大连市2004年三种慢性病重症致残者流行病学分析

总结大连市2004年三种慢性病重症致残者流行病学特征。收集需去家中体检复查的2004年以前享受三种慢性病医保补助的重症致残者临床资料及检查结果,采用描述性方法分析流行病学特征。凡患三种慢性病(高血压病、糖尿病具有合并症之一、冠心病陈旧性心肌梗死或已植入支架者)且已享受医疗补助者,复检符合诊断标准者入选。结果2004年大连市内四区参加医保总数约110万人,申报复检41283人,实际检诊人数33078人,检诊率82.52%;检诊合格人数29583人,检诊合格率70.69%。其中因重症致残报名要求需去家中体检者3199人,检诊合格者2861人,合格率89.43%。重症致残者占符合三种慢性病诊断标准人数的9.67%,约占全部参保人数的0.26%,证明三种慢性病重症致残率较高。     

理论思维、工程思维、评价思维的界定与联系——谈对缺血性脑血管病临床实践若干问题的思考

理论思维是力求逻辑自恰、规避自相矛盾;工程思维是对逻辑地发现的属性进行非逻辑的复合;评价思维是虚体思维和筹划因素相分离所导致的思维方式。理论思维的成果必须通过工程思维付诸实践,评价思维是对实践的结果进行评价,评价的结果是对工程思维或/和理论思维的成果进行反思。对缺血性脑血管病实践中的理论思维、工程思维和评价思维的界定与相互联系进行探讨。     

从中西医学的竞争和渗透谈现代中医临床思维的变革

现代中医的临床思维正在发生着变革,一个以辨病为纲,辨证为目,辨病论治为经,辨证论治为纬的临床思维新模式,已经呼之欲出。这正是２１世纪中医学发展的必由之路,学术界必从唯物辩证法的角度来审视这场变革,并因其势而利导之。     

Impact of outpatient non-myeloablative haematopoietic stem cell transplantation in quality of life vs. conventional therapy

The role of outpatient hematopoietic stem cell transplantation (HSCT) as a therapeutic tool has been strengthened significantly because of the increasing number of patients undergoing this treatment. Due the very nature of this procedure, one of the aspects that should not be overlooked is the quality of life (QOL) of patients undergoing HSCT. Thus, one must consider not only health status after treatment, but also, the psychosocial implications for the patient. This is an observational, longitudinal, and prospective study to assess QOL in patients undergoing outpatient HSCT vs. similar patients receiving medical treatment (MxTx). By applying the COOP/WONKA charts on five occasions (pre-HSCT/initial, post-HSCT/first month, and at 3, 6, and 9 months), thirty-eight patients were analysed, 19 with HSCT and 19 with MxTx with no differences in age, gender or diagnosis. The initial survey found significant differences only in pain perception, which was higher in the HSCT group (p = .08); at the first month, there was a greater tendency for feelings of depression or anxiety in the HSCT group (p = .016), with more limitations in social (p = .003) and daily (p = .044) activities. From 3 months post-HSCT, the results were very similar. The differences persisted only in the area of social activities. Four patients developed graft-versus-host disease with no significant difference in the scores obtained compared to other transplant patients at 3, 6, and 9 months (p = .26) of follow-up.     

The CODE: A revised battery for coping and defense and its relations to subjective health

A condensed test battery (the CODE) based on the Utrecht Coping List (UCL) and part of the Defense Mechanisms Inventory (DMI) has been developed to assess coping and defense in large population studies. It was tested for reliability and validity in students and back pain patients. Principal components factor analysis of the subscales of the UCL and DMI in the student sample revealed two coping clusters: “Instrumental mastery-oriented coping” and “Emotion-focused coping” and two defensive clusters: “Cognitive defense” and “Defensive hostility”. “Instrumental mastery-oriented coping” was negatively related to subjective health complaints measured with Ursins Health Inventory (UHI). The back pain patients were clearly different from the students, using less coping and more defensive strategies. They had more subjective health complaints that showed negative correlations with “Instrumental mastery-oriented coping”. The CODE is a comprehensive battery that may be valid for large population studies of psychological determinants of muscle pain and other subjective health problems.     

病证周一论

中医和西医是两大立体网络系统,虽各自有其发生发展过程,但二者在一定条件下可以同一,如同一病人中西医两种诊断,中西医病名证名,其概念的外延相交叉,相交部分呈现交融状态,即是二者同一的条件。就客观而言,两系统之交融状态是病证同一的前提,就认识而言,只有先认识病证同一,方能认识这二系统之交融同一。所谓病证同一,是运用中医理论和方法对西医疾病全过程本质认识,移植西医病名转化为中医的基本证,初步实现中医病证与西医病名在理论与临床上融汇同一,进而实现中医现代化。     

Le malade génétique responsable « La loi des suspects »

A patient suffers of a genetical disease. He does not wish to inform his family. Is he responsible for a lost of chances of his parents, chances to prevent the disease, or to receive care? Is there a second class of patients?     

宫腔镜诊治宫腔内疾病的价值

宫腔镜技术在诊断和治疗宫腔内疾病方面已经有着不可替代的地位。对比过去的B超以及诊刮,宫腔镜加诊刮是诊断宫腔内疾病的金指标。宫腔镜电切手术也是宫腔粘连、子宫畸形的最佳手术方式。临床医生应有系统的观点,以循证医学模式为指导,充分尊重患者的意愿,个性化地将这项技术应用于患者。     

解读《恶性肿瘤骨转移及骨相关疾病临床诊疗专家共识》

肿瘤专业工作者不仅要关注患者的抗癌治疗,同时也要关注他们的康复与姑息治疗,骨转移是肿瘤患者的常见转移病灶。《恶性肿瘤骨转移及骨相关疾病临床诊疗专家共识》（2007年版）适时地对恶性肿瘤骨转移及骨相关疾病提出了指导性意见,体现了肿瘤的综合治疗原则,其特点为：（1）多学科合作的结晶;（2）以高级别循证医学证据为基础;（3）突出了实践性和可操作性。和一切“诊断规范”一样,《共识》一方面对指导肿瘤科及其他相关科室医师们的临床实践发挥积极作用,同时又需要在实践中继续得到检验。     

古埃及医治心理疾病的方法透析

宗教文化是古埃及文明的重要组成部分,对古埃及心理医学产生了重要影响。为预防心理疾病,保障身心健康,古埃及人发明了一整套预防和医治心理疾病的方法。屏弃其中的迷信成分,这些疗法对于我们今天心理医学的发展、个人心态的调整与和谐社会的构建,仍有借鉴意义。