李七一教授治疗冠心病经验

[目的]总结李七一教授治疗冠心病的经验。[方法]分别从李七一教授对冠心病病因病机的认识和辨证与辨病相结合等方面论述李七一教授治疗经验,并以案例佐证。[结果]李七一教授认为本病病机多为＂气阴两虚、痰瘀痹阻＂,提倡治疗宜辨证辨病结合,标本兼顾。临证常以自拟冠心平为基本方加减治疗并取得比较好的临床效果。[结论]李七一教授采用标本兼顾,通痹补虚并施的综合疗法,补气阴、祛痰瘀,显著改善了冠心病心绞痛症状,延缓了冠心病病程的进展,提高了冠心病患者的生活质量,疗效明显。     

Partner Counselling and Referral Services (PCRS) for HIV in Armed Forces - Visiting a Blind Spot

The Indian armed forces have over 5000 cases of human immunodeficiency virus (HIV) infection since 1990. The spouses of the affected soldiers are at a constant risk of contracting infection if not informed of their husband''s HIV status. The onus of counselling the spouse has been delegated to the commanding officer (CO) of the soldier as per policy. The spouses usually reside at their hometown away from the soldier''s unit and bridging this “geographical discordance” and offering effective counselling becomes a tricky issue for the commanding officer (CO). This article examines the effectiveness of this strategy as practised in Indian armed forces.Key Words: HIV, Partner counseling     

石雕作业工人职业危害知晓度及防护行为调查

目的：了解石雕作业工人对职业危害的知晓度和防护行为。方法测定石雕加工过程中不同工艺流程的粉尘浓度和噪声强度,并随机抽取某石雕加工厂的60名男性石雕工人作为调查对象,采用自行设计的调查问卷对调查对象进行问卷调查。结果石雕作业环境中粉尘浓度最小为23.33 mg/m3,最大为125.33mg/m3,粒径低于5μm的呼吸性粉尘的构成比为66.0%~78.9%,噪声为90.0~104.0 dB（A）。工人对石雕作业的职业危害知晓度的调查显示,总体知晓度为18.33%~100.00%,其中对“粉尘可导致尘肺”的知晓度为38.33%,对“噪声可导致耳聋”的知晓度为70%;工人在石雕作业中针对危害因素采取的主动防护行为的调查,总体防护率为8.33%~76.67%,其中“工作时是否戴防尘口罩”防护率为8.33%,“工作中是否佩戴耳塞”的防护率为16.67%。结论石雕作业环境粉尘噪声为危害均较严重,工人对石雕作业危害知晓度较低,主动防护行为更低。     

Novel assays for quality evaluation of XueBiJing: Quality variability of a Chinese herbal injection for sepsis management

XueBiJing is an intravenous five-herb injection used to treat sepsis in China. The study aimed to develop a liquid chromatography-tandem mass spectrometry (LC-MS/MS)- or liquid chromatography-ultraviolet (LC-UV)-based assay for quality evaluation of XueBiJing. Assay development involved identifying marker constituents to make the assay therapeutically relevant and building a reliable one-point calibrator for monitoring the various analytes in parallel. Nine marker constituents from the five herbs were selected based on XueBiJing's chemical composition, pharmacokinetics, and pharmacodynamics. A selectivity test (for “similarity of response”) was developed to identify and minimize interference by non-target constituents. Then, an intercept test was developed to fulfill “linearity through zero” for each analyte (absolute ratio of intercept to C response, <2%). Using the newly developed assays, we analyzed samples from 33 batches of XueBiJing, manufactured over three years, and found small batch-to-batch variability in contents of the marker constituents (4.1%–14.8%), except for senkyunolide I (26.5%).     

老年多系统疾病患者中医证候要素初探?

目的初步探讨老年多系统疾病并见的证候要素特征。方法将124例老年多系统疾病患者病例资料按照格式化的信息录入SPSS软件表格,其中计数资料以原有数据表示,计量资料以1或0表示,所有的数据进行格式化设置;中医证候要素按照病性及病位分别录入,有则计为1,无则计为0;计数资料分析采用t检验,计量资料分析采用χ2检验。结果病性类证候要素分布:阴虚65.3%、气虚58.1%、火热41.1%、血瘀37.9%、气滞36.3%;病位类证候要素分布:脾54.8%、肾49.2%、肝24.2%、肺23.4%。80岁以上年龄组气虚证发生率达75%,80岁以下组气虚证发生率为50%。气虚证组平均年龄最大(77.65±9.98)岁,火热证组平均年龄偏低(73.14±8.44)岁;气虚证较无气虚证患者年龄偏大,火热证患者较无火热证患者年龄偏小,均有统计学意义,其他证候要素的有无与平均年龄间无明显统计学差异。痰证多系统疾病并见组的疾病数目最多(6.00±1.83),与无痰证组比较有统计学差异,其他证候要素的有无与老年患者多系统疾病数目之间无明显统计学差异。既往疾病中合并糖尿病、冠心病、慢性肺病的老年多系统疾病患者复合证素的数目更多,证候更加复杂;患有慢性胃炎的老年多系统疾病患者复合证素数目较少,证候相对简单。结论老年多系统疾病中医证候要素具有复杂性、不确定性、特殊性的特点。     

The acquisition of a Laboratory Information System

The Hinsdale Sanitarium and Hospital Pathology Department installed a Pathlab (The MEDLAB Company) Laboratory Information System (LIS) in October of 1977. Acquisition of the system was based upon a study, “Justification for a Laboratory Information System”, prepared in October 1976. This report presents findings on the evaluation of this system after 21/2 years of operation in relationship to the initial objectives developed in the justification study. The impact of the system on personnel (intra- and extradepartmental) as it relates to daily activities was also considered. The effectiveness of the system in contributing to the goals of improving the operation and management of the laboratory by enhancing communication of our services toward quality patient care was carefully studied through users' opinion surveys evaluation. The evaluation plan is developed by first describing the initial basic system, initial costs, and the impact of continuing costs to the institution (service, software modification, etc.). The department's problem areas were identified along with deviations from the justification expectations of the LIS. The conditions existing currently and attitudes of user personnel toward the system were surveyed at all levels of the institution. The survey revealed that 20 (87%) of 23 specific goals or expectations stated in the original justification report were satisfied. There was a partial achievement of 2 objectives (8.7%), and 1 (4.3%) was not achieved. The survey also revealed a net annual cost reduction of $128,756 as a result of the LIS. Payback period to recover the entire system's cost is estimated at 4.0 years. This includes all purchased hardware and software to date.     

浅谈俞根初《通俗伤寒论》的温病证治特点

[目的]总结俞根初《通俗伤寒论》的温病证治特点,以期为温病学研究注入新意。[方法]通过整理《通俗伤寒论》中有关“温病”的论述内容,并进行分析讨论。[结果]《通俗伤寒论》一书虽未大论温病之名,但其内容却可见温病之实,在温病的诊断、治疗及病后调护等方面都有自己独特的见解。[结论]《通俗伤寒论》虽以“伤寒”为名,贯穿始终,但后学当明此“伤寒”为广义之伤寒,为四时外感百病之总名也。本书既发皇仲景本意,又融汇了后世温病学医家之论以补仲景伤寒论温病之不足,体现了俞根初“寒温一统”的学术思想,开创了绍派伤寒研究之先。     

基于Kano模型的儿科药学教学质量提升的关键要素

  目的  运用Kano模型,探索儿科药学教学质量提升的关键要素。  方法  选取2021年10月至 2022年6月于昆明市儿童医院药剂科实习的学生为调查对象,开展7个维度50个要素的Kano 模型问卷调查,进行Kano模型分析。  结果  “明确的实习目标”、“药学相关法律法规”等10项为必备属性,占20%;“完善的带教计划”、“详细的轮转安排”等18项为期望属性,占36%;“儿童疾病特点课程”、“儿童药动药效学特点课程”等12项为魅力属性,占24%;“带教老师的学历、职称”、“儿科处方审核”等10项为无差异属性,占20%。  结论  为提高儿科药学教学质量,必须提供“明确的实习目标”、“药学相关法律法规”等10个必备属性要素,满足实习生的基本服务需求;优先满足“完善的带教计划”、“详细的轮转安排”等期望属性的18个要素,提高儿科药学教学满意度;不断改进魅力属性的12个要素,彰显儿科药学教学质量特色;适当追踪无差异属性的10个要素,适时削减和调整,减轻繁重的教学任务。根据研究结果对实习生教学进行优化,为培养优秀的儿科药师奠定基础。     

“Understanding” Medical School Curriculum Content Using KnowledgeMap

Objective: To describe the development and evaluation of computational tools to identify concepts within medical curricular documents, using information derived from the National Library of Medicine's Unified Medical Language System (UMLS). The long-term goal of the KnowledgeMap (KM) project is to provide faculty and students with an improved ability to develop, review, and integrate components of the medical school curriculum.Design: The KM concept identifier uses lexical resources partially derived from the UMLS (SPECIALIST lexicon and Metathesaurus), heuristic language processing techniques, and an empirical scoring algorithm. KM differentiates among potentially matching Metathesaurus concepts within a source document. The authors manually identified important “gold standard” biomedical concepts within selected medical school full-content lecture documents and used these documents to compare KM concept recognition with that of a known state-of-the-art “standard”—the National Library of Medicine's MetaMap program.Measurements: The number of “gold standard” concepts in each lecture document identified by either KM or MetaMap, and the cause of each failure or relative success in a random subset of documents.Results: For 4,281 “gold standard” concepts, MetaMap matched 78% and KM 82%. Precision for “gold standard” concepts was 85% for MetaMap and 89% for KM. The heuristics of KM accurately matched acronyms, concepts underspecified in the document, and ambiguous matches. The most frequent cause of matching failures was absence of target concepts from the UMLS Metathesaurus.Conclusion: The prototypic KM system provided an encouraging rate of concept extraction for representative medical curricular texts. Future versions of KM should be evaluated for their ability to allow administrators, lecturers, and students to navigate through the medical curriculum to locate redundancies, find interrelated information, and identify omissions. In addition, the ability of KM to meet specific, personal information needs should be assessed.     

急性脑梗死患者单病种质量控制总结

目的 总结海南省某院急性脑梗死患者单病种质量控制的执行及经验。方法 根据卫生部“第一批单病种质量控制指标”设计表格,将查阅的98例脑梗死患者病历资料记录在预先设计的表格上,以Excel对病案资料进行分析。结果 7.14%的患者在3 h内就诊;75.51%的患者在45min内完成头颅CT检查,35.71%患者在45 min内完成急诊血液检查;4.08%的患者进行溶栓治疗;所有入院脑梗死患者均得到抗栓治疗;58.16%的患者进行了康复治疗;68.37%的患者治疗有效;平均住院日14.18 d,平均住院总费用16 358元,平均药物比例49.54%。结论 某院对脑梗死患者的诊疗基本符合单病种质量控制指标要求。     

自身免疫性脑炎相关癫痫对儿童认知功能影响

目的：探讨自身免疫性脑炎相关癫痫对儿童认知功能的影响。方法选择2010年2月-2014年2月新乡市中心医院（以下简称“我院”）收治的自身免疫性脑炎引发癫痫患儿40例为病例组,序贯选择同期在我院行常规体检的健康儿童40名作为对照组。采用中国韦氏儿童智力量表及Halstead-Reita（H-R）儿童神经心理成套测验检测并比较两组儿童智商（IQ）及脑病损程度（DQ）。同时,收集病例组患儿一般情况,采用Logistic回归分析自身免疫性脑炎引发癫痫患儿智力的影响因素。结果病例组患儿智力主要处于低于平常（32.5%）及边界（40.0豫）水平,而对照组主要为平常（85.0豫）水平;病例组IQ值[（72.7±21.8）分]低于对照组[（98.2±8.7）分],差异有统计学意义（P〈0.05）。脑病损程度评价结果显示,病例组患儿DQ一般处于中度（62.5%）,而对照组主要处于正常脑功能（95.0%）水平;两组DQ值比较,病例组[（0.51±0.13）]高于对照组[（0.07±0.02）],差异有统计学意义（P〈0.05）。Logistic回归分析结果显示,发病频率、病程、抗癫痫药种类与自身免疫性脑炎引发癫痫患儿智力相关,且均为危险因素（OR 〉1,P〈0.05）。结论自身免疫性脑炎相关癫痫可降低儿童认知功能,其发生可能与发病频率、病程、抗癫痫药种类相关。     

范炳华教授抱颈提胸法治疗胸椎小关节紊乱症经验

[目的]探究范炳华教授抱颈提胸法治疗胸椎小关节紊乱症的临床经验。[方法]对范炳华教授临床治疗胸椎小关节紊乱症的理论及方法进行整理与分析。[结果]范炳华教授对诊疗脊柱相关疾病提出“症因相关”和“有错必纠”理论,基于此理论首创了“抱颈提胸法治疗胸椎小关节紊乱症诊疗技术”,这项技术在临床上取得了比较好的效果。[结论]范炳华教授治疗胸椎小关节紊乱症的理论有较大创新,其抱颈提胸法治疗胸椎小关节紊乱症效果显著,临床上值得推广。     

Health care of elderly military veteran cadres

With the development of our economy and the improvement of people's living standard, the person's life span has been greatly prolonged. Accordingly, there are more and more requirements on health care. The retired cadres in military sanatoriums are heroes in the revolution of our country, and are treasures to our country. However, with the increase of their age, various kinds of diseases have become the main problem bothering the cadres. At present, our party and government are very concerned about veteran cadres. Hence, the medical workers are facing a new problem and challenge as to how to prevent the diseases and improve the medical treatment, and health care for military veteran cadres. We insist on “the people-oriented service and treatment” and try hard to improve service on “prevention, medical care, rehabilitation, and health care”. In this way, they may suffer from less pain of diseases, have better prognosis, enjoy happier life, and their disease prevalence and mortality may be lower.     

A user-oriented computer interface for health professionals

One of the characteristics of medical information systems, which have been most successful in being integrated into the patient care process, is a cordial type of human interface that embodies a form of input/output generator software coupled with a terminal device that facilitates the selection of input data elements from lists or “menus.” This paper reviews the nature of this involvement in patient care and describes this interface in greater detail, illustrating its intrinsic value as an appropriate human-computer interface for use by medical professionals. As with any successful management information system, a medical information system's use will ultimately be a function of the ease with which it can be incorporated into the decision-maker's (manager's) daily activity. Watson has shown that physicians, after a long orientation period, are willing to use a CRT device that presents information in a convenient manner and allows the input of new data by means of selections from tree-structured lists instead of typing. A technique more natural than the use of a light pen is to simply touch a selection with one's finger. For this reason, our hardware terminal device consists of a 15-inch diagonal CRT with 24 80-character lines activated by the touch of a finger, which passes a direct digital signal to the controlling software for appropriate action. The accompanying software described is best characterized as a nonprocedural “higher level language,” or a “meta language”, designed specifically to process frames of CRT information in such a way as to eliminate much of the inevitable programming modification process. Such a capability takes on the characteristics of a “tool” by which the non-computer-oriented professional actually creates application programs that best serve his own needs. The user is able to concentrate on thewhat of using the computer rather than thehow. The software automatically determines thehow. Its use is not limited to just the presentation of the frames but also involves a method of allowing the user to link these with each other, and with parameter tables in a user-logical fashion. In addition, the frames can be readily modified. The selected parameter becomes data that the application program processes. By means of such an optimum combination of software and hardware, the user exerts significant control over that portion of the system that he interfaces with most directly. This approach also offers considerable flexibility in the design of a system so that it can be changed as the user's needs and expectations grow. The need to reflect the user's requirements in input sequence and method of presentation has been shown to be of particular importance in the design of systems that are expected to be used by health professionals. The details of the software supporting such a technique have been described.     

军校学员干部心理健康状况的比较研究

目的：了解军校学员干部的心理健康状况。方法：用SCL－90量表对分布在国内19个省、自治区和直辖市的57所各类军队高校的12000名学员进行测试。结果：（1）普校学生干部更具有强迫性和恐惧性，军校学员干部人际敏感性、敌对性、偏执性和精神病性更强；（2）军校学员干部心理健康水平高于非学员干部；（3）军校学员干部与非学员干部之间的心理健康水平差异具体表现在：男生组大于女生组；本科组大于专科组；工程技术院校组大于医学院校组。对以上差距的原因进行了初步结论。结论：军校学员干部与普校学生干部心理健康状况各有特点；军校学员干部心理健康状况一般优于非学员干部。应充分发挥学员干部在军校心理教育中的骨干作用，注重对学员、本科学员、工程技术院校学员中非干部的心理辅导.     

重度溃疡性结肠炎合并卡波西肉瘤1例并文献综述

卡波西肉瘤是与人类疱疹病毒-8感染相关的血管增生性疾病,多见于免疫功能低下的人群,服用免疫抑制剂或糖皮质激素可能是导致人类免疫缺陷病毒阴性患者发生卡波西肉瘤的原因之一.本文报告1例接受糖皮质激素治疗的重度溃疡性结肠炎患者发生的皮肤卡波西肉瘤,并进行文献综述.患者男性,64岁,诊断溃疡性结肠炎1年,因重度溃疡性结肠炎发作接受激素治疗,4个多月后患者躯干,四肢出现多发暗紫色丘疹,结节,质地坚硬,下肢为著,经皮肤组织活检病理学检查提示皮肤卡波西肉瘤,免疫组织化学检测显示人类疱疹病毒-8染色阳性,经停用糖皮质激素,并行化疗后病情缓解.分别在万方数据知识服务平台和中国知网以"卡波西肉瘤"和"炎症性肠病"为检索词检索相关文献,未检索到中文文献.在PubMed上以("ulcerative colitis" OR "Crohn's disease" OR "inflammatory bowel disease") AND (Kaposi sarcoma)为检索词检索,共检索到38篇英文文献,另从相关文献中补充,共检索到25例与炎症性肠病相关的卡波西肉瘤,连同本例的26例患者中,男性占绝大多数(80.8%,21/26).平均年龄(51.1±16.4)岁,溃疡性结肠炎20例,克罗恩病6例.22例患者报告了人类免疫缺陷病毒检测结果,均为阴性.所有患者均使用过至少一种免疫功能调节剂,包括糖皮质激素,硫唑嘌呤/6-巯基嘌呤,氨甲喋呤,环孢菌素,抗肿瘤坏死因子α单克隆抗体.14例报告人疱疹病毒-8结果的患者中,13例阳性,1例阴性.病变单纯累及肠道者18例,单纯累及皮肤者3例,5例患者同时累及皮肤和肠道.25例报告了治疗方案,其中3例患者仅停用免疫调节剂,1例患者停药后接受放疗,1例患者停药后接受化疗,20例患者接受手术治疗,总体而言预后良好.炎症性肠病相关的卡波西肉瘤往往与使用激素,免疫抑制剂和生物制剂有关.鉴别卡波西肉瘤,炎症性肠病相关和药物相关的皮肤表现至关重要.此外,在诊疗过程中重视多学科团队的协同作用,能够更早,更准确地对少见病例做出诊断和治疗.     

重度溃疡性结肠炎合并卡波西肉瘤1例并文献综述

卡波西肉瘤是与人类疱疹病毒-8感染相关的血管增生性疾病,多见于免疫功能低下的人群,服用免疫抑制剂或糖皮质激素可能是导致人类免疫缺陷病毒阴性患者发生卡波西肉瘤的原因之一.本文报告1例接受糖皮质激素治疗的重度溃疡性结肠炎患者发生的皮肤卡波西肉瘤,并进行文献综述.患者男性,64岁,诊断溃疡性结肠炎1年,因重度溃疡性结肠炎发作接受激素治疗,4个多月后患者躯干,四肢出现多发暗紫色丘疹,结节,质地坚硬,下肢为著,经皮肤组织活检病理学检查提示皮肤卡波西肉瘤,免疫组织化学检测显示人类疱疹病毒-8染色阳性,经停用糖皮质激素,并行化疗后病情缓解.分别在万方数据知识服务平台和中国知网以"卡波西肉瘤"和"炎症性肠病"为检索词检索相关文献,未检索到中文文献.在PubMed上以("ulcerative colitis" OR "Crohn's disease" OR "inflammatory bowel disease") AND (Kaposi sarcoma)为检索词检索,共检索到38篇英文文献,另从相关文献中补充,共检索到25例与炎症性肠病相关的卡波西肉瘤,连同本例的26例患者中,男性占绝大多数(80.8%,21/26).平均年龄(51.1±16.4)岁,溃疡性结肠炎20例,克罗恩病6例.22例患者报告了人类免疫缺陷病毒检测结果,均为阴性.所有患者均使用过至少一种免疫功能调节剂,包括糖皮质激素,硫唑嘌呤/6-巯基嘌呤,氨甲喋呤,环孢菌素,抗肿瘤坏死因子α单克隆抗体.14例报告人疱疹病毒-8结果的患者中,13例阳性,1例阴性.病变单纯累及肠道者18例,单纯累及皮肤者3例,5例患者同时累及皮肤和肠道.25例报告了治疗方案,其中3例患者仅停用免疫调节剂,1例患者停药后接受放疗,1例患者停药后接受化疗,20例患者接受手术治疗,总体而言预后良好.炎症性肠病相关的卡波西肉瘤往往与使用激素,免疫抑制剂和生物制剂有关.鉴别卡波西肉瘤,炎症性肠病相关和药物相关的皮肤表现至关重要.此外,在诊疗过程中重视多学科团队的协同作用,能够更早,更准确地对少见病例做出诊断和治疗.     

白塞氏病并复发性肺动脉瘤误诊一例并文献复习

目的 加强对白塞病合并肺动脉瘤的临床、影像、病理特点的认识, 提高对白塞病合并肺动脉瘤的早期认识和治疗水平。方法 分析2012 年7 月至2013 年3 月收治的1 例白塞病并复发性肺动脉瘤患者临床资料及诊治经过, 并结合相关文献进行复习。截止2013 年8 月, 以Behcet’sdisease、pulmonary artery aneurysm为检索词, 在PubMed 检索系统进行检索, 在万方数据库中以白塞病、肺动脉瘤为检索词进行检索。结果 反复咯血为该例白塞病合并肺动脉瘤患者主要的临床特点,影像学表现为肺门影增大, 肺血管造影三维重建显示为相应病灶部位肺动脉瘤形成, 并伴有原位血栓形成。患者第1 次入院在胸外科仅诊断为肺动脉瘤, 并行肺叶切除术, 术后病理示肺动脉瘤并血栓形成; 咯血复发, 第2 次入院诊断为肺血栓栓塞症, 予抗凝治疗; 咯血再发, 第3 次入院诊断为白塞病并肺动脉瘤, 予糖皮质激素和免疫抑制剂联合治疗, 咯血明显改善。结论 白塞病合并肺血管病变的典型特点为肺动脉瘤形成, 咯血为主要的临床症状, 血管造影能明确血管瘤的部位, 糖皮质激素加免疫抑制剂是治疗白塞病合并肺动脉瘤的主要手段。     

Implementation of a Patient Charting System: Challenges Encountered and Tactics Adopted in a Burn Center

The rapid movement of information technologies into health care organizations has raised managerial concern regarding the capability of today's institutions to satisfactorily manage their introduction. Indeed, several health care institutions have consumed huge amounts of money and frustrated countless people in wasted information systems implementation efforts. Unfortunately, there are no easy answers as to why so many health informatics projects are not more successful. In this light, the aim of this study is to provide a deeper understanding of how clinical information systems are being implemented by emphasizing research efforts on the dynamic nature of the process, that is, the “how” and “why” of what happened. Using a case study methodology, we examined the implementation of a patient charting system in the Burn Center of a large, not-for-profit, teaching hospital. Based on an in-depth examination of this implementation, several insights are offered to those who have responsibility for managing complex and risky clinical information system implementation projects.     

Use of personal computing technology by deaf-blind individuals

This paper describes a system that enables deaf-blind people to work with microcomputers. The system utilizes the International Morse Code as a general communication medium. The deaf-blind person “hears” Morse code via a vibrotactile device to “see” the computer's screen. This technique enables deaf-blind individuals to receive immediate feedback from their typing and to scan the screen. This makes it possible for them to use the keyboard and screen in the same way as do seeing persons. A side benefit is that it provides a means for deaf-blind people to communicate with the sighted through a common medium: The sighted person can see the screen while the deaf-blind person feels it. Hardware cost to equip a standard personal computer with this interface is negligible. Vibrotactile Morse code is particularly viable because it can be adapted for the individual's particular tactile sensitivities. Morse-encoded tactile communication fits well in a social facilitation context for learning. It is technologically simple and standard. This work can significantly improve the quality of life for deaf-blind individuals because it provides new opportunities for communication and vocation.