脓毒症研究进展及启示

脓毒症(sepsis)是是当前外科ICU所面临的棘手难题。对感染和脓毒症的研究已成为外科学十分活跃的领域之一,所取得的进展已使人们从本质上更深刻、更准确地了解感染与脓毒症,从而为解决这一棘手问题开辟新的途径。脓毒症的研究揭示了人类科学发现和科学认识的普遍规律。     

儿童严重脓毒症的认识现状

儿童严重脓毒症是危重病医学所面临的主要课题及难题.脓毒症发病机制复杂,危及全身各个系统、器官,治疗比较困难,尽管有药物治疗、脏器支持等治疗方法,脓毒症致儿童病死率仍居高不下.近年来,连续性血液净化广泛应用于脓毒症、全身炎症反应综合征及多器官功能障碍综合征的治疗并取得较好疗效,血液净化被视为严重脓毒症的一种有效治疗手段.     

外科脓毒症:从科学认识到合理防治

脓毒症(sepsis)是一种严重威胁患者生命的外科危重症,也是诱发脓毒性休克(septicshock)、多器官功能障碍综合征(MODS)的重要原因.基于对脓毒症的病理生理的认识正不断深入,脓毒症的防治水平业已取得重要的进展.深入认识脓毒症,研究新的防治策略,实施正确的治疗,将有助于提高脓毒症的临床治疗水平.     

脓毒症及其治疗策略的反思

脓毒症是各种严重创伤、烧伤、缺氧、再灌注损伤及外科大手术常见的并发症.目前脓毒症休克的临床病死率仍高达50%以上.对脓毒症发病机制的进一步深入认识和现行治疗措施的反思有助于改善其临床防治.     

严重脓毒症——评价指标带给我们的启示

目前,严重脓毒症的诊断指标已对脓毒症导致的临床情况作出较好的诠释,进一步寻找相关的指标将更有助于临床判断.我们评价了血流动力学和组织灌注参数,免疫紊乱、凝血障碍的相关参数以及前降钙素等指标在临床上的价值.目前所采用的一些指标确实有助于严重脓毒症的诊断,但是,我们需要更特异的指标来指导临床工作.     

外科脓毒症：从科学认识到合理防治

脓毒症(sepsis)是一种严重威胁患者生命的外科危重症,也是诱发脓毒性休克(septic shock)、多器官功能障碍综合征(MODS)的重要原因。基于对脓毒症的病理生理的认识正不断深入,脓毒症的防治水平业已取得重要的进展。深入认识脓毒症,研究新的防治策略,实施正确的治疗,将有助于提高脓毒症的临床治疗水平。     

严重脓毒症与免疫功能障碍

脓毒症多呈现典型的促炎效应和抗炎反应,并与获得性免疫功能障碍同时出现,且免疫细胞中超过80％的基因表达发生改变。由于单核／巨噬细胞细胞因子谱的改变、主要组织相容性复合体Ⅱ类抗原（MHCⅡ）及共刺激分子表达下降以及树突状细胞的凋亡,诱发细胞免疫功能下降;中性粒细胞活性降低和补体系统的激活,又增加感染易感性。T淋巴细胞表现...     

严重脓毒症——评价指标带给我们的启示

目前,严重脓毒症的诊断指标已对脓毒症导致的临床情况作出较好的诠释,进一步寻找相关的指标将更有助于临床判断。我们评价了血流动力学和组织灌注参数,免疫紊乱、凝血障碍的相关参数以及前降钙素等指标在临床上的价值。目前所采用的一些指标确实有助于严重脓毒症的诊断,但是,我们需要更特异的指标来指导临床工作。     

全面认识外科感染合理使用预防性抗生素

外科感染是一种使用抗菌药物解决不了的而常需外科干预的感染,其主要特点是皮肤和黏膜屏障有了破损、多种内源性致病微生物从破坏部分入侵致病.最常见的外科感染是切口部位感染导管相关血循感染、肺炎和泌尿道感染.外科切口部位感染的发生与外科切口各类密切相关,清洁、清洁-污染、污染和污秽四关的感染发生率分别约为2.1%、3.3%、6.4%和7.1%.预防外科感染可从三方面着手,提高宿主抵抗力;手术操作细致;加强围手术期处理,包括预防性抗生素等.预防性抗生系的适应证为Ⅱ、Ⅲ类切口,一般选择一代头孢菌素用于非厌氧菌污染的手术,二代头孢菌素用于厌氧菌污染的手术.应在手术前8小时内用药,并在术后24小时停药,给药方法是一次静脉滴入.此外还需注意提高外科创口的氧张力、保持体温、控制血糖、合理皮肤准备和掌握延迟性一期缝合的适应证等.     

胸腔镜外科的发展、现状与思考

胸腔镜手术已经有近100年的历史,经历了传统胸腔镜外科,电视胸腔镜外科,机器人辅助胸腔镜外科,远程机器人手术等阶段,目前已成为许多胸部疾病的首选治疗手段.但胸腔镜外科的发展并不一帆风顺,经历了兴起、衰落、振兴的过程.我国现处于电视胸腔镜阶段.胸腔镜外科的发展历程是生产力水平和社会需求两个要素综合作用的典型范例,随着21世纪的到来,胸腔镜外科的明天更辉煌.     

实施社区首诊制必先做好条件准备

为了解决群众“看病难,看病责”的问题,国家大力发展社区卫生事业。社区首诊制作为其中一项重要的制度被各地纷纷响应,然而由于我国现阶段社区卫生事业基础尚很薄弱,开展社区首诊制的条件还不具备,因此开展起来困难重重。所以现阶段应以完善社区首诊制的基础条件为工作重心。     

国外心理健康服务及其启示

在回顾了美国、瑞典等国家心理健康服务概况的基础上提出了以下启示：1．中国心理健康服务体系应以构建和谐社会理论为基础;2．在心理服务的教育与培训中,应当尽量兼顾普及知识与提高专业化水平两个目标;3．政府应当大力支持社区心理健康服务以及包含各种社区可用资源的综合性社区服务;4．中国心理健康服务必须从本国文化与国情出发,因此还需要更多这方面的文献总结与实际诃查工作;5．心理健康服务应当全面而有区别地实施予心理健康水平不同的人群。     

Assessing Needs and Developing Interventions with New Populations

ABSTRACT

The predominance of chronic and lifestyle-induced conditions has emphasized the need for greater access to health care in the community. A corresponding concern is educating practitioners so they are equipped to assume positions in the community at graduation. Lack of preparation to work in the community has led to reluctance on the part of practitioners to pursue positions in the community (Walens et al., 1998). However, the current climate of health care creates many opportunities for practitioners and educators who are willing to make a commitment to work collaboratively with agencies in the community for a common good. The purpose of this paper is to broaden understanding of community built practice by sharing a collaborative process in fieldwork education that was undertaken by faculty at the University of Illinois at Chicago.     

The Role of the Occupational Therapist as a Community Consultant

Concern for health development has been in the forefront of occupational therapy practice and training for many years. However, consultation in this area to community agencies and grass roots programs is a relatively new endeavor for occupational therapists. This article describes community consultation in a demonstration project emphasizing the concept of preventive mental health. Steps in establishing the consultation role are discussed using the theoretical constructs of systems consultation. Discussion of the educational objectives for field training in community mental health, community experience during the field training, and the supervisory and communication networks essential to such a program are presented as a model in developing the role of the occupational therapist as a community consultant.     

Developing coordination of services between a mental health center and a public school system

A child-and-family oriented community mental health center of necessity is concerned with the manner in which the school system in its community is providing for the psychological, social, and emotional development of children. Fortunately, over the last decade, the number of school systems that are aware of their responsibility in this regard has greatly increased, and many affluent and enlightened school systems have moved to develop extensive pupil personnel services, functioning in many ways as in-house mental health programs. Where there are mental health providers both within the community and within the school system, however, problems may develop such as professional competition, overlapping functions, and differences with regard to how mental health problems are best dealt with. This paper will examine the relationship of a town-supported mental health program and the town's public school system. Highlighted will be the variety of problems which develop, including those mentioned above, and strategies adopted to resolve the problems.     

Health Beliefs and Practices in an Isolated Polygamist Community of Southern Utah

Short Creek is a largely closed and isolated community on the border between Utah and Arizona, made up of the sister towns of Hildale, Utah, and Colorado City, Arizona. Beginning from childhood, the 6,000 or so members of the Fundamentalist Church of Jesus Christ of Latter-Day Saints (FLDS) are brought up in a lifestyle of plural marriage, meaning a marriage among one man and more than one woman, and are surrounded by their peers in “the covenant.” A lifestyle of plural marriage is likely to affect the health of community members, but its effects have not been studied because of the community’s isolation and distrust of outsiders. This paper addresses several questions that arise in contemplating the health of the Short Creek community: What are the health beliefs in this community, and what are their historical bases? Where do families seek medical care, and for what or at what threshold of illness or injury? What is the attitude of care providers serving this community, and how are the providers viewed by the community? More broadly, this paper examines the ways in which polygamy configures health. In order to meet this objective, this paper aims first to provide a brief account of this community’s history and demographic profile, followed by a discussion of health care in this community and how it is affected by the practice of plural marriage, with the data comprised of qualitative interviews with health care providers to the community. The goals of this project are to gain a rich, historically nuanced understanding of the health of community members, and to identify directions for further academic and policy research. Our findings indicate that health in this community is shaped by limited resources, an attitude of health fatalism, and a profound insularity and corresponding isolation from the outside world.     

Enhancing the Behavioral and Mental Health Services Within School-Based Contexts

ABSTRACT

Recent health care reform provides many new opportunities to expand mental health and behavioral support to students in schools and school–community partnerships. Through newly available funding sources, as well as expanded legislative initiatives, school psychologists can advocate for and become leaders in delivering universal programming, tiered mental health supports, and formalized collaborative efforts with community agencies. The authors highlight the application of tiered levels of services, with current practice samples, designed to address students' mental and behavioral health. Implications for practice are discussed.     

Possession and Medicine in South Central India

Possession is a powerful and surprisingly prevalent belief system in many parts of the developing world. In India it is common for many reasons—isolation, illiteracy, polyglotism, lack of an adequate medical infrastructure, a need for hope. Possession, and the practice of exorcism, is more than just an explanatory system based on superstition and folk lore. It is also an important social structure and force that allows the integration of the sick into the community of the well, and facilitates a first albeit tentative step from the local community to the medical community. In many parts of India, health care delivery as well as social organization is through the practice of possession. Thus, the role and power of possession needs to be appreciated if one seeks to affect health care delivery in India, and further possession should be appreciated if one seeks to better understand how some of its forces might in fact be curative.     

Development of Community Psychology

The growth and development of community psychology in Zambia has been necessitated by many social problems encountered by Zambians be they health, economic or psychological. The work of governmental and nongovernmental organizations at community level has contributed to the development of this sub-field of psychology. Community psychology in Zambia has many challenges to overcome, including the lack of trained manpower and availability of funds. Community psychology has great potential to contribute to the wellbeing of different communities in Zambia.     

Addressing Urgent Community Mental Health Needs in Rwanda: Culturally Sensitive Training Interventions

Rwandan leaders in the health and educational sectors have begun to discuss the necessity for establishing culturally appropriate community-based mental health counselling services in Rwanda, especially trauma counselling. The need for a community psychology approach is anchored in the lingering effects of the genocide and the continuing post-traumatic stress symptoms suffered by many in the population. Capacity building in an effort like this would require the design of multi-level counselling curricula that are sensitive to the social structures within Rwandan culture. These curricular endeavours call for the development of a National Counselling Centre to serve as a structural mechanism for organizing community-based counselling initiatives. We consider the community health services needs in Rwanda here, along with associated challenges and strategies for effective mental health services in a country with a recent history of genocide. A community psychology approach to mental health would benefit Rwandan society by making trauma counselling and recovery services available and accessible to citizens throughout the country.