Washington_State_Department_of_Health_Mold_Pamphlet_

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心理学心理应激

五、生活压力(yālì)与健康
（二）生活压力的来源
1、生活变故（巨砾模式）：
个人日常生活秩序上发生的重要改变.
美国华盛顿大学医学院的Holmes及 Rahe对5000余人进行社会(shèhuì)调查后，将日常生活的变故（life crisis）编制成著名的社会(shèhuì)再适应量表（social readjustment rating scale SRRS）,并以生活变化单位（life change unite LCU）定量。
13．改换专业
39
14．和父母的冲突
39
15．你的女友和男友 38
16．学校工作负担的加重 37
17．出众的个人成就 36
18．在大学的第一学期/季度 35
19．生活条件的改变
31
20．和教师激烈的争论
30
21．低于期望的分数
29
22．睡眠习惯的改变
29
23．社会活动的改变
29
24．饮食习惯的改变
28
生理(shēnglǐ)中介
1、心理神经中介(zhōngjiè)：
交感神经－肾上腺髓质轴
n２、心理(xīnlǐ)－神经－内分泌中介机制：
n
下丘脑－垂体腺－靶腺轴
n３、心理－神经－免疫机制
第二十页，共49页。
四、生活(shēnghuó)压力下的身心反应
（－）生活(shēnghuó)压力下的生理反应
第十七页，共49页。
3、影响认知评价(píngjià)的因素
n应激源的预期(yùqī)
性n应激源的可控性
n如何(rúhé)解释应激源
第十八页，共49页。
常见(chánɡ jiàn)生活中不合理的观念

美国医疗与健康保险信息化概况与经验

[导语：美国IBM资深程序经理、纽约斯隆凯特林肿瘤中心信息系统副总裁、美国安泰保险公司资深副总及信息主管、美国医疗信息主管协会主席、美国红十字会总会董事，这一连串职务使我对他肃然起敬。

30多年的工作，致力于推动信息技术在医疗行业的应用，提升企业的运作效率，提高顾客（患者）的服务品质，降低成本，取得了辉煌的成就，他就是郑惟悌博士.]美国医疗服务费用的昂贵是众所周知的，病人一天住院的费用就达到5000美元，一些人一个月的收入可能还不够支付一天的住院费。

因此，在美国如果没有医疗保险，一次住院治疗的费用账单就可能让你倾家荡产。

美国的医疗保险体系美国的医疗保险有政府支付和个人支付两种方式。

政府性医疗保险计划包括：为65岁以上的老年人设置的联邦医疗保健计划(Medicare)，为低收入家庭提供免费医疗保险服务的州医疗救助计划(Medicaid或Medi-Cal)，以及为小孩和退伍军人设立的医疗保健计划。

另外，联邦政府员工的医疗服务也是由政府买单的，但一般是由政府购买商业保险来实现。

商业医疗保险是保险机构为企业、联邦政府员工和个人提供医疗保险产品，根据个人支付比例的不同，分为不同档次可供选择。

但总体趋势是员工支付的医疗费用越来越高，或者即便费用没有增加，但是提供的服务项目却减少了。

美国的商业保险主要包括HMO、PPO以及POS等形式：HMO(Health Maintenance Organization)是一种管理式医疗保险，叫做健康维护组织。

其投保人初诊时必须要看GP，由GP根据实际情况转诊到本医疗网络(network)内的专科医院或医生。

HMO保费低廉，个人不需付费，医疗网内医生的大部份医疗项目可100%报销，适合企业和团体为员工购买保险，其缺点是选择性差，不能患者选择希望的医院或专家。

PPO(Preferred Provider Organization)选择医疗服务提供者组织。

PPO是保险公司与投保人、医生、医院共同协商，彼此之间获得相互认同的优惠价格的医疗方式。

嗅觉的机制

2004年诺贝尔生理学或医学奖
2004年10月4日，诺贝尔基金会宣布把本年度的诺贝尔生理学或医学奖颁发给美国科学家Richard Axel理查德· 阿克塞尔和Linda B. Buck琳达· 巴克，以表彰他们在研究人类嗅觉方面的贡献。两位科学家的主要成就在于他们揭示了人类嗅觉系统的奥秘，告诉世界“我们是如何能够辨认和记得１万种左右的气味”的。
Axel和Buck的答案
阿克塞尔、巴克和他的同事们开始研究嗅觉神经细胞的蛋白质受体，但是他们并没有直接研究蛋白质，而是转而研究基因。基因是组成我们身体的蛋白质的“图纸”。通常一个基因负责制造一种蛋白质。既然在嗅觉神经细胞的细胞膜上有蛋白质，那么就一定有对应的基因。通过基因克隆的方法。阿克塞尔找到了一群负责制造蛋白质受体的基因。这一群基因只在嗅觉神经细胞中表达。
阿克塞尔和巴克所发现的嗅觉系统的一般性原理似乎也可以应用到其他感觉系统。比如另外一种用于传递信息的“气味”— —信息素(pheromones)。昆虫常常使用这类物质。在哺乳动物中也有类似的现象，但是即便哺乳动物也使用类似的信息素，它们也不是由嗅觉上皮负责感知的。在鼻腔中有一个叫做犁鼻器 (vomeronasal organ)的组织负责感知信息素。
The Nobel Prize in Physiology or Medicine 2004
Richard Axel 1/2 of the prize USA
Linda B. Buck 1/2 of the prize USA Fred Hutchinson Cancer Research Center Seattle, WA, USA
对于嗅觉产生机理这一难解的迷题, 终于由2004年度诺贝尔生理学或医学奖获奖者、美国科学家理查德· 阿克塞尔和琳达· 巴克，通过他们自己开拓性的工作找到了解开这一谜底的钥匙。两位科学家于1991年发表了有关这一课题的基础论文，介绍了气味受体基因大家族。后来，两人又各自独立工作，更加深入地阐明了整个嗅觉系统的工作原理。

FredHutchinson癌症研究中心

Fred Hutchinson 癌症研究中心 (Fred Hutchinson Cancer Research Center)华盛顿大学 (University of Washington)参与调查研究之简式同意书试验方案号：____________________首席研究员姓名：_______________________若您担任法定授权代表、监护人或为本研究中的一名儿童提供家长许可，“您的”和“您”等词指的是您为其提供同意书或家长许可的个人。

您受邀加入一项调查研究请不必急着决定是否要加入此项研究。

您应与家人和朋友就该决定进行讨论。

在您同意加入之前，我们将解释：1.为何要进行此项研究；2.在研究以及任何试验性的程序期间会发生什么事；3.加入此项研究的可预见风险及好处；4.加入研究的其他替代选择及其风险和好处；5.您的隐私权和保密性将如何受到保护；6.遇到疑问时的联系对象。

如情况符合，我们还会解释：1.如果您在研究中受伤，由谁支付治疗费用；2.我们尚未得知的风险的发生几率；3.您可能被从研究中移除的原因；4.参与此项研究的任何费用；5.若您决定退出研究会发生什么事；6.您何时会得知有关此项研究的新发现；7.我们计划让多少人参加此项研究；8.您可能参与的任何选择性研究。

我们将按美国法律要求，于网站上提供此项临床试验的说明。

该网站不会包含能辨识您个人身份的信息。

网站最多只会列出研究结果的摘要。

您随时都可以搜索该网站。

Fred Hutchinson 癌症研究中心 (Fred Hutchinson Cancer Research Center)华盛顿大学 (University of Washington)参与调查研究之简式同意书您的权利您并非一定要加入此项研究。

您可自由表达是否参加的意愿。

若您加入此项研究，您并非一定要坚持到底。

您可以随时（甚至在开始之前）停止。

拒绝参与或停止并不会导致任何惩罚。

您的常规医疗照护将不会改变。

FarmersMarketAsyoubuy,putheavier,firmeroffruitsan

Bring your own bag, basket or a light shopping cart. Recycle plastic bags, by bringing them with you and asking the farmers to use them instead of theirs. Keep an inexpensive cooler in your car to keep produce frБайду номын сангаасsh and safe during hot weather.
able, and fresh means better health for you. You can meet the farmer who grew your food and they can tell you the best ways to prepare the produce you just bought. You can save money, especially on organic produce. Farmers markets provide a livelihood for many farmers who otherwise might not be farming.
6/03
Farmers Market Shopping Tips
Washington Senior Farmers Market
Nutrition Program
5 Fresh fruits and vegetables. 5 Support for local farmers and
farmers markets.
Before you Leave Home

interpreter_use

Cultural Competency
Synonyms: • Culturally effective health care • Culturally sensitive health care • Cross-cultural medicine • Multiculturalism
―Culturally Effective Healthcare:‖
» Continued
Strategies for Working with LimitedEnglish Speaking or Low Literacy Skilled Patients3
• Repeat instructions • Attempt to verify understanding of important points • Avoid invasive, not easily understood procedures at the first visit • Avoid talking ―down‖ to parents • Demonstrate RESPECT
Interpreter Use Training and Introduction to Culturally Effective Healthcare
Community Pediatrics
COMMUNITY PEDIATRICMMUNITY PEDIATRICS
ADVOCACY
Articulate the importance of the pediatrician's role as an advocate at every level (individual, community, national) Use advocacy skills to develop a plan of action regarding relevant community health issues

腰背痛病理生理学译文

Borenstein D. 来源
George Washington University Medical Centre, Arthritis and Rheumatism Associates, 2021 K Street, NW Suite 300, Washington, DC 20006, USA.
Adelphi Values, 290 Congress Street, 7th Floor, Boston, MA, 02210, USA
但是，一般认为迫切需要在这
一领域进一步进行高质量的临
床研究，以支持未来的指导方
Br J Anaesth. 2013年7月;111(1):112-20. doi: 针。 10.1093/bja/aet172.
摘要
急性和慢性腰背痛是最常见的健康问题之一，风湿病学家经常对其进行评价。与此症状相关联的多种可能诊断使得将腰背痛正确归因于特定的疾病十分困难。这种困境需要采取有组织的方法将机械病变患者与罕见全身性疾病患者区分开来。最常见的腰背痛形式是机械病变。
机械原理
• 脊柱重叠段系统 • 功能单元：前后节段 • 每个组成部分的病变可导致系统受损
髓核脱水
当盘断裂时，可能会损伤神经根。
✓ 增加了环隙的载荷 ✓ 裂缝和塌陷（突出） ✓ 移动和/或泄漏（疝气）
后段髓核脱水
变薄的盘
盘退变，骨赘形成
✓ 与贴面的关系发生变化 ✓ 脊柱不稳（骨赘） ✓ 椎管尺寸缩小（狭窄）
腰椎的一般病理解剖状况
上关节突
横突棘突
椎间孔关节间部关节间部缺损（椎骨脱离）
Low back and radicular pain: a pathway for care developed by the British Pain Society.

SPRINT研究解读专题知识

SPRINT研究解读专题知识
第17页
与ACCORD研究对比
ACCORD研究中标准降压组事件发生率为2.09%/年，强化降压组为1.87%/年，ACCORD 研究与SPRINT研究不一致方面： • 排除CKD人群，因为二甲双胍对血糖影响 • 没有纳入年纪＞80岁患者 • 在降压试验中排除了低HDL人群 • 不包含非致死性心脏衰竭或非心梗急性冠脉综合征
SPRSINPTR研I究NT解读St专ud题y知R识esearch Group, Clin Trials. Oct;11(5):532-46.
第14页
主要分析方法
• 主要分析将使用Cox百分比风险模型(时间-事件) • 由临床网站分层 • 将使用意图治疗标准
SPRINT研究解读专题知识
第15页
亚组分析
室肥大(LVH)
SPRSINPTR研I究NT解读St专ud题y知R识esearch Group, Clin Trials. Oct;11(5):532-46.
第10页
SPRINT研究排除标准:
• 卒中 • 糖尿病 • 充血性心力衰竭(有症状或射血分数＜35%) • 蛋白尿＞1g/d • 慢性肾脏病： eGFR < 20 mL/min/1.73m2 (MDRD) • 含有显著不依从特征患者
20.1(10.9)
SPRSINPTR研I究NT解读St专ud题y知R识esearch Group, Clin Trials. Oct;11(5):532-46.
强化降压组 n=4,678
1,684(36.0%) 67.9(9.4)
1,317(28.2%) 79.8(3.9)
139.7(15.8) 78.2(11.9) 1,331(28.5%) 940(20.1%) 29.9(5.8)

美军健康科学大学（Uniform...

美军健康科学⼤学（Uniform...
美军健康科学⼤学（Uniformed Services University of the Health Sciences）成⽴于1972年，是美国⼀流的医科⼤学，有“军事医学领域的西点军校”之称，也是美军⽬前唯⼀的⼀所医科⼤学，为美陆、海、空、陆战队、海岸警卫队及政府公共卫⽣署培养医⽣。

该校要求每⼀个学⽣都必须懂得军⼈的特点和军⼈的⼼理，使⾃⼰成为第⼀流的军医。

⼈学的新⽣必须是美国公民，年龄18～28岁，符合现役军⼈的⾝体条件和其他有关规定，⼈学前获得学⼠（BS/BA）学位。

美军健康科学⼤学医学院学制为4年，医学新⽣⼊学后被授予美军“少尉”军衔领取相应薪⽔并接受免费医学教育。

毕业后可获得医学博⼠学位（MD）并晋升“上尉”军衔且⾄少任军医11年。

教学⽬标是:(l)讲授基础医学知识和熟悉当⼀名军医所需要的知识;(2)将学⽣培养成为具有⼈道主义的医⽣和科学家，尊重和同情他⼈;讲究科学道德;尊重学问，注重研究……
/v_show/id_XOTA5MTIzODM2.html。

Washington University School of Medicine

Washington University School of MedicineFrom Wikipedia, the free encyclopediaJump to: navigation, searchWashington University School ofMedicineEstablished 1891Type PrivateDean Larry J. Shapiro, MDAcademic staff1874Students 1349including 605 MD (183 MD/PhD) 267 OT, 278 PTLocation St. Louis, Missouri, USACampus UrbanWebsite It has been suggested that Washington University Department ofOrthopaedic Surgery be merged into this article or section. (Discuss) Proposed since July 2010.Washington University School of Medicine (WUSM), located in St. Louis, Missouri, is one of the graduate schools of Washington University in St. Louis. One of the top medical schools in the United States, it is currently ranked 4th for research according to 'U.S. News and World Report'and has been listed among the top ten medical schools since rankings were first published in 1987. The School of Medicine consistently ranks first in the nation in student selectivity.[1]Located on the eastern border of Forest Park, it is affiliated with Barnes-Jewish Hospital, St. Louis Children's Hospital, the St. Louis Veteran's Administration Hospital, Shriner's Hospital for Children and several other community sites.Founded in 1891, the School of Medicine has 1,260 students, of which 604 are pursuing a Medical Degree with or without a combined Doctor of Philosophy or other advanced degree. It also offers doctorate degrees inbiomedical research through the Division of Biology and Biological Sciences. The School has developed large physical therapy(273 students) and occupational therapy(233 students) programs, as well as the Program in Audiology and Communication Sciences (75 students) which includes a Doctor of Audiology (Au.D.) degree and a Master of Science in Deaf Education(M.S.D.E.) degree.[2]There are 1,772 faculty, 1,022 residents, and 765 fellows.[citation needed]Contents[hide]∙ 1 Faculty∙ 2 History∙ 3 Campus∙ 4 Nobel Laureates∙ 5 Other associated hospitals∙ 6 References∙7 External links[edit] Faculty17 Nobel laureates have been associated with the School of Medicine. 12 faculty members are fellows of the National Academy of Sciences; 30 belong to the Institute of Medicine. 92 faculty members hold individual career development awards from the National Institutes of Health (NIH). 59 faculty members hold career development awards from non-federal agencies.14 faculty members have MERIT status, a special recognition given by the National Institutes of Health that provides long-term, uninterrupted financial support to investigators. 6 faculty members are Howard Hughes Medical Institute investigators.[edit] HistoryMedical classes were first held at Washington University in 1891 after the St. Louis Medical College decided to affiliate with the University, establishing a Medical Department. Robert S. Brookings, a University benefactor from its earliest days, devoted much of his work and philanthropy to Washington University, and made the improvement of the Medical Department one of his primary objectives. This especially becamea cause for concern after an early 1900s Carnegie Foundation report derided the organization and quality of the Medical Department.[3]Following a trend in medical education across the country, research and the creation of new knowledge became a stated objective in a 1906 course catalog for the medical department. For Brookings and the University, incorporating the Medical Department into a separate School of Medicine seemed to be the next logical step. This process began in 1914 when facilities were permanently moved to their current location in St. Louis's Central West End neighborhood in 1914, and was completed in 1918 with the official naming of the School of Medicine.[4]The Medical School began its escalation from regional renown in the 1940s, a decade when two Nobel Prizes were awarded, in 1944 and 1947, to groups of faculty members. In 1950, a Cancer Research Building was completed, being the first major new building addition to the School of Medicine since its relocation in 1914. More buildings were added in that decade, and in the 1960s the School of Medicine focused on diversifying its student body by graduating its first African-American and substantially increasing the percentage of graduating students who are female to nearly 50%.[4][edit] CampusWashington University Medical CenterWashington University Medical Center comprises 155 acres (0.5 km²) spread over approximately 15 city blocks, located along the eastern edge of Forest Park within the Central West End neighborhood of St. Louis. Barnes-Jewish Hospital and St. Louis Children's Hospital, part of BJC HealthCare, the teaching hospitals affiliated with the School of Medicine, are also located within the medical complex. Many of the buildings are connected via a series of sky bridges and corridors. As of 2008, the School of Medicine occupies over 4,500,000 square feet (420,000 m2) in the entire medical complex.[5]Washington University and BJC HealthCare have taken on many joint venture projects since their original collaboration in the 1910s. The Center for Advanced Medicine, completed in December 2001, is one such collaboration, which houses the Siteman Cancer Center. At 650,000 square feet (60,000 m2), it is one of the largest single buildings in the Medical Complex.[6]In the expansive Medical Complex are several especially large buildings. The Medical Complex's Queeny Tower is the 9th tallest hospital building in the world.[7]Recently completed is the 700,000-square-foot (65,000 m2) BJC Institutes of Health, of which Washington University's Medical School will occupy several floors. It is the largest building constructed on Washington University's campus. Called the BJC Institute of Health at Washington University, it will house the University's BioMed 21 Research Initiative, five interdiscplinary research centers, laboratories, and additional space for The Genome Center.[8]On Monday, July 19, 2010, a news release from the website of the Washington University School of Medicine announced the formation of the Washington University Intellectual and Developmental Disabilities Research Center (WUIDDRC). The new research center was established by a five-year, $6 million grant from the National Institutes of Health(the NIH), and will focus on research to prevent and treat developmental disabilities in children. Special emphasis will be placed on clinical and translational research as well as reaching out to families and the community with resources and services. The center will work closely with the state of Missouri. Dr. Terrie E. Inder, M.D., Ph.D., who is a neonatal specialist and a professor of pediatrics, radiology, and of neurology, will direct the center. It will be under the auspices of the pediatrics department of the medical school, headed by Dr. Alan L. Schwartz, Ph.D., M.D. The center's research focus will be on cerebral connectivity, genetics, and environmental influences. Its sections are administrative, animal models, human clinical, imaging and biostatistics and informatics. The institute will collaborate with other IDDRCs in the Midwest. The center received additional start-up funding from the McDonnell Centers for System Neuroscience and Cellular and Molecular Neurobiology and from the Washington University School of Medicine.Prominent buildings, centers, and spaces at the medical campus includes Barnes-Jewish Hospital, the Central Institute for the Deaf, St. Louis Children's Hospital, Rehabilitation Institute of Saint Louis, Siteman Cancer Center, Center for Advanced Medicine, Charles F. Knight Emergency and Trauma Center, and the Eric P. Newman Education Center.The Medical Complex is accessible via the Central West End MetroLink station, which provides transportation to the rest of Washington University's campuses.[edit] Nobel LaureatesPhysiology or Medicine∙1943: Edward A. Doisy(1893–1986), Faculty of Medicine, 1919–1923 ∙1944: Joseph Erlanger (1874–1965), Chairman, Department of Physiology 1910-1946∙1944: Herbert Gasser(1888–1963), Faculty of Medicine, 1916–1931 ∙1947: Carl F. Cori (1896–1984), Faculty of Medicine 1931-1984 ∙1947: Gerty T. Cori (1896–1957), Faculty of Medicine 1931-1957 ∙1959: Arthur Kornberg, Chairman, Department of Microbiology, 1952–1959∙1959: Severo Ochoa, Faculty of Medicine 1940-1942∙1969: Alfred Hershey (1908–1997), Faculty of Medicine 1934-1950 ∙1971: Earl Sutherland(1915–1974), M.D. 42, Resident in Internal Medicine 1943-1945, Faculty of Medicine, 1945–1953∙1974: Christian de Duve, Faculty of Medicine 1946-1947∙1978: Daniel Nathans (1928–1999), M.D. 54∙1978: Hamilton O. Smith, Washington University Medical Service 1956-1957∙1980: George D. Snell, Faculty of Arts and Sciences 1933-1934 ∙1986: Stanley Cohen, Faculty of Arts and Sciences 1953-1959∙1986: Rita Levi-Montalcini, Faculty of Arts and Sciences, 1948- ∙1992: Edwin G. Krebs, M.D. 43, Resident in Internal Medicine and then a Research Fellow in Biological Chemistry 1945-1948∙1998: Robert F. Furchgott, Ph.D. Faculty of Medicine, 1949–1956 Chemistry∙1970: Luis F. Leloir, Faculty of Medicine 1944∙1980: Paul Berg, Faculty of Medicine 1954-1959[edit] Other associated hospitals∙St. Louis Children's Hospital∙Barnes-Jewish West County Hospital∙Barnes-Jewish St. Peters Hospital∙Christian Hospital∙Northwest HealthCare∙Metropolitan St. Louis Psychiatric Center∙Missouri Baptist Medical Center∙St. Louis Shriner's Hospital[edit] References1.^/about/facts2.^"Programs". . Washington University in St. Louis./pacs/pacsweb.nsf/9ec55b62f7c029f5862573a9006ad75a/f4bd1aaf96bb84cc86256d09005a3e27?OpenDocument. Retrieved 11November 2011.3.^"Medical Campus Tour". Historical Campus Tour: School ofMedicine. /tour/medicine/.4.^ a b Anderson, Paul; Marion Hunt. "Origins and History of theWashington University School of Medicine". Washington University Medical School, Bernard Becker Medical Library./wusm-hist/about.htm. Retrieved2008-07-22.5.^"Facilities". School of Medicine./pages/?page=overview#facilities.6.^"Washington University Medical Center". Washington UniversitySchool of Medicine: Department of Neurology./education/adultresidency/medicalcenter.htm.7.^"World's Tallest Hospital Buildings". Emporis./en/bu/sk/st/tp/ty/hs/. Retrieved 2008-07-22.8.^Ericson, Gwen (October 30, 2007). "Immense new facility to houseBioMed 21 research at Washington University Medical Center".Washington University School of Medicine is committed to advancing the health of human beings through excellence in patient care, education and research through:∙Providing expert care from Washington University Physicians, national leaders in medicine, in more than 50 medical specialties and subspecialties∙Partnerships and affiliations with world-class treatment facilities and organizations to provide effective and innovative patient care, including those provided at the Alvin J. SitemanCancer Center, Barnes-Jewish Hospital and St. Louis Children’sHospital at the Washington University Medical Center ∙Innovative translational research with expertise in both basic science and clinical research. University initiatives seek torapidly advance basic science discoveries into treatment options ∙Multidisciplinary collaborations to advance the world’s understanding, treatment and prevention health disorders andconditions∙Offering individuals the opportunity to participate in a large number of clinical trials∙Education of tomorrow’s leaders in biomedicine, public health and health policy∙ A commitment to community engagement and outreach, including efforts to:∙Understand and remedy disparities in health care∙Education of local, national and international populations on relevant health care topicsLeading the evolution of change in medicine, allied health, public health and health policyMake a giftYour contributions make a profound difference –support the School of Medicine.Find a DoctorWashington University Physicians, the multi-specialty group practice of the School of Medicine, is one of the five largest academic clinical practices in the nation.To schedule an appointment with a Washington University physician, please call:(314) TOP-DOCS(314) 867-3627 • toll free (866) 867-3627Physician DirectoryThe 164-acreWashingtonUniversity Medical Center, spread over 17 city blocks,is located along the eastern edgeof Forest Park in a vibrant, urban community of St. Louis known as the Central West End.Members of the Medical Center include:With more than20,000 employees,the combinedmedical centerinstitutions areamong the largestemployers in the St.Louis metropolitanarea.Barnes-JewishHospital and St.Louis Children'sHospital aremembers of BJCHealthCare. Nationally recognized experts in patient careWashington University Physicians, the multi-specialty group practice of the School of Medicine, is one of the five largest academic clinical practices in the nation.With more than 1,150 university-employed care specialists representing more than 50 specialties and subspecialties in medicine and surgery, Washington University physicians and clinicians provide comprehensive care to more than 430,000 children and adults annually through our clinical offices and partner hospitals throughout St. Louis and the region.Through our affiliation with two of the nation’s leading inpatient facilities, Barnes-Jewish Hospital and St. Louis Children’s Hospital, both ranked among the best by U.S. News & World Report, our doctors and clinical specialists provide a wide array of ambulatory and inpatient services —on the campus of Washington University Medical Center. At the Center for Advanced Medicine, patients receive multi-specialty consultation, diagnostics, medical treatment, same-day surgery and other support services, including cancer care at the Alvin J. Siteman Cancer Center.。

打了新冠疫苗后，如何获取电子版接种报告？这4种方法，快来学

打了新冠疫苗后，如何获取电⼦版接种报告？这4种⽅法，快来学打完疫苗是不是⼩伙伴们只有⼀张⽩⾊的接种记录其实回国的话这张⽩卡就可以证明你是有打过疫苗的，⼤使馆是承认的但是回国⼀次不容易，不能有⼀点点失误所以在拥有⽩卡的同时，⼩伙伴最好还需要停供接种疫苗的电⼦版（上⾯个⼈信息会更完整）接种时的照⽚只要把这三样交给⼤使馆⼀定可以通过，然后就可以做N蛋⽩检测了不知道怎么申请电⼦版？攻略来啦Kk⾃⼰在华盛顿州，所以以华盛顿州为例⽅法⼀联系接种的Pharmacy, Clinic, or School直接进去问就可以了。

⽬前已知cvs只要和她说明要电⼦版，就会给你⽅法⼆有保险的话，联系⾃⼰的家庭医⽣，⼤多数州的医院是和免疫中⼼⽤的⼀个系统所以家庭医⽣就可以帮你获取到⽅法三各州免疫中⼼官⽹Department of Health Office of Immunization>>华盛顿为例⽹址：注册登陆后，就可以看到⾃⼰疫苗接种的各个信息包括完成的和未完成的⾮常的详细Kk登陆了⾃⼰的账户信息很全，直接就可以下载打印如果证书还没有更新不能打印官⽅⽹站获取疫苗信息授权表（ Authorization to Release Immunization Records）填好后发邮件到>>WAIISRecords@收到后会发⼀个暂时的密码给你，并告知下⼀步过程完成后⽴刻就可以在myir上下载打印你的记录了⽅法四如果不想注册myir，或者⾃⼰的州没有免疫中⼼官⽹可以去到各州的健康局⽹站the Department of Health⼀样下载疫苗信息授权表填好后发邮件到>>WAIISRecords@卫⽣部收到以后就会发你的完整疫苗接种记录去你的邮箱需要5个⼯作⽇每个州的电⼦记录⼤同⼩异，⼤家只需要找到本周的免疫中⼼和健康局⽹站就好了然后根据指⽰获取疫苗记录当然kk⾃⼰觉得最简单的就是myir和家庭医⽣啦希望对⼤家有帮助。

JAMA美国医学会杂志投稿须知

3500字 50 75参考 ≤4个表格和/或数字结构化摘要关键点小标题应该包括“一个元分析” 遵循EQUATOR报告指南，包括PRISMA和MOOSE
https:///journals/jama/pages/instructions-for-authors
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关爱危重病人
这些手稿是原创的研究报告，最好是临床试验或系统评价（参见上文对文章类别的稿件提交要求分类），几乎涵盖了从预防和分类，复苏和急性治疗到危重病的任何方面，姑息关怀。手稿为危重病人的诊断，预后和治疗以及探索危重病医学的病理生理，技术，伦理或其他相关方面提供了新的见解。遵循EQUATOR报告指南。对于原始数据和系统评价的报告，需要一个结构化的摘要; 请参阅准备原始数据报告摘要的说明或摘要评论。需要3个要点清单（见关于准备要点的指导）。最大长度：不超过5个表格和/或数字的文字（不包括摘要，表格，数字，致谢，参考文献和在线材料）的3000字。
临床试验
https:///journals/jama/pages/instructions-for-authors
回到顶部
3/29
2018/1/10
关于作者的说明| JAMA | JAMA网络
ICMJE将临床试验定义为任何研究项目，前瞻性地将人类参与者分配到干预组或比较组，以研究干预和健康结果之间的因果关系。干预包括但不限于药物，手术程序，装置，行为治疗，教育程序，饮食干预，质量改善干预，护理过程改变等。所有报告临床试验的手稿，包括那些仅限于对试验结果进行二次探索性或事后分析的手稿，都必须包括一份试验方案的副本，包括完整的统计分析计划（见方案），CONSORT流程图（图） CONSORT 清单。所有临床试验必须在适当的在线公共登记处进行登记（见试验注册要求）。有关准备报告集群试验，非劣效性和等效试验以及实用试验的附加指导，请参见CONSORT声明的扩展。每份手稿应清楚地陈述客观或假设; 设计和方法（包括研究设置和日期，患者或参与者纳入和排除标准，或数据来源，以及如何选择这些研究）; 任何干预措施的基本特征; 主要成果措施; 研究的主要成果; 讨论部分将结果与发表的文献结合起来，解决研究限制; 和结论。遵循EQUATOR报告指南。必须提供结构化的摘要，并在摘要末尾列出试用注册信息（注册名称，试用ID和URL）; 有关更多信息，请参阅准备原始数据报告摘要的说明。需要3个要点清单（见关于准备要点的指导）。最大长度：不超过5个表格和/或数字的文字（不包括摘要，表格，数字，致谢，参考文献和在线材料）的3000字。小标题应包括“随机临床试验”一词。

浙江省亚全能干细胞库

什么是干细胞
分类
作用
作用
自体外输入的干细胞可以激活体内沉睡的干细胞，甚至促进这些细胞增殖，一起作用于人体，改善人体的状态。
什么是
分类
干细胞
诱导定向分化激活宿主内源性干细胞
旁分泌作用
作用作用
促进细胞新陈代谢
什么是
分类
作用
干细胞
作用
细胞的活动受细胞因子调控，干细胞可以分泌包括 TGF（转化生长因子）、FGF（成纤维细胞生长因子）在内的多种因子，改善体内微环境，修复细胞损伤、促进细胞生长，恢复细胞的正常生理功能。
为什么要储存干细胞
进行性肌营养不良：
中国患者，孪生兄弟， 10岁，治疗前平卧时不能抬头，坐起费力，不能站立及行走，四肢肌力3级，体重分别为17、19公斤。
为什么要储存干细胞
进行性肌营养不良：
干细胞治疗4次后，头可抬离床面，坐起明显灵活，可独立站立，并可步行20米左右，四肢肌力达到4级，食欲增强，体重各增长3公斤。
白血病
脑瘫、视神经发育不良、老年痴呆、糖尿病、肝硬化等
什么是
分类
作用
干细胞
分类
近年来发现，胎盘中存在的亚全能干细胞介于胚胎干细胞和成体干细胞之间，分化能力更具全能性，但不会成瘤。
Cell Surface Markers
Type
SSEA-4 Oct-4 CD117 CD105 CD29 CD44 CD166 CD73 CD90 CD133 CD45 CD34
树干和起源生命的种子
什么是干细胞
分裂、分化
什么是
干细胞
19世纪80年代德国病理学家Cohnheim提出骨髓中可能存在非造血组织的干细胞 1951 Lorenz报告第一个骨髓移植（BMT）动物实验 1980 我国首例HLA相合异基因亲缘BMT报告 1986 Broxmeyer发现脐带血富含造血干细胞 1990 Caplan发现大鼠骨髓间充质干细胞（MSC） 1991 Thomas因骨髓移植治疗白血病获得诺贝尔首次临床医学奖 1998 研究人员第一次从人胚胎中分离出干细胞

生物统计Biostatistics就业前景(世毕盟留学)

生物统计Biostatistics就业前景在美国统计学主要有四个研究领域：生物统计、金融统计、数理统计、应用统计，其中金融统计最为热门，而生物统计则是很多植物、生物等学科学生的跨专业首选。

下面就生物统计方向的就业情况逐个介绍。

生物统计专业的毕业生就业前景广阔，可以进入大学从事教学和科研工作，也可以在生物科技公司和制药公司进行统计分析，还有相当数量的毕业生进入了医疗机构。

在美国，生物统计就业的最好地区是东北部和加州。

东北部从新泽西州到纽约州，都有很多的药厂，很多大公司的总部也在这一带，并且麻省的科研机构非常多，因为这里是美国生物医学方面科研机构最集中的地方。

生物统计学在重点领域的应用：• 公共卫生，包括流行病学、营养学和环境卫生• 基因组学和族群遗传学• 医学• 生态学• 生物检定法• 农学在美国大学中，生物统计有很大一部分设置在公共健康学院(School of Public Health ) 里面，毕业后可以在医院或者科研机构进行研究工作。

有的学校会将统计与生物统计两个专业放在一起（Department of Statistics and Biostatistics)，可见其在美国统计学领域中的热门程度。

在SPH 学院下的生统专业，通常会有MS，MPH 和PHD 学位。

MPH专业主要是针对有博士学位，或相关工作经验的人群，通常学期是一年，多适合美国本土人群申请。

国际学生通常申请MS 或是PHD 学位。

以下是美国几所学校公Public Health School就业情况，供参考：1、Harvard T.H. Chan School of Public Health①Partial List of Job Titles* These students were in our two year Masters programs –some were in a professional track and were in a research track.②Our GraduatesHarvard T.H. Chan School of Public Health graduates, fellows and interns are interested in and well-prepared for a wide range of career opportunities.Among these are positions with:• Community-Based Organizations and Contract Research Organizations• Consulting Firms• Hospitals and health services delivery organizations• Local, state, and federal government agencies• Managed care, pharmaceutical, and biotechnology companies• Not-for-profit and public interest/advocacy organizations• Relief and international agencies, non-governmental organizations/Private V oluntary Organizations• Research facilities• Schools, colleges and universities, think tanks, and more③Salary Info (2015)2、JHU Bloomberg School of Public HealthCareers：Below is employment data from a survey administered to MPH alumni in January 2016.①MPH GRADUATE EMPLOYMENT DATA$70,000-$80,000 – Median Salary Range80% – Employed in domestic public health positions20% – Employed in global health positions②Type of OrganizationsFederal Government: 20%Hospital or Other Healthcare Provider: 18%University Healthcare Setting: 17%Non-Profit (Foundation or Programmatic): 15%Consulting Firm: 12%Non-Profit/Research: 5%State or Local Health Department: 5%Health Insurance: 4%NGO: 4%③Top 10 EmployersJohns Hopkins UniversityBoston Children’s Hospital, Cedars-Sinai Health System, Brigham and Women's Hospital, Johns Hopkins HospitalMinistry of Health (Brazil, Austria, Norway)State & Local Health DepartmentsFDA, USAID, CDC, HHS, HRSA, Indian Health ServicesBooz Allen Hamilton, ICF International, JS Consultancy Services, Leidos, McKinsey & CompanyChase Brexton Health Care, Kaiser PermanenteCatholic Relief ServicesJHPIEGO, CCP, Population Council, Sabin Vaccine Institute, Pew Charitable Trusts WHO, UNICEF④Top 10 Job TitlesResearcher, Research Associate, Senior Research AnalystDirector, Associate Director, Executive Director, Branch ChiefConsultant, Associate, Strategy ConsultantFellow, Intern Postdoctoral FellowManager, Project Manager, Supervisor, LeadEpidemiologist, BiostatisticianNurse Practitioner, NursePublic Health PhysicianProgram Officer, Program AssociateDoctoral StudentThe employment data found here is from MPH alumni who responded to our survey inquiries January 2016 through March 2016. The data is intended to provide an overview of the employment and education status of our recent graduates Work authorization status, additional graduate degree, past work experience, labor market trends, overall economic climate and graduate dedication to seeking meaningful employment must all be taken into consideration when making conclusions regarding these statistics.3、Columbia Mailman School of Public Health4、Yale School of Public HealthEmployment MetricsSelected Employers by Industry 2015 & 2016 MPH Graduates:①Business & Industry (biotech, pharma, insurance, health IT) Abt AssociatesAcumen (Sphere Institute)Athena HealthAlexion PharmaceuticalsBlue Ivy VenturesBlue Shield CaliforniaChemonicsCipherHealthCR BardCVS HealthEpicGenentechHumanaJD FinanceMcKinsey & CompanyOxeon PartnersPfizerUnited Health Group②Consulting & Advisory ServicesAdvisory Board CompanyAnalysis GroupBaker TillyBoost Healthcare ConsultingBooz Allen HamiltonBroad Haven AssociatesChartis GroupClarion ConsultingDeloitteECG Management ConsultantsLeavitt PartnersLinksbridge SPCMcKinsey & CompanyPA ConsultingShoppers Mart (Canadian eq. of CVS Health)③Further EducationPhD ProgramBrown UniversityHarvard UniversityNorthwestern UniversityUCLAUniversity of Southern CaliforniaUTMB-GalvestonYale UniversityMedical SchoolGeorgetown UniversityIcahn School of Medicine-Mount SinaiThomas Jefferson UniversityUniversity of ConnecticutUniversity of Rochester School of MedicineWeil Cornell Medical SchoolYale School of Medicine④Other (Law, Fellowships)Duke UniversityFox FellowFulbright FellowUniversity of California-Berkeley⑤Government/Public SectorCDC Allan Rosenfield Global Health Surveillance Fellowship Center for Disease ControlCenter for Medicare & Medicaid ServicesCT Agricultural Experiment StationEnvironmental Protection AgencyFL Department of HealthHealth Policy CommissionNew Jersey Department of Public Health NYC Department of HealthPhiladelphia Department of HealthSkagit County Department of Public Health The Fund for Public Health/NYUS Army Public Health CenterUSDA/FDAWashington State Board of Health⑥Hospital Based ResearchBoston Children's HospitalCenter for Infection-Columbia University Harvard Chan School of Public Health Massachusetts General HospitalPenn MedicineUniversity California San Francisco - UCSF University of North CarolinaUpstate Medical UniversityVanderbilt University Medical Center Weill Cornell- Global Health CenterYale CAREYale School of Medicine⑦Hospitals/Medical CentersCleveland ClinicGriffin HospitalKaiser PermanenteLife Care ServicesMedical PracticeNY Presbyterian HospitalTrinity HealthUniversity Miami HospitalUniversity of Southern California Brooklyn Medical CenterUniversity of ChicagoKaiser PermanenteUCLA HealthSutter HealthYale New Haven Health System University of Wisconsin Hospitals⑧NGO/Non Profits/FoundationsCA Family Health CouncilCARE International Commonwealth FundHenderson CollegiateImpact InitiativesPharos Global Health Advisors Results for DevelopmentYale China AssociationYale Global Health Justice Fellowship Yale Young Scholars Program⑨Policy Institute/Think Tanks Global Health Leadership Institute Global Health Leadership Institute Health Management Academy IMPAQ International Mathematica Policy ResearchMPH in Biostatistics①Business & IndustryHumanaJD FinanceCR Bard②Hospital Based ResearchColumbia UniversityMaria Fareri Children’s Hospital Yale UniversityFurther Study (2015 Graduates) Emory UniversityUniversity of PennsylvaniaYale School of Medicine。

美国国立卫生研究院介绍

使命与目标The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the nation’s medical research agency — making important discoveries that improve health and save lives.NIH’s mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability.∙to foster fundamental creative discoveries, innovative research strategies, and their applications as a basis for ultimately protecting and improvinghealth;∙to develop, maintain, and renew scientific human and physical resources that will ensure the Nation's capability to prevent disease;∙to expand the knowledge base in medical and associated sciences in order to enhance the Nation's economic well-being and ensure a continued high return on the public investment in research; and∙to exemplify and promote the highest level of scientific integrity, public accountability, and social responsibility in the conduct of science.In realizing these goals, the NIH provides leadership and direction to programs designed to improve the health of the Nation by conducting and supporting research:∙in the causes, diagnosis, prevention, and cure of human diseases;∙in the processes of human growth and development;∙in the biological effects of environmental contaminants;∙in the understanding of mental, addictive and physical disorders; and∙in directing programs for the collection, dissemination, and exchange of information in medicine and health, including the development and support of medical libraries and the training of medical librarians and other healthinformation specialists.组织构成The National Institutes of Health is made up of 27 different componentscalled Institutes and Centers. Each has its own specific research agenda, often focusing on particular diseases or body systems. All but three of these components receive their funding directly from Congress, and administrate their own budgets. NIH leadership plays an active role in shaping the agency's research planning, activities, and outlook.The Office of the Director is the central office, responsible for setting policy for NIH and for planning, managing, and coordinating the programs and activities of all the NIH components.Headquarters for the Office of the Director and the Institutes and Centers are located in Bethesda, Maryland, USA. NIH has more than 75 buildings in a campus-like environment over 300 acres. Some research is performed on campus instate-of-the-art laboratory facilities, although more than 80% of research activities are conducted by scientists working in every state and around the world.。

奥巴马医改计划

奥巴马医改计划
奥巴马选举时提出的政纲三大议题之一
内容摘要
奥巴马医改计划，这位前任美国总统奥巴马在选举时提出的三大政纲之一，终于在2010年3月得到了国会的通过。这一改革的目标，是为那些没有医疗保险的美国公民提供医疗保障。初看起来，这个法案似乎仅仅是在成立公营医疗保险，管制私人市场转保，由私人健保转到公营健保。然而，深入探究，大家会发现，这个法案的真正野心远不止于此。现在，这个法案建议的，是限制美国全民购买医疗保险，不容许保险公司以疾病等借口对受保人拒保，或擅自增加保费。这无疑是对整个保险行业的深度改革，也是对每一个美国人的生活保障的强有力保障。你瞧，这就是奥巴马医改计划的魅力。它不仅仅是一个简单的医疗保障方案，更是一个对整个社会制度进行深度改革的伟大尝试。它向我们展示了，一个总统的伟大，不在于他做了多少事，而在于他能为人民解决多少实际问题，能为这个社会带来多少正面的改变。
内容摘要
在这一点上，奥巴马总统做到了。他的医改计划，让我们看到了一个有担当、有理想的总统形象。他用自己的行动，证明了“为人民服务”不仅仅是一句口号，而是他实实在在的行动准则。因此，当我们回顾奥巴马总统的医改计划时，我们不仅仅是在评价一个医疗保障方案，更是在评价一个总统对人民的忠诚，对社会的责任，对国家的热爱。这就是奥巴马医改计划的真正价值，也是它对我们的启示。
发展历史
发展历史
1912年，时任美国总统的西奥多·罗斯福（Theodore Roosevelt）对德国总理俾斯麦（Otto Von Bismarck）40年前提出的改革表示赞同，从而想要通过新的医疗保险政策。但这些政策由于其后辈——1913年起担任美国总统的伍德罗·威尔逊（Woodrow Wilson）的反对未能得以实施。

本科生练习题_(医学生文献检索操作题)

本科生练习题一、网络资源检索1.利用百度检索出文献类型是PDF，文献内容是“冠心病”的文献，输入的是什么，检索的结果数量是多少？2. 利用Google查找网页标题中含“创新型大学”一词的页面，输入的是什么，检索结果数量是多少？3. 如何在google上查找造血干细胞的幻灯片？4. 利用google学术搜索查找我校李群伟教授在《泰山医学院学报》上发表的文章，并被引次数最高的文献。

此外，你能得到李教授的院系和邮件联系方式吗？5. 通过Google学术搜索检索论文“抗甲突汤治疗甲亢突眼症的临床疗效观察”被引用情况。

6.在google 或百度中检索关于网页制作的Powerpoint教学课件，给出检索策略和检索命令。

（提示：Powerpoint文件格式为ppt）7. 查找人类首次登月成功的时间、国家、宇航员姓名和宇宙飞船的名称。

8.提供SPECT中英文名称9. 《中华放射学杂志》被引频次最高的论文作者10. 以Google()为例，检索《中国循证医学杂志》上发表的篇名中包含“循证医学”（词组）的文章被引用情况。

要求提供检索词、检索步骤，检索结果数量，抄下被引频次最高一篇论文的题录和引用该文献且被引频次最高的他引文献题录。

11.查找2000年在《中国心理卫生杂志》上发表的心理健康（词组，出现在篇名）文献的被引情况，应使用何种搜索引擎，该如何检索？写出检索词和操作步骤，抄下被引频次最高的文献题录。

12. 你知道王老吉的历史是怎样的？创始人又是谁？你能找到他的图片吗？13.使用high wire press检索2005-至今西咪替丁治疗胃溃疡的文章，写出检索步骤和结果数。

二、中国生物医学文献数据库（CBMdisc）CBMdisc的检索步骤进入数据库系统：双击桌面快捷方式cbmWin2004，在出现的窗口上点击左键，进入CBM数据库，点击窗口右下方的开始键，进入数据库检索系统。

实习题一：检索肝癌的MRI诊断评价1. 进行主题词检索（1）进行MRI的主题词检索。

奥巴马总统在白宫玫瑰园就《平价医疗法案》英语演讲稿_英语演讲稿_

奥巴马总统在白宫玫瑰园就《平价医疗法案》英语演讲稿THE PRESIDENT: Everybody, have a seat.MS. BAKER: Hello. My name is Janice Baker. I havethe privilege to say that I'm the firstperson in the state of Delaware to enrollfor health insurance through the new marketplace. (Applause.) Like many consumers out there, it took me a number of frustratingattempts beforeI could apply for and select my plan.I kept trying because I needed access to thenew healthcare options.I had applied to three privateinsurance companies only to be rejected due to preexistinghealthconditions. I am too young for Medicare,but I'm too old not to have some health issues. Iwas able to find a policy I am thrilled with, saving $150 a month, andmuch lower deductiblesthan my previous policy that I held through my smallbusiness.I'm here today to encourage otherpeople like me who needs access to quality, affordableinsurance, and to tellthem to have patience with such a new system. Without this ability toget this insurance, Iknow that a single hospital stay could have bankrupted me and mybusiness.Thank you all. And I am now honored to introduce thePresident of the United States. (Applause.)THE PRESIDENT: Great job.MS. BAKER: Thank you. Thank you.THE PRESIDENT: Thank you. (Applause.) Thank you,everybody. Well, thank you, Janice.And thanks to everybody here for coming onthis beautiful day. Welcome to the WhiteHouse.About three weeks ago, as thefederal government shut down,the Affordable Care Act'shealth insurancemarketplaces opened for business across the country. Well, we've now gottenthe government backopen for the American people, and today I want to talk about how we'regoing toget the marketplaces running at full steam, as well. And I'm joined today by folks whohave eitherbenefited from the Affordable Care Act already, or who are helping theirfellowcitizens learn about what this law means for them and how they can get covered.Of course, you've probably heardthat –- the new website where people canapply for healthinsurance, and browse and buy affordable plans in most states –- hasn'tworkedas smoothly as it was supposed to work. And the number of people who have visitedthe site has beenoverwhelming, which has aggravated some of these underlying problems.Despite all that, thousands ofpeople are signing up and saving money as we speak. ManyAmericans with a preexisting condition,like Janice, are discovering that they can finally gethealth insurance likeeverybody else.So today, I want to speak toevery American who's looking to get affordable healthinsurance. I want you to know what's available to youand why it may be a good deal for you.And for those who've had some problems with the website, I want to tellyou what we're doingto make it work better and how you can sign up to getcovered in other ways.But before I do that, let meremind everybody that the Affordable Care Act is not just awebsite. It's much more. For the vast majority of Americans -- for 85percent of Americanswho already have health insurance through your employer orMedicare or Medicaid -– you don'tneed to sign up for coverage through awebsite at all. You've already gotcoverage. WhattheAffordable Care Actdoes for you is to provide you with new benefits and protections that havebeenin place for some time. You may not knowit, but you're already benefiting from theseprovisions in the law.For example, because of theAffordable Care Act, young people like Jasmine Jennings, andJessica Ugalde,and Ezra Salop, all of whom are here today, they've been able to stay ontheirparents' plans until they're 26. Millions of other young people are currently benefiting fromthat part ofthe law. (Applause.) Another part of the Affordable Care Act isproviding seniors withdeeper discounts on their prescription medicine. Billions of dollars have been saved byseniorsalready. That's part of thelaw. It's already in place. It's happening right now.Already, because of theAffordable Care Act, preventive care like mammograms and birthcontrol are freethrough your employers. That's part ofthis law. (Applause.) So there are a widerange of consumerprotections and benefits that you already have if you've got healthinsurance.You may not have noticedthem, but you've got them, and they're not going anywhere. Andthey're not dependent on a website.Here's another thing that theAffordable Care Act does. In stateswhere governors andlegislatures have wisely allowed it, the Affordable CareAct provides the opportunity for manyAmericans to get covered under Medicaidfor the first time. So in Oregon, forexample, that'shelped cut the number of uninsured people by 10 percent just inthe last three weeks. Thinkaboutthat. That's 56,000 more Americans whonow have health care. (Applause.) That doesn'tdepend on a website.Now, if you're one of the 15percent of Americans who don't have health insurance -- eitherbecause you can'tafford it orbecause your employer doesn't offer it, or because you're asmallbusinessperson and you have to go out on the individual market and buy it onyour ownand it's just too expensive -- October 1st was an important date. That's when we opened thenew marketplaceswhere people without health insurance, or who can't afford healthinsurance, orwho aren't part of a group plan, can finally start getting affordable coverage.And the idea is simple. By enrolling in what we're calling thesemarketplaces, you becomepart of a big group plan -- as if you were working fora big employer -- a statewide group planthat spreads risk between sick peopleand healthy people, between young and old, and thenbargains on your behalf forthe best deal on health care. What we'vedone is essentially create acompetition where there wasn't competitionbefore. We created these big groupplans, and nowinsurers are really interested in getting your business. And so insurers have created new healthcareplans with more choices to be made available through these marketplaces.And as a result of this choiceand this competition, prices have come down. When you addthe new tax credits that many people are eligible forthrough the law, then the prices comedown even further. So one study shows that through new optionscreated by the Affordable CareAct, nearly 6 in 10 uninsured Americans willfind that they can get covered for less than $100 amonth. Think about that. (Applause.)Through the marketplaces, you canget health insurance for what may be the equivalentof your cell phone bill oryour cable bill, and that's a good deal.So the fact is the product of theAffordable Care Act for people without health insurance isquality healthinsurance that'saffordable. And thatproduct is working. It's reallygood. And itturns out there's a massivedemand for it. So far, the nationalwebsite, , has beenvisited nearly 20 million times. Twenty million times. (Applause.) And there's great demand atthe state level as well, because there are abunch of states that are running their ownmarketplaces.We know that nearly one-third ofthe people applying in Connecticut and Maryland, forexample, are under 35years old. They understand that they canget a good deal at low costs,have the security of health care, and this is notjust for old folks like me -- that everybodyneeds good quality healthinsurance. And all told, more than halfa million consumers across thecountry have successfully submitted applicationsthrough federal and state marketplaces. Andmany of those applications aren't just for individuals, it's fortheir entire families. So evenmorepeople are already looking to potentially take advantage of the high quality,affordableinsurance that is provided through the Affordable Care Act.So let me just recap here. The product is good. The health insurance that's being providedisgood. It's high quality and it'saffordable. People can save money,significant money, bygetting insurance that's being provided through thesemarketplaces. And we know thatthedemand is there. People are rushing tosee what's available. And those who havealready hada chance to enroll are thrilled with the result. Every day, people who were stuck withsky-highpremiums because of preexisting conditions are getting affordableinsurance for the first time, orfinding, like Janice did, that they're savinga lot of money. Every day, women arefinally buyingcoverage that doesn't charge them higher premiums than men forthe same care.(Applause.)Every day, people are discovering that newhealth insurance plans have to cover maternitycare, mental health care, freepreventive care.So you just heard Janice's story-- she owns her own small business. Sherecently became thefirst woman to enroll in coverage through Delaware'sexchange. And it's true, it took her afewtries, but it was worth it after being turned down for insurance threetimes due to minorpreexisting conditions. So now she'll be covered, she'll save 150 bucks a month, and shewon'thave to worry that one illness or accident will cost her her business that she'sworked sohard to build.And Janice is not alone. I recently received a letter from a womannamed Jessica Sanford inWashington State. And here's what she wrote: “I ama single mo m, no child support, self-employed, and I haven't had insurance for15 years because it's too expensive. Myson hasADHD and requires regular doctor visits and his meds alone cost $250per month. I have had anongoingtendinitis problem due to my line of work that I haven't had treated. Now, finally, weget to have coverage becauseof the ACA for $169 per month. I wascrying the other day when Isigned up. Somuch stress lifted.”Now, that is not untypical for alot of folks like Jessica who have been struggling withouthealthinsurance. That's what the AffordableCare Act is all about. The point is, theessence of thelaw -- the health insurance that's available to people -- isworking just fine. In somecases,actually, it's exceeding expectations -- the prices are lower than we expected,the choice isgreater than we expected.But the problem has been that the website that'ssupposed to make it easy to apply for andpurchase the insurance is notworkingthe way it should for everybody. Andthere's nosugarcoating it. The websitehas been too slow, people have been getting stuck during theapplicationprocess. And I think it's fair to saythat nobody is more frustrated by that than I am -- precisely because theproduct is good, I want the cash registers to work. I want the checkoutlines to be smooth. So I want people to be able to get this greatproduct. And there's no excusefor theproblems, and these problems are getting fixed.But while we're working out the kinks in thesystem, I want everybody to understand thenature of the problem. First of all, even with all the problems , the website isstill working for a lot of people -- just not asquick or efficient or consistent as we want. Andalthough many of these folks have found that they had to wait longerthan they wanted, oncethey complete the process they're very happy with thedeal that's available to them, just likeJanice's.Second, I want everybody toremember that we're only three weeks into a six-month openenrollment period,when you can buy these new plans. (Applause.) Keep in mind theinsurancedoesn't start until January 1st; that's the earliest that theinsurance can kick in. No one whodecidesto purchase a plan has to pay their first premium until December 15th. And unlike theday after Thanksgiving salesfor the latest Playstation or flat-screen TVs, the insurance plansdon't runout. They're not going to sell out. They'll be available through the marketplace-- (applause) -- throughout the open enrollment period. The prices that insurers have set willnotchange. So everybody who wants insurancethrough the marketplace will get insurance,period. (Applause.) Everybody who wants insurance through the marketplace will getinsurance.Third, we are doing everything wecan possibly do to get the websites working better, faster,sooner. We've got people working overtime, 24/7, toboost capacity and address the problems.Experts from some of America's top private-sector tech companies who, bythe way, have seenthings like this happen before, they want it to work. They're reaching out. They're offering tosend help. We've had some of the best IT talent in theentire country join the team. Andwe'rewell into a “tech surge” to fix the problem. And we are confident that we will get all theproblems fixed.Number four -- while the websitewill ultimately be the easiest way to buy insurancethrough the marketplace, itisn't the only way. And I want toemphasize this. Even as weredouble ourefforts to get the site working as well as it's supposed to, we're alsoredoubling ourefforts to make sure you can still buy the same quality,affordable insurance plans availableon the marketplace the old-fashioned way-- offline, either over the phone or in person.And, by the way, there are a lotof people who want to take advantage of this who are morecomfortable workingon the phone anyway or in person. So letme go through the specifics as tohow you can do that if you're having problemswith the website or you just prefer dealing witha person.Yesterday, we updated the website'shome page to offer more information about the otheravenues to enroll inaffordable health care until the online option works for everybody. So you'llfind information about how to talkto a specialist who can help you apply over the phone or toreceive adownloadable application you can fill out yourself and mail in.We've also added more staff tothe call centers where you canapply for insurance over thephone. Those are already -- they've beenworking. But a lot of people havedecided first to go tothe website. Butkeep in mind, these call centers are already up and running. And you can getyour questions answered byreal people, 24 hours a day, in 150 different languages. The phonenumber for these call centers is1-800-318-2596. I want to repeat that --1-800-318-2596. Waittimes have averagedless than one minute so far on the call centers, although I admit that thewaittimes probably might go up a little bit now that I've read the number out loudon nationaltelevision. (Laughter.)But the point is the call centersare available. You can talk to somebodydirectly and theycan walk you through the application process. And I guarantee you, if one thing is worththewait, it's the safety and security of health care that you can afford, orthe amount of moneythat you can save by buying health insurance through themarketplaces. (Applause.)Once you get on the phone with atrained representative, it usually takes about 25minutes for an individual toapply for coverage, about 45 minutes for a family. Once you applyfor coverage, you will becontacted by email or postal mail about your coverage status.But you don't have to just gothrough the phone. You can also apply inperson with the helpof local navigators -–these are people specially trainedto help you sign up for health care, andthey exist all across the country, oryou can go to community health centers and hospitals. Justvisit to findout where in your area you can get help and apply forinsurance in person.And finally, if you've alreadytried to apply through the website and you've been stucksomewhere along theway, do not worry. In the coming weeks,we will contact youdirectly,personally, with a concrete recommendation forhow you can complete your application,shop for coverage, pick a plan thatmeets your needs, and get covered once and for all.So here's the bottom line. The product, the health insurance isgood. The prices are good.It is a good deal. People don't just want it; they're showing upto buy it. Nobody is madder thanmeabout the fact that the website isn't working as well as it should, which meansit's going toget fixed. (Laughter andapplause.)。

2014国际压疮指南_中文版

指南的制定
完整版《临床实践指南》列出了完整的方法程序。美国压疮咨询委员会（NPUAP），欧洲压疮咨询委员会（EPUAP）和泛太平洋压力损伤联盟（PPPIA）彼此协作，更新了压疮预防与治疗的各项指南，将原有两个版本的指南（预防与治疗）整合入一个综合性临床实践指南中。
本指南由一个跨专业指南制定小组（GDG）和多个工作小组（SWG）制定，每个小组都由上述三家机构的数名代表组成。
本指南的目的仅限教学和提供信息。本指南所含信息在发表之时是准确的。科研技术飞速变化，本指南所含信息可能会与今
后的学术进展不符。医疗从业者应当紧跟科研技术的进展，随时了解可能影响到自己决策制定的学术进展。使用了各种产品的通用名。本指南任何内容均不是为特定产品做推荐的。本指南所含任何内容均不是为了在编码标准或保险政策方面提供建议。本指南不是为各种产品和器械提供完整的安全性信息和使用信息；但按常规纳入了现有的安全资料和使用方法信息。本文所含研究的各项不良事件，列在“证据总结”和“警告声明”中。所有产品均应按厂商提供的说明书来使用。
本指南的局限性及正确使用
“指南”是系统性制定的表述，用来帮助医疗从业者和患者对于特定的临床条件判断应当采取哪些正确的卫生护理措施。推荐意见可能并不适用于所有情况。
须由医疗从业者根据现有资料和患者的具体情况，来决定采用某一特定的推荐意见。不可将本指南所含任何内容作为特定病例的医学建议。
制定本指南所使用的方法缜密，因此指南制定小组成员相信：使用这些研究支持推荐意见是可靠而准确的。为严格评估本指南所含的研究，我们付出了种种努力。但是，我们并不担保本指南所引用的具体研究的可靠性和准确性。
本指南的推荐意见是正确临床实践的总体指导，要由符合资质的医疗从业者根据自己对具体病例所作临床判断且考虑到患者的个人意愿和可供使用的资源，予以执行。本指南的执行要有文化意识，严肃认真，并遵照“保护、参与、合作”的宗旨。