防治血管剩留风险的决策探讨

针对冠心病和(或)2型糖尿病患者,已有许多有效的防治措施.然而,尽管接受了当前的标准治疗,这类患者仍会反复发生许多大血管和微血管事件,这种现象称之为血管刺留风险.有许多因素影响血管剩留风险的存在,其中最为重要的是致动脉粥样硬化性血脂异常.因此,采取积极的全面干预措施如改善生活方式、联合降脂以改善所有的脂质异常指标,是最大程度降低血管剩留风险的动向.     

ICU患者外出检查风险分析与对策

为了探讨ICU危重患者外出检查风险的原因,从而降低ICU危重患者外出检查风险,本文通过对312例ICU患者外出检查风险因素进行讨论分析,研究降低风险的对策,即在规范ICU患者外出检查流程、做好检查前准备和注意途中安全及返回后的护理,结果提示285例患者无意外发生,安全返回病房,其余27例患者存在一定风险,但在相应处理措施下均安全返回病房。     

科技与经济发展带来血管外科治疗模式的转变

血管外科在近十年发展迅速,其手术治疗已由传统开放手术为主转变成微创腔内治疗术为主的模式.这是科技与经济发展的必然结果,是现代医学新理念的具体体现.因此,要求从事血管外科的医务工作者科学看待手术模式的转变,熟练掌握各种新技术,努力创新,优化设计,降低手术风险及患者痛苦,提高手术安全性及患者术后生活质量.     

ICU患者外出检查风险分析与对策

为了探讨ICU危重患者外出检查风险的原因,从而降低ICU危重患者外出检查风险,本文通过对312例ICU患者外出检查风险因素进行讨论分析,研究降低风险的对策,即在规范ICU患者外出检查流程、做好检查前准备和注意途中安全及返回后的护理,结果提示285例患者无意外发生,安全返回病房,其余27例患者存在一定风险,但在相应处理措施下均安全返回病房.     

从ACCORD研究中再认识2型糖尿病强化降糖治疗

心血管并发症是2型糖尿病患者的主要死亡风险.减少2型糖尿病患者的心血管病死亡风险是2型糖尿病患者临床治疗的重要目的.强化降糖治疗能减少糖尿病患者心血管并发症及糖尿病相关死亡,但不同的个体应有不同的强化降糖措施和不同的标准.对于老年人、糖尿病病程长、心脑血管疾病高危人群需要在注重安全性的基础上进行个体化治疗.     

医疗风险防范与化解新趋向

新的《医疗事故处理条例》实施以后,患者的自我保护意识不断增强、高精尖医疗器械的应用、新技术的不断开展等均增加了医疗行为的风险,医疗风险管理显示出日益重要的作用。新形势下医疗风险管理的新趋向是建立自愿的医疗责任保险、组织患者参加医疗风险保险、建立强制性医疗责任保险制度、卫生行政部门代理保险业务、建立医疗援助基金等方式,提出了在风险控制的基础上,加强风险融资的措施。     

关注降压药物的选择，促使更有效的降压达标

我国成人高血压患病率高达18.8%,全国有高血压患者约1.6亿。合理的药物治疗是降压达标的主要措施,如何进行正确选择成为摆在我们面前的难题。目前,降压药物主要包括利尿剂、β受体阻断剂、血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂、钙拮抗剂和α受体阻断剂6类。因降压治疗的收益主要来自于降压本身,为了提高降压达标率及高血压患者的用药依从性,目前多主张低剂量联合治疗。     

炎症性肠病高凝状态与干预策略

炎症性肠病(IBD)患者发生静脉血栓(VTE)事件的风险大约是正常人的2倍~3倍,主要包括深静脉血栓(DVT)和肺栓塞(PE)。虽然具体机制尚不明确,但是研究发现IBD患者血液的高凝状态与纤溶系统的改变、血小板异常、凝血系统的激活以及血管内皮功能异常等有关。疾病严重程度、是否住院以及治疗的相关药物都影响着IBD患者的静脉血栓发生风险,积极改善疾病严重程度,谨慎选择治疗药物对于预防静脉血栓的发生有重要意义。肝素在改善IBD患者的高凝状态中起着重要作用,应根据指南对静脉血栓的发生进行积极的预防和治疗。     

论留日经历对傅抱石美术史观的影响

傅抱石作为20世纪中国美术"留日派"的代表人物,在30年代初期师从日本导师金原省吾学习三年,而后十几年间,他有许多关于中国美术史和中国画论的研究论文、著作面世,影响甚广。试图从傅抱石留日前后对待中日美术心态的变化以及日本导师对其美术史观的影响来探讨留日经历对其美术史观的影响,并作出合理的阐释。     

关注降压药物的选择,促使更有效的降压达标

我国成人高血压患病率高达18.8%,全国有高血压患者约1.6亿.合理的药物治疗是降压达标的主要措施,如何进行正确选择成为摆在我们面前的难题.目前,降压药物主要包括利尿剂、β受体阻断剂、血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂、钙拮抗剂和α受体阻断剂6类.因降压治疗的收益主要来自于降压本身,为了提高降压达标率及高血压患者的用药依从性,目前多主张低剂量联合治疗.     

药物治疗的风险及其处理

造成药物治疗风险的因素包括药物因素、病情因素、患者因素、用药因素及管理因素等。通过对药物进行严格监管,对医药从业人员加强培训和教育,对民众开展科普教学和用药指导,可以降低药物治疗的风险。风险事件主要表现为用药差错、药物不良反应或药物治疗无效。在药物治疗中,首先必须时刻警惕和及时发现风险;其次需要全面评估风险,还要对疾病风险和药物治疗风险进行比较。应尽可能避免药物治疗的风险,对于必须承受的风险,需采取相应措施,减少风险事件发生的概率和严重程度。如果存在较大风险,务必同时设计处理风险事件的预案,并与患者及其家属保持良好的交流和沟通。     

Evaluating the Source of the Risks Associated with Natural Events

Within philosophy there has been little discussion of the risks associated with natural events such as earthquakes. The first objective of this paper is to demonstrate why such risks should be the subject of more sustained philosophical interest. We argue that we cannot simply apply to risks associated with natural events those insights and frameworks for moral evaluation developed in the literature considering ordinary risks, technological risks and the risks posed by anthropogenic climate change. The second objective of this paper is to identify and develop a framework for the moral evaluation of the source of the risks associated with natural events, or the actions which sustain and impact such risks. Our discussion concentrates on the ways the construction and modification of built and natural environments can alter the probability of occurrence of natural events and the character and magnitude of the impact that such events have. We then argue for the need to develop a standard of reasonable care for decisions about the built and modified natural environment, which accounts for technical and resource constraints, as well as the place of natural hazard mitigation in public policy.     

The cerebrovascular model of depression in late life

Depression in older people, especially depression with an older age of onset, may be a manifestation of acquired brain disease. The cerebrovascular model of depression, often referred to as "vascular depression," hypothesizes that otherwise clinically occult small vessel brain disease contributes to the pathogeneses of some late-life depressive conditions. This paper reviews several lines of evidence supporting the cerebrovascular model and addresses the limitations of the existing literature. Several directions for future research are noted, including empirical testing of the notion that cerebrovascular disease might underlie the pathogeneses of depression with prominent executive dysfunction or other cognitive impairments. At this time, there are no specific therapeutic options for patients with suspected vascular depression beyond standard approaches to depression treatments, although education about the possibly greater risks of chronicity should be included in treatment planning. Therapy of cerebrovascular risk factors and stroke-risk reduction are important as consistent with general practice guidelines, although it is not known whether this will reduce the incidence or improve the outcome of late-life depression.     

Challenges of Honesty

The analytic method builds on honesty, specifically in the moment-to-moment events of the micro-process. Ferenczi was a researcher who experimented with the limits (including the limits of honesty) of the method to its extremes. Honesty is a moral virtue, and from that perspective all events and phenomena of the moment have an ethical aspect. Self-analysis—a prerequisite and an important component of the analytic stance—puts on trial the analyst’s capacity and willingness to be honest. This paper examines these ethical aspects in the micro-process and the unavoidable dilemmas connected with it. The important settings where self-analysis is used are: being in analysis, conducting analysis and in supervision. The limits of honesty in these settings are also discussed. Recently, case discussion groups have been playing an increasingly important role in analytic conferences and also in training. The risks and limits of honesty in case discussion groups deserve to be studied.     

前瞻性情绪作为社会风险的信息源假说：公共场景下风险决策的情绪及文化机制探讨

本研究从梳理决策的情绪理论入手, 在综合几种主要理论的基础上提出了“前瞻性情绪作为社会风险信息源”的假说。前瞻性情绪是在决策过程中产生的, 由于对决策选择的预期而感受到的, 进而影响决策行为的情绪。社会环境下的风险事件具有突发和稍纵即逝的特征, 如果一个公民对这类风险事件做出反应, 其结果的概率难于量化。在这种情况下, 前瞻性情绪能够为决策者快速提供有关信息, 并形成对决策预期结果严重性和可能性的综合表征, 从而成为公众场景下风险决策的有效线索。不同前瞻性情绪的组合在面对社会性风险事件时具有针对性的作用。近年来在文化比较中对于面子、荣誉和尊严文化的划分, 也为我们研究文化的情绪特征和行为效应提供了理论框架。本研究拟通过四项研究和多个实验探讨前瞻性情绪如何影响公众场景下人们的风险应对行为, 并对三种文化的情绪特征进行比较, 探索情绪性决策中个人因素、群体因素、及文化因素如何共同决定公共场景下风险决策(如亲社会行为或反社会行为)的发生与发展, 同时也期望为公共政策的制定及风险管理提供科学依据。     

Risk and Religion: Toward a Theology of Risk Taking

Historically the concept of risk is rooted in Renaissance lifestyles, in which autonomous agents such as sailors, warriors, and tradesmen ventured upon dangerous enterprises. Thus, the concept of risk inseparably combines objective reality (nature) and social construction (culture): Risk = Danger + Venture. Mathematical probability theory was constructed in this social climate in order to provide a quantitative risk assessment in the face of indeterminate futures. Thus we have the famous formula: Risk = Probability (of events) × the Size (of future harms). Because the concept of harm is always observer relative, however, risk assessment cannot be purely quantitative. This leads to the question, What are the general conditions under which risks can be accepted? There is, after all, a difference between incurring a risk and bearing the costs of risks selected for by other agencies. Against this background, contours of a theology of risk emerge. If God creates a self‐organizing world of relatively autonomous agents, and if self‐organization is favored by cooperative networks of autopoietic processes, then the theological hypothesis of a risk‐taking God is at least initially plausible. Moreover, according to the Christian idea of incarnation, God is not only taking a risk but is also bearing the risks implied by the openness of creation. I thus argue for a twofold divine kenosis—in creation as well as in redemption. I discuss some objections to this view, including the serious counterargument that risk taking on behalf of others remains, even for God, a morally dubious task. What are the conditions under which the notion of a risk‐taking God can be affirmed without leaving us with the picture of God as an arbitrary, cosmic tyrant? And what are the practical implications for the ways in which human agents of faith, hope, and love can learn to cope with the risks of everyday life and of political decisions?     

The role of behavioral experience in judging risks.

This study used conditional risk assessments to examine the role of behavioral experiences in risk judgments. Adolescents and young adults (ages 10-30; N = 577) were surveyed on their risk judgments for natural hazards and behavior-linked risks, including their personal experiences with these events. Results indicated that participants who had experienced a natural disaster or engaged in a particular risk behavior estimated their chance of experiencing a negative outcome resulting from that event or behavior as less likely than individuals without such experience. These findings challenge the notion that risk judgments motivate behavior and instead suggest that risk judgments may be reflective of behavioral experiences. The results have implications for health education and risk communication.     

Academic resilience of immigrant youth in Greek schools: Personal and family resources

Abstract

This cross-sectional study examined, first, whether and how immigrant youth’s personal and family resources account for individual differences in their academic achievement, and second, whether social risks and immigrant status further contribute to academic achievement after controlling for these resources. The sample consisted of 300 middle school adolescents, 73 students from Albania and 227 Greeks (mean age 13.9 years), enrolled in Greek urban middle schools. Three risks (immigrant status, family social adversity and negative life events), two personal resources (locus of control and self-efficacy beliefs) and four family resources (parental school involvement, family support, father and mother education) for academic achievement were included. Each of these personal and family resources, separately, predicted higher academic achievement, equally for immigrant and nonimmigrant youth. Family social adversity, but not negative life events, continued to predict academic achievement, over and above personal and family resources. Finally, immigrant status continued to predict academic achievement over and above resources and other social risks. The results highlight the important link between the family context and youth’s personal agency, on the one hand, and doing well in school, on the other. However, they also reveal that social and immigrant status, two societal-level, social position variables that may also involve experiences that are outside the control of the family and youth, present further risks to youth’s academic achievement.     

Experimental Tests of Risk Ladders in the Elicitation of Perceived Likelihood

Risk ladders have the potential to improve numeric judgments of low‐likelihood events by providing information about the likelihoods of comparison risks, thereby letting respondents make risk estimates “in context.” However, to date this tool has been studied systematically only in communication of risk, not in elicitation of perceived likelihoods. In three studies, we evaluated the benefits of risk ladders on the consistency, validity, and mean‐level accuracy of elicited likelihood judgments. When estimates for low‐likelihood hazards were elicited using different numeric response scales (e.g., “1 in x” and “x in 100,000”), scale type had a strong effect on the magnitudes of the elicited estimates, and viewing a risk ladder (Experiment 1) or comparison risks (Experiments 2 and 3) did not attenuate this effect of scale type. Similarly, we found no evidence that risk ladders or comparison risks improved the convergent validity of numeric estimates, as measured using correlations with risk ratings made on alternative scale types. Finally, viewing comparison risks tended to reduce gross overestimation of rare events, with relatively less change in estimates for mid‐likelihood and high‐likelihood hazards. This suggests that comparison risks can spread responses to cover a wider range of values but do not ameliorate scale effects. In the elicitation of numeric risk estimates, how you ask matters, even if you let people make estimates “in context” through the use of comparative risk information. Copyright © 2015 John Wiley & Sons, Ltd.