活化α7烟碱型乙酰胆碱受体对呼吸机相关肺损伤模型大鼠的保护机制研究

目的评价激活α7烟碱型乙酰胆碱受体对大鼠呼吸机相关肺损伤的影响。 方法采用随机数字法将32只雄性Sprague Dawley大鼠分为：对照组（C组）、机械通气组（V组）、烟碱预处理+机械通气组（N组）、甲基牛扁碱（MLA）+烟碱+机械通气组（MLA组）,每组8只。C组大鼠气管插管后不进行机械通气,保留自主呼吸,其余各组大鼠机械通气2 h。N组大鼠在机械通气前30 min腹腔注射1 mg/kg的烟碱;MLA组大鼠在腹腔注射烟碱前30 min先腹腔注射1 mg/kg的MLA,其余各组大鼠腹腔注射等量等渗NaCl溶液。机械通气结束后即刻处死大鼠,计算各组大鼠肺组织湿重/干重、苏木素-伊红（HE）染色、肺组织损伤病理学评分,并采用Western-blotting检测白细胞介素1β（IL-1β）、IL-6、肿瘤坏死因子α（TNF-α）蛋白表达水平。 结果C组大鼠肺泡形态结构正常;V组大鼠肺泡形态结构破坏,大量炎症细胞浸润;N组大鼠肺泡形态结构稍破坏,少量炎症细胞浸润;MLA组大鼠肺泡形态结构破坏,肺泡萎陷,较多炎症细胞浸润。4组大鼠肺组织湿重/干重、损伤评分、IL-1β、IL-6及TNF-α蛋白表达水平比较,差异均有统计学意义（F = 168.009、647.579、138.005、192.706、178.094,P均< 0.05）。进一步两两比较发现,V组大鼠肺组织湿重/干重、损伤评分、IL-1β、IL-6、TNF-α蛋白表达水平均较C组更高（P均< 0.05）;N组大鼠湿重/干重、损伤评分、IL-1β、IL-6、TNF-α蛋白表达水平均较V组明显降低（P均< 0.05）;MLA组大鼠肺组织湿重/干重、损伤评分、IL-1β、IL-6、TNF-α蛋白表达水平均较N组明显升高,差异有统计学意义（P均< 0.05）。 结论烟碱对呼吸机相关肺损伤的大鼠模型具有保护作用,其机制与激活α7-nAChR有关。     

细胞外信号调节激酶在油酸型急性肺损伤大鼠肺组织中的表达及意义

目的 观察油酸致伤后大鼠肺组织细胞外信号调节激酶（ERK）和磷酸化ERK（P-ERK）与肿瘤坏死因子（TNF-α）及白介素-6（IL-6）释放的关系。方法 健康雄性SD大鼠60只，随机分为油酸1h组。油酸2h组。油酸4h组，油酸24h组和对照组，观察各组肺组织病理学改变，免疫组化法和蛋白定量法（Western blot）测定肺内ERK。P-ERK表达，放免法检测血清、BALF、肺组织匀浆液中TNF-α及IL-6水平。结果 油酸组大鼠支气管、肺泡上皮细胞、肺血管内皮细胞、肺泡巨噬细胞上表达ERK和P-ERK明显增多，血清、BALF、肺组织匀浆液中TNF-α及IL-6水平明显升高。TNF-α与ERK和P-ERK表达峰值时间均为1h，IL-6表达峰值时间为4h。结论 ERK信号通路参与调节油酸型急性肺损伤大鼠IL-6的释放过程，与TNF-α为互相促进的关系。     

细胞因子和水钠通道蛋白在急性肾损伤致肺损伤中的作用

目的 通过双肾动静脉夹闭建立急性缺血性肾损伤大鼠模型,观察大鼠肺病理生理的变化,观察上皮细胞钠通道蛋白(α-ENaC)和水通道蛋白1(AQP1)在急性肾损伤所致肺损伤中的作用.方法 健康雄性Wistar大鼠60只.体质量300～ 320 g,随机(随机数字法)分成健康对照组(A组),急性肾损伤组(B组),每组30只.造模后,处死大鼠,苏木素伊红(HE)染色检查肺组织病理变化,计算肺W/D比值,支气管肺泡灌洗液(BALF)中蛋白质量浓度.检测肺组织中水通道蛋白1、肺上皮钠通道蛋白的质量浓度.测定血清及BALF中IL-6与TNF-α的质量浓度.结果 B组大鼠在实验后6h动脉血pH值开始下降,酸中毒逐渐加重,与A组比较差异具有统计学意义(P＜0.05).B组与A组的氧分压各时间点之间相比差异无统计学意义(P＞0.05).与A组相比,B组在实验后2h肺泡灌洗液中蛋白水平、肺W/D值开始明显增加,差异具有统计学意义(P＜0.05).B组实验后8h肺泡上皮肿胀,肺泡壁增宽,肺泡间质水肿明显,肺泡内可见炎症细胞、红细胞和蛋白渗出,表现出急性肺损伤的病理改变.B组在实验后2h血清及肺泡灌洗液中TNF-、IL-6的质量浓度开始增加,肺组织中AQP1、α-ENaC表达开始逐渐减少,与A组比较,差异具有统计学意义(P＜0.05).结论 急性肾损伤早期肺泡上皮-内皮屏障功能已经受到了影响,急性肺损伤已经发生.急性肾损伤后早期体内TNF-α、IL-6含量明显增加,肺表达AQP1及α-ENaC的减少,可能是急性肾损伤早期引起肺损伤的原因之一.     

大鼠低温爆震伤对肺组织中IL-1β和TNF-α表达的影响

目的:建立大鼠低温爆震伤致肺损伤模型,研究爆震伤后大鼠血清和肺组织中IL-1β和TNF-α表达的变化。方法:将40只大鼠随机分成空白对照组(10只)、低温对照组(10只)及低温实验组(20只),进行爆震伤造模,实验后对大鼠进行状态观察,行苏木精-伊红染色观察肺脏病理变化,采用ELISA方法检测大鼠血清中IL-1β和TNF-α含量,采用荧光定量PCR和Western blot方法测定IL-1β和TNF-α基因和蛋白相对表达量变化,并对其结果进行分析。结果:苏木精-伊红染色结果显示,低温对照组大鼠肺脏有少量炎性细胞,低温实验组大鼠肺组织肺泡壁增厚,有大量的血细胞及炎性细胞产生。血清ELISA结果显示,低温对照组和低温实验组大鼠血清中IL-1β和TNF-α含量高于空白对照组(P0.05)。荧光定量PCR和Western blot结果显示,低温对照组和低温实验组大鼠肺组织中IL-1β和TNF-α基因相对表达量高于空白对照组,且低温实验组大鼠肺组织中IL-1β和TNF-α基因相对表达量高于低温对照组(P0.05);低温对照组和低温实验组肺组织中IL-1β和TNF-α蛋白相对表达量高于空白对照组,且差异有统计学意义(P0.05);与低温对照组比较,低温实验组肺组织中IL-1β和TNF-α蛋白相对表达量较高,且差异有统计学意义(P0.05)。结论:大鼠低温肺爆震伤导致血清中IL-1β和TNF-α含量升高,肺组织中IL-1β和TNF-α基因和蛋白的相对表达量升高,其损伤机制可能是IL-1β和TNF-α表达量升高导致炎症反应的产生。     

乌司他丁对重度烫伤大鼠全麻中肺组织保护作用的实验研究

目的 探讨重度烫伤后麻醉时乌司他丁预处理对机械通气造成的肺组织损伤是否具有保护作用.方法 90只Wistar大鼠,随机分为3组,对照组30只,全麻组30只,乌司他丁组30只.建立大鼠重度烫伤模型后,对照组不进行机械通气,全麻组和乌司他丁组机械通气1 h（乌司他丁组通气前接受乌司他丁预处理）.通过观察肺组织大体标本,HE染色观察肺部病理学改变,电镜观察组织超微结构改变,评估肺系数,免疫组织化学染色检测肺组织细胞因子TNF-α、IFN-γ IL-2的表达水平来检测重度烫伤后,乌司他丁对机械通气造成的肺损伤是否具有保护作用.结果 对照组和全麻组大鼠两肺明显水肿,可见出血灶,切面疏松、肿胀;乌司他丁组大鼠两肺充血水肿相对温和.HE染色可见乌司他丁组肺组织病变轻于全麻组.电镜下：对照组和全麻组肺组织细胞器破坏严重;乌司他丁组相应改变较轻.对比肺系数发现乌司他丁组肺系数与全麻组相比显著下降.免疫组织化学结果显示乌司他丁预处理后肺组织表达TNF-α、IL-2、IFN-γ的强度较全麻组显著降低.结论 乌司他丁对重度烫伤大鼠全麻时机械通气所导致的肺损伤具有保护作用.这种保护作用可能与乌司他丁降低细胞因子TNF-α、IFN-γ、IL-2的表达水平有关.     

大黄对急性肺损伤大鼠血浆和支气管肺泡灌洗液中炎症细胞因子表达的影响

目的:探讨大黄对实验性急性肺损伤(ALI)大鼠炎症细胞因子在血浆和肺泡灌洗液中表达的影响.方法:用舌下静脉注射内毒素(LPS)的方法复制ALI模型,将145只雄性Wistar大鼠随机分成LPS组、对照组、大黄治疗组和地塞米松治疗组;分别测定大鼠血浆和支气管肺泡灌洗液中肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)和IL-8含量.结果:与对照组相比,LPS组血浆和支气管肺泡灌洗液中TNF-α、IL-1β和IL-8均明显升高(P均<0.05),而地塞米松治疗组和大黄治疗组则均明显下降(P<0.05或P<0.01).结论:LPS诱导的大鼠ALI表现为肺和全身炎症反应;大黄和地塞米松能减轻肺和全身炎症反应,其机制可能是通过抑制TNF-α、IL-1β和IL-8活性来实现的.     

益气活血中药对急性肺损伤大鼠血浆和肺组织中炎症介质的影响

目的 探讨益气活血中药黄芪与丹参对急性肺损伤(ALI)模型大鼠血浆和肺组织匀浆中炎症介质的影响.方法 将30只雄性SD大鼠按随机数字表法分为正常对照组、模型组、中药组,每组10只.采用气管滴入脂多糖(LPS)法复制ALI动物模型.模型组和正常对照组每日灌胃2ml生理盐水,中药组每日灌胃0.25 mg/L的益气活血中药2ml,均连用1周.采用放射免疫法检测各组大鼠血浆及肺组织匀浆中肿瘤坏死因子-α(TNF-α)、白细胞介素(IL-1、6、8)含量.结果 中药组大鼠血浆及肺组织匀浆中TNF-α含量(μg/L)分别为　35.59±7.05、3.01±1.78,均低于模型组(均P＜ 0.05);IL-1含量(μg/L)分别为0.22±0.13、0.35±0.08,IL-6含量(ng/L)分别为32.56±9.72、105.82± 16.13,IL-8(μg/L)分别为0.52±0.22、1.23±0.52,均低于模型组(P＜ 0.05或P＜ 0.01);中药组各项指标与正常对照组比较差异无统计学意义(均P＞0.05).结论益气活血中药黄芪和丹参可能是通过抑制TNF-α、IL-1、6、8生成和释放,从而起到对模型大鼠ALI的防治作用.     

黄芪注射液对急性肺损伤大鼠热休克蛋白70核转录因子-κB表达的影响

目的 探讨黄芪注射液对急性肺损伤血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及肺组织热休克蛋白70(HSP70)、核转录因子-κBp65(NF-κBp65)蛋白表达的影响.方法 54只Sprague-Dawley(SD)雄性大鼠随机分为对照组、模型组、黄芪组,每组18只,对照组生理盐水5.0 mL/kg尾静脉注射,模型组尾静脉注射脂多糖(LPS)5.0 mg/kg复制急性肺损伤模型,30 min后黄芪组给予黄芪注射液10 g/kg,对照组和模型组给予等量生理盐水,各组分别于制模后2、6、12 h处死大鼠,心脏取血、留取肺组织标本,采用苏木素-伊红(HE)染色、光镜下观察肺组织病理变化,检测肺组织湿干重比(W/D),酶联免疫吸附法(ELISA)检测血清TNF-α、IL-6浓度,免疫组织化学法检测HSP70和NF-κBp65蛋白表达量.结果 模型组肺间质及肺泡明显充血水肿,大量炎性细胞浸润;黄芪组肺间质及肺泡充血水肿明显减轻,少量炎性细胞浸润.模型组、黄芪组各时间点肺组织W/D明显高于对照组(P<0.01);模型组肺组织W/D 12 h达高峰;黄芪组肺组织W/D 12 h下降程度最大,明显低于模型组各时间点(P<0.01).模型组、黄芪组各时间点血清TNF-α、IL-6浓度明显高于对照组(P<0.01);模型组血清TNF-α、IL-6浓度6 h达高峰;黄芪组血清TNF-α、IL-6浓度12 h降至最低,明显低于模型组各时间点(P<0.01).模型组、黄芪组各时间点HSP70蛋白表达量明显高于对照组(P<0.01);模型组HSP70蛋白表达量6 h达高峰;黄芪组HSP70蛋白表达量12 h达高峰,明显高于模型组各时间点(P<0.01).模型组、黄芪组各时间点NF-κBp65蛋白表达量明显高于对照组(P<0.01);模型组NF-κBp65蛋白表达量6 h达高峰;黄芪组NF-κBp65蛋白表达量12 h降至最低,明显低于模型组各时间点(P<0.01).结论 黄芪注射液可能通过提高HSP70表达,从而抑制NF-κB活性,下调TNF-α、IL-6的合成,减轻炎症反应,发挥肺损伤的保护作用.     

氨溴索对急性肺损伤的保护作用

目的 通过建立急性肺损伤大鼠模型和体外肺泡巨噬细胞培养体系,观察急性肺损伤中,肺泡巨噬细胞在氨溴索干预前后细胞因子表达的情况,探讨氨溴索可能的肺损伤保护机制.方法 一、体内实验:大鼠24只,随机分成3组,每组8只:(1)正常对照组;(2)急性肺损伤组:采用腹腔注射酵母悬液方法复制大鼠急性肺损伤模型;(3)氨溴索治疗组:建立ALI大鼠模型后用氨溴索干预.观察指标主要有:肺部病理学改变、测量大鼠肺系数、血氧分压,肺泡巨噬细胞TNF-α、IL-10、IL-24 mRNA的表达则采用通过逆转录-聚合酶链式反应(RT-PCR)技术检测.二、体外实验:收集肺泡巨噬细胞后分3组:(1)正常对照组:肺泡巨噬细胞中加无菌生理盐水;(2)LPS组:予LPS 10 mg/L刺激肺泡巨噬细胞;(3)LPS+氨溴索组:予LPS10 mg/L和氨溴索180 μmol/L刺激肺泡巨噬细胞.分别于刺激前(0 h),刺激后(6、12、24 h)留取细胞.通过RT-PCR技术检测肺泡巨噬细胞TNF-α、IL-10、IL-24 mRNA的表达变化.结果 氨溴索治疗组在病理改变,肺系数,动脉血氧分压等各项指标均优于急性肺损伤组,氨溴索干预治疗组,TNF-α、IL-10、IL-24 mRNA表达水平均明显下降,与急性肺损伤组比较差异有统计学意义(P＜0.05),但仍高于正常对照组.体外实验也得出了相同的结论.结论 氨溴索可抑制急性肺损伤或LPS刺激的肺泡巨噬细胞TNF=α、IL-10、IL-24细胞因子mRNA的表达水平.     

长时间单肺通气对兔两侧肺灌洗液中TNF-α、IL-8的影响

目的:通过兔单肺通气模型,观察长时间单肺通气后肺灌洗液中TNF-α、IL-8浓度的变化.方法:选择新西兰大白兔35只,分为对照组(C组)、双肺通气组(TLV组)和单肺通气组(OLV组),每组5只兔.TLV组和OLV组按通气时间1、3、5 h分为3亚组,随后恢复双肺通气30min.对照组只行实验操作而不通气.观察通气时的心率(HR)、平均血压(MAP)、血气分析值、支气管肺泡灌洗液(BALF)中TNF-α、IL-8浓度.结果:与通气开始相比,OLV组在通气5hHR增高、MAP降低(P<0.01),pH、PaO2、SaO2在单肺通气后降低,PaCO2在OLV5h后升高(P<0.01);TLV组HR、MAP、pH、PaCO2在各观察时点无统计学差异(P>0.05).OLV组左右肺的TNF-α和IL-8值在通气5 h增高(P<0.01);TLV组的左肺的TNF-α和IL-8值在通气5 h增高(P<0.01);OLV组通气5 h左肺TNF-α、IL-8值与TLV组左肺比较有显著差异(P<0.01).结论:单肺通气时肺损伤程度与单肺通气时间成正比,单肺通气肺损伤比双肺通气肺损伤严重.     

科技论文作者应积极使用规范的科技名词

规范和统一科技名词对促进科技进步、支撑学科发展及对外交流具有重要意义,但目前国内规范科技名词的推广与使用仍有不足之处,广大科技工作者应积极使用规范科技名词。     

Comparison of the APACHE III, APACHE II and Glasgow Coma Scale in acute head injury for prediction of mortality and functional outcome

Objectives: This study examines the efficacy of the predicting power for hospital mortality and functional outcome of three different scoring systems for head injury in a neurosurgical intensive care unit (NICU). Design: On the day of admission, data were collected from each patient to compute the Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II and III, and Glasgow Coma Scale (GCS) scores. Hospital mortality was defined as the deaths of patients before discharge from hospital. Early mortality was defined as death before the 14th day after admission. Late mortality was defined as death after the 15th day from admission. Functional outcome was evaluated by Index of Independence in Activities of Daily Living (Index of ADL). Setting: An 8-bed NICU in a 1270-bed medical center in Taichung Veterans General Hospital. Patients and participants: Two hundred non-selected patients with acute head injury were included in our study in a consecutive period of 2 years. Patients less than 14 years old were not included. Interventions: None. Measurements and results: Sensitivity, specificity and correct prediction outcome were measured by the chi-square method in three scoring systems. The Youden index was also obtained. The best cut-off point in each scoring system was determined by the Youden index. The difference in Youden index was calculated by Z score. A difference was also considered if the probability value was less than 0.05. The area under Receiver Operating Characteristic (ROC) curve was computed. Then the area under ROC of each scoring system was compared by Z score. There was statistical significance if p was less than 0.05. For prediction of hospital mortality, the best cut-off points are 55 for APACHE III, 17 for APACHE II and 5 for GCS. The correct prediction outcome is 82.4% in APACHE III, 78.4% in APACHE II and 81.9% in the GCS. The Youden index has best cut-off points at 0.68 for APACHE III, 0.59 for APACHE II, and 0.56 for GCS. The area under Receiver Operating Characteristic (ROC) curve is 0.90 in the APACHE III, 0.84 in the APACHE II and 0.86 in the GCS. There are no statistical differences among APACHE III and II, and GCS in terms of correct prediction outcome, Youden Index and the area under the ROC curve. Other physiological variables excluding GCS in APACHE III and II (AP III-GCS, AP II-GCS) have less statistical value in the determination of mortality for acute head injury. For the prediction of late mortality, APACHE III and II yield significantly better results in the area under the ROC curve, correct prediction and Youden index than those of GCS. Other physiological variables (AP III-GCS and AP II-GCS) play an important role in the prediction of late mortality in APACHE scores. For prediction of the functional outcome of surviving patients with acute head injury, the APACHE III yields the best results of correct prediction outcome, Youden index and the area under the ROC curve. Conclusion: The APACHE III and II may not replace the role of GCS in cases of acute head injury for hospital or early mortality assessment. But for prediction of the late mortality, the APACHE III and II have better accuracy than GCS. Other physiological variables excluding GCS in the APACHE system play a crucial contribution for late mortality. GCS is simple, less time-consuming and economical for patients with acute head injury for the prediction of hospital and early mortality. The APACHE III provides better prediction for severe morbidity than GCS and APACHE II. Therefore, the APACHE III provides a good assessment not only for hospital and late mortality, but also for functional outcome. Received: 22 May 1995 Accepted: 2 September 1996     

构建基于ICF的功能和残疾评定的理论和方法

《国际功能、残疾和健康分类》(ICF)是世界卫生组织发布的核心分类之一。本研究探讨了根据ICF的生物-心理-社会模式建立功能和残疾评定的统一的理论基础和术语系统,以及开发标准化功能和残疾评定工具的理论与方法。     

Identification of problems in the functioning of individuals with schizophrenia from the expert perspective: an Internet-based survey

Purpose: The purpose of the study was to identify aspects of functioning and related environmental factors that are relevant to schizophrenia from the perspective of health professionals experienced in treating individuals with this disorder using the International Classification of Functioning, Disability and Health (ICF).

Method: An international pool of experts from diverse health care disciplines was surveyed to identify problems in functioning experienced by individuals with schizophrenia and the environmental factors that impact their functioning. On the basis of established rules, all answers were translated to the ICF by two independent researchers.

Results: One-hundred and eighty-nine experts from all six World Health Organization regions identified 4776 meaningful concepts, of which 92% were linked to 347 different ICF categories. Of the 347 categories, 194 were second-level categories, 151 were third-level categories and 2 were fourth-level categories. Ninety-five second-level ICF categories, 43 third-level categories and 1 fourth-level category reached percentage frequency of at least 5%. The majority of the categories were attributed to body functions, activities and participation, and environmental factors.

Conclusions: Health professionals identified a wide range of problems in functioning that reflect the complexity and breadth of schizophrenia, specifically activity limitations and participation restrictions that are particularly relevant for individuals with schizophrenia. Knowing these functioning problems can guide the design of patient-oriented rehabilitation programmes.

• Implications for rehabilitation

• Schizophrenia may result in impaired functioning in multiple daily life activities. The International Classification of Functioning, Disability and Health (ICF) can help in identifying the needs and problems of these individuals.

• The reported list of ICF categories can facilitate a systematic application of the ICF in schizophrenia and can help to design and implement coordinated and patient oriented rehabilitation programmes with a biopsychosocial approach.

• According to health professionals surveyed, activity limitations and participation restrictions are broadly affected in this population and are highly influenced by neurocognitive and social cognitive deficits and environmental factors.

     

A systematic review of the barriers and facilitators to the provision and use of low-tech and unaided AAC systems for people with complex communication needs and their families

Abstract

Purpose: Speech-language pathologists may introduce augmentative or alternative communication (AAC) systems to people who are unable to use speech for everyday communication. Despite the benefits of AAC systems, they are significantly underutilized by the people with complex communication needs. The current review aimed to synthesize the barriers and facilitators to the provision and use of low-tech and unaided AAC systems. 

Materials and methods: Relevant literature was identified via a systematic search strategy. Included articles (n?=?43) were evaluated using the Critical Appraisal Skills Programme. Qualitative framework analysis was then completed with reference to the International Classification of Functioning, Disability, and Health (ICF). 

Results and conclusion: Most barriers and facilitators were coded as contextual factors within the ICF. Of most prominence were environmental factors, including attitudes of and supports provided by professionals, family members, and the society at large. Themes were also identified which related to the personal factors, including the user’s own attitude, socioeconomic status, and culture. Beyond these contextual factors, the remaining codes related to body functions such as cognition and movement. There are numerous barriers to the provision and use of low-tech and unaided AAC systems, which may contribute to the inadequate use of these systems by people with complex communication needs. Suggestions for reducing these barriers are presented with regards to the person with complex communication needs, their family, and the professionals involved in their care.

• Implications for Rehabilitation

• AAC systems can reduce participation restrictions for people with complex communication needs.

• The provision and use of AAC systems is influenced by environmental factors, personal factors, and features of a person’s body function.

• SLPs may need to collaborate with a large multidisciplinary team to successfully introduce AAC systems.

• SLP, teaching, and nursing students require theoretical and practical experience in AAC throughout their training to enable the provision and use of these systems.

     

中国卫生技术评估与循证准入管理探索

目的探索从卫生部层面采用卫生技术评估的高质量证据,对影响广、费用高、风险大、有争议的卫生技术实行准入管理的可行性.方法借鉴国外卫生技术评估与循证管理实践的经验,在国内建立了四家卫生技术评估和循证医学相关机构,推动和开展卫生技术评估工作.以"脐带血造血干细胞库"、"人类辅助生殖技术"、"人类精子库"等技术的管理问题为切入点,领导开展技术评估,以高质量证据制定卫生部的准入管理办法和条例.结果开展多项有关医疗设备、临床医疗技术、预防与疾病控制的筛查技术等方面研究与评估;制定了多个单项技术评估与循证准入管理办法:<脐带血造血干细胞库管理办法>、<人类辅助生殖技术管理办法>、<人类精子库管理办法>等,指导各地机构和人员认证,规范管理.结论在我国建立卫生技术评估与循证准入管理制度已有一定基础,还需不断改进与完善,逐步形成行之有效的卫生技术准入管理运行机制.     

Validation of the Comprehensive ICF Core Set for obstructive pulmonary diseases from the perspective of physiotherapists

Background and Purpose. The ‘Comprehensive ICF Core Set for obstructive pulmonary diseases’ (OPD) is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with OPD. To optimize a multidisciplinary and patient‐oriented approach in pulmonary rehabilitation, in which physiotherapy plays an important role, the ICF offers a standardized language and understanding of functioning. For it to be a useful tool for physiotherapists in rehabilitation of patients with OPD, the objective of this study was to validate this Comprehensive ICF Core Set for OPD from the perspective of physiotherapists. Method. A three‐round survey based on the Delphi technique of physiotherapists who are experienced in the treatment of OPD asked about the problems, resources and aspects of environment of patients with OPD that physiotherapists treat in clinical practice (physiotherapy intervention categories). Responses were linked to the ICF and compared with the existing Comprehensive ICF Core Set for OPD. Results. Fifty‐one physiotherapists from 18 countries named 904 single terms that were linked to 124 ICF categories, 9 personal factors and 16 ‘not classified’ concepts. The identified ICF categories were mainly third‐level categories compared with mainly second‐level categories of the Comprehensive ICF Core Set for OPD. Seventy of the ICF categories, all personal factors and 15 ‘not classified’ concepts gained more than 75% agreement among the physiotherapists. Of these ICF categories, 55 (78.5%) were covered by the Comprehensive ICF Core Set for OPD. Conclusion. The validity of the Comprehensive ICF Core Set for OPD was largely supported by the physiotherapists. Nevertheless, ICF categories that were not covered, personal factors and not classified terms offer opportunities towards the final ICF Core Set for OPD and further research to strengthen physiotherapists' perspective in pulmonary rehabilitation. Copyright © 2009 John Wiley & Sons, Ltd.     

21世纪的纳米医学展望

评述了纳米医学的理论和应用意义、研究领域和最新进展。