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Storylines of family medicine Ⅻ:family medicine and the healthcare system

Family Medicine and Community Health 2024年第S3期12卷 109-118页

作者： william B Ventres Leslie A Stone Jeannette E South-Paul kendall M Campbell Aerial R Petty Hima Ekanadham kurt C Stange Rebecca S Etz william L Miller Robert L Ferrer Marianna kong Thomas Bodenheimer Roger Strasser Sharon C M Reece Joshua freeman John M Westfall Family and Preventive Medicine University of Arkansas for Medical Sciences College of MedicineLittle RockArkansasUSA Meharry Medical College NashvilleTennesseeUSA Family Medicine University of Texas Medical Branch at Galveston School of MedicineGalvestonTexasUSA Family Medicine Residency Program New York-Presbyterian Columbia University Medical CenterNew YorkNew YorkUSA Center for Family and Community Medicine Columbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA Center for Community Health Integration Case Western Reserve University School of MedicineClevelandOhioUSA Family Medicine and Population Health Virginia Commonwealth University School of MedicineRichmondVirginiaUSA Family Medicine Lehigh Valley Health NetworkAllentownPennsylvaniaUSA University of South Florida Morsani College of Medicine TampaFloridaUSA Family and Community Medicine UT Health San Antonio Long School of MedicineSan AntonioTexasUSA Family and Community Medicine University of California San Francisco School of MedicineSan FranciscoCaliforniaUSA Northern Ontario School of Medicine University SudburyOntarioCanada Family Medicine Baylor Scott and White HealthTempleTexasUSA Family Medicine University of Kansas School of MedicineKansas CityKansasUSA DARTNet Insitute AuroraColoradoUSA

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine,as interpreted by individual family physicians and medical educators in the USA and elsewhere around the ***‘Ⅻ:Family medicine and the future of the healthcare system’,authors address the following themes:‘Leadership in family medicine’,‘Becoming an academic family physician’,‘Advocare—our call to act’,‘The paradox of primary care and three simple rules’,‘The quadruple aim—melding the patient and the health system’,‘Fit-for-purpose medical workforce’,‘Universal healthcare—coverage for all’,‘The futures of family medicine’and‘The 100th essay.’May readers of these essays feel empowered to be part of family medicine’s exciting future.

关键词： system illustration family

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2007年ACC／AHA非心脏手术围手术期心血管评估与管理指南：实施概要

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麻醉与镇痛 2010年第6期6卷 1-28页

作者： Lee A Fleisher Joshua A Beckman kenneth A Brown Hugh Calkins Elliott Chaikof kirsten E Fleischmann william k freeman James B Froehlich Edward k kasper Judy R kersten Barbara Riegel John F Robb Sidney C Smith Alice k Jacobs Cynthia D Adams Jeffrey L Anderson Elliott M Antman Christopher E Buller Mark A Creager Steven M Ettinger David P Faxon Valentin Fuster Jonathan L Halperin Loren F Hiratzka Sharon A Hunt Bruce W Lytle Rick Nishimura Joseph P Ornato Richard L Page Lynn G Tarkington Clyde W Yancy

美国心脏病学院镁国心脏协会工作组有关实践指南的一份报告（编写委员会对2002年非心脏手术围手术期心血管评估指南的修改）

关键词：非心脏手术管理指南血管评估围手术期 ACC/AHA 美国心脏病学院实践指南心脏协会

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Ground-based and additional science support for SMILE

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Earth and Planetary Physics 2024年第1期8卷 275-298页

作者： J.A.Carter M.Dunlop C.Forsyth k.Oksavik E.Donovon A.kavanagh S.E.Milan T.Sergienko R.C.Fear D.G.Sibeck M.Connors T.Yeoman X.Tan M.G.G.T.Taylor k.Mcwilliams J.Gjerloev R.Barnes D.D.Billet G.Chisham A.Dimmock M.P.freeman D.-S.Han M.D.Hartinger S.-Y.W.Hsieh Z.-J.Hu M.k.James L.Juusola k.kauristie E.A.kronberg M.Lester J.Manuel J.Matzka I.McCrea Y.Miyoshi J.Rae L.Ren F.Sigernes E.Spanswick k.Sterne A.Steuwer T.Sun M.-T.Walach B.Walsh C.Wang J.Weygand J.Wild J.Yan J.Zhang Q.-H.Zhang Planetary Sciences Group School of Physics and AstronomyUniversity of LeicesterUniversity RoadLeicesterLE17RHUK Rutherford Appleton Laboratory Space Science Technology Facilities CouncilOxfordshireUK School of Space and Environment Beihang UniversityBeijing 100191China key Laboratory of Space Environment Monitoring and Information Processing Ministry of Industry and Information TechnologyBeijing 100017China Department of Space and Climate Physics UCLMullard Space Science LaboratoryHolmbury St.MaryDorkingSurreyRH56NTUK Birkeland Centre for Space Science Department of Physics and Technology.University of BergenBergenNorway Department of Physics and Astronomy University of Calgary2500 University DriveCalgaryAlbertaCanada T2N 1N4 British Antarctic Survey CambridgeUK Swedish Institute of Space Physics KirunaSweden West Highfield Campus University of SouthamptonUniversity RoadSO171BJUK Goddard Space Flight Center NASAGreenbeltMarylandUSA Athabasca University AthabascaCanada ESTEC European Space AgencyNetherlands University of Saskatchewan SaskatoonCanada The Johns Hopkins University Applied Physics Laboratory LaurelMarylandUSA Swedish Institude of Space Physics UppsalaSE 75121Sweden Tongji University Shanghai 200092China Center for Space Plasma Physics Space Science Institute4765 Walnut Street Suite BBoulderColorado80301USA Polar Research Institute of China Shanghai 200136China Finnish Meteorological Institute(FMI) Finland Department of Earth and Environmental Sciences(Geophysics) Ludwig Maximilian University of Munich(LMU)MunichTheresienstr.41MunichD-80333Germany Canadian Space Agency MontrealCanada GFZ German Research Centre for Geosciences PotsdamGermany Nagoya University Institute for Space Earth Environment ResearchCenter for Integrated Data ScienceNagoyaAichiJP 464-8601 Northumbria University Newcastle upon TyneTyne and WearUK NE18ST National Space Science Center Chinese Academy SciencesBeijing 100190China Arctic Geophysics University Centre in Svalbard

The joint European Space Agency and Chinese Academy of Sciences Solar wind Magnetosphere Ionosphere Link Explorer(SMILE)mission will explore global dynamics of the magnetosphere under varying solar wind and interplanetary magnetic field conditions,and simultaneously monitor the auroral response of the Northern Hemisphere *** these large-scale responses with medium and fine-scale measurements at a variety of cadences by additional ground-based and space-based instruments will enable a much greater scientific impact beyond the original goals of the SMILE ***,we describe current community efforts to prepare for SMILE,and the benefits and context various experiments that have explicitly expressed support for SMILE can offer.A dedicated group of international scientists representing many different experiment types and geographical locations,the Ground-based and Additional Science Working Group,is facilitating these *** include constructing an online SMILE Data Fusion Facility,the discussion of particular or special modes for experiments such as coherent and incoherent scatter radar,and the consideration of particular observing strategies and spacecraft *** anticipate growing interest and community engagement with the SMILE mission,and we welcome novel ideas and insights from the solar-terrestrial community.

关键词： magnetosphere ionosphere magnetosphere-ionosphere coupling ground-based experimentation SMILE conjunctions missions

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ACC／AHA2006年非心脏手术围手术期心血管评估指南更新：关于围手术期β-受体阻滞剂使用的专题更新--美国心脏病学会／美国心脏协会医疗指南工作组报告（非心脏手术围手术期心血管评估2002指南更新编写委员会）

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麻醉与镇痛 2008年第1期4卷 2-10页

作者： Lee A. Fleisher, MD, FACC Joshua A. Beckman, MD, FACC kenneth A. Brown, MD, FACC, FAHA Hugh Calkins, MD, FACC, FAHA EUiott L. Chaikof, MD, PhD kirsten E. Fleischmann, MD, MPH, FACC william k. freeman, MD, FAC James B. Froehlich, MD, MPH, FACC Edward k. kasper, MD, FACC Judy k kersten, MD, FACC Barbara Riegel, DNSc, RN, FAHA John F. Robb, MD, FACC 李恒(译) 阎哲(译) 杨承祥(校) Society for Vascular Medicine and Biology Official Representative American Society of Nuclear Cardiology Official Representative Heart Rhythm Society Official Representative Society for Vascular Surgery Official Representative American Society of Echocardiography Official Representative Society of Cardiovascular Anesthesiologists Official Representative Society for Cardiovascular Angiography and Interventions Official Representative 不详

美国心脏病学会／美国心脏协会（ACC／AHA）医疗指南工作组尽力避免因编写委员会成员与企业的关系或个人利益而导致的任何实际的、可能的，或者是已发现的利益冲突。编写委员会的所有成员以及本文件的同行评议人必须对可能被视为是实际... 详细信息

美国心脏病学会／美国心脏协会（ACC／AHA）医疗指南工作组尽力避免因编写委员会成员与企业的关系或个人利益而导致的任何实际的、可能的，或者是已发现的利益冲突。编写委员会的所有成员以及本文件的同行评议人必须对可能被视为是实际上或是潜在的利益冲突进行声明。工作组对以上声明进行审查。在每次会议上，这些声明必须口头汇报给编写委员会的每位成员；当发生变动时，编写委员会对声明进行更新并再次核查。编写委员会成员和企业的关系见附表1，同行评议人与企业的关系见附表2。本指南旨在确定在大多数情形下满足大部分患者需求的方案。指南反映了对当前可获得的科学文献进行系统分析后专家们达成的共识，其目的在于提高医疗质量。如果将指南用于管理／投资决策，其终极目标应是医疗质量得到提高并服务于患者。关于具体患者的医疗问题，必须由医疗人员和患者根据具体情况共同做出最终决定。Sidney C Smith，Jr．，MD，FACC，FAHA ACC／AHA医疗指南工作组主席Elliot ***，MD，FACC，FAHA

关键词： ACC/AHA 美国心脏病学会美国心脏协会医疗指南 β-受体阻滞剂委员会工作组非心脏手术

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Limitations in assessment of mucosal healing in inflammatory bowel disease

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World Journal of Gastroenterology 2010年第1期16卷 15-20页

作者： Hugh James freeman Department of Medicine University of British Columbia

An emerging parameter to define the effectiveness of new therapeutic agents in clinical trials,and by extension,for use in day-to-day clinical practice has been labeled mucosal *** has been hypothesized that complete healing of the intestinal mucosa in inflammatory bowel diseases should result in reduced disease complications,reduced hospitalization and reduced surgical *** implication,the natural history of inflammatory bowel disease might then be altered. Measurement of mucosal healing,however,is largely observational,requiring repeated invasive endoscopic examinations,sometimes with mucosal *** indirect imaging methods may play a role in this assessment along with other surrogate markers,including intestinal *** measurements may have significant limitations that prohibit precise correlation with symptom-based disease activity indices in clinical *** likely reflects the dynamic nature of this evolving and individualized inflammatory process that tends to be focused,but not limited,to the mucosa of the intestinal tract.

关键词： Intestinal mucosa Digestive system endoscopy Clinical trials

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Surveillance for colitis-associated colon neoplasia

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World Journal of Gastroenterology 2010年第37期16卷 4646-4651页

作者： Hugh James freeman Department of Medicine University of British Columbia

The risk of developing colon cancer is increased in colitis patients, particularly if the disease is extensive and its duration long-standing. Endoscopic guidelines have been developed with the goal of detecting early neoplastic changes prior to development of advanced malignancy. Unfortunately, the natural history of this superimposed neoplastic process in colitis appears to be very heterogeneous and poorly understood. Moreover, there are numerous confounding variables in colitis patients that limit accurate assessment of the surveillance effectiveness of colonoscopy and multi-site biopsy protocols. Although the clinical challenge posed to even the most experienced clinicians remains significant, evolving methods of endoscopic imaging may facilitate better evaluation of this highly select group of patients.

关键词： Ulcerative colitis Crohn’s disease Colon cancer Surveillance colonoscopy Colon biopsies

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Complications of collagenous colitis

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World Journal of Gastroenterology 2008年第11期14卷 1643-1645页

作者： Hugh James freeman Department of Medicine(Gastroen-terology) University of British ColumbiaVancouver V6T 1W5Canada

Microscopic forms of colitis have been described, including collagenous colitis. This disorder generally has an apparently benign clinical course. However, a number of gastric and intestinal complications, possibly coincidental, may develop with collagenous colitis. Distinctive inflammatory disorders of the gastric mucosa have been described, including lymphocytic gastritis and collagenous gastritis. Celiac disease and collagenous sprue （or collagenous enteritis） may occur. Colonic ulceration has been associated with use of nonsteroidal anti-inflammatory drugs, while other forms of inflammatory bowel disease, including ulcerative colitis and Crohn＇s disease, may evolve from coUagenous colitis. Submucosal ＂dissection＂, colonic fractures or mucosal tears and perforation from air insufflation during colonoscopy may occur and has been hypothesized to be due to compromise of the colonic wall from submucosal collagen deposition. Similar changes may result from increased intraluminal pressure during barium enema contrast studies. Finally, malignant disorders have also been reported, including carcinoma and lymphoproliferative disease.

关键词： Colonic fractures Colonic perforation Celiac disease Collagenous gastritis Collagenous sprue Cat scratch colon Colon cancer Microscopic colitis

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Reproductive changes associated with celiac disease

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World Journal of Gastroenterology 2010年第46期16卷 5810-5814页

作者： Hugh James freeman Department of Medicine (Gastroenterology) University of British Columbia Hospital

Celiac disease is a mucosal disorder of the small intestine that may be triggered by dietary exposure to gluten in genetically-susceptible *** disorder is often associated with diarrhea,malabsorption and weight loss along with other extra-intestinal *** changes have been described,including impaired fertility and adverse pregnancy outcomes possibly related to immune-mediated mechanisms or nutrient *** possible pathogenetic factors that may alter placental function include maternal celiac disease autoantibodies binding to placental transglutaminase,and genetic mutations that may facilitate microthrombus *** noting activation during pregnancy or the puerperium may be important,and suggest that celiac disease may also be hypothetically precipitated by maternal exposure to one or more fetal antigens.

关键词： Celiac disease Infertility Pregnancy Post-partum celiac disease Fetal outcome

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Colorectal cancer risk in Crohn's disease

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World Journal of Gastroenterology 2008年第12期14卷 1810-1811页

作者： Hugh James freeman Department of Medicine (Gastro-enterology) University of British Columbia UBC Hospital Vancouver BC Canada

There is recognized increased risk for colorectal cancer in patients with inflammatory bowel disease, particularly in long-standing and extensive ulcerative colitis. There also appears to be an increased rate of intestinal cancer in Crohn's disease, including both colon and small bowel sites. In Crohn's disease, evidence suggests that detection of colorectal cancer may be delayed with a worse progno-sis. Some risk factors for cancer in Crohn's disease include the extent of inflammatory change within the colon and the presence of bypassed or excluded segments, inclu-ding rectal "stump" cancer. In addition, the risk for other types of intestinal neoplasms may be increased in Crohn's disease, including lymphoma and carcinoid tumors. Earlier detection of colorectal cancer based on colonoscopy scre-ening and surveillance may be achieved but, to date, this has not translated into a positive survival benefit. Moreo-ver, newer staining methods and evolving micro-endos-copic techniques show promise, but have not significantly altered management. Future research should focus on development of molecular or other bio-markers that might predict future dysplasia or cancer development in Crohn's disease.

关键词： Colon cancer Crohn's disease Surveillance Small bowel cancer

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Refractory celiac disease and sprue-like intestinal disease

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World Journal of Gastroenterology 2008年第6期14卷 828-830页

作者： Hugh James freeman Department of Medicine (Gastroenterology) University of British Columbia Vancouver BC Canada

Celiac disease is a gluten-dependent small intestinal mucosal disorder that causes malabsorption, often with diarrhea and weight loss. Diagnosis is based on detection of typical biopsy changes in the proximal small bowel, followed by evidence for an unequivocal response to a gluten-free diet. Refractoriness in celiac disease may be due to poor diet compliance, sometimes intentional, or consumption of ubiquitious sources of gluten. Alternatively, the original diagnosis may not be correct (eg., duodenal Crohn's disease), or a second cause for symptoms may be present (eg., collagenous colitis, functional bowel disorder). In some with recurrent symptoms, a complication may be present (eg., collagenous sprue, small bowel carcinoma, lymphoma). In some, a response to a gluten-free diet can not be unequivocally defined, and more precise historical terms have been used including "sprue-like intestinal disease" or "unclassified sprue". Although a "wastebasket diagnosis", these likely represent a heterogeneous group, and some, but not all, may develop lymphoma. Precise definition will be critical in the future as an array of new treatments, including biological agents, may emerge.

关键词： Refractory celiac disease Refractory sprue Unclassified sprue Celiac disease Intestinal lymphoma T-cell enteropabhy

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