目的:通过病例对照研究方法分析不同体质量指数(BMI)的非瓣膜性房颤(NVAF)患者服用利伐沙班的安全性和有效性.方法:纳入 2020 年 1 月至 2022 年 6 月就诊于上海市普陀区长风街道长风社区卫生服务中心、桃浦镇第二社区卫生服务中心门诊,服用固定剂量利伐沙班(15 mg/d)抗凝治疗的NVAF患者 279 例.将患者分为BMI正常组(18.5～23.9 kg/m2)157 例、BMI 24.0～27.9 kg/m2(超重组)72 例和BMI≥28.0 kg/m2(肥胖组)50 例,未观察到BMI＜18.5 kg/m2 的患者.比较三组治疗6 个月后的凝血功能,同时观察三组栓塞事件与出血事件的发生率.结果:服用利伐沙班 6 个月,正常组凝血酶原时间、活化部分凝血活酶时间显著短于其他两组(P＜0.05);三组血红蛋白、血小板计数、其他凝血功能指标差异均无统计学意义(P＞0.05).三组使用利伐沙班的有效性、用药安全性差异无统计学意义(P＞0.05).结论:在不同BMI患者中,使用利伐沙班对NVAF的抗凝治疗具有相近的临床疗效与安全性.

Objective:To develop the modified medication regimen complexity index of Chinese version (mMRCI-C)and test its reliability and validity.Method:The Chinese version of MRCI was developed by modification,translation and back translation. The MRCI was interculturally adapted by 2-rounds of expert consultation and pilot study to ensure the semantics, content and conceptual equivalence. The validation of the mMRCI-C scale was tested among 420 community-dwelling elderly patients with type 2 diabetes mellitus(T2DM) in Shanghai Changfeng Community Health Service Center from October to December 2020. SPSS 23.0 was used to analyze the reliability and validity of the scale.Results:The mMRCI-C scale included 3 dimensions, namely drug dosage form (14 entries), medication frequency (5 entries), and additional instructions (6 entries), with a total of 25 entries. Among 420 valid questionnaires collected,the respondents were 212 males (50.4%) and 208 females (49.6%) with a mean age of (71.4±8.1) years. The test-retest reliability was 0.999 and internal consistency reliability was 0.849. The content validity exceeded 0.80,the convergent validity was 0.932; and discriminant validity P<0.001. Conclusion:The preliminary testing results show that the reliability and validity of the mMRCI-C scale are satisfactory.

目的 评价家庭医生-专家"双签约"模式在社区老年慢病患者管理中的应用.方法 选取2019年5月-2020年3月在长风社区卫生服务中心管理的老年慢病患者120例,采用随机数字表法分为对照组(n=60)、观察组(n=60)2组.对照组患者与家庭医生"1+1+1"签约服务,予以常规慢病管理方式进行干预,观察组患者与家庭医生-专家进行"双签约",予以专家指导下的分层管理.针对2组患者干预后的血糖控制率、血压控制率、患者满意度及干预前后的焦虑抑郁评分进行比较.结果 观察组患者干预后的血糖控制率、血压控制率、满意度均高于对照组,差异有统计学意义(P＜0.05).干预后观察组的焦虑、抑郁评分低于对照组(P＜0.01),且与干预前比较,差异有统计学意义(P＜0.01).结论 家庭医生-专家"双签约"模式在社区慢病患者管理中的实施可以较好地控制患者的血糖、血压,提高患者的满意度,稳定患者的情绪,有较高的应用效果.

Objective:To survey on the job satisfaction and job burnout among family doctors in Putuo District and the related factors.Methods:A questionnaire survey on job satisfaction and job burnout was conducted among 164 family doctors in Putuo District from November to December, 2019. There were 103 participants who had completed standardized residency training (trained group) and 61 participants who did not received training (non-trained group). The general situation, job satisfaction and job burnout were compared between two groups; and the related factors were analyzed.Results:The overall job satisfaction score of family doctors was 116.6±15.2, which was in the "average" level; the job satisfaction rate in the trained group (8.7%) was significantly higher than that in the non-trained group (3.3%) (χ 2=9.759). The age ( r=-0.161, P=0.039), working years ( r=-0.204, P=0.009), professional title ( r=-0.217, P=0.005) were the influencing factors for job satisfaction. Job satisfaction was negatively correlated with three dimensions of job burnout: emotional exhaustion ( r=-0.202, P=0.010), sense of personal achievement ( r=-0.158, P=0.043) and depersonalization ( r=-0.193, P=0.013). Conclusion:The job satisfaction is not high with certain degree of job burnout among family doctors in community health service centers of Shanghai Putuo district. To increase job satisfaction it is necessary to establish a rational work system, optimize the working conditions, enhance incentive measures, and improve psychological status of family doctors.

目的:探讨社区开展絮刺拔罐联合耳体针对肩关节周围炎的疗效.方法:选择2019年1月至2019年12月上海市普陀区长风街道长风社区卫生服务中心收治的肩关节周围炎患者90例,随机分为絮刺拔罐联合耳体针治疗组(综合治疗组)、耳体针罐组和体针罐组各30例.三组均进行每周3次治疗,10次为1个疗程,连续治疗2个疗程.比较治疗前后视觉模拟量表(VAS)评分及生存质量量表(SF-36)评分.结果:三组治疗后VAS评分均较同组治疗前改善(P<0.01),综合治疗组VAS评分明显低于耳体针罐组及体针罐组(P<0.01).三组治疗后生理内容综合测量(PCS)、心理内容综合测量(MCS)及总评分均较同组治疗前提高(P<0.01),综合治疗组PCS评分及总分均显著优于耳体针罐组及体针罐组(P<0.01),耳体针罐组PCS评分则优于体针罐组(P<0.01).结论:絮刺拔罐联合耳体针的镇痛效果显著,能提高肩关节周围炎患者生存质量,值得在社区推广.

安宁疗护指为患有不可治愈疾病的临终患者提供减轻痛苦的医疗护理服务,达到提高患者生命质量、节约医疗成本的目的 .居家安宁疗护服务通过对临终患者及其家属提供基础医疗、镇痛药物指导、医疗咨询、护理指导、心理关怀和支持等服务提升患者的生命质量.通过探讨居家安宁疗护的服务目的 、服务优势、服务模式、存在问题及上海地区居家安宁疗护的发展现状,从而形成居家安宁疗护服务指南,推广居家安宁疗护服务,为改善和提高临终患者的末期生命质量、促进医疗资源的合理利用提供参考.