预防脑卒中——心内科医生责无旁贷

脑卒中是发病率和病死率高的疾病，在美国，脑卒中是位于心脏病和癌症之后的第3位致死原因疾病。据估计，美国每年有73万人发生脑卒中，其中约16万人因此而死亡，其致死率高达20％。在我国，脑血管病也已成为危害中老年人身体健康和生命的主要疾病。全国每年新发脑卒中约200万人，每年死于脑血管病约150万人，75％以上留有不同程度的残疾，估计每年用于脑卒中治疗的费用约120亿元人民币，已日益成为沉重的财政负担。     

心内科医生应关注糖代谢

流行病学证据表明心血管疾病患者伴糖代谢异常十分常见,伴糖代谢异常显著增加心血管疾病患者死亡和临床事件风险.关注心血管疾病患者糖代谢异常的筛查和管理,已成为心血管疾病综合管理的重要组成部分. 一、糖代谢异常合并心血管疾病的现状 中国每年近一千万死亡人数中80％由非传染性疾病导致.未来20年内,40岁以上中国人患至少一种非传染性疾病的数量将翻1～2倍,2005-2015年,仅心血管疾病、卒中和糖尿病三种疾病将在中国导致5500亿美元损失,如不能有效遏制,将会给我国带来沉重的经济和社会负担.     

“侵入性”心内科医生的培训

Conti于1984年在阐述如何培训临床心内科医生时提出培训时间须2～3年,其中心导管4个月,心脏专科门诊(咨询)4个月,冠心病监护病室8个月,非侵入性检查8个月,第三年据各人的需要选修一种专业。1985年11月1--2日在美国马利兰州Bethesda举行的第17届Bethesda讨论会上,就“成人心内科医生训练”进行全面讨论,包括8个训练任务:(1)临床心脏病学;(2)心电图;(3)心导管术;(4)超声;(5)核心脏与核学磁共振;(6)心脏起搏;(7)心律失常与特殊电生理检查;(8)心血管研究工作。随后,于1986年Conti提出了“侵入性”心内科医生     

高度关注高血糖 心内科医生的责任

1糖尿病是心血管疾病的等危症《新英格兰医学杂志》1999年发表芬兰East-West研究,提示在为期7年的随访时间里,确诊为糖尿病患者的预后与有心肌梗死史的患者相当。2001年,美国国家胆固醇教育计划成人治疗指南Ⅲ(NCEP-ATPⅢ)中将糖尿病列为冠心病的等危症正是基于这一发现。早在1999年,美国心脏学会就明确提出“糖尿病是心血管病”的观点。糖尿病患者罹患心血管疾病的危险是无糖尿病者的2~4倍。无心肌梗死史的糖尿病患者未来8~10年发生心肌梗死的危险高达20%,大约等同于已患心肌梗死患者再发心梗的危险。而已患心肌梗死的糖尿病患者未来再…     

心内科医生行肾动脉狭窄的介入治疗切实可行

动脉粥样硬化是全身性疾病,累及头颅血管可引起脑缺血,累及冠状动脉（冠脉）可引起心肌缺血,累及肾动脉可引起肾脏缺血,累及四肢血管可引起四肢功能障碍。冠脉狭窄所致的冠心病因为其危害最大,故最容易受到关注。冠脉的介入治疗也随着器械的发展开展得越来越普遍,冠脉造影及介入的普遍开展为及时发现很多并没有突出临床表现的肾动脉狭窄病人提供了可能。     

心内科医生心脏超声专项培训的体会

探讨心内科医生心脏超声专项培训的方法与经验。方法 组织我科主治医师、住院医师、进修医师、专业学位研究生进行心脏超声基本技能专项培训,采用观摩讲解-记录报告-上机实习-病例分析的模式分阶段实施,配合便携式超声诊断仪的操作学习。结果 经过3个月专项培训,所有参训医生均掌握心脏超声的基本技能,可独立完成简单的切面检查、数据采集,满足临床危急重症抢救时急诊超声检查的需要。结论心脏超声专项培训可提高心脏专科医生对超声检查的理解,有利于危急重症的病情判断及救治。     

脑卒中的预防

脑卒中在我国的发病率与死亡率占世界首位．虽近些年来死亡率已有明显下降．但发病率仍居高不下．即使在西方国家脑卒中死亡率从1993年以来下降18．5％．但发病率仅下降0．7％（据美国心脏协会报道）。     

病在腿上险在心上——心内科医生应关注外周血管疾病

外周血管疾病是“心脏以外的心脏病”。以前,临床医生和患者常将注意力集中到冠心病和脑卒中等心脑血管事件的后果,但动脉粥样硬化是一种全身性疾病,除冠状动脉和脑动脉外,还常累及包括下肢动脉在内的外周动脉,这种弥漫性的动脉粥样硬化对判断患者的预后有重要的意义。无论有无     

西红柿与预防脑卒中

新证据表明番茄红素不仅仅是抗癌因子。现在,享用西红柿的理由又多了一个:最近一项神经病学研究发现西红柿或有助于降低缺血性卒中的风险——大脑动脉受阻,导致脑细胞缺氧而死。朱弯劳斯(Edward Giovannucci)博士是哈佛公共健康学院营养学和流行病学教授。     

Management of adverse clinical events by duty physicians in a nursing home

BACKGROUND AND AIMS: The nature of adverse clinical events (ACE) during duty hours (16:00-08:00 and holidays), as well as the way they are addressed by duty physicians (DP) in a nursing home (NH) are the subject of this study. METHODS: Data, including medical details concerning ACEs and the resultant referrals to hospital, were collected prospectively during 183 consecutive days in a 90-bed NH. RESULTS: Ninety-six residents experienced 370 ACEs, representing an average of one for every 44.5 patient days. The highest rate of events was during evening hours (18:00-21:00). The most prevalent ACE was fever (32%). Most cases (53%) were treated by the DPs on site. No intervention was needed in 19% of cases, whereas 28% of ACEs (104 cases) were referred to the Emergency Room (ER) of a general hospital. Sixty-six percent of these were actually admitted. The rate of ER referral of residents was one for every 158 patient days. About 40% of the referred patients had been discharged from hospital the previous week. High fever was the commonest cause for referral: 47%. During the working hours of the study period, the rate of referral by the staff physician was only 1 for every 915 patient days. Only 17% of these had high fever. CONCLUSIONS: Evening rounds by staff physicians, strengthening of working relations with hospital physicians, as well as fostering intravenous treatment in NHs, are suggested as means for reducing hospital transfers. A standardized method for the reporting of ACEs and referrals to hospitals should be adopted in order to facilitate comparisons between NHs and to evaluate its use as a quality indicator.     

Prevention of sudden cardiac death

The problem of sudden cardiac death (SCD) is complex and many questions concerning the pathophysiologic mechanism are still unanswered. At present the only reliable way of recognizing high risk patients is by means of left ventricular dysfunction, measured as LV-EF相似文献   

Improved radiation protection for physicians performing cardiac catheterization

Physicians and their assistants performing diagnostic angiography must be concerned with the radiation exposure they receive. The introduction of hemiaxial projections for imaging has increased diagnostic accuracy but has also greatly increased the physicians' exposure to scattered radiation. This increase is especially critical for the eyes and thyroid of the physician who routinely performs these procedures. To reduce such exposure a ceiling-suspended shield (60 × 45 cm), made of 6.4 mm glass with a 19.5 kg/m² (4 lb/ft²) lead equivalency, was developed. During procedures the shield is interposed between the physician and the region of the patient acting as the source of scattered radiation. The degree of radiation protection to the operator was assessed by measuring the distribution of scattered radiation in the vicinity of the operator with and without the shield. The effectiveness of the shield was determined in the 30 ° right anterior oblique (RAO), 5 ° left anterior oblique (LAO), 35 ° LAO, and 50 ° LAO-15 ° cranial angulations. At critical heights such as the level of the eyes and thyroid, scattered radiation levels were reduced by 85% or greater in all angulations. Without interfering with the physician's ability to observe the patient or manipulate the catheter, this shield can significantly reduce the physician's exposure to radiation.     

Benefits of training physicians in advanced cardiac life support

Unexpected cardiopulmonary arrests occur commonly both in the prehospital setting and in the course of hospital care. Survival after prehospital arrest is improved if bystanders and paramedics are trained in basic and advanced cardiac life support. However, within the hospital, the bystanders are the physicians; it is not known if life support training of these hospital-based physician bystanders leads to improved survival. Therefore, we reviewed the outcome of resuscitation attempts in a teaching hospital during two matching six-month periods, before (period 1) and after (period 2) institution of a mandatory course in Advanced Cardiac Life Support (ACLS) for medical houseofficers. It was concluded that survival after inhospital cardiopulmonary arrest is significantly increased if house officers who staff the Code teams are trained in ACLS.