The use of CAM in a New Zealand-based general practice: a multiple case-study

OBJECTIVE: To explore the factors which underpin the healthcare consumers' decision-making to use CAM in the primary setting. DESIGN: An explorative, multiple case-study of seven convenience-sampled participants where in-depth, semi-structured interviews were employed. RESULTS: The findings showed that participants would continue to utilise CAM, even where CAM had no scientific evidence. The participants believed that CAM should be integrated into mainstream healthcare service delivery. CONCLUSIONS: There are few international studies that have reported on the utilisation and prevalence of CAM within the General Practice (GP) or clinic setting. The reasons why clients select specific CAM therapies, where they are offered in these settings, remain unclear. This study, however, casts further light on this matter.     

Efficacy and Safety of First-Line Immunotherapy Combinations for Advanced NSCLC: A Systematic Review and Network Meta-Analysis

IntroductionA series of randomized controlled trials have investigated different first-line immunotherapy combinations, but the optimal combination strategy is yet to be established.MethodsWe performed a systematic review and Bayesian network meta-analysis by retrieving relevant literature from PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, and major international conferences. We included published and gray sources of randomized clinical trials comparing immunotherapy combinations with other treatments as first-line treatments for patients with advanced NSCLC. This study was registered in the Prospective Register of Systematic Reviews (CRD42020210501) to ensure transparency.ResultsWe analyzed a total of 16 studies involving 8278 patients and including 10 immunotherapy combinations. For patients without programmed death-ligand 1 (PD-L1) selection, pembrolizumab plus chemotherapy was found to be comparable with sintilimab plus chemotherapy in providing the best overall survival (OS) benefit (hazard ratio = 0.96, 95% confidence interval [CI]: 0.72–1.29). Furthermore, atezolizumab plus bevacizumab plus chemotherapy seemed to provide the best progression-free survival (hazard ratio = 0.45, 95% CI: 0.36–0.55) and the best objective response rate (OR = 0.23, 95% CI: 0.12–0.42). Subgroup analysis by PD-L1 suggested that nivolumab plus ipilimumab plus chemotherapy was associated with the best OS in patients with PD-L1 less than 1% and that pembrolizumab plus chemotherapy was associated with the best OS in patients with PD-L1 greater than or equal to 1%. Pembrolizumab and sintilimab were associated with relatively fewer grade greater than or equal to 3 adverse events when compared with other immunotherapies combined with chemotherapy.ConclusionsOur results suggest that antiprogrammed death-1 combinations are associated with potentially higher survival outcomes than anti–PD-L1 combinations with comparable safety profiles. Moreover, pem-chemo and nivo-ipi-chemo seem to be superior first-line immunotherapy combinations for patients with advanced NSCLC with positive and negative PD-L1 expression, respectively. Although atezo-beva-chemo treatment provided the best progression-free survival and objective response rate, the addition of chemotherapy to immunotherapy would increase the toxicity, especially when antiangiogenesis drugs are simultaneously added.     

新医改背景下医院软实力构建的路径探讨

软实力是医院综合实力的重要组成部分,主要包括医院的价值观念、文化感召力、医疗服务水平、品牌影响力、管理水平等。新医改的推行是为了解决群众“看病难,看病贵”的问题,使医疗回归公益性,增强医院的吸引力。医院应该树立正确的价值观、塑造优良文化、完善医疗服务体系、加强医院品牌建设、改进医院管理模式,加强医院软实力建设。     

新疆某高等医学院校少数民族医学生心理健康现状研究

目的：探讨新疆某高等医学院校不同专业少数民族医学生心理健康状况及其影响因素。方法随机抽取新疆某高等医学院校在校329名少数民族医学生,采用精神症状自评量表 SCL-90对不同专业学生的健康状况进行测评,比较不同性别、不同专业少数民族医学生心理健康的差异。结果少数民族男、女生躯体化、强迫、恐怖、抑郁、焦虑和其他因子比较差异有统计学意义（P ＜0．01）;不同专业少数民族医学生 SCL-90总分及各因子得分差异有统计学意义（P ＜0．05-0．01）,维吾尔医学专业学生 SCL-90各因子得分高于其他专业学生。结论高等医学院校应根据少数民族医学生心理健康状况的影响因素采取有针对性的心理健康教育工作,预防心理疾患,有效地帮助学生解决心理问题,从而提高少数民族医学生整体的心理健康水平。     

Importance of Manually Entering Blood Glucose Readings When Wireless-Compatible Meters Are Not Being Used with an Insulin Pump

Background:

The objective was to determine if there were differences in blood glucose monitoring (BGM) data downloaded from insulin pumps of patients who use meters that wirelessly transmit data to their insulin pumps (i.e., wireless group) and those who do not (i.e., nonwireless group).

Methods:

Blood glucose monitoring data were downloaded from the meters and insulin pumps of 47 children and adolescents with type 1 diabetes mellitus. Independent and paired t tests compared BGM data downloaded from meters and BGM data downloaded from insulin pumps.

Results:

There were significant differences in BGM data downloaded from the insulin pumps of patients using wireless meters compared to those using nonwireless meters. Wireless patients appeared to engage in more BGM, had more low and in-range BG readings and fewer very high BG readingss than nonwireless patients. However, a comparison of BGM data downloaded from meters and insulin pumps of nonwireless patients indicated that their insulin pump data significantly underestimated the number of BGM readings conducted, as well as the number of low and in-range readings, while overestimating the number of very high BGM readings.

Conclusions:

Because patients who use nonwireless-compatible meters do not manually enter their low and in-range BGM readings into the insulin pump, BGM data downloaded only from pumps may provide an incomplete representation of BGM frequency or results. It is recommended that patients use meters that directly communicate with pumps or perform bolus calculations. Patients should be educated about the importance of manually entering all BGM readings if they do not use a wireless-compatible meter with their insulin pump.     

网络成瘾大学生计算机化心理干预的个案研究

目的:探索计算机化的在线心理干预在大学生网络成瘾中的效果。方法:开发一套计算机化的大学生网络成瘾在线干预系统"健康上网自助中心"。该系统包括"准备开始"、"自我了解"、"新的目标"和"走向成功"四个模块。采用个案研究的方法,通过量化的效果评估指标和质性的访谈对三名大学生网络成瘾个案在应用计算机化心理干预方案后的效果进行分析。结果:干预能够明显降低部分被试的上网时间和网络成瘾程度,提高其上网时间的合理用途比例和上网满意度,但仍有个别被试未能得到有效改变。访谈结果表明干预方案能够有效地提高个体对于上网问题的觉察,增强其改变的意愿,并从方案中学到改变的方法。结论:计算机化的在线干预系统作为一种网络成瘾干预的新途径具有成本-效益的优势,实际应用时可与传统方法互补。     

在军队医学院校开展医学美学教学的探讨

医务人员的美学素养高低直接影响着疾病防治的质量。军队医学院校担负着为军队培养高素质新型军事医学人才的重任,在军队医学院校开展医学美学教育,是适应医学发展和军队现代化建设的需要,也是全面提高军队医学生综合素质的需要。结合在军队医学院校开展医学美学教学的实践,对医学美学的教学意义、教学内容及教学方法进行了探讨。