综合性中医院名老中医档案的建立和管理

名老中医档案是综合性中医院档案管理的一个重要组成部分,它详实地记录了名老中医的学术思想和临证经验,集中体现了中医药学术特点、理论特性,为医院系统整理、深度挖掘名老中医的经验积累了丰富的素材、梳理了清晰的思路,对开展名老中医学术思想研究、推动名老中医经验传承具有十分重要的意义。本文将从明确建档对象和收集范围,创新收集模式和方法,建立健全名老中医档案管理制度和开发利用名老中医档案等方面进行概述。     

中医传承与保护模式的制度创新

中医传统的传承模式已受到现代社会的各种挑战,其传承中所形成的成果难以得到现行法律的有效保护。建立以中医药传统知识保护名录为核心的传承模式是中医界与时俱进的选择,也是通过制度创新来获得自主知识产权的有效路径,不但可以系统、完整地整理名老中医的学术经验,合理界定名老中医的学术贡献范围并赋予相应的权益,而且可以有效树立名老中医的良好市场信誉,阻止他人对名老中医经验知识的不当占有,促进中医界的学术交流和知识发展。     

名老中医治疗肥胖的规律探析

目的：探析名老中医治疗肥胖的证素特征规律,为中医临床辨证治疗肥胖提供新的思路和方法。方法：选择知网、维普数据检索软件,检索筛选出名老中医治疗肥胖文献17篇,运用spss17.0软件对这17篇治疗肥胖的辨证分型及证素进行统计分析。结果：出现频数最高的证型为痰瘀互结型,其次为脾胃气虚型和痰湿内蕴型;脾在病位证素中出现的频数最多,其次为肝,胃居第三位;病性证素中频数最高的是与病理产物有关的证素,主要是痰、湿、血瘀,其次是气虚、气滞。结论：多数名老中医认为肥胖形成多与痰、湿、血瘀等病理产物和气虚有关,病变实多虚少,并常伴气滞,病位与脾关系最为密切。常用化痰祛湿、活血化瘀、健脾益气等法,从脾着手治疗是名老中医治疗肥胖的重要的方法。     

浅谈临床医疗信息数据挖掘

文章从数据挖掘的基本概念出发,分析了医疗信息数据挖掘的特点,介绍了门急诊管理、临床医疗资源配置、疾病诊断等信息中数据挖掘技术的应用,并提出展望。     

皮炎汤治疗血热型药疹52例分析

皮炎汤是中国中医研究院1名老中医朱仁康的经验方。近几年，我们应用皮炎汤治疗血热型药疹，疗效满意，现总结如下。     

唐廷汉治疗胃痛经验

唐廷汉主任医师是内江、资阳地区名老中医,从事中医临床及教学工作40余年,从常达变,自成风格,从医以来忙于诊务,偶有札记。应用中医理、法、方、药诊治内、妇、儿科多种疾病,对胃肠及肾病尤有研究,现将唐师诊治胃痛的经验整理如下。1和法是治疗胃痛的重要法则和法为八法之一,“     

数据挖掘在医疗质量安全监控系统应用的可行性研究

从理论上对数据挖掘及其在医疗质量安全监控系统中应用的可行性进行分析,分析显示数据挖掘在医疗安全监管领域有应用价值。     

自古名医善养生

养生是祖国医学的一个组成部分,对防治疾病、健康长寿有一定效果,善于养生的老中医都较长寿.据有关医书记载,从秦汉到近代414名中医,平均年龄为77.5岁.寿高者如孙思貌102岁,现代老中医施今墨、蒲辅周、王文鼎、岳美中均寿享八九十岁而终.     

浅析中医经典药对的配伍特点与用药规律

本文通过阐述张洪义教授应用卷柏、泽兰治疗月经不调,舒脾而和血,疏肝以行血,共奏缓破缓行之妙;从心神论治,运用兴奋-抑制双向调节之法,采用黄连、肉桂治疗顽固性失眠;运用补土泻木、阴阳调节之法,选用白芍、白术治疗溃疡性结肠炎等,总结了张老运用经典药的配伍特点及用药规律,探析了张老运用"整体调节"之法的一些临证经验及心得体会,旨在提炼、总结张老行医五十余载过程中,运用"整体调节"之法的独到之处,从而进一步研究、形成名老中医学术观点、学术思想,切实做好名老中医药专家学术思想传承工作,将名老中医学术观点、学术思想运用于临床实践中,以期为临床诊治疾病提供一定的参考、借鉴。     

数据挖掘技术在慢性阻塞性肺疾病中医诊疗研究中的应用进展

当前,采用数据挖掘(data mining,DM)技术在中医药领域的研究处于不断发展状态,其是研究中医领域学术成果的重要方法之一。本文通过整理当前使用DM技术研究中医药治疗慢性阻塞性肺疾病(慢阻肺)的相关文献,并对其进行逐一分析,将其分为名老中医经验、辨证用药规律及中医外治法3个方面,对纳入的相关文献研究内容进行综述,了解当前DM技术在中医药诊疗慢阻肺的最新研究进展,获取最新的动态,为临床工作中研究慢阻肺提供便捷的途径。     

当代名中医痢疾医案43则中药配伍及方证规律的数据挖掘分析

目的探讨当代名中医治疗痢疾的中药配伍及方证规律。方法收集43篇医案,采用关联规则与频数分析方法进行统计,数据分析在SPSS Clementine统计软件上进行。结果四诊信息与中药、病因与中药、证候与中药之间有对应规律,根据关联规则挖掘提出的基本方与中医证治痢疾理论切合。结论采取关联规则与频数分析方法能较好地挖掘名老中医关于痢疾的中药配伍及方证规律的经验。     

围绝经期妇女就诊及激素替代治疗态度调查

目的了解广东省围绝经期妇女的医疗保健行为，为有针对性地开展更年期预防保健工作提供依据。方法对广东省珠江三角地区、山区、东西两翼地区的地市级、县级的围绝经期妇女4489人进行问卷调查，用SPSS软件进行分析。结果我省围绝经期妇女有更年期症状的比例较高，但自我保健意识薄弱，就诊率仅为19．9％，其中36．2％的妇女就诊于内科，34.1％的妇女就诊于中医科，仅20．3％的妇女就诊于妇产科；在被调查人群中使用激素替代(HRT)治疗的比例仅1．496；围绝经期妇女的医疗保健行为受文化程度、职业、经济发展、是否绝经及不同地域等因素的影响。结论需要进一步提高围绝经期妇女的自我保健意识，尤其要加强对农村、山区等地围绝经期妇女健康教育。     

Is ‘bareback’ a useful construct in primary HIV‐prevention? Definitions,identity and research

This paper discusses sexual health strategies among Chilean women living in Melbourne, Australia. Twenty in-depth qualitative interviews and a survey questionnaire were administered to 100 Chilean-born women. Findings illustrate the importance of 'authority' when it comes to 'socially risky' illnesses like sexually transmitted diseases (STDs). Women stressed that western trained doctors are the only answer for STDs and the only way women can protect themselves from getting STDs is by visiting the doctor. The western trained doctor is seen to have the authority and legitimacy to treat the disease and heal the social relationships threatened by STDs. Chilean women continue to value the importance of alternative medicine within the array of health and medical seeking behaviours, although their use has shifted from the traditional Latin American folk healer to the Chinese doctor, herbalist and other alternative medical practitioners, including naturopaths. We conclude by arguing that while traditional medicines are still widely used by the Chilean migrant community, when it comes to 'socially risky' conditions such as STDs, western trained doctors, because of their conferred power, authority and social legitimacy, are key figures for prevention and treatment.     

名医素质特征与培养规律的初步研究

目的 探索名医的基本素质特征和培养规律.方法 在文献检索和专家访谈的基础上,采用自设问卷方式进行调查,并对调查结果数据进行统计分析.结果 知名医学专家与患者及家属在名医的内涵、培养目标、成长历程等问题上的观点是一致的,但在名医的培养周期、评价标准、培养方式等问题上存在着不同的观点.结论 名医不仅要拥有精湛的医术和高尚的医德,还要得到老百姓和医师同行的认可.名医的成才需要良好的成长环境和自由发展的空间,在成长的过程中我们可以通过发挥个人主观能动性,增强科室内部凝聚力,健全医师的考核体系,缓解紧张的医患关系,改革医学的教育模式等途径来培养名医.     

基层医生传染病及突发公共卫生事件报告处置能力研究

  目的  了解中国基层医生传染病及突发公共卫生事件报告处置能力现状，并探讨提升基层医生能力策略。  方法  采用多阶段抽样和典型抽样，选取东部地区(江苏省)、中部地区(安徽省、河南省)、西部地区(重庆市、甘肃省)的基层医生进行问卷调查。  结果  在纳入分析的8 374位基层医生中，6 906位(82.5%)基层医生具备传染病及突发公共卫生事件报告处置能力，分别有7 261位(86.7%)、7 633位(91.2%)、7 867位(93.9%)基层医生具备风险管理能力、发现与报告管理能力、协助处置与管理能力；工作越接近基层的医生，工作实践经验越丰富，能力水平越高。  结论  中国基层医生传染病及突发公共卫生事件报告处置能力总体较好，但风险管理能力有待提升，需加强培训演练，积累工作经验，实现传染病及突发公共卫生事件的有效应对。     

“You get old,you get breathless,and you die”: Chronic obstructive pulmonary disease in Barnsley,UK.

We report patients, family members and health professionals’ experiences of Chronic Obstructive Pulmonary Disease (COPD) in Barnsley, northern England. A widespread belief that having “bad lungs” is part of normal ageing shapes everyday experience in this former mining town. People with COPD, and their families, link its cause to the areas industrial past and are sceptical of a medical orthodoxy that attributes cause to smoking. They doubt doctors’ objectivity. Encouraging uptake of care, promoting smoking cessation, and developing care planning would be enhanced by engaging with the significance of place in the social narrative of health evident in this town.     

架起"健康"的桥梁——医患矛盾的现状调查及寻求医患关系平衡点的探索性研究

调查了医患关系的现状并寻求解决或者缓和医患矛盾的途径，提出了一套“金融保险和医疗法律复合型人才介入医疗纠纷处理”的方案并探索其可行性。通过对上海、苏州几家具有代表性的市级医院的医生和患者以及几所著名高校的医学生和法学生总计742份的问卷调查，同时结合与几个知名保险公司、法院的相关负责人的访谈发现：虽然现今的医患关系某种程度上说有些紧张，医疗纠纷处理的现状不容乐观、但大家对医患关系的前景还是充满了希望。与此同时．提出的设想也得到了社会各界的认同与支持。     

医疗纠纷对临床医生心理影响及其对策研究

目的 探讨医疗纠纷中医生心理压力的影响因素.方法 应用<焦虑自评量表>(SAS)和<职业压力量表>(OSI),对某市3所三级甲等医院的52名近两年发生过医疗纠纷的临床医生进行调查;同时,随机选取未发生过医疗纠纷的63名临床医生及50名非临床工作人员设为对照组,进行问卷调查.结果 发生过医疗纠纷的临床医生普遍存在焦虑状况,焦虑测评平均分值(58.27±11.38)高于对照组;医患关系、法律责任及医疗岗位,与医生心理压力状况呈正相关.结论 医疗纠纷的发生导致了医生的心理压力加大.应积极对医生进行心理疏导,加强心理训练,改善执业环境.     

Empathy and the application of the 'unbearable suffering' criterion in Dutch euthanasia practice

A pivotal due care criterion for lawful euthanasia in the Netherlands is that doctors must be convinced that a patient requesting for euthanasia, suffers unbearably. Our study aims to find out how doctors judge if a patient suffers unbearably. How do doctors bridge the gap from 3rd person assessment to 1st person experience? We performed a qualitative interview study among 15 physicians, mainly general practitioners, who participated earlier in a related quantitative survey on the way doctors apply the suffering criterion. Results show that doctors follow different 'cognitive routes' when assessing a patients suffering in the context of a euthanasia request. Sometimes doctors do this imagining how she herself would experience the situation of the patient ('imagine self'). Doctors may also try to adopt the perspective of the patient and imagine what the situation is like for this particular patient ('imagine other'). Besides this we found that the (outcome of the) assessment is influenced by a doctor's private norms, values and emotions considering (the performance of) euthanasia. We conclude by arguing why doctors should be aware of both the 'cognitive route' followed as well as the influence of their own personal norms on the assessment of suffering in the context of euthanasia requests.     

Hospital doctors and their schemas about appropriate prescribing

OBJECTIVES: To investigate cognitive schemas and schema systems used by hospital doctors to influence prescribing, particularly in terms of making appropriate prescribing decisions, and to compare the numbers and content of schemas between doctors with different levels of experience. DESIGN: Qualitative interviews with a purposively selected sample. PARTICIPANTS AND SETTING: Seven pre-registration (PRHOs) and 5 senior house officers (SHOs) and 5 consultants from a range of medical specialties in a teaching hospital. RESULTS: The qualitative analysis of the themes and patterns explored during the interviews indicated that all doctors articulated schemas that influenced their behaviour. The junior doctors seemed to have simplistic schemas, with interdoctor agreement; the consultants appeared to have more sophisticated schemas, with greater individual variation. Those schemas adopted by the PRHOs (prescribing "novices") could be subsumed by, rather than contradicted by, those of the consultants (prescribing "experts"), with a transitional stage demonstrated by the SHOs. The most noticeable distinction was the greater emphasis by consultants on holistic patient care and what might be seen as their separate schemas for appropriate prescribing stemmed from that premise. In contrast, junior doctors appeared to have had a single schema that encompassed both prescribing generally and appropriate prescribing. CONCLUSIONS: Although the design of this study was cross-sectional rather than longitudinal, the findings suggest that the acquisition and adjustment of schemas and schema systems are significant factors in the professional development of the hospital doctor from novice through to expert. It could be hypothesised that house officers possess simpler schemas as a way of coping with their job demands, which evolve in complexity as they gain experience. However, the transitional stage found with the SHOs is critical during cognitive development, with implications for the training and support available to doctors throughout their professional careers.