北京市东城区安贞苑社区慢性病相关危险因素分析

<正>随着社会经济的发展和期望寿命的延长,慢性非传染性疾病(简称慢性病)已对人类的生活和健康带来了巨大影响[1]。慢性病是指以恶性肿瘤、心脑血管疾病及慢性阻塞性肺部疾病及糖尿病等为代表的一类疾病,具有病程长、病因复杂、迁延性、无自愈性和很少治愈性等特点[2]。多项研究表明,慢性病的发生与不良健康行为关系密切[3]。慢性     

重视中国特色的高脂血症脂肪肝的研究

脂代谢紊乱是引起心脑血管疾病和肝脏损害的重要原因,目前我国约有3亿脂代谢紊乱患者,高甘油三酯血症和非酒精性脂肪性肝病(NAFLD)是其两大表型,两者相互影响并常合并存在,共同促进肝硬化、2型糖尿病和动脉硬化性心脑血管疾病的发病,以NAFLD为中心的脂代谢紊乱性疾病是目前我国严重的公共卫生问题[1-3]。随着国民生活水平的普遍提高、城市化的进程以及妊娠期和哺乳期营养过度,脂代谢紊乱性疾病正呈低龄化和大众化流行趋势,严重威胁国民健康和社会的发展及稳定。深入研究高脂血症NAFLD发病及转归机制以及寻找早期诊断和有效干预的靶点是我国人口与健康领域的重大科学问题。     

老年慢性病社区化管理的效果

慢性病是指一类无传染性的长期积累对机体产生损害的疾病总称,其全称为慢性非传染性疾病,主要包括心脑血管疾病,如高血压、冠心病等,慢性阻塞性肺疾病,如慢性肺炎、肺气肿等,还有糖尿病、精神病等[1,2].本研究观察社区化管理在老年慢性病中的应用效果.     

慢性病规范化管理在家庭病房中的应用

<正>近年来,随着我国经济的发展,老龄化进程加快,人类的疾病、死因构成正在发生变化,慢性非传染性疾病(慢性病)如高血压、冠状动脉粥样硬化性心脏病(冠心病)、糖尿病以及脑卒中等问题日益严峻,成为我国居民主要死因[1]。世界卫生组织统计,每年慢性病导致的死亡占死亡总数的60.0%,经济损失占全球疾病负担的一半[2]。大量研究表明,我国慢性病主要由高危行为及不健康的生活方式引起,如吸烟、过度饮酒、超重等。目前,慢性病的     

脂代谢紊乱与胰岛素抵抗的相关性研究进展

随着社会老龄化、经济快速发展和人们生活水平的不断提高,我国人群的平均血脂水平正逐步上升,截至目前全国血脂异常患病人数高达1.6亿人[1].胰岛素抵抗( insulin resistance,IR)是一种常见的病理生理现象,与脂质代谢紊乱密切相关.脂质代谢紊乱对细胞具有毒性作用,可引起或加重IR和影响胰岛β细胞功能,同时IR和胰岛素分泌不足又可进一步加重脂质代谢紊乱,从而引起一系列代谢紊乱及相关疾病,如2型糖尿病、代谢综合征、心脑血管疾病等.     

呼吸系统疾病患者护理管理的现状、问题及思考

<正>近年来,由于细菌、病毒等微生物感染、人口老龄化发展、环境污染加剧、吸烟率增加以及生活方式改变等,呼吸系统疾病的发病率和死亡率不断升高[1-2]。世界卫生组织数据显示,慢性呼吸系统疾病(chronic respiratory diseases, CRD)已成为继心脑血管疾病和恶性肿瘤之后的全球第三大致死类疾病[3]。常见的呼吸系统疾病如慢性阻塞性肺疾病(chronic obstractive pulmonary disease,     

胰腺衍生因子与非酒精性脂肪性肝病

非酒精性脂肪性肝病(NAFLD)是一种与全身糖脂代谢紊乱、心脑血管疾病、肝脏纤维化进展甚至肝脏肿瘤发生和发展密切相关的系统性疾病[1-3]。在其发病过程中,糖脂代谢产物、细胞的氧化应激、非感染性免疫反应以及细胞的质膜系统稳态失衡起到重要作用[4]。现有的假说在理解肝脏发生脂肪变之后的损伤过程方面已经有了比较深入的认识,但在针对胰岛素抵抗发生过程中β细胞功能由过度代偿到衰竭为何伴有单纯性的肝脏脂质沉积这一现象尚缺乏合理的解释。通过重新审视脂肪肝这个累及多脏器的脂代谢稳态失衡综合征的病理生理过程,结合近年来逐渐被认识的器官间对话共同参与肝脏糖脂代谢稳态调节的理论,研究肝脏和胰腺两个组织间可能存在的交互调节,可能对阐明NAFLD发生、发展的机制及其伴随的胰岛功能改变有重要帮助。     

高血压并发糖代谢紊乱与心血管疾病

<正>随着社会经济的发展和人民生活水平的提高,人们的生活方式发生了改变,高血压、糖尿病、高脂血症的发病率在全国范围内迅速的增加,而近几年的研究发现这些疾病往往是同时发生的。1988年Reaven首次提出代谢综合征(metabolic syndrome,MS)的概念,其基本特征是高血压、高血糖、高血脂和肥胖,各组成成分均是引起心脑血管疾病的独立危险因素。而当几种疾病伴发时,其发生心脑血管并发症的危险就会成指数倍的增长。近几年的研究发现,高血压常与糖代谢紊乱并存,高血压人群发生糖尿病的危险为非高血压人群的2～4倍,而伴发糖代谢紊乱后,高血压患者发生心血管并发症的危险可增加2～3倍。     

慢性阻塞性肺疾病合并抑郁的发病机理研究进展

非传染性疾病(Noncommunicable diseases,NCDs)包括慢性肺病、心脏病、中风、癌症和糖尿病在内的非传染性疾病每年导致3500万人死亡,占世界死亡人数的近三分之二,慢性阻塞性肺疾病(chronic abstructive pulmonary disease,COPD)是一种主要的呼吸性非传染性疾病,目前是全球第三大死因[1]。有报道称慢阻肺是一种躯体心理疾病,气道分泌的炎症因子进入血液循环和全身性疾病,如心血管疾病,骨质疏松症,焦虑抑郁和代谢综合征[2]。抑郁的高患病率引起了医生的关注,抑郁在慢阻肺中并存,对慢阻肺患者的发病率和死亡率有显著的不利影响,与慢阻肺的死亡风险增加密切相关[3]。具有高抑郁症状的慢阻肺患者在慢阻肺自然病程中也经常比无抑郁症状的患者,更早经历首次住院,心理共病也与更差的肺功能,呼吸困难,患有慢阻肺和抑郁症的患者比没有抑郁症的患者更有可能在疾病的早期经历更大的呼吸困难[4]。     

胰高血糖素样肽1及其类似物治疗2型糖尿病的研究进展

糖尿病已成为继心脑血管疾病和肿瘤之后,第三位严重危害人民身体健康的慢性非传染性疾病。预计到2025年,全球糖尿病患者将达到3.66亿,其中90%为2型糖尿病（type 2 diabetes mellitus,T2DM）[1]。     

珠海市西部地区HIV／AIDS病例随访管理模式探索和实践

目的探索艾滋病病毒（HIV）感染者／艾滋病（AIDS）病人（简称HIV／AIDS病人）随访管理新模式,有效地随访管理艾滋病病例。方法按照国家疾病预防控制中心设计的“个案随访表”的随访内容,制订工作指引,对镇医院、社区卫生服务中心及其他相关人员进行培训,对HIV／AIDS病例进行现况调查、行为干预和转介。结果在珠海市西部地区探索以疾病预防控制中心、镇医院、社区卫生服务中心随访管理为主（三级纵向）,抗病毒治疗机构、美沙酮维持治疗点和羁押机构（横向）等协助进行的随访管理网络新模式后,增强了当地医务人员防控艾滋病能力的同时,HIV／AIDS病例的随访率由原来的不足60％上升到90％以上,CD4^＋T淋巴细胞检测率、抗病毒治疗覆盖率等指标也都有很大的提高。结论新的随访管理模式成效显著,在深入推行该模式的同时,应加强非政府组织（NGO）和个人在HIV／AIDS病例随访管理中的作用,加大自愿咨询和检测门诊的宣传、转介力度,以及时发现艾滋病的非阳性配偶／固定性伴中的潜在感染者。     

Dynamic ocean management increases the efficiency and efficacy of fisheries management

In response to the inherent dynamic nature of the oceans and continuing difficulty in managing ecosystem impacts of fisheries, interest in the concept of dynamic ocean management, or real-time management of ocean resources, has accelerated in the last several years. However, scientists have yet to quantitatively assess the efficiency of dynamic management over static management. Of particular interest is how scale influences effectiveness, both in terms of how it reflects underlying ecological processes and how this relates to potential efficiency gains. Here, we address the empirical evidence gap and further the ecological theory underpinning dynamic management. We illustrate, through the simulation of closures across a range of spatiotemporal scales, that dynamic ocean management can address previously intractable problems at scales associated with coactive and social patterns (e.g., competition, predation, niche partitioning, parasitism, and social aggregations). Furthermore, it can significantly improve the efficiency of management: as the resolution of the closures used increases (i.e., as the closures become more targeted), the percentage of target catch forgone or displaced decreases, the reduction ratio (bycatch/catch) increases, and the total time–area required to achieve the desired bycatch reduction decreases. In the scenario examined, coarser scale management measures (annual time–area closures and monthly full-fishery closures) would displace up to four to five times the target catch and require 100–200 times more square kilometer-days of closure than dynamic measures (grid-based closures and move-on rules). To achieve similar reductions in juvenile bycatch, the fishery would forgo or displace between USD 15–52 million in landings using a static approach over a dynamic management approach.Although traditional fisheries management has focused on assessing the health of individual fish stocks, there has been a strong trend over the past two decades toward the incorporation of ecosystem components into fisheries management (1, 2). Ecosystem-based fisheries management (EBFM) seeks to meet multiple, potentially conflicting goals across ecological, economic, and social objectives (3, 4). Meeting these goals is made more complex in marine ecosystems due to the inherent dynamic nature of the oceans. In response to continuing difficulty in managing the ecosystem impacts of fisheries in a highly dynamic environment, including bycatch (i.e., the accidental interaction of fishing gear with nontarget species), interest in the concept of dynamic ocean management (DOM) has accelerated (5–10). Maxwell et al. (8) define dynamic management as “management that changes in space and time in response to the shifting nature of the ocean and its users based on the integration of new biological, oceanographic, social and/or economic data in near real-time” (8). Dynamic management reflects advancement in our ability to manage ocean resources across finer spatial and temporal scales as a result of technological improvements that have paved the way for higher-resolution collection of both fisheries and environmental data (e.g., electronic logbooks, vessel monitoring systems, smartphone technology, remote sensing, and animal tracking) (9). The existing literature has focused on the presumed capacity of dynamic management to increase management efficiency across both ecological and economic objectives (7, 8), and in codifying the different approaches to dynamic management across fisheries and other applications (7, 10). However, little to no empirical research exists to quantify the implied benefits of dynamic management or compare the efficiency of the various spatiotemporal management measures. Additionally, and critically, the benefits of dynamic management hinge on the premise that it is capable of managing resources at scales more aligned with resources and resource users, yet we lack a quantitative assessment of how scale influences the effectiveness of dynamic management—both in terms of how it reflects underlying ecological processes, and how this relates to the efficiency of dynamic management approaches.     

Alcoholism/Addiction as a Chronic Disease

Summary

Although characterized as a chronic disease for more than 200 years, severe and persistent alcohol and other drug (AOD) problems have been treated primarily in self-contained, acute episodes of care. Recent calls for a shift from this acute treatment model to a sustained recovery management model will require rethinking the natural history of AOD disorders; pioneering new treatment and recovery support technologies; restructuring the funding of treatment services; redefining the service relationship; and altering methods of service evaluation. Recovery-oriented systems of care could offer many advantages over the current model of serial episodes of acute care, but such systems will bring with them new pitfalls in the personal and cultural management of alcohol and other drug problems.     

对医院知识团队的几点认识

医院知识团队是由医务知识工作者为主体构成的团队,团队管理方式能够增进协同作战能力,改善组织绩效.医院间激励的竞争、医院的扁平化组织特征以及医院的特有工作方式使团队管理方式在医院里有较高的应用价值,医院知识团队的管理主要从组织层面的跨团队管理和知识团队的自我管理两方面来实现.     

输血科在临床输血工作中的作用

<正>输血科肩负临床输血工作,是临床参与临床急救及危重患者救治的重点科室。为了进一步规范临床用血,提高血液使用效能,本文就如何科学、合理、安全用血进行剖析,特别是通过对临床输血流程科学合理的管理,加强输血科与临床用血科室沟通,把握临床用血指征,规范临床用血疗效评估,持续改进临床输血工作,提高临床用血质量,把安全输血提高到重要地位。1输血科要对临床医护人员进行输血相关知识的针对性培训     

Management of Neuropsychiatric Symptoms of Dementia in Clinical Settings: Recommendations from a Multidisciplinary Expert Panel

Noncognitive neuropsychiatric symptoms (NPS) of dementia (aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, disinhibition) affect individuals with dementia nearly universally across dementia stages and etiologies. NPS are associated with poor outcomes for individuals with dementia and caregivers, including excess morbidity and mortality, greater healthcare use, and earlier nursing home placement, as well as caregiver stress, depression, and difficulty with employment. Although the Food and Drug Administration has not approved pharmacotherapy for NPS, psychotropic medications are frequently used to manage these symptoms, but in the few cases of proven pharmacological efficacy, significant risk of adverse effects may offset benefits. There is evidence of efficacy and limited potential for adverse effects of nonpharmacological treatments, typically considered first line, but their uptake as preferred treatments remains inadequate in real‐world clinical settings. Thus, the field currently finds itself in a predicament in terms of management of these difficult symptoms. It was in this context that the University of Michigan Program for Positive Aging, working in collaboration with the Johns Hopkins Alzheimer's Disease Research Center and Center for Innovative Care in Aging sponsored and convened a multidisciplinary expert panel in Detroit, Michigan, in fall 2011 with three objectives: to define critical elements of care for NPS in dementia; to construct an approach describing the sequential and iterative steps of managing NPS in real‐world clinical settings that can be used as a basis for integrating nonpharmacological and pharmacological approaches; and to discuss how the approach generated could be implemented in research and clinical care.     

Pharmacists' Role in Improving Diabetes Medication Management

Today there are significant gaps between reaching the goal of “optimal medication therapy” and the current state of medication use in the United States. Pharmacists are highly accessible and well-trained—yet often underutilized—key health care professionals who can move us closer toward achieving better medication therapy outcomes for patients. Diabetes medication management programs led by pharmacists are described. This is consistent with the “medical home” concept of care that promotes primary care providers working collaboratively to coordinate patient-centered care. Pharmacists utilize their clinical expertise in monitoring and managing diabetes medication plans to positively impact health outcomes and empower patients to actively manage their health. In addition, pharmacists can serve as a resource to other health care providers and payers to assure safe, appropriate, cost-effective diabetes medication use.     

绩效管理在康复医院管理中的应用探析

随着我国医疗体制改革的逐渐深化,医院的管理体制走进了新的阶段。在现代康复医院管理中绩效管理使用的得当与否,对医院的综合竞争力有着至关重要的作用。本文通过对绩效管理的含义及意义进行分析,探索绩效管理在实际应用中存在的问题,并针对现实问题提出针对性的解决措施和建议。