从不同高血压防治指南的比较看高血压治疗策略的变化

为减少因高血压造成的各种心血管事件,世界不同地区制定或修订了适合自己的高血压防治指南.通过对JNC7、ESH/ESC及2004年中国高血压防治指南的比较及分析,以便能更全面、正确地理解和发展我国新的高血压指南,并将该指南灵活运用于实际工作.     

从JNC高血压指南的演变史看盐与高血压的关系

高血压是当今世界上最大的流行病,是脑卒中、心脏病及肾脏病最主要的危险因素。通过回顾比较不同时期的JNC高血压指南,了解对盐与高血压关系认识的发展过程,体会限盐对高血压防治的重要性及发展前景。     

中美欧高血压指南之比较

通过高血压的定义、分类,危险因素评估,危险分层及治疗,比较了中国、美国、欧洲高血压治疗指南相同和不同,这对于我国高血压的防治有十分重要的意义.     

高血压防治模式探讨

高血压是一种严重危害人体健康的生活方式病,也是一种心身疾病。它的危害性较之烈性传染病有过之而无不及。但高血压防治仍停留在“专家模式”一头热的困局上,临床指南与临床实践有较大差距。高血压知晓率、治疗率和控制率均低。造成“三低”的原因有:(1)对高血压这种慢性、流行性疾病的危害性认识不足;(2)健康观念存在误区;(3)迷信一劳永逸的治疗方法;(4)人群防治知识缺乏、素质低下。高血压防治是一个科学的综合管理过程,只有从健康教育入手,全面提高人群高血压防治知识水平,才能开创高血压防治的新局面。健康追求不应只是个人行为,还必须是群体行为和社会行为。人群有了健康观念、健康心态和健康智慧,高血压的防治才能取得真正的成效。     

阿司匹林在高血压治疗中的应用与意义

高血压,即使是经过了治疗,仍较正常人有较高的心血管并发症的发生。高血压有关的并发症对患者的生活质量及预后有较大的影响。其首要死亡原因是缺血性事件。阿司匹林是经过大量安慰剂对照、随机临床试验证实、可降低首次心肌梗死及缺血性脑卒中危险的抗血小板药物。近年来有关阿司匹林在防治缺血性心血管病方面的循证医学证据逐渐增多,国内及国际的心血管病防治指南均推荐应用阿司匹林。随着卒中预防领域内几项关键性的临床试验（ESPRIT、CHARISMA及WHS）的公布,美国心脏协会／美国卒中协会写作委员会对2006版指南的内容进行了更新。本文结合新的临床试验的证据,对阿司匹林在高血压治疗中的意义进行了分析,以期能更适当地应用阿司匹林,减少与高血压有关的缺血事件,提高人口的生存质量及寿命。     

阿司匹林在高血压治疗中的应用与意义

高血压,即使是经过了治疗,仍较正常人有较高的心血管并发症的发生。高血压有关的并发症对患者的生活质量及预后有较大的影响。其首要死亡原因是缺血性事件。阿司匹林是经过大量安慰剂对照、随机临床试验证实、可降低首次心肌梗死及缺血性脑卒中危险的抗血小板药物。近年来有关阿司匹林在防治缺血性心血管病方面的循证医学证据逐渐增多,国内及国际的心血管病防治指南均推荐应用阿司匹林。随着卒中预防领域内几项关键性的临床试验（ESPRIT、CHARISMA及WHS）的公布,美国心脏协会／美国卒中协会写作委员会对2006版指南的内容进行了更新。本文结合新的临床试验的证据,对阿司匹林在高血压治疗中的意义进行了分析,以期能更适当地应用阿司匹林,减少与高血压有关的缺血事件,提高人口的生存质量及寿命。     

高血压防治模式探讨

高血压是一种严重危害人体健康的生活方式病,也是一种心身疾病.它的危害性较之烈性传染病有过之而无不及.但高血压防治仍停留在"专家模式"一头热的困局上,临床指南与临床实践有较大差距.高血压知晓率、治疗率和控制率均低.造成"三低"的原因有:(1)对高血压这种慢性、流行性疾病的危害性认识不足;(2)健康观念存在误区;(3)迷信一劳永逸的治疗方法;(4)人群防治知识缺乏、素质低下.高血压防治是一个科学的综合管理过程,只有从健康教育入手,全面提高人群高血压防治知识水平,才能开创高血压防治的新局面.健康追求不应只是个人行为,还必须是群体行为和社会行为.人群有了健康观念、健康心态和健康智慧,高血压的防治才能取得真正的成效.     

不同高血压治疗指南的比较与分析

为了更好的控制高血压的发病率和死亡率,达到对高血压患者的最佳和规范化治疗,各国家和地区的医疗机构均制定了相应的治疗指南,并及时进行更新和修正。由于这些指南之间存在着不同程度的差异,导致医疗工作者在学习和实践中产生了一定的困惑,通过运用哲学的思维和方法论对四种主要的高血压治疗指南的异同点进行比较和分析,有利于我国临床医师更好地将其运用于临床,从而更好地控制高血压患者的病情。     

高血压病人呼唤全程医疗保健模式--把高血压技术因素与非技术因素相结合

高血压是全世界 ,也是我国最常见的心血管系统疾病。业已证明 ,有效控制血压及其相关危险因素 ,可以降低脑卒中、冠心病的发生率及死亡率。但是 ,1999年世界卫生组织及国际高血压协会高血压处理指南指出 :将研究发现用于临床实践仍有困难 ,“半数”法则适用于世界上许多国家 ,(仅半数高血压者知道血压高 ,其中仅一半接受治疗 ,后者仅一半达标 )。强调如果不将指南变成行动 ,将一是无成[1] 。解决半数法则 ,要求我们认真研究如何才能更好地完成将研究成果转化为病人切实受益的临床实践。将高血压治疗模式由治疗为主的医院就诊模式转为以预防…     

不同高血压治疗指南的比较与分析

为了更好的控制高血压的发病率和死亡率,达到对高血压患者的最佳和规范化治疗,各国家和地区的医疗机构均制定了相应的治疗指南,并及时进行更新和修正.由于这些指南之间存在着不同程度的差异,导致医疗工作者在学习和实践中产生了一定的困惑,通过运用哲学的思维和方法论对四种主要的高血压治疗指南的异同点进行比较和分析,有利于我国临床医师更好地将其运用于临床,从而更好地控制高血压患者的病情.     

高血压患者长期应用阿司匹林应注意的问题

我国高血压患者人数已高达1．6亿。高血压的严重后果是心脑血管血栓性事件（心绞痛、心肌梗死、脑梗死等）发生率的显著增高。大量的证据显示,每天100mg阿司匹林可以有效预防血栓性事件,使心肌梗死的发生率下降1／3,脑梗死发生率下降1／4,心血管疾病病死率下降1／6,国内外指南均明确规定有适应证的高血压患者需终身服用阿可匹林。本文就长期应用阿司匹林应注意的问题做一综述。     

Die Behandlung paraphiler Störungen mit GnRH-Agonisten unter besonderer Berücksichtigung ethischer und rechtlicher Aspekte

Current guidelines recommend the use of antiandrogenic medication in addition to psychotherapeutic procedures in the treatment of patients and sexual offenders with severe paraphilic disorders and a high to very high risk of committing severe sexual offences. This article provides an overview about the current state of research concerning the effectiveness and possible side effects of antiandrogens and discusses the legal and ethical basis of using antiandrogens in the therapy of paraphilic disorders with a focus on gonadotropin-releasing hormone (GnRH) agonists. Meanwhile, a great deal of empirical evidence exists with respect to the effectiveness of GnRH agonists for lowering paraphilic sexual fantasies and behaviors; however, GnRH agonist treatment also still has a risk of mild to severe undesired side effects, e.?g. hypertension, hyperlipidemia, liver damage, bone demineralization and depression. Nevertheless, in German forensic psychiatric institutions a not insignificant proportion of patients are treated with antiandrogens and furthermore, in the last few years treatment with GnRH agonists has become more important. In Germany, GnRH agonists can only be used on a voluntary basis; however, in some European countries and North American states legal statutes for compulsory treatment also exist. This is clearly contrary to the recommendations of current international guidelines. In light of the fact that GnRH agonist treatment could violate basic human rights, the need for an ethically sound approach is even more important in the decision for therapy with GnRH agonists. This article provides some proposals for a treatment approach that is in line with current ethical and legal requirements.     

The Infectious Diseases Society of America Lyme guidelines: a cautionary tale about the development of clinical practice guidelines

Flawed clinical practice guidelines may compromise patient care. Commercial conflicts of interest on panels that write treatment guidelines are particularly problematic, because panelists may have conflicting agendas that influence guideline recommendations. Historically, there has been no legal remedy for conflicts of interest on guidelines panels. However, in May 2008, the Attorney General of Connecticut concluded a ground-breaking antitrust investigation into the development of Lyme disease treatment guidelines by one of the largest medical societies in the United States, the Infectious Diseases Society of America (IDSA). Although the investigation found significant flaws in the IDSA guidelines development process, the subsequent review of the guidelines mandated by the settlement was compromised by a lack of impartiality at various stages of the IDSA review process. This article will examine the interplay between the recent calls for guidelines reform, the ethical canons of medicine, and due process considerations under antitrust laws as they apply to the formulation of the IDSA Lyme disease treatment guidelines. The article will also discuss pitfalls in the implementation of the IDSA antitrust settlement that should be avoided in the future.     

Guidelines with Strategies for Enhancement of Resilience and Psycho-Social Well-Being in Professional Nurses

There are currently no guidelines available for enhancement of resilience in professional nurses. This study aims to provide broad guidelines with specific strategies that may enhance resilience and psycho-social well-being in professional nurses. These guidelines are based findings from previous qualitative research on resilience in professional nurses in the public and private sector in South Africa. We used Kumpfer's (1999) theoretical model of resilience to frame the guidelines. Resilience among professional nurses appears to vary in manifestation across settings of practice.     

ISSUES AND IMPLICATIONS OF ESTABLISHING GUIDELINES FOR THE USE OF BEHAVIORAL TECHNIQUES

Several guidelines surrounding the use of behavioral procedures have recently appeared, the best of which is that of the National Association of Retarded Citizens (NARC). Some issues and implications of the establishment of guidelines are briefly reviewed in the context of the NARC guidelines. Issues include the factual versus opinion bases for guidelines and the need to continue the development of explicit behavioral criteria for assessing staff competence. Implications for programs include the impact of guidelines on professional boundaries, administrative decision-making, and budgeting, together with the dangers of expanding the regulatory bureaucracy. Several miscellaneous impacts are noted, including a potential for curbing innovative behavioral technology.     

The American psychological Association's practice guidelines for men and boys: Are they hurting rather than helping male mental wellness?

Introduced in 2018, the American Psychological Association's (APA) Practice Guidelines for Men and Boys was intended to provide helpful direction for practitioners when seeing male patients. This followed in the tradition of other practice and clinical guidelines for clinical work with specific identity populations. However, the practice guidelines for men and boys quickly became controversial given concerns that the guidelines were disparaging of men and boys, particularly those with traditional values and sought to impose progressive or feminist gender norms and ideologies rather than remaining focused on clinical wellness and empathy. This review finds that, though the guidelines were offered in good faith, many of the critiques are likely valid. Specifically, the guidelines failed to acknowledge significant evidence for biological influences on gender (e.g., hormonal, and hypothalamic influences on gender identity and gendered behavior), were unintentionally disparaging of traditional men and families, and were too closely wedded to specific sociocultural narratives and incurious of data not supporting those narratives. It is concluded that there are reasonable concerns that the current guidelines may do more harm than good by dissuading traditional men and families from seeking counseling.     

Design and Development of the ITC Guidelines on Computer-Based and Internet-Delivered Testing

This article describes the design and development of the International Test Commission's (ITC, this issue) Guidelines for Computer-Based and Internet-Delivered Testing. It examines some of the reasons why the ITC Council decided to invest in a program of research, consultation, and conferences designed to develop internationally agreed-on guidelines specifically aimed at computer- and Internet-based testing and describes the methodology involved in developing and disseminating the guidelines. Through a process of reviewing relevant literature and organizing conferences and wide consultations, a set of internationally recognized guidelines that highlighted good practice issues in computer/Internet testing were developed. The guidelines will raise awareness among all stakeholders in the testing process of what constitutes good practice in computer/Internet testing and can be used as a benchmark to set local standards and guidelines. Further issues are raised from the research, not least the need to ensure that with advances in technology and science comes the updating of training in tests and testing to keep up with such advances.