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血清C_肽、尿微量白蛋白与糖化血红蛋白应用于糖尿病肾病诊断中的效果分析

血清C_肽、尿微量白蛋白与糖化血红蛋白应用于糖尿病肾病诊断中的效果分析

血清C肽、尿微量白蛋白与糖化血红蛋白应用于糖尿病肾病诊断中的效果分析陈丹,胡丽,王彬阶麻城市人民医院检验科,湖北麻城438300[摘要]目的探究血清C肽(C-PR)、尿微量白蛋白(mAlb)与糖化血红蛋白(HbA1c)应用于糖尿病肾病(dia‐betic nephropathy, DN)的诊断效果。

方法回顾性分析2021年4月—2022年4月麻城市人民医院检验科收治的95例糖尿病(diabetes mellitus, DM)患者的临床资料,依据是否合并肾病划分为DM组(50例)、DN组(45例),基于相同时期选取到本院接受健康体检的志愿者60名作为对照组,均接受C-PR、mAlb、HbA1c检测,分析联合检测效果。

结果DN组C-PR水平最低,对照组最高,DN组mAlb、HbA1c水平最高,对照组最低,差异有统计学意义(P<0.05)。

联合检测诊断灵敏度97.78%、特异度93.33%,均显著高于C-PR、mAlb或HbA1c单一检测结果,差异有统计学意义(P<0.05)。

结论在DN患者中实施C-PR、mAlb、HbA1c联合检测具有较高的诊断价值,便于患者尽早得到有效治疗。

[关键词] 血清C肽;尿微量白蛋白;糖化血红蛋白;糖尿病肾病;糖尿病[中图分类号] R587.2;R692.9 [文献标识码] A [文章编号] 1672-4062(2023)06(b)-0181-04 Analysis of the Effect of Serum C Peptide, Urine Microalbumin and Gly⁃cated Hemoglobin Applied to the Diagnosis of Diabetic NephropathyCHEN Dan, HU Li, WANG BinjieDepartment of Laboratory, Macheng People′s Hospital, Macheng, Hubei Province, 438300 China[Abstract] Objective To explore the diagnostic effect of serum C-peptide (C-PR), urinary microalbumin (mAlb) and glycated hemoglobin in diabetes nephropathy (DN). Methods Retrospective analysis was made on the clinical data of 95 patients with diabetes mellitus (DM) admitted to the Laboratory Department of Macheng People′s Hospital from April 2021 to April 2022. They were divided into DM group (50 cases) and DN group (45 cases) according to whether they were complicated with kidney disease or not. Based on the same period, 60 volunteers who received physical ex‐amination in our hospital were selected as the control group, all of whom received C-PR, mAlb, and HbA1c tests, and the effect of the joint test was analyzed. Results The C-PR level in the DN group was the lowest, while the control group was the highest, the levels of mAlb and HbA1c in the DN group were the highest, while the control group was the lowest, the difference was statistically significant (P<0.05). The diagnostic sensitivity and specificity of the com‐bined test were 97.78% and 93.33%, which were significantly higher than those of the single test results of C-PR, mA1b, or HbA1c, and the difference was statistically significant (P<0.05). Conclusion The implementation of com‐bined C-PR, mAlb, and HbA1c assay in DN patients has high diagnostic value and facilitate patients to get effective treatment as early as possible.[Key words] Serum C peptide; Urine microalbumin; Glycated hemoglobin; Diabetic nephropathy; Diabetes mellitus糖尿病(diabetes mellitus, DM)作为我国较为常见的一种慢性代谢性疾病,据流行病学调查显示,我国每11个人里面就有1例糖尿病,患病率高达30.2%,且近年来随着人们生活方式及饮食习惯的改变,患病率呈现出逐年递增趋势,引起了社会各界的广泛重视。

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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。

医学护理中英文对照外文翻译文献

医学护理中英文对照外文翻译文献

医学护理中英文对照外文翻译文献(文档含英文原文和中文翻译)宗教信仰在应对乳腺癌患者以后生活中的作用目的:识别并检查新诊断为乳腺癌的老年患者中是否存在宗教和精神应对策略现象。

方法:一个简易样本,由被招募来进行为期6个月的诊断的33名65岁女性组成。

受访者被要求参加一个会提出灵活性问题的结构式访谈。

访谈的誊本由三名研究人员各自独立分析讨论其主题,直至达成共识。

结果:参加者的宗教背景为:17名新教徒,五,六名犹太人,天主教和另外四个其它教徒。

她们在出席宗仪式的频率上存在着很大的不同。

而在健康危机期她们的宗教和/或精神信仰或增加或保持不变。

誊本分析显示出了三个主题。

宗教和宗教信仰为受访者提供了必要的情感支持(91%)、社会支持(70%)来面对她们的乳腺癌,以及赋予了她们一些使日常生活变得有意义的能力,特别是癌症经验(64%)。

结论:宗教和宗教信仰为新诊断为乳腺癌的老年女性患者提供了一些重要的应对这些疾病的方法,这些方法也得到了诊断医生的认可。

这可能对于鼓励这些患者寻求宗教的支持和/或重新与她们的宗教团体再结合是非常重要的。

引言一个关于乳腺癌的新的诊断已被证实对女性有重大的影响(格里,1979;琼斯和格林伍德1994;罗兰和马西,1996分;安徒生,1998)。

在老年妇女中,乳腺癌是最常见的癌症,其影响还会因为人口老龄化继续上升。

更好的了解老年妇女如何应对乳腺癌可以使人们更好的增强功能和改善生活质量。

最近日益让人们产生浓厚兴趣的是,宗教或信仰在患者对乳腺癌的反应中所扮演的角色。

在这些老年人中,宗教经常可以帮助她们缓解生理疾病中的固有压力,比如那些伴随着医师会诊、治疗及其它事件所产生的相关压力(包括罗斯,1982;考恩威博士(1985 - 1986);曼弗雷德和皮克特,1987)。

宗教或者精神依赖的正面效应,一直被认为是社会支持的次要规定,其通过与社会性的或教会有关的方式来进行宗教活动。

人们去教堂敬拜时通过培养友情和社会关系来获得能够提供正式的和非正式的社会网络的支持。

学术英语(医学)-课后词组

学术英语(医学)-课后词组

学术英语(医学)课后词组Unit 11.neuron overload 神经过载2.a typical office visit 典型的诊所就诊3.DEXA scan DEXA扫描4.medical practice 行医5.blood pressure control 血压控制6.health maintenance 健康保持7.mammogram report 乳房X线检查报告8.physical examination 体检9.side effect of a medication 药物的副作用10.perpetual panic 永久的恐慌11.practicing physicians 职业医生12.transplant field 移植领域13.medical budget 医疗预算14.paracetamol tablet 扑热息痛药片15.childproof cap 防孩子打开的盖子16.randomized clinical trial 随机临床试验17.random allocation 随机分配18.patient prognosis 病人的预后19.control group 对照组20.a 10-year follow-up study 10年的跟踪研究21.a medical ward 内科病房22.infectious hepatitis 传染性肝炎23.Severe malaise 身体严重不适24.bilirubin metabolism 胆红素代谢25.permanent liver damage 永久的肝损伤26.exacerbate pathophysiology 加重病理生理状况27.medical literature 医学文献28.clinical investigation 临床调查29.incidence of relapse 复发率30.clinical epidemiology 临床流行病学31.strict bed rest 严格的卧床休息32.hospital stay 住院33.recurrent jaundice 反复发作的黄疸34.clinical course 临床病程35.intravenous morphine 静脉注射吗啡36.diastolic blood pressure 舒张压37.brain perfusion 大脑血灌输38.primary care初级保健39.aorto-coronary arterial bypass主动脉冠状动脉旁路rmed treatment decision知情治疗决41.an international humanitarian group一个国际人道组织42.the Red Cross 红十字会43.the first major relief effort第一次重大援助工作44.casualty of war 战争中的人员伤亡45.emergency relief efforts 紧急援助Unit 21.re-emerging/re-emergent/resurgent disease(再现疾病)2.new flu strain新流感变种3.antibiotics and vaccine抗生素和疫苗4.infectious disease传染病5.emergent/emergent disease新现疾病6.prevention strategy预防策略7.bubonic plague腺鼠疫8.pathogenic microbes病原微生物9.public heath authority公共卫生机构10.drug resistance抗药性11.an course of antibiotic therapy抗生素治疗疗程12.scarlet fever猩红热13.the level of virulence毒性水平14.flu pandemic流感大流行15.surface antigen 表面抗原16.genetic shift基因改变17.neurological complications 神经性并发症18.waning of immunity免疫力减弱19.public health infrastructure公共卫生基础设施20.a malaria case一个疟疾病例21.swine flu猪流感22.tuberculosis bacillus结核杆菌23.the level of morbidity/incident发病率水平24.health professional保健专业人士tent tuberculosis潜伏结核病26.tuberculin skin test结核素皮试27.screening programmes筛查计划28.interferon gamma tests γ干扰素测试29.drug toxicity药物毒性30.an curable disease一种可治愈的病31,intractable infectious disease难治的传染病32.an unknown pathogen一种未知的病原体33.chronic gastric ulcer慢性胃溃疡34.exposure to carries of disease接触带病者35,genetic recombination基因重组36.agent of bioterrorism生物恐怖活动病原37.foodborne infections通过食物传播的传染病Unit 31.the surge of adrenaline 肾上腺素激增2.an internal medicine residency 内科实习期3.an autoimmune disease 自体免疫4.loss of stamina 丧失持久力5.transient weakness 短暂的虚弱6.becoming bedridden 卧床不起7.a building block基本构件8.an animal model 动物模型9.to slow neurodegeneration减缓神经退化10.to excrete toxins排除毒素11.to optimize nutrition 优化营养12.toxic load毒素载量13.the risk of relapse 复发危险14.physician self-experimentation医生自我实验15.a clinical trial 临床试验16.neuromuscular electrical stimulation 神经肌肉电刺激17.physical therapist 理疗师18.the impact of micronutrient 微量营养素的影响19.brain function 脑功能20.track the emotional flow 跟踪情绪波动21.coordination of emotions 情绪协调22.cardiovascular reactions 心血管反应23.feeling of rapport 亲密感觉24.rapid synchronization 迅速同步25.emotional contagion 情绪传染26.to mutually regulate 互相调节27.a psychobiological unit生物心理单元28.emotional solace 情感慰藉29.functional magnetic resonance imaging功能性磁共振30.to activate brain zones激活该脑部区域31.to make it mandatory使之成为强制性32.a dubious project 无把握的项目33.medical background 医学背景34.proof of concept 概念验证35.dose regimen 剂量方案plication or concomitant conditions并发症与合并症37.anti-tumor agents 抗肿瘤的药剂38.standard therapy标准疗法39.pharmacological properties 药理学特性40.poor solubility 溶解性差41.in vivo pharmacology 体内药理学Unit 4plementary medicine 补充医学2.alternative medicine 替代医学3.a medical paradigm 医疗模式4.acupuncture and herbs 针灸和草药5.adjunct treatment 辅助治疗6.nausea and vomiting 恶心,呕吐7.post-operative dental pain 术后牙痛8.clinical trials 临床试验9.physical therapy 物理疗法,理疗10.therapeutic modalities 治疗方法11.a therapeutic intervention治疗干预12.research design 研究设计13.magnetic resonance 磁共振14.positron emission tomography 正电子发射型计算机断层成像15.analgesia effect 止痛效果16.biomedical establishment 生物医学界17.rehabilitation unit康复中心18.licensed acupuncturist 持照针灸师19.therapeutic strategy治疗策略20.herbal formula草药配方21.a wide array of complications 各式各样的并发症22.integrative East-West medicine 中西医结合23.acute abdominal pain 急性腹痛24.to administer medicines 施药,用药25.surgical procedure 外科手术26.scientific evaluation 科学评估27.prevalence statistics患病率统计28.conventional therapies 传统疗法29.evidence-based models of care询证医学模式30.stress management 压力处理31.peripheral nervous system 周围神经系统32.physiologic mechanism生理机制33.mechanistic and reductionistic studies 机制和还原式研究34.cost-effectiveness research 效益研究35.clinical outcomes 临床结果36.preclinical and clinical studies 临床前及临床研究37.plausible mechanisms可能的机制38.manipulative therapies 推拿治疗39.homeopathic medicine 顺势疗法40.naturopathic medicine 自然疗法41.meditation and yoga冥想与瑜伽Unit 51.a health crisis 健康危机2.physical symptom 身体症状3.energy and vitality 能量和活力4.be completely immune from sth.对某事完全免疫5.virus of falseness 虚假的病毒6.stressful lifestyle 有压力的生活方式7.robust emotion 健全的感情8.fragile health 脆弱的健康9.to balance our mind ,body and spirit平衡心理、身体和精神10.spiritual life精神生活11.the blockage to wellness 通向身心健康的“路障”12.repressed emotions 被压抑的感情13.genuine feelings and emotion真情实感14.physiological influences 心理影响15.fully integrated human beings 十全十美的人16.decaying teeth 蛀牙17.nutrition professor 营养教授18.burgeoning waistline 迅速膨胀的腰围19.bottled water 瓶装水20.caloric intake 热量摄入21.to curb appetite 节制食欲22.grains and protein 谷物和蛋白质23.childhood obesity 儿童肥胖症24.lean protein 精益蛋白质25.dietary habits 饮食习惯26.quality of life 生活质量27.diary category 乳制品类28.prevention of diabetes糖尿病的预防29.sodium content 钠的含量Unit 61.nursing homes养老院2.hospice/end-of-life care临终关怀3.congestive heart failure充血性心衰4.available around-the-clock 24小时随叫随到5.coronary care unit冠心病监护室6.to respond to treatment对治疗有反应7.skilled nursing facility专业护理机构8.end-of-life/hospice care生命终末期护理fort care舒适护理10.hospital discharge planner出院计划专员11.symptom care症状护理12.palliative care姑息疗法13.fatal illness绝症14.chronic obstructive pulmonary disease慢性阻塞性肺病15.experimental treatments实验性治疗16.spiritual advisor精神顾问17.to discontinue all treatment终止所有治疗18.to go through dialysis经历透析19.a PAP smear巴氏涂片检查20.patient-doctor relationship医患关系21.to provide care-as-usual提供常规医护22.preventive examinations预防性检查23.off the beaten path离开熟路,另辟蹊径24.to mold into a shape塑形25.To renew a prescription照旧处方再开药26.in vitro fertilization体外受精27.basic biology基础生物学28.embryonic stem cell research胚胎干细胞研究29.to collaborate with an outside与圈外人合作30.a test-tube baby试管婴儿31.reproductive sciences生殖科学32.to administer hormone施用激素33.to isolate immature eggs 分离未成熟卵子34.empirical observations经验观察35.pioneering work首创研究36.a fibre-optic endoscope光导纤维内窥镜37.ethical guidelines伦理原则38.societal concern社会关注39.infertile couples不孕不育夫妇40.inherited disease遗传疾病41.cystic fibrosis囊泡性纤维症42.ethical dilemma伦理困境Unit 71.a nursing station 护士站2.life-support machines 生命维持系统fort measure 舒适护理措施4.to withdraw treatments 停止治疗5.paternalistic decision-making process 家长式决策程序6.patient empowerment 给病人授权7.medical ethicist 医学伦理学家8.ethical principle 伦理准则9.clinical ideal 临床理念10.patient-centered care 以病人为中心的护理11.patient autonomy 病人自主权12.treatment option 治疗选择13.exclusive purview 专属领域14.emergency decisions 紧急状况下做的决定15.physician restraint 对医生的限制16.anxiety and confusion 焦虑与困惑17.ethical transgression 违背伦理18.family practice 家庭医疗19.widespread metastases 广泛转移20.aggressive treatment 积极治疗21.primary lesion 原发病灶22.to recommend follow-up 建议随访23.electronic record 电子病历24.pulmonary emboli 肺栓塞puterized tomography 计算机断层扫描CT26.bilateral infiltrates 双侧浸润27.a chest X-ray X线胸片28.left lower-lobe pneumonia 左下肺叶肺炎bored breathing 呼吸困难30.the hospice team 临终关怀团队31.chronic illness 慢性病32.psychosocial aspects 社会心理学领域33.evidence-based guideline 循证临床指南34.to implement a plan of care 实施治疗方案Unit 81.human subject 人体研究对象2.biomedical research 生物医学研究3.accepted therapy 公认的治疗4.a formal protocol 正式方案5.the principle of beneficence 有利原则6.the principle of justice 公正原则7.autonomous agents 有自主能力的行为者8.diminished autonomy 自主性减弱9.be exposed to risk of harm 使……面临受害危险10.Hippocratic Oath 希波克拉底誓言11.fairness in distribution 分配的公正性rmed consent 知情同意13.fair procedure and outcomes 公正的程序和结果14.the operating table 手术台15.an ethical obligation 伦理责任16.a pediatric neurosurgeon 儿科神经外科医生17.to perform the surgery 做手术18.blood flow 血流19.intensive care 重症监护20.adoptive father 义父21.biological father 生父22.psychological needs 心理需要23.medical judgment 医学判断24.occupational therapy 职业疗法25.to contract meningitis 感染脑膜炎26.to die of an infection 死于感染27.blood vessel 血管28.imbalances in circulation 循环的不平衡29.the welfare of human research subjects 人类研究对象的安宁30.to approve or disapprove all research activities 批准或不批准所有的研究活动31.to review a protocol 审查一个研究计划32.at risk of civil or criminal liability 有民事或刑事责任的危险Unit 91.medical school curriculum 医学院课程2.the medical education community 医学教育界3.to meet the public’s expectation 达到公众的期待4.personal attribute 个人品质5.to place value on 看重6.clinical malady 临床疾患7.diagnostic errors 诊断错误8.classic manifestation 典型临床表现9.the civic mindedness of physicians 医生的民本意识10.polite chatter 礼貌的闲谈11.bedside manner 医生对患者的态度,临床举止12.to scan hospital directory 搜索医院名录13.a integral part 不可分割的一部分14.underserved communities 服务匮乏的社区15.primary care shortage 初级保健缺乏16.certification evaluations 证书评估17.to address the needs 应对需要18.the basics of anatomy 解剖基础知识19.a teaching hospital 教学医院20.an academic medical center 学术医学中心21.to affiliate with teaching hospitals 隶属于教学医院22.continuing medical education credits 继续医学教育学分Unit 101.medical coverage 医疗保险支付范围2.Medicare and Medicaid 医疗保险和医疗救助3.a single-payer system 单一支付者系统4.to subsidize the uncovered 补贴无保险的人5.to deliver value care 提供医疗6.duplicative tests 重复的检查7.a sustained study 长期的研究8.vision deficit 视力缺陷9.a transesophageal echocardiogram (TEE)经食管超声心动图10.an trial thrombus 心房血栓11.a massive embolic stroke 大面积栓塞型脑中风mon carotid artery 颈总动脉13.intracranial branches 颅内段14.middle cerebral artery syndrome 大脑中动脉综合征15.intracranial bleeding 颅内出血16.brain-stem herniation 脑干脱疝17.neurologic recovery 神经功能恢复18.mechanical ventilation 机械通气19.anticoagulant treatment 抗凝血治疗20.intravenous infusion 静脉输液21.an academic surgeon 学术型外科医生22.hospital administrator 医院管理者23.inbound ambulance 入院的救护车24.elective surgery 可做可不做的手术25.acute myocardial infarction 急性心肌梗死26.time-critical conditions 对治疗时间要求紧迫的疾病27.cardiac arrest 心搏停止28.traumatic injuries 外伤,创伤29.percutaneous coronary intervention 经皮冠状动脉介入术30.a multi-payer model 多家支付者模式31.universal insurance programs 全民保险计划32.for-profit insurance 以盈利为目的的保险33.pharmaceutical companies 制药公司34.home-brewed remedy 自创的治疗方法35.pay the bill out-of-pocket 自掏腰包付费。

制度伦理视域下重大公共卫生事件医疗救治人员人文关怀措施制度化研究

制度伦理视域下重大公共卫生事件医疗救治人员人文关怀措施制度化研究

制度伦理视域下重大公共卫生事件医疗救治人员人文关怀措施制度化研究*杨芳,刘群英,张蔚(安徽医科大学医学人文研究中心,安徽合肥230032,********************)〔摘要〕医务人员是人民生命安全和身体健康的“守门人”。

新冠肺炎疫情防控期间,中央和地方密集出台一系列医疗救治人员的人文关怀措施,蕴含着丰富的中华民族道德底蕴,彰显了医患命运共同体的道德伟力。

当前亟需发挥制度优势,以制度伦理重塑德性伦理,固化和筑牢人文关怀措施的道德之基,创新长效机制营造尊医重卫社会风气,增强常态化疫情防控能力,提高公共健康风险治理水平。

〔关键词〕制度伦理;公共卫生事件;医疗救治人员;人文关怀;疫情防控〔中图分类号〕R-052〔文献标志码〕A〔文章编号〕1009-8565(2029)09-0048-05 DOI:10.12026/j.issn.1009-8565.2669.29.10Research on InstitutionaUzation of Humanistic Care Measures for Menical Treatment Personnei m Major Public Incidents frrm the Perseective of Instithtionai EthicsK4NG Fang,HU Qunying,,HANG W u I(Medicat Humanitins Resenrca Centnc.,Pnnut Medical UdfuPiHUat230932,ChCa,E-mail zhangfang9996@126*com)Abstracy:The medicnf personnel are the"gdWdepe”of people's life safety an.boky health j DuUna the prevention an.contul of COVID-19,the central an.locnf novemmedls have introkuced a seUes of humanistic cnu measures for medicnt tuPwent personnel,whicO contain UcO moral heUtpv of the Chinese nation an.Uemonstraiv the moral stunath of Uoctoc-patieni faie community.At puseni,it is uraeni W made full use of institutional pydritpes:resPape moral ethics with institutional ethics:solidify an.consolidaiv the moral fopnnpion of humanistic core measures:innovaW Iona-Wrm mecOanisms te cuPe a social atwospUero thai vvluvs medicnt core an.health core:euhpco the capacity of requlac epidemic prevention anU control:an.improve the level of puUlic health Ush mppemuPKeywords:System Ethics:PuUlic Health Emeraencivs:Medical Personnel:Humanistic Caro:Epidemic Preveni Pon anU Control在党和政府及社会各界的共同努力下,尊医重卫社会风气积极向好。

CRRT的几个基本概念

CRRT的几个基本概念

Return Pressure Positive +50 to +150 mmHg
Effluent Pressure Negative or Positive >+50 to -150 mmHg
高通量旳滤器 面积 1.6-2.2平方米
HVHF
总之,对重症脓毒血症或合并休克患者, CRRT极难设定上限计量,尚需研究,超滤
率至少应≥35ml/kg/h。
Access Pressure Negative -50 to -150 mmHg
Filter Pressure Positive +100 to +250 mmHg
凝措施) 局部肝素抗凝法 局部枸橼酸盐抗凝法 低分子肝素抗凝法 无肝素抗凝法 前列腺素抗凝法
前列腺素抗凝法
原理:阻断血小板粘附功能和汇集功能 有人以为比肝素安全,半衰期极短(2min) 缺陷:停用后抗血小板活性时间长(24H) 无中和制剂 调整需依赖血小板汇集试验 药物剂量依赖性低血压发生率高 应用
技术构成三
滤器 聚砜膜(AV400及AV600)滤器 聚丙烯腈膜(AN69)滤器
AN 69
AV600
血液滤过器旳构造
血液入口
透析液和滤 出液出口
横断面
空心纤维 膜
透析液入 口
血液出口
空心纤维外面 (滤出液) 空心纤维里面 (血液)
血滤器
种类
聚砜膜
聚丙烯晴膜
聚酰胺
膜通透性
低通量滤器 <10000D
治疗中旳经典压力
治疗中旳经典压力
动脉压Access Pressure
测量当血液离开病人血液通路(例如双腔导管)时 旳压力(体外旳)

英国临床试验成功埋植式心脏除颤器

英国临床试验成功埋植式心脏除颤器
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Confusion Denial Anger Sabotage
“Much ado about nothing. Everything will stay the same”
“Are they out of their minds, cutting my staff by 25%?”
“Let’s create a committee to discuss the issue.”
COMMITMENT
Lack of understanding
People question or oppose the idea itself: They don’t understand what goal you are trying to accomplish They don’t know what impact the change will have on them They think there is not enough staff to execute the idea
Resource Requirements
During the I-phase
How does the demand on project team members change? What other people resources are needed outside the project team? Is there a need for investment? - is this approved? Is a change in working methods proposed which impacts human or process resources? - is this accepted and approved? Have all interested management approved the outline plan described in the D-phase?
Manipulate those who oppose Apply force of reason Ignore resistance Play off relationships Make deals Kill the messenger Give in too soon
Why wrong? They increase resistance The win might not be worth the cost They create fear and suspicion They separate those who want the change and those whose support is needed
Lack of skills
People will need to learn new
Responsibilities Procedures Systems Competencies
…and will question whether they are able to
Wrong positions ...
Reasons why people resist change, and remedies
Coaching Training Lack of skills Practice Lack of motivation Acknowledge Participation Big picture Lack of underMeaning standing
A Breakthrough Approach
M E D I C
easure ap xplore valuate efine solutions escribe modified process mplement mprove ontrol onform
The I-phase
I
Phase Focus: To plan, implement and monitor the designed improvement Deliverables: Implementation plan Communication Plan Plan for overcoming any resistance to the change Monitoring the Improvement
Track costs against budget
• React quickly to any over-spend situation - control or gain re-approval
Publish the ongoing financial statement to line management
Project Plan
Make a detailed project plan from the list of Activities and Countermeasures Draw Gantt charts Check the feasibility of the plan Use software familiar to local resources
How does the project impact a Business Balanced Scorecard Goal? What impacts will this project have on other business units and employees? What benefits will derive from this project? Has the value of the benefits been updated?
Lack of Understanding Lack of Motivation Lack of Skills
Mistakes in managing Resistance Effective reaction to Resistance
Types of resistance (1)
“Why are we doing this? Yet another project!”
MEDIC - I
The I Phase
MEDIC - I Overview
Content
Updating the Business case & sistance to change Project Plan Communication Plan
Dealing with resistance: The next slides address ….
Types of resistance In what form does resistance appear? Reason for resistance Why does resistance occur?
I
Project plan
Resource requirements
Budget/Control
Dealing with Resistance
Communication
Updating the Business case & objectives
During the MEDIC phases so far, some parts of the business case may have changed. Check:
The Implementation Phase
Updating the Business case & objectives
Element Element 1 Element111 TheMarketing Marketing Element TheMarketing Element11 TheMarketing Element Strategy TheMarketing TheMarketing THEStrategy prioritises and Strategy The- -identifies, prioritises and identifies, Strategy Strategy aprioritises and ensures -identifies,aprioritises andintegrated identifies, consistent, IMPLEMENTATION in Strategy consistent,elements ensures -identifies,aprioritises andintegrated approach to all key ensures consistent, integrated approach to all key elements ensures consistent, integratedin - -identifies,aprioritises and process. approach to all generation PHASE consistent,elements inin . the demand key elements ensures a to all key integrated approach the demand generation process ensures a consistent, integrated approach to all generation process. the demand key elements in approach to all generation process. the demand key elements in the demand generation process. the demand generation process.
Dates Tasks
Budgeting and Control
Ensure that all costs for the project implementation are budgeted:
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