Efficacy of self-help manuals for anxiety disorders in primary care: a systematic review

OBJECTIVE: The purpose of this study was to review effectiveness studies of self-help manuals for anxiety disorders in primary care. METHODS: A systematic review of six identified randomized controlled trials was carried out. In addition to outcome, the articles were coded on quality variables. RESULTS: The studies included differed with respect to the methodological quality, measurements used and size of the study population. Despite these differences, global results suggest that a self-help manual is an effective treatment possibility for primary care patients with anxiety disorders. The more time that was spent on guidance on the use of the self-help manual the greater was its effectiveness. CONCLUSION: Treatment with a self-help manual for anxiety disorders may be effective in primary care. Data are lacking on the feasibility and cost-effectiveness of these manuals.     

Clinical ophthalmology instruction for medical students

A ten-day ophthalmology clerkship for third-year medical students is described. The curriculum, detailed in a day-by-day syllabus, sets specific student goals, evaluates attainment of the goals by a pre-post test, utilizes a student-oriented study guide keyed to major textbooks as core material with slide-tape and videotape supplements, and emphasizes daily supervised patient examinations. Constant modification of the clerkship on the basis of student assessment has sustained it as a popular workable clinical experience.     

Shape of the relapse curve and long-term abstinence among untreated smokers

Objective To describe the relapse curve and rate of long‐term prolonged abstinence among smokers who try to quit without treatment. Method Systematic literature review. Data sources Cochrane Reviews, Dissertation Abstracts, Excerpt Medica, Medline, Psych Abstracts and US Center for Disease Control databases plus bibliographies of articles and requests of scientists. Study selection Prospective studies of self‐quitters or studies that included a no‐treatment control group. Data extraction Two reviewers independently extracted data in a non‐blind manner. Data synthesis The number of studies was too small and the data too heterogeneous for meta‐analysis or other statistical techniques. Results There is a paucity of studies reporting relapse curves of self‐quitters. The existing eight relapse curves from two studies of self‐quitters and five no‐treatment control groups indicate most relapse occurs in the first 8 days. These relapse curves were heterogeneous even when the final outcome was made similar. In terms of prolonged abstinence rates, a prior summary of 10 self‐quitting studies, two other studies of self‐quitters and three no‐treatment control groups indicate 3–5% of self‐quitters achieve prolonged abstinence for 6–12 month after a given quit attempt. Conclusions More reports of relapse curves of self‐quitters are needed. Smoking cessation interventions should focus on the first week of abstinence. Interventions that produce abstinence rates of 5–10% may be effective. Cessation studies should report relapse curves.     

乌鲁木齐市城市济困医院医疗服务状况调查

目的通过对乌鲁木齐市12家济困医院医疗现状的调查和研究，了解目前济困医院的发展情况，并针对存在的问题提出相应的改进意见。方法对乌鲁木齐市12家济困医院的医疗服务情况进行现状研究，并对获得的资料进行统计描述。结果对济困医院的医疗服务现状、人力资源、业务收入、医疗设施、对贫困人群的优惠情况进行描述，从中发现一些存在的优点和存在的问题。结论济困医院虽然对解决贫困人群，“五保户”人群“看病贵，看病难”的问题具有较好的实际意义。但是他们目前急需解决的就是人才问题与医疗设备的改进和增加的问题。     

Decision aids for familial breast cancer: exploring women''s views using focus groups

BACKGROUND: There is increasing need for accessible information about familial breast cancer for those facing complex decisions around genetic testing, screening and treatment. Information currently includes leaflets and computerized decision aids, offering interactive interfaces to clarify complex choices. OBJECTIVE: Exploration of users' views and reactions to three decision aids for genetic testing for breast cancer using focus groups. SETTING: A regional cancer genetics service in the UK. PARTICIPANTS: Women over 18 years of age who had been referred to Cancer Genetics Service for Wales (CGSW) and had received a risk assessment for familial breast cancer. METHODS: Qualitative study involving one pilot and six extended focus groups with 39 women at high, moderate and population risk. Two CD-ROMs and one paper-based aid evaluated for: clarity of presentation, ease of handling, emotive response, increased knowledge and greater informed choice. RESULTS: Women reported variable preferences for different types of decision aids and mixed emotions, indicating the sensitivity of raising issues in decision support tools, lack of consensus over the most appropriate aid and no systematic differences between risk groups. Women remarked that aids increased their knowledge, particularly about breast cancer genes and risk and wanted a decision aid designed within the context of the NHS, in both paper-based and CD-ROM formats from an authoritative source. Mixed views about presentation styles suggest decision aids would be most effective with a user-selected range of formats. CONCLUSIONS: Decision aid development should be informed by users and should meet the needs of those concerned about their risk of breast cancer in the UK. Without such aids, patients will continue to search for information from a variety of sources of varying quality.     

A lecture on lecturing

There are major differences between a lecture and a paper for publication. Often the printed word is spoken at meetings, a kind of compulsive public reading which has robbed the lecturer of the chance of oratory and the audience of a little enjoyment. The simple fact is that although doctors read aloud badly (actors do this far better) most can learn to speak spontaneolsly and with animation; but this requires time and effort, both of which are donated in a miserly way. The successful lecturer is generous and considerate of his audience--a rare being at medical meetings.     

全自动程序切换助听器技术临床应用的效果评估

目的评估全自动程序切换技术(Liaison Full Shell)助听器在临床中对听力损失患者的康复效果。方法本临床测试是通过助听器使用者的日常经历与临床客观验证来证明被测助听器的效果,采用前后对照试验法,以此保证测试结果的可靠性及客观性。本临床测试是对试验用助听器配戴前后的听力水平和言语理解度做出比较。在配戴试验用助听器前。测出受试者每个人的听力损失类型及程度．言语理解度．不舒适阈,然后听力师根据病人的情况进行验配与调试,每一位受试者配戴每一种试验用助听器不少于3周时间,其间受试者有任何的不适。都应接受听力师的调试。若调试没有效果将中止临床试验。在配戴试验用助听器后,用声场测试受试者配戴助听器后的听阈值,用2cc3耦合腔和真耳测量客观方法验证助听效果。结果在20倒中,平均听阈值提高到35dBHL,在真耳测试中全部达到目标增益和最大输出。在声场测试中。平均功能增益达到60dB HL。结论助听前和助听后的听力阈值明显改善,具有显著性意义。     

听障老年人的助听器验配

目的探讨听障老年人助听器验配的方法和技巧。方法对112名受试者进行跟踪随访，客观记录他们使用助听器的感受，分析助听器验配方法和技巧对助听器效果的影响。结果老年人的行为认知和听觉反应能力极大地左右着助听器的配戴效果；气骨导听阈，舒适阈，不适阈、言语识别阈的检查和使用对于老年人助听器验配十分重要；低频部分的听力补偿要低于目标值，高频部分要略高于目标增益值；老年人助听器配戴的适应期平均为3个月；双耳配戴的效果明显优于单耳。结论完全按照助听器验配软件设计的程序给老年人验配助听器很难达到理想的效果，而验配经验、技巧和验配后的适应性训练在其中发挥着巨大的作用。     

伴有重振听力障碍者的助听器验配

目的探讨伴有重振的听力障碍者助听器验配方法。方法对于伴有重振的听力障碍者在选配助听器时尽可能选择压缩线路的数字助听器,或者是具备自动增益功能的助听器;在助听器的调节时应注重最大声输出的限制,并适当降低听觉动态范围较窄的个别频率的增益;此外助听器的适应性训练和随诊调节助听器也是验配成功的重要环节。结果92%的患者获得了满意的配戴效果。结论伴有重振的听力障碍者验配助听器要采用适当的方法。