新型冠状病毒肺炎预防与营养治疗方案汇总分析

目的:全面检索国内新型冠状病毒肺炎(以下简称:COVID-19)疫情发生以来预防与营养治疗的专家建议、指南及相关文献,就COVID-19预防与营养治疗策略做一分析总结,以期为临床应用提供参考。方法:检索国家卫生健康委、中医药管理局官方网站以及中国知网、万方、维普等相关数据库,纳入有关COVID-19预防与营养治疗的推荐方案(截止日期到2020年4月1日),分类汇总分析。结果:共检索出中文文献20篇,发表时间为2020年1月至3月。其中膳食营养预防5篇、营养治疗专家建议6篇、指南1篇、危重症病人规范化营养治疗路径1篇、营养评估1篇、个体化1篇、呼吸系统疾病营养支持系统评价1篇及特殊人群4篇。结论:合理的营养膳食以及时机恰当、方案个体化、监护常态化的营养支持是COVID-19预防及治疗过程中必不可少的手段之一,临床应在规范的前提下推广应用。     

Investigating the relationship between social care supply and healthcare utilization by older people in England

Since 2010, adult social care spending in England has fallen significantly in real terms whilst demand has risen. Reductions in social care supply may also have impacted demand for NHS services, particularly for those whose care is provided at the interface of the health and care systems. We analyzed a panel dataset of 150 local authorities (councils) to test potential impacts on hospital utilization by people aged 65 and over: emergency admission rates for falls and hip fractures (“front‐door” measures); and extended stays of 7 days or longer; and 21 days or longer (“back‐door” measures). Changes in social care supply were assessed in two ways: gross current expenditure (per capita 65 and over) adjusted by local labor costs and social care workforce (per capita 18 and over). We ran negative binomial models, controlling for deprivation, ethnicity, age, unpaid care, council class, and year effects. To account for potential endogeneity, we ran instrumental variable regressions and dynamic panel models. Sensitivity analysis explored potential effects of funding for integrated care (the Better Care Fund). There was no consistent evidence that councils with higher per capita spend or higher social care staffing rates had lower hospital admission rates or shorter hospital stays.     

Effectiveness of Preventive Therapy for Persons Exposed at Home to Drug-Resistant Tuberculosis,Karachi, Pakistan

In Karachi, Pakistan, a South Asian megacity with a high prevalence of tuberculosis (TB) and low HIV prevalence, we assessed the effectiveness of fluoroquinolone-based preventive therapy for drug-resistant (DR) TB exposure. During February 2016–March 2017, high-risk household contacts of DR TB patients began a 6-month course of preventive therapy with a fluoroquinolone-based, 2-drug regimen. We assessed effectiveness in this cohort by comparing the rate and risk for TB disease over 2 years to the rates and risks reported in the literature. Of 172 participants, TB occurred in 2 persons over 336 person-years of observation. TB disease incidence rate observed in the cohort was 6.0/1,000 person-years. The incidence rate ratio ranged from 0.29 (95% CI 0.04–1.3) to 0.50 (95% CI 0.06–2.8), with a pooled estimate of 0.35 (95% CI 0.14–0.87). Overall, fluoroquinolone-based preventive therapy for DR TB exposure reduced risk for TB disease by 65%.     

Cost-Effectiveness of an Online Intervention for Caregivers of People Living With Dementia

ObjectivesLittle evidence exists on costs or cost-effectiveness of online interventions for caregivers of people living with dementia. We aimed to assess cost-effectiveness of online cognitive behavioral therapy (CBT) for dementia caregivers with mild-to-moderate depression/anxiety, with or without telephone support, relative to a psychoeducational control treatment.DesignCost-effectiveness study of data from 3-armed randomized controlled trial comparing computerized CBT (cCBT) or telephone-supported cCBT (cCBT+Telephone) to modular online educational program on dementia (Psychoeducation).Setting and ParticipantsUK-resident adult dementia caregivers with mild-to-moderate anxiety/depression.Cost-effectiveness analysisWe calculated health and social care costs, from participant-reported data collected at baseline, 12, 26 weeks, costs of intervention delivery. We examined 3 outcomes: cost of one-point reduction in General Health Questionnaire–12 (GHQ-12) rating at 26-weeks, cost of prevented “caseness” on GHQ-12 at 26 weeks, and cost per quality-adjusted life year (QALY) based on Short Form–6 Dimensions (SF-6D) over 26 weeks.ResultsData from 176 participants (44 cCBT, 91 cCBT+Telephone, 41 Psychoeducation) were analyzed. Costs did not differ between cCBT and Psychoeducation; costs were £125 higher in cCBT+Telephone. Control and intervention groups did not differ on GHQ-12. Caseness was lower in cCBT+Telephone than Psychoeducation; cost of preventing a case was £610, and probability of cost-effectiveness on this outcome reached 98.5% at willingness to pay (WTP) of £12,900. Mean QALY did not differ between cCBT+Telephone and Psychoeducation. QALY gain in cCBT was 0.01 (95% CI 0.001, 0.021). Cost per QALY was £8130. Although base case probability of cost-effectiveness of cCBT was 93% at WTP-per-QALY of £27,600, sensitivity analyses suggested cCBT+Telephone was the more cost-effective.Conclusions and ImplicationsWe report preliminary evidence for adopting telephone-supported online CBT. This may be cost-effective in preventing a case of mental health disorder if, absent a societally accepted WTP threshold for this outcome, payers are willing to pay £12,900. Future research should investigate whether supported/unsupported online CBT improves health-related quality of life.     

早期认知-行为干预对冠心病介入治疗患者心功能及自我管理能力的影响

目的 观察早期认知-行为干预对冠心病介入治疗患者心功能及自我管理能力的影响。方法 将2019年2月至2021年2月于我院接受介入治疗的100例冠心病患者随机分为观察组与对照组各50例。对照组予以常规护理,观察组在对照组基础上实施早期认知-行为干预。对比两组的心功能[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)及左室后壁厚度(LVPWd)]、自我管理能力。结果 护理后,观察组的LVEF高于对照组, LVEDD、 LVPWd低于对照组(P<0.05)。护理后,观察组症状管理、角色功能、情绪控制、沟通能力评分均高于对照组(P<0.05)。结论 早期认知-行为干预可显著改善冠心病介入治疗患者心功能状态与自我管理能力,促进其病情恢复,值得临床推广应用。     

儿童心理问题的家庭治疗原则与策略

儿童心理问题的常规治疗包括心理治疗和药物治疗,但是两者具有一定的局限性和社会不适性。家庭对儿童的成长具有重大影响,也是儿童出现心理问题的重要源头,所以家庭的介入对于心理问题儿童的治疗非常关键。家庭治疗的主要原则包括培养儿童的独立性、解决儿童与外界之间的冲突以及重视家庭成员间的和谐关系。家庭治疗所采取的策略主要是转变家庭内部态度、重视家庭的整体性、心理治疗和家庭治疗的互相配合以及对医学诊断的重视。在专业医学诊断指导下,通过家庭介入传统的心理治疗,从而更好地改善儿童所面临的心理问题。本文回顾了现有的儿童心理问题的研究成果,强调了家庭对儿童心理问题的影响,总结了儿童心理问题的家庭治疗原则和策略。     

健脾清热中药治疗Ⅰ型幽门螺杆菌相关性胃炎的研究

目的　研究健脾清热中药对Ⅰ型幽门螺杆菌相关性胃炎的疗效。方法　 10 0例Ⅰ型幽门螺杆菌感染的慢性胃炎患者随机分成 2组。研究组 (A组 ) 5 0例 ,服用健脾清热中药 (汤剂 ) 5 0ml 3 日 ,雷尼替丁 15 0mg 2 日 ;对照组(B组 ) 5 0例 ,口服甲硝唑 40 0mg 2 日 ,阿莫西林 10 0 0mg 2 日 ,雷尼替丁 15 0mg2 日 ,疗程均为 2周。停药 4周后给予1 4　C -UBT试验。结果　临床症状缓解率A组高于B组 (P <0 .0 5 ) ,HP的根除率两组间不存在显著差异 (P >0 .0 5 ) ,而A组产生的治疗副作用少。结论　健脾清热中药外加雷尼替丁是一种根除Ⅰ型幽门螺杆菌和缓解慢性胃炎症状的有效组合。     

胞二磷胆碱治疗轻度脑梗塞急性期52例的疗效分析

目的　探讨在轻、中度脑梗塞急性期使用胞二磷胆碱的临床疗效。方法　本文选择轻度脑梗塞急性期5 2例 ,在使用抗凝、溶栓治疗的基础上加用胞二磷胆碱作治疗组 ,另选择 31例不加用胞二磷胆碱作对照组进行临床疗效观察。治疗组使用胞二磷胆碱 0 .5加入 10 %葡萄糖注射液 2 5 0ml,一日一次 ,静滴 ,十天为一疗程 ,连用 1-3个疗程。结果　治疗组有效率为 92 .31% ,其中显效率 36 .5 4% ;对照组 5 4.84% ,显效率 16 .13% ,显著低于治疗组 (P <0 .0 1)。疗程观察以第三个疗程为宜 ,其有效率占治疗组有效率的 5 8.33%。结论　胞二磷胆碱在脑梗塞急性期使用 ,主要是促进脑梗塞可逆性组织损伤的恢复 ,防止脑缺血后改变的加重 ,使脑细胞活化 ,促进脑细胞机能的修复 ,是一种既安全可靠 ,又经济实用的脑细胞活化剂。     

梗死前心绞痛对急性心肌梗死溶栓治疗及近期预后的影响

目的　探讨梗死前心绞痛对急性心肌梗死溶栓治疗及近期预后的影响。方法　本文将 98例急性Q波心肌梗死病人 ,按梗死前 4 8h内心绞痛的有无 ,分为AP( +)和AP( - )组 ,分别观察两组溶栓再通率、CPK峰值、达峰时间、坏死Q波导联数、住院期间心力衰竭、恶性心律失常、心源性休克的发生率、病死率 ,出院时室壁瘤及左室射血分数。结果　两组均有显著性差异。结论　梗死前心绞痛对急性心肌梗死有潜在的治疗意义 ,可影响预后。     

化学性血管再狭窄大鼠模型的建立

为了开展对平滑肌增生引起血管狭窄的实验研究。用化学方法损伤内皮细胞建立血管平滑肌增生模型。方法是利用不同浓度三氯化铁和改变作用时间,造成不同程度的血管内皮损伤,使平滑肌细胞从中膜迁移到内膜增生形成的动脉狭窄,其病理变化和气囊插管法相似,操作容易,可定量控制损伤程度,个体间差异较小,适于大规模药效试验和新药筛选。