醫(yī)學(xué)交流課件：3 如何制定一個(gè)心臟康復(fù)方案-心臟康復(fù)方案的核心內(nèi)容

1、How to set up a Cardiac Rehabilitation (CR) program core components of CR 如何如何制定制定一個(gè)心臟康復(fù)一個(gè)心臟康復(fù)方案方案- -心臟康復(fù)方案的核心內(nèi)容心臟康復(fù)方案的核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 CR how to set up 心臟康復(fù)心臟康復(fù) - - 如何設(shè)立如何設(shè)立 CR can easily be added to any exi

2、sting cardiovascular department or a clinic for internal medicine as an outpatient / ambulatory department 心臟康復(fù)心臟康復(fù)可以很容易地可以很容易地被添加進(jìn)任何現(xiàn)有的心血管科室或內(nèi)科診所中作為 門診/非住院型科室 Most important before !: 開始前最重要！開始前最重要！ several future partners such as colleagues, faculty members, hospital directors and referring doctor

3、s have to be convinced that such a CR program is needed, effective and affordable 必需說服未來的合作伙伴未來的合作伙伴例如：同事、教職工、醫(yī)院主任和顧問醫(yī)師等， 心臟康復(fù)心臟康復(fù)方案方案是被需要是被需要的的、有效用、有效用的而且可以被的而且可以被負(fù)擔(dān)負(fù)擔(dān)得得起起的的。 Saner 2010 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 CR how to

4、 set up 心臟康復(fù)心臟康復(fù) - - 如何設(shè)立如何設(shè)立 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 CR how to set up 心臟康復(fù)心臟康復(fù) - - 如何設(shè)立如何設(shè)立 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 CR how to set up 心臟康復(fù)心臟

5、康復(fù) - - 如何設(shè)立如何設(shè)立 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Team 團(tuán)隊(duì)團(tuán)隊(duì) Location 地址地址 Program 方案方案 Finances 財(cái)政財(cái)政 Promotion 推廣推廣 Evaluation 評(píng)估評(píng)估 Quality control 質(zhì)量控制質(zhì)量控制 Saner, CR workshops by EACPR, 2010 CR how to set up 心臟康復(fù)心臟康復(fù) - - 如何設(shè)立如何設(shè)立

6、 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Essential Staff 核心職員核心職員 physician* / cardiologist* 醫(yī)師*/心臟病學(xué)家* physiotherapist 物理治療師 dietician 營養(yǎng)學(xué)家 Secretary 秘書 * in Germany mandatory by health providers and also in some European Countries ful

7、ltime employed 德國醫(yī)療服務(wù)提供方必須將以上職位設(shè)為 全職崗位，一些歐洲國家也有相同要求。 Optional Staff 選配職員選配職員 psychologist 心理學(xué)家 sports scientist 運(yùn)動(dòng)科學(xué)家 stress / Relaxation - specialist 壓力/放松 - 專家 smoking cessation specialist 戒煙專家 social worker 社工 researcher 研究員 CR how to set up 心臟康復(fù)心臟康復(fù) - - 如何設(shè)立如何設(shè)立 Folientitel 11 pt CR how to set u

8、p a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Locations 地址地址 gymnasium 體育館 fitness centre 健身中心 teaching room(s) 課堂 (out- and indoor) areas for walking, hiking, cycling 步行、徒步、騎自行車的（室內(nèi)和室外）區(qū)域 heated Pool (add.)*fuj 溫水池（附加） sauna (add.)* 桑拿 （附加） * higher energy costs 更高的能量消耗 CR

9、how to set up 心臟康復(fù)心臟康復(fù) - - 如何設(shè)立如何設(shè)立 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Equipment 設(shè)備設(shè)備 12-canal ECG 12導(dǎo)聯(lián)心電圖 cycle- or treadmill-ergometer 功率車或跑臺(tái)-測功儀 Doppler-echocardiography, abdominal and vessel-ultrasound (Doppler / Duplex), 多普勒超聲

10、心動(dòng)圖 、腹部和血管超聲（多普勒/雙功多普勒） emergency equipment and room 急救設(shè)備和急救室 chest X-ray (optional) 胸部X光（選配） CR how to set up 心臟康復(fù)心臟康復(fù) - - 如何設(shè)立如何設(shè)立 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 program minimal 方案方案- 最低限度最低限度 regular basic program 常規(guī)基礎(chǔ)常規(guī)基礎(chǔ)方案

11、方案 out-patient phase II 8 - 12 weeks, 2-3 x per week 門診階段II 8-12周，每周2-3天 in-patient phase II 3 - 4 weeks, 5-5 days per week 住院階段II 3-4周，每周5-5.5天 program intensity 方案方案強(qiáng)度強(qiáng)度 two (or more depending on number of patients) different intensity levels 2個(gè)不同的強(qiáng)度水平（或者根據(jù)患者數(shù)量增加） CR how to set up 心臟康復(fù)心臟康復(fù) - - 如何設(shè)

12、立如何設(shè)立 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Program optional (concept currently in work) 方案方案-可可選選 （理念正在研（理念正在研發(fā)發(fā)中）中） PAD (peripheral artery disease) 外周動(dòng)脈疾病外周動(dòng)脈疾病 reduced walking distance (with pain) 步行距離縮短（有痛感） multiple / more risk f

13、actors 多個(gè)/更多風(fēng)險(xiǎn)因素 (evtl. less) motivated 缺乏動(dòng)力（或較少） different exercise patterns 不同的運(yùn)動(dòng)模型 “sicker” patients 病情更嚴(yán)重的患者 Drr, Westphal, Marx, Nebel, unpublished (DGPR working group 2017) CR how to set up 心臟康復(fù)心臟康復(fù) - - 如何設(shè)立如何設(shè)立 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel Si

14、egRehaSeptember. 2017 Program optional 方案方案- -可選可選 CHF (chronic heart failure) HF-REF ( HF-PEF) 慢慢性心力衰竭性心力衰竭射血分?jǐn)?shù)下降心力衰竭射血分?jǐn)?shù)下降心力衰竭（正常射血分?jǐn)?shù)心力衰竭）正常射血分?jǐn)?shù)心力衰竭） (severe) reduced left ventricular function （嚴(yán)重）左心室功能減退 ICD / CRT - devices 除顫器/起搏器 - 裝置 intensive monitoring needed 需要密切監(jiān)控 intensive medical treatme

15、nt incl. medication 集中醫(yī)學(xué)治療，包括藥物 long-term follow up 長期隨訪 CR how to set up 心臟康復(fù)心臟康復(fù) - - 如何設(shè)立如何設(shè)立 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 CR how to set up - core components 心臟康復(fù)心臟康復(fù)- -如何設(shè)立如何設(shè)立- -核心內(nèi)容核心內(nèi)容 Piepoli et al 2010 通過心臟康復(fù)來進(jìn)行二級(jí)預(yù)防：從

16、理論知識(shí)到實(shí)施。通過心臟康復(fù)來進(jìn)行二級(jí)預(yù)防：從理論知識(shí)到實(shí)施。 歐洲心血管疾病預(yù)防和康復(fù)協(xié)會(huì)心臟康復(fù)方面的意見書。歐洲心血管疾病預(yù)防和康復(fù)協(xié)會(huì)心臟康復(fù)方面的意見書。 歐洲心臟病學(xué)會(huì)歐洲心臟病學(xué)會(huì) Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Piepoli et al 2016 2016 2016 歐洲心血管疾病預(yù)防臨床實(shí)踐指南歐洲心血管疾病預(yù)防臨床實(shí)踐指南 CR how to set up - core components 心臟康

17、復(fù)心臟康復(fù)- -如何設(shè)立如何設(shè)立- -核心內(nèi)容核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 CR professions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Physician - Patient assessment Physical activity counselling with Sports scientist 醫(yī)師 - 評(píng)估 體育活動(dòng) - 咨詢運(yùn)動(dòng)科學(xué)家

18、 Sports scientist / Physiotherapist - Exercise training (ET) 運(yùn)動(dòng)科學(xué)家/物理理療師 - 運(yùn)動(dòng)訓(xùn)練(ET) Dietician - Diet and nutritional counselling 營養(yǎng)學(xué)家- 飲食和營養(yǎng)咨詢 Nurse - general assessments, wound management, ECG, stress testing (ergometer) 護(hù)士 - 總體評(píng)價(jià)， 傷口管理， 心電圖，運(yùn)動(dòng)負(fù)荷測試 （測功計(jì)） Nurse - Weight and blood pressure (BP) monit

19、oring 護(hù)士 - 體重和血壓監(jiān)控 Nurse / Physician - Medication, risk factor management 護(hù)士/醫(yī)師 - 藥物，風(fēng)險(xiǎn)因素管理 Psychologist - Smoking cessation 心理學(xué)家 - 戒煙 Psychologist / Social worker - Psychosocial management 心理學(xué)家/社工 - 社會(huì)心理管理 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSepte

20、mber. 2017 Physician - Patient assessment 醫(yī)師 - 醫(yī)師評(píng)估 Physical activity counselling Sports scientist / Physiotherapist - Exercise training (ET) Dietician - Diet and nutritional counselling Nurse - Weight control management Nurse / Physician - Lipid management Nurse - Blood pressure (BP) monitoring Psy

21、chologist - Smoking cessation Psychologist / Social worker - Psychosocial management CR professions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Physician - Patient assessment 醫(yī)師 - 評(píng)估 Clinical

22、history: CV risk factors, co-morbidities, disabilities 臨床病史：臨床病史： 心血管危險(xiǎn)因素，合并癥，殘疾 Symptoms of CV disease: NYHA class, A.p. CCS class, rhythm 心血管疾病癥狀：心血管疾病癥狀： NYHA分級(jí)，分級(jí)，A.p. CCS分級(jí)，節(jié)律 adherence to medication low salt foods; 品類繁多的食物；低鹽食物； “mediterranean” diet: vegetables, fruits, wholegrain cereals and

23、bread, fish (especially oily), lean meat, low fat dairy products “地中?！憋嬍常菏卟?、水果、全谷物麥片和面包、魚（尤其是富含油的）、瘦肉、 低脂奶制品 CR professions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Dietician - Diet and nut

24、ritional counselling II 營養(yǎng)學(xué)家- 飲食和營養(yǎng)咨詢II Replace saturated fat with the above foods and with monounsaturated and polyunsaturated fats from vegetable (oleic acid/olive oil and rapeseed oil) and marine sources to reduce total fat to less than 30% of energy, of which less than 1/3 is saturated 用上面提到的食物和

25、植物及海魚中所含的單不飽和脂肪和多不飽和脂肪代替飽和脂肪。 將脂肪總量減少到總攝入能量的30%以下，其中不到1 / 3是飽和脂肪。 Avoid: 避免避免 overweight, particularly beverages and foods with added sugars and salty food 超重，尤其是有添加糖的飲料和食物，以及咸食。 Goal: 510% loss of of body weight and modification of associated risk factors 目標(biāo)：目標(biāo)：降低降低5-10%5-10%的體重的體重，以及相關(guān)風(fēng)險(xiǎn)因素的改變。 CR

26、professions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 CR professions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland

27、 Nebel SiegRehaSeptember. 2017 Physician - Patient assessment Physical activity counselling Sports scientist / Physiotherapist - Exercise training (ET) Dietician - Diet and nutritional counselling Nurse - Weight control management 護(hù)士 - 體重控制管理 Nurse / Physician - Lipid management Nurse - Blood pressu

28、re (BP) monitoring Psychologist - Smoking cessation Psychologist / Social worker - Psychosocial management CR professions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Nurse - Weight control man

29、agement 護(hù)士 - 體重控制管理 Weight reduction recommended in obese patients: 建議肥胖患者減重減重 BMI 30 or waist circumference 102* cm in men 88* cm in women) 身體質(zhì)量指數(shù)30或男性腰圍102，女性腰圍 should be considered in overweight patients (BMI 25 or waist circumference 94* cm in men or 80* cm in women) esp. if associated with mult

30、iple RF (such as hypertension, hyperlipidaemia, smoking, insulin resistance or diabetes) 身體質(zhì)量指數(shù)或男性腰圍cm或女性腰圍，應(yīng)被視為超重 ，尤其是與多種風(fēng)險(xiǎn)因素有關(guān)的（如高血壓、高血脂、抽煙、抗胰島素性或糖尿 病） (*kaukasian / european standard meausures) （白人歐洲標(biāo)準(zhǔn)測量） Goal: 目目標(biāo)標(biāo)： ： 510% reduction of body weight / year and modification of associated risk facto

31、rs 每年降低的體重和相關(guān)風(fēng)險(xiǎn)因素的改變 CR professions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Physician - Patient assessment Physical activity counselling Sports scientist / Physiotherapist - Exercise train

32、ing (ET) Dietician - Diet and nutritional counselling Nurse - Weight control management Nurse / Physician - Lipid management 護(hù)士醫(yī)師脂質(zhì)管理 Nurse - Blood pressure (BP) monitoring Psychologist - Smoking cessation Psychologist / Social worker - Psychosocial management CR professions and core components 心臟康復(fù)

33、心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Nurse / Physician - Lipid management 護(hù)士醫(yī)師脂質(zhì)管理 Assess lipid profile 血脂分析評(píng)估血脂分析評(píng)估 Modify diet, physical activity, medication if appropriate 在適當(dāng)情況下改變飲食、體育活動(dòng)和用藥 Primary goal: 主

34、要目標(biāo) LDL-C 100 mg/dl (2.5 mmol/l), option of 70 - 80 mg/dl (2.0 mmol/l) if feasible, particularly if associated with multiple RFs 低密度脂蛋白膽固醇 100 mg/dl (2.5 mmol/l)，如果可行使其 40 mg/dl (1.0 mmol/l) in men and 45 mg/dl (1.2 mmol/l) in women; 男性高密度脂蛋白膽固醇水平 40 mg/dl (1.0 mmol/l)，女性 45 mg/dl (1.2 mmol/l) total

35、 cholesterol level less than 175 mg/dl, option of 155 mg/dl if feasible 總膽固醇水平低于175 mg/dl，如果可行使之 155 mg/dl fasting triglyceride level 150 mg/dl (1.7 mmol/l) 空腹甘油三酯 150 mg/dl (1.7 mmol/l) CR professions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehab

36、ilitation centre Roland Nebel SiegRehaSeptember. 2017 Physician - Patient assessment Physical activity counselling Sports scientist / Physiotherapist - Exercise training (ET) Dietician - Diet and nutritional counselling Nurse - Weight control management Nurse / Physician - Lipid management Nurse - B

37、lood pressure (BP) monitoring 護(hù)士血壓監(jiān)控 Psychologist - Smoking cessation Psychologist / Social worker - Psychosocial management CR professions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Nurse -

38、Blood pressure (BP) monitoring / encourage self monitoring ! 護(hù)士 - 血壓監(jiān)控 / 鼓勵(lì)自我監(jiān)控 Measure BP frequently at rest 休息時(shí)頻繁測量血壓休息時(shí)頻繁測量血壓 during exercise BP should be monitored if hypertension on effort is suspected 如果懷疑患者有努力情況下的高血壓，運(yùn)動(dòng)時(shí)應(yīng)監(jiān)測血壓 resting systolic BP 130139 or diastolic BP 8589 mmHg: 靜息收縮壓 130-139

39、 或靜息舒張壓 85-89 毫米汞柱 life-style modifications, exercise, weight management, sodium restriction, and moderation of alcohol intake (i.e., 30 g/day in men and 140 or diastolic BP 90 mmHg 靜息收縮壓140 或 靜息舒張壓 90 毫米汞柱 initiate drug therapy 開始藥物治療 Goals: BP 140/90 mmHg (or 135/85 mmHg with self-measurement or H

40、olter-RR (24 hours) 目標(biāo)：目標(biāo)： 血壓血壓 140/90 mmHg (或者通過自測或或者通過自測或 Holter-RR（24小時(shí)）小時(shí)） 135/85 mmHg） CR professions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Physician - Patient assessment Physical a

41、ctivity counselling Sports scientist / Physiotherapist - Exercise training (ET) Dietician - Diet and nutritional counselling Nurse - Weight control management Nurse / Physician - Lipid management Nurse - Blood pressure (BP) monitoring Psychologist - Smoking cessation 心理學(xué)家-戒煙 Psychologist / Social wo

42、rker - Psychosocial management CR professions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Psychologist - Smoking cessation I 心理學(xué)家 - 戒煙 I All smokers should be professionally encouraged to perm

43、anently stop smoking all forms of tobacco 應(yīng)該從專業(yè)的角度鼓勵(lì)所有煙民永遠(yuǎn)戒絕吸食所有形式的煙草 Special programs and/or pharmacotherapy (including nicotine replacement) recommended 建議使用特別方案和/或藥物療法（包括尼古丁替代療法） Assess smoking status, use of other tobacco products 評(píng)估吸煙狀態(tài)以及其他煙草制品的使用情況 Specify both amount of smoking (cigarettes pe

44、r day) and duration of smoking (number of years), “pack-years” 明確吸煙量（每天抽多少支煙）和煙齡（共抽煙多少年），以及“吸煙指數(shù) ”。 CR professions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Psychologist - Smoking cessation

45、II 心理學(xué)家 - 戒煙 II Determine readiness to change 明確改變的意愿 if ready, choose a date for quitting 如果已經(jīng)準(zhǔn)備好，選一個(gè)開始戒煙的日期 Assess for psychosocial factors that may impede success 評(píng)估可能阻礙戒煙成功的心理因素 Intervention: provide structured follow-up (Germany: 2 3 months), behavioural advice and group or individual counselli

46、ng 介入：提供有組織的回訪（德國：2-3個(gè)月）、行為建議、團(tuán)體或個(gè)人咨詢 Offer nicotine replacement therapy, varenicline, or both 提供尼古丁替代療法、伐尼克蘭，或兩者皆有 Goal: Long-term abstinence from smoking 目標(biāo)：長期戒煙目標(biāo)：長期戒煙 CR professions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre

47、 Roland Nebel SiegRehaSeptember. 2017 Physician - Patient assessment Physical activity counselling Sports scientist / Physiotherapist - Exercise training (ET) Dietician - Diet and nutritional counselling Nurse - Weight control management Nurse / Physician - Lipid management Nurse - Blood pressure (B

48、P) monitoring Psychologist - Smoking cessation Psychologist / Social worker - Psychosocial management 心理學(xué)家心理學(xué)家/ /社工社工 - - 心理社會(huì)管理心理社會(huì)管理 CR professions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 201

49、7 Psychologist / Social worker - Psychosocial management I 心理學(xué)家心理學(xué)家/ /社工社工 - 心理社會(huì)管理心理社會(huì)管理 Screen for psychological distress as indicated by clinically significant levels of depression, anxiety, anger or hostility, social isolation, marital/family distress, sexual dysfunction/adjustment, and substanc

50、e abuse of alcohol and/or other psychotropic agents 心理困擾心理困擾的篩查，如臨床意義上的抑郁、焦慮、憤怒或敵意、社會(huì)孤立 、婚姻/家庭痛苦、性功能障礙/性調(diào)節(jié)、酒精和/或其他精神藥物濫用 Use interview and/or other standardized measurement tools 使用訪談使用訪談和/或其他標(biāo)準(zhǔn)測量工具標(biāo)準(zhǔn)測量工具 CR professions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set

51、up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Psychologist / Social worker - Psychosocial management II 心理學(xué)家心理學(xué)家/ /社工社工 - - 心理社會(huì)管理心理社會(huì)管理 Intervention: 介入：介入： individual and/or small group education and counselling on adjustment to heart disease, stress management, and healt

52、h-related lifestyle change (profession, car driving and sex activities resumption) 關(guān)于心臟病調(diào)整、壓力管理、健康相關(guān)生活方式調(diào)整（專業(yè)、汽車駕駛和性活動(dòng)恢 復(fù)）方面的個(gè)人和個(gè)人和/ /或小團(tuán)體教育和咨詢或小團(tuán)體教育和咨詢 Whenever possible, induce spouses and other family members, domestic partners, and/or significant others: 只要可能，就讓伴侶和其他家庭成員、家庭伴侶和/或其他重要人員參與進(jìn)來 self-h

53、elp strategies, ability to obtain social support 自助策略、獲得社會(huì)支持的能力 vocational counselling in case of work related stress 職業(yè)輔導(dǎo)，在遇到工作相關(guān)壓力的時(shí)候 Goal: Absence of clinically significant psychosocial problems, acquisition of stress management skills 目標(biāo)：不出現(xiàn)臨床意義上的顯著心理問題，獲得壓力管控的技能目標(biāo)：不出現(xiàn)臨床意義上的顯著心理問題，獲得壓力管控的技能 CR p

54、rofessions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Physician - Patient assessment Physical activity counselling Sports scientist / Physiotherapist - Exercise training (ET) Dietician - Diet

55、 and nutritional counselling Nurse - Weight control management Nurse / Physician - Lipid management Nurse - Blood pressure (BP) monitoring Psychologist - Smoking cessation Psychologist / Social worker - Psychosocial management 心理學(xué)家心理學(xué)家/ /社工社工 - - 心理社會(huì)管理心理社會(huì)管理 CR professions and core components 心臟康復(fù)心

56、臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation centre Roland Nebel SiegRehaSeptember. 2017 Psychologist / Social worker - Psychosocial management III 心理學(xué)家心理學(xué)家/ /社工社工 - - 心理社會(huì)管理心理社會(huì)管理 Screen for work related distress and work caused diseases as for barriers for ret

57、urn to work (RTW) 篩查成為重返工作崗位(RTW)障礙的工作壓力和職業(yè)病 Whenever possible, include company doctor, labour unionist and employer(s) - if accepted, family doctor: 只要可能，就讓公司醫(yī)生、工會(huì)會(huì)員和雇主參與進(jìn)來- 如果能接受，還有家庭醫(yī)生： inspection of workplace, propose modification of workplace, intensity and organisation of work if necessary, as

58、sess functional capacity, consider vocational rehabilitation program 檢查工作場所檢查工作場所，如有必要，建議建議改變改變工作場所、強(qiáng)度和工作結(jié)構(gòu)，評(píng)估功能性能力 ，考慮職業(yè)康復(fù)計(jì)劃 possible support by company and/or social security system if feasible 如果可行，由公司和/或社會(huì)保障體系提供可能的支持 Goals: unrestricted or modified / supported / gradual RTW, esp. prevent unemployment 目標(biāo)：目標(biāo)： 不受限制的或已改變的不受限制的或已改變的/ /有支持的有支持的/ /逐漸的重返工作崗位，尤其預(yù)防失業(yè)情況的發(fā)逐漸的重返工作崗位，尤其預(yù)防失業(yè)情況的發(fā) 生生 CR professions and core components 心臟康復(fù)心臟康復(fù) - - 專業(yè)和核心內(nèi)容專業(yè)和核心內(nèi)容 Folientitel 11 pt CR how to set up a cardiac rehabilitation cen