哮喘防控模式的几点思考

简单介绍了在支气管哮喘患者教育和管理工作中的若干体会.结果表明,我们所采取的哮喘教育管理体系(包括哮喘患者门诊、哮喘患者协会和哮喘宣教中心)是一种先进的医疗服务模式,不仅可以有效地改善医患关系,还可以显著提高哮喘患者对哮喘认知水平和防治疾病的依从性,提高哮喘控制水平、生命质量,减少非预约门诊、急诊、住院次数,降低医疗费用.     

哮喘控制与医疗改革

达到并维持哮喘控制和减少未来风险是哮喘的管理目标,绝大多数患者通过药物治疗可以实现这一目标。但目前哮喘控制率很低,除与GINA和我国哮喘诊治规范实施不足有关外,还与传统医疗结构、医疗体制和医疗观念有关,加速医疗改革,人人享有基本医疗卫生服务是提高哮喘控制率的重要环节。     

哮喘控制与医疗改革

达到并维持哮喘控制和减少未来风险是哮喘的管理目标,绝大多数患者通过药物治疗可以实现这一目标.但目前哮喘控制率很低,除与GINA和我国哮喘诊治规范实施不足有关外,还与传统医疗结构、医疗体制和医疗观念有关,加速医疗改革,人人享有基本医疗卫生服务是提高哮喘控制率的重要环节.     

我国城镇社区医疗单位如何进行哮喘防控

哮喘防控工作是一项长期而艰巨的任务,城镇社区医疗单位在工作中应推广以"哮喘临床控制"为核心的哮喘治疗循环模式,即评估患者的哮喘控制水平、治疗并达到哮喘控制、监测并维持哮喘控制。当患者出现哮喘急性发作时,应遵循哮喘急性发作的治疗流程规范处理,尽快有效控制患者的症状。     

我国城镇社区医疗单位如何进行哮喘防控

哮喘防控工作是一项长期而艰巨的任务,城镇社区医疗单位在工作中应推广以"哮喘临床控制"为核心的哮喘治疗循环模式,即评估患者的哮喘控制水平、治疗并达到哮喘控制、监测并维持哮喘控制.当患者出现哮喘急性发作时,应遵循哮喘急性发作的治疗流程规范处理,尽快有效控制患者的症状.     

浅析专家会诊中心在门诊医疗中的作用

随着物质生活水平的日益提高,人们对医疗、保健的需求越来越高。为缓解看专家门诊难和在门诊能及时解决疑难杂症会诊问题,江苏省人民医院于1997年成立了高级专家会诊中心。中心成立十余年来,会诊、就诊的患者逐年增多,中心以优质的服务,得到患者的好评,作为门诊医疗的“特殊”窗口发挥了越来越大的作用。     

浅析专家会诊中心在门诊医疗中的作用

随着物质生活水平的日益提高,人们对医疗、保健的需求越来越高.为缓解看专家门诊难和在门诊能及时解决疑难杂症会诊问题,江苏省人民医院于1997年成立了高级专家会诊中心.中心成立十余年来,会诊、就诊的患者逐年增多,中心以优质的服务,得到患者的好评,作为门诊医疗的"特殊"窗口发挥了越来越大的作用.     

构建妇科门诊和谐医患关系的伦理学思考

本文从医院管理因素、医务人员因素和患方因素三个方面对妇科门诊医患关系的影响因素进行伦理学分析,提出加强医院管理;医务人员转变服务理念,改善服务态度;加强业务学习,提高医疗水平和加强宣传,改善医务人员社会形象是改善医患关系,提高患者满意率,增强医疗竞争优势的关键。     

做好哮喘控制工作利国又利民

本文结合我院哮喘教育管理工作的成绩和经验,系统地阐述了做好哮喘控制工作的重要意义,包括减少哮喘发作减轻患者痛苦;提高哮喘患者生命质量;降低医疗费用;减轻社会和家庭负担;减少误工误学,保护社会生产力;有助于解决"看病贵"问题和构建和谐的医患关系等。     

做好哮喘控制工作利国又利民

本文结合我院哮喘教育管理工作的成绩和经验,系统地阐述了做好哮喘控制工作的重要意义,包括减少哮喘发作减轻患者痛苦;提高哮喘患者生命质量;降低医疗费用;减轻社会和家庭负担;减少误工误学,保护社会生产力;有助于解决"看病贵"问题和构建和谐的医患关系等.     

Childhood asthma: family therapy as an adjunct to routine management

A controlled trial of the effectiveness of family therapy for asthmatic children has been completed, and the results indicate that family therapy may have a part to play in the management of asthma. Our observations have shown that an interaction of psychosocial factors can have a significant effect on the course of the asthma by setting up a circular system which may ultimately lead to clinically intractable asthma, as well as intense emotional distress. Treatment is based on an understanding of the interactional model with the aim of interrupting the progressive sequence of events. A family approach is indicated when (1) emotional factors seem to be playing a significant part; (2) the asthmatic child is manifesting behaviour problems; (3) there is evidence of family psychopathology or (4) the asthma is not being reasonably well controlled with conventional methods of management.     

对哮喘患者进行教育管理的内容和方法

目前尚不能根治哮喘,然而长期管理有助于达到哮喘控制,哮喘教育是其重要组成部分。哮喘教育内容应包括哮喘的诊断、预防及治疗相关的知识、技能。应当采取个体化、循序渐进的教育方式,集体教育是个体化教育重要的补充。     

Interaction of asthmatics and their spouses: A preliminary study of individual differences

Some asthmatics show evidence of airways reactivity triggered by strong emotions. Six case studies of married patients with severe asthma are reported. The videotaped interactions of the asthmatic and his/her spouse were coded for affect and behavior. Repeated measures of pulmonary function and affective state were recorded before and after two interaction tasks. Over the course of the experimental period, two patients' pulmonary function improved and four patients' deteriorated. In general, decreased pulmonary function was associated with more self-rated hostility and depression. The results are discussed in terms of their implications for the intra- and interpersonal factors that are important in asthma management.     

A Randomized Controlled Pilot Study of Motivational Interviewing to Change Attitudes about Adherence to Medications for Asthma

The day-to-day management of asthma relies on patient self-care practices; in particular, adherent use of asthma medications is fundamental for asthma management. However, most persons with asthma do not use their medications to clinically acceptable standards. The purpose of this study was to test the efficacy of a brief educational intervention to enhance knowledge and skills relevant to asthma self-care, and the efficacy of motivational interviewing to improve attitudes toward taking medications as prescribed. Twenty-five adults with asthma were randomly assigned to receive a brief educational intervention alone, or education plus motivational interviewing. Over time, all participants improved their knowledge of asthma and skills using a metered dose inhaler. Participants who received education alone showed a decreased level of readiness to adhere with their medications over time, whereas participants who received motivational interviewing were more likely to show a stable or increased level of readiness to adhere over time. Among participants who described themselves as not consistently adhering with their medications at the first evaluation, those who received motivational interviewing endorsed more positive attitudes toward taking medications over time. The results are supportive of the utility of motivational interviewing in enhancing participants' attitudes toward adherent medication use. Future research should test if attitude change is reflected in change in medication use.     

La qualité de vie d'enfants asthmatiques participant à un programme d'éducation à la maladie

Our purpose is here to study the quality of life of asthmatic children involved in a program of education. Regarding this, we used the “OK. ado” of Manificat and Dazord, the Trait-Anxiety inventory for children of Spielberger, the questionnaires of educative diagnostic “Ce que tu sais” and “À toi de jouer” and our observations during the different sessions of the program of education. The analysis of the results we obtained for the questionnaires of educative diagnostic, and for the Trait-Anxiety inventory, combined with our observations confirmed the elements of the literature: asthma badly affects quality of life among children. It also shows the importance not to neglect the experience of asthmatic children in their treatment. Nevertheless, results obtained for the quality of life questionnaire (“OK. ado”) doesn't reveal the same dissatisfaction of children regarding their quality of life. This contradiction leads us to wonder about the influence of a group into the educational program and about the opposition between assessment of the quality of life and experience of the disease.     

哮喘教育和管理工作中的一些新的启示与思考

简要叙述了目前哮喘防治中存在的问题,提出必须彻底转变哮喘防控模式,简单介绍了我们自己的哮喘教育和管理的具体做法及其效果,最后就哮喘的防控和管理提出一些值得思考的问题,包括建立和谐医患关系,减轻医疗经济负担,建立新型疾病防控模式和医疗服务体系等。     

Systemic Research on Chronicity Factors in Infantile Asthma

This work is the result of research into chronicity factors in infantile asthma. The research had two main goals. The first, using a sample of 100 asthmatic children, was to reconstruct the therapeutic history of the individual patients on the hypothesis that the therapeutic intervention they had undergone in fact conditioned the quality of the cure demand. The second was to evaluate the influence of family dynamics on the chronic development of infantile asthma. A comparison was made between two interactive models using a sample of 10 families with asthmatic children with chronic tendencies and a sample of 10 normal families. The results show that typical dysfunctional interactive patterns exist in the experimental sample and that they are correlated with the perpetuation of the asthmatic symptom. The paper concludes that every therapeutic intervention that is limited to dealing with the biological component of the asthmatic symptom and ignores the influence of family dynamics becomes itself a major chronicity factor. Thus a “systemic” intervention is considered necessary to prevent chronicity.     

神经营养素3在小儿哮喘中表达的临床意义

神经营养素3（NT-3）参与了神经系统的发育和功能发挥.最近研究发现它在呼吸系统疾病,尤其是哮喘的发病中也发挥重要作用.本课题采用酶联免疫吸附实验（ELISA）检测哮喘各组和正常对照组血清中NT-3的表达水平;用NT-3体外刺激正常人外周血单核细胞（PBMC）,采用ELISA法检测培养上清中IL-6和TNFα的表达水平.结果显示,与对照组相比,在哮喘组血清中NT-3的表达水平明显增高;并且它在哮喘发作期和缓解期中的表达量也要高于正常组;另外,NT-3可以显著促进PBMC分泌IL-6和TNFα.以上结果提示,可以将NT-3在小儿哮喘患者血清中的表达水平作为诊断病变过程的标记物,并且NT-3在维持气道高反应性方面也起到一定作用.