中医治疗脑卒中后抑郁症的最新临床进展

脑卒中后抑郁症为脑卒中后常见的并发症之一,给患者、家属及社会带来沉重负担。查阅近年来临床相关文献,并进行总结综述。表明中医治疗脑卒中后抑郁症具有多样疗法,且便于操作,疗效确切,无不良反应。依据临床相关研究,在今后研究发展上,提出了问题并指明了方向。     

赴尼医疗防疫救援队抗震救灾做法

总结由成都军区总医院为主体抽组的国家级医疗防疫救援队赴尼泊尔,建立创伤救治中心实施地震医学救援的任务特点和具体做法,并就情况研判、装备更新和预案研究等三个方面提出建议.     

先天性并指畸形治疗的回顾性分析

目的探讨先天性并指畸形的治疗体会,规范治疗方法,提高治愈率。方法对我院近两年收治的30例先天性并指畸形患者,采用游离植皮及皮瓣等6种手术方法进行分指。以掌背侧顺行推进皮瓣、掌背侧逆行岛状皮瓣、五角推进皮瓣、局部“V—Y—W”推进皮瓣及菱形皮瓣重建指蹼：以“Z”形和全厚皮片修复指体。结果本组24例总体治疗效果满意,其余6例行二次手术,其中植皮坏死3例,手指瘢痕屈曲挛缩2例,指蹼创面感染、继发瘢痕增生形成不全并指1例。结论并指的手术时机应选择在出生后6个月～2年,并指的手术设计应注重指蹼的重建,重建的方法应首选掌背侧顺行或逆行皮瓣转移术：指体修复应选择全厚皮片,以预防手指的屈曲挛缩。     

基于“温经散寒、补肾活血”治疗痛经验案1则

现如今,痛经已经严重影响各个年龄阶段女性的日常学习、常规工作和生活,广大患者迫切希望消除月经来潮前后及行经期间的痛苦。冯晓玲教授临床经验丰富,认为痛经之病因病机不外乎虚实两端,病位在冲任两脉及胞宫,以寒凝血瘀型多见。首辨虚实、次调气血以及标本同治为治疗痛经的3种特色辨治方法,针对寒凝血瘀型痛经,温经散寒,调和气血,治病求本,效如桴鼓,发挥了中医药治疗痛经的独特优势,临床疗效值得肯定。后附医案1则加以佐证。     

Bella and the white water rapids

Abstract

This article is an exploration of the feeling state engendered in the art psychotherapist when working with a child who had been emotionally and sexually abused. It attempts to discover the meaning of what happened in a therapy when no verbal or thinking interaction could initially take place. It describes the difficulty of finding a way to articulate the fragmented information available, both to bring to consciousness the snippets of memory presented, and to structure them into an organised story.

Thinking appeared to be what the child was desperate to avoid. It was far too painful for her, so anger and abuse were used as a defence. Noise was produced during therapy, so that the artwork, the games and in particular the experience of projective identification could not be thought about. The noise often led to the art psychotherapist being silenced and also unable to think.

Countertransference feelings were communicated, including shame, hatred, love and fear. These were explored to help find meaning, which led to understanding that the child needed to experience attachment to a constant and non-retaliatory Other. This made the experience of both merging and separation from the therapist an enabling space in which to find symbol and thought.     

Real-time elastography for the differentiation of benign and malignant superficial lymph nodes: a meta-analysis

Background

Real-time elastography (RTE), as a non-invasive method, is used for the classification of benign and malignant lymph nodes (LNs) and developed as an alternative to biopsy. Elasticity score (ES) and strain ratio (SR) are used for the interpretation of RTE. We studied the performance of RTE for diagnosis of malignant LNs using meta-analysis.

Methods

PubMed, the Cochrane Library, ISI Web of Knowledge, China National Knowledge Infrastructure were searched. The studies published in English or Chinese relating to the diagnostic value of RTE for superficial LNs were collected. Hierarchical summary receiver operating characteristic (HSROC) curve was used to examine the RTE accuracy. Clinical utility of RTE for LNs was evaluated by Fagan plot analysis.

Results

A total of 9 studies which included 835 LNs were analyzed. The summary sensitivity and specificity for the diagnosis of malignant LNs were 0.74 (95% confidence interval (CI), 0.66–0.81) and 0.90 (95% CI, 0.82–0.94) for ES, and 0.88 (95% CI, 0.79–0.93) and 0.81 (95% CI, 0.49–0.95) for SR, respectively. Compared to ES, SR obviously improved the diagnostic sensitivity value. The HSROCs were 0.88 for ES and 0.91 for SR, respectively. After RTE results over the cut-off value for malignant LNs (“positive” result), the corresponding post-test probability for the presence (if pre-test probability was 50%) was 88% for ES and 82% for SR, respectively; while, in “negative” measurement, the post-test probability was 22% and 13%, respectively.

Conclusion

RTE has a high accuracy in the classification of superficial LNs and can potentially help to select suspicious LNs for biopsy.     

Outcome measurement in functional somatic syndromes: SF-36 summary scores and some scales were not valid

Objective

This study aimed to test the validity of the 36-item Short-Form Health Survey (SF-36) scales and summaries in patients with severe functional somatic syndromes (FSS), such as fibromyalgia and irritable bowel syndrome.

Study Design and Setting

One hundred twenty patients with severe FSS enrolled in a randomized controlled trial filled in the SF-36 questionnaire. We tested for data quality, central scaling assumptions, and agreement with the conceptual model.

Results

Most SF-36 scales were found to be valid; however, three scales (role physical, role emotional, and general health) did not satisfy predefined criteria for construct validity, internal consistency, or targeting to the sample. The correlations between SF-36 scales differed considerably from those reported in the general population. As a consequence, the SF-36 summaries, physical component summary (PCS) and mental component summary (MCS), did not accurately reflect their underlying scales and were negatively correlated (r = −0.46, 95% CI [−0.60 to −0.31]).

Conclusion

Although the SF-36 is a valuable instrument to assess perceived health in patients with severe FSS, there are problems with some of the scales and with the scoring procedure of the summaries. The SF-36 PCS may, therefore, not accurately measure the physical health status of these patients. Alternative summary measures are needed.     

Implementing a breast cancer registry and treatment plan/summary program in clinical practice: A pilot program

BACKGROUND:

There is a need to better measure and improve the quality of oncology care and improve communication with patients and other providers. The American Society of Clinical Oncology Breast Cancer Registry (BCR) pilot evaluated the feasibility and acceptability of prospective data collection for quality assessment in daily clinical practice. Data were used to create and share treatment plans/summaries (TPSs) at the point of care.

METHODS:

Using a web‐based tool, 20 diverse practices entered clinical data on each new early‐stage breast cancer patient into the BCR for 14 months (September 2009 through November 2010). The tool created individual TPSs that were shared with patients. Practices received practice‐specific and aggregate BCR quality measures data, participated in a survey, and received a participation stipend.

RESULTS:

Twenty practices entered 2014 patients into the BCR, collecting demographic, clinical, and treatment information. Fifty‐two percent of practice participants replied to an end‐of‐pilot survey: 73% were satisfied with the BCR and web‐based tool, 31% expressed concern regarding time and effort, and 52% reported additional practice costs during the pilot. Among those who created or shared the TPSs, 90% thought the documents improved oncologist‐patient communication, and 95% favored using BCR data for practice quality improvement.

CONCLUSIONS:

Prospective data collection for quality assessment is feasible and allows sharing of TPSs with patients at the point of care. Future efforts should focus on decreasing implementation burden to practices, broadening participation, examining costs, and, most importantly, assessing its effects on patient outcomes. Cancer 2013. © 2012 American Cancer Society.     

Patient perspectives on breast cancer treatment plan and summary documents in community oncology care

BACKGROUND:

Although the routine use of treatment plans and summaries (TPSs) has been recommended to improve the quality of cancer care, limited data exist about their impact on quality, including patient satisfaction and coordination of care.

METHODS:

Patients received TPSs as part of the American Society of Clinical Oncology Breast Cancer Registry (BCR) pilot program of 20 community oncology practices. Participants were surveyed 2 to 4 weeks after receiving a TPS to evaluate their perceptions of the document. Patients who were receiving chemotherapy received the TPS as separate plan and summary documents (at the start and the end of treatment) and could complete 2 surveys. Others received a single integrated TPS. Eligible survey participants had stage 0 through III breast cancer and were enrolled in the BCR.

RESULTS:

Of 292 consented patients, 174 (60%) completed at least 1 survey. Of 157 patients who recalled receiving a TPS, 148 (94%) believed that the documents improved patient‐physician communication, and 128 (82%) believed that they improved communication between physicians; 113 (72%) said the documents increased their peace of mind, whereas 2 (1%) had less peace of mind. Of 152 patients (97%) who still had their documents, 147 (97%) said they were useful, and 94 (62%) had given or planned to give the documents to another physician. All 63 patients who were surveyed after receiving a summary recommended that practices continue to provide TPSs to patients.

CONCLUSIONS:

Participants in this study expressed high satisfaction with TPSs. Additional research is needed to study the broad‐scale implementation of the BCR and to evaluate the impact of routine use of TPSs on the quality of care delivered. Cancer 2013. © 2012 American Cancer Society.     

慢性阻塞性肺疾病肺气虚证重点研究室建设经验总结

国家中医药管理局慢性阻塞性肺疾病肺气虚证重点研究室自建设以来,制定研究目标,凝练研究方向,重视团队建设,加强人才培养,注重理论创新,临床实验结合,获得多项国家级重大科研课题,延伸开展肺气虚证相关病证的基础及有效方药开发研究,获得多项重要研究成果,为对肺气虚证做了比较全面系统的研究,肺气虚证的更深入研究奠定了基础,为肺系病证的研究起到带动和示范作用。