公共卫生监测的过去、现在和未来:(三)未来

目的 该文通过描述公共卫生行动的计划、实施和评价,及对卫生数据不断地系统地进行收集、分析、解释和利用公共卫生信息的过程,对公共卫生监测的未来发展进行综述。不限于传统的传染病监测,公共卫生监测已被应用到多个领域,计算机信息技术也被引入到公共卫生监测中,监测的方法也有了很大的转变和改进,同时也面临着巨大的挑战,需要卫生工作者加强合作,提高全球监测能力。     

The nursing shortage. Past, present, and future

According to healthcare experts, the present nursing shortage is going to extend to 2020 with an estimated 400,000 RN vacancies. A number of factors are contributing to the shortage: an increase in the age of registered nurses, decreased school enrollment, increased career opportunities for women, changes in the healthcare delivery system, nurse "burn-out," and the public's misunderstanding of what nurses do. Additionally, a number of social and economic trends are going to affect the healthcare delivery system in the future, such as: aging of the population, increased technology, the increase of the health/wellness movement, changes in employee's work ethic, influence of Generation X and dot.com workers, and scarcity of entry-level and low-wage workers. If nursing is going to be a major player in the healthcare delivery system in 2020, nurses must take an active role in developing and implementing a strategic plan. We need to look beyond solutions used in the past, such as increasing compensation and modifying school curriculums.     

EMS in Taiwan: Past,present, and future

Taiwan is a small island country located in East Asia. From around 1995 modern concepts of the EMS were imported and supported by legislation. Considerable progress has since been made towards the construction of an effective pre-hospital care system. This article introduces the current status of the EMS in Taiwan, including the systems, response configurations, funding, personnel, medical directorship, and outcome research. The features and problems of in-hospital emergency care are also discussed. Key areas for further development in the country vary depending on regional differences in available resource and population density. An analysis of the strength, weakness, opportunity, and threats of the evolving EMS in Taiwan could be an example for other countries where the EMS is undergoing a similar process of development and optimisation.     

Influenza. Past,present, and future

Influenza is a viral infection of the respiratory tract spread by airborne transmission. Vaccination remains the best strategy for influenza prevention, and is especially recommended for high-risk groups, such as residents of nursing or residential homes, as well as those with diabetes, chronic renal failure, or chronic respiratory conditions. The clinician must realize the importance of active surveillance in addition to symptomatology interpretation and diagnostic testing to reliably and efficiently diagnose influenza. Active surveillance allows the clinician to monitor regional patterns of influenza movement to know when influenza is present in any given area. Surveillance data allows the practitioner to effectively time vaccination programs and implement prophylaxis protocols as indicated. An influenza management protocol ensuring the prompt recognition and management of influenza outbreaks should be devised and implemented for high-risk facilities. Managing clients with influenza requires prompt diagnosis and initiation of therapy, including use of antivirals available for the prevention or treatment of influenza. Because of the severity of morbidity and mortality caused by the influenza virus among older adults in particular, it is imperative that gerontological nurses have expert knowledge related to influenza. The clinician who participates in active influenza surveillance, promotes vaccination programs, implements influenza management protocols, and stays abreast of recent breakthroughs in the arena of influenza research--such as the development of neuraminidase inhibitors--will be able to contribute to diminishing the morbidity and mortality impact associated with influenza.     

The clinical role of nurse lecturers: Past, present, and future

The clinical role of nurse lecturers has been the subject of much debate since the transfer of nurse education into Higher Education Institutions within the United Kingdom. This article provides a critical evaluation of the clinical role of nurse lecturers in terms of policy drivers and strategies for implementing national guidelines. Policies from the initiation of Project 2000, through to recent consultation documents on the support of students in practice, are evaluated. Formal aspects of the nurse lecturer remit, such as link tutor and personal supervisor roles, are discussed in terms of their impact on clinical practice. There is also a brief review of the development of the lecturer practitioner role as a bridge between education and practice. The fundamental arguments in support of nurse lecturers maintaining a clinical role in practice are analysed. This analysis includes consideration of the concept of 'clinical credibility' in terms of the impact on teaching and the closure of the theory-practice gap. The article concludes with suggestions for strategies to resolve the ongoing debate surrounding the clinical role of nurse lecturers. These recommendations include a review of staff:student ratios in nurse education, re-evaluation of the need for a clinical role, and the use of innovative recruitment and development strategies by higher education institutions.     

Past, present, and future: a 7-year update of Viagra (sildenafil citrate)

More than 30 million men are estimated to have erectile dysfunction (ED) in the United States. Worldwide, ED is estimated to affect more than 150 million men, and that number is expected to exceed 300 million men by the year 2025. The prevalence of ED ranges from 7% in men aged 18-29 years to 85% in men aged 76-85 years. In addition, a recent report showed that 68% of patients with ED aged 18 years and older have at least one comorbid diagnosis of hypertension, hyperlipidaemia, diabetes or depression, and research suggests that ED may be an early indicator of systemic vascular disease. Viagra (sildenafil citrate), the first-in-class phosphodiesterase type 5 (PDE5) inhibitor, was introduced in 1998 for the treatment of ED. In the 7 years since its market launch, more than 750,000 physicians have prescribed sildenafil to more than 23 million men, helping establish an excellent safety and efficacy record. Clinical studies have demonstrated that sildenafil successfully treats ED of varied organic, psychogenic or mixed aetiology, and is effective in men with ED and comorbidities such as hypertension, hyperlipidaemia, diabetes or depression. Sildenafil was a breakthrough medication that addressed a previously unfulfilled medical need. The impact of sildenafil has stimulated academic, clinical and industrial research to better understand the nature of sexual function and develop better treatment and management for sexual dysfunctions such as ED. With the advent of other erectogenic therapies for the treatment of ED, this 7-year update will focus on the unique history and development of sildenafil, its current use and applications and its future directions and indications. Special emphasis is placed on the impact of sildenafil on our understanding of sexual health and on the extensive safety and efficacy data that have been amassed from numerous clinical trials.     

中国心身医学：过去、现状与展望

本文中我们探讨了中国心身医学发展的历史,现状和未来展望。中国心身医学发展有鲜明特色,发展起源早但始终未形成完整的体系。直到1980年后中国心身医学才在相关组织和国际交流的推动下向体系化和学科化的方向发展。1993年,中华医学会心身医学分会成立,推动我国心身医学在科研、临床、教育、国际交流等方面不断进展。在未来,中国心身医学应当在发扬祖国医学特色的基础上,吸取西方心身医学的先进经验,有序推进体系化进程,实现中国心身医学的长足发展。