远程心脏监护技术在慢性病管理中的应用

我国慢性病患者数量庞大,而医师和医院数量相对不足,应积极借助远程心脏监护技术解决这一问题。远程心脏监护技术可用于心血管病患者的检查、监护及管理,健康状况评测和急危重症实时、快速诊断及报警急救。除该技术外,目前应用于心血管病患者的远程监护技术还有生理多参数远程监护技术和影像技术：前者包括远程血压监护、远程血糖监护、远程血氧饱和度监护、远程睡眠呼吸障碍监测、远程向量、立体心电图等;而后者包括心脏血管超声、CT、磁共振等。远程心脏监护技术不仅实用,而且性价比高。对慢性病患者的管理而言,该技术最重要的方面是心率管理、心律失常管理和危急情况及时预警;通过对病情变化早发现、早诊断、远程问诊咨询,可节省医疗费用、降低住院率和缩短住院时间。     

机器人化护理床的智能健康住宅系统

智能健康住宅的概念主要是基于在家庭环境下为患有某些慢性疾病或身体存在某种缺陷，本应该被送人医院或者其他特殊护理机构接受治疗的老年人提供自主、独立、高质量的生活。本文介绍一种机器人化护理床的智能健康住宅系统，可为老年人或残疾人群在家居生活中提供护理和身体健康状况远程监控。     

远程心电诊断危急值管理和质控系统关键问题研究

远程心电信息系统在优化心电检查流程,提高医师工作效率,推进分级诊疗,及时诊断处理急性心肌梗死、恶性心律失常等危急重症心电图等方面发挥着重要作用,然而在运行中也有一些问题亟须解决,涉及心电图危急值管理、心电诊断和质控水平提升等。通过心电图危急值的编制与分级、危急值传输队列排序、优先诊断、危急值心电图标记和预警,以及心电图危急值基层医院接诊技术指导、心电图危急值患者的随访与诊疗质量评价,构建完善的心电图危急值管理系统。通过心电图图像质量比对、诊断报告质量评价、时间质量管理、心电信息联网基层医疗机构及其从业人员准入标准的制定,切实加强心电远程诊断质量控制。通过心电图危急值管理和心电远程诊断质量控制系统的构建与完善,能更好地对危急重症患者进行远程心电监护和随访,实现优质卫生资源的共享。     

基于物联网云计算技术的远程医疗在老年慢性病管理中的研究进展

<正>调查显示,80%的老年人至少患有一种慢性病,50%的老年人患有两种慢性病~([1]),其中以高血压、糖尿病、冠心病尤为显著~([2]),中国居民死亡原因中慢性病所占比例约为80%,高出全世界平均水平的20%~([3])。随着互联网和云计算一体化的迅速发展,物联网的出现推动着医疗信息向高效率、高质量监测管理和精准定位方向发展~([4])。随之兴起了运用于老年慢性病患者的电子健康服务、远程健康监测和电子健康系统~([5]),物联网     

银川市城市社区老年人群健康状况调查

目的了解银川市城市社区老年人健康状况,为社区卫生服务中心制定良好的有针对性卫生保健服务计划提供依据.方法采用问卷访问和体格检查相结合的方法,对银川地区城市社区老年人进行了入户调查.结果 80.1%的老年人群有慢性病史,常见慢性病患病率前10位的是:高血压、骨关节病、冠心病、胃病、高脂血症、慢性支气管炎、糖尿病、肥胖、脑血管病、肿瘤.回族老人慢性病患病率高于汉族.结论银川市老年人群健康状况不容乐观,应积极开展社区医疗、健康教育、预防、卫生保健等公共服务,加强慢性病的防治和管理,改善健康状况,提高老年人活质量.     

瑞昌市城区老年人慢性病的调查分析与防范策略

随着社会经济的发展，人们生活水平的提高以及医疗条件的改善，急性传染病患病率已得到有效控制，而以非传染性疾病为主的慢性病，逐渐替代了既往的发病顺位，成为人类健康的主要威胁。为了解老年人慢性常见病的分布特点，探讨防范老年人慢性病的策略，笔者于2007年4～10月对瑞昌市城区60岁以上老年人慢性常见病的患病情况进行了调查，现报告如下。     

日照市农村老年人慢性病调查分析

目的了解日照市农村老年人健康状况、常见慢性病患病率及分布特征。方法方法面对面访谈。结果农村老年人慢性病患病率为74.35%,患病率位于前3位的是风湿病(36.31%)、高血压(24.50%)和慢性支气管炎(18.16%);女性风湿病患病率高于男性(P=0.000 4),慢性胃炎患病率则低于男性(P=0.009 1);随着增龄,风湿病、慢性支气管炎、慢性胃炎和慢性前列腺疾病患病率均有增加趋势(P<0.05),高血压则有降低趋势(P=0.005 9),随着经济收水平升高风湿病患病率有降低趋势(P=0.030 4);不同居住方式间慢性胃炎患病率有差别(P=0.000 1)。结论日照市农村老年人慢性病患病率较高,医疗卫生部门要充分考虑其疾病谱和人群特点,有针对性地开展医疗服务。     

西部农村老年人对中医护理服务需求及应用现状

目的 了解西部农村老年人对中医护理的认知和需求情况.方法 选取湘、鄂、渝、黔四省市西部边区281例农村老年人进行面对面问卷调查.结果 西部农村老年人对中医护理不了解者115例(40.9％);对中医护理相关的医疗服务需求主要包括:老年病的康复、中药用药护理、中医养生保健、疾病诊疗、慢性病护理、传染病护理;多元Logistic回归分析检验表明,中医护理了解程度是常用中医操作技术需求和中药用药护理需求的第1位影响因素.结论 西部农村老年人对中医护理的认知程度低,对中医护理服务的需求呈现多样化,中医社区医疗获取和中医护理了解程度对中医护理服务需求具有重要影响.     

国外老年长期护理服务供给体系及启示

长期护理是指在一个比较长的时期内,持续地为患有慢性疾病和功能性损伤的人提供的护理。它包括健康服务、社会服务、居家服务、运送服务或其他支持性的服务。其目的在于保证那些不具备完全自我照料能力的人能继续得到其个人喜欢的以及较高的生活质量,而不是解决特定的医疗问题。随着年龄的增长,生理和心理功能随之下降,老年人患慢性病和遭受     

天津市主城区居家养老老年人社区医疗护理需求

目的探讨天津市居家养老老年人对社区医疗护理的具体需求。方法采用量性和质性研究相结合方法,了解居家养老老年人400人社区医疗护理需求。结果 33.5%首诊选择社区卫生服务机构;居家老年人在社区卫生服务机构接受的基本医疗护理服务主要为开药、一般性治疗、定期体检和中医药服务,天津市社区卫生服务机构基本能满足其需求;26%的居家老年人签订了家庭责任医生,多因素Logistic回归分析显示,文化程度、月收入和有无慢性病均对未签约居家老年人签约意愿有显著影响(P0.05);居家老年人健康管理意识和主动参与的积极性有待提高;56.5%的居家老年人愿意接受临终关怀服务,但知晓程度低,多因素分析显示,文化程度和日常生活能力对居家老年人临终关怀接受意愿有显著影响(P0.05)。结论天津市社区医疗护理服务还需进一步地提升与发展,以满足居家老年人多样化服务需求。     

河北省燕郊社区717名老年人慢性病现况调查

目的 了解影响三河市开发区老年人健康状况的几种常见慢性病的现况，为开展社区老年卫生服务提供依据。方法 采用整群抽样方法对河北省燕郊年龄≥60岁717名老年人进行问卷调查。结果 老年人慢性病总患病率为92．1％，其中男性患病率91．2％，女性93．0％，两者差异无显著性。70．0％的老年人同时患有2种及以上慢性病。患病率位于前5位的病种依次是高血压(46．2％)、心脏病(26．9％)、骨关节炎或风湿性关节炎(21．9％)、口腔与牙病(16．2％)、颈椎病(16．0％)。文化程度、离退休前职业、医疗保障、居住状况、是否经常主动获得医疗保健知识、支付医疗保健费用有无困难是影响老年人患多种慢性病的因素。结论 慢性病是危害老年人健康的主要卫生问题，应充分考虑老年人疾病谱的特点，开展有针对性的社区卫生服务，提高老年人健康水平。     

Health insurance system and payments provided to patients for the management of severe acute pancreatitis in Japan

The health insurance system in Japan is based upon the Universal Medical Care Insurance System, which gives all citizens the right to join an insurance scheme of their own choice, as guaranteed by the provisions of Article 25 of the Constitution of Japan, which states: “All people shall have the right to maintain the minimum standards of wholesome and cultured living.” The health care system in Japan includes national medical insurance, nursing care for the elderly, and government payments for the treatment of intractable diseases. Medical insurance provisions are handled by Employee’s Health Insurance (Social Insurance), which mainly covers employees of private companies and their families, and by National Health Insurance, which provides for the needs of self-employed people. Both schemes have their own medical care service programs for retired persons and their families. The health care system for the elderly covers people 75 years of age and over and bedridden people 65 years of age and over. There is also a system under which the government pays all or part of medical expenses, and/or pays medical expenses not covered by insurance. This is referred to collectively as the “medical expenses payment system” and includes the provision of medical assistance for specified intractable diseases. Because severe acute pancreatitis has a high mortality rate, it is specified as an intractable disease. In order to lower the mortality rate of various diseases, including severe acute pancreatitis, the specification system has been adopted by the government. The cost of treatment for severe acute pancreatitis is paid in full by the government from the date the application is made for a certificate verifying that the patient has an intractable disease.     

Quality of life in chronic diseases: perceptions of elderly patients

Quality of life is an important consideration in medical decisions involving elderly patients and a clinical outcome measure of health care. Elderly outpatients (N = 126) with five common chronic diseases (arthritis, ischemic heart disease, chronic pulmonary disease, diabetes mellitus, and cancer) and their physicians were interviewed to better characterize patient quality of life. Patients generally perceived their quality of life to be slightly worse than "good, no major complaints" in each chronic disease. Physicians' ratings were generally worse than and only weakly associated with the patients' ratings of quality of life in each chronic disease. Significant independent correlates of patients' ratings of quality of life included the patients' perceptions of their health, interpersonal relationships, and finances. These results suggest that quality of life in elderly outpatients with chronic disease is a multidimensional construct involving health, as well as social and other factors. Physicians may misunderstand patients' perceptions of their quality of life.     

Dialysis in the elderly

More and more elderly (>65 years) patients are now reaching end-stage renal disease (ESRD) due to better management of co-morbid diseases. There are complex medical issues that need to be addressed when managing ESRD in this patient group. The option of dialysis in the elderly is a viable one. However, it needs careful consideration of patients' choices besides coexisting illnesses. Ideally, dialysis should prolong survival. However, an equally important issue is quality of life on dialysis. Life should be added to years and not years added to life. This often involves multidisciplinary input from various disciplines involved in patient care. Other than life on dialysis, the only other alternative is conservative management. Conservative management is not 'passive palliative therapy'. Rather, it involves active management of various clinical issues in a sick and vulnerable patient who does not have age on his side. All elderly patients have unique issues and no generalizations can be made. However, careful analysis makes it possible to offer dialysis to the right patient in the elderly and very elderly (>75 years and beyond) subgroups.     

Preventing osteoporosis: the new significance of hyperparathyroidism

Although a cautious approach is essential, there is still no safe and effective chronic medical therapeutic regimen that can substitute for surgical management of primary hyperparathyroidism in the elderly. The primary care physician should recognize that: the natural history of this disease is variable and unpredictable; symptomatic disease in the elderly patient may be easily overlooked; and therefore, older patients who have vague and varied nonspecific neuromuscular, GI, and constitutional complaints or acquired behavior disturbances should be carefully scrutinized. This approach to hyperparathyroidism should lead to earlier diagnosis and symptomatic relief in many patients who would otherwise be viewed as merely "old" or as chronic complainers.     

Caregiving issues in the geriatric medical encounter

Families provide much-needed care for dependent older persons, which can be both burdensome and stressful. In addition to providing personal care, families often are essential for optimal chronic disease management. Thus, two critical functions of the medical encounter are to provide empathic support to family caregivers and to provide education about chronic diseases and their management. Concomitantly, a conscious effort must be made to not compromise the doctor-older patient relationship, insofar as possible. Managing the doctor-patient-family caregiver relationship is challenging, especially in the settings of cognitive impairment and end-of-life care. In these circumstances in particular, both older patients and their families need the care of their physicians.     

Comorbidity and dementia

Epidemiological data suggest a strong association between aging, dementia and comorbidity such as cancer, chronic renal failure or undernourishment. These chronic conditions may lead to invasive diagnosis procedures as well as to difficult therapeutic management. When they occur in elderly patients with cognitive disorders or dementia, physicians and caregivers should apply specific care program. For example, if an adjuvant chimiotherapy is discussed for an old demented patient with cancer, informed consent and details about the treatment program should be carefully provide. At the onset of a chronic disease, the assessment of its prognosis as well as its impact on the autonomy or quality of life is particular when the patient is also demented. We discuss the specific characteristics about management of demented elderly patients who require high risk treatment because of severe and lethal diseases.     

Intensive care management of pneumonia in the elderly

Arterial hypoxemia, hypercapnic respiratory failure, hypotension, and depressed level of consciousness are the usual reasons for admitting a patient with pneumonia to an intensive care unit (ICU). Once the decision has been made to manage the patient in the ICU, age has little effect on the immediate goals of therapy, which include correction of hypoxemia, maintenance of adequate alveolar ventilation, and provision of sufficient blood pressure and cardiac output to support organ function until physiological homeostasis is restored as the pneumonia is controlled by appropriate antimicrobial therapy. Age-related decreases in physiological reserve are the major reasons specifically to consider ICU management of elderly pneumonia patients. These physiological changes increase the probability of major organ system failure with the development of pneumonia, and increase the likelihood that pneumonia will require ICU management. This has implications for the clinician regarding the selection and timing of therapeutic interventions. Unfortunately, the reduction of physiological reserve and the increased prevalence of coexistent chronic disease also result in significant mortality rates for elderly patients with pneumonia, potentially limiting the benefits of intensive care in this population. This raises a second issue: When, if ever, should intensive care not be used in the management of an elderly patient with severe pneumonia? A full discussion of the ethical issues surrounding this question is beyond the scope of this article, however, good medical ethics begin with sound medical judgment and are based upon solid clinical data. Accordingly, this article will also address the implications of age and underlying disease in the assessment of prognosis and use of the ICU in patients with pneumonia.