论著

综合性医院门诊幽门螺杆菌感染及耐药情况研究

Investigation of Helicobacter pylori infection and antibiotic resistance in outpatients at a general hospital

:1669-1676
 
       目的  调查深圳地区综合性医院门诊幽门螺杆菌(Hp)对8种常见抗菌药物的耐药情况。方法  采集13C呼气试验阳性的患者胃黏膜标本313例,进行Hp分离培养及抗菌药物敏感性试验。结果  313例患者分离培养得到247例Hp菌株,培养阳性率78.91%,不同性别、不同年龄患者Hp分离培养阳性率比较差异无统计学意义(P>0.05)。Hp对甲硝唑、克拉霉素、左氧氟沙星、利福平、阿莫西林、四环素、呋喃唑酮、庆大霉素耐药率依次为88.66%(219/247)、38.46%(95/247)、38.06%(94/247)、4.05%(10/247)、1.21%(3/247)、0.40%(1/247)、0.40%(1/247)、0(0/247)。双重耐药率为38.46%(95/247),其中Hp对克拉霉素+甲硝唑组合耐药率最高(18.62%,46/247),对甲硝唑+左氧氟沙星耐药率居其次(17.00%,42/247)。多重耐药率为19.84%(49/247)。不同年龄、性别患者双重耐药率、多重耐药率比较差异均无统计学意义(P>0.05)。结论  深圳地区分离的Hp菌株对甲硝唑、克拉霉素、左氧氟沙星耐药率相对更高,且双重耐药、多重耐药情况严重。
        Objective  To investigate the antibiotic resistance of Helicobacter pylori(Hp)to eight commonly  used antibiotics in outpatients of general hospitals in Shenzhen.Methods  Gastric mucosal samples were collected from 313 patients who tested positive for the  13C breath test,and Hp strains were isolated and cultured.Antibiotic susceptibility testing was performed on the isolated Hp strains.Results  Of the 313 patients,247 Hp strains were isolated,with a culture-positive rate of 78.91%.There was no significant difference in culture-positive rates between different genders and age groups(P>0.05).The resistance rates to metronidazole,clarithromycin,levofloxacin,rifampicin,amoxicillin,tetracycline,furazolidone,and gentamicin were 88.66%(219/247),38.46%(95/247),38.06%(94/247),4.05%(10/247),1.21%(3/247),0.40%(1/247),0.40%(1/247),0(0/247),respectively.The dual resistance rate was 38.46%(95/247),with the highest combination  resistance observed in clarithromycin + metronidazole(18.62%,46/247),followed by metronidazole + levofloxacin(17.00%,42/247).The multi-drug resistance rate was 19.84%(49/247).There were no significant differences in dual resistance rates(P>0.05)or multiple resistance rates(P>0.05)between different age groups and genders.Conclusions  The Hp strains isolated in Shenzhen exhibited relatively higher resistance rates to metronidazole,clarithromycin,and levofloxacin,with substantial dual and multi-drug resistance.
医学教育

医院门诊西药房“分-全带教”模式的探索与实践

Exploration and practice of the “divided-comprehensive precepting” model in hospital outpatient pharmacy

:203-207
 
目的 分析医院门诊西药房“分-全带教”模式的应用效果,为提高药房实习生的教学质量提供参考价值。方法 选取广州市番禺区中心医院药学部门诊西药房2020年9月—2022年7月的48例实习生(包含进修生、研究生)作为研究对象,对所有实习生实施“分阶段、分层级、分诊断单元窗口学习、全面能力培养”的“分-全带教”模式。观察所有实习生入科实习前后的考核成绩。结果 通过“分-全带教”实施后,实习生的理论知识(94.15±3.38)分、药学服务技能评分(90.56±3.99)分均比实习前有所提升,且实习生的学习兴趣(94.21±3.70)分、巩固知识点(91.98±3.56)分、提高医患沟通(92.73±3.81)分、认识自身技能不足(92.06±3.50)分同时提升(P<0.05)。结论 采用“分-全带教”模式明显提升对医院门诊西药房的实习生中的教学效果,实习生的理论和实践技能均有所提高,其药学服务能力同时得到提高。
Objective To analyze the application effectiveness of the “divided-comprehensive precepting” model in the hospital outpatient pharmacy and provide reference value for improving the teaching quality of pharmacy interns.Methods Forty-eight interns(including visiting scholars and graduate students)from the Pharmacy Department of Panyu Central Hospital in Guangzhou,China,from September 2020 to July 2022 were selected as the research subjects.The “divided-comprehensive precepting” model,characterized by “staged,tiered,diagnosis unit-specific window learning,and comprehensive competency development” was implemented for all interns.The scores of all interns before and after entering the internship were observed.Results After the implementation of the“divided-comprehensive precepting”model,the scores of interns in theoretical knowledge(94.15±3.38)and pharmaceutical service skills(90.56±3.99)were improved compared to those before the internship.Moreover,interns’scores in learning interest(94.21±3.70),consolidating knowledge(91.98±3.56),enhancing doctor-patient communication(92.73±3.81)and recognizing their own skill deficiencies(92.06±3.50)were also improved.Conclusions The “divided-comprehensive precepting” precepting model significantly enhances the teaching effectiveness in the internship of hospital outpatient pharmacy.Interns’ theoretical and practical skills are improved,enhancing their pharmaceutical service capabilities.
论著

广东省某三甲医院门诊老年患者补充与替代医学使用现状及影响因素分析

Analysis of the current status and influencing factors of complementary and alternative medicine in a tertiary hospital

:84-89
 
目的 了解门诊老年患者补充与替代医学(CAM)使用现状及影响因素。方法 采用便利抽样法,选取2020年11月—2021年2月广东省某三甲医院老年科门诊就诊的老年患者作为研究对象,调查方法采用一般资料调查表和CAM使用情况调查表进行横断面调查。应用二元Logistics回归分析探讨门诊老年患者使用CAM的影响因素。结果 参与调查的123例老年患者中,有75例(61.0%)老年患者使用CAM,使用CAM的项目主要为中草药、药膳等中国传统医学项目。支付方式是门诊老年患者是否使用CAM的影响因素,使用医保支付的患者较公费、自费患者更愿意使用CAM(OR=5.054,95%CI:1.452~17.590,P<0.05)。结论 CAM在门诊应用广泛,我们应充分发挥我国传统医学优势,为老年人疾病防治提供更多的思路。政府层面也可进一步提高医保覆盖范围,让更多的患者有经济能力可以接受安全、有效的治疗。
Objective To investigate the current status of complementary and alternative medicine(CAM)use and the influencing factors of elderly patients in outpatient clinic.Methods Using the convenience sampling method,the elderly patients treated in the geriatric outpatient department of a Class A tertiary Hospital in Guangdong from November 2020 to February 2021 were selected.General data and the CAM usage questionnaire were collected.Binary logistics regression analysis was used to explore the factors influencing CAM use in elderly patients.Results Seventy-five(61.0%)of 123 elderly patients used CAM.Chinese herbal medicine and medicinal diet were the most common CAM.Payment method was a factor affecting whether elderly outpatient patients use CAM.Insured patients were more willing to use CAM than self-funded patients(OR=5.054,95%CI:1.452-17.590,P<0.05).Conclusions CAM is widely used in outpatient clinics.We should make full use of our country’s traditional medicine,to provide different thoughts of diseases prevention and treatment in elderly patients.The government can also further enlarge the coverage of health insurance,so that more patients can afford safe and effective treatment.
临床诊疗

南沙新区三级医院门诊患者健康教育需求调查

Demand investigation of health education outpatients of a grade hospital in Nasha District

:110-112
 
目的 了解南沙新区三级医院门诊患者健康教育需求情况,为制定医院健康教育策略提供科学依据。方法 采用随机抽样的方法,利用自制调查问卷对287名门诊患者进行健康教育需求调查。结果 青年期患者、大专以上文化程度患者健康教育需求率高,需求的健康教育内容最高的为传染病防治健康教育,需求的健康教育方式依次为医患交流、护患交流、微信公众号或网站宣传。结论 南沙新区三级医院门诊患者健康教育需求较高,应根据门诊患者的不同特点,制定有针对性措施进行健康教育,以提高其健康素养水平。
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