多元思辨模式在咳嗽诊疗实践中的应用与体会

咳嗽是一种常见病、多发病,中西医治疗一般都不难,但是咳嗽变异性哮喘、慢性阻塞性肺疾病及喉源性咳嗽等慢性肺系疾病病程较长,西医治疗比较棘手且取效不易。文章旨在通过3则咳嗽验案,介绍"审症(抓主症)-辨人(体质)-诊病-识证(方证)"四位一体的多元思辨模式在咳嗽诊疗实践中的应用,首当抓主症,次辨体质,明确诊断,从方证入手,谨守病机,遣方用药常以经方和后世经典方化裁治疗咳嗽,衷中参西,圆机活法,该思路和方法对于指导中医临证施治具有重要的参考价值。     

悲伤情绪的研究及其在临终病人家属护理中的应用

从悲伤的定义、特征、表现方式及其过程对悲伤情绪进行了综述。并将其运用到临终病人家属的护理中，以期对临床护理有所帮助。     

HIV感染者及AIDS病人压力研究现状

从国内外对人类免疫缺陷病毒(HIV)感染者及艾滋病(AIDS)病人的压力源、压力水平影响因素以及压力造成的负性影响等方面的研究情况进行综述,帮助有关工作人员从社会心理学角度寻找一些促进健康的措施。     

实习护生常见问题的探析

目的探讨实习护生的常见问题和解决对策。方法创建护理案例论坛并将其分为临床决策、伦理道德、护理技术、师生关系、护患关系和职业防护6个板块；从江西省3所大专院校中招募护生77名，邀请护生将实习过程中遇到的问题以案例的形式发送至论坛；定期登录论坛与辅导老师共同探讨这些问题的解决方法。结果护生实习期间向各板块发送的案例数量排序依次为师生关系、护患关系、职业防护、临床决策、伦理道德和护理技术。结论护生临床实习期间遇到的主要问题存在于师生关系、护患关系和职业防护方面，护理教育工作者应对护生加强相关知识和技能的教育，以提高他们在实习期间对这些问题的应对能力。     

吴鞠通法象用药临证举隅

中医理论是于现象之中阐明气化之妙,形质之上发明无形之奥,因此中药用药理论,其本质是法象用药,诸如质地之轻重、形状之殊异、纹理之疏密、气之清浊、味之厚薄、五运六气之禀赋、阴阳五行之制化等等,总括无余,然后心裁意度,对证切机,收效宏捷。文章试对吴鞠通运用法象中药临证运用的经验进行文献整理和分析,探讨《温病条辨》中法象中药的运用规律,旨在对温病临床治疗发挥指导意义。     

临床药师参加会诊的典型病例分析

目的:总结临床药师参加会诊的典型病例,以便为临床药师的工作提供参考。方法:结合以往临床药师参加的会诊工作,从个体化给药方案的制定、药品不良反应的判别、参与中毒急救、不良反应监测、围术期预防性使用抗菌药物的选择等几个方面进行总结。结果:通过参加会诊,临床药师能够为临床提供帮助,对药师的工作有一定的指导作用。结论:通过以上会诊工作的开展,临床药师的建议得到临床医生的采纳,药师自身素质明显提高。     

临床药师参与3例重症感染病例治疗的经验体会

目的:结合襄阳市第一人民医院临床药师参与感染性病例会诊的情况,探讨临床药师在重症感染性病例药物治疗过程中的经验与教训,促进抗菌药物的合理使用。方法:回顾性分析我院临床药师参与的3例重症感染性病例的药物治疗方案调整过程。结果:临床药师通过干预用药,配合医生为患者提供最佳的用药方案,使患者获得优质的医疗服务。结论:临床药师参与患者药物治疗会诊,将成为医院整体医疗技术工作中不可或缺的一环,临床药学依托患者与临床才能有更广阔的发展空间。     

临床药师学员的病例教学方法探讨

目的:探讨适合带教临床药师学员的病例教学模式。方法:根据临床药师学员工作的基本要求,采用以问题为导向的病例教学方法、模拟病例教学法以及DV演示教学法对临床药师学员进行带教。结果:通过对临床药师学员的病例教学经验进行总结,制定病例教学流程。通过病例教学,可以培养临床药师学员信息收集、整理的能力,训练学员交流沟通和参与临床药物治疗的能力,使其能够更快的掌握开展临床药学服务的方法。结论:病例教学法是提高临床药师学员带教质量和学员素质的有效方法。     

Association Between Human Cases and Poultry Outbreaks of Highly Pathogenic Avian Influenza in Vietnam From 2003 to 2007: A Nationwide Study

This study quantifies the spatio‐temporal association between outbreaks of highly pathogenic avian influenza H5N1 in domestic poultry (n = 3050) and human cases (n = 99) in Vietnam during 2003–2007, using rare events logisitic regression. After adjusting for the effect of known confounders, the odds of a human case being reported to authorities increased by a factor of 6.17 [95% confidence interval (CI) 3.33–11.38] and 2.48 (95% CI 1.20 – 5.13) if poultry outbreaks were reported in the same district 1 week and 4 weeks later respectively. When jointly considering poultry outbreaks in the same and neighbouring districts, occurrence of poultry outbreaks in the same week, 1‐week later, and 4 weeks later increased the odds of a human case by a factor of 2.75 (95% CI 1.43–5.30), 2.56 (95% CI 1.31–5.00) and 2.70 (95% CI 1.56–4.66) respectively. Our study found evidence of different levels of association between human cases and poultry outbreaks in the North and the South of the country. When considering the 9‐week interval extending from 4 weeks before to 4 weeks after the week of reporting a human case, in the South poultry outbreaks were recorded in 58% of cases in the same district and 83% of cases in either the same or neighbouring districts, whereas in the North the equivalent results were only 23% and 42%. The strength of the association between human and poultry cases declined over the study period. We conclude that owner reporting of clinical disease in poultry needs to be enhanced by targeted agent‐specific surveillance integrated with preventive and other measures, if human exposure is to be minimized.     

HIV-positive Romanian Adolescents: Acquisition Routes,Risk Behaviors,and Psychological Correlates

This research evaluated risk behaviors in HIV-positive adolescents (N = 153) receiving routine HIV medical care from their providers at a large medical center in Bucharest, Romania. Although the participants were of an appropriate age (M = 15.94 years) to have acquired HIV as one of the large numbers of pediatric AIDS cases during Ceau?escu’s Communist regime, many (20%) reported acquiring HIV sexually, relatively recently. The sample as a whole exhibited significant deficits in HIV knowledge, attitude, subjective norm, perceived control, and intention; significant risk behavior also appeared in terms of reports of unprotected intercourse with both HIV-positive and -negative partners. These results imply a change in the epidemiological model for HIV transmission in Romania, with increased sexual transmission of HIV. Discussion centers on interpretations of these patterns and drawing implications for HIV risk reduction for young people in Romania.