最新NICEGuidelinesonDyspepsia
新一代大学英语发展篇综合教程2答案
新一代大学英语发展篇综合教程2答案Unit 1 Philosophy and thoughtsiExplore 11-5 iExplore 1:Building your languageTASK 11.charisma2.brilliant3.uglyTASK 21.awkward /razor-sharp2.straightforward3.toughTASK 3ing a counter-example2.debate their ideas3.begin a conversationTASK 41.question the assumption2.reveal the limits3.understand the natureTASK 5B B B A B BiExplore 21-7 iExplore 2:Building your languageTASK 11.been painted as2.is counted among3.known asTASK 21.reforms2.brought aboutid down the rules4.formulate the creedTASK 31.under the impulsion of2.played a role of some importance3.grown in size and influenceTASK 4Reference:1.Many descendants of Confucius were identified and honored by successive imperial governments with titles of nobility and official posts.2.Sima Niu.one of Confucius' disciples, came of noble ancestry from the Song state.3.As a member of the craft or artisan class.Mozi lived in humble circumstances and his philosophy was distinctively anti-aristocratic.4.Jiang Taigong was more than 70 years old, but the ruler did not give him an office and people all referred to him as a mad fellow.5.After Confucius resigned his post in the state of Lu, he began a series of journeys around the small kingdoms of northeast and central China, including the states of Wei.Song, Chen, and Cai.6.By Confucius age, the Zhou kings had been reduced to mere figureheads, and real power was put into the hands of various local rulers.iProduce1-8 Unit project1-8 Unit project 1-3Reference:Great minds think alike?Good morning, ladies and gentlemen.Today I'm going to talk about two great thinkers.Socrates and Confucius.two men with great minds.Both English and Chinese have a saying about great minds,"Great minds think alike" and "英雄所见略同."Then do Socrates and Confucius think alike?I will try to compare the two great minds interms of their lives.thoughts and influence.Now let's get started.Both Socrates and Confucius seemed to lead a meaningful and colorful life.As a young man, Socrates had been a brave soldier fighting in a war.Confucius'early life seemed to be equally difficult, since he had to earn his living at menial tasks.After that, it seems that Socrates and Confucius followed different ways in their lives.In middle age.Socrates did nothing but ask people questions in the marketplace.By contrast, Confucius tried all possible ways to achieve his dream.For example, he had been a teacher.gathering young men to study his doctrines.He was also given an office in the government, although he did not have real power.When he saw that he could accomplish nothing.he resigned his post and set off on travels to advocate his Way in other states.After that, he resumed his teaching.Socrates and Confucius spent their lives in different ways.because they had different pursuits.Socrates spent his whole life pursuing wisdom by asking questions.For Socrates,wisdom meant understanding the true nature of our existence,including the limits of what we can know.He declared that if we do not think about what we are doing, then life is not worth living.Therefore.he kept asking questions to himself and to others.By doing this, he helped people understand such concepts as moral and courage and realize what they knew and what they didn't.Socrates would die rather than give up his pursuit of wisdom and truth.Confucius, however, pursued common welfare, that is, the well-being of all the common people.During his times, the common people lived a miserable and tragic life.Confucius could not tolerate these conditions and resolved to devote his life to trying to right them.According to Confucius, in a natural and normal state of society men should Confucius and the rulers should aim to bring about the welfare and happiness of all the common people.As I have mentioned,he tried all possible methods to achieve this goal.He taught young men to promote his doctrines; he worked in the government to put his teachings into practice;he also travelled around many states to find a ruler who would use his Way.Socrates and Confucius pursued different things, but both had great influence.Socrates laid the foundation of Western philosophy.With him the subject really took off.However.the two thinkers have influenced the Western tradition and the Chinese tradition in different ways.Following Socrates'pursuit of truth and wisdom.Western thinkers seemed to be more interested in studying the physical world.After Confucius, Chinese thinkers paid more attention to interpersonal relationships.Then, do great minds think alike? Well, they may have different pursuits, but they have the same devotion to their pursuits.That is what I have learned about Socrates and Confucius.Thank you.iAssess1-10 Unit testPart I1.eccentric2.irritating3.enforce4.restore5.allegiance6.betrayed/betray7.strives8.intriguedPart ⅡB C A B B APart ⅢPart III 1-1Reference:和很多人一样, 亚里士多德也因最好的论点并不总能赢得辩论而困扰。
中国肾移植受者结核病临床诊疗指南(2023版)
· 指南与共识·中国肾移植受者结核病临床诊疗指南（2023版）中华医学会器官移植学分会 【摘要】 本指南旨在为肾移植受者结核病的临床管理提供全面而实用的指导。
首先，概述了肾移植受者结核病的特殊性，强调了其高发生率及临床表现的多样性。
为了更好地理解患者的病情，建议在移植前进行结核病相关的评估，并注意移植术后对结核病的监测。
在诊断方面，详细介绍了目前常用的结核病诊断方法，并提供了在肾移植受者中的适用性评估。
在确诊后，讨论了在免疫抑制药应用的背景下，如何平衡结核病治疗和排斥反应的策略，并关注了潜在的药物相互作用。
预防方面，强调了在肾移植前对结核病的筛查。
本指南旨在提高医务人员对肾移植受者结核病管理的认知，促进更有效的临床实践，提高受者的生活质量。
【关键词】 肾移植；结核病；结核分枝杆菌；结核菌素皮肤试验；潜伏感染；活动性结核病；γ-干扰素释放试验；免疫抑制药【中图分类号】 R617, R52 【文献标志码】 A 【文章编号】 1674-7445（2024）03-0002-10Guideline for clinical diagnosis and treatment of tuberculosis in kidney transplant recipients in China (2023 edition) Branch of Organ Transplantation of Chinese Medical Association. Peking University People's Hospital , Beijing 100044, China Corresponding author: Wang Qiang, Email: ****************【Abstract 】 This guideline aims to provide comprehensive and practical guidance for clinical management of tuberculosis in kidney transplant recipients. First, it summarizes the particularity of tuberculosis in kidney transplant recipients, and highlights the high incidence and diverse clinical manifestations. To better understand the patients'conditions, relevant assessment of tuberculosis is recommended before kidney transplantation. Extensive attention should be paid to the monitoring of tuberculosis after kidney transplantation. Regarding the diagnosis, the guideline explicitly introduces common diagnostic approaches for tuberculosis, and evaluates the applicability in kidney transplant recipients.After the diagnosis is confirmed, it discusses how to balance the treatment and rejection of tuberculosis under the background of immunosuppressants, and focuses upon the potential drug interaction. In terms of prevention, it emphasizes the screening of tuberculosis prior to kidney transplantation. This guideline is designed to deepen the understanding of medical staff for tuberculosis management in kidney transplant recipients, promote more effective clinical practice and improve the quality of life of the recipients.【Key words 】 Kidney transplantation; Tuberculosis; Mycobacterium tuberculosis ; Tuberculin skin test; Latent infection; Active tuberculosis; Interferon gamma release assay; Immunosuppressant结核病是全球最常见的高致死率的感染性疾病之一[1]。
苏格兰 围术期预防的抗菌药物使用
KEY TO EVIDENCE STATEMENTS AND GRADES OF RECOMMENDATIONS
LEVELS OF EVIDENCE 1++ 1+ 12++ 2+ 23 4 High quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias Well conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias Meta-analyses, systematic reviews, or RCTs with a high risk of bias High quality systematic reviews of case control or cohort studies High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal Non-analytic studies, eg case reports, case series Expert opinion
机械通气临床应用指南(中华重症医学分会2024)
机械通气临床应用指南中华医学会重症医学分会（2024年）引言重症医学是探讨危重病发生发展的规律，对危重病进行预防和治疗的临床学科。
器官功能支持是重症医学临床实践的重要内容之一。
机械通气从仅作为肺脏通气功能的支持治疗起先，经过多年来医学理论的发展及呼吸机技术的进步，已经成为涉及气体交换、呼吸做功、肺损伤、胸腔内器官压力及容积环境、循环功能等，可产生多方面影响的重要干预措施，并主要通过提高氧输送、肺脏爱护、改善内环境等途径成为治疗多器官功能不全综合征的重要治疗手段。
机械通气不仅可以依据是否建立人工气道分为“有创”或“无创”，因为呼吸机具有的不同呼吸模式而使通气有众多的选择，不同的疾病对机械通气提出了具有特异性的要求，医学理论的发展及循证医学数据的增加使对呼吸机的临床应用更加趋于有明确的针对性和规范性。
在这种条件下，不难看出，对危重病人的机械通气制定规范有明确的必要性。
同时，多年临床工作的积累和多中心临床探讨证据为机械通气指南的制定供应了越来越充分的条件。
中华医学会重症医学分会以循证医学的证据为基础，采纳国际通用的方法，经过广泛征求看法和建议，反复仔细探讨，达成关于机械通气临床应用方面的共识，以期对危重病人的机械通气的临床应用进行规范。
重症医学分会今后还将依据医学证据的发展及新的共识对机械通气临床应用指南进行更新。
指南中的举荐看法依据2024年ISF提出的Delphi分级标准(表1)。
指南涉及的文献依据探讨方法和结果分成5个层次，举荐看法的举荐级别依据Delphi分级分为A E级，其中A 级为最高。
表1 Delphi分级标准举荐级别A 至少有2项I级探讨结果支持B 仅有1项I级探讨结果支持C 仅有II级探讨结果支持D 至少有1项III级探讨结果支持E 仅有IV级或V探讨结果支持探讨课题分级I 大样本，随机探讨，结果清楚，假阳性或假阴性的错误很低II 小样本，随机探讨，结果不确定，假阳性和/或假阴性的错误较高III 非随机，同期比照探讨IV 非随机，历史比照和专家看法V 病例报道，非比照探讨和专家看法危重症患者人工气道的选择人工气道是为了保证气道通畅而在生理气道与其他气源之间建立的连接，分为上人工气道和下人工气道，是呼吸系统危重症患者常见的抢救措施之一。
《2024版中国抑郁症诊疗新方针》更新要点英文版
《2024版中国抑郁症诊疗新方针》更新要点英文版New Guidelines for Depression Diagnosis and Treatment in China in 2024In 2024, China has introduced updated guidelines for the diagnosis and treatment of depression. The key focus of these new guidelines is to improve the accuracy of diagnosis and provide more effective treatment options for individuals suffering from depression.One of the main updates in the guidelines is the emphasis on early detection and intervention. Healthcare professionals are encouraged to screen for depression symptoms in routine medical appointments and refer patients for further evaluation if necessary. This proactive approach aims to identify depression in its early stages and prevent it from worsening.Another important aspect of the updated guidelines is the incorporation of holistic treatment approaches. In addition to traditionalmedication and therapy, the guidelines recommend the use of alternative treatments such as mindfulness meditation, exercise, and dietary changes. These holistic approaches aim to address the physical, emotional, and social aspects of depression to improve overall well-being.Furthermore, the guidelines highlight the importance of personalized treatment plans. Healthcare providers are encouraged to consider individual factors such as age, gender, and co-occurring medical conditions when designing treatment plans for patients with depression. This personalized approach is intended to improve treatment outcomes and ensure that patients receive the most effective care.In addition, the updated guidelines emphasize the need for ongoing monitoring and follow-up care. Healthcare providers are advised to regularly assess the progress of patients undergoing treatment for depression and make adjustments to their treatment plans as needed. This continuous monitoring is crucial for ensuring that patients receive the support they need to manage their symptoms and prevent relapse.Overall, the 2024 guidelines for depression diagnosis and treatment in China reflect a comprehensive and patient-centered approach to addressing this mental health condition. By focusing on early detection, holistic treatment, personalized care, and ongoing monitoring, these guidelines aim to improve outcomes for individuals living with depression in China.。
2023年《ESPEN指南：共病住院患者营养支持》解读
·指南解读·【摘要】 由于我国人口老龄化趋势加快和居民生活行为方式的转变，致使慢性病共病成为公众健康的一大挑战。
共病现象使患者病情更加复杂、营养状况不佳，给患者健康和社会造成沉重负担。
2018年，欧洲临床营养和代谢学会（ESPEN）发布了《共病住院患者营养支持指南》，从共病住院患者的营养筛查、评估、需求、监测和干预等方面提供了22项建议和4项声明。
基于不断更新的研究证据，2023年6月ESPEN 指南工作组对2018版指南进行了更新，即2023年《ESPEN 指南：共病住院患者营养支持》，为共病住院患者提供了基于最新循证证据的营养支持建议。
本文对该指南进行解读，并就营养筛查和评估、口服营养补充、肠内营养和肠外营养、能量需求量的估算、蛋白质目标量、微量营养素的补充、特定疾病的营养补充、早期营养支持、出院后营养支持、身体功能检测、能量和蛋白质达标量、营养支持的组织管理、基础疾病对营养支持的影响、药物或营养素相互作用、营养生物标志物共15个方面进行重点分析，旨在为我国临床共病住院患者营养管理实践提供指导。
【关键词】 慢性病共病；共病；共病现象；营养支持；管理；指南；解读【中图分类号】 R 36 【文献标识码】 A DOI：10.12114/j.issn.1007-9572.2023.0824Interpretation of the 2023 ESPEN Guideline on Nutritional Support for Polymorbid Medical InpatientsWU Taiqin ，GAN Xiuni *，GAO Yan ，ZHANG Huan ，YANG LiDepartment of Critical Care Medicine ，the Second Affiliated Hospital of Chongqing Medical University ，Chongqing 400010，China*Corresponding author ：GAN Xiuni ，Professor/Chief nurse/Doctoral supervisor ；E-mail ：***************.cn【Abstract 】 Due to the accelerating trend of aging and transformation of residents ' lifestyles and behaviors in China，multiple chronic conditions have become a major public health challenge. The phenomenon of comorbidities complicates patients ' conditions and poor nutritional status，causing a heavy burden on patients ' health and society. In 2018，the European Society for Clinical Nutrition and Metabolism（ESPEN）published the ESPEN Guidelines on Nutritional Support for Polymorbid internal medicine patients ，which provides 22 recommendations and four statements on nutritional screening，assessment，requirements，monitoring and procedure of intervention for polymorbid medical inpatients. Based on continuously updated research evidence，the 2018 version of the guideline was updated by the ESPEN Guideline Working Group in June 2023，ESPEN Guideline on Nutritional Support for Polymorbid Medical Inpatients ，to provide evidence-based recommendations on nutritional support for the polymorbid patient population hospitalized in medical wards. This article interprets and focuses 15 key points of the guideline，include nutritional screening and assessment，oral nutritional supplements，enteral nutrition and parenteral nutrition，estimation of energy requirements，protein targets，micronutrients supplementation，disease-specific nutritional supplementation，early nutritional support，post-discharge nutritional support，monitoring of physical functions，energy and protein requirements，organizational changes in nutritional support，impact of underlying diseases on nutritional support，drug-基金项目：重庆市自然科学基金面上项目（CSTB2022NSCQ-MSX0816）引用本文：吴太琴，甘秀妮，高燕，等. 2023年《ESPEN 指南：共病住院患者营养支持》解读［J］. 中国全科医学，2024，27（21）：2557-2564. DOI：10.12114/j.issn.1007-9572.2023.0824. ［］WU T Q，GAN X N，GAO Y，et al. Interpretation of the 2023 ESPEN Guideline on Nutritional Support for Polymorbid Medical Inpatients ［J］. Chinese General Practice，2024，27（21）：2557-2564.© Editorial Office of Chinese General Practice. This is an open access article under the CC BY-NC-ND 4.0 license.扫描二维码查看原文慢性病共病通常是指个体同时患有两种或两种以上的慢性疾病，简称“共病”［1］。
2016 英国国家卫生与临床优化研究所(NICE)指南复杂骨折的评估和管理(英文)
2016 英国国家卫生与临床优化研究所（NICE）指南:复杂骨折的评估和管理（英文）2016 英国国家卫生与临床优化研究所（NICE）指南: 非复杂骨折的评估和处理唯医小编发布于：2016-04-26 更新于：2016-04-26前言在英国，骨折的年发病率约为3.6%，终生发病率近40%。
每年在英国发生的180万例骨折中，大多数为非复杂性骨折，包括范围广泛的各种外伤，涵盖从婴儿到老年的所有人群。
涉及不同的骨头，不同的损伤机制。
治疗选择的范围也是广泛的。
正因为如此，非复杂骨折为英国国家医疗服务体系(NHS)带来巨大的挑战。
许多非复杂骨折在最少的临床干预下可以获得满意的结果。
但医疗过程可以使事物复杂化，花费不必要的时间和精力去处理不需过多处理的骨折。
然而，一些非复杂骨折可能是轻微的，易于漏诊，但是其长期效果可能是差的，比如说舟状骨骨折。
所以就需要在确保损伤需要治疗，不被漏诊和避免过多治疗(自己可以恢复)之间建立平衡关系。
本指南涵盖小儿(16岁以下)和成人(16岁以上)非复杂骨折的诊断、处理和后续治疗。
它涉及以下重要临床领域︰·初期疼痛管理和固定·急性期的评估及影像诊断·急诊处理·下一步骨科处理本指南并不涉及所有可能情况以及每个单一骨折。
它的选材基于一些可以用询证医学的方法解决的非复杂骨折一般处理的代表性话题。
同时，本指南还针对临床实践中存在较多变异的领域提出了建议。
本指南不涉及颅骨骨折、髋部骨折、脊柱损伤、骨盆骨折、开放骨折以及骨质疏松症和骨关节炎的处理。
一.初始疼痛管理和制动1.疼痛评估(1)有关成人疼痛评估，请参考NHS成人患者体验服务指南。
(2)根据患者的年龄、发育阶段和认知功能使用适合的疼痛评估量表。
(3)使用与住院前相同的疼痛评估量表来评估住院期间的疼痛。
2.成人疼痛初始药物处理(16岁以上)(1)在开始阶段，对于成人疑似长骨骨折的疼痛，如胫骨、腓骨、肱骨、桡骨、尺骨骨折(16岁以上)，采用下列治疗：• 对轻度疼痛使用口服对乙酰氨基酚• 对中度疼痛使用口服对乙酰氨基酚和可待因• 对重度疼痛使用静滴对乙酰氨基酚辅以静脉吗啡，并逐渐增加剂量以达到产生止痛效果。
世界卫生组织儿童标准处方集
WHO Model Formulary for ChildrenBased on the Second Model List of Essential Medicines for Children 2009世界卫生组织儿童标准处方集基于2009年儿童基本用药的第二个标准目录WHO Library Cataloguing-in-Publication Data:WHO model formulary for children 2010.Based on the second model list of essential medicines for children 2009.1.Essential drugs.2.Formularies.3.Pharmaceutical preparations.4.Child.5.Drug utilization. I.World Health Organization.ISBN 978 92 4 159932 0 (NLM classification: QV 55)世界卫生组织实验室出版数据目录：世界卫生组织儿童标准处方集基于2009年儿童基本用药的第二个标准处方集1．基本药物 2.处方一览表 3.药品制备 4儿童 5.药物ISBN 978 92 4 159932 0 (美国国立医学图书馆分类：QV55)World Health Organization 2010All rights reserved. Publications of the World Health Organization can be obtained fromWHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: ******************). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the aboveaddress(fax:+41227914806;e-mail:*******************).世界卫生组织2010版权所有。
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
PPI
Interventions for uninvestigated dyspepsia
Review medications for possible causes of dyspepsia, for example, calcium antagonists, nitrates, theophyllines, bisphosphonates, steroids and NSAIDs.
Flowchart of referral criteria:
Immediate referral is indicated for significant acute gastrointestinal bleeding- same day.
Urgent endoscopic investigation: (Red Flags) –whithing 2 weeks patients of any age with dyspepsia when presenting with any of the following: chronic gastrointestinal bleeding, progressive unintentional weight loss, progressive difficulty swallowing, persistent vomiting, iron deficiency anaemia, epigastric mass or suspicious barium meal.
In some patients with an inadequate response to therapy it may become appropriate to refer to a specialist for a second opinion. Emphasise the benign nature of dyspepsia. Review long-term patient care at least annually to discuss medication and symptoms.
Offer low-dose treatment with a limited number of repeat prescriptions. Discuss the use of treatment on an as-required basis to help patients manage their own symptoms.
Offer lifestyle advice, including advice on healthy eating, weight reduction and smoking cessation, promoting continued use of antacid/alginates.
There is currently inadequate evidence to guide whether full-dose PPI for 1 month or H. pylori test and treat should be offered first. Either treatment may be tried first with the other being offered if symptoms persist or return.
Routine endoscopic investigation(up to 2 month) of patients of any age, presenting with dyspepsia and without alarm signs, is not necessary. However, in patients aged 55 years and older with unexplained and persistent recent-onset dyspepsia alone, an urgent referral for endoscopy should be made.
Continue on intervention
Detection: use carbon-13 urea breath test, stool antigen test or, when performance has been validated, laboratory-based serology.
or testing for and treating H. pylori. There is currently
insufficient evidence to guide which should be offered first. A 2-week washout period following PPI use is necessary before
NICEGuidelinesonDyspepsi a
Dyspepsia – management of dyspepsia in adults in primary care
Interventions for uninvestigated dyspepsia
Initial therapeutic strategies for dyspepsia arith a proton pump inhibitor (PPI) for min 1 month
Eradication: use a PPI, amoxicillin, clarithromycin 500 mg (PAC500) regimen or a PPI, metronidazole, clarithromycin 250 mg (PMC250) regimen.
Do not re-test even if dyspepsia remains unless there is a strong clinical need.