针刺京骨穴联合推拿治疗背肌筋膜炎临床研究

目的探讨针刺京骨穴联合推拿治疗背肌筋膜炎的临床疗效。方法将2016年10月—2018年10月收治的背肌筋膜炎患者86例纳入研究,采用随机数字表法分组。对照组43例予以推拿治疗,观察组43例予以针刺京骨穴联合推拿治疗。比较2组患者的治疗总有效率、VAS评分及Oswestry功能障碍指数、痊愈所用时间。结果观察组治疗总有效率为95.3%,而对照组仅为81.4%,差异有统计学意义(P<0.05);2组治疗后VAS评分、Oswestry功能障碍指数均有下降,观察组上述指标低于对照组,差异有统计学意义(P<0.05);观察组痊愈所用时间短于对照组,差异有统计学意义(P<0.05)。结论针刺京骨穴联合推拿治疗背肌筋膜炎的临床疗效突出,可缓解背部疼痛、恢复功能活动,并缩短了愈合时间,提高了生活质量,值得一定的临床推广。     

Characteristics of drowning deaths in an inner city river

A study was undertaken of all drowning deaths that occurred over a 30-year period from 1988 to 2017 in the urban section of the River Torrens, Adelaide, South Australia, an augmented waterway that runs through the central business district. Autopsy records from Forensic Science South Australia (FSSA) were reviewed. There were 34 drownings (0–5 cases/yr) with 28 males and 6 females (M;F = 4.6:1), with an age range for males of 18-76yrs (mean 42.0; SD 18.0) and for females of 20-84yrs (mean 69.3; SD 24.5). There were 15 (44%) accidents, 11 (32%) suicides, 1 (3%) homicide and 7 (21%) undetermined. Of the 22 cases during or after 1994 with complete toxicology reports, 10 (45%) had a blood alcohol concentration (BAC) of greater than 0.05% (g/100 mL) with an illicit substance detected in 4 (18%) cases: (MDMA (3,4-methylenedioxymethamphetamine), methylamphetamine and THC (delta-9-tetrahydrocannabinol) acid). The presence of various therapeutic drugs was also detected in 10 cases (45%) including temazepam, fluoxetine, diazepam, olanzapine, amitriptyline, carbamazepine, codeine, citalopram and valproate. Although the numbers of cases were not high, the urban portion of the River Torrens had a much higher number of drowning events per kilometre compared to other inland waterways in South Australia such as the Murray River. This is most likely due to the vulnerability that exists for intoxicated individuals in the city from falls into the water and to the availability of the river as a means of suicide to members of the adjacent urban population.     

慢性肺心病哮喘持续状态218例临床分析

目的探索治疗慢性肺心病哮喘持续状态的方法。方法回顾性分析1983年10月～2005年3月收治的218例慢性肺心病哮喘持续状态患者的临床资料。结果哮喘持续状态在48h以内被控制的62例（28．4％）；在72h以内控制的56例（25．7％）；在120h以内控制的25例（11．5％）；在168h以内控制的34例（15．6％）；痊愈出院177例（81．2％）；死亡41例（18．8％）。结论（1）治疗慢性肺心病哮喘持续状态．根据患者的病理变化．综合治疗．效果显著。（2）在治疗过程中．要恰当选择抗生素和平喘药；对那些血液黏滞度增高的患者．要加用血液稀释疗法。（3）测定血液黏滞度和氧饱和度．可以指导治疗、估计预后．应当列为常规检查。     

瘢痕疙瘩的综合治疗研究

目的探讨瘢痕疙瘩的综合治疗方法和临床效果评价。方法自2002年3月至2007年9月对82例98处瘢痕疙瘩采用综合方法进行治疗,手术切除＋电子射线放射治疗60例72处瘢痕,注射曲安奈得注射液＋局部贴敷硅凝胶膜治疗22例26处瘢痕,根据刘文阁法判断临床疗效,进行效果评价。结果手术切除＋电子射线放射治疗60例72处瘢痕治愈69处,无效3处,注射曲安奈得注射液＋局部贴敷硅凝胶膜治疗22例26处瘢痕治愈16处,无效10处。结论瘢痕疙瘩需采取综合治疗,尤以手术切除＋电子射线放射治疗为最佳选择。     

"在线期刊-写作-讨论"结合教学与临床医学教育

以参加教学改革的(01)口腔大专2个班90人为实验组，以采取传统授课方式的(00)口腔大专2个班96人为对照组，实验组采用问卷调查，将实验组和对照组课后对授课内容进行测试的成绩进行横向对比，结果表明与“在线期刊-写作-讨论”结合的临床课教学方式对培养医学生的临床思雄能力、自学能力、解决问题的能力、学生自我表达能力、收集资料能力、文字表达能力等比传统教学方式有明显的提高，对提高临床医学专业专科医学生综合素质有明显的效果。     

卒中急性期病人中医综合康复护理效果观察

[目的]探讨中医综合康复护理对卒中急性期病人神经功能缺损及日常生活能力（ADL）的影响。[方法]选择2004年9月-2006年9月在3家协作医院住院的卒中急性期238例病人为研究对象，随机分为实验组和对照组，两组药物治疗基本相同。实验组按中医综合康复护理方案进行护理．对照组采用卒中护理常规进行护理。对入选的病人在入院第1周内和4周后进行神经功能缺损及ADL的评定。[结果]4周后实验组在临床神经功能缺损、ADL等方面明显优于对照组，差异有统计学意义（P〈0．01）。[结论]中医综合康复护理可促进肢体的功能恢复，提高病人的ADL。     

综合性(师范)大学医学教育教学改革及思考

本文阐述了医学院校并入综合性(师范)大学后,如何利用和发挥综合性大学优势,全面实施素质教育;医文渗透,医理融合;深化教育教学改革;加强师资队伍建设与学科建设探索的体会,并对今后的发展提出某些战略性思考。     

前列平胶囊治疗慢性前列腺炎湿热瘀阻证的药品临床综合评价

目的：探索前列平胶囊治疗慢性前列腺炎湿热瘀阻证的药品临床综合价值,为临床基本用药管理的相关决策提供证据。方法：该研究以《药品临床综合评价管理指南（2021年版试行）》为依据,通过系统梳理前列平胶囊治疗慢性前列腺炎湿热瘀阻证的现有研究,结合相关数据库资料和问卷调查结果,基于循证医学、临床流行病学、临床医学、循证药学、药物经济学、卫生统计学、卫生技术评估等学科基础,采用多准则决策分析模型（MCDA）和CSC 2.0软件,对药品的安全性、有效性、经济性、创新性、适宜性、可及性6个维度及中医药特色进行定性与定量相结合的综合评价。结果：安全性,基于国家药品不良反应监测中心自发呈报系统（SRS）、安全性文献分析、药理毒理实验报告等证据,前列平胶囊安全性等级评价为A级,安全性好。有效性,基于药理药效学研究及Meta分析结果,综合有效性证据价值及证据质量,最终有效性等级评价为B级。经济性,前列平胶囊为国家医保乙类药物,与同类中成药价格相比,前列平胶囊的日均费用属中等,服药过程中无相关费用增加,经济学研究显示前列平胶囊联合α受体阻滞剂与单用α受体阻滞剂比较,具有较好经济性。综合经济学证据质量评价和经济性...     

Interdisciplinary Protocol for Surgery in Older Persons: Development and Implementation

As the population ages, more older adults will undergo surgical procedures, and common physiologic changes can raise the risk for surgical complications while increasing morbidity and mortality. In conjunction with the National Surgical Quality Improvement Program, we piloted a comprehensive and interdisciplinary assessment and intervention protocol for perioperative care for patients aged ≥75 years undergoing elective general, gynecology-oncologic, and orthopedic surgery. The intervention included screening tools for cognitive, functional, and nutritional deficits, a Geriatric Nurse Champion on each inpatient surgical unit, and an interdisciplinary Geriatric Surgery Quality Committee. Our intervention group was compared to surgical patients during the same time period 1 year prior to the intervention, and the groups were well matched in demographics and comorbidities. The intervention group had significantly higher rates of advance care plan documentation in analysis of all patients (P < .001) and in subgroup analysis of those 85 and older (P = .006). The preintervention group had less postoperative delirium compared to the postintervention group but it was not significant and there was no difference in length of stay between groups. Various explanations for the minimal impact of the protocol exist: small sample size, presence of other hospital initiatives to reduce pressure ulcer and delirium, and clinician’s awareness of project planning that led to incorporating ideas prior to official implementation. Future research implementing this protocol in naïve and/or underperforming institutions may demonstrate a greater effect. Larger sample size as well as implementation in other surgical fields may reveal a significant impact. However, if additional study does not reveal a meaningful impact of a comprehensive geriatric assessment for surgical patients, then consideration must be made regarding unrecognized factors in surgical care for older adults or perhaps that factors cannot be mitigated in older adults because they are intrinsically a higher surgical risk.     

Prognostic Interplay of Functional Status and Multimorbidity Among Older Patients Discharged From Hospital

ObjectivesThe purpose of this study was to investigate the prognostic weight of multimorbidity and functional impairment over long-term mortality among older patients discharged from acute care hospitals.DesignA prospective multicenter observational study.Setting and ParticipantsOur series consisted of 1967 adults aged ≥65 years consecutively admitted to acute care wards in Italy, in the context of the Report-AGE project.MethodsAfter signing a written informed consent, all patients underwent comprehensive geriatric assessment by Inter-RAI Minimum Data Set acute care. The primary endpoint of the present study was long-term mortality. Patients were grouped into 3 functional clusters and 3 disease clusters using the K-medians cluster analysis. The association of functional clusters, disease clusters, and Charlson score categories with long-term mortality was investigated through Cox regression analysis and the intercluster classification agreement was further estimated. Finally, the additive effect of either disease clusters or Charlson score on predictive ability of functional clusters was assessed by using changes in Harrell’s C-index and categorical Net Reclassification Index (NRI).ResultsFunctional clusters, disease clusters, and Charlson score were significant predictors of long-term mortality, but the interclassification agreement was poor. Functional clusters predicted mortality with greater accuracy [C-index 0.66, 95% confidence interval (CI) 0.65–0.68] compared with disease clusters (C-index 0.54, 95% CI 0.53–0.56), and Charlson score (C-index 0.58, 95% CI 0.56–0.59). Adding multimorbidity (NRI 0.23, 95% CI 0.14–0.31) or Charlson score (NRI 0.13, 95% CI 0.03–0.20) to functional cluster model slightly improved the accuracy of prediction.Conclusions and ImplicationsFunctional impairment may better predict prognosis compared with multimorbidity, which may be relevant to optimally address individuals’ needs and to design tailored preventive interventions.