郭为汀运用自拟方治疗痹证经验

郭为汀老师将痹证分为风痹、寒痹、湿痹、湿热痹、气血肝肾亏虚痹、痰瘀痹阻痹六大型,应用自拟经验方,分别以祛风除痹汤、散寒除痹汤、化湿除痹汤、清热利湿宣痹汤、养血补肾除痹汤、龙凤蠲痹汤结合食疗外用方,疗效显著。     

浅谈老干部思想政治工作主体与客体的关系

本文探讨了老干部思想政治工作主体和客体关系问题;简析了思想政治工作主客体的内涵及相互关系;提出了开展老干部思想政治工作就要强化客体的能动作用。具体表现在以下三个方面:①客体主动配合主体实施教育管理计划;②客体以自己的威望、素质和能力影响思想政治工作主体;③客体自觉地把自身的思想转化为行动,用正确的思想指导实践。实践证明,这对做好老干部思想政治工作具有现实的指导意义。     

南通市离休干部医疗服务利用分析

目的:对南通市参加医疗保险的离休干部医疗服务利用量与费用进行分析,为科学、有效实施离休干部医疗保险提供依据.方法:用SPSS11.0分析2000年至2002年医疗实际数据.结果:(1)门诊利用率90%以上,年人均门诊23次,住院利用率42.9%～48.2%,年人均住院4.5次,平均住院日46～42天;(2)年人均医疗费17 002.9～22 521.4元,年平均增长15%,住院费用增速快于门诊费用.离休干部医疗服务利用各项指标均远高于同期70岁以上参保者.建议:南通市离休干部存在与当前国力不相符的过度利用.建议建立稳定可靠的基金筹集渠道,并引入适当的费用控制机制.     

The distribution of parotid gland neoplasms in a veteran population

ObjectiveSalivary gland tumors account for 6%–8% of head and neck neoplasms with the parotid gland as the most common primary site. Pleomorphic adenomas (PA) are considered the most common benign parotid gland neoplasms, followed by Warthin tumors (WT). The goal of this study was to investigate the distribution of parotid gland neoplasms among a United States veteran population.DesignRetrospective chart review.SettingWashington DC Veterans Affairs Medical Center.ParticipantsVeterans who underwent fine needle aspiration (FNA) for a parotid gland mass from 2000 to 2018 were included. Medical records were reviewed for gender, age, tobacco use, surgery date, and pathology results.Main outcome measuresChanges in the distribution of parotid neoplasms and tobacco use over an 18-year period.ResultsOf 141 patients with parotid gland masses, 86.5% (n = 122) were benign, 9.9% (n = 14) were malignant, and 3.5% (n = 5) were indeterminate. Of benign tumors, WT accounted for the majority at 51.6%, followed by PA at 40.2%. When stratified by decade (2000–2009 and 2010–2018), the proportion of WT compared to all other benign and malignant neoplasms increased from 31.6% to 53.6%, whereas the proportion of PA decreased from 36.8% to 33.3%. The rate of tobacco use was unchanged at approximately 32.0% among our cohort from 2000 to 2018.ConclusionAmong our cohort of veteran patients, WT was the most common benign parotid tumor and has increased in incidence over the last two decades despite an unchanged smoking rate.     

Presidential address: International medical graduates in the surgical workforce and the Veterans Affairs hospitals: where are we coming from? Where are we going?

The demand for physicians has fluctuated from shortages to oversupply, with reliance on international medical graduates (IMGs) during periods of shortages. Twenty-four percent of the total physician workforce and 20% of general surgeons are IMGs. To address an estimated shortage of 200,000 physicians by 2020 to 2025, a constant and stable supply of IMG physicians, in addition to greater numbers of graduating medical students is needed. General surgery, especially in underserved areas, will be severely affected, and little has been done so far to address this shortage. Over the years, Veteran Affairs hospitals have addressed physician shortages in their facilities by relying on IMGs despite mounting difficulties with visa sponsorship. A sensible solution is presented to address general surgery shortages in the United States while preventing global brain drain.     

Role and treatment of early maladaptive schemas in vietnam veterans with PTSD

The role of early maladaptive schemas in understanding and treating post‐traumatic stress disorder (PTSD) was investigated. The first study examined the role of perceived adverse parenting and early maladaptive schemas in the development of PTSD in Australian and New Zealand Vietnam war veterans (n = 220). Veterans diagnosed with PTSD scored higher on the Young Schema Questionnaire (L3) and had higher scores on the Measure of Parental Style than veterans not diagnosed with PTSD. The results suggest that early maladaptive schemas have an important role in the development or maintenance of PTSD in Vietnam veterans. The second study measured at baseline, termination and 3 months the early maladaptive schemas, PTSD, anxiety and depression of war veterans (n = 54) participating in a PTSD group treatment programme that included schema‐focused therapy. Scores on the PTSD Checklist, the Hospital Anxiety and Depression Scale, and 17 schemas decreased significantly after treatment. Change scores for the schema treatment were compared with change scores of war veterans (n = 127) who had completed a manualized cognitive–behavioural therapy programme without schema‐focused therapy. Pre‐treatment measures were similar in both groups. Nevertheless, PTSD and anxiety improved more significantly for the schema‐focused therapy group. Together, these findings support the feasibility of schema‐focused therapy to assist veterans with PTSD. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message:

• War veterans with PTSD may have high levels of early maladaptive schemas.
• Early maladaptive schemas, possibly arising from adverse parenting, may be a vulnerability factor for PTSD.
• Addressing early maladaptive schemas, with schema‐focused therapy, should be considered within PTSD treatment programmes.