“类医生”:医务社会工作的发展趋向

医务社会工作的出现与发展是我国医疗卫生体制改革的必然要求。在医院里采用"类医生"的发展模式是我国医务社会工作的发展趋向,即给予医务社工岗位及编制、发挥医务社工处理各类医患问题的能力、多层面的推介医务社工。

Endoscopic Classification of Esophagic Eosinophilia

Introduction： EoE （eosinophilic esophagitis） is an inflammatory condition characterized by a dense eosinophilic infiltrate in the esophageal epithelium. In Brazil, it remains a poorly diagnosed disease due to the lack of interaction between the clinician, the endoscopist, and the pathologist. The diagnosis is performed by histological study of esophageal biopsies, with at least fifteen eosinophils per high-power field （EOS/HPF）. Some doubts remain with respect to patients with a clinical picture and symptoms compatible with the disease （EoE）, but who have a lower number of eosinophils than established. The main objective of this study was to create an endoscopic classification for EsEo （esophageal eosinophilia）, which pointed the way to the endoscopist towards the diagnosis. Methods： This study was a prospective, two-year study, at a gastrointestinal endoscopy center where all patients with endoscopic symptoms and/or endoscopic findings suggestive of EsEo were biopsied for histological examination of EOS/HPF. After the study and compilation of the results, a retrospective study was performed, based on a review of electronic medical records, where the same diagnosis was searched, although at a period when this classification was not adopted. Results： A total of 4,251 endoscopies were performed between September 2011 and September 2013. Two biopsies were performed, aimed at lesions, in 133 patients with clinical picture or imaging suggestive of EsEo. Eosinophils were found in 55 patients, corresponding to an incidence of 1.29% of the total population studied and 41.35% of the suspected cases of the disease. EoE was diagnosed in 24 patients during the period of this study. In the two-year retrospective study, only two cases of EoE were found. Conclusions： The results of this study demonstrate that the endoscopic standardization of esophageal lesions, suggestive of eosinophilia, in this case by classification, alerts the endoscopist for the diagnosis of EoE, prompting him to perform targeted biopsies. Further, it was observed that two samples of esophageal tissue were sufficient for the diagnosis. The relationship between the clinical picture, endoscopy, and histology was not evident in this study.

Leaming to Be a Tea Art Practitioner： An Anthropologist＇s Self-Reflection

Becoming a tea art practitioner, or charen （茶人）, involves cultivation of body and mind. This paper attempts to document the long-term process of bodily and mindful cultivation from an anthropological, participant-observation, and self-reflective point of view. I will describe my experiences from entering the world of Taiwan Residents tea art through learning the great variety of teas and the techniques for making them, designing my own tea sets, and performing in tea gatherings. This learning process has gone well beyond what is required of a researcher, or a good observer, because it has not only allowed me to understand, interpret, and analyze the aesthetics and ritual of Taiwan Residents tea art but it has also required that I ＂designs＂ or be creative in presenting Taiwan Residents tea art to my own cultural members. This substantially changes my status from the objective observer my profession requires, to a dedicated performer and even a designer/creator of my own culture. My self-reflexivity in this process points to not only methodological issues but also theoretical ones, including recent academic interest in materiality, cultural performance, lifestyle, bodily discipline, and the senses. Through self-reflection, I intends to reveal connections among them.

On Mechanisms of Human Behavior： The ＂Mind Blindness Phenomenon＂ in Philosophy, Religion, Science, and Medicine

The phenomenon described here has no scientific title, but occurs frequently in daily living, from science to philosophy, religion, and medicine. In every field of human endeavor, when a view is expressed, sharp and profound differences of opinion ensue. Initially, we coin this phenomenon as ＂understanding blindness＂ or ＂mind＇s awareness.＂ Thereafter, we decide to refer to it as ＂mind blindness,＂ a concept introduced to science by Professor Simon Baron-Cohen, who coins it for a cognitive disorder associated with autism, Asperger＇s syndrome, and schizophrenia. Baron-Cohen＇s usage has subsequently been extended to dementia, bi-polar disorders, antisocial personality disorders, and even normal aging. In our view, definition and identification of ＂mind blindness＂ in philosophy, religion, science, medicine, and at end-of-life care can help mankind to better understand mechanisms of human behavior, and the causes of conflicts, controversies, contradictions, and sharp differences of opinion in human life, and even to solve some of them.

A systematic survey on the diagnosis strategy and patient management of type 1 diabetes by Chinese physicians

The qualification of physicians is a key factor in controlling type 1 diabetes(T1 D) since they provide crucial information to their patients about self-management. To investigate whether Chinese physicians' medical strategies influence the control of T1 D in their patients, we designed a questionnaire to survey Chinese physicians, which covered their diagnosis and patient-management strategies for T1 D. A total of 442 completed questionnaires were received from 35 public hospitals in 12 cities. The results showed Chinese physicians mainly diagnosed T1 D based on the clinical features and islet dysfunction. One-third of physicians in this study still prescribed non-basal-bolus insulin regimens to their T1 D patients. More than 80% of the doctors prescribed alpha-glucosidase inhibitors as adjunctive therapy, in addition to insulin therapy. Moreover, most of the physicians in China did not pay attention to identify coexistent autoimmune diseases. T1 D patients in China were not armed with self-management knowledge and skills, which should be provided by their doctors. One of the circumstances leading to insufficient disease control in Chinese T1 D patients is the ineffective therapeutic strategy prescribed by their physicians. We need to promote knowledge of efficient strategies among physicians in China to achieve better disease control in Chinese T1 D patients in the future.

A review of the use of pteridophytes for treating human ailments

The aim of this review was to explore the pharmacological activity of early tracheophytes （pteridophytes） as an alternative medicine for treating human ailments. As the first vascular plants, pteridophytes （aka, ferns and fern allies） are an ancient lineage, and human beings have been exploring and using taxa from this lineage for over 2000 years because of their beneficial properties. We have documented the medicinal uses of pteddophytes belonging to thirty different families. The lycophyte Selaginella sp. was shown in earlier studies to have multiple pharmacological activity, such as antioxidant, anti-inflammatory, anti-cancer, antidiabetic, antiviral, antimicrobial, and anti-Alzheimer properties. Among all the pteridophytes examined, taxa from the Pteridaceae, Polypodiaceae, and Adiantaceae ex- hibited significant medicinal activity. Based on our review, many pteridophytes have properties that could be used in alternative medicine for treatment of various human illnesses. Biotechnological tools can be used to preserve and even improve their bioactive molecules for the preparation of medicines against illness. Even though several studies have reported medicinal uses of ferns, the possible bioacUve compounds of several pteridophytes have not been identified. Furthermore, their optimal dosage level and treatment strategies still need to be determined. Finally, the future direc- tion of pteridophyte research is discussed.

The Extraarticular Symptoms Influence ACR Response in the Treatment of Rheumatoid Arthritis with Biomedicine: A Single-blind, Randomized, Controlled, Multicenter Trial in 194 patients

Objective: The extraarticular symptoms are important in the pattern differentiation of traditional Chinese medicine (TCM), and the present study is designed in an attempt to find the associations between the extraarticular symptoms and American College of Rheumatology (ACR) Response in 194 cases of rheumatoid arthritis (RA) treated with biomedicine. Methods: The data were obtained from a randomized clinical trial. One hundred ninety-four RA patients were treated with the biomedical therapy (diclofenec, methotrexate and sulfasalazine). ACR20 response in 24 weeks was used for the efficacy evaluation. Eighteen symptoms (including 13 extraarticular symptoms) that TCM practitioners focus on were collected for exploration on the association between the symptoms and the efficacy of the biomedical therapy with association rules method. Results: After 24 weeks, a total of 135 patients receiving biomedicine had achieved an ACR20 response. The association rules analysis on each symptom showed that soreness in the waist was more associated with ACR20 response, but with lower support (selected sample size based, 20.10% and 14.95% respectively); cold intolerance and cold joint were found to be associated with ACR20 response with higher support (48.97% and 53.61% respectively), and the confidences (predicted effective rate) were 73.08% and 71.23% respectively. The associations between combination of symptoms (among them, there was at least one extraarticular symptom) and ACR20 response indicated that cold intolerance or cold joint with higher confidence and support were the most important extraarticular symptoms. Conclusion: The RA patients with "cold intolerance" and "cold joints", which are the extraarticular symptoms that TCM practitioners focus on, may show higher ACR20 response when treated with the biomedical approach.