目的：分析社区护理对居家部分失能老人自我护理能力的影响。方法：选择北京市丰台区和义社区卫生服务中心（以下简称中心）所管理辖区内的64例居家部分失能老年人作为研究对象。依据随机数字的方法分为对照组以及观察组，每组均32例老年人。对照组老年人采用常规的护理干预方式。观察组老年人在常规护理干预方式基础上实施社区护理的措施。对比两组老年人干预前后的生活质量、自我护理能力和抑郁、焦虑情况。对比两组老年人干预过程中的差错发生比例。对比两组老年人家属对于护理干预的满意度。结果：经过干预后，观察组老年人的生活质量评分、自我护理能力评分增高，抑郁和焦虑评分降低。（P<0.05）对照组在干预前后的生活质量评分，抑郁和焦虑评分未发生明显的变化。（P>0.05）在干预过程中，观察组老年人的差错发生比例明显低于对照组（P<0.05）。观察组老年人家属对于护理干预的满意度评分高于对照组（P<0.05）。结论：在居家部分失能老年人群之中，采用社区护理的模式实施管理，可有助于改善老年人的生活质量水平以及自我护理能力，降低老年人的负性情绪，控制老年人护理过程中的差错发生风险，提升护理干预的满意度。

Objective:To understand the status of knowledge, attitude and practice of metabolic syndrome(MS) among the elderly in the community and analyze its influencing factors, so as to provide guidance for the prevention and treatment of MS.Methods:From January 2021 to August 2021, permanent residents(residence duration ≥6 months)aged 65 and above with regular health check examination in Fangzhuang Community Health Service Center of Fengtai District, Beijing were investigated using self-designed MS knowledge, attitude and practice questionnaire.After excluding 34 incomplete questionnaires, the 491 valid questionnaires were recycled with questionnaire valid percentage of 93.5%(491/525). The survey results were analyzed by descriptive analysis, Mann-Whitney U test, Kruskal-Wallis H test and multiple linear regression analysis and multiple linear regression.Results:The scores of MS knowledge, attitude and practice of the elderly in the community were 7(5, 10), 9(8, 10)and 19(18, 21)respectively.The correct answer rate of the diagnostic criteria of MS components was less than 50%.The score of knowledge about MS in the elderly was positively correlated with the scores of attitudes( r=0.263)and practice( r=0.134)(all P<0.01). The results of univariate and multiple linear regression analysis showed that gender, attending educational lectures and the prevalence of MS were the influencing factors of MS knowledge score(all P<0.05). Leisure time, attending educational lectures, pre-retirement occupation and regular health check examination were the influencing factors for MS attitude score(all P<0.05); attending educational lectures, leisure time, regular health check examination and pre-retirement occupation were the influencing factors for MS practice score(all P<0.05). Conclusions:The elderly in the community have a low level of knowledge about the components and diagnostic criteria of MS, but have a positive attitude and practice towards the prevention and treatment of MS.The level of knowledge, attitude and practice of MS is affected by health education lectures, occupation, regular health check examination and other factors.Health education on the diagnostic criteria and the awareness of disease prevention for the elderly in the community should be strengthened to improve the levels of the knowledge, attitude and practice of MS.

Objective:To understand the current situation of scientific research ability and training needs of community nurses in China.Methods:The convenient sampling method was used to select 3 633 community nurses from 16 provinces/autonomous regions/municipalities from June to August 2021 to investigate. The contents of the questionnaire included general information, Self-Assessment Scale of Scientific Research Ability for Nursing Staff, scientific research attitude and training needs. A total of 3 633 questionnaires were recovered, of which 3 561 were valid, with an effective recovery rate of 98.0%. Univariate analysis and multiple linear regression analysis were used to analyze the influencing factors of the total score of self-assessment of scientific research ability of community nurses.Results:The total score of scientific research ability of 3 561 community nurses was 39.00 (28.00, 60.00) . The results of multiple linear regression analysis showed that nursing working years, highest education, received research courses/training, working experience in academic organizations/academic journals, participating in academic conferences or above the municipal level in the past 5 years and having plans to improve academic qualifications in the next 5 years were the influencing factors of scientific research ability of community nurses ( P<0.05) , jointly explained 15.4% of the total variance (adjusted R2=0.154, P<0.001) . Community nurses had training needs in data collection and organization, scientific research design, literature retrieval, scientific research topic selection, data statistical analysis and statistical software operation and submission skills. Conclusions:Subjective self-assessment scientific research ability and objective scientific research output of community nurses need to be improved and key scientific research talents need to be cultivated.

目的:评价社区老年健康服务模式在脑卒中患者居家健康管理中的应用效果.方法:采用便利抽样方法,选取60例在北京市丰台区方庄社区卫生服务中心建立个人健康档案且签订家庭医生服务协议的脑卒中居家患者作为研究对象,随机分为观察组和对照组各30例.对照组采用常规居家照护服务模式,实验组采用基于老年综合评估及多学科健康管理的社区老年健康服务模式,比较4个月后两组患者日常生活活动能力及生活质量评分的差异.结果:干预4个月后实验组患者的日常生活活动能力、生活质量评分均高于对照组,差异有统计学意义(P<0.05).结论:基于老年综合评估及多学科健康管理的社区老年健康服务模式有效提升了脑卒中患者日常生活活动能力及生活质量,对脑卒中患者康复护理、长期照护等居家健康管理有积极作用,值得在社区推广.

总结社区卫生服务机构在社区新型冠状病毒肺炎疫情联防联控中应急管理的经验,为国内社区卫生服务机构的基层社区疫情防控提供参考.通过构建包片健康网格化管理体系,完善防控规范措施,加强人员培训与督导,优化重点人群排查与健康管理工作流程,利用信息化技术实现社区防控宣传关口前移及社区包片健康管理等措施,充分发挥社区卫生服务机构在新型冠状病毒感染的肺炎疫情防控中的“网底”作用,以确保防控工作规范有序,实现守好社区疫情防控的第一道关,有效遏制疫情扩散和蔓延.

目的 为促进北京市社区卫生服务机构为失能老人提供有效的上门医疗服务,构建了北京市失能老人上门医疗服务评估指标体系.方法 基于对前期查阅的政策文件、文献和成熟的评估工具的研究,初步拟定了评估指标条目池,并设计了专家咨询表.在全国范围内选择在上门医疗服务或老年综合评估领域富有经验的综合医院老年科医生、社区全科医生及社区护士共15名专家,在2019年1-5月通过邮件向专家下发专家咨询表,进行两轮德尔菲法专家咨询,并统计专家的个人信息以及专家权威程度相关指标,建立失能老人上门医疗服务评估指标体系.结果 两轮咨询下发的专家咨询表均全部回收且全部有效,专家积极系数均为100.0％,15名咨询专家权威程度在0.700～0.942,平均为0.847,达到了可接受的标准.第一轮专家咨询的指标重要性、可行性专家协调系数分别为0.172和0.207(均P＜0.001),第二轮分别为0.301和0.314(均P＜0.001),专家意见趋于一致,咨询结果可靠.最终构建的失能老人上门医疗服务评估指标体系包括了服务安全、身体一般状况、认知与精神状态、躯体功能、日常生活能力和环境与资源共6项一级指标和28项二级指标.结论 咨询专家具有很高的积极性,且专家的权威程度较高.两轮咨询后专家对各一、二级指标的评价意见趋于一致,有足够的协调性,本研究构建的失能老人上门医疗服务评估指标体系结果可信.

目的 调查北京市老年2型糖尿病患者的社会网络现状并分析其影响因素.方法 采用自行设计的一般情况调查问卷、Lubben社会网络量表简表、糖尿病自我管理活动问卷、社会支持评定量表、老年抑郁量表简表,对北京市300例老年2型糖尿病患者进行横断面调查.结果 老年2型糖尿病患者社会网络得分(16.75±7.02)分,家庭网络得分(8.32±3.63)分,朋友网络得分(8.43±4.74)分,22.67％的患者存在社会网络不足.社会支持、自我管理、是否吸烟、在世子女数是影响老年2型糖尿病患者社会网络水平的重要因素(均P＜0.01).结论 北京市老年2型糖尿病患者的社会网络整体处于中等水平,对老年2型糖尿病患者进行干预时,需充分考虑患者社会网络水平及影响因素,协助患者提高自我管理及社会支持水平,从而促进其社会网络水平的提升.

Objective To analyze the clinical effect of comprehensive community intervention in the adjuvant therapy for women with mild to moderate stress urinary incontinence.Methods From April to December in 2016,a total of 60 women with mild to moderate stress urinary incontinence were recruited by putting up posters in Fangzhuang Community Health Service Center,Fengtai District,Beijing,and they were divided into community group and hospital group according to the recruitment order,each of 30 cases. Women in hospital group received biofeedback combined with electrical stimulation treatment in Gynecology and Obstetrics Clinic,Peking Union Medical College Hospital,while women in community group received comprehensive community intervention(as adjuvant therapy)based on biofeedback combined with electrical stimulation treatment in Fangzhuang Community Health Service Center,Fengtai District,Beijing;both groups continuously intervened and followed up for 12 weeks.Leakage volume of 1-hour urinal pad test and Incontinence Quality of Life Scale(I-QOL) score before intervention,8 and 12 weeks after intervention were compared between the two groups.Results During follow-up,11 cases in hospital group lost,while no one in community group lost;lost rate of follow-up in community group was statistically significantly lower than that in hospital group(P<0.05). There was significant interaction between time and method in leakage volume of 1-hour urinal pad test and I-QOL score(P<0.05);main effects of time and method were significant in leakage volume of 1-hour urinal pad test and I-QOL score(P<0.05). After 8 and 12 weeks of intervention,leakage volume of 1-hour urinal pad test in community group was statistically significantly less than that in hospital group,respectively,while I-QOL score in community group was statistically significantly higher than that in hospital group,respectively(P<0.05).Conclusion &nbsp;Based on biofeedback combined with electrical stimulation treatment,comprehensive community intervention(as adjuvant therapy)can effectively improve the treatment compliance and quality of life,reduce the urinal leakage volume in women with mild to moderate stress urinary incontinence.

目的 探讨北京市某区社区护理骨干培训项目的实施效果.方法 对44名来自北京某区不同社区卫生服务站的护理骨干进行培训,内容包括护理管理、技术操作、疾病管理3个模块,培训结束后对参加培训者进行综合能力考核,同时采用自制的满意度调查表对培训对象进行满意度调查,并设有开放性的问题了解其对培训的意见和建议.结果 培训对象考核成绩为(79.96土10.85)分.参加培训的社区骨干,超过70％的人员对培训的满意程度较高,但仍有20.5％的培训对象认为培训不能增加其自信程度,2.3％的培训对象认为培训不能满足其工作需求.结论 护理骨干培训是在有限时间和条件下进行社区护士全员培训的一种途径.为提高培训效率和效果,培训的内容、方式、时间等都是需要考虑和实践的要素.

目的:探讨基于IFOC模式,从医养结合的角度构建的居家养老服务一体化平台,在目标人群中开展治疗及疾病相关护理、出院后恢复期康复治疗、生活照料和精神慰藉医疗相关服务;分析IFOC模式在社区居家养老服务中运用效果.方法:运用回顾性研究方法,调取北京市丰台区某两家社区卫生服务中心2016年3-11月签订家庭医生式服务协议且有居家医疗护理服务需求的240例患者作为研究对象,翻阅和查看240例患者的一般信息、居住状况、主要疾病和健康状况及所接受的居家康复护理指导等资料进行收集,通过半结构式访谈,了解联合辖区地段居委会、志愿者服务团队工作人员共同进行入户访视后,患者对提供的医疗服务模式、医护人员以往慢病管理经历和对服务满意度的评价.结果:调查显示,240例入组患者均系慢性病患者且签订家庭医生式服务协议,均为慢病管理平台规范管理的患者;全科医生根据服务类型填写居家养老医疗服务入户评估记录表,其中治疗型服务人次数共计727人次,占总服务率的52.04％;康复型服务人次数共计270人次,占总服务率的19.33％;舒缓照顾型服务人次数共计400人次,占总服务率的28.63％;接受访谈的患者对家庭医生服务团队上门提供的医疗护理服务整体过程总体满意.结论:IFOC模式下开展医疗服务巡诊及个案护理计划有利于解决目标人群居家养老时存在的医疗、护理及康复等需求,使患者无论在何处养老均能享受优质便捷的医疗服务,同时提高了居家带病患者的生存质量和对医疗护理服务的满意度,为保障老年人健康奠定了基础;社区卫生服务机构与辖区地段居委会加强合作,明确岗位职责,健全评估和管理机制,提高了医疗养老资源利用效率,加强了机构间的信息交流和资源的有效利用,逐步赢得居家老年人的信任,为居家养老医疗服务发展奠定基础.

社区居家养老是一项治理养老难题的社会福利政策,各地区在实践中均取得了一些积极成果和可供借鉴的经验.方庄社区卫生服务中心围绕贯彻落实北京市、丰台区两级为民办实事项目,全面开展居家养老提升工程,以老年人居家养老的现实需求为导向,围绕居民个人及家庭健康需求组织服务,以人工智能、电子数据、互联网及物联网技术为支撑,整合社区资源为辖区老年人提供精细化、精准化、可及性的医疗服务,探索形成了基于智慧家庭医生优化协同(IFOC)模式的社区居家养老医疗服务模式.本文主要对该模式进行介绍,并分析其优势和尚存问题,从而为社区居家养老服务政策的制定提供参考与建议.

健康教育作为基本公共卫生服务的重要内容之一,其如何有效开展关系到社区卫生服务工作的全局.在人员相对不足的情况下把社区健康教育工作落到实处,是摆在我国社区卫生服务机构面前的重要课题.北京市方庄社区卫生服务中心根据社区实情,深刻分析并充分发挥了社区护士在开展健康教育的优势,取得了较好的效果.本文总结了该中心社区健康教育工作开展的经验,以期对社区同行开展此项工作提供方法选项.

Objective To explore the practical effect of family doctor service on promoting hierarchical diagnosis and treatment in Fangzhuang community.Methods By equidistant random sampling method,587 patients with type 2 diabetes mellitus who signed contract with family doctors in Fangzhuang Community Health Service Center from 2011 to 2015 were selected as the study subjects.Their data taking type 2 diabetes mellitus and its complications as first diagnosis were extracted from the Beijing Management Center of Medical Insurance Affairs.A statistical analysis of these data including times of outpatient visiting and hospitalization,outpatient costs of medical care and medical insurance fund,hospitalization costs of medical care and medical insurance fund in primary health care institutions,secondary hospitals and tertiary hospitals was conducted in this study.Results From 2011 to 2015,there was significant difference in the per capita number of outpatient visit between primary health care institutions and tertiary hospitals among patients who had signed contract (P<0.05);there were no significant differences in the per capita number of outpatient visit and per capita number of hospitalization in secondary hospitals,and the per capita number of hospitalization in tertiary hospitals among the research subjects (P>0.05).From 2011 to 2015,there was significant difference in outpatient costs of medical care per capita between primary health care institutions and tertiary hospitals among the subjects (P<0.05);there were no significant differences in the per capita costs of medical care and hospitalization in secondary hospitals,and the per capita costs of hospitalization in tertiary hospitals among the research subjects (P>0.05).From 2011 to 2015,there was significant difference in the per capita costs of outpatient medical insurance fund between primary health care institutions and tertiary hospitals among the subjects (P<0.05);there were no significant differences in the per capita costs of outpatient and hospitalization medical insurance fund in secondary hospitals,and the per capita costs of hospitalization medical insurance fund in tertiary hospitals among the subjects (P>0.05).Conclusion The family doctor service in Fangzhuang community has effectively reduced the number of outpatient visit and saved medical expenses to a certain extent of patients with type 2 diabetes mellitus,and has a positive significance in achieving initial diagnosis in community and promoting hierarchical diagnosis and treatment system.

The aim is to introduce and offer personalized and one-to-one health management information to signatory stroke patients of Fangzhuang Community Health Service Center by their family doctor service team, based on the Intelligent Family doctors Optimized Coordination model to integrate community resources as well as data from the Community Health Management Platform. The two-way referral channel has been established to build a "hospital-community-home" continuation of care platform, in order to address the present and potential issues for those discharged signatory stroke patients, and provide schemes and ideas to practice of the combination of medical treatment and endowment. After preparation and practice in advance, the two-way referral channel has been applied well, and the "hospital-community"dual referral system has been achieved, so as to verify the path is effective. Meanwhile, the concept of "up and down linked, continual nursing and multiparty cooperation" has been put into practice.

OBJECTIVE:To investigate the differential diagnostic value of DTI parameters in breast mass lesions by comparing apparent diffusion coefficient (ADC), fractional aniotropy (FA) and maximum eigenvalue (λ1)of normal glandular tissue, benign lesions and malignant lesions.METHODS:A total of 71 women patients with 74 mass lesions between December 2013 and October 2015 were enrolled from Beijing Chao-Yang Hospital.MRI protocol included dynamic contrast-enhanced MRI (DCE-MRI)and diffusion tentor imaging(DTI) were executed.The ADC, λ1 and FA of lesions and normal glandular tissue were calculated.The ADC, λ1 and FA of lesions were compared by paired t test between the benign/malignant tumors and the contratlateral healthy breast tissue.ROC curve analysis was performed to compare diagnostic performance based on the area under the curve(AUC). The sensitivity and specificity of the DCE-MRI combined with ADC and DCE-MRI combined with λ1 were calculated.RESULTS:The ADC, FA and λ1 values of malignant lesions were (1.09±0.18)×10(-3) mm(2)/s, 0.22±0.02 and(0.97±0.19)×10(-3) mm(2)/s , these values of benign lesions were (1.52±0.19)×10(-3) mm(2)/s, 0.21±0.02 and(1.79±0.19)×10(-3) mm(2)/s, there were statistically significant differences (all P<0.05). Area under the curve of ADC, FA and λ1 were 0.990, 0.605 and 0.978, respectively. The AUC of FA was lower than that of ADC and λ1(P<0.01, <0.01), but there was no difference between the AUC of ADC and that of λ1(P=0.131 6). The sensitivity DCE-MRI combined with ADC and DCE-MRI combined with λ1 was 88.6% vs 97.1%(P=0.353 3), the specificity was 84.6% vs 97.4%(P=0.113 0).CONCLUSION:ADC and λ1 is helpful to differentiate malignant from benign in mass lesions.

Objective:To explore the method and effect of home nursing care for patients with cerebral apoplexy based on information technology management platform. Methods: A prospective study was used to study the stroke patients in the family physician service agreement with the community health service center in Fangzhuang. Take electronic ifle data as a baseline, the self-designed questionnaire was used to search the object of study basic information, health assessment, sick of home care needs investigation. 12 months after the intervention, the disease control, life and quality of life of the patients were evaluated by 6 months after the intervention. At the same time, the patient's family visit to the assessment of the situation into a chronic disease management information platform, to give a continuous chronic disease management. Results:In 6 months and 12 months after treatment, the patients' self-care ability index (Barthel) and quality of life (SIS) score were higher than those in control group, the difference was statistically signiifcant. Conclusions: In the information chronic disease management service model of community stroke patients with home care service work, timely and accurate access to patient health status, the implementation of continuous: related care, standardized stroke patients with community management, improve the patient's self-care ability and quality of life.

Objective To evaluate disinfectant efficacy of air disinfector and ultraviolet lamp.Methods Domestic literatures were searched by computer,RevMan 5 .3 software provided by the Cochrane collaboration was used for quantitative analysis,efficacy of two kinds of air disinfection methods was compared. Results A total of 1 1 articles met the inclusion criteria. Because the heterogeneity of literatures,random effects model analysis was adopted, colony forming unit (CFU)before disinfection(WMD= -26.28,95% CI:[-60.31,7.75],P>0.05 )and immediately-after disinfection(WMD= 22.45,95% CI:[-34.24,79.13],P>0.05)had no obvious difference between two methods respectively,but CFU of air disinfector 2 hours after disinfection was significantly less than ultraviolet lamp group(WMD= -345.11,95% CI:[-478.28,-211.94],P<0.05).Conclusion Air disinfector has good continuous disinfection efficacy.

Objective:To build the standardized families in the community,so as to provide the real family visit scene for students.Methods:The standardized families in community nursing practice base were built mainly through four steps including community standardized families recruitment,form of communities standardized family assessment questionnaire,assessment of community standardized families data and community standard-ized families training.Results:After 2 times of training,4 standardized families were established,and they can master the stated principle and coordination method in family visit.The community standardized family proces-ses were established,to establish a standardized teaching mode for families visit of community nursing teaching in the practice.Conclusion:Community standardized families can receive family visits at any time according to the needs of community nursing practice teaching.It can provide a stable content statement,in order to improve the communities practice teaching resources.

Objective:To study the methods and effectiveness of health education by Fangzhuang community nurses using the means of information. Methods:By using the intelligent chronic disease management platform, we establish a scientiifc, personality health education and assessment guidance module for signed patients;carry out the hierarchical classiifcation health education. With direct access to the database and the data of questionnaire, this study investigate and evaluate the effects before and after the health education intervention. Result:After using one year of information means to implement the health education for signed patients, the patients' awareness rate with risk factors of chronic disease were higher than before intervention. The awareness rate of the overweight or obesity, smoking, diet were 85.7%, 72.5%, 86.3%before intervention, and were increased to 95.3%, 87.0%, 94.0%after intervention. The difference was statistically signiifcance. Conclusion:By means of information technology, community nurses of Fangzhuang community health service center carry out health education for patients with chronic disease and achieved good results.

Objective:The purpose of this study was to evaluate the impact of computer-aided detection (CAD)on the performance of mammogram reader in interpreting pure calcification lesion.Methods:A retrospective review was performed in 46 patients with pure calcification lesion detected by full-field digital mammography (FFDM),and every lesion was given a BI-RADS score before and after CAD analysis.The BI-RADS scores of lesion before and after CAD analysis were com-pared.The overall diagnostic accuracy and sensitivity for detecting malignant lesion were compared between analysis before and after CAD.Results:There was significant difference in the BI-RADS scores (χ2 =78.04,P <0.001)and in the diagnos-tic accuracy of lesions (P =0.001)between analysis before and after CAD.There was no significant difference in the sensi-tivity of detecting malignant lesion between analysis before and after CAD (P =0.059).Conclusion:Our results indicate that systematic application of CAD with FFDM in a clinical patient population should be effective in assisting radiologist to im-prove the mammogram interpretation accuracy and the sensitivity of detecting breast cancer.