应重视中草药对华法令药效影响

华法令是治疗房颤及心脏外科术后的常用药,但是其治疗窗窄,剂量个体差异大,易并发各种出血事件,使用时需严格控制国际标准化比率(INR).中草药在我国应用广泛,研究发现多类中草药会通过多种途径影响华法令代谢,导致血栓形成、脑血管意外等并发症发生.临床须判明各种中草药对华法令功能的影响,保证药物使用安全.     

住院患者华法林抗凝治疗现状调查与分析

了解住院患者华法林的抗凝现状,分析临床用药特点,为临床药师开展抗凝治疗管理提供参考。调查笔者所在医院2016年6月~12月399例华法林抗凝患者住院期间的抗凝现状,并对调查结果进行统计分析。笔者所在医院华法林主要用于非瓣膜性房颤、静脉血栓防治及心脏瓣膜病等;国际标准化比值(INR)低于2.0的病例占53.28%,INR在2.0~3.0范围的病例占32.48%,华法林达标剂量范围0.375mg~7.250mg,个体差异达20倍;56.28%的患者重叠用低分子肝素桥接抗凝,仅5.76%患者达标后2天停用;出血并发症发生率为3.26%,其中46.15%患者出血时INR大于3。华法林临床应用不够规范,INR达标率偏低,积极开展抗凝药物治疗的规范化管理具有重要意义。     

老年人房颤治疗方法的选择

老年人群房颤发病率高,缺血性脑卒中风险大,又是抗凝治疗导致出血的高危人群,因此要大胆地选择华法林抗凝治疗,并小心地严密监测INR值(1.6～2.5),严格控制其他出血危险因素.老年房颤心律失常的治疗重在个体化,重在改善症状,首选控制心室率;发作时血流动力学不稳定且药物不能满意地控制心室率时才选择复律治疗;症状明显而药物疗效欠佳患者可选择导管消融治疗.     

中医“证概念”符号化的倡议与中医诊疗标量化的探讨

中医学是以“概念为单元”的功能医学,经络是功能网络。中医的“证”是外在的、变化着的、阶段性的。随着病的变化,证也在变化,质在变,量也在变。它有整体可控性,用模糊数学给中医的证候标量化,以便临床选方用药,“以数据治”。概念语言符号化,使中医古老的语形结构换上新衣,方便与当代科技沟通,进入网络传播,这或许是中医逐步走向现代化的一个切入点,一座桥梁。     

浅谈脂肪肝的降脂治疗

脂肪肝是一种常见病,多伴有高脂血症,大部分需要降血脂治疗。由于降血脂药物的不恰当使用,有时反而造成脂肪肝的加重以及肝功能的损害。因此,应在治疗原发病、控制饮食、增加运动3个月后,未达到满意效果的患者中,选择适当的降血脂药物进行治疗,并在治疗过程中监测肝功能变化。     

Health and Healing: Spiritual, Pharmaceutical, and Mechanical Medicine

Modern medical practice is identified as a relatively recent way of approaching human ill health in the wide scope of how people have addressed sickness throughout history and across a wide range of cultures. The ideological biases of medical or “allopathic” (disease as “other” or “outsider”) practice are identified and grafted onto other perspectives on how people not engaged in modern medicine have achieved healing and health. Alternative forms of healing and health open a consideration of ethnomedicine, many forms of which are unknown and, hence, untested by modern medical research. Ethnomedicine the world over and throughout human history has displayed unique spiritual (vitalism), pharmaceutical (herbs/drugs), and mechanical (manipulation/surgery) approaches to treating illness. The argument is that modern allopathic medicine would do well to consider such “world medicine” as having valuable alternative and complementary therapies, the use of which could enhance contemporary medical advice and practice.     

民间医药的内涵实质及研究意义

民间医药是指某一地区或人群中长期用于预防和治疗疾病,有临床实践经验积累,但未形成系统的传统医药学理论,未被典籍所录载,具有独特疗效的草药、处方和医疗技术,它是传统医学中三大组成部分之一。加强民间医药的研究对于促进现代中医药发展、保护我国非物质文化遗产和民间知识产权、造福人类具有积极的作用和意义。     

从中西医结合角度探讨代谢综合征

代谢综合征的发生、发展、变化错综复杂,中医的病因病机学说有很多包括脾胃功能失常、肝失疏泄、痰浊瘀血阻滞等。由于老年人抗病能力和修复能力低下,往往同时合并多种其他病变。所以,在辨证研究上需要一个标准化的、符合实际情况的、临床可行的分型。由于目前的中医临床研究的深度和广度还不足以产生一个辨证分型的方案,所以可分期对待,在分期的基础上进一步辨证论治。治疗的重点在于纠正代谢紊乱,改善和延缓合并症的发生及发展。中医学整体调整的理念和中药中的多种成分的多重作用,有利于多因素多系统病变的防治。中药可通过不同途径和环节改善胰岛素敏感性,在防治代谢综合征方面可能有着广阔的前景。     

21世纪我国消化病学发展战略的若干思考

就21世纪消化病的研究与发展的方向和展望,从宏观调控与哲学思想方面提出了如下几个措施;预防为主,人文社会为本;加强基础研究,充分利用科技成果;突出重点,循序渐进;促进中西医结合,充分利用和研究中医药的临床疗效;重视人才培养,提高梯队素质。     

用科学的证据和科学的管理指引心血管疾病的防治

心血管疾病的防治不仅仅是心血管医生的问题,还是一个在循证医学引领下的一个全民生活方式改变的问题,也需要多学科相关专业的联盟,涉及心血管疾病治疗规范的形成与普及,对于疾病发生、发展各个阶段的科学管理更是冠心病的防治效果的重要保障。本文针对心血管病冠心病预防的具体实施,从几方面打开了一个全新的视野。     

Adverse-effect profile of kava

The use of alternative therapies has increased substantially over the last decade, particularly for more chronic conditions such as anxiety. Among the most widely used treatments are medicinal herbs, or phytomedicines, such as kava (Piper methysticum), which has demonstrated anxiolytic activity in both animal models and clinical samples. Kava has several advantages over conventional pharmacologic treatments for anxiety--in clinical settings it has been associated with better tolerability and lack of physiologic dependence and withdrawal. However, phytomedicines are not rigorously regulated in the United States and systematically collected safety data are very limited. These issues are a leading concern regarding the safety of medicinal herbs such as kava. In this report, the safety profile for kava is provided, including findings from a study of its use in generalized anxiety disorder. Safety parameters assessed include occurrence of adverse events, withdrawal symptoms, effect on heart rate, blood pressure, laboratory assessments, and sexual function. No differences were found between kava and placebo on any of the parameters evaluated. The data support the safety of kava in treating anxiety at 280 mg kava lactones/day for 4 weeks.     

The Complex Use of Religion in Decisions on Organ Transplantation

Because of its existential character, organ transplantation is strongly connected to a person’s view of life. This article describes how participants in a focus group use religious elements in decision-making on transplantation medicine in four European countries. Further these findings are related to two influential theologians: James Gustafson and Paul Ramsey, and their thinking on the role of religion in medical ethics. Both participants’ and theologians’ use of religious elements is complex, and show significant variety in regard to both content and form. Decisions in transplantation medicine would benefit from considering the complexity of religious views when striving for informed consent as participative involvement.     

Medicine and Spiritual Healing Within a Region of Canada: Preliminary Findings Concerning Christian Scientists’ Healthcare Practices

Christian Science is the largest and most recognized of various spiritual healing groups that encourage members to forgo or overcome the need for medicine. Even so, it appears that some Scientists occasionally use medicine. In this study, I argue that Scientists in one region of Canada respond to influences on their healthcare practices differently and follow a variety of healthcare practices. These practices range from refusing medically necessary treatment (which could potentially harm individuals’ health) to making full use of the medical system. I base my findings primarily on interviews with eleven current members and one former Christian Scientist.