社区肿瘤患者心理支持需求调查

目的了解心理支持对肿瘤患者影响,从而更好地开展社区肿瘤患者随访工作,提高患者生存质量。方法采用随机整群抽样的方法,对上海市黄浦区社区随访管理的肿瘤患者进行需求问卷调查,对其中乳腺癌患者开展了心理状态干预,并对其进行效果评估。结果需求问卷共调查1 174份,需心理支持者高达94.0%;乳腺癌患者经过干预后,干预组与对照组分别在干预前后对比,患者在心理状态方面的差异有统计学意义;干预组干预前后比较心理状态方面的差异也有统计学意义,而对照组前后两次在心理状态方面的差异无统计学意义。结论心理支持对肿瘤患者的身心康复有着积极的促进作用,有益于医患之间的沟通。     

上海市闵行区社区肿瘤患者康复随访工作模式探讨

利用肿瘤防制网络对肿瘤现患病人进行分级随访管理是上海市肿瘤防治工作内容之一。现有的随访工作模式为一对一式（由乡镇、街道一级医院的社区医生利用上门、电话等方式开展一对一终生康复随访工作）,由于受随访医生的专业性、连续性及随访时间的限制,不能充分达到预定的随访目的。2003～2004年,我们在闵行区某街道对90名社区肿瘤病人改变随访方式,并通过与对照组的对比,了解以社区为单位,群体互助康复为方法,专家指导为保证,社区医生为后盾的新随访模式的可行性。     

上海市社区高血压患者对社区高血压随访管理工作的评价及需求

目的了解上海市高血压患者对社区高血压随访管理工作的评价和需求,为进一步整改和提高社区高血压随访管理水平提供依据。方法对上海市长宁区现有的高血压患者随访管理系统中登记在册的高血压重点管理对象中随机抽取1018名高血压患者。采用自行设计调查问卷,由经过培训的调查员对高血压患者进行面对面调查。结果 97.3%的高血压患者认为高血压随访管理工作有必要,99.1%的高血压患者对医生的访视工作满意,50.5%的患者希望临床医生访视,26.0%的患者希望由公共卫生医生,49.9%的患者希望集中到社区卫生服务站点访视,24.2%的患者希望上门访视,8.8%的患者希望电话访视。被管理的高血压患者的总体知识知晓率较高,但对长期高血压易导致肾病和高血压患者血压降到正常仍需吃药这两方面知识的知晓率较低,分别为76.7%和77.0%。不同的年龄组、管理组别、文化程度和访视方式的患者高血压知识得分差异有统计学意义(P<0.01或P<0.05)。结论高血压患者对随访管理工作满意度较高,但对随访医生、随访方式和随访内容有进一步的需求。     

肿瘤患者健康教育需求调查

罹患肿瘤不仅给患者造成生理上的巨大伤害，同时在心理上也给患者带来严重创伤，进而产生恐惧、焦虑、悲伤、痛苦等情绪，这些心理反应又通过中枢神经系统、内分泌系统、免疫系统等的作用，加重病情变化，对治疗和康复都有着十分不利的影响。为此，在肿瘤患者的护理过程中开展有效的健康教育就显得尤为重要。为了解肿瘤患者的健康教育需求，有针对性地开展健康教育，我们在我院内科某科室的肿瘤患者中开展了健康教育需求调查，现将报告如下。     

远程会诊后肿瘤疾病随访调查分析

目的基于全面提高随访质量、实现病案信息连续完整性。方法以148名远程会诊肿瘤患者为样本,开展后续随访调查,依据调查实际,对基本情况、远程随访接受度、影响随访因素等进行统计分析,形成数据支撑。结果男性80人,女性68人。年龄31-50岁之间患者46.62%,发病初期患者31.08%,已接受手术治疗患者43.24%,影响远程治疗推广的主要原因是治疗方式和理念宣传广泛度还不够。结论消除患者远程治疗多方顾虑,确保患者病案信息连续完整,建立病种远程随访信息系统。     

肿瘤随访现状与进展

肿瘤患者随访旨在获得肿瘤患者接受治疗后的疗效、康复状况、复发转移情况、生存质量、生存状态等信息,面这些信息已逐渐成为临床科研、医院管理不可或缺的部分.本研究从肿瘤随访的意义、现状、信息来源、随访内容、模式和方法、影响随访的因素等方面的做法和进展进行综述,为构建和完善肿瘤患者随访系统提供理论依据.     

肿瘤随访现状与进展

肿瘤患者随访旨在获得肿瘤患者接受治疗后的疗效、康复状况、复发转移情况、生存质量、生存状态等信息,而这些信息已逐渐成为临床科研、医院管理不可或缺的部分。本研究从肿瘤随访的意义、现状、信息来源、随访内容、模式和方法、影响随访的因素等方面的做法和进展进行综述,为构建和完善肿瘤患者随访系统提供理论依据。     

安徽省肿瘤随访工作思考

<正>恶性肿瘤的发病和死亡一直居于人类疾病谱和死因谱的前列,近些年来更是呈现逐年上升趋势。预计2020年全球恶性肿瘤新发病例将达到1500万,死亡1 000万,现患病例3 000万。在我国肿瘤死亡占全部死因的四分之一~([1])。据估计我国2011年新发恶性肿瘤病例约3 372 175例,发病率为250.28/10万;死亡病例2 113 048例,死亡率为156.83/10万~([2])。有文献~([3])预测我国在未来20年     

社区患者需求调查与分析

目的准确把握社区居民的医疗服务需求,为政府合理设置社区医疗服务项目提供决策依据,并引导社区医疗机构改进服务。方法以北京市朝阳区某小区379名居民为调查对象,设计专用调查表,采用访谈调查方式。结果初步掌握该小区居民9个方面的医疗需求意愿。     

Family physician involvement in cancer care follow-up: the experience of a cohort of patients with lung cancer

PURPOSE There has been little research describing the involvement of family physicians in the follow-up of patients with cancer, especially during the primary treatment phase. We undertook a prospective longitudinal study of patients with lung cancer to assess their family physician’s involvement in their follow-up at the different phases of cancer.METHODS In 5 hospitals in the province of Quebec, Canada, patients with a recent diagnosis of lung cancer were surveyed every 3 to 6 months, whether they had metastasis or not, for a maximum of 18 months, to assess aspects of their family physician’s involvement in cancer care.RESULTS Of the 395 participating patients, 92% had a regular family physician but only 60% had been referred to a specialist by him/her or a colleague for the diagnosis of their lung cancer. A majority of patients identified the oncology team or oncologists as mainly responsible for their cancer care throughout their cancer journey, except at the advanced phase, where a majority attributed this role to their family physician. At baseline, only 16% of patients perceived a shared care pattern between their family physician and oncologists, but this proportion increased with cancer progression. Most patients would have liked their family physician to be more involved in all aspects of cancer care.CONCLUSIONS Although patients perceive that the oncology team is the main party responsible for the follow-up of their lung cancer, they also wish their family physicians to be involved. Better communication and collaboration between family physicians and the oncology team are needed to facilitate shared care in cancer follow-up.     

高血压患者不同社区随访管理模式干预效果评价

目的 了解浙江省杭州市余杭区不同社区随访管理模式对高血压患者管理效果的影响,为探寻新的管理模式提供理论依据。方法 采用分层随机抽样方法在杭州市余杭区抽取的2 187例高血压患者进行问卷调查,应用SPSS 19.0统计软件分析不同社区随访管理模式对高血压患者高血压知识知晓率、服药依从性和行为改变的影响。结果 余杭区高血压患者高血压知识知晓率、总体服药依从率和总体行为改变率分别为73.07%、54.78%和43.80%;单独式随访模式高血压患者高血压知识知晓率为70.00%,低于集体式随访模式的82.93%（χ²=253.621,P<0.001）;单独式随访模式高血压患者总体行为改变率为45.98%,高于集体式随访模式的36.80%（χ²=9.370,P<0.05）;单独式和集体式11种随访模式比较,医生上门+定期集中模式高血压患者高血压知识知晓率最高（99.67%）,医生上门+病人到门诊模式高血压患者服药从率最高（88.24%）,电话随访模式高血压患者行为改变率最高（67.15%）。结论 集体式随访模式有利于高血压患者高血压知识知晓率的提高,而单独式随访模式更有利于患者行为的改变。     

吸毒感染HIV者危险行为及随访情况分析

目的 了解乌鲁木齐市社区吸毒人群艾滋病病毒感染情况及随访情况。方法 对社区吸毒人群中检出的艾滋病病毒感染者建立个人档案,追踪随访,了解其行为方式、健康状况和采取的干预措施。结果 社区吸毒者中人类免疫缺陷病毒(HIV)感染率为19.41%,随访保持率为72.71%,共用针具率为87.04%,而安全套使用率极低,为6.98%。随访方式主要通过多项目的支持,给与这些感染者以关怀、帮助,消除社会歧视。结论 乌鲁木齐市社区吸毒人群HIV感染率高,加强对其追踪随访,引导他们参与到相关的支持、就治项目中,降低危险行为,控制艾滋病的流行传播。     

退休矿工与离尘后定诊矽肺病人肺通气功能的14年动态观察

深入研究退休矿工肺通气功能的损害情况。方法本文对某镍矿４５名退休矿工、３７名离尘后定诊矽肺患者和４０名对照矿工的肺通气功能进行了１４年的追踪与配对追踪观察。结论长期接触高浓度的矽尘,矿工退休离尘后肺通气功能仍在丧失,损害的严重程度可与矽肺患者相比。     

对痛风患者行电话随访式健康教育的效果评价

目的对痛风患者行电话随访式健康教育,并对教育效果进行评价。方法将2011年1月—2012年6月在河北联合大学附属医院出院的血尿酸异常的痛风患者236人随机分为对照组和干预组,对照组给予常规治疗和出院健康教育。干预组在此基础上给予定期电话随访式健康教育。1年后评价两组患者对痛风相关知识的知晓率、血尿酸值正常率、痛风复发率、生活方式改变的情况。结果两组患者对痛风相关知识的知晓率、痛风复发率、血尿酸值正常情况、生活方式改变的差异比较,均有统计学意义（P〈0．05）。结论电话随访式健康教育可有效地提高痛风患者的自我保健知识和保健意识,降低血尿酸水平和痛风发病次数,改变痛风患者的生活方式,提高痛风患者生活质量。     

A sense of security for cancer patients at home: the role of community nurses

The present paper reports on a qualitative research project designed to expose the presently unrecognised minutiae of community nurses' work with cancer patients at home, and to identify the ways in which these, combined to form comprehensive care episodes, contribute to physical and psychosocial well-being. The project was conducted in two locations in New South Wales, Australia, one metropolitan and one rural. The research model focused on particular nurse-patient encounters, and involved pre- and post-encounter interviews with nurses, post-encounter interviews with patients and carers, and observation of the encounters themselves. Participants included generalist community nurses, cancer patients being cared for at home, and their primary carers where appropriate. This research demonstrates that regular contact with generalist community nurses is associated with a strong sense of security about the immediate situation for home-based cancer patients and their primary carers. This sense of security is a significant component of patient and carer physical and psychosocial well-being, and may have implications for health services utilisation. In the present paper, the authors outline the factors underpinning this sense of security, and argue that these findings contribute important new knowledge that is vital for contemporary debates about role responsibilities and continuity of care for cancer patients.     

出院患者对随访干预形式满意度调查分析

目的:加强对出院患者规范化管理。方法:问卷抽样调查2009年5月唐山市协和医院出院后接受随访的患者200人,内容主要为出院患者对随访这种干预形式的满意度情况。结果:经过六个月的随访后患者的满意度明显高于随访过一个月的患者,包括用药指导、复诊指导、心理帮助等。结论:出院后患者对随访这种干预形式有较高的满意度,医院应重视出院后管理,为出院患者提供更全面的健康服务。     

慢性病人社区卫生服务需求影响因素分析

目的探讨深圳市慢性病病人社区卫生服务需求、利用及其影响因素,为慢性病社区综合防治的实施提供科学依据。方法采取分层随机抽样方法,抽取深圳市26个社区1841名15岁以上常住居民,对其进行问卷调查。调查内容包括:人口社会学特征、慢病患病情况、两周患病情况、社区卫生服务实际利用及意愿等。结果深圳市慢性病患病率为20·86%,前10位慢性病是高血压、类风湿性关节炎、视力问题、慢性胃肠炎和消化性溃疡、睡眠困难、椎间盘疾病、偏头痛、龋齿、冠心病、糖尿病。因素分析表明,社区慢病卫生服务受社区康复服务中心设点布局、就诊手续和环节等因素影响。结论提高社区卫生服务的可及性和方便程度,才能促进慢性病人有效利用社区卫生服务。     

Estimating life expectancy and related probabilities in screen-detected breast cancer patients with restricted follow-up information

Issues such as life expectancy after diagnosis, the number of life years gained by early diagnosis through screening, the probability of dying from breast cancer or of dying from other causes during the lead time period or thereafter can be derived from information on complete survival after diagnosis. A method is presented to estimate complete survival and relevant outcomes after diagnosis of screen-detected cancer when the follow-up period is substantially shorter than the maximum follow-up possible. Survival after diagnosis until death from breast cancer is modelled as the sum of the lead time (LT) and the post-lead time (PLT), where both time periods follow exponential distributions and are assumed to be independent. The survival period after diagnosis until death from causes other than breast cancer (X) is assumed to follow a Gompertz distribution. The survival period after diagnosis until death from any cause (Z) is modelled as the minimum of LT+PLT and X. Maximum likelihood methods were then used to estimate all parameters of Z. This procedure for obtaining maximum likelihood estimates of Z does not need the cause of death (breast cancer or other), which is an advantage over most other methods. Especially in older patients, it may be difficult or even impossible to ascertain the true cause of death. The model was applied to data from the long-term breast cancer screening programme in Nijmegen, the Netherlands. Complete survival was estimated on the basis of survival data on 528 screen-detected breast cancer patients, diagnosed in 1975-1997 and with a mean follow-up of 8.9 years. Estimated life expectancy ranged between 22.3 and 9.0 years for patients diagnosed at the age of 50 and 79 years, respectively, that is, 6.1 and 0.7 life years gained by screening. Through early diagnosis and treatment, screen-detected patients diagnosed at the age of 50 years may have reduced their lifetime risk of dying from breast cancer from 79 per cent to 56 per cent; at the age of 79 the reduction of risk is reduced from 23 per cent to 13 per cent.     

参加医疗保险卵巢癌患者住院费用及影响因素

目的 了解天津市参加城镇职工基本医疗保险的卵巢癌患者住院费用构成及其影响因素,为控制医疗费用的不合理增长提供参考依据。方法 从天津市2003-2007年参保住院患者资料库中抽取卵巢癌患者1 635例,对其住院费用情况进行回顾性分析。结果 天津市2003-2007年参保卵巢癌患者住院总费用为20 035 629.53元,人均住院费用中位数为9 824.59元;卵巢癌患者住院费用中药品费、检查费、治疗费、手术费、床位费、材料费、输血费、成分输血费和其他费用分别占72.35%、13.53%、5.88%、3.37%、3.22%、0.35%、0.39%、0.48%和0.43%。多元线性回归分析结果表明,药品费和检查费比重越大、住院天数越多、医院级别越高,参保卵巢癌患者住院费用越高。结论 住院天数、医院级别、药品费比重和检查费比重是参保卵巢癌患者住院费用的主要影响因素。