北京市养老机构老年人营养状况调查及其影响因素研究

背景　在人口老龄化日益加剧的社会背景之下，家庭养老功能不断减弱，机构养老成为今后发展的必然趋势。据报道，很多养老机构的老年人营养不合理，严重影响老年人的健康状况与生活质量。目的　通过调查北京市养老机构老年人营养现状及其影响因素，为全科医师营养教育及老年人生活质量提升提供理论依据。方法　2014年10月-2015年12月，采用方便整群抽样的方法，抽取了北京市7家养老机构，对符合纳入标准的老年人进行面对面问卷调查，问卷内容包括：一般情况、微型营养评定量表（MNA）、日常生活活动能力指数（BI）、老年人抑郁量表（GDS）。采用二元Logistic回归分析养老机构老年人营养状况的影响因素。结果　本研究共发放问卷258份，回收有效问卷258份，有效回收率为100%。被调查的258例老年人中，存在营养不良及存在营养不良发生风险的老年人共计75例（29.1%）。不同年龄、性别、婚姻状况、体质指数（BMI）、医疗费用支付方式、生活自理能力及精神状态的老年人营养状况比较，差异有统计学意义（P<0.05）。二元Logistic回归分析结果显示：年龄〔OR（95%CI）=2.349（1.070，5.156）〕、BMI〔OR（95%CI）=0.092（0.036，0.239）〕、医疗费用支付方式〔OR（95%CI）=0.208（0.083，0.522）〕、日常活动能力〔OR（95%CI）=10.214（3.099，33.669）〕、患病种数〔OR（95%CI）=2.682（1.248，5.763）〕及精神状态〔OR（95%CI）=4.822（2.005，11.600）〕是老年人营养状况的影响因素（P<0.05）。结论　北京地区养老机构的老年人面临着营养不良及营养不良发生风险的健康威胁，高龄、低BMI、抑郁、合并多种疾病、日常活动能力低下及无医保是其独立危险因素，需要对老年人加强个性化营养教育和营养治疗。     

放疗在肝癌治疗中应用的研究进展

肝癌是临床上常见的恶性肿瘤，因早期症状不典型，至发现时往往已为中晚期，失去最佳手术治疗时机和机会。作为非手术治疗之一的放射治疗技术，其发展在近年来已有了较大的进步。放疗包括体外放疗和体内放疗，皆具有一定的治疗效果和相对可控的不良反应。本文就肝癌放射治疗的应用进展作一综述。     

Patient-Centered Framework for Rehabilitation Research in Outpatient Settings

Conducting high-quality clinical research is dependent on merging scientific rigor with the clinical environment. This is often a complex endeavor that may include numerous barriers and competing interests. Overcoming these challenges and successfully integrating clinical research programs into clinical practice settings serving rehabilitation outpatients is beneficial from both a logistical perspective (eg, supports efficient and successful research procedures) and the establishment of a truly patient-centered research approach. Leveraging our experience with navigating this research-clinical care relationship, this article (1) proposes the Patient-Centered Framework for Rehabilitation Research, a model for integrating patient-centered research in an outpatient clinical setting that incorporates a collaborative, team-based model encompassing patient-centered values, as well as strategies for recruitment and retention, with a focus on populations living with disabilities or chronic diseases; (2) describes application of this framework in a comprehensive specialty multiple sclerosis center with both general strategies and specific examples to guide adaptation and implementation in other settings; and (3) discusses the effect of the framework as a model in 1 center, as well as the need for additional investigation and adaptation for other populations. The 5 interconnected principles incorporated in the Framework and which prioritize patient-centeredness include identifying shared values, partnering with the clinical setting, engaging with the population, building relationships with individuals, and designing accessible procedures. The Patient-Centered Framework for Rehabilitation Research is a model presented as an adaptable roadmap to guide researchers in hopes of not only improving individual patients’ experiences but also the quality and relevance of rehabilitation research as a whole. Future investigation is needed to test the Framework in other settings.     

中医体质研究40年回顾与展望

文章回顾中医体质研究40年来在6大理论创新、3大技术创新、4大转化应用、2大学术平台方面取得的辉煌成就。展望未来，中医体质研究将积极策应国家需求，进一步发挥其原创优势、深化理论研究、完善技术方法、加快平台建设、提升服务能力，为实施“健康中国”战略作贡献。     

新冠肺炎“动态清零”常态化下应急梯队护士体验的质性研究

目的 研究新型冠状病毒肺炎常态化疫情防控下应急梯队护士的真实体验。提出针对性改善护士的心理状况的方法和建议。方法 于2021年10月选取上海市静安区闸北中心医院应急梯队的护士11名为研究对象，对其进行半结构式面对面谈话，并采用Colaizzi七步分析法进行资料分析。结果 进入应急梯队的护士普遍存在着紧张焦虑，情绪低落，身心疲惫等心理问题。而执行完应急任务后的成就感，社会的认同，多方的理解支持，有利缓解心理压力。结论 通过对新型冠状病毒肺炎常态化疫情防控下应急梯队护士的真实体验的了解，护士普遍存在各种心理问题，需要给予针对性的干预措施，提高应急梯队成员的心理素质和应急能力。     

Challenges with Forecasting Budget Impact: A Case Study of Six ICER Reports

Background

Payers frequently rely on budget impact model (BIM) results to help determine drug coverage policy and its effect on their bottom line. It is unclear whether BIMs typically overestimate or underestimate real-world budget impact.