Effect of Maximal Oxygen Pulse on Patients with Chronic Obstructive Pulmonary Disease

Objective This study evaluated the effect of maximal oxygen pulse(O_(2)P_(max))on patients with chronic obstructive pulmonary disease(COPD)and confirmed the predictive effect on acute exacerbations of COPD(AECOPD).Methods This retrospective study included 91 participants who underwent cardiopulmonary exercise testing(CPET),lung function testing,a dyspnea scale assessment,and a 3-year follow-up.The participants were divided into two groups according to the O_(2)P_(max)value.Exercise capacity,ventilatory conditions,gas exchange efficiency,and dyspnea symptoms were compared,and the correlations between O_(2)P_(max)and these indices were evaluated.The ability of O_(2)P_(max)to predict AECOPD was examined.Results Exercise capacity,ventilatory conditions,and gas exchange efficiency were lower,and dyspnea symptom scores were higher in the impaired O_(2)P_(max)group(P<0.05).O_(2)P_(max)was positively correlated with forced vital capacity(FVC)%,forced expiratory volume in 1 sec(FEV_(1))%,FEV_(1)/FVC%,anaerobic threshold(AT),work rate(WR)%,aximal oxygen uptake(VO_(2))%,VO_(2)/kg_(max),VO_(2)/kg_(max)%,WR_(AT),WR_(max),VO_(2AT),VO_(2max),and V,and was negatively correlated with EqCO_(2AT),and EqCO_(2max)(P<0.05).Most importantly,O_(2)P_(max)could be used to predict AECOPD,and the best cut-off value was 89.5%(area under the curve,0.739;95%CI,0.609–0.869).Conclusion O_(2)P_(max)reflected exercise capacity,ventilation capacity,gas exchange capacity,and dyspnea symptoms in patients with COPD and may be an independent predictor of AECOPD.

隶属关系视角下村级卫生组织治理模式探析

目的探究村级卫生组织在不同时期的隶属关系,为家庭医生政策的推行、基层卫生治理体系建设提供理论参考。方法采取文献及政策文件研究、案例分析方法,结合村级卫生组织的地方治理经验,梳理不同时期村级卫生组织的隶属关系。结果村级卫生组织的治理模式因农村经济基础的变化和地区差异存在不同,理论上在政府和乡镇卫生院两大治理主体下,可存在多种治理模式,但是不同的模式各有弊端,诸如跨领域管理、效率低下、利益对立等。结论针对村级卫生组织隶属关系和治理现状,在构建基层卫生治理体系目标下,紧密型乡村一体化、乡村医生职业化以及乡村医生协会的建立,为村级卫生组织治理提供了新的视角。