全国三级医院专家和北京市海淀区社区专家对中国高血压指南认识的调查分析

目的评估全国三级医院专家和社区专家对高血压指南认知和执行的差异。方法采取抽样法选择全国三级医院高血压专业44名专家(三级医院专家组),北京市海淀区社区卫生服务中心全科医学专家29名(社区专家组)。参照2018年中国高血压防治指南和2019年高血压基层诊疗指南初步建立评估问卷,对问卷中血压监测、危险因素、靶器官损害三部分内容进行评分。比较三级医院专家与社区专家对高血压指南认识的重要性和可行性的差异。结果三级医院专家组通过手机APP督促家庭自测血压和初诊动态血压比例的可行性评估明显低于社区专家组(75.0%vs 93.1%,P=0.048;81.8%vs 100.0%,P=0.040)。三级医院专家组初诊、叶酸干预后复查和每年复查同型半胱氨酸的重要性评估明显低于社区专家组,每年复查同型半胱氨酸比例的可行性评估明显低于社区专家组,差异有统计学意义(P<0.05,P<0.01)。三级医院专家组初诊颈动脉超声、混合斑或软斑治疗后复查、初诊超声心动图、左心室肥厚每年复查及心肌梗死和心力衰竭根据需要调整检查比例的可行性评估明显低于社区专家组,差异有统计学意义(P<0.05)。结论三级医院专家和社区专家对高血压指南认知和执行在某些指标上存在不同,希望通过培训和临床实践缩小差异,进一步提升血压管理水平。

急诊社区获得性肺炎患者的快速诊断——解读《急诊成人社区获得性肺炎诊治专家共识》

急性呼吸道感染是患者至急诊就诊的首位病因,其死亡率在感染性疾病中居首位.无论在发达国家还是发展中国家,社区获得性肺炎（community acquired pneumonia, CAP）都是导致死亡的重要原因之一,而CAP患者是急诊留观、急诊住院和ICU收治的主要对象,占了急诊医疗资源的很大部分,因此,急诊医师必须予以足够的重视.

医务专家进社区卫生服务的主题定位质疑及其策略调整

目前全国普遍采取医务专家进社区服务,这是社区卫生服务发展的难得机遇。但这个措施的定位如今大多数都局限于社区卫生机构的支援性医疗服务,这不但难以完全发挥其应有的积极作用,而且有悖社区卫生服务的"六位一体"全面主题,可能误导加重传统"重医疗、轻预防"在社区卫生服务中的影响。对此极有必要作策略调整,即把专家只在社区卫生机构的支援性医疗服务转向整个社区所有居民"六位一体"的主体性研究服务。

学习:城市社区治理中知识的沟通与交流

21世纪初由国家主导的社区建设运动,激发了中国城市社区大量的治理实践,也使社区治理领域呈现出"双重碎片化"特征。基于S市三个社区的田野调查,尝试从学习的视角提出一个反思性研究框架,通过参与观察和半结构式访谈等研究方法,分析社区三类专家以及各自所拥有的知识类型与局限,探讨目前城市社区产生碎片化特征的原因。研究发现,当前社区治理的困境在于各类专家所拥有的知识在迅速扩张与分化的同时,知识间的协同更新却较为缓慢,亦即纵向知识的高度积累由于横向学习机制的缺乏,难以形成知识的实质进步。各类专家所掌握的知识无法使社区治理受益,反而可能形成逆向的负效应。社区治理困境的解决依赖于社区专家集体学习能力的提高,而不是依靠某一类专家单方面的知识累积。

基于主题图构建知识专家学术社区研究

针对目前分众分类法的缺陷,提出主题图Topic Maps这一解决策略,并对国外主题图驱动的标签网站Fuzzzy进行分析,在此基础上提出基于主题图构建知识专家学术社区的原型。知识专家学术社区是学科专家和学者进行学术交流、知识共享的虚拟社区,通过这一网络平台可以将知识个体融入到社会当中,实现学术研究过程的协同和合作,解决目前学术人员的信息交流和知识共享相对滞后的问题,促进知识的创新。

Policy implications for community-managed forestry in Cambodia from experts＇ assessments and case studies of community forestry practice

Over the last 40 years, it has been shown at the global level that sustainable forestry can be achieved through comprehensive forest management,with the decentralized institutional arrangements of community-managed forestry coordinated by effective policy implementation. However, there is still a shortage of evidence regarding whether communitybased forestry is well characterized by forest policies,assessing what action is most needed and how best to address the challenges faced by community-based forestry in halting deforestation and promoting rural livelihoods. The study analyzed experts' assessments of the characteristics and success of communitymanaged forestry in Cambodia and explored three case studies of community-managed forestry practice to identify priorities for addressing forest policy implementation inadequacies in halting deforestation and promoting rural livelihoods. There were two methods of data collection. Firstly, this study used a survey of 27 experts to analyze perceptions about how far forest policy supported community-managed forestry effectively, the major challenges faced by the national community-managed forestry program, and the community-managed forestry contribution to halting deforestation and reducing rural poverty.Secondly, data was collected by content analysis of three case studies to explore the knowledge and practical experience of local experts about community-managed forestry practice at local level.The study employed Kendall's Coefficient of Concordance to analyze the level of concordance of experts on related forest policies(n=15) considering community-managed forestry, the challenges faced by the national community-managed forestry program,and the actions required to enable communitymanaged forestry to support communities. Analysis revealed that experts were in moderate agreement,denoted by Kendall's W=0.152, on how well forest policies articulate and implement the characteristics of community-managed forestry. Ranking of the major challenges faced by the national communitymanaged forestry program yielded Kendall's W of0.104, indicating the confidence in the ranking among experts was fair. There was only low confidence in the ranking of the action needed, with Kendall's W of0.055. Content analysis of the three case studies examining local experts' opinions on the attributes of community-managed forestry concerning the access,local participation and protection of the sustainable forestry revealed that Attribute one ‘Local people have access to the forest land and forest resources', and Attribute three ‘Local people begin by protecting and restoring the forests', received high attention from local experts. Of lesser importance or agreement was attributing two: local participation in decision-making concerning the forest.

解读社会热点难点、推动社科知识普及——绵阳市社科联组织专家参加“文明社区建设专家论坛”

为了提高市民的科学文化素质，提升绵阳文明水平，力争绵阳明年首批进人全国文明城市的行列。在绵阳市社科联的大力支持下，中共涪城区委党校、区文明办、《文明社区建设》编辑室从3月开始联合开办了“