Renewed vision on pulmonary rehabilitation service delivery for chronic obstructive pulmonary disease management beyond COVID-19

Pulmonary rehabilitation (PR) is a cornerstone management for chronic obstructive pulmonary disease (COPD). International respiratory societies defined PR is more than “just an exercise program”; it is a comprehensive care delivered by a team of dedicated healthcare professionals with a strong emphasis on long-term health-enhancing Behaviors. However, “Uncertainty” exists with varied reasons for the political and geographical barriers of referral, uptake, attendance, and completion of PR in both primary and secondary care. Besides, COVID-19 pandemic has sparked many global controversies and challenges on pulmonary rehabilitation service delivery. Post-COVID-19 guidelines emphasize on integrated care rehabilitation for patients with COPD. Thus, this concise review intends to understand the gaps in United Kingdom healthcare policies, practices, and PR services resources. To date, there is no clear consensus on PR integrated care model pathway to address the unmet needs, measure the health and social care disparities; adds to the disease burden of COPD. Based on the culmination of evidence, this perspective offers a theoretical framework of PR integrated service model, a pathway to deliver high-value personalized care to patients with COPD.     

Community-based integration of management of non-communicable diseases in China

Non-communicable diseases (NCDs) are a leading cause of deaths and of disease burden in China. This paper analyzes the rationale and implications of a community-based approach to a better coordinated NCDs care and management system in China. As argued by the author, the buildup of an integrated NCDs care delivery system is feasible now and large health expenditures will be saved if more stable outpatients with NCDs could be shifted to community health facilities to receive their medications. However, the key issues remain in building a general practitioner led (GP-led) primary care delivery system in China. Some prominent issues include the shortage of quality generalists, lack of proper incentives and management mechanisms, and the absence of patients and provider, and restrictive arrangements in basic health insurance policies. Even with these hard-to-solve issues, some recent reform initiatives for integrated NCDs care delivery in some localities have demonstrated originality and creativeness in developing better coordination between primary and secondary NCDs care. However, without large-scale public sector reform, innate issues with human resource development, income distribution and financing of public healthcare providers cannot be solved. It may take a long time to see deep integration of primary and secondary NCDs care in China.     

Epidemiology of biopsy‐proven glomerular diseases in Chinese children: A scoping review

BackgroundGlomerular disease is the leading cause of chronic kidney disease globally. No scoping review reports have focused on China''s spectrum of glomerular diseases in children. This study aimed to systematically identify and describe retrospective studies on pediatric glomerular disease based on available data on sex, age, study period, and region.MethodsSix databases were systematically searched for relevant studies from initiation to December 2021 in PubMed, Embase, Web of Science, Global Health Library, Wangfang Database, and CNKI.ResultsThirty‐four studies were identified in the scoping review, including 40,430 patients with biopsy‐proven diagnoses. The proportion of boys was significantly higher than that of girls. In this study, 28,280 (70%) cases were primary glomerular disease, 10,547 (26.1%) cases were diagnosed as secondary glomerular disease, and 1146 (2.8%) cases were hereditary glomerular disease. Minimal change disease is the most common glomerular disease among children in China, followed by mesangial proliferative glomerulonephritis, IgA nephropathy, and purpura nephritis. We observed increments in glomerular diseases in periods 2 (2001–2010) and 3 (2011–2021). The proportion of major glomerular diseases varies significantly in the different regions of China.ConclusionThe spectrum of pediatric glomerular diseases varied across sex, age groups, study periods, and regions, and has changed considerably over the past 30 years.     

新型冠状病毒肺炎定点收治医疗机构医院感染防控策略

新型冠状病毒肺炎(COVID-19)是一种由新型冠状病毒(SARS-CoV-2)引起的急性传染病,其出现及其传播给全球公共卫生安全带来了极大的挑战。COVID-19定点收治医疗机构是收治确诊患者,特别是重症和危重症患者的前沿阵地。如何快速建立针对疫情的医院感染防控体系,降低医疗机构内传播的风险,保证一线医务人员、其他员工与来院就诊的其他患者及家属免遭感染,同时保证新型冠状病毒感染确诊患者诊疗救治工作的顺利开展,是很多医疗机构都会直接面对的问题。首都医科大学附属北京佑安医院作为北京市级定点收治新型冠状病毒肺炎患者医疗机构之一,通过总结和归纳其疫情期间的具体对策,以探索医院感染防控策略。     

重性精神障碍患者社区管理存在问题的调查与分析

目的了解重性精神疾病患者社区管理开展的项目、管理对象及存在问题,为社区重性精神病患者管理提供信息和依据。方法采用问卷调查法,对54名社区卫生服务中心及站的医护人员的一般情况、在社区重性精神障碍患者管理工作中发现的问题及在工作中存在的不安全因素进行调查分析。结果存在的主要问题有:精神卫生体系不健全,实施社区管理的法律法规以及风险防范对策不完善,家属及社会对重性精神障碍患者社区管理的认知不足。结论为确保社区管理安全和减轻医务工作者的风险,满足重性精神障碍患者社区管理的需求,促进患者社会功能的改善,应建立完整的社区管理制度。     

疾病防控体系中公共卫生伦理学教育的意义与实践挑战

在国家公共卫生改革的背景下,公共卫生伦理学教育应成为疾病防控体系的重要支柱之一。公共卫生伦理学教育能够培养人的道德品质、责任感和伦理决策能力,通过保证疾病防控体系设计的合理性和实施的正当性,以应对客观存在的公共卫生伦理难题。公共卫生伦理学教育应在医疗卫生人才培养的基础上延伸为公民健康素养教育,对不同受教育对象应设置不同教育目标。此外,公共卫生伦理学教育还需应对外部教育环境改变与其自身研究力量薄弱等现实问题。     

新冠肺炎疫情给诊断学教学带来的思考

21 世纪初人类在经历过非典型性肺炎（SARS）、埃博拉、寨卡等重大疫情后,对新发烈性传染性疾病有了更加深入的认识,对这些重大疾病的防控和诊治取得了巨大的突破,有力地保障了人类的健康和安全。然而2019 年末的这场疫情——新型冠状病毒肺炎（简称新冠肺炎,COVID-19）来势汹汹,对我国各级政府、公共卫生体系、临床诊治等方面都是一个巨大的考验。及时、迅速明确诊断是对新冠肺炎实施精准防控和精准治疗的前提和基础。作者基于在驻地的教学工作经验,结合亲身参加武汉抗击新冠肺炎疫情临床一线工作者的实践体会,对临床医学生诊断教学进行深入的思考。     

新冠肺炎疫情下医学生心理健康服务需求及教育对策———以首都医科大学本专科生为例

目的探讨新型冠状病毒肺炎疫情对本专科医学生心理健康状况的影响,了解学生心理健康服务需求,提出教育对策,为高校心理健康教育工作提供参考。方法选取首都医科大学全日制本科生、专科生为研究对象,通过网络问卷匿名自愿参与。结果大部分医学生（83.4%）自评总体状态良好,目前“不需要心理辅导或帮助”占 78.5%,其现实需求前三位是“学业指导”（62.4%）, “时间规划”（51.0%）,“情绪调节”（30.4%）;后续希望获得学校心理健康服务形式中心理测评占31.1%,网络心理咨询占24.1%,心理科普知识占21.5%。疫情期间遇到困难时,学生主要选择求助“家人”（87.7%）和“朋友”（77.4%）,求助心理咨询师、辅导员和导师较少。结论疫情防控期间本专科医学生整体平稳,心态理性平和,心理健康服务工作应以学生的学业需求为切入点,关注学生情绪状况,有效开展多元化的心理支持方式。     

Thirdhand smoke: Genotoxicity and carcinogenic potential

Thirdhand smoke (THS), the residual tobacco smoke remaining in the environment after tobacco has been smoked, represents a hidden and underestimated public health hazard. Evidence supports its widespread presence in indoor environments. Exposure to secondhand smoke (SHS), a precursor of THS, has been well documented as a risk factor for human cancers, especially lung cancer. However, the concept of THS as a distinct entity that poses health risks for small children has developed only recently and the associations of THS with cancer risk and other chronic diseases are poorly understood due to limited numbers of studies to date. In this perspective, we mainly summarize all published studies on the genotoxicity and carcinogenic potential of THS exposure. These studies begin to fill the knowledge gap in our understanding of cancer risk of THS. Accumulating data from existing and future studies will help reduce the tobacco-related cancer incidence through changes in lifestyle and tobacco control policies.     

衢州地区老年人科学营养知信行状况抽样调查与对策研究

目的:了解衢州地区老年人科学营养知信行状况.方法:整群随机抽样法选取428名老年人,就保健科学营养知识模块7项、态度模块7项、行为模块2项内容进行调查.对比城乡间、慢病者与无慢病者间、不同性别间差异.结果:科学营养知识正确率46.3％,在食疗、保健食品、心理状况是保健养生重要内容、保健品可用来治疗疾病、会了解保健食品成...     

Self-management interventions for adults with stroke: A scoping review

BackgroundStroke is a principal cause of mortality and disability globally. Numerous studies have contributed to the knowledge base regarding self-management interventions among chronic disease patients, but there are few such studies for patients with stroke. Therefore, it is necessary to analyze self-management interventions among stroke patients. This scoping review aimed to systematically identify and describe randomized controlled trials (RCTs) of self-management interventions for adults with stroke.MethodsA review team carried out a scoping review on stroke and self-management interventions based on the methodology of Arksey and O''Malley, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, Embase, Web of Science, CINAHL Plus Full Text, Medline Plus Full Text, and Cochrane Central Register of Controlled Trials were searched from inception to July 2020.ResultsFifty-four RCTs were included. The most popular study design is comparing a self-management intervention to usual care or waitlist control condition. Physical activity is the most common intervention topic, and interventions were mainly delivered face to face. The majority of interventions were located in inpatient and multiple settings. Interventions were conducted by various providers, with nurses the most common provider group. Symptom management was the most frequently reported outcome domain that improved.ConclusionsSelf-management interventions benefit the symptom management of stroke patients a lot. The reasonable time for intervention is at least 6–12 months. Multifarious intervention topics, delivery formats, and providers are adopted mostly to meet the multiple needs of this population. Physical activity was the most popular topic currently. Studies comparing the effect of different types of self-management interventions are required in the future.     

BNP、D-D、hs-CRP检测在慢性心力衰竭中的应用

目的 对于慢性心力衰竭疾病开展BNP、D-D以及hs-CRP检测的具体方法 以及应用价值进行分析.方法 选取慢性心力衰竭患者资料150例施行分析,根据所选150例慢性心力衰竭患者心功能分级情况对其进行分组,另外选取正常体检人员资料50例作为对照组,四组患者全部接受BNP、D-D以及hs-CRP检测.结果 慢性心功能衰竭患者的BNP、D-D以及hs-CRP检测结果 与对照组对比差异明显(P<0.05);不同级别心功能患者的BNP、D-D以及hs-CRP检测结果 对比差异明显(P<0.05).结论 临床中针对慢性心力衰竭患者提供BNP、D-D以及hs-CRP检测,对疾病诊断、病情发展判断和预后具有非常重要的作用.     

“南山班”拔尖创新人才培养体系的构建与实践

医学教育肩负着教育和健康两大民生工程，随着疾病谱的变化、健康需求广泛性的凸显、医学模式的转变，新时代的医学教育必须主动适应新要求，着力培养未来解决健康领域重大科学问题和应对重大疾病防控挑战的医学拔尖创新人才。作为担负医药卫生人才培养主体的地方院校如何开展拔尖创新人才培养改革试验更具战略性意义。面对临床医学拔尖创新人才培养面临的突出问题，广州医科大学以“南山精神”为引领，构建具有鲜明特色的“三制三化三融合”拔尖创新人才培养模式，并取得积极成效，旨在为地方院校培养高水平医药卫生人才提供思路。     

基于健商理论指导下的体检中心慢性胃病健康管理的应用

目的探究与分析基于健商理论指导下的体检中心慢性胃病健康管理应用效果观察。方法选取本院自2018年3月—2019年3月收治的体检中心慢性胃病患者90例,采取随机数字表法分为对照组与观察组,每组各45例,对照组给予常规健康管理,观察组给予基于健商理论指导下管理,对比两组管理前后健商水平、生活质量。结果两组健康管理后与健康管理前相比自我保健、健康知识、生活方式、精神状态以及生活技能评分均升高,观察组健康管理后与对照组健康管理后相比上述评分改善更加显著,组间差异具有统计学意义(P<0.05)。两组健康管理后与健康管理前相比躯体功能、认知功能、角色功能、情绪功能以及社会功能评分均升高,观察组健康管理后与对照组健康管理后相比上述评分改善更加显著,组间差异具有统计学意义(P<0.05)。结论基于健商理论指导下的健康管理应用于体检中心慢性胃病患者当中可明显提高健商水平,促进提高生活质量。     

医科大学医学生健康教育培训需求度和满意度现状分析

目的 了解医学生学习《健康教育》课程的满意度、需求度现状及差异,为《健康教育》课程优化提供参考。方法 以某医科大学在校临床医学生为研究对象,分析医学生对课程内容的需求度和满意度及二者差异。课程内容包括服药依从性、戒烟干预、合理膳食、心理压力管理、中医康复技术、慢性传染病健康教育、急性传染病健康教育、移动健康技术教育、运动康复指导及健康促进理论。采用频数和构成比指标进行统计描述,采用卡方检验进行健康教育课程学习情况与专业/ 学制之间、相关课程内容学习的需求度与学制的差异,相关课程内容学习需求度与满意度的关联比较采用秩和检验。以P ＜ 0.05 为差异具有统计学意义。结果 戒烟干预、合理膳食、心理压力管理、中医康复技术、慢性传染病健康教育、急性传染病健康教育、移动健康技术教育及健康促进理论八项的学习需求度在长学制医学生与五年制医学生中的总体分布位置不同（U ＝ 2.4、2.2、2.5、2.3、2.4、2.4、2.3、2.0,P 均＜ 0.05）;服药依从性、戒烟干预、合理膳食、心理压力管理、慢性传染病健康教育、急性传染病健康教育、移动健康技术教育及运动康复指导八项的满意度与需求度之间的总体位置分布不同（U ＝ 6.2、5.2、7.2、9.2、5.9、6.1、2.1、3.2,P 均＜ 0.05）;不同学制的医学生对于慢性病人、老年人、孕产妇、传染病人、高危人群和职业暴露人群的健康教育重点关注人群侧重有所不同,其差异具有统计学意义（χ2 ＝ 8.9、14.2、9.9、6.9、23.9、17.8,P 均＜ 0.05）;在教学方式上,不同学制的医学生对于教师课堂讲授和小组讨论的偏好上的差异具有统计学意义（χ2=6.3、9.5,P 均＜ 0.05）。结论 当前健康教育课程的教学内容和结构未能完全满足不同学制、年级医学生的学习需求,需要对课程教学内容、教学方式和开设时间进行进一步的优化设计。     

2型糖尿病并发症预防护理及健康教育体会

目的探讨2型糖尿病患者的健康教育和并发症预防性护理效果。方法选取我院于2017年1月-2019年1月收治的100例2型糖尿病患者,随机分成对照组和试验组,每组各50例,对照组行常规护理,试验组行健康教育和并发症预防护理,比较两组患者的护理效果。结果试验组的空腹血糖、血糖下降幅度改善程度均优于对照组(P<0.05),试验组的肾病、心脑血管和眼病等并发症发生率低于对照组(P<0.05),试验组的疾病知晓率和护理满意度均高于对照组(P<0.05)。结论健康教育能有效提高2型糖尿病患者对疾病知晓率和护理满意度,增加患者的临床治疗配合度,进而有效控制患者血糖。同时对并发症进行预防性护理效果明显,能有效降低糖尿病患者并发症的发生。     

综合医院慢性病管理体系建立及防控效果评价

目的探讨建立综合医院慢性病(CNCD)管理体系并对其在我院试行效果进行评价。方法选取2019年1月1日-2020年9月30日我院各科室收治的CNCD患者作为研究对象,按照是否实施综合医院CNCD管理体系将所有患者分为两组,2019年1月1日-2019年12月31日实施综合医院CNCD管理体系前CNCD患者临床资料作为对照组,2020年1月1日-2020年9月30日实施综合医院CNCD管理体系后CNCD患者临床资料作为观察组,对两组临床资料进行对比分析。同时选取20名我院CNCD管理及防治岗骨干组成专家组,对我院CNCD管理体系进行评价。结果 CNCD管理体系实施后患者CNCD疾病知识掌握情况、治疗依从性、按时复诊率、患者就诊满意度及CNCD管理能力均显著高于CNCD管理体系实施前(P <0.05)。结论我院构建的综合医院CNCD管理体系基本符合我院实际情况,自该制度实施以来我院CNCD管理能力得到显著提升,CNCD筛查能力的提升大大增加了无症状患者的检出率,对CNCD防控具有重要意义,同时患者就诊满意度和治疗依从性均得到提升,表明我院CNCD管理体系适用于我院,值得沿用。     

生命伦理学视域中的健康教育——基于新型冠状病毒肺炎疫情的反思

健康教育是通过有计划地提供利于个人健康和社区健康的学习机会,包括一些旨在提高健康素养的交流形式,以提高人们健康知识,发展生活技能。面对新型冠状病毒肺炎疫情这一重大突发公共卫生事件,健康教育的重要性凸显出来,其尊重生命、健康责任、健康关爱权等生命伦理内涵也为预防疫情提供相关理论支撑。为更好地实现健康教育在面对重大突发公共卫生事件中的作用,应从建立健康的生活方式、增强传染性疾病的预防意识、加强公众健康道德教育与普及死亡教育等方面加强健康教育。     

北京市家庭医生团队成员视角下的出诊服务认知情况调查

目的  结合北京市家庭医生团队成员对出诊条件、人员、程序等方面的认知情况及意见，完善家庭医生团队出诊服务制度。方法  对北京市3个城区部分社区医院家庭医生团队成员进行问卷调查。结果  全科医生和护士、家庭医生助理的认知情况一致：在出诊条件上，分别有39.45%、54.13%的成员不认同限制患者年龄、病种，60.55%认为重度以上失能患者才可享受出诊服务；在出诊人员上，65.14%的成员认同一医一护出诊；在出诊程序上，43.12%的成员认同“患者申请、家庭医生审核评估、社区医院批准后出诊”流程。结论  建议政府相关部门明确出诊条件、重点照顾70岁以上罹患慢性病且重度以上失能患者；根据诊疗目录明确出诊医务人员配置；规范、简化出诊决定程序。     

Self-management interventions for adults with stroke: A scoping review

BackgroundStroke is a principal cause of mortality and disability globally. Numerous studies have contributed to the knowledge base regarding self-management interventions among chronic disease patients, but there are few such studies for patients with stroke. Therefore, it is necessary to analyze self-management interventions among stroke patients. This scoping review aimed to systematically identify and describe randomized controlled trials (RCTs) of self-management interventions for adults with stroke.MethodsA review team carried out a scoping review on stroke and self-management interventions based on the methodology of Arksey and O'Malley, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, Embase, Web of Science, CINAHL Plus Full Text, Medline Plus Full Text, and Cochrane Central Register of Controlled Trials were searched from inception to July 2020.ResultsFifty-four RCTs were included. The most popular study design is comparing a self-management intervention to usual care or waitlist control condition. Physical activity is the most common intervention topic, and interventions were mainly delivered face to face. The majority of interventions were located in inpatient and multiple settings. Interventions were conducted by various providers, with nurses the most common provider group. Symptom management was the most frequently reported outcome domain that improved.ConclusionsSelf-management interventions benefit the symptom management of stroke patients a lot. The reasonable time for intervention is at least 6–12 months. Multifarious intervention topics, delivery formats, and providers are adopted mostly to meet the multiple needs of this population. Physical activity was the most popular topic currently. Studies comparing the effect of different types of self-management interventions are required in the future.