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The burden of cardiovascular disease is heavy, the condition is complex, and the clinical decision-making methods are diverse. Taking coronary heart disease and implantable cardioverter defibrillator implantation as examples, this paper illustrated the shared decision-making framework in cardiovascular disease. Patient participation in diagnosis and treatment decision-making will enhance their sense of control and gain. Strategies to improve the quality of shared decision-making include developing effective decision-making aids, enhancing patients’ risk perception abilities, and empowering patients to enhance their decision-making abilities.
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Traditional Chinese medicine(TCM) treatment models are rich and unique, including patient-led decision-making, doctor-led decision-making, and doctor-patient shared decision-making. However, doctor-led decision-making is more common. The connotation of TCM shared decision-making is rich, including not only the smooth flow of information and the encouragement and support of equal participation by patients, but also the discussions on various aspects of diet, exercise, emotions, daily life, physiology, psychology, society, and nature that affect health based on the unique holistic concept of TCM. Integrating "shared decision-making" into the treatment process of TCM can be divided into four steps according to the process of "diagnosis and treatment". TCM shared decision-making has advantages and limitations, requiring both doctors and patients to meet certain objective conditions, and there are also special situations in TCM treatment where shared decision-making cannot be applied. Multiple ways to enhance the decision-making ability of doctors and patients, scientific evaluation and matching treatment plans, development of decision-making aids, and smooth channels for information transmission can all enhance the shared decision-making ability of doctors and patients.
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OBJECTIVE:To provide reference for pharmacists to participate in the management of chronic disease. METHODS:A total of 259 patients with chronic airway disease [included asthma and chronic obstructive pulmonary disease (COPD)] met the inclusion criteria were selected from our hospital and 5 community health care centers of medical consortium. These patients received medication safety assessment management,which was led by clinical pharmacists of our hospital with the participation of community pharmacists,including medication safety comprehensive evaluation and risk classification management, follow-up and medication guidance, integrated prescriptions checking, establishment of shared database. 1 years after the implementation,the effectiveness were evaluated by score the relatived indicators in related groups. RESULTS:After a year of the management mode practice,compared with before intervention,the patients'safety medication cognitive ability score in high-risk and low-risk group increased from(4.49±1.26)and(7.31±1.01)to(5.40±1.56)and(7.44±0.91);medication adherence score increased from(4.96±1.21)and(7.08±1.24)to(6.66±1.08)and(7.38±0.98);ACT score from asthma patients increased from (16.15±2.58)and(21.15±1.03)to(16.80±2.57)and(21.64±1.55);CAT score from COPD patients decreased from(25.51± 4.07) and (14.90 ± 3.95) to (24.20 ± 3.96) and (13.80 ± 4.08);the rate of irrational prescription effective identification and intervention by pharmacists increased from 3.6％ and 1.4％ to 9.4％ and 7.6％,respectively. All the differences above were statistically significant (P<0.05). CONCLUSIONS:The participation of pharmacists in long-term medication safety assessment management for chronic airway disease patients can improve patients'safety medication cognitive ability,medication adherence, disease control and the pharmacists'ability of irrational drug use identification and intervention.
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The prevention,diagnosis,treatment,and recovery of serious diseases can't be well done without the family's proper awareness and wisdom of choices.The target population of the prevention and control of serious diseases and health education should take a family as the basic unit and let the family become the first line of defense against the serious diseases.The idea and practice of Healthy Family has established a strong bond between the Healthy China strategy and the broad masses of the people,helping achieve the bottom-up interconnection and promoting Healthy China 2030 to benefit all.
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This paper explores in brief history and development of nursing ethics in the past decades in China. In the past ten years, many original articles and textbooks are published and academic communication is active in the area of nursing ethics. Currently China nursing ethics has set up its concepts framework, and formed the ethical problem-based research paradigm, and published its ethical guideline. This paper concludes with recommendations for improving the quality of nursing ethics research in contemporary China.
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Objective To study the prevalence and the related risk factors of diabetic peripheral neuropathy(DPN) after good blood glucose well controlled among in middle-aged and old-aged population with type 2 diabetes mellitus in a community of Beijing.Methods DPN was screened by Michigan neuropathy screening instrument (MNSI),and common blood biochemical parameters were tested,among over 45 years of age registered population patients with type 2 diabetes mellitus in Shuangjing community of Chaoyang District of Beijing.Results The blood glucose control rate was 90.36％ (253/280),and the prevalence of DPN was 25.36％ (71/280) with male of 24.47 ％ (23/94) and female of 25.81％ (48/186).Univariate analysis showed that both age and HbA1c in DPN group were higher than that of non-DPN group,and the differences were statistically significant(P =0.000,0.008).The level of plasma low density lipoprotein cholesterol(LDL-C) of the DPN group was lower than that of the non-DPN group,and the difference was statistically significant (P=0.017).The hypertension prevalence rate of the DPN group was 87.32％(62/71),higher than that of the nonDPN group(75.6％ (158/209)),and the difference was statistically significant (P =0.037).The multivariate logistic regression analysis showed that the estimate of parameter for age was 0.143 (P =0.0001),OR was 1.153,95％CI was from 1.029 to 1.219,for HbA1c was 0.529(P=0.03),OR was 1.698,95％CI was from 1.053 to 2.738,and for LDL-C was-O.919 (P =0.018),OR was 0.399,95％ CI was from 0.186 to 0.854.Conclusion The prevalence of DPN is still above 25％ among middle-aged and old-aged in a community,even though the well controlled rate of blood glucose control rate is above 90％.It is possible that old age and HbA1c are related to DPN,apart from blood glucose.
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Objective:To investigate the reasons of the tension of doctor-patient relationship and the medical violence from the perspective of the doctors, in order to provide a reference for finding a viable solution. Methods:Questionnaires survey were conducted about doctors' working conditions in 45 hospitals of 9 provinces. Results:On-ly 3. 6% medical staff had a harmonious doctor-patient relationship, the causes for the tense doctor-patient rela-tionship were poor communication with patients (75%), medical limitations (46. 2%);From the patients perspec-tive, the patients 'unpleasant caused by overtreatment due to complex illness accounted for 54. 2%;Institutional health-related reasons accounted for 82 . 6%. Conclusions:In the past five years after the new health care re-form, the tense doctor-patient relationship has not been released. So, should focus on training to enhance the com-munication skills of medical personnel and medical humanities education while the implementation of the national health care reform, in order to reduce iatrogenic conflicts.
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@#ObjectiveTo explore the clinical features and diagnosis of one Kennedy's disease.MethodsOne patient was clinically diagnosed as Kennedy's disease on the basis of the clinical features including slowing progression of disease, symptoms, nervous system signs, electromyography and nerve conduction velocity results and family history. His CAG number from the repetitive CAG sequence in the first exon of androgen receptor gene was determined using PCR.ResultsThe progression of Kennedy's disease is usually much slower. The CPK and testosterone levels increased in patient. EMG revealed neurogenic injury. The numbers of CAG region of the first exon of androgen receptor gene were 51 in the patient.ConclusionDespite its relatively typical manifestations, the definite diagnosis of Kennedy's disease should be made by detecting the number of CAG from the repetitive CAG region in the first exon of androgen receptor gene.
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In order to provide the "guiding principles of clinical research on mild cognitive impairment (MCI) (protocol)" edited by Beijing United Study Group on MCI of the Capital Foundation of Medical Developments (CFMD) with evidence support, clinical criteria, subtypes, inclusion and exclusion of MCI, and use of rating scales were reviewed. The authors suggested that MCI clinical criteria and new diagnosis procedure from the MCI Working Group of the European Alzheimer's disease Consortium (EADC) may better reflect the heterogeneity of MCI syndrome. Diagnostic rating scales including Clinical Dementia Rating (CDR), Global Deterioration Scale (GDS), Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) and Instrumental Activities of Daily Living (IADL) are very useful in definition of MCI but can not replace its clinical criteria. Absence of major repercussions on daily life in patients with MCI was emphasized, but the patients may have minimal impairment in complex IADL. According to their previous research, the authors concluded that highly recommendable neuropsychological scales with cut-off scores in the screening of MCI cases should include Mini-Mental State Examination (MMSE), logistic memory test such as Delayed Story Recall (DSR), executive function test such as Clock Draw Test (CDT), language test such as Verbal Category Fluency Test (VCFT), etc. And finally, the detection of biological and neuroimaging changes, including atrophy in hippocampus or medial temporal lobe in patients with MCI, was introduced.
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Mild cognitive impairment (MCI), as a nosological entity referring to elderly people with MCI but without dementia, was proposed as a warning signal of dementia occurrence and a novel therapeutic target. MCI clinical criteria and diagnostic procedure from the MCI Working Group of the European Alzheimer's Disease Consortium (EADC) may better reflect the heterogeneity of MCI syndrome. Beijing United Study Group on MCI funded by the Capital Foundation of Medical Developments (CFMD) proposed the guiding principles of clinical research on MCI. The diagnostic methods include clinical, neuropsychological, functional, neuroimaging and genetic measures. The diagnostic procedure includes three stages. Firstly, MCI syndrome must be defined, which should correspond to: (1) cognitive complaints coming from the patients or their families; (2) reporting of a relative decline in cognitive functioning during the past year by the patient or informant; (3) cognitive disorders evidenced by clinical evaluation; (4) activities of daily living preserved and complex instrumental functions either intact or minimally impaired; and (5) absence of dementia. Secondly, subtypes of MCI have to be recognized as amnestic MCI (aMCI), single non-memory MCI (snmMCI) and multiple-domains MCI (mdMCI). Finally, the subtype causes could be identified commonly as Alzheimer disease (AD), vascular dementia (VaD), and other degenerative diseases such as frontal-temporal dementia (FTD), Lewy body disease (LBD), semantic dementia (SM), as well as trauma, infection, toxicity and nutrition deficiency. The recommended special tests include serum vitamin B12 and folic acid, plasma insulin, insulin-degrading enzyme, Abeta40, Abeta42, inflammatory factors. Computed tomography (or preferentially magnetic resonance imaging, when available) is mandatory. As measurable therapeutic outcomes, the primary outcome should be the probability of progression to dementia, the secondary outcomes should be cognition and function, and the supplement outcome should be the syndrome defined by traditional Chinese medicine. And for APOE epsilon4 carrier, influence of the carrier status on progression rate to dementia and the effect of treatment should be evaluated.
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Objective To describe the clinical features, radiological and pathological characteristic and the treatment of the cerebral arteriovenous malformations (AVM) which were appeared diffuse on angiography. Methods The related clinical information of 8 cases with AVM which were diagnosed by cerebral angiogram were reviewed and analyzed. Results 8 cases were found to be diffuse AVM. They were mostly presented with intracerebral hemorrhage. On angiography, the AVM included multiple small arterial feeders, a diffuse, wedge-shaped and puddling appearance of the contrast dye, without an identifiable compact nidus. Multiple draining veins were noted. 4 cases were underwent craniotomy, the AVM were completely removed in 2 cases, 1 case who was pretreated with embolization had residual nidus after operation, and the nidus of the other one case was not removed completely because the nidus located in the eloquent area of the brain. On histological examination, normal brain tissue were found in the abnormal AVM vessels. In the rest 4 cases, 2 patients died of repeated intracerebral hemorrhage, and the other 2 cases received no special treatment. Conclusion The diffuse cerebral AVM is different from the typical AVM on angiography and histopathology. Because of its' diffuse character, it should be treated individually. If the lesion locates in the silent areas of the brain, craniotomy should be taken, but it is difficult to remove the nidus completely.
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Objective: Through treatment based on differentiation of symptoms and signs and classification of defi nited patients of maternofetal blood group incompatibility, detecting anti-A or Anti-B antibody and erythrocyte immune complex chaplet rate(RICR) and erythrocyte receptor chaplet rate(RC3bR) , etc, to observe the therapeutic effect and mechanism of prescriptions mainly with Yinchenhao Decoction. Methods: Patients definited maternofetal blood group incompatibility were divided into control group and observation group according to random principle in 1:3 ratio. Then, observation group was divided into moist heat group(SRG), moist heat and defi ciency of spleen qi group (SR+PQXG) and moist heat and defi ciency of kidney qi group(SR+SQXG) according to syndrome differentiation. Corresponding prescriptions were used, every 30 doses 1 course. Before and after treatment, the anti-A or anti-B antibody and RICR, RC3bR were detected in peripheral blood. Results: In Yinchenhao Decoction group with 21 cases, the anti-A or anti anti-B antibody decreased, including 5 case (1:64) and 4 case (1:32). In group of syndrome differentiation with 63 cases, the anti-A or anti anti-B antibody decreased, including 33 case(1:64) and 20 case (1:32). Before and after treatment, RICR of control group and observation group were(19.43?5.29), (19.57?6.50)and (20.59? 7.96), (23.77?5.12), respectively. RC3bR were(11.62?4.16), (12.42?6.60)and(11.93?4.10), (13.96?6.40)respectively. There was signifi cant difference of before and after treatment in obserbation group(P0.05). Conclusion: In cutting down anti-A and anti-B antibody, and increasing RICR and RC3bR fi eld, the observation groups were better than control group.
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Objective:To examine the reliability and validity of the telephone version of Information-Memory-Concentration Test (T-IMCT) in screening dementia when administered by telephone To evaluate the relation of the face-to-face and the telephonic interview for assessing the cognitive status Methods:T-IMCT was adapted from Information-Memory-Concentration test for the telephonic interview 65 subjects with dementia and 67 normal control subjects were examined by an experienced clinician, including clinical, neuropsychological and instrumental examination (CT or MRI) T-IMCT was administrated by telephone after 2 weeks, comparing the score from face-to-face interview with telephonic interview 20 subjects were administered the test twice by the same doctor to measure the test-retest reliability, and another 20 subjects were administered the test by two doctors to measure the inter-rater reliability Informants supervised the subjects to insure the authenticity of assessment administered by telephone Results:T-IMCT achieved a sensitivity of 80% and specificity of 80 6% in differentiating demented from healthy control subjects There was a high correlation between face-to-face interview and telephonic interview, Pearson’s correlation coefficient was 0 92 (P
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Nowadays,evidence-based approach has been more and more applied to the study of bioethics.It is of increasing significance in collecting and using evidence in a systematic way in ethical decision making process.Evidence-based methods,which mainly gained from evidence-based medicine,contribute to the development of bioethics.Of course,a plenty of challenges are also confronted.By far,it is not a sound ground for the philosophy of bioethics.In addition,there is no clear idea about what kind of evidence-based approach should be introduced into the field of bioethics.
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0 05)between AD and aging c ontrol subjects or MCI patients. Conclusions Episodic memory impairment and semantic memory impairment beside the immediat ely recall and naming are the earliest and most pervasive memory deficit in mild AD patients, and episodic memory impairment is more specific than semantic memo ry impairment for the diagnosis of AD.
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Violent trespass against medical right dangerously harms medical staffs' health,both physically and mentally.It disarranges normal infirmary system on medical diagnosis and treatment.The research carried out in 80 hospitals covering 10 provinces indicates that presently violent trespass against medical right occurs from time to time;moreover this shows an up-growing trend.Such phenomena take place in various medical colonies and medical organizations diverse themselves obviously.This passage analyzes the causes of violence from the aspects of society,hospital and physician-patient relationship.
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Objective:To observe the reliability and validity of the Chinese version of Telephone In-terview for Cognitive Status-Modified (TICS-m). Methods:62 dementia patients and 63 community-dwelling healthy eldly individuals were assessed. TICS-m was examined by telephone and face-to-face. Results:The correlation between face-to-face and telephone interview was 0.79~0.97.The spearman correlation coefficient of inter-rater reliability were 0.89-0.97 and intra-rater reliability 0.91-0.98. The sensitivities of TICS-m and the memory factor score were both high. The TICS-m and three parts were all significantly correlated with MMSE and CDR. Conclusion:Face-to-face and telephone interview of TICS-m was highly correlated. In-ter-rater reliability and intra-rater reliability were good. The TICS-m is valid and reliable when used to screen dementia, especially mild dementia.