Communication about self-care in traditional acupuncture consultations: The co-construction of individualised support and advice

Objective

To analyse the co-construction of self-care advice in traditional acupuncture consultations.

Method

Analysis of 27 audio-recorded and transcribed consultations, involving 7 practitioners, augmented by integrating the data from 15 patient interviews and regular practitioner discussions.

Results

Self-care talk was initiated equally by practitioner and patient, and was threaded through and between acupuncture consultations. It involved interactive discussions that were interwoven with other types of talk, especially life-world and acupuncture talk. Practitioner engagement in self-care talk appeared to increase with experience. The self-care talk was co-constructed within the context of a relationship that was characterised by continuity, mutuality and trust.

Conclusion

Self-care support and advice was integral to the practice of traditional acupuncture and individualised in terms of the patient's life-world and/or the Chinese medicine diagnosis. The co-construction of self-care talk did not replicate the asymmetry of conventional medical consultations.

Practice implications

The active participation of both patients and acupuncture practitioners in self-care talk may be related to professional practice that is underpinned by a holistic theory base such as Chinese medicine and is delivered in the context of therapeutic relationships based on continuity, mutuality and trust. These findings may inform professional education and the design of multi-disciplinary care pathways.     

Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation

Extracorporeal membrane oxygenation (ECMO) is a form of prolonged cardiopulmonary bypass used to temporarily sustain cardiac and/or respiratory function in critically ill patients. Extracorporeal membrane oxygenation further complicates the management of critically ill patients who already have profound physiologic derangements with consequent altered pharmacokinetics. The purpose of this study is to identify and critically review the published literature describing pharmacokinetics in the presence of ECMO. This review revealed a dearth of data describing pharmacokinetics during ECMO in critically ill adults, with most of the available data originating in neonates. Of concern, the present data indicate substantial variability and a lack of predictability in drug behavior in the presence of ECMO. The most common mechanisms by which ECMO affects pharmacokinetics are sequestration in the circuit, increased volume of distribution, and decreased drug elimination. While lipophilic drugs and highly protein-bound drugs (eg, voriconazole and fentanyl) are significantly sequestered in the circuit, hydrophilic drugs (eg, β-lactam antibiotics, glycopeptides) are significantly affected by hemodilution and other pathophysiologic changes that occur during ECMO. Although the published literature is insufficient to make any meaningful recommendations for adjusting therapy for drug dosing, this review systematically describes the available data enabling clinicians to make conclusions based on available data. Furthermore, this review serves to highlight the need for well-designed and conducted clinical and laboratory-based studies to provide the data from which robust dosing guidance can be developed to improve clinical outcomes in this most unwell cohort of patients.     

火针疗法联合中药治疗寻常痤疮的疗效观察

目的观察火针疗法联合中药治疗寻常痤疮的疗效,为寻常痤疮寻求一种更加有效的治疗方法。方法将90例寻常痤疮患者随机分为治疗组和对照组,治疗组采用火针疗法联合中药治疗;对照组采用克林霉素磷酸酯凝胶联合中药治疗。4周后判定疗效。结果在愈显率、疗效指数、皮损改善方面,治疗组与对照组有显著性差异。结论火针疗法联合中药治疗寻常痤疮的疗效优于克林霉素磷酸酯凝胶联合中药治疗。     

重症颅脑外伤病人的一站式急救护理

目的探讨一站式急救护理对于重症颅脑外伤病人的影响。方法选择我院2010年1月～2011年12月收治因各种原因导致的重症颅脑外伤患者72例,对所有患者采取了专业的一站式急救护理的方法。其中包括严密监察患者病情,针对性的个体化护理措施以及积极的预防并发症。运用患者从入院到出院全程救治模式。结果所有患者通过本院一站式急救护理治疗,痊愈27例,有效43例,无效死亡2例。总治疗有效率达97.2%。死亡率2.7%。结论重症颅脑外伤病人通过专业系统化的一站式急救护理,在充分整合医院医疗资源,突出"绿色通道"的作用下,不仅能及时有效提高患者的抢救率及治疗有效率,在预防及减少并发症,改善预后方面也有着明显的作用,值得推广。     

经B超引导选择性门静脉化疗栓塞在肝癌治疗中的应用

目的:探讨B超选择性肝动脉化疗栓塞(TACE)联合经皮穿刺导管选择性门静脉化疗栓塞(SPVCE)治疗中晚期原发性肝癌(PHC)的价值。材料与方法:将133例中晚期PHC随机分成2组,对照单纯的选择性肝动脉化疗栓塞(TACE)与TACE加SPVCE的治疗效果。结果:TACE组和TACE加SPVCE总有效率[缓解和部分缓解(CR+PR)]分别为38%和59%,差异有显著意义(p<0.01),0.5、1、2年生存率TACE组分别为93.1%、65.4%、36.1%,TACE加SPVCE组分别为100%、95.1%、59.8%。两组差异有显著意义(p<0.01)。结论:TACE加SPVCE治疗中晚期PHC是一种有效的方法,效果优于单纯的TACE。     

益肾降糖丸配合西药治疗早期糖尿病肾病60例临床疗效观察

目的：探讨益肾降糖丸治疗糖尿病肾病（DN）的临床疗效。方法：将120例DN患者随机分为治疗组和对照组。对照组60例给予常规治疗,治疗组60例在对照组治疗基础上加服益肾降糖丸,观察两组治疗前后的临床疗效及血糖和肾功能指标的变化情况。结果：治疗组总有效率（83．33％）高于对照组（66．67％）,差异有统计学意义（χ2=4．44,P〈0．05）;两组治疗后空腹血糖、餐后2h血糖、糖化血红蛋白、24h尿蛋白定量、血尿素氮、血肌酐与治疗前比较差异均有的统计学意义（均P〈0．05）,但是治疗组改善情况均明显优于对照组改善情况（均P〈0．05）。结论：益肾降糖丸可降低DN患者血糖,减轻蛋白尿。     

灯盏花素联合丁咯地尔治疗急性脑梗死的疗效观察

目的观察灯盏花素联合丁咯地尔治疗急性脑梗死的疗效及不良反应。方法将120例首次发病的急性脑梗死患者随机分成治疗组(灯盏花素+丁咯地尔)和对照组(复方丹参+维脑路通)各60例。治疗14d测定和评价治疗后的临床疗效、神经功能、运动功能和血液流变学指标的变化。结果灯盏花素联合丁咯地尔治疗急性脑梗死临床有效率为58.3%,明显优于对照组的35.0%,差异有统计学意义(P<0.05)。治疗后2组神经功能缺损评分均减少,且治疗组优于对照组(P<0.05,P<0.01);治疗组运动功能改善率为58.3%,明显优于对照组的35.0%,差异有统计学意义(P<0.01)。血液流变学指标方面治疗组均明显优于对照组(P<0.05)。结论灯盏花素联合丁咯地尔治疗急性脑梗死疗效良好。     

参芎葡萄糖注射液治疗急性脑梗死的临床疗效分析

目的评估参芎葡萄糖注射液治疗急性脑梗死患者的临床疗效,并评价其用药安全性。方法 100例急性脑梗死患者随机分为治疗组和对照组,每组50例。治疗组在常规治疗的基础上加用参芎葡萄糖注射液;对照组在常规治疗的基础上加复方丹参注射液,治疗14d后,对2组治疗前后神经功能缺损评分、临床疗效、血液流变学指标及不良反应进行分析。结果 2组治疗后神经功能缺损评分较治疗前降低（P〈0.05）,但治疗组降低更明显（P〈0.05）;治疗组的有效率显著高于对照组（P〈0.01）。治疗组治疗后血小板聚集率、红细胞压积、纤维蛋白原较治疗前改善（P〈0.01或P〈0.05）;对照组血小板聚集率、红细胞压积较治疗前改善（P〈0.05）;治疗组的红细胞压积、纤维蛋白原较对照组改善更明显（P〈0.05）。治疗组1例出现皮疹,对照组未出现明显不良反应。结论 参芎葡萄糖注射液治疗急性脑梗死疗效可靠,临床用药安全,值得推广使用。     

Therapeutic immunization in HIV infected Ugandans receiving stable antiretroviral treatment: a Phase I safety study

Therapeutic immunizations in HIV infection may boost immunity during antiretroviral treatment. We report on the first therapeutic vaccine trial in Uganda, Africa. This open label Phase I trial was designed to assess the safety, tolerability and immunogenicity of a therapeutic HIV-1 vaccine candidate. Thirty HIV positive volunteers receiving a stable regimen of antiretroviral therapy with CD4 counts >400 were recruited for the safety evaluation of LFn-p24C, a detoxified anthrax-derived polypeptide fused to the subtype C HIV gag protein p24. The vaccine was well tolerated and HIV RNA levels remained undetectable following three immunizations. CD4 counts in vaccine recipients were significantly higher compared to the control individuals after 12 months. HIV-specific responses were associated with higher gain in CD4 counts following LFn-p24C immunizations. Volunteers were subsequently asked to undergo a 30-day period of observed treatment interruption. 8/24 (30%) individuals showed no evidence of viral rebound during treatment interruption. All demonstrated prompt suppression of viral load following resumption of ART. Our data demonstrate the safety of LFn-p24C and suggest that adjunct therapeutic immunization may benefit select individuals in further boosting an immune response.     

Preclinical evaluation of HIV-1 therapeutic ex vivo dendritic cell vaccines expressing consensus Gag antigens and conserved Gag epitopes

Background

Dendritic cell (DC) therapy is a promising technology for the treatment of HIV infected individuals. HIV-1 Gag- and Nef RNA-loaded DC have previously been shown to induce immune responses ex vivo following coculture with autologous lymphocytes. However, polyfunctionality and memory responses following coculture have not been evaluated. In addition, little is known regarding whether specific HIV-1 proteome components, such as highly conserved regions of the HIV-1, could enhance clinical responses following DC therapy.

Methodology and principal findings

To determine the breadth of the immune responses to antigen loaded DC, we analyzed polyfunctional T cell response ex vivo to Gag RNA loaded DC. Blood samples were used to generate monocyte derived DC, which were then matured and cocultured with autologous lymphocytes. We found that cytokine-matured DC loaded with Gag RNA was able to induce Gag-specific IFN-γ and IL-2 responses after a 12-day coculture. We characterized these responses by polyfunctional intracellular cytokine staining and evaluation of T cell memory phenotypes. Central memory CD8+ T cells were induced ex vivo after DC coculture from each of 3 patients, and the effector memory pool was increased by DC coculture from 2 patients. We also observed a decrease in the terminal effector and intermediate CD8+ T cell pool and an increase in the naïve/other population. There was a reduction in terminal effector and intermediate CD4+ T cells, and a corresponding increase in naïve/other CD4+ T cells. Finally, we evaluated conserved regions of Gag as a novel DC therapy immunogen and found that a conserved element (CE) p24 Gag antigen elicited IFN-γ and IL-2 responses comparable to those induced by a full-length Gag antigen.

Conclusions

We showed that RNA-loaded DC therapy induced a polyfunctional T cell response ex vivo, supporting the use of such DC-therapy for HIV infection. However, the central and effector memory phenotypes of T cells did not appear to be enhanced during coculture with Gag RNA-loaded DC. Furthermore, comparable antigen-specific responses were induced in HIV infected individuals using full-length Gag or only conserved elements of the Gag p24 protein. This indicates that immune responses can be focused onto the conserved elements of Gag in the absence of other Gag components.