老年住院患者衰弱指数与血清25羟维生素D关系的研究

目的 探讨老年住院患者衰弱指数与血清25羟维生素D水平的相关性.方法 选择老年住院患者100例,依据老年综合评估构建衰弱指数(frailty index based on a Comprehensive Geriatric Assessment,FI-CGA);抽取静脉血标本,测定血清25羟维生素D[25(OH)D]水平;依据25 (OH)D水平将研究人群分为严重缺乏组、缺乏组、不足组和充足组.结果 本研究人群FI-CGA的中位数(四分位数间距)为0.172(0.096～0.216),与维生素D缺乏组[0.154(0.103～0.196)]、不足组[0.107(0.085～0.155)]和充足组[0.071(0.066～0.073)]相比,维生素D严重缺乏组[0.234(0.133～0.367)]的FI-CGA显著升高;Spearman相关分析显示FI-CGA与25 (OH)D呈负相关(r=-0.499,P＜0.001).有序多分类Logistic回归分析结果显示25 (OH)D是FI-CGA的独立保护因素(P＜0.001).结论 老年住院患者中,衰弱指数与维生素D、年龄、性别相关,应注重高龄、女性患者的衰弱筛查,适量补充维生素D可能成为预防和治疗衰弱的一种有效手段.     

衰弱老年人尿失禁发生率的meta分析

目的:系统评价衰弱老年人尿失禁发生率。方法:检索Pub Med、CENTRAL、Embase、CINAHL、Web of Science、CNKI、Sino Med、VIP、Wanfang数据库中关于衰弱老年人尿失禁发生率的横断面研究,检索时限均从建库时间至2020年12月,并进行meta分析。结果:共纳入15篇文献,包含8378例患者。meta分析结果显示,衰弱老年人尿失禁总的发生率为39.1%[95%CI(27.0%,51.2%)]。亚组分析结果显示衰弱老年人尿失禁发生率:男性、女性分别为40.0%、59.6%; 60～69岁、70～79岁、≥80岁组分别为49.8%、43.1%、50.7%;社区和医院分别为33.5%、43.0%;自我报告相关症状诊断和量表诊断分别为29.5%、57.6%;在2010年前后调查的分别为52.1%、40.4%;亚洲、欧洲、美洲分别为36.2%、42.9%、54.1%。结论:衰弱老年人尿失禁发生率较高,不同性别、年龄、研究场所、诊断方法、调查时间的尿失禁发生率存在差异。     

实验室衰弱指数对老年CAP住院患者并发脓毒症及脓毒性休克风险的预测价值

目的 探讨实验室衰弱指数（FI-LAB）对老年社区获得性肺炎（CAP）住院患者发生脓毒症及脓毒性休克风险的预测价值。方法 回顾性纳入住院的老年CAP患者502例。选取40个入院后24 h内首次采集的常规实验室指标和生命体征指标构建FI-LAB,FI-LAB<0.35为非衰弱组,FI-LAB≥0.35为衰弱组。判定脓毒症和脓毒性休克的发生情况。采用修正Poisson回归构建预测模型并采用受试者工作特征（ROC）曲线分析预测价值。结果 多因素修正Poisson回归分析显示衰弱是老年CAP并发脓毒症和脓毒性休克的危险因素（P<0.001）。将FI-LAB乘以100后纳入多因素修正Poisson回归分析,发现FI-LAB每增加0.01,发生脓毒症及脓毒性休克的风险分别增高5.9%和6.2%（均P<0.001）。FI-LAB预测脓毒症及脓毒性休克的ROC曲线下面积分别为0.865和0.850,最佳截断值分别为0.28和0.42。结论 衰弱增加CAP并发脓毒症及脓毒性休克的风险。FI-LAB可预测CAP患者发生脓毒症和脓毒性休克的风险,早期发现高危人群。     

社区骨关节炎患者衰弱现状及影响因素

目的 调查社区骨关节炎（OA）患者衰弱现状,并分析其影响因素。方法 回顾性分析2021年4月至6月在泰州市2个社区医院保存健康档案的OA患者204例,通过填写一般量表、衰弱量表以及西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分量表,比较患者的衰弱现状,并分析衰弱的可能影响因素。结果 受试OA患者衰弱总分为（2.10±0.88）分,衰弱发生的比例为25.5%(52例),单因素分析结果显示,不同年龄、性别、家庭人均月收入、婚姻、体重指数（BMI）以及WOMAC评分的OA患者的衰弱得分比较,差异有统计学意义（P<0.05）,多元线性回归分析结果显示,年龄、BMI、WOMAC评分是衰弱的危险因素（P<0.05）;婚姻是衰弱的保护因素（P<0.05）。结论 OA患者衰弱发生率较高,且受到多因素影响,WOMAC评分是OA患者衰弱的主要危险因素,作为可控制的因素,医护人员可多加关注,制定有效的治疗措施,从而改善OA患者的衰弱状态。     

福州市养老机构老年人衰弱水平及其影响因素调查

目的 调查福州市养老机构老年人衰弱水平及其影响因素.方法 采用随机分层整群抽样法,抽取福州市4所养老机构的125例老年人为研究对象.采用一般情况调查表、Fried衰弱表型量表、老年抑郁量表、匹兹堡睡眠质量指数问卷进行横断面调查.结果 衰弱及衰弱前期老人分别占40％和56％.其中,握力低下、步行速度减慢和躯体活动量低为发...     

老年人合理膳食对健康状况的影响

随着社会进步，人民生活水平的提高，我国居民的膳食结构发生了很大变化，肥胖问题不断飙升，那么老年人的营养状况和抗氧化营养素的摄人与肥胖到底有哪些重大联系和影响。首先，肥胖症被认为是一种营养过剩所造成的营养不良性疾病，也可认为是一种能量代谢紊乱疾病，是老年人常见的疾病，极易导致心血管疾病和糖尿病，严重影响生活质量和寿命。参考某军区医院老干部调查资料表明，老年人发胖的原因主要是中年以后基础代谢消耗的能量降低，体力劳动减少，     

BODE指数应用于COPD治疗的价值研究

目的研究BODE指数在慢性阻塞性肺病(COPD)治疗中的价值。方法选择稳定期COPD患者56例。判定BODE指数,连续随访一年,采用圣乔治呼吸问卷(SGRQ)和一般健康状况调查问卷的方式统计患者的健康及生活质量。结果 COPD患者的BODE指数高,其病死率也高。BODE指数和SGRQ评分以及患者就诊的次数明显相关。结论 BODE指数和COPD患者的预后以及生活质量的关系密切,是一种方便易行的COPD评估工具。     

老年冠心病患者衰弱评估工具研究进展

老年冠心病患者衰弱的发生率高,且衰弱可预测老年冠心病患者的不良预后。在临床工作中采用适宜的评估工具进行衰弱的早期识别,有助于预防不良预后。本文对当前老年冠心病患者衰弱评估工具的内容和生化指标的研究进展进行综述,发现目前应用于老年冠心病衰弱患者的评估工具大部分未进行汉化,生化指标暂未明确和规范,有待进一步完善。     

生物标志物结合衰弱评估量表对老年房颤患者的衰弱预测价值

房颤与衰弱均为增龄性疾病,对于老年房颤患者,应尽早完善衰弱评估以便进行针对性管理。目前衰弱评估工具多为各类评估量表,但逐渐发现血液中诸多指标变化与衰弱存在相关性,如C-反应蛋白、降钙素原等炎症因子,低密度脂蛋白、骨保护素、三碘甲状腺原氨酸等代谢指标及D-二聚体等纤溶指标。这些生物指标或可作为衰弱标志物与量表共同评估衰弱状况,使衰弱评估结果更为精确、客观。本文就生物标志物结合衰弱评估量表对老年房颤患者的衰弱预测价值进行综述,旨在为临床及科研提供参考。     

Management of osteoporosis in the elderly

ABSTRACT

Background: Osteoporosis is predominantly a condition of the elderly, and the median age for hip fracture in women is approximately 83 years. Osteoporotic fracture risk is multifactorial, and often involves the balance between bone strength and propensity for falling.

Objective: To present an overview of the available evidence, located primarily by Medline searches up to April, 2009, for the different management strategies aimed at reducing the risk of falls and osteoporotic fractures in the elderly.

Results: Frailty is an independent predictor of falls, hip fractures, hospitalisation, disability and death in the elderly that is receiving increasing attention. Non-pharmacological strategies to reduce fall risk can prevent osteoporotic fractures. Exercise programmes, especially those involving high doses of exercise and incorporating balance training, have been shown to be effective. Many older people, especially the very elderly and those living in care institutions, have vitamin D inadequacy. In appropriate patients and given in sufficient doses, vitamin D and calcium supplementation is effective in reducing both falls and osteoporotic fractures, including hip fractures. Specific anti-osteoporosis drugs are underused, even in those most at risk of osteoporotic fracture. The evidence base for the efficacy of most such drugs in the elderly is incomplete, particularly with regard to nonvertebral and hip fractures. The evidence base is perhaps most complete for the relatively recently introduced drug, strontium ranelate. Non-adherence to treatment is a substantial problem, and may be exacerbated by the requirements for safe oral administration of bisphosphonates.

Conclusion: Evidence-based strategies are available for reducing osteoporotic fracture risk in the elderly, and include exercise training, vitamin D and calcium supplementation, and use of evidence-based anti-osteoporotic drugs. A positive and determined approach to optimising the use of such strategies could reduce the burden of osteoporotic fractures in this high-risk group.     

基层医疗机构药品使用信息公开评估指标体系研究

目的建立基层医疗机构药品使用信息公平评估指标体系,推进基层医疗机构药品使用信息透明化建设。方法通过文献研究,结合各地实践,参考财务公开等相关内容建立指标体系。结果提出了药品使用信息公开状况评估指标体系构建的原则,构建基层医疗机构药品使用信息公开评估指标体系,明确基层医疗机构药品使用信息需公开的内容及评价方法。结论基层医疗机构药品使用信息公开评估指标体系的构建是科学性与艺术性的结合,促进了基层医疗机构药品使用信息透明化进程,但尚需结合各地实际,多维度考虑。     

Muscle power training in the institutionalized frail: a new approach to counteracting functional declines and very late-life disability

Skeletal muscle power decreases earlier than muscle strength with advancing age and is more strongly associated with functional test performance than muscle strength in elderly populations. In addition, some studies have shown that resistance training designed to improve muscle power output (high speed of movement) enhances several functional outcomes in the healthy elderly. Therefore, muscle power has emerged as a factor that is also potentially associated with functional limitations in frail elderly adults. The purpose of this review was to provide recent evidence regarding the association between skeletal muscle power and functional capacity in physically frail individuals. Scielo, Science Citation Index, MEDLINE, Scopus, Sport Discus and ScienceDirect databases were searched from 1990 to 2014. Recently, it has been shown that functional capacity among frail elderly adults could be improved by performing resistance training at a high speed of movement with a loading stimulus that optimizes muscle power output. Routine multicomponent interventions that include muscle power training should be prescribed to institutionalized oldest old because such interventions improve the overall physical status of frail elderly individuals and prevent disability and other adverse outcomes. This result is especially important in frail subjects, who urgently need to improve their functional capacities to prevent adverse outcomes such as falls, hospitalizations, disability, or even death.     

不同项目的需氧运动对中老年血脂的影响

目的通过对西北地区中老年人,进行达到靶心率的不同项目的有氧运动的锻炼监测,观察其对中老年人血脂的影响。方法对539名中老年受试者进行了12周,每周4次以上,每次30~40min的指导锻炼、监测、追踪的研究。结果对于中年男子,慢跑快走可显著降低胆固醇及低密度脂蛋白,传统体育有降低甘油三酯的作用。对于老年男子,有氧体操有显著降低胆固醇、低密度脂蛋白的作用。中老年女性运动前后血脂变化差异无统计学意义。结论达到靶心率的不同项目的有氧运动可以降低胆固醇、低密度脂蛋白、甘油三酯,防治高血脂。     

An inter-rater reliability study of the Opiate Treatment Index

The development of standardized instruments to evaluate treatment outcome fo opioid dependence is necessary to determine individual patients' progress within a particular treatment programme and to compare treatment outcomes across programmes. This paper reports the results of an inter-rater reliability study utilizing the Opiate Treatment Index (OTI). The OTI questionnaire is a standardized opiate treatment evaluation tool developed within a research setting. The main aim of this study was to determine within the clinical setting of a Methadone Treatment Programme (MTP), whether information given by patients differed significantly according to whether the OTI questionnaire was administered by clinicians working within the service, or by an unknown research assistant. Results indicated that overall there were few differences between the information given to clinicians compared with that given to the research assistant and that in general, inter-rater reliability was good. A number of issues related to the development and use of treatment outcome measures in clinical settings are highlighted and it is proposed that for MTPs a shorter questionnaire, based on the OTI, be developed.     

孕中晚期钙营养干预对孕妇骨钙影响的研究

目的 探讨妊娠期不同方式钙干预对孕期妇女骨钙的影响。方法 对59名26～36岁健康孕妇进行膳食调查．随机分为三组．在各组能量和营养素摄入相近的情况下，分别对研究组进行不同方式的钙营养支持干预。结果 孕期每天膳食钙摄入量不足450mg孕妇血清钙、磷稳定．不随着钙摄入量的增加而改变；补充钙剂后可以增加骨钙含量。结论孕妇膳食钙摄入量较低．但其血钙、磷水平相对恒定．不受钙摄入量的影响。经补充钙剂有助于改善孕妇骨钙储备。     

关于构建药店GSP认证评估指标体系的探讨

目的:探讨构建药店《药品经营质量管理规范》(GSP)认证评估指标体系。方法:移植公共政策评估方法和政策德尔菲法,分析药店GSP认证评估指标体系的结构和初步评估指标。结果与结论:运用上述方法,可构建起药店GSP认证评估指标体系,即目标层、准则层和指标层,并在此基础上确立初步评估指标。     

生存质量量表制定中的指标筛选方法

本文对可用于生存质量测定量表制定中的一些指标筛选方法进行了概括、分析与讨论,并结合生存质量测评的特点提出了另外一些筛选方法。