Care,agency and criminality: Making sense of authorised extended distribution in the accounts of key stakeholders

IntroductionOne of the current harm reduction debates in Australia concerns the legalisation of the extended distribution of sterile needles and syringes, a practice that is currently unlawful in most Australian settings.MethodsWe used data from a unique pilot program of authorised extended distribution to document the opinions held by 22 key stakeholders -service staff, drug users and police - about the risks and benefits of authorisation, and to analyse the ways in which drug users were understood within these.ResultsOpinions were strongly in favour of authorising extended distribution, based on the belief that this would reduce the transmission of hepatitis C. However, stakeholders also identified that distributors risked attention from police and some noted that the consequences of this would be borne by distributors themselves and not the services that support them. These opinions rested on specific assumptions about people who inject, some of which reflect negative constructions of drug users as a source of danger to the public or as helpless ‘addicts’ with little control over their risk reduction. But there were other representations that positioned drug users more positively as responsible agents with a strong duty of care to themselves and others whose choices are often limited by inadequate service structures. Staff participants drew on these understandings in careful and strategic ways, arguing for the rationality and expertise of drug users, while also problematizing the individualised approach that any form of authorised extended distribution might take.ConclusionWe argue that localised and incremental changes such as those that took place to support this pilot project, and the extensive support for extended distribution among stakeholders in this study including police, creates meaningful opportunities to think about extended distribution differently, which can in turn support conditions for future discussions about legislative change.     

经尿道膀胱肿瘤电切术中闭孔神经反射的临床研究

目的探讨利用针形电极诱发神经反射、弧形切割并结合肿瘤基底部闭孔神经阻滞在经尿道膀胱肿瘤电切术（TURBT）中预防闭孔神经反射的效果。方法 2008年4月至2010年10月,82例膀胱肿瘤患者在椎管麻醉下行TURBT,对针形电极弧形切割诱发的闭孔神经反射采用肿瘤基底部闭孔神经阻滞。结果术中针形电极诱发闭孔神经反射27例,通过肿瘤基底部深肌层水平方向浸润注射利多卡因后闭孔神经反射消失。27例均顺利完成手术,未发现膀胱壁破裂、严重出血等并发症。结论针形电极弧形切割结合肿瘤基底部闭孔神经阻滞可有效预防TURBT术中闭孔神经反射,降低膀胱穿孔及严重出血的发生率。该方法简便易行,具有一定临床应用价值。     

针吸型肌肉活检联合免疫荧光在假肥大型肌营养不良诊断中的应用

目的 探讨应用针吸型肌肉活检结合免疫荧光染色诊断假肥大型肌营养不良症的应用价值及意义。方法 应用针吸型活检术取533例假肥大型肌营养不良症患者(415例DMD, 118例BMD)的肌组织,采用HE染色观察肌细胞形态,免疫荧光染色技术检测抗肌营养不良蛋白, 以2 例正常人的肌细胞作为对照。结果 正常人肌细胞膜上抗肌萎缩蛋白染色阳性,可见沿肌细胞膜分布完整的荧光条带; DMD 患者肌膜染色阴性,肌细胞膜完全不显色; BM D患者染色弱阳性, 可见沿肌细胞膜分布的间断斑片状荧光带。结论 应用针吸型活检术联合免疫荧光染色可以有效的检测抗肌营养不良蛋白的表达, 有助于DMD 和BMD 的确诊及鉴别诊断。     

关于提高经皮胸穿针吸活检技术效果的初步探讨

本文分析了63例经皮胸穿针吸活检资料.细胞学标本获取率为96.9%,组织学标本获取率达62.5%,肺癌的针吸活检阳性率(敏感性)为92.5%,活检诊断肺癌的准确率(特异性)为100%,气胸发生率10.8%。认为应用适当粗的(18～17.5gauge)活检针和同轴穿刺针,采取透视与 CT 两种导向手段结合选用的方法,注意穿刺抽吸的关键性手法,会极有助于提高穿刺成功率和组织学标本获取率,而并发症发生率不高。     

16G粗针超声导向穿刺活检对中央型肺肿块的诊断价值

目的评价16G粗针对中央型肺肿块(CTPM)行超声引导经皮穿刺肺活检(US-PCNB)的诊断价值及安全性.方法对31例采用16G针行US-PCNB病例资料进行回顾性分析.结果31例中29例取材成功,5例发生轻微并发症.结论对于超声能够显示的CTPM,采用16G粗针行US-PCNB组织标本满意,取材成功率高,是一种比较安全的活检方法.     

Treatment of 72 cases of sciatica by needle warming therapy plus Tuina

取环跳和居髎为主穴,并根据疼痛特点取配穴,针刺得气后温针.起针后配合推拿治疗.应用此法治疗了72例坐骨神经痛患者,痊愈53例,显效13例,有效4例,无效2例,总有效率为97.2%.     

针刀结合针刺治疗中风后痉挛性瘫痪的研究现状

中风（脑卒中）是临床常见病、多发病,其发病率和致残率都很高,在脑卒中幸存者中有3／4留有残疾,预防残疾的形成并减轻其影响是脑卒中康复治疗的中心内容。痉挛性瘫痪是脑卒中后严重的后遗症,肢体痉挛状态成为后遗症中最棘手的问题,是脑卒中康复的核心和难点。能否有效地抑制痉挛,进而诱发部分分离运动,是提高康复效果的关键。因此,寻找有效地缓解脑卒中后肢体痉挛状态的治疗方法为当前医学界的重要课题之一。本文综述了中风后痉挛性瘫痪近年针刀、针刺治疗研究进展,希望能为临床治疗提供更好的帮助。     

Treatment of Alopecia Areata with Plum-blossom Needles plus Moxibustion： A Report of 53 Cases

用梅花针叩刺斑秃区,后用艾条在患处温灸,治疗斑秃患者53例,并以口服薄芝片为对照治疗54例.3个疗程后前者总有效率为96.2%,后者为70.4%,两组疗效差异有统计意义.     

套管式长针深层软组织松解术的临床特点与应用

套管式长针属古代“九针”中“长针”的范畴,可祛深邪久痹,通过松解神经根,刺激相应区域的肌肉,以调节机体生理功能。套管式长针深层软组织松解术依据中医学经筋理论和以痛为腧理论,属于古代针刺中的“经刺”“报刺”“恢刺”及“合谷刺”等范畴。通过针刺疏散瘀滞之气血,以通治痛。套管式长针弥补普通毫针刺激量小及松解类针具风险较大的不足,兼具针刺调衡、提插松解的双重作用。套管式长针深层软组织松解术对深层肌纤维紧张所导致的各类难治性疼痛类疾病疗效明显,为临床医生提供了新的治疗方式,具有较高的推广及应用价值。