北京市医药分开和医耗联动综合改革对中医服务的影响评估

目的:分析北京市医药分开和医耗联动综合改革对北京市中医类医疗服务及收入的影响。方法:基于北京市39家中医类医院监测数据进行描述性分析和基于分段回归的多元间断时间序列模型。结果:北京市两次公立医院综合改革对中医服务收入及服务量均有显著影响,特别是在医药分开综合改革之后,北京市二、三级中医类医院针灸、推拿收入以及中药饮片收入占比明显增长,但针灸科和推拿科的门诊人次数显著下降。结论:北京市医药分开与医耗联动综合改革总体上促进了中医医疗服务收入的提升,促进了中药饮片的使用,但也为中医服务设起了一道价格门槛,合理控制门槛高低,使中医药能惠及更多群众是关键。     

Acupuncture and traditional Chinese medicine

Acupuncture and other therapeutic techniques of traditional Chinese medicine (moxibustion, herbal therapy, massage and physiokinesitherapy, Chinese medical exercises) were introduced in Italy and Europe after the Second World War. Especially acupuncture is utilized in private and public health services; in Italy only medical doctors can practice acupuncture because it is considered a "medical act" from 1982. Some private schools organize four years courses of acupuncture and Chinese medicine and have acquired an interesting experience in teaching, clinical practice and editing in this field. The National Institutes of Health (NIH) in USA stated, in a consensus conference held in November 1977, that "there is clear evidence that needle acupuncture is efficacious for adult post-operative and chemotherapy nausea and vomiting and probably for the nausea of pregnancy".     

上海市西医医师开展中医药服务面临问题的思考

中西医相结合是在我国特有历史条件下产生的。西医医师学习中医药技能,在临床联合开展中医药服务促进医学进步。但由于西医开展中医药服务活动相关法律法规的滞后或空白,目前存在具体问题需要解决。第一,必须明确界定西医医师开展中医药服务需要具备的资质和条件;第二,需要明确西医医师开展中医药服务工作的范畴,保障医疗质量与安全;第三,应当强化教育培训,加强西医医师中医药在职教育。第四,必须进一步加强卫生监督执法的规范性。     

Use frequency of traditional Chinese medicine in Taiwan

Background

Use of Traditional Chinese medicine (TCM), an important category of complementary and alternative medicine (CAM), has increased substantially in Western countries during the past decade. Use of TCM is also widespread in the Chinese population. However, few informative data have been obtained to date by large-scale investigations of TCM use in the Chinese population. This study was aimed at elucidating the demographics and patterns of TCM use in Taiwan.

Methods

We employed the complete datasets of TCM outpatient reimbursement claims from 1996 to 2001, including the use of Chinese herbal remedies, acupuncture and traumatology manipulative therapy, to analyse use frequencies, the characteristics of TCM users, and the disease categories that were treated by TCM in Taiwan.

Results

At the end of 2001, 6,142,829 (28.4%) among the 21,653,555 valid beneficiaries of the National Health Insurance in Taiwan had used TCM during the year. However, 13,536,266 subjects (62.5%) had used TCM at least once during the whole 6-year period from 1996 to 2001, with a total of 156,224,266 visits (mean 11.5 visits per user). The mean number of TCM users per annum was 5,733,602, with a mean increment of 1,671,476 (29.2%) of new users yearly. Among TCM users, female was higher than male (female:male = 1.13:1), and the age distribution displayed a peak at around the 30s, followed by the 20s and 40s. Chinese herbal remedies (85.9%) were the most common TCM modality used by this population, followed by acupuncture (11.0%) and traumatology manipulative therapies (3.1%). Private TCM clinics provided most of the TCM care (82.6%), followed by private TCM hospitals (12.0%). The top ten major disease categories for TCM visits were diseases of the respiratory system, musculoskeletal system and connective tissue; symptoms, signs and ill-defined conditions; injury and poisoning; diseases of the digestive system, genitourinary system, skin and subcutaneous tissue, nervous system and sense organs, circulatory and endocrine system; nutritional and metabolic diseases; and immunological disorders.

Conclusion

TCM was popular among the Chinese population in Taiwan during the period studied. More than 60% of all subjects had used TCM during the 6-year interval. TCM was widely used by the Chinese population to treat problems and diseases of major human organ systems recognised by western medicine. This study provides information about the use frequencies of TCM and the disease categories treated by TCM, which should be useful for health policy makers and for those considering the integration of TCM and Western medicine.     

The growing acceptance of complementary and alternative medicine

Alternative and complementary medicine is becoming more popular among consumers and prescribed more by health care professionals. Alternative medicine can be traced back thousands of years, however, it wasn't introduced to the United States until the early 1900s. Alternative medicine encompasses a wide range of therapies including homeopathy, naturopathy, chiropractic, massage and bodywork therapy, meditation, nutritional supplements, and herbal remedies. Understanding the background and benefits of these alternatives is important to all health care professionals.     

针灸康复科中医护理临床教学路径实际效果分析

目的探讨针灸康复科中医护理临床教学路径实际效果。方法纳入2016年2月—2017年2月100名针灸康复科中医护理教学护理实习生以数字表法分组。传统模式组采用传统的护理教学方法,临床教学路径组采用临床教学路径法。比较针灸康复科中医护理带教老师对护理实习生出科时的中医理论考试成绩、中医操作考试评分、综合能力评分;护理实习生对教学模式的满意度。结果临床教学路径组针灸康复科中医护理带教老师对护理实习生出科时的中医理论考试成绩、中医操作考试评分、综合能力评分高于传统模式组,差异有统计学意义(P<0.05);临床教学路径组护理实习生对教学模式的满意度高于传统模式组,差异有统计学意义(P<0.05)。结论针灸康复科中医护理教学中临床教学路径法的运用效果确切,可提升护理实习生的满意度,提高护理实习生对针灸康复科中医护理理论和操作的掌握度和临床综合能力。     

How do skilled nursing rehabilitation managers track efficiency and costs?

Financial and efficiency indicators have not been used extensively by skilled nursing (SNF) rehabilitation managers, but may prove useful in the prospective payment system (PPS)-dominated long-term care (LTC) environment. The purpose of this pilot study was to demonstrate a method for measuring the extent of SNF rehabilitation managers' use of volume, revenue, cost, and manpower indicators; and whether usages differ among occupational, physical, and speech therapy managers. The subjects were 74 occupational, 75 physical, and 72 speech therapy managers employed by a multinational health care corporation. A total of 221 Likert scale surveys were mailed to SNF rehabilitation managers to obtain data on use of 32 efficiency and financial indicators. The 32 indicators were in four categories: visit volume, revenue, costs, and manpower utilization. Twelve indicators were used regularly by at least 60% and three were used regularly by 85-100% of respondents. The response rate was 17.89%. Chi-square analyses were performed for therapy discipline and response frequency. None was significant at 0.05. Three of the payermix indicators demonstrated post-hoc significance in "regular" or "sometimes" use by the physical therapy managers. The results show discipline-specific differences among LTC rehabilitation managers in the extents of efficiency and financial indicator usage for decision making. Suggestions for future use of the survey instrument are provided. The method proved useful for demonstrating differences in the combinations and degrees of use of the 32 indicators. The results point to a need to educate SNF rehabilitation managers in cost-monitoring techniques. Recommendations for cost monitoring are provided.     

Evidence-based medicine and the diverse cultures of healing

The term "unconventional medicine" refers to a remarkably heterogeneous group of theories and practices (homeopathy, herbal medicine, acupuncture, etc.) different from those peculiar to the dominant health system of a particular society. An unifying characteristic of these practices is that they have not been scientifically tested and that unconventional practitioners largely deny the need for such testing. However, established research procedures are to be considered adequate to address the majority of questions related to unconventional therapies and promising unconventional therapies should be subjected to the same level of scientific scrutiny that is required for drug therapies used within the official medicine. While many questions about the risk/benefit ratio of unconventional therapies remain unanswered, millions of people are spending millions of dollars each year in several developed countries, thus, to define strategies aimed at the careful evaluation of these practices is needed.     

中医治疗早期膝关节骨性关节炎的临床研究

目的讨论中医在早期膝关节骨性关节炎的治疗效果。方法选择2010年9月—2012年9月间,患有早期膝关节骨性关节炎的患者146例,随机分为中医组和西医组,中医组采用中医理论指导下的中药内服、外洗,针灸、推拿的方法进行治疗,西医采用西药治疗,6个月后比较两组患者疗效。结果中医组患者总有效率为93.75%,西医组患者总有效率为38.24%,结果差异显著,具有统计学意义(P<0.05);治疗后中医组膝关节功能评分(1.23±0.56)分,疼痛程度(0.56±0.22)分,功能恢复时间(65.36±11.33)d,西医组膝关节功能评分(2.84±1.32)分,疼痛程度(2.84±1.35)分,功能恢复时间(125.14±8.62)d,结果差异显著,具有统计学意义(P<0.05)。结论运用中医方法治疗早期膝关节骨性关节炎功能恢复更快更好,总有效率更高,是值得临床应用和推广的好方法。     

中医体质气虚质中风病人的临床护理

目的探讨中医体质气虚质中风病人的临床护理体会。方法取2012年7月至2013年7月我院收治的80例气虚体质中风患者为研究对象,随机将其分为对照组和实验组各40例,对照组接受常规基础护理,实验组则接受饮食调养、心理干预以及捏脊、针灸与按摩刺激等中医护理干预措施。采用自制问卷对两组的临床效果进行统计。结果与对照组相比,实验组总有效率更高,组间差异有统计学意义(P<0.05)。结论在中医理论体系中,中医体质学是"治未病"这一学术思想的集中体现。临床针对气虚体质患者实施中医饮食调养、心理干预以及捏脊、针灸与按摩刺激,可显著提升治愈率。     

肿瘤同时放化疗治疗的研究

综合治疗已成为治疗肿瘤的最基本原则,放化疗也已成为肿瘤在临床治疗上最为常见的综合的治疗形式。本文对中西医综合疗法、抗氧化剂对肿瘤放化疗的影响以及中药注射剂和针灸疗法对肿瘤放化疗的辅助作用进行讨论。     

社区医院开展中医药服务的相关因素分析

目的：分析社区医院开展中医药服务的相关因素,为进一步加强中医药在社区卫生服务中的运用和发展提供科学的决策依据。方法选取2009-2012年的全院门诊数据,统计出每月的总门诊人次、中医医疗收入、中成药收入、中草药收入、开展的中医项目数、中医人员配置和中医药品的配置等数据,应用SPSS 19．0统计软件对数据进行因子分析。结果中医人员和中医设备配置为影响社区医院开展中医药服务的第一因素,其特征值为3．187,加强社区医院中医药队伍建设,提高医务人员的业务水平,能使更多医务人员开展中医药服务,配备中医医疗设备为中医药服务项目的开展提供硬件保障;中医药品配备为影响社区医院开展中医药服务的第二因素,其特征值为2．474,种类齐全的中医药品有利于开展中医全科医疗服务;中成药收入是目前社区医院中医业务收入的主要影响者,是影响社区医院开展中医药服务的第三因素,其特征值为1．996,源于中成药易于被患者和非中医医务人员接受,其用量明显大于中草药。结论社区医院开展中医药服务,首先应考虑中医药人才队伍的建设,中医设备的配置是开展中医非药物治疗项目的必要条件,中医药品的配备特别是中药饮片品种是否齐全会影响社区医院的中医药服务的开展。     

Rehabilitation in the nursing home: how much,why, and with what results.

Although rehabilitation is considered an important component of long-term care, few studies have looked at the factors associated with the provision of rehabilitation in this setting. The authors examined one State''s skilled nursing homes to gain information on their rehabilitation practices. Data for this study came from a mail survey and from the licensing applications filed with the State Division of Facility Services. Sixty-nine percent of the State''s nursing homes responded to the survey. All reported that they provided specialized physical therapy, occupational therapy, or speech therapy, or all three, but the numbers of patients reported to be enrolled in such therapies on a daily basis varied from 0 to 64 percent of the facility''s census. Factors positively associated with the provision of rehabilitation included the number of full-time registered nurses on the staff and the belief of the facility administrator that the purpose of rehabilitation is to restore function so that patients can be discharged. Facilities that employed their own therapists rather than contract for these services reported significantly more patients enrolled in daily therapies. And a significant positive correlation was observed between the provision of daily rehabilitation services and discharge of patients in those facilities that hired their own rehabilitation staff. These findings suggest that the provision of rehabilitation in nursing homes has different goals and outcomes and that there are facilities with identifiable characteristics that appear more successful in returning patients to their homes.     

分析中药、针灸、推拿联合治疗失眠的价值

目的探讨失眠患者通过联合采取针灸、推拿及宁心安神中药口服治疗的临床价值。方法抽取本院2018年3月-2019年5月70例失眠患者并根据入院顺序来分组,对照组单纯应用宁心安神中药进行口服治疗,观察组在此基础上联合针灸、推拿疗法,对比两组睡眠质量及心理抑郁和焦虑情绪的改善情况。结果经治疗观察组的睡眠质量优良率97.14%,对照组80.00%(P<0.05);两组入组前HAMA、HAMD分值均较高(P>0.05),治疗后观察组HAMA、HAMD分值低于对照组(P<0.05)。结论失眠患者治疗中联合采取宁心安神中药口服与针灸、推拿疗法可取得理想疗效,有助于提升患者睡眠质量并改善负性情绪。     

针刺配合盆炎丸治疗慢性盆腔炎疗效

目的观察针刺配合中药利湿化瘀治疗慢性盆腔炎的临床疗效。方法118例慢性盆腔炎患者随机分成治疗组(针刺配合盆炎丸组)和对照组(盆炎丸组),各59例。观察治疗前后血液流变学指标。结果治疗组与对照组总有效率分别为94.91%与84.75%。两组均可改善血液流变学指标,但治疗组明显优于对照组(P0.01)。结论针刺结合中药盆炎丸治疗慢性盆腔炎疗效显著,能明显改善血液黏稠度。     

推拿结合Vojta神经发育疗法治疗脑瘫88例临床分析

【目的】 分析推拿结合Vojta神经发育疗法治疗脑性瘫痪的疗效。 【方法】 将88例脑瘫患儿随机分为两组,对照组42例给予推拿、针灸、等传统医学综合康复治疗3个月;观察组46例在综合康复基础上加用现康复Vojta神经发育疗法进行治疗3个月。再运用Vojta姿势反射7项姿势检查对治疗前后进行测评。 【结果】 观察组有效率达95.7%,而对照组有效率为76.2%,两组比较差异有统计学意义(P＜0.05)。 【结论】 推拿结合Vojta神经发育疗法治疗脑瘫真实有效。     

Evaluating traditional Chinese medicine using modern clinical trial design and statistical methodology: application to a randomized controlled acupuncture trial

Traditional Chinese medicine (TCM), used in China and other Asian counties for thousands of years, is increasingly utilized in Western countries. However, due to inherent differences in how Western medicine and this ancient modality are practiced, employing the so-called Western medicine-based gold standard research methods to evaluate TCM is challenging. This paper is a discussion of the obstacles inherent in the design and statistical analysis of clinical trials of TCM. It is based on our experience in designing and conducting a randomized controlled clinical trial of acupuncture for post-operative dental pain control in which acupuncture was shown to be statistically and significantly better than placebo in lengthening the median survival time to rescue drug. We demonstrate here that PH assumptions in the common Cox model did not hold in that trial and that TCM trials warrant more thoughtful modeling and more sophisticated models of statistical analysis. TCM study design entails all the challenges encountered in trials of drugs, devices, and surgical procedures in the Western medicine. We present possible solutions to some but leave many issues unresolved.     

Music therapy in physical medicine and rehabilitation

The therapeutic effects of music are being recognized increasingly in the field of rehabilitation medicine. More music therapists are being employed in physical medicine and rehabilitation centres, with the goal of using music therapy services to assist in the physical recovery and health maintenance of clients. In spite of the benefits of physical rehabilitation programs, client participation to their full potential is often not observed. Music encourages participation in exercises and activities. Music can ease the discomfort and difficulty associated with exercise and therapy activities, and help ensure consistent participation. One of the goals of the music therapist is to provide a means for the client to express him/herself in a musical activity. Music therapy and rehabilitation medicine are starting to find a common niche in working together with clients who have various neurological, orthopaedic, and paediatric conditions. Therapeutic application of music in rehabilitation contributes to the quality of life of individuals with disabilities. Combined goals could include improving strength, range of motion, balance, communication, and cognition. Continued efforts in clinical practice and research will build on the information already available to further define possible applications of music therapy in rehabilitation, and its outcome and benefits. Occupational therapists can use the therapeutic medium of music, and the services of the music therapy discipline, in assisting clients to maximize their functional independence in their daily occupational roles.     

Effectiveness of occupational medicine center-based physical therapy.

A 1-year study was performed to evaluate discharge from therapy and return-to-work outcomes from rehabilitation services offered at four occupational medicine centers for work-related musculoskeletal injuries. The mean number of visits before discharge from therapy for 699 patients was 45% less than a national benchmark (mean visit number, 5.7 +/- 4.2 vs 10.5 +/- 9.1; P < 0.001). Return-to-work outcomes at discharge from therapy showed that 94% had returned-to-work. A telephonic satisfaction survey failed to identify client complaints associated with therapy. Assuming that reduced visit numbers would be reflected in a proportionate decrease in lost workdays, the program saved employers approximately $1.4 million, or $2000 per client. The authors attribute the improved outcomes to early therapy using active rather than passive techniques and an emphasis on patient education and home exercise programs.     

Early rehabilitation service utilization patterns in young children with developmental delays

OBJECTIVE: There is a growing demand for interdisciplinary rehabilitation services for children with developmental disabilities, however, information is lacking on service utilization patterns. This study describes the type, frequency and location of initial rehabilitation services provided to young children recently diagnosed with a developmental delay. METHODS: A telephone survey was conducted on a consecutive cohort of children referred to subspecialists for the first investigation of their delay. RESULTS: Out of 129 respondents, only 30 (23%) did not receive any rehabilitation services within the first 6 months following medical evaluation, and 61 (47%) received two or more services. Services were provided most frequently in the hospital setting, especially for occupational or physical therapy (73-80%). Services were less often rendered in a rehabilitation centre (5-13%) or in the community (< 10%). Services were provided privately for a subset, particularly for speech language pathology and psychology (34% and 30% respectively). Interventions were typically given weekly or bi-weekly. Children receiving physical therapy were significantly younger whereas children referred to speech language pathology were older than the age of our cohort at intake. Overall, parents' educational level did not influence services received with the exception of private services, which were more likely to occur in children of fathers with university education. CONCLUSIONS: The findings would suggest that long waiting times and lack of resources may limit access to comprehensive services, particularly in community settings. Service utilization patterns were not consistent within types of developmental disability, suggesting that formal and co-ordinated interdisciplinary programmes are not in place for this population of interest.