慢性阻塞性肺疾病健康教育的作用及面临的问题

将82例稳定期COPD患者随机分为两组,治疗组接受为期半年的健康教育,对照组不接受健康教育。观察半年前后两组的吸烟比例、呼吸困难评分、吸入治疗比例及正确率和半年内急性发作次数;并比较半年前后的生活质量评分、疗效评估和肺功能指标。发现：半年的健康教育可增加稳定期COPD患者的戒烟率,减少反复急性发作,从而提高生活质量。缺乏经济效益及未受到足够的重视和宣传,制约了健康教育的普及,因此发展社区卫生医疗服务势在必行。     

结核病直接督导短程化疗策略的伦理学视角

从伦理学角度探讨了结核病直接监督下短程化疗(DOTS)策略以及DOTS策略实施过程中若干问题。DOTS策略被认为是当今结核病诊治和管理的最有效方法,体现了医学伦理学的公益论;尊重病人的选择及隐私是有效控制结核的重要内容,标准化疗方案和个体化疗方案应视病情而定;医务人员应有良好的综合素质。     

特殊人群结核病的流行病学调查

为了了解某监狱犯人中结核病的患病及结核菌耐药情况,为防治提供依据,采用痰检和结核菌素试验的方式对研究对象进行普查,结核分枝杆菌采用罗氏培养,药敏试验采用比例法。结果显示,PPD试验总阳性率为60．54％。痰检发现24例患者,涂阳患病率为898．54／10万。培养菌株总耐药率为95．83％,其中初治耐药率、复治耐药率和多重耐药率分别为87．5％,100％和73．91％。提示该特殊人群结核病患病率高于一般人群。     

医师知识结构和思维方式与肺血栓栓塞症诊断

肺血栓栓塞症是常见的临床病症,因其临床表现多样,易发生误诊漏诊而导致较高的病死率。但“凡事预则立,不预则废”,充分掌握肺血栓栓塞症的知识、以正确的思维方式引导临床诊疗可以有效减少和避免误诊漏诊。     

Religious Coping, Psychological Distress and Disability Among Patients with End-Stage Pulmonary Disease

A growing body of literature suggests that individuals who face life-threatening situations turn to religion to help them cope. Religion has been cited as the most frequently used resource to cope with stressful events (K. I. Pargament, 1997). The present study was the first to investigate the religious coping methods of patients with lung disease who are awaiting transplant and to identify which coping methods are associated with distress and disability. The study was an exploratory, cross-sectional analysis of 90 patients with end-stage pulmonary disease who were being evaluated for transplant. Results indicated that religiosity was highly prevalent. Patients employed a combination of religious coping efforts, but mostly used coping methods considered positive. Patients with late-onset pulmonary diseases used religious coping strategies more frequently than patients with cystic fibrosis. Hierarchical regression analyses identified a subset of religious coping strategies that predicted 27%, 14%, and 34% of the unique variance in depression, overall disability, and psychosocial disability, respectively.     

环肺静脉消融策略在房颤治疗中地位的思考

房颤是临床上最常见的快速心律失常之一,对患者危害极大。由于对它发病机制的认识不同导致了临床上不同的治疗方法。肺静脉及环肺静脉开口的肺静脉前庭在房颤的发生和维持中的作用已引起人们的共识。本文通过对房颤机制认识的回顾及治疗方法进展,来探讨环肺静脉消融在临床实践中的重要性,为将来的治疗策略提供依据。     

Illness perception in people with chronic obstructive pulmonary disease

Illness perception (IP) concerns how patients evaluate living with a disease. To get a broader understanding of IP in patients with chronic obstructive pulmonary disease (COPD), we investigated whether breathlessness is an important precursor of IP and whether IP in its turn is related to mental health, physical health and global quality of life (QOL). One hundred and fifty‐four patients with COPD participated in a cross‐sectional survey. Participants underwent pulmonary function testing, provided socio‐demographic and clinical information, and completed the following standardized instruments: Brief Illness Perception Questionnaire, Respiratory Quality of Life Questionnaire, Short‐Form 12 Health Survey and the Quality of Life Scale. Multiple regression analyses were performed. A high IP score indicates that a patient believes that his/her illness represents a threat. Participants with a high score on the IP dimensions consequences, identity, concern and emotional representation, experienced more breathlessness. High scores on the IP dimensions consequences, identity and concern were associated with impaired physical health and high scores on the IP dimensions consequences, identity and emotional representation were associated with impaired mental health. Impaired global QOL was associated with high scores on the IP dimensions consequences, identity, concern, coherence and emotional representation. The strength of the associations between breathlessness and physical/mental health and global QOL decreased when certain dimensions of IP were included as predictors, indicating that IP to some extent acts as a mediating factor. These findings may have practical implications of patient counselling by helping COPD patients to cope with their disease by restructuring their personal models of illness.     

Situating Standards in Practices: Multi Drug-Resistant Tuberculosis Treatment in India

Public health care needs to cope with a basic dilemma between providing standardized care within public programmes across entire and at times resource-constrained countries and adapting this care locally when responding to individual needs. This tension between standardization and local adaptation becomes particularly obvious for the prolonged and complicated treatment of multidrug-resistant tuberculosis (MDR-TB). Situated standardization, as introduced by Zuiderent-Jerak [2007a, 2007b] offers a way out of this dilemma. It helps to focus on how standards need to be situated in practice rather than viewing standardization and local adaptation as mutually exclusive practices. How do actors relate standardization and individual care in their practices of treating MDR-TB? Results from qualitative fieldwork at the first MDR-TB treatment sites of the Indian TB programme show that actors situate standards in a particular way. They assess the role of guidelines in a particular situation and on that basis recognize the core recommendations of guidelines or go beyond the guidelines. This allows actors to negotiate how standards should be situated and reconciles the dilemma between local adaptation and standardization. Having guidelines internalized, as is common for Indian TB control, bears both promises and pitfalls for engaging in standardization processes in a situated manner. The results contribute to science and technology study scholarship on guideline development. They highlight how actors coordinate the situating of standards and how this depends upon cultures of control. This illustrates the potential of qualitative studies on local adaptation for guideline developers by revealing existing practices of relating and negotiating local adaptation and standardization.     

临床整合医学的必要性及实施中存在的问题——以慢性阻塞性肺疾病及其合并症的诊治为例

近年来人们逐渐认识到慢性阻塞性肺疾病(COPD)是一种全身性疾病,即COPD不仅会影响到气道和肺,还会引起一系列合并症,包括心血管疾病、骨质疏松、焦虑和抑郁、癌症、感染、代谢综合征和糖尿病等。这些合并症会显著地影响COPD疾病严重程度和预后,因而必须对COPD进行整体防控,然而COPD的上述合并症的诊治分属不同学科,所以要做好COPD的整体防控就需要相关学科进行医学整合。     

Trajectories of self-efficacy in persons with chronic illness: An explorative longitudinal study

Background: Self-efficacy is important for changing health behaviour in persons with chronic illness. Longer term trajectories have not been previously explored.

Objective: This study’s objective was to explore the trajectories of self-efficacy in two different groups with chronic illnesses attending a patient education course.

Design: The study design was a longitudinal, comparative cohort study with five time points during a one-year follow-up, using repeated measures analysis of variance.

Setting and participants: Persons with morbid obesity (n = 55) and persons with chronic obstructive pulmonary disease (COPD; n = 56) were recruited at the start of patient education courses in Norway and followed-up four times the following year.

Main outcome measure: The General Self-Efficacy Scale was the main outcome.

Results: Obese persons showed a linear pattern of increasing self-efficacy during the follow-up period, whereas persons with COPD had an initial increase followed by a decrease in self-efficacy. Having paid work was associated with a more positive self-efficacy trajectory.

Conclusion: The results provide support for the currently employed patient education course for morbidly obese persons. In contrast, persons with COPD may need more extensive and/or more frequent support in order to increase and maintain self-efficacy across time.