集束化管理策略在血透室新型冠状病毒肺炎防控中的应用效果观察

目的 观察集束化管理策略在新型冠状病毒肺炎防控工作中的应用效果及透析患者疫情防控认知行为的改变。方法 对血透室实施全员集束化管理策略,采用自行设计调查问卷,对155例门诊透析患者进行调查。结果 在血透室应对新型冠状病毒肺炎疫情防控工作中,应用集束化管理策略后,工作人员职业防护合理规范,疫情期间医务人员及透析患者零感染。疫情对患者规律透析、正常生活及心理健康影响不大。疫情期间患者认知及行为有所改变,透析患者普遍能够配合各项防控措施执行。结论 在血透室应对新型冠状病毒肺炎防控工作中实施集束化管理策略效果显著,可明显提高患者对疫情防控的认知,并能够积极配合医疗护理工作,确保血透室各项防控工作有序开展,避免相关院内感染发生。     

神经重症监护病房防控新型冠状病毒感染专家共识(第一版)

2019冠状病毒病（COVID-19）疫情期间,神经急危重症患者的救治难度增加,挑战巨大。疫情期间以神经系统疾病就诊的部分患者可能合并COVID-19,容易误诊、漏诊,并带来隐形传播和院内感染。神经重症监护病房（NCU）院内感染发生风险高。在疫情防控期间,神经急危重症患者救治应将疫情防控放在重要位置,充分进行筛查及风险评估,权衡利弊,在及时救治患者的同时,减少COVID-19传播风险。     

神经重症监护病房防控新型冠状病毒感染专家共识

2019冠状病毒病（COVID-19）疫情期间，神经急危重症患者的救治难度增加，挑战巨大。疫情期间以神经系统疾病就诊的部分患者可能合并COVID-19，容易误诊、漏诊，并带来隐形传播和院内感染。神经重症监护病房（NCU）院内感染发生风险高。在疫情防控期间，神经急危重症患者救治应将疫情防控放在重要位置，充分进行筛查及风险评估，权衡利弊，在及时救治患者的同时，减少COVID-19传播风险。     

口腔门诊护理危机管理在新型冠状病毒肺炎疫情防控中的应用

新型冠状病毒肺炎疫情防控形势严峻复杂,且口腔门诊因其诊疗特殊性,感染风险较高。实施护理危机管理,加强预检分诊管理从而有效识别传染病可疑患者,树立护理人员感染防控意识,诊疗操作中严格执行标准预防措施,对环境、物体表面、器械设备等进行规范管理,可降低感染风险。     

从新型冠状病毒疫情演变看传染病流行期间消化内镜如何做好感染防控

新型冠状病毒感染可以表现为多种消化道症状。消化内镜作为一项侵入性的具有高度感染传播风险的诊疗项目更是感染防控的重点及难点。多个国家在感染防控措施中积累了一定的经验，该综述总结了现有的国内外关于消化内镜诊疗的感染防控指南及建议，旨在为消化内镜常态化疫情防护及有序恢复诊疗工作提供参考。     

胆囊结石伴急性胆囊炎患者在新型冠状病毒肺炎疫情期间的防控和诊治

目前,新型冠状病毒肺炎疫情依然十分严峻,全国各地高度重视疫情防控工作。胆囊结石伴急性胆囊炎作为肝胆外科常见的急腹症之一,发病急、进展快,需要早期诊断和及时有效的治疗。在疫情防控的特殊时期,应合理收治患者,减少院内交叉感染。胆囊结石伴急性胆囊炎常伴有发热,要明确是否合并有新型冠状病毒感染的情况,合理选择治疗方案,制订个体化治疗措施。在确保患者得到及时有效的诊治的同时,落实落细患者及陪护人的防控工作,切实防止院内感染的发生。重视医务人员的个人防护工作,科学施救,切实保障医务人员的人身安全。     

新型冠状病毒肺炎疫情防控期间ERCP 诊疗专家共识

为降低新型冠状病毒肺炎疫情防控期间经内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography,ERCP）诊疗工作中医患感染的风险,国家消化内镜专业质控中心联合中国医师协会内镜医师分会、中华医学会消化内镜学分会组织相关专家制定了《新型冠状病毒肺炎疫情防控期间ERCP诊疗专家共识》,旨在规范诊疗流程、防控与洗消措施,确保医患双方的诊疗安全。     

新型冠状病毒肺炎疫情防控期间急诊内镜防控管理

目的探讨新型冠状病毒肺炎(COVID-19)防控期间消化内镜中心感染控制管理与内镜诊疗的安全。方法在COVID-19疫情防控期间,通过组织与防控培训,包括成立应急防控小组、拟定疫情期间消化内镜诊疗规范及重新布局诊疗区域、疫情培训、岗位调整等,从急诊内镜诊疗前对COVID-19的筛查到诊疗过程中的防控,以及隐匿患者应急处理等方面设定科学合理防护工作规范及感染防控方案。对2020年2月在解放军总医院第七医学中心消化内镜中心行急诊内镜检查患者的COVID-19疫情防控情况进行评估分析。结果 2020年2月1日至2020年2月28日,共行急诊内镜检查及治疗患者24例,男∶女为19∶5,中位年龄61.5岁(12～89岁);行胃镜检查10例(41.67%),行结肠镜检查5例(20.83%),行ERCP 9例(37.5%)。其中6例患者CT显示肺部感染。在此期间,所有内镜操作间空气消毒达标。对24例患者及家属进行随访发现均未感染COVID-19。结论适应防控形势发展趋势,拟定特殊时期防控诊疗规范,做法科学性强,措施有效可行。     

对新型冠状病毒肺炎疫情期间口腔器械使用原则、洗消、管理的思考

自新型冠状病毒肺炎疫情暴发至今，国内外都出现了大量的确诊病例。随着疫情的蔓延，感染病例数的增加，尤其是最新报道指出存在气溶胶传播途径感染的可能，引起了口腔行业的重视，并由此引发了口腔工作者们对口腔诊疗日常感染控制工作的思考：如何在日常口腔诊疗工作中控制感染，避免医源性交叉感染的发生?本文根据各级疫情防控经验，结合多年传染病专科医院口腔科门诊工作经验，着重从器械使用、洗消及管理方面对口腔科门诊的防控工作提出一些建议和思考，期望对口腔科的日常诊疗工作，尤其是针对烈性呼吸道传染病、血源性传染病患者的诊疗工作提供一定的指导和帮助。     

新型冠状病毒肺炎患者在机械通气条件下使用呼吸机的感染防控关键问题探讨

新型冠状病毒肺炎疫情引起全球关注,其强传播力导致感染人数众多,且医务人员占一定比例。在当前患者多且负压病房"供不应求"的情况下,如何做到最大限度的环境保护,加强对各种传播风险的防范,尽可能避免医务人员和其他患者的二次感染,显得尤为重要。因此,现着重探讨新型冠状病毒肺炎患者在机械通气条件下如何通过细节管理进行感染防控,以减少病毒对患者的污染。     

Statins and dementia

The incidence and prevalence of dementia are increasing. Dementia is a major cause of disability. Alzheimer’s disease (AD) is the most common type of dementia. There are no good prevention or treatment options. Experimental animal and laboratory studies have suggested that cholesterol metabolism in the brain is important in the causal pathway for dementia, possibly by modifying amyloid metabolism. A few studies have showed a possible relationship between mid-life blood cholesterol levels and risk of dementia, including AD. Case-control studies report that patients with AD were less likely to use lipid-lowering drugs, especially statins. Longitudinal epidemiology studies have not demonstrated a decreased risk of AD among statin users versus nonusers. Two clinical trials of statin therapy to reduce cardiovascular disease have not shown any reduction in risk of cognitive decline or dementia. The results of two secondary prevention trials will be reported shortly. In spite of negative studies, the possibility remains that statin therapy may reduce risk of dementia and AD. Primary prevention trials are difficult and expensive and will likely not be done in the United States.     

Methodological issues and therapeutic perspectives in vascular dementia: a review

Vascular dementia (VaD) is the most common form of dementia after Alzheimer's disease (AD). However, it is now increasingly recognized that not only is VaD a heterogeneous syndrome but also that VaD and AD are not mutually exclusive. Thus, the currently used criteria may no longer be sufficient for an accurate diagnosis of VaD. In addition, although it is widely assumed that risk factors for vascular disease are also risk factors for VaD, the evidence, in most cases, is circumstantial. For the effective prevention of VaD, therefore, large-scale and long-term clinical trials are required to investigate the validity of these putative risk factors. These trials should also include the VaD subtypes in their outcome measurements and to this end a simplified classification system should be adopted. Additional large-scale trials are required to facilitate the secondary prevention and symptomatic treatment of VaD, in particular to investigate the potential application of several nootropic and neuroprotective drugs. In both cases, these clinical trials should aim to move the field of VaD from opinion-based medicine to evidence-based medicine.     

Cognitive impairment in diabetic patients: Can diabetic control prevent cognitive decline?

It is well recognized that the prevalence of dementia is higher in diabetic patients than non‐diabetic subjects. The incidence of diabetes has been increasing because of dramatic changes in lifestyles, and combined with longer lifespans as a result of advances in medical technology, this has brought about an increase in the number of elderly diabetic patients. Together, aging and diabetes have contributed to dementia becoming a serious problem. Progression to dementia reduces quality of life, and imposes a burden on both patients themselves and the families supporting them. Therefore, preventing the complication of dementia will become more and more important in the future. Although many mechanisms have been considered for an association between diabetes and cognitive dysfunction, glucose metabolism abnormalities such as hyperglycemia and hypoglycemia, and insulin action abnormalities such as insulin deficiency and insulin resistance can be causes of cognitive impairment. Recent large‐scale longitudinal studies have found an association between glycemic control and cognitive decline, although it is still unclear how cognitive decline might be prevented by good glycemic control. However, at an early stage, it is necessary to detect moderate cognitive dysfunction and try to reduce the risk factors for it, which should result in prevention of dementia, as well as vascular events. In the present review, in addition to outlining an association between diabetes and cognitive function, we discuss how glycemic control and cognitive decline are related.     

Sturzprävention bei Menschen mit Demenzerkrankungen

Elderly persons suffering dementia are at increased risk for falls. Because of this, an investigation of the state of the science and the state of the art in fall prevention in patients suffering dementia has been made. A systematic literature review showed lack of documentation of effective interventions in preventing falls in persons with cognitive impairment. This was the reason for studying which measures nurses undertake in the field of long-term-care. Focus-group interviews with experienced geriatric nurses were undertaken. Nurses assume that there are specific risk factors in this patient group which have to be taken into account. Cognitive deficits are causing an increased fall risk in a specific manner. Geriatric nurses have ideas about how to adapt interventions for persons with dementia. They also assume that interventions primarily addressing cognitive disorders may also reduce the risk of falling. The interventions mentioned by the interviewed experts have not yet been examined concerning their effectiveness, therefore, fall prevention for people with dementia has to be further differentiated and systemized on a scientific basis.     

Pr?vention der vaskul?ren Demenz

During recent years, increasing knowledge has been obtained from clinical studies about the impact that vascular factors have on cognitive function and dementia. Due to demographic reasons and still insufficient control of all vascular risk factors, dementia and associated problems are of increasing importance and will have impact on economical and social development in most countries. The incidence of cognitive impairment and dementia will increase exponentially. As long as no causal therapy for dementia exists, diagnosis and control of risk factors for dementia will need much more attention. Hypertension is not only the most important risk factor for stroke that often leads to dementia but also for silent brain infarcts, which are also associated with onset of dementia. Uncontrolled hypertension is associated with cognitive impairment and sufficient control of hypertension in middle-aged patients can reduce the risk of dementia in older ages. Nevertheless, treatment of all other risk factors (e.g., diabetes mellitus, hyperlipidemia, atrial fibrillation) is important to reduce the onset of not only vascular but also Alzheimer dementia.     

Risk factors for in-hospital death in elderly patients over 65 years of age with dementia: A retrospective cross-sectional study

As the population continues to age, dementia is becoming a huge social, economic, and healthcare burden. However, the risk factors for in-hospital death in elderly patients over 65 years of age with dementia are not well understood. Identifying factors that affect their prognosis could help clinicians with scientific decision-making.To examine the risk factors for in-hospital death in elderly patients over 65 years of age with dementia in the Geriatric Department of West China Hospital.In this retrospective, cross-sectional study, we analyzed inpatients aged ≥65 years with dementia between 2010 and 2016 using electronic medical records from the Information Center of West China Hospital. The risk factors for death were assessed using multivariable logistic regression.Out of a total of 2986 inpatients with dementia, 3.4% died. Patient deaths were related to digestive diseases, respiratory diseases, circulatory diseases, urinary diseases, and chronic obstructive pulmonary disease, whereas patient survival was associated with osteoporosis and Parkinson disease. Patients with a mean length of hospital stay of ≥60 days had an increased risk of death (all P <.05). In the multiple logistic regression analysis, age ≥80 years, digestive diseases, respiratory diseases, urinary diseases, diabetes, chronic obstructive pulmonary disease, and ≥7 comorbidities were risk factors for death.Mortality in hospitalized older patients with dementia is low, but some risk factors may be easily ignored. These findings could raise awareness among clinicians and caregivers about risk factors in hospitalized older patients, particularly hospitalized elderly patients with multiple comorbidities. Therefore, to reduce mortality, early prevention and management of potential risks are necessary.     

Kommunikations-TAnDem

The program Kommunikations-TAnDem was developed with the primary purpose of increasing the communication competence of family caregivers of dementia patients. Further aims were to reduce the burden of family caregivers and to increase the quality of life of dementia patients. The effectiveness of the Kommunikations-TAnDem was tested in a controlled training study with 22 participants using a waiting-group control design and process measurement. The results of the study verify effects for the variables "Communication competence", "Caregivers knowledge about communication in dementia", "Quality of life of dementia patients" and "Directly perceived burden of family caregivers. Therefore it can be concluded that the Kommunikations-TAnDem is a method of indirectly supporting dementia patients by training the family caregivers. The results of research in this program underline very clearly the relevance of the inclusion of the family caregivers in intervention programs and the importance of communication competence for the well-being of dementia patients and their caregivers.     

Atrial fibrillation and dementia

Emerging evidence has shown a consistent association between AF and risk of dementia, including Alzheimer׳s disease. It is likely that a constellation of various mechanisms combine to cause dementia in AF patients. Both AF and dementia share multiple common risk factors, and as such these may be targets of early prevention strategies to reduce risk. In patients with AF, choices regarding type and duration of anticoagulation as well as rhythm- and rate-control strategies can influence dementia risk.     

Microvascular brain damage with aging and hypertension: pathophysiological consideration and clinical implications

Loss of cognitive function and hypertension are two common conditions in the elderly and both significantly contribute to loss of personal independency. Microvascular brain damage - the result of age-associated alteration in large arteries and the progressive mismatch of their cross-talk with small cerebral arteries - represents a potent risk factor for cognitive decline and for the onset of dementia in older individuals. The present review discusses the complexity of factors linking large artery to microvascular brain disease and to cognitive decline and the evidence for possible clinical markers useful for prevention of this phenomenon. The possibility of dementia prevention by cardiovascular risk factors control has not been demonstrated. In the absence of research clinical trials specifically and primarily designed to demonstrate the antihypertensive treatment efficacy for reducing the risk of dementia, further evidence demonstrating that it is possible to limit the progression of microvascular brain damage is needed.     

Prevention of type 2 diabetes: An update

With the rising tide of the diabetes epidemic leading to increased morbidity and mortality (primarily from cardiovascular disease), together with failure to control the disease and its associated complications, prevention of diabetes appears to be the logical option for curbing this epidemic. Several trials have been completed, and others ongoing, using various strategies for diabetes prevention. In this review, we provide an update on diabetes prevention strategies, highlighting the rationale behind such interventions, together with an outlook of the ongoing efforts that are likely to provide additional options for patients at risk for diabetes.