方庄社区卫生服务中心的社区中医康复服务工作形成了以社区为依托,中医康复科的中医师及专业康复师团队为核心骨干力量,家庭医生签约服务团队成员之间相互协作,社会工作者为辅助力量,由社区康复服务对象及残联等有关部门参与的全方位、社会化的中医康复服务网络.社区中医康复服务是家庭医生签约服务工作中重要的组成部分.在社区慢性病干预管理、残疾人管理、健康宣教、改善患者心理状态及生存质量等方面均体现出其重要作用.

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.

目的 探讨健身气功八段锦降低社区老年人跌倒风险的疗效.方法 将符合纳入标准的120例老年人随机分为2组,对照组60例依原常规生活,不安排进行特殊的运动训练;治疗组60例采用健身气功八段锦功法进行锻炼,2组疗程均为30d,比较2组治疗前后以及组间的Morse跌倒危险因素评估、Berg平衡量表评分、“起立-行走”计时测试时间、焦虑自评量表SAS评分以及SF-36健康调查量表等指标的改善情况.结果 治疗组治疗前后各项评估指标相比较,均有显著性差异(P＜0.05);经过治疗后,治疗组与对照组相比较,治疗组各项评估指标均明显优于对照组(P＜0.05).结论 健身气功八段锦锻炼在一定程度上能够有效降低社区老年人的跌倒风险.

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.

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 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:To explore the clinical effects and nursing intervention of lavage in treatment of patients with vaginitis.Method:One hundred and twenty patients of vaginitis were randomly divided into the control group and the observation group,each group of 60 cases. Two groups of patients were treated by ozone multi-function irrigation. The control group was only given conventional nursing. The observation group was not only given conventional nursing but also given special nursing. The therapeutic effect and nursing satisfaction between the two groups were compared after treatment. Result:The total effective rate of the control group was 70.00%while the observation group was 96.67%after treatment,and the difference between the two groups were statistically significant(P<0.05).The nursing satisfaction rate of the control group was 73.33%while the observation group was 95.00%after treatment,and the difference between the two groups were statistically significant(P<0.05). Conclusion:The clinical effect of special nursing combined with ozone multi-function irrigation in treatment of vaginitis disease is excellent and the satisfaction rate is high. It is worth popularization and application.

目的：探讨健康教育干预在阴道炎护理中的应用。方法：通过设置调查问卷收集阴道炎患者的基本资料，根据患者的文化程度，对阴道炎的了解程度，患者自己的心理状态，给予患者不同的健康教育干预护理。结果：健康教育完成后，共发放问卷956份，收回有效调查问卷932份，有效率为97.5%。健康教育前，患者对阴道炎了解率为12.9%(123/956)，健康教育完成后，患者对阴道炎了解率为96.1%(896/932)，比较差异有统计学意义(P<0.05)。健康教育完成后，患者满意924例，满意率为99.1%。结论：健康教育是医患关系的重要纽带，对加强医患之间的沟通很有帮助，因此做好健康教育是做好医患关系有效途径之一。

Objective To establish a multiple regression equation of long delayed recall of the amnestic mild cognitive impairment,in order to predict the scores.Methods 248 old people were investigated by convenience sampling.Auditory verbal learning test (AVLT) was used to evaluate the ability of memory of the old people,and their general demographic data were collected.Multivariate linear regression analysis was conducted,the regression model was established and AVLT-long delayed recall scores (N5) to the predicted value got from the 3 times scores of study stage scores (N1,N2,N3) and short delayed recall (N4) of Auditory Verbal Learning Test were compared.Results The multiple linear regression equation between the variables was established.There was no significant difference between N5 and the predicted value.Conclusions N2,N3,N4 could be used to predict N5 during screening of amnestic mild cognitive impairment to make the screening process faster and briefer.When the score ≤4 points,the screening continues,if the score ＞5 points,the screening ceases in order to improve the efficiency of screening.

Objective To explore the effect of Australia′s motivation conversation technology in prevention and management of diabetes commitunity.Methods Introducing Australia′s motivation conversation technology and establishment of a happy life with diabetes club.From fangzhuang five community health station,100 diabetic patients aged over 50 were selected as the members of a happy life with diabetes club,who were randomly divided into intervention group and control group,each 50 patients.Two groups of patients with diabetes prevention interventions,community intervention group in patients with diabetes community control adopted when motives talk technology,compared with two groups of patients interentions effect.Results Two groups of patients after intervention in the past six months in the community clinic of times comparison.Difference has statistically significant(P0.01);At the side of psychological changes of two groups patients in recent one month(feel nervous,helpless,oppression and depression,oneself useless) has statistically significant(P0.05);The behavior differences between two group patients that directed by a physician has statistically significant(P0.05).After intervention,the triacylglycerol level of Intervention group patients is obviously lower than control group,difference has statistically significant(P0.01).But the difference of the mass,systolic pressure,fasting glucose,glycated hemoglobin level did not have statistically significant(P0.05).Conclusion Prevention and management of diabetes community,application of motivation conversation technology that can comprehensive improve the level of prevention diabetes community,is feasible and effective.