社区糖尿病患者医疗保健质量现状调查

目的评价我国社区糖尿病（DM）患者医疗保健质量现状。方法对上海、成都、长沙、厦门市4个社区的1047例DM患者进行问卷调查,了解在过去一年中接受各种预防性保健服务的情况。结果被调查者中HbA1c、足部、眼底和尿白蛋白检查的比例较低,分别是11．8％、13．1％、25．9％和20．1％;HbA1c、血脂、眼底、足部、尿白蛋白检查等5项均接受的患者占调查对象的2．96％。结论我国社区DM患者预防性保健服务利用不足,医疗保健质量差,与我国DM防治指南的要求相距甚远。     

城市中老年回族居民常见慢性疾病调查与社区医疗保健

城市社区医疗预防保健服务是完善社区服务功能的一项重要工作,我市已基本建成社区卫生服务体系的框架.为了更好地探讨社区医疗保健运作的方法和服务内容,我院社区卫生服务中心于2000年7月至9月对辖区内2490名30岁以上的回族居民进行了高血压、冠心病、脑血管疾病、慢性支气管炎、糖尿病等常见慢性疾病的调查.     

社区高血压患者健康教育需求调查分析

目的 了解社区高血压患者对健康教育的需求情况,以便采取更合理的教育方式满足患者需求.方法 采用问卷调查法,对高血压患者的一般资料、患者对健康教育内容需求情况以及患者对健康教育方式需求情况进行调查.结果 高血压患者的健康教育需求程度普遍较高;在健康教育内容方面,最关心血压的监测,其次是合理用药指导、病因与危险因素;在健康教育形式方面,患者最希望与医护人员面对面交谈.结论 在开展健康教育时,要针对患者对健康教育知识需求的特点,有针对性地进行宣教.     

社区老年人不良生活方式现状调查研究

目的 了解目前社区老年人存在的不良生活方式,探索能为老年人提供更有针对性的、便利、有效的健康指导的途径,促其转变不良生活方式,减少疾病的发生.方法 在龙华街道随机抽取两个社区共180例老年人,采用自行设计的调查问卷进行调查.结果 180例被调查者中吸烟者占43.89%,饮酒者占52.22%,嗜盐（咸）者占57.22%,嗜甜食者占35.56%,喜油炸食品者占18.89%,高脂高胆固醇者占47.78%,超重者占42.22%,肥胖者占15.56%,缺乏运动者占73.89%,自己监测血压者占6.67%,自己监测血糖者占1.67%.结论 社区老年人普遍存在不良的生活方式,全科医师团队对社区老年人健康指导及促其转变不良生活方式方面有明显优势.     

长春市社区居民对社区护理服务认知和需求的调查

目的 了解长春市社区居民对社区护理服务认知和需求情况.方法 选取长春市某社区225户居民进行面对面的问卷调查,实际调查了208户家庭的户主.结果 208户居民中57.3%及以上的居民希望社区护士在疾病护理、疾病预防和健康促进三方面开展各项服务,前5位项目为:疾病护理方面的社区紧急救护、老年慢性病护理、上门基础护理,疾病预防方面的老年慢性病预防宣教和健康促进方面的口腔卫生宣教.住处与最近的医院或卫生站的距离(X_10)是各项社区护理需求的影响因素.结论 居民在疾病护理、疾病预防和健康促进三方面对社区护理提出了较高的需求,提高社区护理服务质量迫在眉睫.     

上海市社区老年人服务利用与需求现况调查

目的　全面了解老年人各种服务利用的现状。方法　对 １ ２０３ 名社区老年人 １３ 项一般性服务项目的利用、自觉需求、服务提供者情况分析。结果　社区老年保健服务的主要内容是交通工具、家访服务、家事服务、社会／娱乐活动、餐饮准备、护理性照护几项。老年人的服务提供者以家人为主。结论　今后社区应适当增加社会／娱乐活动设施和生活照顾、医疗保健服务机构,减轻家庭照顾的负担。此外,社区有必要增加综合评估服务、老年医疗服务及心理健康服务等新的服务内容。     

社区中老年人血脂异常情况调查分析

对本社区中老年人血清总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）进行筛查,统计不同性别血脂异常发生率。结果：血脂异常检出率为35.13%,男性TG异常、LDL-C异常、HDL-C异常发生率明显高于女性,两者比较差异有统计学意义（P〈0.05）;男性的TC、TG、LDL-C水平明显高于女性,而男性HDLC水平明显低于女性,两组血脂水平比较差异有统计学意义（P〈0.05）。结论：本社区中老年人血脂异常检出率高,尤其男性,需加强防治工作。     

银川市西夏区老年人社区护理需求调查分析

为了解银川市西夏区社区老年人的健康状况和护理需求，以期为老年人社区护理服务提供依据，2005年6—8月就该社区老年人的健康状况和护理需求开展了抽样调查。     

上海市社区脑卒中患者康复需求调查分析

目的 了解上海市脑卒中患者社区康复现状及需求,为今后施行有效社区康复干预提供客观依据。方法 在上海市黄浦区半淞园街道社区采用随机抽样方法调查32例脑卒中患者,20例脑卒中患者看护人,填写本研究组自行设计的调查问卷和欧洲五维健康指数量表(EQ-5D)。结果 走路有些问题较走路没有问题的、卒中后出现抑郁焦虑并发症较没有出现发症的脑卒中患者选择康复需求的可能性增加;存在行走困难和吞咽困难的脑卒中患者更需要家庭康复技巧及辅助器具的指导;存在吞咽困难和抑郁焦虑状态的脑卒中患者需要心理干预;病程长及存在语言、吞咽障碍的脑卒中患者更需要康复知识指导;有尿路感染并发症的脑卒中患者需要居家环境改造的指导。结论 存在不同功能障碍的脑卒中患者对社区康复需求不同,社区康复工作应重点加强对脑卒中患者的心理干预及康复训练指导。     

医学寄生虫学教育实施质量工程的构想和探索

突破"特殊认识活动论"的传统教学框架,将理性的"医学专业知识"回归富含人文精神的"医学科学文化",以构筑纵横交错的生命探索情境,"以人为本","立德树人",彰显医学"拯救生灵"的神圣,在"生命"与"实践"中发展"倚重生命"的医学专业课程素质教育新体系.该文以<医学寄生虫学>作为模式课程提出实施质量工程的构想并付诸实施.     

社区卫生双诊制现状分析

目的通过对天津市红桥区社区卫生服务机构转诊数据的观察和测量,了解该地区转诊行为的变化,分析社区双诊制的形成情况,探讨其调节关键点及存在的问题。方法查阅转诊记录及采用问卷调查的形式,收集相关数据进行回顾性研究。结果 2011年上转患者855例次,下转患者205例次,以需要进行产后访视和慢性病的患者为主;综合性医院和专科医院中70.23%的医生口头建议转诊,52.11%的医生告知患者转诊医院程序;下转患者对社区医院后续治疗满意度较高,达86.25%;72.16%的患者对首诊制不认可。结论双诊制的深入健康发展仍需要加强政策支持,强化沟通协调,进一步提高社区卫生服务机构的技术水平。     

Pediatric Asthma Care in the Emergency Department: Measuring the Quality of History-Taking and Discharge Planning

The National Asthma Education and Prevention Program NAEPP Guidelines include recommendations for history-taking and discharge planning during an asthma visit, but there are no tools to measure performance. The objectives of this study were to define and operationalize key elements of history-taking and discharge planning, to develop a tool for measuring these elements, and to evaluate the quality of history-taking and discharge planning in the emergency department (ED) during visits for asthma using the new tool. Expert opinion and extensive literature review were used to develop a 13-item checklist containing items that should be documented during history-taking and provided during discharge planning for an ED visit for an acute asthma exacerbation by children. A convenience sample of 90 pediatric emergency medicine physicians and allergists rated each item in the checklist. The checklist was used to score audiotapes of asthma visits in the ED. Subjects were 154 parents of asthmatic children aged 4-9 years seeking care in nine inner-city EDs affiliated with asthma centers participating in the National Cooperative Inner-City Asthma Study and the physician/providers who delivered care. Seven of the 13 items on the checklist were rated as required to be performed by more than 90% of the allergist/pediatric emergency medicine physicians. Only 10% of the 154 visits included all seven of the highly rated items, whereas 19% of the visits included three or fewer. Only 7 of the 13 items (54%) were performed in more than 50% of the visits, and 4 items were performed in fewer than 25% of visits. Based on expert ratings, the checklist for measuring elements of history-taking and discharge planning during asthma visits appears to have considerable face validity. In the visits studied, the overall performance of these elements was low. Interventions to improve performance on the checklist might lead to improved care for children with asthma who frequent the ED.     

Cost-Effectiveness Analysis in the Treatment of Hypertension: A Medical View

The clinical benefits of anti-hypertensive treatment include reductions in stroke and myocardial infarction, heart failure, renal and ocular damage and possibly cognitive impairment. The cost-effectiveness of treatment generally falls within a range considered acceptable to funders of health care in developed countries, and has been shown to vary with age, gender and pre-treatment blood pressure. In a largely asymptomatic condition, small quality of life impairments resulting from treatment could offset these clinical and economic benefits, but evidence suggests that treatment is associated with slight improvements in quality of life. A limitation of these analyses is that the needs of developing countries are not met. The ccst-effectiveness of anti-hypertensive treatment may be unattractive to developing countries when compared with interventions that achieve greater health gains per dollar spent.     

Pediatric Asthma Care in the Emergency Department: Measuring the Quality of History-Taking and Discharge Planning

The National Asthma Education and Prevention Program NAEPP Guidelines include recommendations for history-taking and discharge planning during an asthma visit, but there are no tools to measure performance. The objectives of this study were to define and operationalize key elements of history-taking and discharge planning, to develop a tool for measuring these elements, and to evaluate the quality of history-taking and discharge planning in the emergency department (ED) during visits for asthma using the new tool. Expert opinion and extensive literature review were used to develop a 13-item checklist containing items that should be documented during history-taking and provided during discharge planning for an ED visit for an acute asthma exacerbation by children. A convenience sample of 90 pediatric emergency medicine physicians and allergists rated each item in the checklist. The checklist was used to score audiotapes of asthma visits in the ED. Subjects were 154 parents of asthmatic children aged 4-9 years seeking care in nine inner-city EDs affiliated with asthma centers participating in the National Cooperative Inner-City Asthma Study and the physician/providers who delivered care. Seven of the 13 items on the checklist were rated as required to be performed by more than 90% of the allergist/pediatric emergency medicine physicians. Only 10% of the 154 visits included all seven of the highly rated items, whereas 19% of the visits included three or fewer. Only 7 of the 13 items (54%) were performed in more than 50% of the visits, and 4 items were performed in fewer than 25% of visits. Based on expert ratings, the checklist for measuring elements of history-taking and discharge planning during asthma visits appears to have considerable face validity. In the visits studied, the overall performance of these elements was low. Interventions to improve performance on the checklist might lead to improved care for children with asthma who frequent the ED.     

射频消融手术对阵发性室上性心动过速患者的生活质量影响分析

【摘要】目的 观察射频消融手术（RFCA）对阵发性室上性心动过速（paroxysmal superventricular tachycardia,PSVT）患者生活质量的影响。方法 临床纳入2008年1月~2014年1月因PSVT入住我院心内科并行RFCA的患者55例。其中,男性31例,女性24例,平均年龄（54.1±9.3）岁,入院时PSVT平均病程（20.1±15.9）个月。采用SF-36生活质量量表对患者手术前后生活质量进行评分比较,并按年龄和性别进行亚组分析。结果 术后,患者一般健康状况（GH）、生理机能（PF）、生理职能（RP）、情感职能（RE）、社会功能（SF）、躯体疼痛（BP）、精力（VT）以及精神健康（MH）等评分均明显高于术前[GH,57.9±14.3比35.8±15.7; PF,92.0±22.6比71.5±17.6; RP, 55.7±34.6比29.4±20.3;RE,75.5±37.3比27.7±25.4;SF,79.6±15.4比61.9±20.7;BP,74.9±10.6比62.7±6.5;VT,75.6±17.5比52.2±24.4;MH,89.6±21.4比71.2±30.9;差异均具有显著性（P＜0.05）];根据年龄进行对比,青年组（＜45岁）GH、RP、VT评分明显高于中老年组（≥45岁）,差异有显著性（P＜0.05）;根据性别进行对比,女性组GH、RE评分明显高于男性组,差异有显著性（P＜0.05）。结论 通过RFCA,能够显著改善阵发性室上性心动过速患者术后生活质量,且青年及女性改善程度较为显著。