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Objective:To survey the status quo of hospice care service in community health service centers in Shanghai.Methods:A questionnaire survey was conducted to investigate the situation of hospice care services from January 2021 to December 2021 in 16 community health service centers selected by stratified sampling from 16 districts in Shanghai.Results:Among 16 community health service centers, 13 provided inpatient hospice care services, 16 provide home hospice care and 14 provided outpatient hospice care services; and totally 1 935 (77.93%), 158 (6.36%) and 390 (15.71%) patients received palliative care, respectively. In centers providing inpatient hospice care service, the average bed number was 12 (10, 20); the annual number of patients was 58 (29, 137); the average length of hospital stay was (29.55±11.18) days; and the bed occupancy rate was (55.51±30.02)%, which in urban districts was significantly higher than that in rural districts ((74.76±19.33)% vs.(39.00±28.32)%; t=2.61, P=0.024). The number of patients receiving home hospice care in each center was 10 (3, 19) and the average duration of home service was (66.97±29.41) days. The proportion of physician fee of inpatient hospice care and that of home hospice care were (8.61±5.27)% and (6.25±3.11)%, respectively. While the proportion of medication expenses of inpatient hospice care and that of home hospice care were (35.60±16.13)% and(49.58±9.16)%, respectively. The outpatient hospice service were opened 2.0 (1.0, 4.0) days a week in 14 centers and 95 (58, 199) patients received services. Inpatient services were mainly provided for the patients with non-malignant chronic diseases (53.23%, 1 030/1 935), while home hospice care (89.87%, 142/158) and outpatient hospice care (83.85%, 327/390) mainly provided service for malignant patients. Conclusion:There is still room for improvement about the hospice care services delivered by community health service centers in Shanghai:discrepancy of utilization of hospice care services between urban districts and rural districts, low utilization of home and outpatient hospice care services, unreasonable cost composition in inpatient and home hospice care services.
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Pain is one of the most frightening and unbearable symptoms in cancer patients, approximately 80% of patients with advanced cancer have pain, and a systematic review shows that the prevalence of breakthrough cancer pain (BTcP) was 59.2%. Breakthrough pain often has a significant negative effect on quality of life of patients, which is related to a direct effect (suffering) and an indirect effect (interference with activities of daily living). Clinical management of BTcP is still not satisfactory despite the availability of various effective pain relief agents. The purpose of this review is to summarize the current situation of the management of BTcP at home and abroad, and to discuss the factors that hinder the management of BTcP.
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Objective:To investigate the work stress and its influencing factors among hospice care physicians and nurses in medical institutions in Shanghai.Methods:It was a cross-sectional study. The study was carried out between December 2021 and January 2022. By use of multistage random sampling, 256 hospice care physicians and nurses were selected from community healthcare centers, secondary and tertiary hospitals in Shanghai to attend a WeChat-based survey using a self-designed questionnaire. The chi-square test was used to compare the differences in prevalence of work stress and stressors among all subjects with different characteristics. Binary logistic regression analysis was used to explore the major determinants associated with work stress. And the sources of work stress and the expepectd decompression countermeasures were investigated.Results:A total of 256 valid questionnaires were collected with a recovery rate of 100.0%. The median of work stress score was 7.5 (6.0, 9.0). Logistic regression analysis showed that those aged>40 years old and working for ≥5 years in hospice care service had higher level of work stress ( OR=3.78, 2.04; P=0.007, 0.039), and those with monthly income>10 000 RMB Yuan had lower level of work stress ( OR=0.34, P=0.005). The top three stressors were the death of patients (88.3%, 226/256), low income (78.1%, 200/256), difficulty in promotion (67.2%, 172/256). The top three way that doctors and nurses desired to reduce work stress were to increase income (88.3%, 226/256) and optimize performance appraisal target (78.1%, 200/256) and promotion mechanism (66.0%, 169/256). Conclusions:In general, the work stress among hospice care physicians and nurses is at a high level in Shanghai and the stressors are widely distributed. Age, monthly salary and years of working in hospice care unit are independent factors of work stress. Improving salary, optimizing performance appraisal target and promotion mechanism are the most desired strategies to reduce work stress among hospice care physicians and nurses.
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OBJECTIVE：To study the hepatotoxicity of main components of Polygonum multiflorum ，and investigate its toxic mechanism based on metabolic enzymes. METHODS ：ADMETlab 2.0 platform was used to forecast the toxic or carcinogenic effects of emodin ，physcion，rhein，stilbene glycoside and gallic acid on liver ，skin and heart. The effects of those components on cytochrome P 450 enzyme system （CYP1A2，CYP2C9，CYP2C19，CYP2D6，CYP3A4）were evaluated. The effects of different concentrations of emodin ，rhein，stilbene glycoside and gallic acid （10，20，40，80 μmol/L）on the survival rate of normal hepatocyte L 02 were detected. The effects of major components of P. multiflorum on the activity of UGT 1A1 enzyme were studied by in vitro reaction system ，using bilirubin as substrate. RESULTS ：Main components of P. multiflorum ，ie. emodin ，physcion， rhein and gallic acid ，showed strong toxic effects on the liver ，while stilbene glycosides possessed weak toxic effects on the liver. Emodin and physcion had strong inhibitory effects on CYP 1A2 and medium inhibitory effects on CYP 2C9，CYP2D6 and CYP3A4；rhein showed medium inhibitory effects on CYP 1A2 and CYP 2C9，while stilbene glycoside and gallic acid possessed weak inhibitory effects on the above enzymes. Emodin （40，80 μmol/L）and gallic acid （40，80 μmol/L）could significantly reduce the survival rate of L 02 cells（P＜0.01）. The inhibition rate of 5，10，20，40，80 μmol/L emodin and gallic acid（except for 5 μmol/L emodin）on UGT 1A1 enzyme increased significantly （P＜0.01），and the inhibition effect of emodin on UGT 1A1 enzyme was reversible competitive inhibition. CONCLUSIONS ：The main components of P. multiflorum ，ie. emodin ，rhein and physcion ， are hepatotoxic ；the mechanism of it may be associated with inhibiting the activity of CYP 1A2 and CYP 2C9 and competitively blocking rate-limiting enzyme UGT 1A1 in the process of bilirubin metabolism.
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Objective To develop a stroke knowledge instrument for middle-aged and aged people in community general outpatient clinics.Methods A stroke knowledge measurement tool was developed and the reliability and validity of the tool were evaluated.The developed measurement tool was applied for patients aged 45 to 75 years old from 10 community health service centers of three Shanghai districts,and the knowledge scores of the target population were analyzed.Results A total of three dimensions and 14 items were made up of the stroke knowledge instrument.A total of 1 750 subjects,including 709 males and 1 041 females with an average age of (65.93±3.67) years,were included in the survey.The standardized Cronbach's coefficient was 0.742,and split-half correlation coefficient was 0.686 (P＜0.01) for instrument test performance.There was a positive correlation between the sub-instrument and the overall-instrument,and the correlation coefficient was 0.448-0.728 (P＜0.01) for content validity.The full score rate of overall stroke knowledge instrument was 8.46％(148/1 750),the full score rate for disease early symptomswas 46.00％(805/1 750),that for drug-related knowledge was 54.40％(95/1 750) and that for high risk factors was 17.94％(314/1 750).Logistic regression analysis showed that females,subjects with higher education level and married/cohabitation state had higher knowledge scores (P＜0.01).Conclusions The developed stroke knowledge instrument has good reliability and validity for the middle-aged and aged population of community general outpatient clinic.The stroke knowledge levels are less satisfactory for this study population.
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One hundred and fifty diabetic patients,who received management by community family doctors and hospital consortium (1+1+1) team for at least 1 year,were enrolled from January 2017 to May 2017.After that they continued to receive the management for 1 more year by the team which were trained with TeamSTEPPS (team strategies and tools to enhance performance and patient safety).The management effect before and after TeamSTEPPS training was compared.After the TeamSTEPPS training,the team management ability was improved,so that the compliance of diabetic patients with medical advice,regular examination of blood glucose,regular follow-up assessment,health education,regular exercise and diet control were all better than before,and the differences were statistically significant (all P＜0.01).Fasting blood glucose,postprandial 2 h-blood glucose,glycosylated hemoglobin and LDL-C levels were all lower than before,and the achieved rate of the above indicators were also increased (P＜0.05).It is suggested that application of TeamSTEPPS in team training can effectively enhance the management ability for chronic disease of family doctors and improve compliance and clinical indicators of patients with diabetes under management.
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Objective@#To examine the prevalence of depression and anxiety symptoms, and the related factors in family members of schizophrenic patients in a Shanghai community.@*Methods@#From March to May 2017, the family members of 206 schizophrenic patients registered in Xuhui district Kangjian community of Shanghai were enrolled in this cross-sectional survey. The participants were evaluated with Patient Health Questionnaire Self-rating Depression Scale (PHQ-9) and the Anxiety Screening Scale (GAD-7). The factors related to depression and anxiety symptoms were analyzed.@*Results@#The detection rates of depressive symptoms and anxiety symptoms in the family members of schizophrenia patients were 40.3%(83/206) and 37.9%(78/206), respectively.Univariate analysis showed that the relationship with the patient, education levels were the influencing factors of depressive symptoms (χ2=17.045, 9.702; P<0.01); while age, relationship with the patient, education levels were factors related to the occurence of anxiety symptoms (χ2=11.862, 22.042, 15.060; P<0.01). Multivariate regression analysis showed that the parents of patient was more prone to depressive symptoms than spouses (OR=2.861, P<0.01); higher education was more prone to be depressive than primary education (OR=10.071, P<0.01). Age group 18-40 years were more prone to anxiety than the age group ≥66 years (OR=0.060, P<0.05); sibling relationship is more prone to anxiety than spouse relationship (OR=10.018, P<0.01), followed by parental relationship (OR=7.467, P<0.01); higher education was more prone to anxiety than primary education (OR=5.119, P<0.05).@*Conclusions@#There is high prevalence of depression and anxiety symptoms in family members of schizophrenic patients, which is related to the relationship with the patient, the education level of family members and other factors.
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Objective To evaluate the application of TeamSTEPPS in training of community osteoporosis management team .Methods The TeamSTEPPS was applied for training of osteoporosis management team, and 1 513 residents aged ≥45 year were screened for osteoporosis in Kangjian community from January 2014 to March 2017.The identified patients with osteopenia and osteoporosis were intervened for one year.Cognitive level of the risk factors and symptoms associated with osteoporosis were assessed by questionnaires before and after the intervention .The bone density was examined at baseline and 6 months, 12 months after intervention.The effect of intervention was evaluated .Results A total of 467 patients (30.87%) with osteopenia and 476 patients (31.46%) with osteoporosis were detected .The cognitive levels of osteoporosis risk factors , including low calcium, vitamin D deficiency, lack of exercise, low weight, women menopause, matrilineal family history, smoking, excessive alcohol drinking and coffee drinking, were higher than those before intervention ( χ2＝62.909,78.742,59.974,50.478,29.512, 34.699,6.500,15.779,6.089,all P＜0.05).The awareness rates of symptoms , including lower back pain or body bone pain, shorter height and hunchback , low energy or nonviolent fracture , were also increased (χ2＝59.942,76.220,16.856,all P＜0.01).After intervention, the bone mineral density levels were increased compared to those before intervention (F＝530.28, P＜0.01 for osteopenia group; F＝339.51, P＜0.01 for osteoporosis group ); meanwhile, the differences were also significant between 6 months, 12 months after intervention and before intervention , between 12 months and 6 months after intervention (t＝-0.452,-0.968,-0.516,all P＜0.01 for osteopenia group; t＝-0.530,-1.045,-0.518, all P＜0.01 for osteoporosis group ).Conclusion The community osteoporosis management team trained by TeamSTEPPS can effectively improve the management levels of osteoporosis among residents in the community.
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TeamSTEPPS (team strategies and tools to enhance performance and patient safety) defines four core capabilities in teamwork which can be trained: leadership,situation monitoring,mutual support and communication.TeamSTEPPS is a successful medical team training project and its effectiveness has been proved.The application of TeamSTEPPS can provide a new teaching model for general practice training.
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TeamSTEPPS(Team Strategies & Tools to Enhance Performance & Patient Safety)is an evidence-based set of teamwork tools,aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.It integrates teamwork skills with clinical practice to improve team performance in healthcare services and improve the quality of care effectively.The article introduces the TeamSTEPPS course and its clinical application.
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The effect of shark cartilage active extract (SCAE) on the lung metastasis and the immune function were studied in C57 mice with oral administration. The formation of pulmonary metastasis (B16 melanoma)was significantly inhibited, with an inhibitory rate of 33. 1%. The proliferation rate of spleen cells to ConA was obviously increased,the increased rate being as high as that of the normal. The cytotoxicity of LAK cells is also increased,but lower than that of the mormal.
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Cartilage antuumor component (CATC) was isolated from a 1 mol/L guanidine hydrochloride extract of bovine cartilage by acetone fractioned precipitation and superfiltration. Using human skin fibroblasts as a normal control, it was demonstrated that CATC inhibited the DNA synthesis of Hela, QGY7703 tumor cell lines and bovine artery endothelial cells, but accelerated the normal cells, when the concentration was below 1250 ?g/ml. At the concentration of 5 000 ?g/ml, CATC inhibited the two cell lines. With human tumor stem cell assay, CATC inhibited the stem cell growth of Hela and QGY7703 cell lines. These suggest that CATC has the effects of inhibiting angiogenesis and tumor cells.
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Objective: To study the effects of different niacin nutritures on behaviors of stressed rats. Methods: 100 Wistar male rats were assigned into 10 groups:control, pair-fed, nicotinamide (NAM) deficiency (ND), low-dose NAM supplement (LNS 40 mg/kg diet) and high-dose NAM supplement (HNS 500 mg/kg diet), and the corresponding restrained groups. 24 h urinary excretion of N1-methylnicotinamide (NMN), body weight changes, behaviors in the open-field test, plasma cortisol, nitric oxide(NO) and liver nitric oxide synthase(NOS) were determined. Results: Compared with the control group, restrained rats had relatively lower urinary NMN. Both ND and restrainted stress retarded the body weight gains . Rats in the control and LNS groups had relatively shorter latency time in the open-field test. Restrained rats had higher plasma cortisol and NO than those in the corresponding control group. However, rats with HNS had the lowest plasma cortisol concentrations. Dietary supplement of NAM increased liver NOS . Conclusions: Restraint stress may increase niacin depletion and appropriate NAM supplement has positive effects on stress adaptation in rats.