第五章 传染病学_临床医学_医药卫生_专业资料.pptVIP

措施：肺结核患者被动检测 在普通就诊中发现肺结核的可疑患者 对可疑患者进行对痰涂片检查 痰涂片检查阳性中启动足够的治疗 持续对已启动治疗的患者进行治疗 被动监测 (1) 在一般就诊中发现肺结核可疑患者 -What we need, therefore, is a discriminating sign at an early stage of illness, and moreover, one that can easily be operationalised. Discriminating sign Workload (exams to be carried out) Result (sputum positive detected) “cough1 week” 700 44 “cough 2 weeks” 350 43 Marginal cost or marginal return 350 exams 1 case (1)在一般就诊中发现肺结核可疑患者 In this case, “cough 2 weeks’ appears to be the most efficient screening sign. Other sign: -weight loss (well-nourished population) -night sweat （1）在一般就诊中发现肺结核可疑患者 In conclusion, a decentralized and versatile service is necessary. Permanence will be an asset, but rather a secondary one. Quality (2) 痰涂片检查 -technical competence: -training to acquire the necessary skill -sufficient frequency to maintain the skill -some kind of quality control system (supervision, quality testing) -decentralized structure (3) 痰涂片检查阳性者启动抗结核治疗 common situation: patients are diagnosed as PTB in the hospital and that treatment is started in the hospital. After 2 or 3 months these patients are referred back to the HC for further continuation of treatment. -the initiation of treatment can best be integrated in the package of activities of the same service (multipurpose and decentralized). （4）持续进行抗结核治疗 -maintaining continuity: accessibility (decentralized service) -other factors (social context and individual tendency): sex, age, literacy, degree of schooling. -identifying individual causes with the patients, by asking him why he is irregular. -search for solutions with patients -a capacity to listen and to hear things outside our own ‘professional’ logic - a capacity to ‘empathize’ 操作性分析（OA）(M.Piot’s Model) 1.定义 通过对卫生服务功能进行综合分析，构造模型识别实施特定健康问题干预时可能存在的问题。以定量分析为主。 2.方法 (1) 选