唐宋“五脏中风”证治特色探析

针对金元以后五脏中风研究逐渐淡化,至今罕有研究的现象,追溯《千金方》、《太平圣惠方》中的相关内容,剖析唐宋时期五脏中风证治特色。认为,与康宋以前相比,该时期的五脏中风在病证上,逐渐由一般证候向具体病证转化;在治疗上,《千金方》寒温并用,创内风论治之先河;《太平圣惠方》突出各脏中风特点,区分五脏用药,拓展内风治法。指出唐宋时期五脏中风证治方面取得的成就对今日中医临床仍有启迪。     

Randomized, controlled trial of prescribing training in a South African province

OBJECTIVES: Prescribing practices impact greatly on drug use and expenditure. The situation in developing countries is often compounded by a limited health budget. Furthermore, because of role substitution in these countries, prescribers are often not formally trained in rational prescribing. The study described in this paper assesses the effect of a prescribing training intervention for primary health care nurses. DESIGN: A generic training-of-trainers course and a 4-day effective prescribing course were presented to 24 provincial trainers. These trainers then conducted effective prescribing workshops for 20 primary health care nurses per workshop. In 1997, 457 prescribers were trained by this method in South Africa's Northern Province. The study investigated the impact of the training on prescribing practices for two target conditions, in a control and a study group of 11 clinics each, 1 month after and 3 months after the intervention. SETTING: Primary health care clinics in the Lowveld Region of the Northern Province of South Africa. RESULTS: Prescribing practices for the two conditions examined were significantly improved by the training. Changed behaviour was not only seen in prescribing for upper respiratory tract infections, used as an example condition, but also for diarrhoea and/or vomiting, a common condition in the region, which was not included in the training programme. These results show that prescribers not only retained the knowledge gained, but were also able to apply their new skills to other conditions (transfer effect). The change in the study group was maintained for 3 months after training, while there were no significant improvements in prescribing in the control group. INTERPRETATION: The training intervention had a beneficial effect on prescribing practices.     

温肝法的学术渊源及方药整理研究

通过整理历代医家主要著作中关于温肝法的记载,阐述温肝法的学术渊源。运用计量学方法,选取文献中温肝法常用方药,建立数据库,进行药物频次统计,总结出温肝法高频药物和温肝法所治病证的治疗原则,以期更好的指导临床。     

“脾色必黄 瘀热以行”发挥

在《金匮要略·黄疸病脉证并治》中,张仲景阐述了黄疸病湿热发黄的病机为＂脾色必黄,瘀热以行＂,认为黄疸主要病位在脾胃,＂瘀热以行＂是其根本病机,其关键在于湿、脾、瘀三个字。治疗上应该把握祛湿、健脾、活血三个方面,并需注意相关禁忌证。     

《千金方》胎产病中的“治未病”特色

通过梳理《千金方》妇人7卷,探讨其胎前产后病防治方法。孕期按月调理,起居饮食,精神调摄详备方案,并列出各时期的防流产方;临产详列禁忌和注意点以防难产;产后调护和补养之法,善于用药膳和酒剂等饮食疗法。诸法体现了孙氏对妇女胎前、产后及各个时期疾病在未病知防、欲病救萌、已病防变等方面“治未病”的思想和方法。     

某院门诊不合理用药处方分析

目的了解门诊患者不合理用药情况,促进合理用药。方法随机抽取2011年门诊处方9 600张。对不合理用药处方进行统计分析。结果不合理处方占所查处方的4.12%,主要表现在用法用量不当,选用药物不当,配伍不合理,重复用药,联合用药不合理等。结论应建立合理用药监督机制,促进临床合理用药。     

我院门诊处方不合理用药分析

目的:探讨不合理用药的类型及原因,促进合理用药。方法:抽查我院2011年门诊处方3600张,对抽查处方中不合理用药情况进行统计分析。结果:3600张处方中共发现不合理用药处方352张,占9.8%。其中无指征使用抗生素占2.7%、重复用药占2.1%、过度用药占1.0%、给药方法不当占0.8%、配伍不当1.7%,其他情况占1.5%。结论:我院不合理用药水平低于文献报道,但是仍然需要改进。要减少问题处方,促进合理用药,需社会、医院、医务人员的共同参与和努力。     

Same system, different outcomes: comparing the transitions from two paper-based systems to the same computerized physician order entry system

Objective

To compare how nurses in two different paper-based systems perceive the impact of a computerized physician order entry (CPOE) system on their medication-related activities.

Setting

13 non-surgical, adult inpatient wards in a Dutch academic hospital.

Methods

Questionnaire survey of 295 nurses before and 304 nurses after the implementation of a CPOE system. These nurses worked with two different paper-based medication systems before the implementation: ‘Kardex-system’ and ‘TIMED-system’. In the Kardex-system, the structure of the nursing medication work was similar to that of after the CPOE implementation, while in the TIMED-system, it was different. ‘Adaptive Structuration Theory’ (AST) was used to interpret the results.

Results

The response rates were 52.2% (154/295) before and 44.7% (136/304) after the implementation. Kardex-nurses reported more positive effects than TIMED-nurses. TIMED-nurses reported that the computerized system was more inflexible, more difficult to work with, and slower than the TIMED-system. In the TIMED group, the overall mean score of the computerized process was not significantly different from that of the paper-based process. Moreover, nurses in both groups were more satisfied with the post-implementation process than with the pre-implementation process. Nevertheless, none of groups reported a better workflow support in the computerized system when compared to that of the paper-based systems.

Conclusions

Our findings suggest that not only the technology but also large differences between pre- and post-implementation work structure influence the perceptions of users, and probably make the transition more difficult. This study also suggests that greater satisfaction with a system may not necessarily be a reflection of better workflow support.     

陈自明辨治中风病的经验

对陈自明《妇人大全良方》中以中风为主证的医方及部分医案进行分析,归纳为中风伤寒宜调理荣卫、偏虚受风宜养血祛风、热甚生风宜清热熄风、肝风鸱张宜平肝熄风、痰浊蒙蔽宜涤痰开窍、寒中于里宜温中祛寒,对现今防治中风证极富参考价值。