Motivational Interviewing, 2nd ednWilliam Miller and Stephen RollnickThe Guilford Press. ISBN: 1‐572‐30563‐0, 2002, 428 pp with index, £26.95 (hbk)

More people with intellectual disability are living independent lives. They can and do experiment with substances that the wider community try, such as alcohol and drugs (both legal and illicit). Unfortunately for some, they develop problems related to their use of these substances. Face‐to‐face, semi‐structured interviews were conducted with 13 professionals who work in Intellectual Disability Services and Alcohol &; Drug Services to discover their experiences of caring for people with intellectual disabilities who hazardously use substances. Although small numbers of people presented to these services, many more people with intellectual disabilities used Intellectual Disability Services for support, rather than their local Alcohol &; Drug Services. While the numbers may be relatively small, the challenges this client group pose are very perturbing in relation to their physical, emotional and social health. The professionals reported a lack of education in working with this doubly disadvantaged population. Moreover, policies were absent to guide staff to work collaboratively with this often‐ignored population. These findings are discussed in light of the innovative practices that are occurring in other parts of the UK regarding the recognition, assessment treatment and long‐term management of this population. Intellectual Disability Services and Alcohol &; Drug Services need to work more closely together if the needs of this population are to be effectively met.     

涤痰化瘀法治疗慢性肺源性心脏病急性期临床观察

慢性肺源性心脏病中医属于肺胀范畴,是一种比较常见的心脏病,采用部分涤痰、活血化瘀药物配合西医治疗慢性肺源性心脏病的急性发作并进行疗效观察,结果发现这些药物的应用,能够明显提高肺心病急发期的治疗效果,现总结如下.     

基于CARC评价中西医结合治疗COVID-19病例报告质量

[目的]分析截止2020年3月15日国内发表的中西医结合治疗新型冠状病毒肺炎(COVID-19)的病例报告质量,为提高国际突发公共卫生事件的病案报告质量提供依据,并为今后的临床实践和研究提供方法学参考.[方法]通过检索知网、万方数据库自2020年1月1日—3月15日所发表的相关文献,筛选出相关病例报告,根据中医药病案报...     

黄芪保心汤治疗冠心病心绞痛的临床观察

目的:观察黄芪保心汤治疗冠心病心绞痛的临床疗效,并探讨其相关作用机制。方法:纳入痰瘀互结证冠心病心绞痛患者126例,随机分为治疗组和对照组,每组各63例。对照组患者给予西医常规治疗,治疗组患者在西医常规治疗基础上加服黄芪保心汤,两组治疗周期均为8周。评价两组患者的中医证候疗效;检测患者的血浆黏度、红细胞压积、全血低切黏度、全血高切黏度、纤维蛋白原(Fg)等血液流变学指标,检测天冬氨酸氨基转移酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)及血浆内皮素(ET)、血栓素B2(TXB2)、前列腺素F1α(PGF1α)水平。结果:治疗后,治疗组的中医证候疗效总有效率为90.48%,对照组为84.13%,治疗组疗效优于对照组(P0.05)。治疗后,治疗组患者的血浆黏度、红细胞压积、全血低切黏度、全血高切黏度、Fg水平均明显降低(P0.05,P0.01),对照组患者的全血低切黏度、Fg水平亦明显降低(P0.05,P0.01),且治疗组患者的血浆黏度、全血低切黏度、全血高切黏度水平低于对照组(P0.01)。治疗后,两组患者的CK-MB、CK、LDH水平均显著降低(P0.05,P0.01),治疗组患者的AST水平亦降低(P0.01),且治疗组患者的CK-MB、CK、LDH、AST水平低于对照组(P0.05,P0.01);治疗后,两组患者的TXB2、ET水平均显著降低(P0.01),PGF1α水平升高(P0.01),且治疗组患者的TXB2、ET水平低于对照组(P0.05),PGF1α水平高于对照组(P0.01)。结论:黄芪保心汤结合西医常规疗法治疗痰瘀互结证冠心病心绞痛患者,能够较好改善患者的中医证候,降低患者的心肌酶水平,减轻心肌细胞损伤,其作用机制可能与改善患者的血液流变学,提高血浆PGF1α及降低TXB2、ET水平有关。     

Health workforce governance: Processes,tools and actors towards a competent workforce for integrated health services delivery

A competent health workforce is a vital resource for health services delivery, dictating the extent to which services are capable of responding to health needs. In the context of the changing health landscape, an integrated approach to service provision has taken precedence. For this, strengthening health workforce competencies is an imperative, and doing so in practice hinges on the oversight and steering function of governance. To aid health system stewards in their governing role, this review seeks to provide an overview of processes, tools and actors for strengthening health workforce competencies. It draws from a purposive and multidisciplinary review of literature, expert opinion and country initiatives across the WHO European Region's 53 Member States. Through our analysis, we observe distinct yet complementary roles can be differentiated between health services delivery and the health system. This understanding is a necessary prerequisite to gain deeper insight into the specificities for strengthening health workforce competencies in order for governance to rightly create the institutional environment called for to foster alignment. Differentiating between the contribution of health services and the health system in the strengthening of health workforce competencies is an important distinction for achieving and sustaining health improvement goals.     

活血止痛软胶囊联合玻璃酸钠治疗膝骨性关节炎临床观察

目的观察活血止痛软胶囊口服联合玻璃酸钠关节腔注射治疗膝骨性关节炎的临床疗效。方法 68例膝骨性关节炎患者随机分为两组。对照组仅采用玻璃酸钠关节腔注射治疗,治疗组则在此基础上加用活血止痛软胶囊口服治疗,治疗4周后对两组患者的临床疗效、临床体征和症状积分进行比较。结果治疗组总有效率显著优于对照组(P0.05)。治疗组的症状和体征积分优于对照组(P0.05)。结论活血止痛软胶囊口服联合玻璃酸钠关节腔注射治疗膝骨性关节炎疗效好。     

针灸药合用治疗膝骨关节炎疗效观察

目的观察针刺、雷火灸为主治疗膝骨关节炎的疗效。方法将84例患者随机分为两组。治疗组采用针刺、雷火灸结合硫酸氨基葡萄糖胶囊治疗,对照组单纯口服硫酸氨基葡萄糖胶囊。1周为1疗程,1疗程后进行疗效评定。结果治疗组总有效率优于对照组(P0.05);膝关节疼痛及功能评分比较,治疗组优于对照组(P0.05)。结论针刺、雷火灸为主治疗膝骨关节炎疗效显著。     

养心定悸方治疗心房颤动的疗效观察

目的观察养心定悸方治疗心房颤动的疗效。方法 90例房颤患者随机分为两组。对照组予西医常规治疗,治疗组在此基础上应用养心定悸方。结果治疗组总有效率明显优于对照组(P0.05)。结论养心定悸方对房颤患者有较好的疗效。     

前路减压内固定结合中药治疗脊髓型颈椎病

目的探讨应用颈前路椎体次全切钛网植骨钢板内固定结合中药治疗相邻二节段脊髓型颈椎病的临床效果。方法回顾性分析47例采取颈前路椎体次全切钛网植骨钢板内固定脊髓型颈椎病患者资料。对照组行手术治疗,治疗组术后结合中药治疗,观察并比较其近期疗效。结果所有患者均随访6-24个月。术后椎间高度及生理曲度维持良好。按JOA评分术前及随访时改善率评定疗效,术后6月,治疗组临床疗效均明显高于对照组(P0.05)。结论应用颈前路椎体次全切钛网植骨钢板内固定、结合中药治疗脊髓型颈椎病,减压彻底、术后恢复理想、疗效满意。     

鼻渊舒口服液联合克拉霉素对慢性鼻窦炎患者症状及Lund-kennedy评分的影响

目的观察用鼻渊舒口服液联合克拉霉素治疗慢性鼻窦炎的临床效果,并探讨其对患者临床症状及Lundkennedy评分的影响。方法 116例慢性鼻窦炎患者随机分为两组,对照组给予克拉霉素胶囊口服治疗,治疗组在对照组治疗的基础上给予鼻渊舒口服液,15d后观察两组临床症状的改善情况,对证候给予评分,观察评分的变化情况;用Lund-kennedy评分对鼻腔内情况进行评估;检测治疗前后血清白细胞介素-2(IL-2)、白细胞介素-6(IL-6)水平的变化情况,计算临床治疗的有效率。结果治疗后,治疗组的总有效率明显高于对照组(P0.05);两组患者的脓涕、鼻塞、头痛、嗅觉下降等临床症状较治疗前有所改善,证候积分较治疗前比有所下降,以治疗组患者的变化幅度更为明显(P0.05);两组Lund-kennedy评分均较治疗前有所降低,以治疗组的降低程度更为明显(P0.05);两组IL-2、IL-6水平较治疗前有所下降,以治疗组患者的下降幅度更为明显(P0.05)。结论鼻渊舒口服液联合克拉霉素能有效改善慢性鼻窦炎患者的临床症状,降低其鼻腔Lund-kennedy评分,抗炎作用明显,疗效确切。