CT-guided intervertebral foramen puncture and radiofrequency thermocoagulation through the superior margin of costotransverse joint for the treatment of refractory post-herpetic neuralgia in the upper thoracic segment / 中华全科医师杂志

Objective:To evaluate the efficacy of radiofrequency thermocoagulation with CT-guided transforaminal puncture of intervertebral foramen through the superior margin of costotransverse joint for refractory post-herpetic neuralgia (PHN) in the upper thoracic segment.Methods:Thirty patients with PHN in the upper thoracic segment underwent radiofrequency thermocoagulation with CT-guided intervertebral foramen puncture. The visual analogue scale and self-rating depression scale were used to evaluate the degree of postoperative pain and mental state before and after treatment, and patients were followed by telephone or outpatient visit.Results:No infection occurred after radiofrequency thermocoagulation in all 31 PHN patients. After operation, all patients had hypoesthesia in skin of the original pain area, the pain was significantly relieved, and the mental state improved significantly. The VAS scores were 5.94±0.93, 2.74±0.69, 2.68±0.70 and 2.45±0.51 before and 3 hours, 1 week, 1 month after treatment( t=18.80, t=18.80, t=16.44, all P<0.01). The SDS scores were 58.6±12.2, 47.7±4.4, 48.1±4.8 before and 1 week, 1 month after treatment( t=6.75, t=5.86, all P<0.01). There were 13 patients with moderate or severe depression before treatment, while no patients with moderate or severe depression after treatment; only 5 patients had mild depression one month after surgery. There was no hypoxemia under nasal catheter during the operation. Intraoperative hypertension was found in 19 cases; after treatment with Urapidil (12.5 - 50.0 mg), the blood pressure was not higher by 20% of the basal blood pressure and<180/100 mmHg (1 mmHg=0.133 kPa). No pneumothorax, perioperative cardiovascular and cerebrovascular accidents occurred. Conclusion:Radiofrequency thermocoagulation with CT-guided intervertebral foramen puncture through the superior margin of costotransverse joint can effectively relieve refractory PHN of the upper thoracic segment with safety.

Clinical study of one-stage lymphatics-venous anastomosis to prevent upper extremity lymphedema of breast cancer after radical resection / 国际肿瘤学杂志

Objective To investigate the value of one-stage lymphatics-venous anastomosis in radical mastectomy of breast cancer to prevent post-mastectomy upper limb lymphedema.Methods Ninety patients requiring radical mastectomy of breast cancer in Tangshan Tumor Hospital Affiliated to North China University of Science and Technology from March 2010 to May 2013 were collected as the objects.They were divided into the control group (45 cases) and the treatment group (45 cases) using block randomized grouping (concealment of allocation).Both groups underwent radical mastectomy of breast cancer, and the treatment group was treated with one-stage lymphatics-venous anastomosis on the basis of radical mastectomy.The operation times, amount of bleeding, hospitalization times, postoperative complications and the numbers of axillary lymph node dissection of the patients in the two groups were compared, and the postoperative upper limb lymphedema incidence rates of the patients in the two groups were compared.Results The operative times of the patients in the treatment group and the control group were (152.82 ± 18.76) min and (78.92 ± 10.33) min respectively, and amount of bleeding were (416.64 ± 94.65) ml and (250.84 ± 63.17) ml, with statistical significances (t =-20.39, P =0.00;t =-4.48, P =0.00).The average hospitalization times of the patients in the treatment group and the control group were (14.91 ± 5.44) d and (13.45 ± 2.36) d respectively, the numbers of axillary lymph node dissection were 14.63 ± 3.37 and 14.37 ± 3.18, the numbers of postoperative complications occurred were 9 cases (20.00％) and 5 cases (11.11％), with no statistical significances (t =-0.47, P =0.64;t =0.75, P =0.46;x2 =1.35, P =0.38).Compared with the control group, the treatment group has lower incidence of upper extremity lymphedema (13.95％ vs.40.91％) and lower swelling degree, with statistical significance (x2 =8.48, P =0.03).Conclusion One-stage lymphatics-venous anastomosis in radical masteetomy of breast cancer can effectively transfer lymph diversion to the venous circulation and reduce the incidence of limb lymphedema, which has significant preventive effect.

Comparison of efficacy of three kinds of neurolytic celiac plexus block in patients with upper abdominal cancer pain / 中华麻醉学杂志

Objective To compare the efficacy of three kinds of neurolytic celiac plexus block (NCPB) in the patients with upper abdominal cancer pain.Methods Sixty-seven patients of both sexes,with upper abdominal cancer,aged 45-64 yr,weighing 52-69 kg,were randomly divided into 3 groups using a random number table:single-needle NCPB using crura of diaphragm space approach group (group S,n =23),double-needle NCPB via an anterior and posterior crura of diaphragm space approach group (group D,n =22),and continuous NCPB via crura of diaphragm space approach group (group C,n =22).In S and D groups,NCPB was performed with single injection of anhydrous alcohol 25-30 ml after CT-guided successful single and double punctures,respectively.In group C,a catheter was inserted into the crura of diaphragm space and then anhydrous alcohol 25-30 ml was injected via the catheter once a day for 3 consecutive days to perform NCPB.Before treatment,at 1 week after treatment,1,2,4 and 6 months after treatment,the daily consumption of morphine and VAS score were recorded.The therapeutic efficacy was evaluated using VAS weighted value calculation.The development of adverse effects such as diarrhea,hypotension,dysuria and damage to nerves was recorded.Results Compared with S or D groups,the daily consumption of morphine was significantly decreased at 4-6 months after treatment,the rate of effective treatment was increased at 4-6 months after treatment,and the incidence of hypotension was decreased in group C.The incidence of diarrhea was significantly higher in D and C groups than in group S.Conclusion For the patients with upper abdominal cancer pain,continuous NCPB via crura ofdiaphragm space approach provides perfect efficacy with fewer adverse reactions,and the efficacy is better than that of single-needle NCPB using crura of diaphragm space approach or double-needle NCPB via an anterior and posterior crura of diaphragm space approach.

Evaluation of the application of medical humanities care at three clinical departments of the hospital / 中华医院管理杂志

By means of literature review,expert interviews and experts sorting,the authors identified three approaches of medical humanities care,and applied them to three clinical departments of top ten incidence of medical disputes of the hospital in 2012.These departments have similar number of beds,and covered both internal medicine and surgery departments.The purposes of the study are to evaluate the effects of medical humanities care measures in clinical departments,and to make relevant thoughts and suggestions.

Establishment of doctor-oriented j ob evaluation factor system for general hospitals and survey analyses on its reliability and validity / 吉林大学学报(医学版)

Objective To investigate the highly-recognized job evaluation factors among the doctors from tertiary general hospitals and to establish a doctor-oriented job evaluation factor system for general hospitals followed with the reliability and validity analyses.Methods A questionnaire about the highly-recognized 23 job evaluation factors was launched among 791 doctors by the stratified sampling from six tertiary general hospitals in Beijing,and the factors were from a job evaluation model of tertiary general hospitals.Initial factor solutions were obtained by the principal components analysis of all evaluation factors and the main factors whose eigenvalues were over one were extracted as evaluation dimensions. Factor loadings were attained through Varimax and the factor whose factor loading was lower than 0.5 was eliminated.A reliability analysis by calculating Cronbachαcoefficient and a validity analysis with structural equation modeling were sequentially conducted on the job evaluation factor system.Results A doctor-oriented job evaluation factor system for general hospitals including 22 factors subject to 3 dimensions was established while the factor of job relevance was removed. The internal consistency coefficients of the dimensions were greater than 0.8 according to the calculation of Cronbachα, which showed a nice reliability. Several main indexes for evaluating the model fitting were all close to 0.9,which indicated a fair structural validity. Conclusion A doctor-oriented job evaluation factor system for general hospitals is established with fair reliability and validity,which could provide more references to the job evaluation of the doctors in tertiary general hospitals.

A Qualitative Research of Medical Humane Care in Improving Doctor-patient Relationship / 中国医学伦理学

Using the method of semi -structure interviews to pre-interview 6 experts and officially interview10 experts , then the record of the interview was compiled into the paper .Using the grounded theory method to encode material of the interview , a summary was made for each case base on data collation and analysis .This paper ana-lyzed the humanities concern the connotation of the application in the construction of a harmonious doctor -patient relationship and the specific measures .On the basis of the application of humanistic care in the construction of a harmonious doctor -patient relationship , significance and limitation is discussed .

Medical model and perspectives for hospital development / 中华医院管理杂志

Medical model is the product of medical practice and crystallization of the essence of medicine and insights of life based on human being's fights against diseases for ages.Medical practice and medical model change fundamentally with the changing needs of human.being for health,having undergone for example from biomedical model to biopsychosocial(BPS)model.Thanks to perspectives of Epistemology and practice theory,the medical model is nourishing itself with BPS theories and methodologies for sustainable development,helping human being to better understand health and life multi-dimensionally.In such a model,individual hospitals will shift from focusing on disease care to provision of wholesome and sustained health services,while hospital systems will shift from coordination to resources reallocation and vertical integration.Thus the hospitals will gain new perspectives and broader horizon for development in the future.