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。
《2023年欧洲器官移植学会共识声明
《2023年欧洲器官移植学会共识声明：肝移植中的生物标志物》摘译白易，李金明，张雅敏天津市第一中心医院肝胆胰外科，天津 300392通信作者：张雅敏，138****************（ORICD：0000-0001-7886-2901）摘要：2023年8月，欧洲器官移植学会在线发表了“2023年欧洲器官移植学会共识声明：肝移植中的生物标志物”。
该共识主要围绕肝移植中的生物标志物、临床适用性和未来需求等方面展开，通过回顾有关原发性疾病复发、慢性肾脏疾病发展和安全摆脱免疫抑制的文献，来探索新的生物标志物在预测肝移植预后方面的作用。
该共识从肝移植后复发性肝脏疾病、复发性肝细胞癌、摆脱免疫抑制、慢性肾脏疾病进展四个方面展开研究，强调了生物标志物在预测或检测疾病复发中的重要性，同时也提出了仍需要更大规模的前瞻性研究以提高证据质量。
笔者团队对该共识声明进行摘译，系统介绍了该共识声明中四个方面的研究以及相关讨论和结论，以期为肝移植中新生物标志物的发现和探索提供更多循证医学证据。
关键词：肝移植；生物标志物；共识；欧洲基金项目：国家自然科学基金（82372194）；天津市卫生健康科技项目（TJWJ2021ZD002， TJWJ2023MS012）An excerpt of European Society for Organ Transplantation consensus statement on biomarkers in liver transplantation （2023）BAI Yi， LI Jinming， ZHANG Yamin.（Department of Hepatobiliary and Pancreatic Surgery， Tianjin First Central Hospital， Tianjin 300392， China）Corresponding author： ZHANG Yamin，138****************（ORICD： 0000-0001-7886-2901）Abstract：In August 2023， the European Society for Organ Transplantation （ESOT） published the ESOT Consensus Statement on Biomarkers in Liver Transplantation online. The consensus statement focuses on biomarkers in liver transplantation，clinical applicability， and future needs and explores the role of new biomarkers in predicting liver transplantation outcomes by reviewing the literature on primary disease recurrence， development of chronic kidney disease （CKD）， and safe weaning of immunosuppression. This consensus statement conducts studies from the four aspects of recurrent liver disease after liver transplantation，recurrent hepatocellular carcinoma，weaning of immunosuppression，and CKD progression，emphasizes the importance of biomarkers in predicting or detecting disease recurrence， and proposes that large-scale prospective studies are still needed to improve the quality of evidence. The author’s team gives an excerpt of the consensus statement and systematically introduces the four aspects of the consensus statement and related discussions and conclusions，in order to provide more evidence-based medical evidence for identifying and exploring new biomarkers for liver transplantation.Key words：Liver Transplantation； Biomarkers； Consensus； EuropeResearch funding：National Natural Science Foundation of China （82372194）；Tianjin Health Science and Technology Project （TJWJ2021ZD002， TJWJ2023MS012）共识确立过程由欧洲器官移植学会（ESOT）及其各部门专门的工作组负责，工作组确定了与肝移植（livertransplantation，LT）中生物标志物相关的关键问题。
《2022年欧洲肝病学会临床实践指南：肝性脑病的管理》摘译
《2022年欧洲肝病学会临床实践指南：肝性脑病的管理》摘译*王钲钰 韩国宏#西安国际医学中心医院消化与介入血管外科（710100）摘要 2022年欧洲肝病学会肝性脑病临床实践指南围绕肝性脑病的定义、诊断、鉴别诊断和治疗，为一系列临床关键问题提供循证医学证据答案，以研究对象、干预措施、对照和结局（PICO ）的格式呈现。
本编译版共识不涉及肝性脑病的病理生理学，亦不枚举肝性脑病的全部现行治疗选择，主要就上述临床关键问题的推荐进行摘译汇总，并提供循证医学证据建立的方法和与这些证据解读相关的信息。
关键词 肝硬化； 肝性脑病； 诊断； 预防； 疾病管理An Excerpt of 2022 European Association for the Study of the Liver Clinical Practice Guidelines on the Management of Hepatic Encephalopathy WANG Zhengyu, HAN Guohong. Department of Digestive and Interventional Vascular Surgery, Xi'an International Medical Center Hospital, Xi'an (710100)Correspondence to:HANGuohong,Email:139****************Abstract In 2022, the European Association for the Study of the Liver clinical practice guidelines on the management of hepatic encephalopathy (HE) present evidence ⁃based answers to a set of relevant questions, which formulated in participant, intervention, comparison, and outcome (PICO) format on the definition, diagnosis, differential diagnosis and treatment of HE. This excerpt does not cover the pathophysiology of HE and does not cover all available treatment options. It presents the readers with translations and summarizations of the above mentioned recommendations.The methods through which it was developed and any information relevant to its interpretation are also provided.Key words Liver Cirrhosis; Hepatic Encephalopathy; Diagnosis; Prevention; Disease ManagementDOI ： 10.3969/j.issn.1008⁃7125.2023.01.005*原文刊载于《中华消化杂志》，经中华医学会和《中华消化杂志》编辑部授权转载#本文通信作者，Email:139****************2022年欧洲肝病学会（European Association forthe Study of the Liver, EASL ）管理委员会选择相关专家成立临床实践指南（clinical practice guideline, CPG ）小组，旨在为肝性脑病的诊断和管理提供最佳证据。
《2022NICE指南痛风的诊断和管理》解读ppt课件
对于反复发作或慢性痛风患者，需要长期使用降尿酸药物 ，如别嘌醇、丙磺舒等。这些药物通过抑制尿酸生成或促 进尿酸排泄来降低血尿酸水平。
其他药物
对于合并高血压、高血脂等代谢性疾病的患者，需要同时 治疗这些疾病以降低痛风发作的风险。例如，使用降压药 、降脂药等。
03
诊断方法与技术进展
临床表现与鉴别诊断
定期随访
痛风患者应定期接受随访，监测尿酸水平、肾功能等指标，及时调 整治疗方案。
并发症预防
积极治疗高尿酸血症，降低痛风发作频率和严重程度。同时，注意 预防痛风相关并发症，如肾结石、肾功能不全等。
患者教育
加强对患者的健康教育，提高患者对痛风的认识和自我管理能力。鼓 励患者积极参与治疗过程，与医生共同制定和执行治疗方案。
THANKS
感谢观看
关节液检查
偏振光显微镜检查关节液 ，出现双折光的针形尿酸 盐结晶，是确诊痛风的金 标准。
影像学技术在诊断中应用
X线检查
可见软组织肿胀、关节面 不规则等表现，但特异性 不高。
超声检查
可发现关节积液、滑膜增 生等病变，且对尿酸盐结 晶的沉积有较高的敏感性 。
双源CT检查
能够特异性识别尿酸盐结 晶，对痛风的诊断具有较 高的价值。
降尿酸药物可能会引起一些副作用，如皮疹、胃肠道不适等，需密 切观察并及时处理。
其他辅助性治疗措施介绍
饮食调整
痛风患者应遵循低嘌呤饮食，减少高嘌呤食物的摄入，如动物内 脏、海鲜等。
增加水分摄入
多喝水有助于促进尿酸排泄，降低血尿酸水平。
控制体重和避免过度饮酒
肥胖和过度饮酒都是痛风的危险因素，应积极控制体重并避免过度 饮酒。
《2022NICE指南痛风的诊断和管 理》解读
NICE&SCIE Dementia guideline
Carers
The rights of carers to an assessment of needs as set out in the Carers (Equal Opportunities) Act 2004 should be upheld. Carers of people with dementia who experience psychological distress and negative psychological impact should be offered psychological therapy, including cognitive behavioural therapy, by a specialist practitioner.
NICE is the independent organisation in the NHS, responsible for producing guidance based on the best available evidence of effectiveness and cost effectiveness to promote health and to prevent or treat ill health.
Behaviour that challenges
People with dementia who develop behaviour that challenges should be assessed at an early opportunity to establish the likely factors that may generate, aggravate or improve such behaviour.
七叶洋地黄双苷滴眼液治疗视频终端性儿童异常瞬目症的效果研究
论著China &Foreign Medical Treatment 中外医疗七叶洋地黄双苷滴眼液治疗视频终端性儿童异常瞬目症的效果研究谢海涛平邑县妇幼保健院眼保健科，山东临沂 273300［摘要］ 目的 探讨视频终端性儿童异常瞬目症患儿采用七叶洋地黄双苷滴眼液展开对应治疗后获得的临床效果。
方法 方便选取2021年3月—2023年2月平邑县妇幼保健院收治的58例视频终端性儿童异常瞬目症患儿为研究对象，根据投掷硬币法分为参照组和研究组，每组29例。
参照组采用的治疗药物为玻璃酸钠滴眼液，研究组采用的治疗药物为七叶洋地黄双苷滴眼液。
对于两组患儿的用药总有效率、不良反应（眼部刺痛感、眼部烧灼感）总发生率以及临床症状评分展开对比。
结果 研究组用药总有效率（93.10%）高于参照组（72.41%），差异有统计学意义（χ2=4.350，P <0.05）。
两组不良反应（眼部刺痛感、眼部烧灼感）总发生率比较，差异无统计学意义（P >0.05）。
治疗前，两组临床症状评分比较，差异无统计学意义（P >0.05）；治疗后，研究组临床症状评分显著低于参照组，差异有统计学意义（P <0.05）。
结论 对于视频终端性儿童异常瞬目症患儿的治疗，同玻璃酸钠滴眼液展开比较，七叶洋地黄双苷滴眼液的有效应用，可在对安全性做出保障情形下，提升患儿的治疗效果，显著缓解系列症状，可促进视频终端性儿童异常瞬目症患儿的良好预后。
［关键词］ 七叶洋地黄双苷滴眼液；视频终端性儿童异常瞬目症；治疗效果；不良反应；临床症状［中图分类号］ R4 ［文献标识码］ A ［文章编号］ 1674-0742（2023）12(b)-0013-04Effect of Aesculin Digitalis Eye Drops in the Treatment of Video-terminal Abnormal Blinring Syndrome in ChildrenXIE HaitaoDepartment of Eye Health, Pingyi County Maternal and Child Health Hospital, Linyi, Shandong Province, 273300 China[Abstract] Objective To investigate the clinical effect of aesculin digitalis eye drops in children with video-terminal abnormal blinring syndrome. Methods 58 children with video terminal abnormal blinking disorder treated in Pingyi County Maternal and Child Health Hospital from March 2021 to February 2023 were conveniently selected as thestudy objects, and were divided into the reference group and the research group according to coin tossing method, with 29 cases in each group. The reference group was treated with sodium hyaluronate eye drops, while the study group was treated with aesculin digitalis eye drops. The total effective rate, the total incidence of adverse reactions (eye tinglingsensation, eye burning sensation) and clinical symptom score of the two groups were compared. Results The total effec⁃tive rate of the study group (93.10%) was higher than that of the reference group (72.41%), and the difference was sta⁃tistically significant (χ2=4.350, P <0.05). There was no statistically significant difference in the total incidence of ad⁃verse reactions (stinging sensation and burning sensation) between the two groups (P >0.05). Before treatment, there was no statistically significant difference in clinical symptoms scores between the two groups (P >0.05). After treat⁃ment, the clinical symptom score of the study group was significantly lower than that of the reference group, and the difference was statistically significant (P <0.05). Conclusion Compared with sodium hyaluronate eye drops for the treat⁃ment of children with video terminal abnormal blink, the effective application of esculus digitalis eye drops can im⁃prove the treatment effect of children with video terminal abnormal blink, significantly alleviate a series of symptoms, DOI ：10.16662/ki.1674-0742.2023.35.013[作者简介] 谢海涛（1972-），男，本科，副主任医师，研究方向为眼科临床。
2017NICE进食障碍的识别和治疗指南
Eating disorders: recognition and treatmentNICE guidelinePublished: 23 May 2017/guidance/ng69© NICE 2017. All rights reserved.Y our responsibilityThe recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.Contents Overview (4)Who is it for? (4)Recommendations (5)1.1 General principles of care (5)1.2 Identification and assessment (9)1.3 Treating anorexia nervosa (11)1.4 Treating binge eating disorder (18)1.5 Treating bulimia nervosa (20)1.6 Treating other specified feeding and eating disorders (OSFED) (23)1.7 Physical therapy for any eating disorder (23)1.8 Physical and mental health comorbidities (23)1.9 Conception and pregnancy for women with eating disorders (27)1.10 Physical health assessment, monitoring and management for eating disorders (28)1.11 Inpatient and day patient treatment (31)1.12 Using the Mental Health Act and compulsory treatment (34)Terms used in this guideline (34)Context (36)Recommendations for research (37)1 Psychological treatments for binge eating disorder (37)2 Duration and intensity of psychological treatment (38)3 Predictors of acute physical risk (38)4 Treating an eating disorder in people with a comorbidity (39)5 Maintaining benefits after successful treatment of anorexia nervosa (40)Update information (41)May 2017 (41)This guideline replaces CG9.erviewOverviewOvThis guideline covers assessment, treatment, monitoring and inpatient care for children, young people and adults with eating disorders. It aims to improve the care people receive by detailing the most effective treatments for anorexia nervosa, binge eating disorder and bulimia nervosa. Who is it for?Healthcare professionalsCommissioners and providersOther professionals who provide public services to people with eating disorders (including in education and criminal justice settings)People with suspected or diagnosed eating disorders and their families and carersRecommendationsPeople have the right to be involved in discussions and make informed decisions about their care, as described in your care.Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity) and safeguarding.In this guideline, 'family members' includes the siblings, children and partners of people with an eating disorder.1.1General principles of careving access to servicesImproving access to servicesImpro1.1.1Be aware that people with an eating disorder may:find it difficult or distressing to discuss it with healthcare professionals, staff and otherservice usersbe vulnerable to stigma and shameneed information and interventions tailored to their age and level of development. 1.1.2Ensure that all people with an eating disorder and their parents or carers (asappropriate) have equal access to treatments (including through self-referral)for eating disorders, regardless of:agegender or gender identity (including people who are transgender)sexual orientationsocioeconomic statusreligion, belief, culture, family origin or ethnicitywhere they live and who they live withany physical or other mental health problems or disabilities.1.1.3Healthcare professionals assessing people with an eating disorder (especiallychildren and young people) should be alert throughout assessment andtreatment to signs of bullying, teasing, abuse (emotional, physical and sexual)and neglect. For guidance on when to suspect child maltreatment, see the NICEguideline on child maltreatment.Communication and information1.1.4When assessing a person with a suspected eating disorder, find out what theyand their family members or carers (as appropriate) know about eatingdisorders and address any misconceptions.1.1.5Offer people with an eating disorder and their family members or carers (asappropriate) education and information on:the nature and risks of the eating disorder and how it is likely to affect themthe treatments available and their likely benefits and limitations.1.1.6When communicating with people with an eating disorder and their familymembers or carers (as appropriate):be sensitive when discussing a person's weight and appearancebe aware that family members or carers may feel guilty and responsible for the eatingdisordershow empathy, compassion and respectprovide information in a format suitable for them, and check they understand it.1.1.7Ensure that people with an eating disorder and their parents or carers (asappropriate) understand the purpose of any meetings and the reasons forsharing information about their care with others.Support for people with an eating disorder1.1.8Assess the impact of the home, education, work and wider social environment(including the internet and social media) on each person's eating disorder.Address their emotional, education, employment and social needs throughouttreatment.1.1.9If appropriate, encourage family members, carers, teachers, and peers ofchildren and young people to support them during their treatment.W orking with family members and carers1.1.10Be aware that the family members or carers of a person with an eating disordermay experience severe distress. Offer family members or carers assessments oftheir own needs as treatment progresses, including:what impact the eating disorder has on them and their mental healthwhat support they need, including practical support and emergency plans if the personwith the eating disorder is at high medical or psychiatric risk.1.1.11If appropriate, provide written information for family members or carers whodo not attend assessment or treatment meetings with the person with an eatingdisorder.Consent and confidentiality1.1.12When working with people with an eating disorder and their family members orcarers (as appropriate):hold discussions in places where confidentiality, privacy and dignity can be respectedexplain the limits of confidentiality (that is, which professionals and services haveaccess to information about their care and when this may be shared with others).1.1.13When seeking consent for assessments or treatments for children or youngpeople under 16, respect Gillick competence if they consent and do not wanttheir family members or carers involved.T r aining and competencies1.1.14Professionals who assess and treat people with an eating disorder should becompetent to do this for the age groups they care for.1.1.15Health, social care and education professionals working with people with aneating disorder should be trained and skilled in:negotiating and working with family members and carersmanaging issues around information sharing and confidentialitysafeguardingworking with multidisciplinary teams.1.1.16Base the content, structure and duration of psychological treatments onrelevant manuals that focus on eating disorders.1.1.17Professionals who provide treatments for eating disorders should:receive appropriate clinical supervisionuse standardised outcome measures, for example the Eating Disorder ExaminationQuestionnaire (EDE-Q)monitor their competence (for example by using recordings of sessions, and externalaudit and scrutiny)monitor treatment adherence in people who use their service.Coordination of care for people with an eating disorder1.1.18T ake particular care to ensure services are well coordinated when:a young person moves from children's to adult services (see the NICE guideline ontransition from children's to adults' services)more than one service is involved (such as inpatient and outpatient services, child andfamily services, or when a comorbidity is being treated by a separate service)people need care in different places at different times of the year (for example,university students).1.2Identification and assessment1.2.1People with eating disorders should be assessed and receive treatment at theearliest opportunity.1.2.2Early treatment is particularly important for those with or at risk of severeemaciation and such patients should be prioritised for treatment.Initial assessments in primary and secondary mental health care1.2.3Be aware that eating disorders present in a range of settings, including:primary and secondary health care (including acute hospitals)social careeducationwork.1.2.4Although eating disorders can develop at any age, be aware that the risk ishighest for young men and women between 13 and 17 years of age.1.2.5Do not use screening tools (for example, SCOFF) as the sole method todetermine whether or not people have an eating disorder.1.2.6When assessing for an eating disorder or deciding whether to refer people forassessment, take into account any of the following that apply:an unusually low or high BMI or body weight for their agerapid weight lossdieting or restrictive eating practices (such as dieting when they are underweight) thatare worrying them, their family members or carers, or professionalsfamily members or carers report a change in eating behavioursocial withdrawal, particularly from situations that involve foodother mental health problemsa disproportionate concern about their weight or shape (for example, concerns aboutweight gain as a side effect of contraceptive medication)problems managing a chronic illness that affects diet, such as diabetes or coeliacdiseasemenstrual or other endocrine disturbances, or unexplained gastrointestinal symptomsphysical signs of:malnutrition, including poor circulation, dizziness, palpitations, fainting or pallorcompensatory behaviours, including laxative or diet pill misuse, vomiting orexcessive exerciseabdominal pain that is associated with vomiting or restrictions in diet, and that cannotbe fully explained by a medical conditionunexplained electrolyte imbalance or hypoglycaemiaatypical dental wear (such as erosion)whether they take part in activities associated with a high risk of eating disorders (forexample, professional sport, fashion, dance, or modelling).1.2.7Be aware that, in addition to the points in recommendation1.2.6, children andyoung people with an eating disorder may also present with faltering growth(for example, a low weight or height for their age) or delayed puberty.1.2.8Do not use single measures such as BMI or duration of illness to determinewhether to offer treatment for an eating disorder.1.2.9Professionals in primary and secondary mental health or acute settings shouldassess the following in people with a suspected eating disorder:their physical health, including checking for any physical effects of malnutrition orcompensatory behaviours such as vomitingthe presence of mental health problems commonly associated with eating disorders,including depression, anxiety, self-harm and obsessive compulsive disorderthe possibility of alcohol or substance misusethe need for emergency care in people whose physical health is compromised or whohave a suicide risk.Referral alReferr1.2.10If an eating disorder is suspected after an initial assessment, refer immediatelyto a community-based, age-appropriate eating disorder service for furtherassessment or treatment.1.3Treating anorexia nervosa1.3.1Provide support and care for all people with anorexia nervosa in contact withspecialist services, whether or not they are having a specific intervention.Support should:include psychoeducation about the disorderinclude monitoring of weight, mental and physical health, and any risk factorsbe multidisciplinary and coordinated between servicesinvolve the person's family members or carers (as appropriate).1.3.2When treating anorexia nervosa, be aware that:helping people to reach a healthy body weight or BMI for their age is a key goal andweight gain is key in supporting other psychological, physical and quality of lifechanges that are needed for improvement or recovery.1.3.3When weighing people with anorexia nervosa, consider sharing the results withthem and (if appropriate) their family members or carers.xia nervosa in adultsosa in adultsPsychological treatment for anorePsychological treatment for anorexia nerv1.3.4For adults with anorexia nervosa, consider one of:individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)specialist supportive clinical management (SSCM).Explain to the person what the treatments involve to help them choose which they would prefer.1.3.5Individual CBT-ED programmes for adults with anorexia nervosa should:typically consist of up to 40 sessions over 40 weeks, with twice-weekly sessions in thefirst 2 or 3 weeksaim to reduce the risk to physical health and any other symptoms of the eatingdisorderencourage healthy eating and reaching a healthy body weightcover nutrition, cognitive restructuring, mood regulation, social skills, body imageconcern, self-esteem, and relapse preventioncreate a personalised treatment plan based on the processes that appear to bemaintaining the eating problemexplain the risks of malnutrition and being underweightenhance self-efficacyinclude self-monitoring of dietary intake and associated thoughts and feelingsinclude homework, to help the person practice in their daily life what they havelearned.1.3.6MANTRA for adults with anorexia nervosa should:typically consist of 20 sessions, with:weekly sessions for the first 10 weeks, and a flexible schedule after thisup to 10 extra sessions for people with complex problemsbase treatment on the MANTRA workbookmotivate the person and encourage them to work with the practitionerbe flexible in how the modules of MANTRA are delivered and emphasisedwhen the person is ready, cover nutrition, symptom management, and behaviourchangeencourage the person to develop a 'non-anorexic identity'involve family members or carers to help the person:understand their condition and the problems it causes and the link to the widersocial contextchange their behaviour.1.3.7SSCM for adults with anorexia nervosa should:typically consist of 20 or more weekly sessions (depending on severity)assess, identify, and regularly review key problemsaim to develop a positive relationship between the person and the practitioneraim to help people recognise the link between their symptoms and their abnormaleating behaviouraim to restore weightprovide psychoeducation, and nutritional education and adviceinclude physical health monitoringestablish a weight range goalencourage reaching a healthy body weight and healthy eatingallow the person to decide what else should be included as part of their therapy.1.3.8If individual CBT-ED, MANTRA, or SSCM is unacceptable, contraindicated orineffective for adults with anorexia nervosa, consider:one of these 3 treatments that the person has not had before oreating-disorder-focused focal psychodynamic therapy (FPT).1.3.9FPT for adults with anorexia nervosa should:typically consist of up to 40 sessions over 40 weeksmake a patient-centred focal hypothesis that is specific to the individual andaddresses:what the symptoms mean to the personhow the symptoms affect the personhow the symptoms influence the person's relationships with others and with thetherapistin the first phase, focus on developing the therapeutic alliance between the therapistand person with anorexia nervosa, addressing pro-anorexic behaviour and ego-syntonic beliefs (beliefs, values and feelings consistent with the person's sense of self)and building self-esteemin the second phase, focus on relevant relationships with other people and how theseaffect eating behaviourin the final phase, focus on transferring the therapy experience to situations ineveryday life and address any concerns the person has about what will happen whentreatment ends.osa in children and young peopleoung peoplexia nervosa in children and yPsychological treatment for anorePsychological treatment for anorexia nerv1.3.10Consider anorexia-nervosa-focused family therapy for children and youngpeople (FT-AN), delivered as single-family therapy or a combination of single-and multi-family therapy. Give children and young people the option to havesome single-family sessions:separately from their family members or carers andtogether with their family members or carers.1.3.11FT-AN for children and young people with anorexia nervosa should:typically consist of 18–20 sessions over 1 yearreview the needs of the person 4 weeks after treatment begins and then every 3months, to establish how regular sessions should be and how long treatment shouldlastemphasise the role of the family in helping the person to recovernot blame the person or their family members or carersinclude psychoeducation about nutrition and the effects of malnutritionearly in treatment, support the parents or carers to take a central role in helping theperson manage their eating, and emphasise that this is a temporary rolein the first phase, aim to establish a good therapeutic alliance with the person, theirparents or carers and other family membersin the second phase, support the person (with help from their parents or carers) toestablish a level of independence appropriate for their level of developmentin the final phase:focus on plans for when treatment ends (including any concerns the person andtheir family have) and on relapse preventionaddress how the person can get support if treatment is stopped.1.3.12Consider support for family members who are not involved in the familytherapy, to help them cope with distress caused by the condition.1.3.13Consider giving children and young people with anorexia nervosa additionalappointments separate from their family members or carers.1.3.14Assess whether family members or carers (as appropriate) need support if thechild or young person with anorexia nervosa is having therapy on their own.1.3.15If FT-AN is unacceptable, contraindicated or ineffective for children or youngpeople with anorexia nervosa, consider individual CBT-ED or adolescent-focused psychotherapy for anorexia nervosa (AFP-AN).1.3.16Individual CBT-ED for children and young people with anorexia nervosa should:typically consist of up to 40 sessions over 40 weeks, with:twice-weekly sessions in the first 2 or 3 weeks8–12 additional brief family sessions with the person and their parents or carers(as appropriate)in family sessions and in individual sessions, include psychoeducation about nutritionand the effects of malnutritionin family sessions:identify anything in the person's home life that could make it difficult for themto change their behaviour, and find ways to address thisdiscuss meal plansaim to reduce the risk to physical health and any other symptoms of the eatingdisorderencourage reaching a healthy body weight and healthy eatingcover nutrition, relapse prevention, cognitive restructuring, mood regulation, socialskills, body image concern and self-esteemcreate a personalised treatment plan based on the processes that appear to bemaintaining the eating problemtake into account the person's specific development needsexplain the risks of malnutrition and being underweightenhance self-efficacyinclude self-monitoring of dietary intake and associated thoughts and feelingsinclude homework, to help the person practice what they have learned in their dailylifeaddress how the person can get support if treatment is stopped.1.3.17AFP-AN for children and young people should:typically consist of 32–40 individual sessions over 12–18 months, with:more regular sessions early on, to help the person build a relationship with thepractitioner and motivate them to change their behaviour8–12 additional family sessions with the person and their parents or carers (asappropriate)review the needs of the person 4 weeks after treatment begins and then every 3months, to establish how regular sessions should be and how long treatment shouldlastin family sessions and in individual sessions, include psychoeducation about nutritionand the effects of malnutritionfocus on the person's self-image, emotions and interpersonal processes, and how theseaffect their eating disorderdevelop a formulation of the person's psychological issues and how they use anorexicbehaviour as a coping strategyaddress fears about weight gain, and emphasise that weight gain and healthy eating isa critical part of therapyfind alternative strategies for the person to manage stressin later stages of treatment, explore issues of identity and build independencetowards end of treatment, focus on transferring the therapy experience to situations ineveryday lifein family sessions, help parents or carers support the person to change their behaviouraddress how the person can get support if treatment is stopped.osa who are not having treatmentving treatmenteople with anorexia nervP eople with anorexia nervosa who are not ha1.3.18For people with anorexia who are not having treatment (for example because ithas not helped or because they have declined it) and who do not have severe orcomplex problems:discharge them to primary caretell them they can ask their GP to refer them again for treatment at any time.1.3.19For people with anorexia who have declined or do not want treatment and whohave severe or complex problems, eating disorder services should providesupport as covered in recommendation1.3.1.Dietary advice for people with anorexia nervosaosaDietary advice for people with anorexia nerv1.3.20Only offer dietary counselling as part of a multidisciplinary approach.1.3.21Encourage people with anorexia nervosa to take an age-appropriate oral multi-vitamin and multi-mineral supplement until their diet includes enough to meettheir dietary reference values.1.3.22Include family members or carers (as appropriate) in any dietary education ormeal planning for children and young people with anorexia nervosa who arehaving therapy on their own.1.3.23Offer supplementary dietary advice to children and young people with anorexianervosa and their family or carers (as appropriate) to help them meet theirdietary needs for growth and development (particularly during puberty).osaxia nervosaMedication for anorexia nervMedication for anore1.3.24Do not offer medication as the sole treatment for anorexia nervosa.1.4Treating binge eating disorderchological treatment for binge eating disorder in adults Psychological treatment for binge eating disorder in adultsPsy1.4.1Explain to people with binge eating disorder that psychological treatmentsaimed at treating binge eating have a limited effect on body weight and thatweight loss is not a therapy target in itself. Refer to the NICE guideline onobesity identification, assessment and management for guidance on weight loss and bariatric surgery.1.4.2Offer a binge-eating-disorder-focused guided self-help programme to adultswith binge eating disorder.1.4.3Binge-eating-disorder-focused guided self-help programmes for adults should:use cognitive behavioural self-help materialsfocus on adherence to the self-help programmesupplement the self-help programme with brief supportive sessions (for example, 4 to9 sessions lasting 20 minutes each over 16 weeks, running weekly at first)focus exclusively on helping the person follow the programme.1.4.4If guided self-help is unacceptable, contraindicated, or ineffective after 4 weeks,offer group eating-disorder-focused cognitive behavioural therapy (CBT-ED).1.4.5Group CBT-ED programmes for adults with binge eating disorder should:typically consist of 16 weekly 90-minute group sessions over 4 monthsfocus on psychoeducation, self-monitoring of the eating behaviour and helping theperson analyse their problems and goalsinclude making a daily food intake plan and identifying binge eating cuesinclude body exposure training and helping the person to identify and change negativebeliefs about their bodyhelp with avoiding relapses and coping with current and future risks and triggers.1.4.6If group CBT-ED is not available or the person declines it, consider individualCBT-ED for adults with binge eating disorder.1.4.7Individual CBT-ED for adults with binge eating disorder should:typically consist of 16–20 sessionsdevelop a formulation of the person's psychological issues, to determine how dietaryand emotional factors contribute to their binge eatingbased on the formulation:advise people to eat regular meals and snacks to avoid feeling hungryaddress the emotional triggers for their binge eating, using cognitiverestructuring, behavioural experiments and exposureinclude weekly monitoring of binge eating behaviours, dietary intake and weightshare the weight record with the personaddress body-image issues if presentexplain to the person that although CBT-ED does not aim at weight loss, stopping bingeeating can have this effect in the long termadvise the person not to try to lose weight (for example by dieting) during treatment,because this is likely to trigger binge eating.oung people chological treatment for binge eating disorder in children and young people Psychological treatment for binge eating disorder in children and yPsy1.4.8For children and young people with binge eating disorder, offer the sametreatments recommended for adults with binge eating disorder.Medication for binge eating disorder1.4.9Do not offer medication as the sole treatment for binge eating disorder.1.5Treating bulimia nervosa1.5.1Explain to all people with bulimia nervosa that psychological treatments have alimited effect on body weight.Psychological treatment for bulimia nervosa in adultsosa in adultsPsychological treatment for bulimia nerv1.5.2Consider bulimia-nervosa-focused guided self-help for adults with bulimianervosa.1.5.3Bulimia-nervosa-focused guided self-help programmes for adults with bulimianervosa should:use cognitive behavioural self-help materials for eating disorderssupplement the self-help programme with brief supportive sessions (for example 4 to 9sessions lasting 20 minutes each over 16 weeks, running weekly at first).1.5.4If bulimia-nervosa-focused guided self-help is unacceptable, contraindicated, orineffective after 4 weeks of treatment, consider individual eating-disorder-focused cognitive behavioural therapy (CBT-ED).1.5.5Individual CBT-ED for adults with bulimia nervosa should:。
NCCN临床实践指南：外阴癌(鳞状细胞癌)(2020.V2
Amanda Nickles Fader, MD Ω The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Steven W. Remmenga, MD Ω Fred & Pamela Buffett Cancer Center
NCCN Guidelines Version 2.2020 Vulvar Cancer (Squamous Cell Carcinoma)
NCCN Guidelines Index Table of Contents Discussion
NCCN Vulvar Cancer Panel Members Summary of the Guidelines Updates
Emily Wyse ¥ Patient Advocate NCCN Nicole McMillian, MS Angela Motter, PhD
Ω Gynecologic oncology Þ Internal medicine † Medical oncology ≠ Pathology ¥ Patient advocacy § Radiotherapy/Radiation oncology * Discussion Section Writing Committee
Printed by Qiu Shida on 6/24/2020 10:07:28 AM. For personal use only. Not approved for distribution. Copyright © 2020 National Comprehensive Cancer Network, Inc., All Rights Reserved.
英国NICE发布的最新指南
英国NICE发布的最新指南
祝洪澜
【期刊名称】《国外药讯》
【年(卷),期】2005(000)002
【摘要】英国国家临床最优化研究所(NICE)向英国和威尔士的NHS发布了关于他克莫司(tacrolimus)(Ⅰ)和pimecrolimus(Ⅱ)治疗变应性皮炎及消化不良的指南。
【总页数】1页(P2)
【作者】祝洪澜
【作者单位】无
【正文语种】中文
【中图分类】R181.34
【相关文献】
1.英国NICE技术评估和临床指南的实施对我们的启示 [J], 赵琨;肖月;池延花;郭武栋
2.英国NICE公布2型糖尿病人的部分更新临床治疗指南 [J], 无
3.英国NICE有关VTE、MM、青光眼和高眼压的用药指南 [J], 无
4.NICE发布戒烟治疗最新指南 [J], 黄敏燕（摘）
5.英国NICE推迟发布阿尔茨海默病用药指南 [J], 金伟秋（摘）
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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.