COPD患者整合照护模式分析及相关策略研究

目的:明确慢性阻塞性肺疾病(Chronic Cbstractive Pulmonary Disease,COPD)稳定期患者整合照护模式的基本结构与关键要素,提出发展策略。方法:通过文献检索,以慢病管理模型为理论框架对COPD整合照护方案相关研究进行分析归纳。结果:共纳入16篇文献13项研究。大多数研究对象为老年人,COPD严重程度为中度以上;有以医院为中心、以社区为中心两种类别的10种整合照护模式;均包括慢病管理模型2(含)个以上维度4~12项组织要素:所有整合照护方案均任命了一位协调员,制定了随访方案;9项包含社区资源的整合照护方案均有决策支持,主要方式是提供临床指南及决策过程中整合了专家资源;13项研究都包含患者自我管理,主要包括健康教育、行为管理及改善(10项)。结论:COPD整合照护方案可以依据慢病管理模型构建,建议包括至少两个维度的4项组织要素。其核心内容是任命协调人,制定随访方案,社区参与的照护方案必须给予决策支持。通过健康教育与包含行动计划的行为管理与改善支持患者自我管理。通过信息系统畅通医疗服务人员与患者沟通渠道。     

口服阿昔洛韦治疗水痘的疗效评价

目的对口服阿昔洛韦治疗水痘的疗效进行循证评价。方法使用相关检索词对Cochrane图书馆、MEDLINE及EMBASE等数据库进行检索,获得关于口服阿昔洛韦治疗水痘的疗效的系统评价及随机对照实验,用循证医学的方法对口服阿昔洛韦治疗水痘的疗效进行评价。结果口服阿昔洛韦能减少患者发热的天数及水痘皮疹的数量,但在缩短新生皮损出现时间及减轻皮肤瘙痒等方面尚不明确。结论阿昔洛韦在治疗平素健康儿童水痘患者的重要性仍不明确。     

养老机构护理人员以人为中心痴呆症照护方式的研究进展

随着人口老龄化的加剧，痴呆症患病率呈逐年增长的趋势。日益庞大的痴呆症人群及其复杂的照护管理已成为全球健康卫生系统亟待解决的社会问题。目前痴呆症尚无有效的治疗方法，正确的照护方式可以提高痴呆症患者的生活质量。由于痴呆症患者认知功能和语言功能的下降，日常生活中常存在错误的认知和表达，照护者容易采取以现实为导向的痴呆症照护方式。以人为中心的照护方式是痴呆症照护实践的基本要素，不仅有助于缓解痴呆症患者的精神行为症状，改善痴呆症患者的生活质量，促进其健康和提升幸福感水平，而且有助于减轻照护者的压力和负担，促进积极的照护实践。本文从以人为中心痴呆症照护的概念、评估工具、形式、现状水平及影响因素等方面综述了国内外养老机构护理人员实施以人为中心痴呆症照护的研究进展，提出我国可进一步开展的相关质性研究与干预研究，为国内养老机构管理者采取有效措施，提高护理人员以人为中心痴呆症照护水平提供参考依据。     

老年痴呆患者家庭照顾者负担及干预研究现状分析

目的 明确老年痴呆症患者家庭照顾者负担和干预的研究现状,为减轻照顾者负担提供依据。方法 通过中国知网、万方、维普、Pubmed、Embase、Web of Science等数据库进行文献检索,从老年痴呆患者家庭照顾者的负担情况及其评估工具、干预模式等方面分析。结果 老年痴呆患者家庭照顾者的负担较重;标准化的负担评估工具及有效的干预方法较为缺乏。结论 建议借鉴国内外成功经验,对老年痴呆患者家庭照顾者的负担开发标准化评估工具,及有效的干预策略和方法。     

跟腱病的临床治疗研究进展

目前国内外对跟腱病的诊疗研究较深,主要分为非手术治疗和手术治疗。本文检索1995/2016年度PubMed与CNKI数据库有关跟腱病临床治疗的文献,对治疗跟腱病诊疗方案进行综述,系统总结近些年本病的治疗研究进展,旨在为跟腱病治疗提供更为客观的理论依据。     

我国医学领域本体研究热点分析—共词可视化视角

利用CNKI(《中国学术期刊网络出版总库》、《中国优秀硕士学位论文全文数据库》、《中国博士学位论文全文数据库》、《中国重要会议论文全文数据库》)、CBM(中国生物医学文献数据库)、万方为数据情报源检索国内医学领域本体相关文献,检索时间为1990-2010/06。以共词分析法为主要研究方法,利用BICOMB软件、SAS9.1.3统计工具对这些文献的关键词进行分析,以探讨我国医学领域本体研究现状与热点领域,以期为本体在医学领域的进一步研究提供借鉴和参考。     

长期吸入糖皮质激素对支气管哮喘患儿生长发育的影响

目的 综述长期吸入糖皮质激素（inhaled corticosteroids, ICS）对支气管哮喘患儿生长发育（包括身高、体重和骨密度）的影响，为临床更好的地应用ICS提供参考。方法 以“吸入糖皮质激素”、“ICS”、“哮喘”、“儿童”、“生长发育”、“身高”、“体重”和“骨密度”为CNKI和万方数据库的检索词，以“ICS”、“inhaled corticosteroids”、“bronchial asthma”、“height”、“weight”、“bone density”为pubmed和web of science数据库的检索词进行检索，经筛选后，参考文献共纳入35篇。结果 随着对ICS治疗支气管哮喘临床研究的不断深入，逐渐对其临床受益和副作用有了更多的循证研究和深入认识。结论 关于长期吸入糖皮质激素治疗支气管哮喘是否影响患儿生长发育尚存在一定争议，但大多推荐长期使用最小有效剂量，其安全性和治疗效果较为理想。     

近20年我国慢病管理研究文献的可视化分析北大核心

目的对我国近20年来慢病管理领域发表的文献进行分析,了解国内慢病管理领域研究现状、作者和机构合作网络、慢病管理研究热点及前沿趋势,为今后的慢病管理研究提供更多的参考。方法在三大中文数据库知网(CNKI)、万方、维普数据库中,以“慢病管理”“慢病防治”“慢性病管理”进行主题检索,时间跨度为2000年1月1日至2020年12月31日,检索结果为4237篇文献,经去重、剔除新闻报道及会议通知等相关性不大的文献,总计1007篇与慢病管理相关的文献导入文献分析软件Citespace进行可视化分析。结果自2010年起慢病管理领域的发文量呈明显上升趋势,慢病管理显然已成为近几年的社会热点。目前该领域的研究热点为:糖尿病、高血压等慢性病的管理、健康管理与健康促进、生活质量等。疾病管理模式、互联网医疗、分级诊疗、医养结合等为慢病管理未来的研究前沿。结论随着我国老龄化社会的到来,慢病管理受到持续高度关注,各医疗机构、社区可加强合作,根据该领域的研究新趋势,深入开展科研探索并为实践提供更多的参考。     

我国慢性非传染性疾病健康管理的现状分析与建议

慢病已经逐渐成为各个国家主要的疾病负担,世界卫生组织提倡建立以预防为主的慢病管理创新模式。健康管理是以现代健康概念（生理、心理和社会适应能力）和新的医学模式（生理一心理一社会）以及中医治未病为指导,通过采用现代医学和现代管理学的理论、技术、方法和手段,对个体或群体整体健康状况及其影响健康的危险因素进行全面检测、评估、有效干预与连续跟踪服务的医学行为及过程。其目的是以最小的投入获取最大的健康效益[1]。     

青海地区65岁以上老年群体高血压多病共存患者治疗现状调查

目的调查青海地区65岁以上老年群体高血压多病共存患者治疗现状,旨在为老年高血压多病共存患者的治疗提供参考。方法将青海地区某社区中530例65岁以上高血压多病共存患者纳为研究对象,调查其多病共存主要组合类型及多重用药率,采用汉化用药生活问卷(LMQ)分析患者用药负担,采用STOPP/START标准检测患者是否存在潜在不合理用药(PIM)。同时将年龄、性别、工作状态、婚姻状况、文化程度、是否独居、主要照看者、经济来源、患病种类、用药种数、处方获得方式等纳为分析因素,分析影响高血压多病共存患者不合理用药的独立因素。结果 (1)530例被研究对象中合并2种、3中及4种以上疾病患者占比分别为71.70%、20.00%及8.30%。(2)多病共存排名前五的组合类型分别为高血压合并冠心病(26.04%)、高血压合并血脂异常(16.04%)、高血压合并糖尿病(13.02%)、高血压合并冠心病与血脂异常(7.55%)、高血压合并冠心病与糖尿病(3.96%)。(3)患者服药种类1～11种,平均服药种类为6.13种,其中多重用药率达到83.02%(440/530)。(4)问卷调查显示,多病共存患者处于中重度药物负担状态。(5)以STOPP/START为标准,PIM发生率为32.64%。(6)多因素Logistic回归分析提示,文化程度及二级及以上级别医院获得处方是高血压多病共存患者PIM的保护因素,而用药种类是PIM的危险因素。结论青海地区老年高血压多病共存患者多重用药率高,处于中重度药物负担状态,且PIM发生率高,建议临床加强慢性多病共存患者用药规范性,减轻患者用药负担。     

Antibiotic use and resistance in long term care facilities

IntroductionThe common occurrence of infectious diseases in nursing homes and residential care facilities may result in substantial antibiotic use, and consequently antibiotic resistance. Focusing on these settings, this article aims to provide a comprehensive overview of the literature available on antibiotic use, antibiotic resistance, and strategies to reduce antibiotic resistance.MethodsRelevant literature was identified by conducting a systematic search in the MEDLINE and EMBASE databases. Additional articles were identified by reviewing the reference lists of included articles, by searching Google Scholar, and by searching Web sites of relevant organizations.ResultsA total of 156 articles were included in the review. Antibiotic use in long term care facilities is common; reported annual prevalence rates range from 47% to 79%. Part of the prescribed antibiotics is potentially inappropriate.The occurrence of antibiotic resistance is substantial in the long term care setting. Risk factors for the acquisition of resistant pathogens include prior antibiotic use, the presence of invasive devices, such as urinary catheters and feeding tubes, lower functional status, and a variety of other resident- and facility-related factors. Infection with antibiotic-resistant pathogens is associated with increased morbidity, mortality, and health care costs.Two general strategies to reduce antibiotic resistance in long term care facilities are the implementation of infection control measures and antibiotic stewardship.ConclusionThe findings of this review call for the conduction of research and the development of policies directed at reducing antibiotic resistance and its subsequent burden for long term care facilities and their residents.     

Supporting older people with multimorbidity: The care burden of home health-care assistants in Ireland

The treatment burden inherent in self-managing multiple chronic conditions (multimorbidity) is recognized, but there has been little examination of the care burden experienced by paid home health-care assistants (HCAs) who support older people with multimorbidity. Focus groups were conducted with HCAs in Ireland and data were coded using a thematic analysis approach. Care burden of HCAs was linked with lack of knowledge and information, poor communication, insufficient time and resources, gaps in medication support and work-related stress. Strategies are required to reduce the care burden of HCAs, who are essential stakeholders supporting growing numbers of older people with multimorbidity.     

A qualitative study of work-life choices in academic internal medicine

The high attrition rate of female physicians pursuing an academic medicine research career has not been examined in the context of career development theory. We explored how internal medicine residents and faculty experience their work within the context of their broader life domain in order to identify strategies for facilitating career advancement. Semi-structured interviews were conducted with a purposeful sample of 18 residents and 34 faculty members representing male and female physicians at different career stages. Using thematic analysis, three themes emerged: (1) the love of being a physician (“Raison d’être”), (2) family obligations (“2nd Shift”), and (3) balancing work demands with non-work life (“Negotiating Academic Medicine”). Female researchers and educators reported more strategies for multiple role planning and management than female practitioners. Interventions aimed at enhancing academic internists’ planning and self-efficacy for multiple role management should be investigated as a potential means for increasing participation and facilitate advancement.     

An integrative review combined with a semantic review to explore the meaning of Swedish terms compatible with occupation,activity, doing and task

The aims of this study were to explore the intended meaning of the terms “occupation”, “activity”, “doing”, and “task” used in international occupational therapy literature and from this perspective explore which Swedish terms best capture these meanings. A literature review of occupational therapy-related journals was performed to gain a basic understanding of the term occupation and related terms. In addition, a semantic review was used: English and Swedish dictionaries were reviewed to explore the semantic meaning of the English terms “occupation”, “activity”, “doing”, and “task”, and the Swedish terms “aktivitet”, “syssla/sysselsättning”, “görande”, and “uppgift”. A comparison was also performed by searching for parallels between the results of the literature review, the semantic definitions of the English and Swedish terms and the comprehensive meaning of the Swedish terms aktivitet and syssla/sysselsättning. An overarching idea of the concept of occupation was found in the literature review and for the purposes of this study we have identified this as Occupation for survival. From this overarching idea, three themes were identified: The feature of occupation, Impact of occupation and Occupation an occupational therapy concept. Each theme could be subdivided into sub-themes. The Swedish term aktivitet was found to have more power, strength, and spirit connected to the synonyms found in the semantic analysis than to those connected with the Swedish term syssla/sysselsättning. According to the findings in this study we found that the term “aktivitet” is the best comparable term in Swedish to the English term “occupation”.     

Resilience of patients with chronic diseases: A systematic review

The purpose of this research was to contribute to the development of a resilience‐promoting programme for patients with chronic diseases. A systematic review of literature concerning resilience interventions for patients with chronic diseases was conducted by searching PubMed (including Medline), Science Direct, Web of Science, PsycARTICLES, CINAHL Plus, Embase, and the Cochrane Database for articles featuring the terms “resilience,” “resiliency,” “resilient,” “cancer,” “stroke,” “heart disease,” “diabetes” and “COPD” and published between 8 January 2017 and 15 January 2017. We included all English studies relevant to the topic; however, we excluded: (1) nonrandomised controlled trials and (2) those that mentioned the term “resilience” but did not apply it in their analysis. Seventeen studies—10 on cancer, four on cardiovascular diseases and three on diabetes—were deemed suitable for analysis. We found that, in these studies, (1) diverse definitions of resilience were applied, (2) various intervention durations were used and (3) complex programmes were applied within the resilience‐improving programmes. Our research encourages efforts to operationalise the construct of resilience, so it can be applied in clinical settings, and for the development of more systematic intervention programmes.     

New devices for gastrointestinal endoscopy

Advances in endoscopic therapeutic techniques and procedures are reducing invasiveness, thereby lightening the burden on the patient. At the same time, they are increasing the burden on those who administer the endoscopic therapy to ensure successful outcomes. As we enter the era of minimally invasive therapy, a clear need has arisen for the formulation of a basic strategy for the types of therapeutic methods and devices that can and should be provided for use in clinical medicine. Therefore, I introduced the perspective of my own experience by my original criterion.     

Revising the Suspected-Cancer Guidelines: Impacts on Patients’ Primary Care Contacts and Costs

ObjectivesThis study aimed to explore the impact of revising suspected-cancer referral guidelines on primary care contacts and costs.MethodsParticipants had incident cancer (colorectal, n = 2000; ovary, n = 763; and pancreas, n = 597) codes in the Clinical Practice Research Datalink or England cancer registry. Difference-in-differences analyses explored guideline impacts on contact days and nonzero costs between the first cancer feature and diagnosis. Participants were controls (“old National Institute for Health and Care Excellence [NICE]”) or “new NICE” if their index feature was introduced during guideline revision. Model assumptions were inspected visually and by falsification tests. Sensitivity analyses reclassified participants who subsequently presented with features in the original guidelines as “old NICE.” For colorectal cancer, sensitivity analysis (n = 3481) adjusted for multimorbidity burden.ResultsMedian contact days and costs were, respectively, 4 (interquartile range [IQR] 2-7) and £117.69 (IQR £53.23-£206.65) for colorectal, 5 (IQR 3-9) and £156.92 (IQR £78.46-£272.29) for ovary, and 7 (IQR 4-13) and £230.64 (IQR £120.78-£408.34) for pancreas. Revising ovary guidelines may have decreased contact days (incidence rate ratio [IRR] 0.74; 95% confidence interval 0.55-1.00; P = .05) with unchanged costs, but parallel trends assumptions were violated. Costs decreased by 13% (equivalent to −£28.05, −£50.43 to −£5.67) after colorectal guidance revision but only in sensitivity analyses adjusting for multimorbidity. Contact days and costs remained unchanged after pancreas guidance revision.ConclusionsThe main analyses of symptomatic patients suggested that prediagnosis primary care costs remained unchanged after guidance revision for pancreatic cancer. For colorectal cancer, contact days and costs decreased in analyses adjusting for multimorbidity. Revising ovarian cancer guidelines may have decreased primary care contact days but not costs, suggesting increased resource-use intensity; nevertheless, there is evidence of confounding.     

Equidad y autonomía del paciente en las estrategias de atención a personas con enfermedades crónicas en los servicios de salud de España

ObjectiveTo examine the chronic care models of the different Spanish health services and to discuss the ethical questions derived from implementing some of their components.MethodNarrative review of care strategies and programmes for chronic patients in the different Autonomous Communities, searching in official health departments’ web pages, using the terms “Programmes”, “Strategies”, “Chronic patients”, and “Chronicity”.Results15 programmes were found. Most of them include all components of the chronic care model, “decision-making support” being under-represented. The main conflicts in the autonomy of patients arise from the use of big data to stratify the population and from telemonitoring. The stratification of population does not consider the social factors that accompany the disease.ConclusionsChronic care strategies should consider the autonomy and privacy of patients in the use of clinical data and telemonitoring. In order to be equitable, they would have to provide an integrated health care system, incorporating measures to reduce the inequalities due to the social determinants that accompany the disease.     

Public strategies for improving eHealth integration and long‐term sustainability in public health care systems: Findings from an Italian case study

eHealth is expected to contribute in tackling challenges for health care systems. However, it also imposes challenges. Financing strategies adopted at national as well regional levels widely affect eHealth long‐term sustainability. In a public health care system, the public actor is among the main “buyers” eHealth. However, public interventions have been increasingly focused on cost containment. How to match these 2 aspects? This article explores some central issues, mainly related to financial aspects, in the development of effective and valuable eHealth strategies in a public health care system: How can the public health care system (as a “buyer”) improve long‐term success and sustainability of eHealth solutions? What levers are available to match in the long period different interests of different stakeholders in the eHealth field? A case study was performed in the Region of Tuscany, Italy. According to our results, win‐win strategies should be followed. Investments should take into account the need to long‐term finance solutions, for sustaining changes in health care organizations for obtaining benefits. To solve the interoperability issues, the concept of the “platform approach” emerged, based on collaboration within and between organizations. Private sector as well as beneficiaries and final users of the eHealth solutions should participate in their design, provision, and monitoring. For creating value for all, the evidence gap and the financial needs could be addressed with a pull mechanism of funding, aimed at paying according to the outcomes produced by the eHealth solution, on the base of an ongoing monitoring, measurement, and evaluation of the outcomes.