[導生聚] 內部(自己) intra-rater一致性和外部(同儕) inter-rater一致性

今天下診完趕快趕去導生聚，這次課程跟同學聊到看診的內部(自己) intra-rater一致性和外部(同儕) inter-rater一致性，我覺得臨床上最重要的，在談氣血陰陽之前，中醫四診的一致性更重要，因為要建構intra-rater的一致性，才可以評斷患者舌脈診是否有改變，才可以說這個改變是變好還是變差，才可以作為療效評估。

至於同學來跟診，學生跟主治醫師之間就是inter-rater一致性，當學生跟老師的一致性趨近相同，才可以表示兩個人看到的舌診跟把到的脈診是一樣的，這樣的教學才會有意義，不然常常發生老師把的脈跟學生的感受不一樣，這樣很難說有學到。

[教育訓練] 知道有新的方向，就可以自己補充最新知識與工具，讓自己可以繼續走下去

今天臺北下雨一陣一陣的，患者都擠在最後才來，還好趕快下診後繼續趕到臺大進修，

今天有個患者膽結石本來是2.6 cm，經過一段時間清熱利濕中藥治療後，回診SONO超音波顯示膽結石縮小到1.16 cm，患者連皮膚溼疹都改善很多。

[論文發表] Complementary Chinese Herbal Medicine Therapy Improves Survival of Patients With PancreaticCancer in Taiwan: A Nationwide Population-Based Cohort Study.

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Integr Cancer Ther. 2018 Jun;17(2):411-422. doi: 10.1177/1534735417722224. Epub 2017 Aug 3.

Complementary Chinese Herbal Medicine Therapy Improves Survival of Patients With PancreaticCancer in Taiwan: A Nationwide Population-Based Cohort Study.

Kuo YT1,2, Liao HH1,2, Chiang JH3, Wu MY4,5, Chen BC2, Chang CM6, Yeh MH1,2,7, Chang TT1,8, Sun MF1,4, Yeh CC2,7, Yen HR1,4,5,9,10.

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Abstract

BACKGROUND:

Pancreatic cancer is a difficult-to-treat cancer with a late presentation and poor prognosis. Some patients seek traditional Chinese medicine (TCM) consultation. We aimed to investigate the benefits of complementary Chinese herbal medicine (CHM) among patients with pancreatic cancer in Taiwan.

METHODS:

We included all patients with pancreatic cancer who were registered in the Taiwanese Registry for Catastrophic Illness Patients Database between 1997 and 2010. We used 1:1 frequency matching by age, sex, the initial diagnostic year of pancreatic cancer, and index year to enroll 386 CHM users and 386 non-CHM users. A Cox regression model was used to compare the hazard ratios (HRs) of the risk of mortality. The Kaplan-Meier curve was used to compare the difference in survival time.

RESULTS:

According to the Cox hazard ratio model mutually adjusted for CHM use, age, sex, urbanization level, comorbidity, and treatments, we found that CHM users had a lower hazard ratio of mortality risk (adjusted HR = 0.67, 95% CI = 0.56-0.79). Those who received CHM therapy for more than 90 days had significantly lower hazard ratios of mortality risk than non-CHM users (90- to 180-day group: adjusted HR = 0.56, 95% CI = 0.42-0.75; >180-day group: HR = 0.33, 95% CI = 0.24-0.45). The survival probability was higher for patients in the CHM group. Bai-hua-she-she-cao (Herba Oldenlandiae; Hedyotis diffusa Spreng) and Xiang-sha-liu-jun-zi-tang (Costus and Chinese Amomum Combination) were the most commonly used single herb and Chinese herbal formula, respectively.

CONCLUSIONS:

Complementary Chinese herbal therapy might be associated with reduced mortality among patients with pancreaticcancer. Further prospective clinical trial is warranted.

KEYWORDS:

Chinese herbal medicine; National Health Insurance Research Database; complementary and alternative medicine; pancreatic cancer; traditional Chinese medicine