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2014年3月21日 星期五

［教育訓練］ 新世代序列數據的視覺化分析

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來會診，順便到庇護工廠吃滷味+雞湯

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2014年3月14日 星期五

[論文發表] Chinese Herbal Prescriptions for Osteoarthritis in Taiwan: Analysis of National Health Insurance Dataset，退化性關節炎之中藥處方研究



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 2014 Mar 7;14:91. doi: 10.1186/1472-6882-14-91.

Chinese herbal prescriptions for osteoarthritis in Taiwan: analysis of National Health Insurance dataset. 

退化性關節炎之中藥處方研究


Chen FP, Chang CM, Hwang SJ1, Chen YC, Chen FJ.


Abstract

BACKGROUND:

Chinese herbal medicine (CHM) has been commonly used for treating osteoarthritis in Asia for centuries. This study aimed to conduct a large-scale pharmaco-epidemiologic study and evaluate the frequency and patterns of CHM used in treating osteoarthritis in Taiwan.

METHODS:

A complete database (total 22,520,776 beneficiaries) of traditional Chinese medicine (TCM) outpatient claims offered by the National Health Insurance program in Taiwan for the year 2002 was employed for this research. Patients with osteoarthritis were identified according to the diagnostic code of the International Classification of Disease among claimed visiting files. Corresponding prescription files were analyzed, and an association rule was applied to evaluate the co-prescription of CHM for treating osteoarthritis.

RESULTS:

There were 20,059 subjects who visited TCM clinics for osteoarthritis and received a total of 32,050 CHM prescriptions. Subjects between 40 and 49 years of age comprised the largest number of those treated (19.2%), followed by 50-59 years (18.8%) and 60-69 years group (18.2%). In addition, female subjects used CHMs for osteoarthritis more frequently than male subjects (female: male = 1.89: l). There was an average of 5.2 items prescribed in the form of either an individual Chinese herb or formula in a single CHM prescription for osteoarthritis. Du-zhong (Eucommia bark) was the most commonly prescribed Chinese single herb, while Du-huo-ji-sheng-tang was the most commonly prescribed Chinese herbal formula for osteoarthritis. According to the association rule, the most commonly prescribed formula was Du-huo-ji-sheng-tang plus Shen-tong-zhu-yu-tang, and the most commonly prescribed triple-drug combination was Du-huo-ji-sheng-tang, Gu-sui-pu (Drynaria fortune (Kunze) J. Sm.), and Xu-Duan (Himalaya teasel). Nevertheless, further clinical trials are needed to evaluate the efficacy and safety of these CHMs for treating osteoarthritis.

CONCLUSIONS:

This study conducted a large scale pharmaco-epidemiology survey of Chinese herbal medicine use in OA patients by analyzing the NHIRD in Taiwan in year 2002.




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2014年3月11日 星期二

[門診軼事] 一直催一直催的患者

今天早上我在三診看診，
有一個患者一直催一直催，說怎麼還沒看到他，
診間護理師請他等一下，
過沒多久又開始催

請他把單子拿出來看幾號，

一看.........怎麼是1診的，跑錯間還一直催＝＝
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2014年3月8日 星期六

[臨床病例報告] 3個月後追蹤：15歲女性患者，異位性皮膚炎多年，服用中藥治療約3個月後之手部照片 - 張清貿醫師



異位性皮膚炎女性患者，服用中藥治療3個月後手部照片



異位性皮膚炎女性患者，
服用中藥治療3個月後手部局部特寫照片

 張清貿醫師臨床註記：與3個月前初診時手部皮膚相比，病灶變小，粗糙程度減少，紅斑紅疹持續改善中

 全程病情可參考：

[臨床病例報告] 15歲女性患者，異位性皮膚炎多年，服用中藥治療前後之手部照片 - 張清貿醫師 (2014/03/09更新)

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2014年3月7日 星期五

[論文發表] Using A Questionnaire among Patient, Resident Doctor and Senior Supervisor: Are their Answers the Same? 研究在患者、住院醫師、資深主治醫師使用同一問卷之一致性：三者的答案否相同？

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 2014 Apr;22(2):296-303. doi: 10.1016/j.ctim.2014.02.006. Epub 2014 Mar 4.

Using a questionnaire among patient, resident doctor and senior supervisor: Are their answers the same? 

研究在患者、住院醫師、資深主治醫師使用同一問卷之一致性：三者的答案否相同？

Chang CM1, Wu WH2, Kuo BI3, Lee TY4, Liu CY5, Chang HH6.

Abstract

OBJECTIVES:

This study aims to contribute to the development of objective diagnostic standards in Traditional Chinese Medicine (TCM), in order to improve the training of physicians.

METHODS:

We devised a questionnaire study to evaluate the accuracy of resident doctors' diagnostic skills by comparing their assessment of patients with those of their senior supervising physician and the patients themselves. We selected 39 patients with systemic lupus erythematosus (SLE) at Chang Gung Memorial Hospital, Taiwan, between November 1, 2008 and June 30, 2012, and had the resident doctors (R), their senior supervisor (S) and their patients (P) fill out questionnaires before treatment (V1), immediately after treatment (V5) and two months after treatment (V6), in order to record their assessments on the patients' condition. The R and S questionnaires covered subjective symptoms, tongue, and pulse, while the P questionnaires only included general symptoms. We then compared the assessment records to determine the level of agreement between them.

RESULTS:

The agreements of inquiry during the study for P and S were 0.78 (V1) to 0.84 (V6) and 0.87 (V1) to 0.94 (V6) for R and S, respectively, the agreements between R and S for tongue diagnosis and pulse diagnosis were 0.87 (V1) to 0.90 (V6) and 0.91 (V1) to 0.95 (V6), respectively. All the above agreements improved with time from V1 to V6.

CONCLUSIONS:

The results show that the patient input was feasible and effective and that the questionnaire method provided an objective assessment standard to determine how successfully the resident doctor was trained. Furthermore, it facilitated a training process that could help resident doctors improve their skills.
Copyright © 2014 Elsevier Ltd. All rights reserved.

KEYWORDS:

Agreement; Chinese Medicine diagnosis; Objective and standard assessments; Quality of medical practice; Questionnaire; Systemic lupus erythematosus; Training
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2014年3月5日 星期三

歷年臨床病例報導 (2021/06/15 更新)




歷年臨床病例報導

  1. [臨床病例報告] 張清貿醫師感謝中醫藥與針刺讓臺灣多一個朋友！
  2. [風濕免疫][臨床病例報告] 26歲女性患者，乾癬多年，經張清貿醫師利用桂麻各半湯調和營衛中藥治療3個月前後之照片
  3. [臨床病例報告] 奇特的肺癌T4發現方式，轉移至腦部跟骨頭
  4. [風濕免疫][臨床研究報告]  修格蘭氏症 (Sjögren Syndrome)患者經張清貿醫師利用中藥治療一個月後，Schirmer's test 眼淚測試改善顯著，兩眼從0 mm增加到15 mm
  5. [風濕免疫][臨床研究報告] 修格蘭氏症 (Sjögren Syndrome)患者治療三個月後，Schirmer's test 眼淚測試改善顯著，從0 mm增加到22 mm
  6. [臨床病例報告] 95歲男性患者，經過中藥+針灸治療8個月後，頭髮變黑了，且經過持續治療追蹤，目前頭髮還在變黑  (2016/09更新)
  7. [風濕免疫][臨床研究報告] 60歲女性患者，人參養榮湯治療雷諾氏症候群症狀改善，手指膚色暗沉及皮膚乾燥改善也明顯改善
  8. [風濕免疫][臨床研究報告] 近日Sjögren Syndrome 修格蘭氏症/乾燥症中醫藥治療有感
  9. [臨床研究報告] 六足歲病童，針刺治療粒線體肌病(Mitochondrial myopathy)，治療4個月後癲癇大發作已無，且成功減少Phenobarbital的用量
  10. [臨床研究報告] 7個月大病童，針刺治療臂神經叢麻痺，治療五個月後檢測神經傳導速度及肌電圖其回復進展顯著
  11. [風濕免疫][臨床病例報告] 6個月後追蹤：15歲女性患者，異位性皮膚炎多年，服用中藥治療約6個月後之手部照片
  12. [風濕免疫][臨床病例報告] 3個月後追蹤：15歲女性患者，異位性皮膚炎多年，服用中藥治療約3個月後之手部照片
  13. [臨床病例報告] 以手太陽小腸經(SI Meridian)穴位治療肩頸酸痛案例
  14. [風濕免疫][臨床病例報告] 15歲女性患者，異位性皮膚炎多年，服用中藥治療前後之手部照片
  15. [臨床病例報告] 20180207 針刺風池穴GB20之立即性效果
  16. [風濕免疫][臨床病例報告] 中西醫整合治療紅斑性狼瘡腎炎病例報告 Integrated Therapy Improve Urinary Total Protein in Patients with Lupus Nephritis: A Case Report (本論文後續追蹤持續報告為Stabilityof a Lupus Nephritis Case after One Year of Integrated Therapy. EC Gastroenterology and Digestive System. 2020)
  17. [風濕免疫][持續追蹤] 蛋白尿指數回覆正常範圍了：中西醫整合治療紅斑性狼瘡腎炎之持續追蹤病例報告 20190104
  18. [風濕免疫][臨床病例心得] 淋巴癌併發修格蘭氏症
  19. [風濕免疫] [臨床病例報告] Stability of a Lupus Nephritis Case after One Year of Integrated Therapy 狼瘡性腎炎患者經過整合中西醫學治療一年後之穩定性 (本論文為先前發表病例報告之後續追蹤中西醫整合治療紅斑性狼瘡腎炎病例報告，Integrated Therapy Improve Urinary Total Protein in Patients with Lupus Nephritis: A Case Report)

  20. [臨床病例] 修格蘭氏症Sjögren Syndrome患者服用滋陰潤燥、活血化瘀中藥八週後舌下絡脈瘀改善

  22. 馬碩煒，林虹均，曾偉婷，張清貿*. 中藥治療系統性紅斑性狼瘡合併狼瘡腎炎病例報告. 中醫藥雜誌. 2021

  23. 吳璟凰，林虹均，陳國豐，張清貿*. 針刺治療肌少症之文獻回顧與展望. 台灣骨鬆肌少關節防治學會 TBMJ. 2021

  24. 黃偉勝，林虹均，曾偉婷，張清貿*. 中藥治療修格蘭氏症候群合併系統性紅斑狼瘡病例報告. 中醫藥雜誌. 2020

  25. 陳國豐，曾偉婷，林虹均，張清貿*. 中藥緩解修格蘭氏症合併橋本氏甲狀腺炎之病例報告. 中醫藥研究論叢. 2020


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2014年3月3日 星期一

[臨床病例報告] 以手太陽小腸經(SI Meridian)穴位治療肩頸酸痛案例 - 張清貿醫師






患者左肩在張清貿醫師針完肩頸就放鬆
患者右肩在針完右肩一分鐘後，

右肩頸也放鬆了，


張清貿醫師臨床注記：臨床思考以手太陽小腸經(SI Meridian)穴位為主，治療肩頸酸痛效果極佳。

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2014年3月1日 星期六

[臨床病例報告] 15歲女性患者，異位性皮膚炎多年，服用中藥治療前後之手部照片 - 張清貿醫師 (2014/06/12 更新)




15歲女性患者，異位性皮膚炎多年

 服用中藥治療前之手部照片 

異位性皮膚炎女性患者，服用中藥治療前手部局部特寫照片 

異位性皮膚炎女性患者，服用中藥治療約一個月後手部局部特寫照片

異位性皮膚炎女性患者，服用中藥治療3個月後手部照片


 服用中藥治療3個月後手部局部特寫照片

異位性皮膚炎女性患者，服用中藥治療6個月後手部照片

 ＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝

 與3個月前初診時手部皮膚相比，病灶變小，粗糙程度減少，紅斑紅疹持續改善中

 與6個月前初診時手部皮膚相比，病灶變小，粗糙程度改善明顯，紅斑紅疹幾乎快看不見，但患者自述偶而會癢，抓完破皮後會變嚴重，如果能克制不去抓，會改善更明顯

 張清貿醫師臨床注記：調和營衛為主，
使營血和衛氣不至於「不從，而逆於肉里」
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