第六届健康与信息高峰论坛在沪举行

第六届健康与信息化高峰论坛作为2011中国国际工业博览会科技论坛之一,于2011年11月10日-11日在上海交通大学医学院顺利召开.来自全国各地卫生行政部门、医院、卫生信息相关单位、医学院校、研究所、医疗卫生信息技术研发单位的代表以及十二五863 计划生物和医药技术领域数字化医疗工程的专家和项目承担者参加了大会,并进行了热烈的圆桌讨论.     

“三位一体”艾滋病病例管理模式的建立及实施效果

目的 探索对艾滋病病例“三位一体”管理模式的效果,在解决近年来由于艾滋病病例数量的快速上升以及病例中流动人口比例的不断升高等因素给病例管理工作造成的困难.方法 北京市丰台区疾病预防控制(疾控)中心结合丰台区实际情况,在充分整合医疗资源和社会组织力量的基础上,在中盖艾滋病项目及北京市科委项目的支持下,建立由疾控部门、艾滋病抗病毒定点治疗医院以及非政府组织共同参与的“三位一体”的病例管理模式.结果 2010-2011年丰台区病例管理质量有了很大提升,随访率、CD4淋巴细胞检测率、单阳配偶检测率、抗病毒治疗覆盖率都有了大幅度的上升.结论 该模式突破了原有单一由疾控部门负责艾滋病病例管理的局限,建立了区域病例管理网络,培养了一支病例管理的专业队伍,为病例管理工作开辟了一条新途径.     

性病/艾滋病危机干预三位一体化综合模式评价

目的 探索应用学校–疾病预防控制中心(CDC)-校医院三位一体化综合模式进行大学生性病/艾滋病(STD/AIDS)危机干预的有效性和可行性。方法 采用分层整群抽样方法,以班为单位抽取山西大同大学2~3年级文史、化工、艺术、外语、体育专业1 062名学生作为研究对象,将其随机分为综合干预组(539人)和对照组(523人),综合干预组实施学校-CDC-校医院三位一体的健康教育干预模式,对照组由课题组专家进行健康教育专题讲座,比较2组STD/AIDS相关知识,态度及行为(KAP)情况。结果 干预后,综合干预组STD/AIDS知识、态度和行为得分分别为(40.1±7.5)、(22.6±6.9)、(24.1±6.2)分,均高于干预前的(29.6±9.9)、(17.3±9.8)、(22.9±7.1)分,差异有统计学意义(P=0.00);干预后,综合干预组STD/AIDS基本知识、传播途径、预防知识、社会相关政策得分分别为(16.3±3.6)、(11.6±1.3)、(8.7±0.6)、(4.5±0.4)分,均高于对照组的(13.2±6.7)、(10.5±2.4)、(7.3±2.6)、(4.3±0.6)分,差异有统计学意义(P=0.00);综合干预组发生性行为时从来不用安全套、接触过消毒不严格的牙科器械或手术器械、与他人共用过牙刷、与他人共用过剃须刀、在理发店被剃刀刮伤过、与他人共用过未严格消毒的器械纹身/纹眉/穿耳行为的发生率分别由干预前的14.9%、5.3%、27.8%、42.3%、12.7%和7.2%下降到干预后的6.2%、2.1%、4.5%、11.2%、5.1%和1.9%,差异均有统计学意义(P<0.05)。结论 学校-CDC-校医院三位一体化综合干预模式对高校STD/AIDS危机干预有效且值得推广。     

糖尿病患者的7个误区

不少糖尿病患者都认为就诊时一定要空腹。其买这种观点是错误的,患者看病时是否应该空腹,要根据具体情况而定。例如是初诊还是复诊等。对于初次就诊且怀疑患有糖尿病者,医生为了明确糖尿病的诊断,或了解患者     

“三位一体”急救护理流程在百草枯中毒患者中的应用

目的 探讨“三位一体”急救护理流程在百草枯中毒患者中应用效果.方法 对收治的51例百草枯中毒患者实施“三位一体”急救护理流程,分析抢救的过程,总结抢救效果.结果 该组患者的毒评估时间2.25±0.47min;建立静脉通道的时间4.40±1.62 min;洗胃时间2.45±1.22 h;灌流时间1.75±0.25 h,激素静脉滴注的时间平均3.22±1.34 h.存活率为49.1％(25/51),死亡率为50.9％ (26/51).结论 三位一体急救护理流程组合能够提高百草枯中毒的抢救效率,减少患者的病死率.     

西部机构如何推行“三位一体”综合行政管理体系

<正>西部地区的检验检疫工作是整个检验检疫事业的重要组成部分。随着国家西部地区大开发战略的实施,当地对外开放程度不断扩大、对外经济不断增长、经济实力不断增加,所以西部检验检疫工作面临的内外环境发生着很大变化     

饕餮7问

饕餮，比喻贪吃的人，现在引申为吃。吃什么，怎么吃？才能恰到好处地满足胃口与体力的需要，才能让身体更健康而且不发胖。那些原以为是正确的饮食方法，事实上会将我们的健康推上不归路。在早就不必再为吃不饱而发愁，而吃多或吃少也无需多虑时，如何饕餮，就成了一个非常重要的问题。[编者按]     

Counting Backward by Seven

I delayed my neurology rotation in medical school because I was trying to ignore the symptoms of dementia developing in my mother. They became painfully apparent when I saw my parents less frequently after I moved away for residency, and finally had to be addressed when I had a child of my own and felt unsafe having her care for him. Through my experiences with her and in my training in palliative care and oncology, I have learned that tools like the Mini Mental State Examination (MMSE) and Functional Assessment Staging Test (FAST) can only tell us so much; the true measure of a patient’s decline can be found in the patient’s and family’s own story.Key words: dementia, Alzheimer’s disease, palliative care, hospice

During medical school, I delayed my neurology rotation until the very end, when my elective time was used up and the residency match completed. I recognize now that I was trying to avoid patients with clinical manifestations of dementia—the same symptoms that I was trying hard not to see in my mother.Attending medical school near my parents, and seeing them frequently during those years, made the changes in my mother easier to ignore; memory lapses accumulated gradually, and some visits contained no such warning signs. When my husband and I moved to a different state for my residency, evidence of her ongoing decline grew stark; noticeable changes occurred in the months between visits. Not that any of us acknowledged it. When we were together, we pretended everything was fine. Each time they left, I would lay in bed and cry.My oldest son was born a year later, and when my parents arrived to help, my husband and I could see, even through the fog of sleepless nights, that my mother was not fit to care for him. After retiring as a high school English teacher, she had spent several years as a hospital volunteer, cuddling babies and performing newborn hearing tests. Despite this, she now needed constant reminders to support my son’s head. She seemed oblivious to an infant’s feeding schedule and diet; at noon, she wondered aloud whether he was hungry for lunch, or wanted a glass of water.Months later, after I returned to work, I called my father in advance of their next stay. We both witnessed the same deficits whenever they visited, but we never discussed them. “When you and Mom come up, can you promise me that you’ll watch closely whenever she holds him?” I asked. “And she shouldn’t be the one to heat up his bottles when I’m at work.”He cleared his throat. “If you don’t feel comfortable with us being there, then maybe we shouldn’t come.”I sank back into the pillows. I was working a stretch of nights and had set an alarm to wake up early before my next shift to have this conversation.“Dad,” I finally said. “What’s going on with Mom?”The whole story came tumbling out: how her doctor had checked her thyroid function, her B12 level, and had done an MRI. What the eventual neuropsychiatric testing had shown. How she now crammed for each Mini-Mental State Examination (MMSE), pressing my father for the date and season just before the doctor walked in, but forgetting the answers within moments.Several years later, during my fellowship in hospice and palliative medicine, I learned to measure the march of dementia using the Functional Assessment Staging Test (FAST). Instead of watching the score drop on the MMSE, I began watching the FAST score rise, documenting the accumulation of symptoms leading to hospice eligibility. During my subsequent fellowship in oncology, I added even more scales—Karnofsky performance status; Lansky for the younger patients—to my repertoire of ways to capture a patient’s status. Whether assessing cognitive or physical abilities, these scoring systems attempt to describe in 1 number the patient’s condition, something that would otherwise require an entire narrative to convey. Although useful for documentation and communication between clinicians, if used inappropriately, they can take on a significance I find hard to entrust to a single score. A patient’s diagnosis, history, and laboratory values may fit the eligibility criteria for enrollment in a clinical trial, but if his Karnofsky status is below a specified threshold, he cannot enroll. Another’s downward trending score on the MMSE may trigger upward titration of her cholinesterase inhibitor.Perhaps most importantly, over time, I have learned that these scores mean little to families even when properly explained; that each has their own set of benchmarks. The daughter of one hospice patient seemed impossibly chipper as she bustled around her mother, describing how the woman slept for most of the day but could be roused for ice cream in the afternoons. But tears sprang to the daughter’s eyes as she recounted the day long ago when she, a foreign language teacher just like her mother, had asked her mother for a word in German and realized that her mother’s ability to speak the language was gone.We would do well to remember the value of these patient- and family-specific markers of decline and to include them alongside our standardized assessments. Although they cannot indicate eligibility for a clinical trial or hospice services and will vary among families, they offer vivid illustrations of who patients were before their illness, how drastically their cognitive or functional status has changed, and how this evolution impacts both patient and family. Such open-ended questions—“Tell me about a typical day for your dad last Thanksgiving. How does that compare to now?”—can also provide valuable insight into the emotional and physical health of caregivers, both critical factors in ensuring a patient’s ongoing care.I estimate that my mother is now a FAST 6, but whether she is a 6A, B, or C depends on whether you ask my father or me; I consider her disease more advanced. He continues to struggle with questions of whether he will move her to a memory care facility and, if he does, how he will know it’s the right time: when she grows incontinent or no longer recognizes him? But how many accidents earn a label of incontinence? How many times must she call him “Dad” for him to feel certain that she has recognized him as her husband for the last time?My childhood memories are rife with images of my family hunched together over jigsaw puzzles that grew larger and more intricate with time. When my mother—who holds 2 master’s degrees—could no longer follow book or television plots and was struggling to busy herself throughout the day, my father resurrected the old puzzle table. Their attic steps now contain a seemingly endless supply of brightly colored boxes bearing the images contained within. But over time, the puzzles placed on the table have grown increasingly simpler, with fewer details and pieces. My mother has regressed from completing 1,000-piece puzzles to those with 500 pieces, and now struggles with 250, even when my father constructs the entire border in advance. That, I have learned, is the score that matters to me. How far she can count backward by 7s is academic. The dwindling number of cardboard pieces she can link together charts just how far we have fallen.