针刺联合生物反馈疗法治疗肩周炎的临床疗效观察

目的 评价用针刺联合生物反馈疗法治疗肩周炎的临床疗效。方法 将120例肩周炎患者随机分为针刺组40例、生物反馈组40例和联合组40例。针刺组患者接受针刺针治疗,生物反馈组患者接受生物反馈治疗,联合组患者接受针刺结合生物反馈治疗。各组均连续治疗12天。在患者治疗前、治疗第6天、治疗第12天,医护人员采用疼痛视觉模拟量表（VAS）评价患者的疼痛程度,采用SAS焦虑量表和SDS抑郁量表评价各组患者治疗前后的心理情况。结果 联合组的总有效率为90%,优于针刺组（85%）和生物反馈组（80%）(P<0.05)。各组患者治疗后的VAS评分均较治疗前低,（P<0.05）。治疗后,针刺组和联合组的Melle评分明显降低（P<0.01）。生物反馈组的Melle评分较治疗前降低（P<0.05）。生物反馈组和联合组的SAS和SDS心理状态有改善（P<0.05）。结论针刺结合生物反馈技术可有效缓解肩周炎患者的疼痛,改善肩周炎关节功能。生物反馈技术对于改善患者的心理状态有积极作用,并且两者合用的疗效更好。     

Nd:YAG激光仪治疗太田痣1341例的临床体会

探讨多波长激光仪治疗太田痣的疗效。方法 :我院应用多波长激光仪对 1341例太田痣患者进行皮损区的多次照射治疗。治疗间期 3月 - 6月 ,对患者治疗次数、年龄、颜色以及不良反应等进行了分级别观察研究。结果 :年龄小 ,皮损颜色浅者 ,随治疗次数增加疗效越显著 ,1341例患者经过 1～ 7次左右的治疗 ,痊愈 96 6例 ,显效 2 4 0例 ,有效 6 7例 ,无效 6 8例 ,总显效率 90 % ,总有效率 95 % ,96 6例痊愈患者平均治疗次数为 5 .74次 ,其中小于 6岁儿童为 4 .2 5次 ,一般治疗 5次左右可以治愈 ,无遗留瘢痕。结论 :多波长激光仪治疗太田痣安全有效。     

消化内镜联合四联疗法治疗胃溃疡出血患者的疗效及对再出血率的影响分析

目的 提高胃溃疡出血患者的治疗疗效,论证消化内镜的临床应用价值。方法 选取76例我院2021年1月—2021年12月收治的胃溃疡伴出血患者作为病例样本,采用随机数字法将患者分为两组,每组各38例。对照组行四联疗法,观察组实施联合消化内镜治疗。对两组患者的疗效、再出血率进行对比,并分析总结诱发再出血的危险因素。结果 观察组的临床疗效为97.37%,对照组的临床疗效为89.47%,观察组的临床疗效高于对照组（P<0.05）;观察组的再出血率为2.63%,对照组的再出血率为13.16%,观察组的再出血率低于对照组（P<0.05）;治疗前,两组患者的止血相关因子无显著差异（P>0.05）,但经过积极治疗后,两组患者的止血因子水平均提升,观察组明显高于对照组（P<0.05）。结论 消化内镜联合四联疗法可显著提高临床疗效,降低再出血率。笔者通过临床分析,认为导致胃溃疡出血患者治疗后再出血的主要因素为低血红蛋白、溃疡A1期等。     

A型肉毒杆菌毒素在治疗眼睑及面肌痉挛中的应用

目的:探讨A型肉毒杆菌毒素治疗原发性眼睑痉挛、半侧面肌痉挛的疗效及副作用。方法:对108例眼睑痉挛的患者进行眼睑皮下眼轮匝肌内7点注射A型肉毒杆菌毒素,每个点注射2.5u,半侧面肌痉挛者159例在颧面部肌肉增加2～3处注射。结果:肉毒杆菌毒素A治疗原发性眼睑痉挛肌及半侧面肌痉挛的总有效率为100%,无全身反应,药效作用时间前者平均9周,后者平均13周;重复注射同样有效。结论:本疗法疗效可靠,简便易行,并发症轻而且可逆转,无全身毒副作用,可作为治疗眼睑面肌痉挛的首选疗法。     

中西结合治疗2型糖尿病50例疗效观察

本例采用中西医结合综合治疗措施———糖尿病教育与监测、心理辅导、饮食疗法、运动疗法、中药疗法、西药疗法等对 2型糖尿病 5 0例进行综合调治 ,患者乐从且效果满意。     

肿瘤病人化疗心理特征与护理

目的 :分析肿瘤病人化疗心理特征及护理。方法 :针对 2 2 6例肿瘤病人化疗前中后进行有效的心理护理。结果 :恐惧心理减轻 76例 ,消除 112例 ;;猜疑、焦虑心理减轻 5 9例 ,消除 14 9例 ;绝望心理减轻 2 9例 ,消除 5 8例 ;抗药心理减少 31例 ,消除 36例。结论 :心理护理对肿瘤病人化疗的重要性     

盐酸度洛西汀联合盐酸乙哌立松治疗慢性紧张型头痛的临床研究

目的:评价盐酸度洛西汀联合盐酸乙哌立松治疗慢性紧张型头痛的疗效。方法:收集神经内科门诊及住院就诊的符合慢性紧张型头痛诊断标准的患者220例,依据汉密尔顿抑郁量表(HAMD17)、汉密尔顿焦虑量表(HAMA14)评价患者的情感障碍状态,将其分为A组(不伴焦虑抑郁组,124例)和B组(伴焦虑抑郁组,96例),A、B组再各自随机分为治疗组(A1组62例,B1组48例)和对照组(A2组62例,B2组48例);对照组单用盐酸乙哌立松治疗,治疗组在此基础上加用盐酸度洛西汀。分别于治疗前与治疗2周末、4周末、8周末统计患者头痛发作次数、持续时间、头痛程度;B组(伴焦虑抑郁)患者同时采用HAMD17、HAMA14评价患者的抑郁、焦虑程度。结果:治疗后,A、B两组中治疗组患者的头痛发作次数、头痛持续时间、头痛程度与对照组比较,差异有统计学意义(P<0.05);治疗2周末、4周末、8周末,B组(伴焦虑抑郁)患者的HAMD、HAMA评分与对照组比较,差异有统计学意义(P<0.01);治疗后A、B两组患者中,治疗组的总有效率与对照组比较,差异有统计学意义(P<0.05);两组患者均未见明显不良反应发生。结论:盐酸度洛西汀联合乙哌立松治疗伴或不伴焦虑、抑郁的慢性紧张型头痛患者的疗效较好、安全性高。     

佐金平木、抑木扶土法治疗肺癌化疗后腹泻探讨

目的探讨佐金平木、抑木扶土法中药治疗肺癌化疗后腹泻临床疗效。方法将肺癌化疗后腹泻患者60例随机分为治疗组30例、对照组30例,治疗组采用佐金平木、抑木扶土法中药治疗,对照组用易蒙停,治疗1O天为1疗程,治疗1个疗程后,观察疗效。结果两组腹泻积分差值比较差异有统计学意义(P<0.05﹞,治疗组优于对照组;两组腹泻的临床疗效比较,治疗组显效率、有效率均优于对照组,差异有统计学意义(P<0.05﹞。且治疗组病理变化在用药后较治疗前有明显好转。结论以佐金平木、抑木扶土法治疗肺癌化疗后腹泻临床疗效较好,通过对化疗后腹泻的较好控制,保证了化疗药物疗效较好的发挥,使患者的病理变化有很好的改善作用,值得推广应用。     

气压治疗预防昏迷病人下肢深静脉血栓的效果观察

目的：探讨气压治疗预防昏迷病人下肢深静脉血栓的临床效果。方法：择取我科于2014年1月～2014年12月收治的住院时间超过一周的昏迷病人50例，随机分为人数相同的实验组和对照组，各25人。其中实验组采用气压治疗方法进行治疗，每天两次，每次半小时，半个月一个疗程。对照组则采用传统人工按摩方式进行治疗，每天两次，每次半小时，并辅用相关药物进行预防。对比两种治疗方法在防治深静脉血栓形成方面的不同。结果：两组患者的下肢肿胀情况均有所改善，但行以气压疗法的实验组，其患者恢复情况要明显优于对照组，P＜0.05，差异具有统计学意义；对两组患者治疗前后股静脉和腘静脉的血液流速变化，治疗前两组患者股静脉和腘静脉的血液流速无明显差异，P＞0.05，差异无统计学意义；治疗后两组患者股静脉和腘静脉的血液流速差异明显，实验组股静脉和腘静脉的血液流速明显快于对照组，P＜0.05，差异具有统计学意义。结论：气压治疗具有安全性较高、操作性简便的优越性，病人在治疗过程中不会感到痛苦，副作用极小，且气压疗法的价格也可以被大众所接受。气压疗法有效防治深静脉血栓，为患者生命安全提供安全保障，在减轻患者的痛苦的同时，更是节约了治疗费用和医疗资源，给广大患者和医学工作者带来了福音。     

过氧化碳酰胺联合新三联治疗胎儿宫内窘迫的疗效观察

目的:对过氧化碳酰胺联合新三联治疗胎儿宫内窘迫的疗效进行观察与探讨。方法:对2013年6月到2015年6月期间在莆田荔城区医院接受治疗的64例分娩时发生胎儿宫内窘迫的患者进行临床研究,按照随机方式分为两组,每组32例,对对照组患者进行新三联治疗,对研究组患者进行过氧化碳酰胺联合新三联治疗,分析两组患者的效果。结果:研究组胎儿的胎心改善率(96.88%)与对照组胎儿(62.50%)相比,组间差异明显(P<0.05),研究组重度窒息、轻度窒息、正常的新生儿例数(0例、2例、30例)与对照组新生儿(3例、9例、20例)相比,组间差异明显(P<0.05)。结论:对分娩时发生胎儿宫内窘迫的患者使用过氧化碳酰胺联合新三联治疗效果较好。     

Are psychosocial factors associated with low-back pain among nursing personnel?

The aim of this study was to investigate whether psychosocial factors at work are related to low-back pain among nursing personnel. It was conducted as a short-term follow-up study of 200 Danish female nursing personnel, providing care for the elderly. Self-reported measures of psychosocial factors such as time pressure, emotional demands of clients, control and social support were obtained by questionnaire at baseline, while stress, physical exertion and low-back pain were reported by diary records made in two, three-day periods in the subsequent 6 months. The study examines the possible influence of psychosocial factors preceding low-back pain as well as stress and physical exertion reported simultaneously with low-back pain. Only stress was associated with low-back pain (Odds Ratio (OR)=2.3; Confidence Interval (CI)=1.3-3.9) while neither physical exertion or any of the psychosocial factors were related to low-back pain. A possible pathway connecting emotional demands of clients to low-back pain through the mediation of stress was suggested.     

Work & stress: Information

The aim of this study was to investigate whether psychosocial factors at work are related to low-back pain among nursing personnel. It was conducted as a short-term follow-up study of 200 Danish female nursing personnel, providing care for the elderly. Self-reported measures of psychosocial factors such as time pressure, emotional demands of clients, control and social support were obtained by questionnaire at baseline, while stress, physical exertion and low-back pain were reported by diary records made in two, three-day periods in the subsequent 6 months. The study examines the possible influence of psychosocial factors preceding low-back pain as well as stress and physical exertion reported simultaneously with low-back pain. Only stress was associated with low-back pain (Odds Ratio (OR)=2.3; Confidence Interval (CI)=1.3-3.9) while neither physical exertion or any of the psychosocial factors were related to low-back pain. A possible pathway connecting emotional demands of clients to low-back pain through the mediation of stress was suggested.     

A revolution in genetics: changing medicine, changing lives

The sequencing of the human genome is only the tip of the iceberg. It is the beginning of a revolution that many predict will transform medicine. How will genetics research affect physicians and patients and the practice of medicine? When investigators identify the function and association of human genes with common chronic diseases, diagnosis, treatment, and classification of human diseases will be changed forever. Genetic susceptibility testing allows patients to know their predisposition to disease long before symptoms appear. Physicians can intervene with customized advice so that the patient can prevent, modify, or avoid the predisposed condition by better understanding both his or her genetic and environmental risk for disease. The promise of a genetic approach to drug therapy involves moving from one size fits all to personalized medicine tailored to the individual patient. Physicians will become mentors and counselors, advising patients on the best treatment path given their unique genetic predisposition--even in this sophisticated, high tech field, the physician-patient relationship is likely to improve, highlighted by individualized therapies and personal attention.     

AHP Is Intended for More Than Expected Value Calculations

In a previous paper, Schoner and Wedley [9] presented a way to automatically compute the importance of criteria from the values of alternatives. The following discussion illustrates that the approach of [9] can only be applied if the alternatives under the criteria are measured with a single absolute scale. However, when this does occur, in part or in all of a decision problem, the approach is extraneous. The measurements can (and should) first be combined with the appropriate arithmetic of that scale which reduces that part of the problem to a single dimension and the result can be taken up with the remaining dimensions for consideration with AHP.     

A stochastic programming model for outpatient appointment scheduling considering unpunctuality

Many papers on outpatient appointment scheduling assume that patients arrive on time. However, unpunctuality is a stochastic factor that is inevitable in practice, which leads to patients arriving out of order. A schedule may not be reasonable if a clinic neglects the influence of patient unpunctuality. This paper addresses the outpatient scheduling problem considering unpunctuality (OS-U) by developing a stochastic programming model. We compare the performance of the OS-U system with the strict-punctuality (OS-P) system. We illustrate that the model has an exact and unified formula for cases of patients arriving in the appointment order and arriving out of order. The OS-U problem is solved by using Benders decomposition combined with the sample average approximation (BD-SAA) technique to determine the global optimal set of appointment intervals with the goal of minimizing the weighted sum of all patient waiting times, doctor idle times, and overtime. Numerical experiments indicate that the appointment rule changes when considering unpunctuality, although the set of optimal appointment intervals still takes the shape of dome (interval width increases at first, then remains nearly constant and eventually decreases for the last patients). The OS-P system schedules the first two patients together at the start of a session, whereas the OS-U system schedules them with different appointment times and requires a longer slot between the first two patients if patients tend to arrive early rather than late. The variance of unpunctuality has little impact. The no-show probability has a greater influence on system performances in an OS-U system than those in an OS-P system.     

Coaching und Neurowissenschaften

Representatives of coaching hold that coaching and psychotherapy largely overlap regarding concepts and methods. Therefore, they recommend to adapt from established psychotherapies like behavioral therapy or psychoanalysis scientifically proven concepts and successful treatments. However, psychological and neurobiological personality and effectiveness research demonstrates that the established psychotherapies reveal clear deficits in their working concepts and interventions. In general, the trustful relationship between client/patient and coach/therapist, called “working alliance” or “therapeutic alliance” turns out to be the most effective factor. There is no other form of interventions that is equally effective in all clients or patients. Thus, any coach must be capable of sufficiently identifying the mental state of the client, his/her unique personality, type and strength of his/her deficits and the available resources. Each treatment must occur in parallel at three different levels, i.?e. the mental state and memories, behavior and the manifestations of deficits and problems in the body state.     

Benefits of Surgical Smoothing and Spare Capacity: An Econometric Analysis of Patient Flow

In this study, we examine the hospital's ability to admit patients from its emergency department. From a medical perspective, the number of patients being admitted should depend solely on the patients’ clinical conditions. Using a large‐scale econometric study that includes detailed operational and clinical data on all cardiac patient encounters from a set of 128 hospitals over a period of four years, we show that this is not the case. In particular, we find that independent of their medical condition, many emergency patients are denied hospital admission because of a lack of inpatient beds. Our analysis suggests that having one more inpatient bed at the start of a day can increase the likelihood of an emergency room patient admission by around 3% on average. We examine two policies – active discharge and demand smoothing – that can help hospitals improve patient access. We find that some hospitals actively discharge inpatients when beds become scarce; hospitals that follow such an active discharge protocol are, on average, able to admit more patients. We also investigate to what extent the hospital's ability to smooth its surgical schedule impacts hospital admissions. Hospitals tend to schedule their elective patients early in the week (Mondays and Tuesdays), and discharge them by the weekend in order to minimize weekend staffing, effectively maximizing bed occupancy during the middle of the week. This “weekend effect” artificially induces variability, and reduces effective system capacity. We find that by scheduling patients more uniformly over the week, hospitals can dramatically increase patient access, obviating the need for active discharges or additional capacity investment. Our analysis quantifies these effects, and can help hospitals make effective capacity management decisions in order to improve patient flow.     

An approach to the treatment evaluation of Hodgkin's disease

Hodgkin's disease is a cancer of the lymphatic system. The major feature influencing the type of treatment employed, and the ultimate prognosis, is the stage or extent of disease prior to therapy. This paper is concerned with evaluating the difference in patient progress of two staging procedures. One (pathological staging) procedure is more extensive than the other (clinical staging). The evaluation is carried out by firstly developing a mathematical model of patient progress for pathologically staged patients and then using this model to predict what would have happened to clinically staged patients if they had been treated according to their pathological stage. Comparison of these predictions with actual results suggests that pathologically staged patients appear to remain in disease free survival (remission) following radio-therapy longer than clinically staged patients.     

Appointment scheduling in tandem-type service systems

Appointment-based service systems arise in a broad variety of healthcare settings (for example an outpatient clinic or a dentist). Where most existing algorithms specifically consider the situation of the patient undergoing a single service, in many practical situations multiple services have to be sequentially performed. Modeling the service system as a tandem queue, the main objective of this paper is to generate schedules that soundly balance the interests of patients (i.e., low waiting times) and staff (i.e., low idle times). Importantly, following up on prior work for the single-node queue, we advocate a phase-type based technique that can deal with any service-time distribution (which may, in addition, vary across patients). Relying on a novel recursive scheme to evaluate the sojourn-time distribution of clients in such tandem systems, we show how optimal schedules can be computed. Our technique is illustrated by extensive numerical experimentation, also leading to practical guidelines that apply to a broad range of parameter settings.     

Psychosocial versus biomedical risk factors in Kevorkian's first forty-seven physician-assisted deaths

This article examines biomedical and psychosocial data on the first forty-seven cases of physician-assisted suicide (PAS) of Kevorkian as collected by means of both a physical autopsy and a preliminary psychological autopsy. The following patterns emerge: 1) The physical condition of these PAS patients was not typical of the conditions that lead to death in the United States. 2) Consistent with the above findings, our pilot data indicate that only 31.1 percent of these patients were terminal. While 73.9 percent were described as reporting pain, only 42.6 percent were revealed at autopsy to have a specific anatomical basis for their pain. However 36 percent were described as depressed, 66 percent as having some disability, and perhaps of key importance, 90 percent expressed a fear of dependency. Most important, our pilot data suggest the possibility of large gender differences, since 3) 68.1 percent of these forty-seven PAS's are women and only 31.9 percent are men. This represents the reverse of the gender pattern for completed suicides in the United States in 1995, resembling instead the approximate pattern for unsuccessful suicide attempts. 4) Approximately 75 percent of both men and women in the above sample were described as reporting pain. Men were almost twice as likely to have had an anatomical basis for the pain and three times as likely to be terminal. Our pilot data indicate PAS women are more likely to be described as depressed and twice as likely to have had a history of previous unsuccessful suicide attempts. 5) Kevorkian's patients were older than the typical unaided suicides in America. Reported pain decreases with age as does depression; however anatomical basis for pain increases slightly with age, and no age effect emerges for terminality. 6) Approximately two-thirds of those physician-assisted suicides were at middle SES levels. History of disability was the biggest risk factor for the low SES patients and fear of dependency for the high SES patients.