北京市西城区在职人群健康相关行为危险因素调查分析

目的 探讨北京市西城区在职人群健康相关行为及影响因素,为在职人群健康管理提供科学依据.方法 2008年11月至2009年3月,采用多阶段分层整群随机抽样方法,对西城区15岁以上33 936名常住居民进行抽样调查.利用自行设计的调查表收集被调查人群个人基本情况,测量身高、体重、血压.本文对其中12 980名18～60岁在职人员进行分析,采用多元逐步Logistic回归分析方法探讨在职人群健康相关行为危险因素的影响因素.结果 共发放调查问卷36 761份,回收有效问卷33 936份,有效应答率92.3％.在职人群缺乏体育锻炼率、超重率、吸烟率、饮酒率、嗜盐率、肥胖率分别为62.2％（8 074/12 980）、31.6％（4 104/12 980）、25.0％（3 249/12 980）、23.5％（3 047/12 980）、17.9％（2 324/12 980）和8.7％（1125/12980）.多因素Logistic回归分析表明,缺乏体育锻炼的影响因素分别为：吸烟和嗜盐,男性、年龄和高学历是保护因素（P＜0.05）;超重和肥胖的影响因素分别为：男性、年龄、饮酒和嗜盐,高学历是保护因素（P＜0.05）;吸烟的影响因素分别为：男性、年龄、饮酒、缺乏体育锻炼和嗜盐,高学历是保护因素（P＜0.05）;饮酒的影响因素分别为：男性、年龄、超重和肥胖、吸烟和嗜盐（P＜0.05）;嗜盐的影响因素分别为：超重和肥胖、吸烟、饮酒和缺乏体育锻炼,高学历是保护因素（P＜0.05）.结论 应针对不同在职人群特点开展相应的健康教育和行为干预,积极探索在职人群健康管理的模式.     

健康指导在稳定期COPD治疗中的作用观察

目的探究健康指导在稳定期COPD治疗中的作用。方法随机选取2010年10月至2013年10月我科收治的126例COPD患者,所取病例分为对照组(63例)、指导组(63例)。对照组予以常规治疗,指导组予以健康指导加常规治疗,对照分析两组患者的治疗效果。结果对照组急性加重频次和并发症的发生率明显高于指导组。结论在稳定期COPD的治疗中予以积极健康指导,可减轻患者症状,减少患者的住院率及并发症发生,延缓肺功能的下降,提高了生活质量,     

Reducing postoperative pain by changing the process

Untreated postoperative pain is an important ethical and financial issue that can lead to unnecessary suffering and prolonged stays in hospital. Despite the availability of effective analgesics and a growing body of published material that supports their use, postoperative pain remains a problem worldwide. To reduce acute postoperative pain, we introduced an intervention combining evidence-based analgesic protocols with the education of staff and patients on a surgical ward. The experiences of 68 patients before and 80 patients after the intervention were compared (worst pain scores, duration of pain, and satisfaction). Inadequately controlled pain was significantly reduced after the intervention, which suggests that the introduction of analgesic protocols supported by the education of staff and patients can be beneficial. Despite this, severe pain remained relatively common, indicating room for improvement. Duration of pain and patient satisfaction were not affected by the intervention, and patient satisfaction remained high throughout the study.     

Clinical implementation of systematic medication reconciliation and review as part of the Lund Integrated Medicines Management model – impact on all‐cause emergency department revisits

What is known and objective: Interventions involving medication reconciliation and review by clinical pharmacists can reduce drug‐related problems and improve therapeutic outcomes. The objective of this study was to examine the impact of routine admission medication reconciliation and inpatient medication review on emergency department (ED) revisits after discharge. Secondary outcomes included the combined rate of post‐discharge hospital revisits or death. Methods: This prospective, controlled study included all patients hospitalized in three internal medicine wards in a university hospital, between 1 January 2006 and 31 May 2008. Medication reconciliation on admission and inpatient medication review, conducted by clinical pharmacists in a multiprofessional team, were implemented in these wards at different times during 2007 and 2008 (intervention periods). A discharge medication reconciliation was undertaken in all the study wards, during both control and intervention periods. Patients were included in the intervention group (n = 1216) if they attended a ward with medication reconciliation and review, whether they had received the intervention or not. Control patients (n = 2758) attended the wards before implementation of the intervention. Results and Discussion: No impact of medication reconciliation and reviews on ED revisits [hazard ratio (HR), 0·95; 95% confidence interval (CI), 0·86–1·04]or event‐free survival (HR, 0·96; 95% CI, 0·88–1·04) was demonstrated. In the intervention group, 594 patients (48·8%) visited the ED, compared with 1416 (51·3%) control patients. In total, 716 intervention (58·9%) and 1688 (61·2%) control patients experienced any event (ED visit, hospitalization or death). Because the time to a subsequent ED visit was longer for the control as well as the intervention groups in 2007 than in 2006 (P < 0·05), we re‐examined this cohort of patients; the proportion of patients revisiting the ED was similar in both groups in 2007 (P = 0·608). What is new and conclusion: Routine implementation of medication reconciliation and reviews on admission and during the hospital stay did not appear to have any impact on ED revisits, re‐hospitalizations or mortality over 6‐month follow‐up.     

哮喘健康教育的临床效果

目的研究哮喘健康教育各个方面对临床效果的影响，为系统规范的进行哮喘健康教育提供科学参考。方法对我院呼吸科104例哮喘病患者进行健康教育，出院时以问卷调查的方式，对患者掌握健康教育5个方面的效果进行评价。用Logistic回归分析影响复发住院率的因素。结果疾病知识、饮食注意、日常活动、正确用药和心理情绪合格率分别为43．75％，52．86％，76．68％，70．64％，67．46％；复发住院率22．12％；日常活动、疾病知识和正确用药对应的OR值为0．176，0．451，0．791，差异有统计学意义（P〈0．05），表明是复发住院的重要影响因素。饮食注意和心理情绪OR值均小于1，差异无统计学意义（P〉0．05）。结论对于哮喘的健康教育需要更加规范化，专业化，需要着重注意对日常活动、疾病知识和正确用药等方面有针对性地进行健康教育。