型糖尿病140例,按随机数字表法分为对照组和干预组,每组各70例。对照组患者基本不采取护理措施,干预组患者给予护理干预,比较2组患者自我血糖监测依从性。结果干预组患者血糖监测意义知晓率、血糖监测目标达标率、血糖监测记录率、血糖仪正确使用率均较干预前明显提高,且均明显优于对照组,差异有统计学意义(P0.05);干预组患者空腹及餐后2h血糖均明显低于治疗前,且明显低于对照组,差异有统计学意义(P0.05);干预组患者依从率明显高于对照组,差异有统计学意义(P0.05)。结论通过对2型糖尿病患者进行护理干预,可有效提高患者自我血糖监测的依从性,改善糖尿病患者的治疗效果。     

家庭医生签约服务在2型糖尿病管理中的作用

目的探讨家庭医生签约服务在2型糖尿病治疗中的作用。方法选取120名2型糖尿病患者作为研究对象,随机分为对照组(n=60)和观察组(n=60),对照组患者接受常规糖尿病教育,观察组患者在此基础上接受家庭医生签约服务。对比干预前、干预后12个月患者空腹及餐后2h血糖、BMI指数、糖化血红蛋白、健康知识知晓情况、营养与健身知识—态度—行为得分情况。结果干预后两组患者空腹血糖、餐后2h血糖、BMI指数、糖化血红蛋白均低于干预前,健康知识知晓率、营养与健身知识-态度-行为得分优于干预前,差异有统计学意义(P0.05)。干预后观察组患者空腹血糖、餐后2h血糖、BMI指数、糖化血红蛋白、低于对照组患者,健康知识知晓率、营养与健身知识-态度-行为得分高于对照组患者,差异有统计学意义(P0.05)。结论家庭医生签约服务在2型糖尿病治疗中具有积极的作用,有助于糖尿病患者的病情控制,提高患者健康知识掌握程度,改善患者保健知信行状况。     

同伴教育对2型糖尿病患者血糖及糖尿病知识和焦虑情绪的影响

目的:探讨同伴教育对2型糖尿病患者血糖影响.方法:将2013年1月至3月建立健康档案的300例2型糖尿病患者分为观察组(200例)和对照组(100例).观察组20个同伴教育小组组成,每个小组由一个同伴教育组长和9人组员组成.对照组给予取常规健康教育.评估两组患者的糖尿病防治知识、自我管理能力、焦虑情绪以及血糖控制情况.结果:与对照组相比,干预后观察组糖尿病患者空腹血糖、糖化血红蛋白平均水平均明显降低(P<0.05),糖尿病相关防治知识和自我管理能力的平均得分均明显提高(P<0.05).观察组和对照组患者焦虑情绪评分平均水平都比干预前减低(P<0.05),但观察组焦虑情绪评分的平均水平显著低于对照组(P<0.001).结论:在2型糖尿病患者健康教育中,同伴教育能提高患者的糖尿病相关防治知识和自我管理能力,改善焦虑情绪,从而提高患者的血糖控制.     

授权教育对2型糖尿病患者自我效能、自我管理能力及血糖控制的影响

目的 观察基于授权原理的授权教育对2型糖尿病患者自我效能自我管理能力及血糖控制的影响.方法 150例2型糖尿病患者随机分为2组,干预组76例授权教育及连续性健康教育相结合的教育模式,对照组74例予传统健康教育模式,干预6个月.比较2组干预前后体重指数(BMI)、空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红...     

对糖尿病患者自测血糖宣教的探讨

目的:探讨糖尿病患者自测血糖宣教对血糖控制的积极作用.方法:把随机选取的已自购血糖仪的60例患者,分为宣教组和对照组各30例,并对宣教组进行血糖监测宣教,跟踪记录宣教组和对照组患者的血糖值和糖化血红蛋白值,评价血糖控制指标改善水平.结果:宣教组血糖控制指标改善情况明显优于对照组,有显著性差异(P＜0.05).结论:自测...     

5E康复护理对2型糖尿病患者运动康复效果的影响研究

目的 探索5E康复护理对2型糖尿病患者运动自我效能、自我管理能力、血糖控制情况等运动康复效果的影响。方法 纳入72例2型糖尿病患者为研究对象,对照组36例予常规护理,观察组36例予5E康复护理,共3个月,观察患者SEE、2-DSCS评分、空腹血糖、餐后2h血糖、糖化血红蛋白水平。结果 SEE评分观察组干预后较干预前及对照组有明显提升(P<0.05),对照组干预前后无明显差异(P>0.05)。2组患者干预后比干预前2-DSCS评分、空腹血糖、餐后2h血糖、糖化血红蛋白水平均有所改善(P<0.05),且观察组显著于对照组,差异有统计学意义(P<0.05)。结论 5E康复护理有效提升2型糖尿病患者运动及疾病管理效果。     

个性化护理干预对糖尿病患者血糖控制的影响

目的探讨个性化护理干预对糖尿病患者血糖控制的影响。方法选择我院糖尿病患者共100例,上述患者均符合WHO制定的糖尿病诊断标准,上述患者均为2型糖尿病患者。上述患者随机分为观察组和对照组。对照组患者实施糖尿病常规护理,常规糖尿病健康宣教、对饮食及运动等进行指导等。观察组给予个性化护理干预。对两组患者护理干预前和出院12周后空腹血糖、餐后2h血糖、糖化血红蛋白进行检测,观察上述指标改变情况。结果观察组护理干预前空腹血糖、餐后2h血糖和糖化血红蛋白水平分别与对照组干预前比较,差异无统计学意义（P〉0.05）;观察组患者出院后12周空腹血糖、餐后2h血糖和糖化血红蛋白水平分别与对照组同期比较,差异有统计学意义（P〈0.05）。结论个性化护理干预有利于糖尿病患者血糖控制,护理效果显著,值得借鉴。     

延续护理模式对Ⅱ型糖尿病患者治疗依从性和血糖控制的影响

目的 设计以高级实践护士（APN）为主导的延续护理方案,并评价该方案对Ⅱ型糖尿病患者治疗依从性和血糖控制的影响.方法 选择2011年1月至2012年12月在广州市某医院住院、符合研究标准的Ⅱ型糖尿病患者96例,将其随机分配到干预组及对照组,各48例.两组患者均接受住院及出院常规护理服务,试验组同时还接受以APN为主导的延续护理干预.分别在患者接受干预前、干预4周及12周后收集患者的治疗依从性和血糖资料,采用重复测量方差分析、t检验、卡方检验等统计方法分析结果.结果 干预后4周,干预组治疗依从性总得分以及血糖监测、运动和饮食控制依从性3个维度的得分均高于对照组,且差异有统计学意义（P＜0.05）;干预后12周,干预组治疗依从性总得分及用药、血糖监测和饮食控制依从性3个维度得分均高于对照组,且差异有统计学意义（P＜0.05）;干预后12周,干预组糖化血红蛋白测量值与对照组相比,差异无统计学意义（P＞0.05）,干预组糖化血红蛋白达标率高于对照组,且差异有统计学意义（P＜0.05）.结论 以高级实践护士主导的延续护理模式可以有效提高Ⅱ型糖尿病患者治疗依从性、糖化血糖蛋白达标率.     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.