小儿咳嗽变异型哮喘不同疗法与预后

目的:探讨小儿咳嗽变异型哮喘(CVA)的疗法与预后。方法:CVA患儿79倒随机分成A组(吸入糖皮质激素组).B组(口服氨茶碱和扑尔敏组)、C组(口服沙丁胺醇和酮替芬组)、D组(对照组)。A组予丙酸倍氯米松定量气雾剂吸入,每次100μg,每日2次。B组给予氨茶碱片每次4-5mg/kg,每日3次;扑尔敏每天0.35mg/kg,分3-4次。C组给予沙丁胺醇,每次0.1m/kg,每日2-3次,咳嗽消失后2周停药,酮替芬<3岁每次0.5mg,≥3岁每次1mg,每日均为2次。D组给予止咳、祛痰、抗感染等治疗。各组疗程均为6个月。随访时间半年至4年7个月。结果:用药2周有效率A、B、C组间无显著性差异(P>0.05),但均明显优于D组(P<0.01)。CVA复发率A组(20%)低于B组(45%),但两者在统计学上无显著性差异(P>0.05),可能与样本小有关,A组与C组及D组有显著性差异(P<0.05).B组与C组无显著性差异(P>0.05)。CVA转化为哮喘发生率A组低于B组及C组(P<0.05),明显低于D组(P<0.01)。B组与C组无显著性差异(P>0.05)。药物副作用发生率A、B、C组间无显著性差异(P>0.05)。结论:吸入糖皮质激素、口服氨茶碱和扑尔敏、口服沙丁胺醇和酮替芬对控制CVA对咳嗽症状均有较好疗效,但对预防CVA复发、CVA转化为哮喘,吸入糖皮质激素疗效优于氨茶碱和扑尔敏、沙丁胺醇和酮替芬。     

美国各州对针灸师惩戒制度的立法介绍：以俄亥俄州等12州为例

以有代表性的美国俄亥俄州、伊利诺伊州等12州为例,介绍相对成熟的美国针灸师惩戒制度。惩戒制度主要涵盖实施主体、违法行为种类、责任形式和听证程序等内容。美国大多数州由针灸行业协会组织承担惩戒职能,在惩戒程序启动后,依据各州针灸法案规定的针灸师违法行为类型,视其具体违法情形采取相应的处罚措施。听证程序为针灸师后续的维权活动提供程序保障。     

土耳其中医针灸发展概况

介绍针灸疗法在土耳其的发展历史以及针灸教育、立法、治疗的发展现状等情况。土耳其针灸发展概括有4个显著特点:①作为横跨欧亚两大洲的地区,在传承与发展针灸方面,既有东方国家的传统针灸的成份,也带有欧洲改良的现代针灸的成份;②从针灸传入开始,就趋于理论与临床的结合;③从民间自发传播应用针灸行为到政府层面的立法,其针灸逐渐从无序到有序,从市场行为到政府主导,有力地促进了针灸正规发展;④正规大学参与针灸的教学,大大提升了该国针灸传播与应用的科学性和规范性,更提高了针灸从业人员的素质,增加了民众的可信度,也为针灸的后续发展初步奠定了人才基础。     

西方式针灸的国际传播特点分析与思考

随着中医针灸在西方传播, 西方世界对针灸的研究不断深入, 逐渐形成了西方式针灸的概念。西方式针灸可分为西方国家持续传承与创新发展的中国式针灸、结合西方文明知识体系的西医针灸(如干针疗法、电针疗法), 以及在西方国家重新阐发的基于中国古代传统的古典式针灸(如法国时空针灸、英国五行针灸)。通过考察中医针灸在西方本土化的发展情况, 介绍几种西方式针灸的发展历史及知识体系, 提出西方式针灸通过医院诊所、学术著作、社会组织和教育培训等途径在世界范围传播推广。加强对西方式针灸的关注, 可为国内针灸发展提供世界视野, 促进世界针灸体系的学术繁荣和技术进步。     

《针灸临床实践指南》国际需求的调查:一项横断面研究

ObjectiveThis study aims to get the medical management of acupuncture and moxibustion in the countries and regions where the society members of World Federation of Acupuncture-Moxibustion Societies (WFAS) are located, including the educational background of acupuncture and moxibustion practitioners and the local clinical practice of acupuncture and moxibustion, and the demands of the content and evidence types of Clinical Practice Guidelines (CPGs) of acupuncture and moxibustion in accordance with WFAS standards, so as to provide requirements and reference principles for the development of CPGs of acupuncture and moxibustion in accordance with WFAS standards.MethodsThe convenient sampling method was used to collect the questionnaires, and the WFAS secretariat distributed the questionnaires to 294 contacts of society members from 70 countries and regions in the form of Questionnaire Star four times in April 2020, July 2020, March 2021, and April 2021 respectively. They were then distributed to individual members of acupuncture-moxibustion societies by the contacts. The study content involved the basic information of respondents, including their nationality, occupation, educational background of acupuncture and moxibustion, their local clinical practice and medical management of acupuncture and moxibustion, as well as their demand for CPGs of acupuncture and moxibustion, etc. After the questionnaires were collected, the data were analyzed and described by quantitative research method.ResultsIn all, 302 respondents from 37 countries of six continents responded. The 302 respondents were members of the WFAS society members. (1) Basic information of respondents. They all had acupuncture and moxibustion learning experience, among which, 76.5% (231/302) had the education background of acupuncture and moxibustion professional college training, and 88.4% (267/302) had experience of acupuncture and moxibustion clinical practice. Acupuncturists or traditional Chinese medicine doctors accounted for 63.9% (193/302), western medicine doctors, nurses, and pharmacists accounted for 18.2% (55/302), and researchers and teachers accounted for 6.3% (19/302). (2) Local clinical practice and medical management of acupuncture and moxibustion. The level of clinical practice of acupuncture and moxibustion varies greatly among the regions where the WFAS society members lived. Among them, more countries in Europe have not included acupuncture and moxibustion in medical insurance than those in other continents (x²=26.049, P < 0.01), and more countries have not included acupuncture and moxibustion in public hospital treatment system than those in other continents (x²=113.488, P < 0.01). (3) Demand for CPGs of acupuncture and moxibustion. A total of 93.0% (281/302) respondents believed that WFAS CPGs of acupuncture and moxibustion would be helpful for their local practice. The order of their demand and concern for WFAS CPGs was: acupuncture manipulation > latest progress of acupuncture treatment > choice of acupuncture therapies > safety of acupuncture and moxibustion > combination of acupuncture and other programs. A total of 87.4% (264/302) respondents believed that ancient classics could guide clinical practice, and the ancient literature should be used as evidence for the development of guidelines.ConclusionThe respondents are those future practitioners of CPGs of acupuncture and moxibustion conforming to WFAS standards. Commonly they have clinical practice experience and professional education background. They believe that guidelines will be of help to the clinical practice of acupuncture and moxibustion, hope that WFAS CPGs would recommend effective guidelines for acupuncture manipulation and provide the latest progress in acupuncture treatment and so on, and they believe that classical ancient books can guide their clinical practice. It indicates the necessity and feasibility of formulating the WFAS CPGs of acupuncture and moxibustion. In view of the results of this study, it is suggested that the formulation process of WFAS CPGs of acupuncture and moxibustion should take into account the clinical practice level of acupuncture and moxibustion in each region, as well as its legislation and management situation of acupuncture and moxibustion, so as to meet the needs of users as much as possible.