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#疫情時代如何抓住機會？⠀大家都知道，疫情來臨後，學術期刊偏好收錄與 COVID-19 有關的研究，許多臺灣醫師常認為，我的科根本與 COVID-19 沒什麼關係，怎麼寫？⠀林舜穀醫師沒有抱怨，而是去找出疫情不只有生理病理面向，更有心理與行為面向，利用所在醫院系統完整的就診資料，分析患者的行為改變，並提出對行政體系的建議，實際且有用。#獲Q1期刊接受刊登，實至名歸。⠀🎉 林舜穀醫師團隊，關於 COVID-19 疫情對患者求診中醫行為變化之研究，獲 BMC Complementary Medicine and Therapies 刊登！⠀#深入專業發展因為輕症的失智症病例減少，重症的比例增加，讓我有更多時間跟機會，開發重度失智症的診治方法。此外，我也把握機會發展帕金森氏症和吞嚥困難的中醫治療，還撰寫了失智症、帕金森氏症、慢性阻塞性肺病、心臟衰竭等中醫臨床照護建議。對重症病患的投入心力，是我在疫情期間仍不斷有新病患就診，並且快速恢復門診量的重要關鍵。⠀#改進臨床流程重新規劃自己的門診、會診、護理之家巡診步驟。將紀錄線上化以減少人工填寫時間；線上化後一旦有新資料加入，所有成員都立刻更新最新消息；改進針灸數量記錄方式，並針對高危險的地區規劃提示警訊等等，相關的改進成果也已經投稿到 SCI 期刊。⠀--⠀🚩疫情會過去，論文技能會留下。➠ 2021 / 7 / 10（六）醫學論文與寫作工作坊➠ https://mepa2014.innovarad.tw/event/➠ 今年一定要讓自己的文章登上 PubMed。

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bmc medicine 在新思惟國際 Facebook 的最佳貼文

By 新思惟國際

2021-06-19 19:30:00 有 10 人按讚

#疫情時代如何抓住機會？
⠀
大家都知道，疫情來臨後，學術期刊偏好收錄與 COVID-19 有關的研究，許多臺灣醫師常認為，我的科根本與 COVID-19 沒什麼關係，怎麼寫？
⠀
林舜穀醫師沒有抱怨，而是去找出疫情不只有生理病理面向，更有心理與行為面向，利用所在醫院系統完整的就診資料，分析患者的行為改變，並提出對行政體系的建議，實際且有用。#獲Q1期刊接受刊登，實至名歸。
⠀
🎉 林舜穀醫師團隊，關於 COVID-19 疫情對患者求診中醫行為變化之研究，獲 BMC Complementary Medicine and Therapies 刊登！
⠀
#深入專業發展
因為輕症的失智症病例減少，重症的比例增加，讓我有更多時間跟機會，開發重度失智症的診治方法。此外，我也把握機會發展帕金森氏症和吞嚥困難的中醫治療，還撰寫了失智症、帕金森氏症、慢性阻塞性肺病、心臟衰竭等中醫臨床照護建議。對重症病患的投入心力，是我在疫情期間仍不斷有新病患就診，並且快速恢復門診量的重要關鍵。
⠀
#改進臨床流程
重新規劃自己的門診、會診、護理之家巡診步驟。將紀錄線上化以減少人工填寫時間；線上化後一旦有新資料加入，所有成員都立刻更新最新消息；改進針灸數量記錄方式，並針對高危險的地區規劃提示警訊等等，相關的改進成果也已經投稿到 SCI 期刊。
⠀
--
⠀
🚩疫情會過去，論文技能會留下。
➠ 2021 / 7 / 10（六）醫學論文與寫作工作坊
➠ https://mepa2014.innovarad.tw/event/
➠ 今年一定要讓自己的文章登上 PubMed。

Tags: bmc medicine 疫情時代如何抓住機會獲Q1期刊接受刊登深入專業發展改進臨床流程

新思惟國際

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實用型互動工作坊高品質大型研討會 http://www.innovarad.tw/

實用型互動工作坊高品質大型研討會 (用「心」的新思「惟」)

bmc medicine 在 Dr 文科生 Facebook 的最佳貼文

By Dr 文科生

2021-05-27 20:00:46 有 553 人按讚

哮喘並非想像中的輕鬆

在日常問診的時候，不難發現很多病人都有不同程度的長期咳嗽問題。

有些病人小時候有哮喘，每當換季或做運動時需要用到一些藥物減輕呼吸困難，但長大後便漸漸穩定下來。但有些病人卻未必那麼幸運，哮喘病情一直以來都未曾好過，仍然常常受哮喘困擾。

那麼，到底什麼是哮喘？跟一般感冒的咳嗽有什麼分別？

哮喘是是過敏鐵三角（Atopy）的其中一員
1. 哮喘（Asthma）
2. 鼻敏感（Allergic Rhinitis）
3. 濕疹（異位性皮膚炎）（Atopic Dermatitis）

哮喘大部分都是因過敏反應而產生免疫細胞和因子，例如Eosinophil, interleukin-4 and 5和IgE等，令呼吸道肌肉收縮和氣管收窄，導致呼吸困難的徵狀。過敏原因很多，可以是天氣轉變、常見的花粉、塵蟎和化妝品等等。

長期不受控的哮喘可引致呼吸道慢性炎症，長遠可引致呼吸道組織變異而令哮喘狀況惡況而不受控制，令藥物的效果變差。所以於哮喘早期時盡快治療和良好的長期控制便極為重要。

在香港，不少人都對哮喘認識不深，很多都把早期或慢性哮喘的徵狀當作是一般天氣轉變或小感冒去處理。但這樣是無法長遠控制好病情的。

跟大眾固有印象不同的是，常見哮喘徵狀並不只是咳嗽；胸口痛、喘嗚（Wheezing）、呼吸困難或過速、半夜咳醒或睡眠質素偏差、運動時體能不佳而動輒要停下來休息喘氣等都是常見的徵狀。

那麼，怎麼知道自己是不是患有哮喘？這種情況下便要諮詢醫生的意見，如有需要便會安排進行肺功能測試，如結果是呼吸道受阻而在使用藥物後有改善的話，便很可能有哮喘的問題。

一般來說，哮喘治療主要有以下幾種
1. Short Acting Beta-2 Receptor Agonist（SABA）
2. Short Acting Muscarinic Antagonist （SAMA）
3. Long Acting Beta-2 Agonist （LABA）
4. Long Acting Muscarinic Antagonist （LAMA）
5. Inhaled Corticosteroids （ICS）
6. Leukotriene Antagonist

這些藥物對哮喘到底有什麼功效？而什麼人應為用什麼藥物控制？

首先你需要先諮詢醫生再進行肺功能測試，判斷是否有氣道受阻（Airway obstruction）或氣管抽搐（Bronchospasm）的問題，而這些問題亦可透過氣管擴張劑（bronchodilator）減輕從而改善肺功能。

幾十年前哮喘來來去去都是靠俗稱為藍色噴霧的短效氣管擴張劑（SABA）例如salbutamol。一般來說輕度哮喘的確可以靠SABA在有徵狀時，例如換季、做運動或過敏時減輕徵狀令生活不致太受影響。然而研究發現高達七成的哮喘病人並未能良好的控制哮喘徵狀。[1][2]

很多人都以為哮喘只需要發作時吸一吸氣管擴張劑便會好，但其實如果是中等至嚴重級別的哮喘，單靠短效氣管擴張劑並不能完全控制。SABA亦非沒有副作用，常見的副作用為心跳過速，當病人病情不穩需要不斷使用SABA時，便可能出現以下問題

1. 心跳過速至不適或頭痛
2. 生活質素被哮喘徵狀嚴重影響，例如半夜咳醒需要吸SABA或未能進行運動，因休息不足而經常疲累
3. 哮喘從根本上並未受到控制，長期炎症和過敏反應令氣道組織變異，導致哮喘持續惡化

因此近年愈來愈多新型藥物能提供長久的哮喘控制。當中以吸入性類固醇（ICS）和長效氣管擴張劑（LABA）最為革命性的發展。

吸入性類固醇針對身體因過敏反應所產生導致炎症和氣管收縮的問題，透過壓抑過敏和炎症而紓緩徵狀同時減少長期過敏發炎引致的氣道組織變異。

長效氣管擴張劑例如Salmeterol和Formoterol，跟短效最大的分別是，長效一天只要噴一至兩次，短效在中等至嚴重的患者可能需要每數小時噴上6次甚至更頻密，頻密地使用氣管擴張劑增加了副作用的產生和生活質素的影響。

傳統長效氣管擴張劑能產生長效藥力紓緩氣管收縮、咳嗽和呼吸困難的徵狀，務求達到改善生活質素，讓患者不用半夜醒來或日間經常要停下來吸SABA。近年更有新一代Ultra Long Acting beta2-agonist例如vilanterol，從而達至更穩定和長效的徵狀紓緩。

令人無奈的是，哮喘可以說是一場長期的戰爭，當你日以繼夜夜以繼日要噴氣管擴張劑時，不少患者都會感到無助令大家久而久之不再跟足醫生或藥劑師建議，間中不適才噴一下，令病情未能得到良好控制。

因此，另一個革命性的改變便是combined inhaler，近年不少吸入性哮喘藥物均為混合式，吸一次等於吸了兩種藥物，例如大家可能都見過的Fluticasone/Sameterol和Budesonide/Formoterol。較新的有超長效混合藥物，藥效可持續12-24小時，例如Fluticasone/Vilanterol。這些混合式藥物大大減少病人每天需要使用吸入器的次數，令更多病人更願意持續的使用，

最後想提提大家，使用吸入式噴劑的技巧非常重要，研究發現不少患者技巧欠佳令不少藥物只噴在口內無法成功到達氣管內[3]。近年不少新型吸入式device有特別設計改善這問題，由於種類太多，強烈建議你諮詢你的家庭醫生、護士或藥劑師建議以及讓醫護人員評估你的使用技巧。

視乎患者的臨床狀況，一些病人只需要間中用到SABA；一些病人需要用到SABA+SAMA；嚴重點的病人需要用到SABA+LABA+ICS；醫生可能建議病人使用不同的combination以控制哮喘，所以患有哮喘的話，請務必定期與家庭醫生跟進。

*新型藥物如生物製劑（IgE-inhibitor或Eosinophil Inhibitor或IL-4/5 Inhibitor）由於太複雜的關係便不在此講解，留待下次有機會再跟大家分享。

Reference
[1] Woodcock A, et al. (2017) Effectiveness of fluticasone furoate plus vilanterol on asthma control in clinical practice: an open-label, parallel group, randomised controlled trial. The Lancet

[2] Martyn R Partridge et al (2006). Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study. BMC Pulm Med.

[3] Lia Jahedi, et al (2017). Inhaler Technique in Asthma: How Does It Relate to Patients' Preferences and Attitudes Toward Their Inhalers? Journal of Aerosol Medicine and Pulmonary Drug Delivery.

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Dr 文科生

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90後香港男生 Patreon專欄： https://www.patreon.com/user?u=32901195 Blogger in Meducia 你的健康夥伴 https://www.meducia.com/

bmc medicine 在新思惟國際 Facebook 的最佳貼文

By 新思惟國際

2021-03-11 07:30:00 有 42 人按讚

我的次專科是不需要有論文刊登，只須通過筆試口試就能拿到證照的，所以看著同期其他次專科的同事，每天焦頭爛額的生論文，當時沒有將寫論文當成目標的我，心裡以一種可以逃避災難的慶幸而開心度日，直到畢業下鄉。
　
下鄉後的我，一開始就感受到沒有論文的差異，薪水、履歷、職位等問題一一浮現，而後我同樣因為興趣，而在下鄉期間選擇回到醫院，一邊受重症訓練。
　
但是這回不一樣，如果要考取重症執照需要一篇論文，然後，我才終於決定面對這個一直以來讓我逃避的問題。
　
【2021 / 5 / 8（六）醫學論文與寫作工作坊】　
🔔 2021 已有兩梯次額滿 🔔
　　
5 月梯次名額僅剩 10 幾席｜立即報名
https://mepa2014.innovarad.tw/event/
　
論文架構跟段落書寫的課程，完全顛覆我對寫論文的想像，一直以來，我都認為寫論文需要有好的靈感、好的英文、好的研究主題，各種好上加好才能成就一篇論文。
　
但事實是，寫論文就像填充題而非問答題，有固定的格式、固定的內容、固定的順序、固定的排版，並不是天馬行空想寫什麼就寫什麼。該填的東西都填對了、看起來順眼舒服，自然會有分。
　
💖 太驚人了！校友發表成績大爆發
　　
🏆一月 84 篇創新高🏆
🏆單月 13 位發表第一篇🏆
　　
前前後後跟著老師寫論文、跑統計、投稿，但有種不踏實的感覺嗎？
　
覺得實際上缺乏扎實的寫作方法論嗎？
　
對於投稿策略也沒有想太多，投稿常常被拒絕，寫論文越來越失去熱情，但又想成為一位獨立研究者，到底該怎麼做比較有效率？
　
✓ 不再害怕統計，讓你親手畫出數據圖，有。
✓ 入門稿件寫作與準備要訣，有。
✓ 投稿期刊選擇策略。多元文體與學術參與，有。
✓ 還是寫不出來？過來人時間安排建議，有！
　
內科 #陳一銘醫師，復健科 #吳爵宏醫師，放射科 #蔡依橙醫師，與你一樣的世代，超過 200 篇 SCI 發表經驗，給你最實用的建議。
　
🔔 近期校友傑出榮耀 #每天都有學員發表
https://mepa2014.innovarad.tw/greatachievements/
　
[快訊] 林舜穀醫師團隊，關於 COVID-19 疫情對患者求診中醫行為變化之研究，獲 BMC Complementary Medicine and Therapies 刊登！
　
[快訊] 陳柏成醫師團隊，關於中風後憂鬱與心理危機之關聯研究，獲 BioMed Research International 刊登！
　
[快訊] 蔡明劭醫師團隊，分享深層頸部感染以連續沖洗法治療之個案研究，獲 International Journal of Surgery Case Reports 刊登！
　
[快訊] 張耕閤醫師團隊，使用自製道具安全移除耳道中的蜈蚣之個案研究，獲 Ear, Nose & Throat Journal 刊登！
　
[快訊]陳科廷醫師團隊，關於 EBV-SMT 並有中樞神經侵犯之外科角色的系統性回顧，獲 Cancer Medicine 刊登！
　
新思惟最受歡迎研究入門課程，論文苦手必上。
最「接地氣」的寫作攻略傳承｜立即報名
https://mepa2014.innovarad.tw/event/

Tags: bmc medicine 陳一銘醫師吳爵宏醫師蔡依橙醫師每天都有學員發表

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實用型互動工作坊高品質大型研討會 http://www.innovarad.tw/

實用型互動工作坊高品質大型研討會 (用「心」的新思「惟」)

bmc medicine 在 [email protected] Youtube 的最讚貼文

By [email protected]

2021-03-24 15:00:04 有 11,509 人看過有 0 人喜歡

生蛇－丁昭慧內分泌及糖尿科專科醫生＠FindDoc.com

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（一）什麼原因導致生蛇，和它有什麼病徵？ 00:06

（二）糖尿病與生蛇兩種病症會否互相影響？ 02:04

（三）生蛇有什麼後遺症？如何預防？ 03:09

(本短片作健康教育之用，並不可取代任何醫療診斷或治療。治療成效因人而異，如有疑問，請向專業醫療人士諮詢。)

參考資料：
1 Cohen, J. I. The New England Journal of Medicine, 369(3), 255-263 (2013).
2 Chua, J. V., & Chen, W. H. (2010). Herpes zoster vaccine for the elderly: boosting immunity. Aging health, 6(2), 169–176. https://doi.org/10.2217/ahe.10.5.
3 Johnson, R.W.. Expert Rev Vaccines, 9(3 Suppl):21-26 (2010).
4 CDC. Recommendations of the ACIP. MMWR Early Release 2008; 57. RR-5.
5 John, A. R. et al. Infect Dis Clin N Am, CNA, 31(4), 811–826 (2017).
6 Papagianni, M. et al. Diabetes Ther; 9(2), 545–550 (2018).
7 Muñoz-Quiles, C. et al. Human Vaccines & Immunotherapeutics; 13(11), 2606–2611 (2017).
8 Diabetes UK. Complications of diabetes, Available at: https://www.diabetes.org.uk/guide-to-diabetes/complications (Accessed on 1 July 2020)
9 Fasil, A. et al. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 12, 75–83 (2019).
10 Global report on diabetes. (2016). Geneva: World Health Organization.
11 Johnson, R. W. et al. BMC medicine, 8, 37 (2010).

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香港最全面醫療資訊影片平台，超過200位專科醫生、中醫、物理治療師、營養師等解答你的健康問題。搜尋全港各區醫生資料，即上FindDoc.com! At FindDoc, we aim to increase general public health awareness through our FindDocTV videos. Patients can make doctors’ appointments online using our platform Anytime Anywhere. FindDoc is Free and open to both patients and doctors.

bmc medicine 在 [email protected] Youtube 的最佳貼文

By [email protected]

2020-09-16 17:45:43 有 46,620 人看過有 0 人喜歡

周邊神經病變

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（一）周邊神經病變（peripheral neuropathy）的病因、症狀？

（二）如何分辨背痛和坐骨神經痛？

（三）甚麼是腕管綜合症？

（四）如忽視神經痛楚，會有甚麼嚴重後果？

（五）如何紓緩／治療神經痛楚？

（六）神經問題與缺乏維他命有關？

(本短片作健康教育之用，並不可取代任何醫療診斷或治療。治療成效因人而異，如有疑問，請向專業醫療人士諮詢。)

參考資料：
1. Hsieh, S.C. (1998). Brief Introduction to Peripheral Neuropathy. Medicine Today 25(11) 883-887
2. Martyn, C. N., & Hughes, R. A. (1997). Epidemiology of peripheral neuropathy. Journal of neurology, neurosurgery, and psychiatry, 62(4), 310–318. https://doi.org/10.1136/jnnp.62.4.310 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1074084/?page=1
3. Sindrup, S.H., Otto, M., Finnerup, N.B. and Jensen, T.S. (2005), Antidepressants in the Treatment of Neuropathic Pain. Basic & Clinical Pharmacology & Toxicology, 96: 399-409. doi:10.1111/j.1742-7843.2005.pto_96696601.x Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/j.1742-7843.2005.pto_96696601.x
4. Ekabe, C. J., Kehbila, J., Abanda, M. H., Kadia, B. M., Sama, C. B., & Monekosso, G. L. (2017). Vitamin B12 deficiency neuropathy; a rare diagnosis in young adults: a case report. BMC research notes, 10(1), 72. https://doi.org/10.1186/s13104-017-2393-3 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5273828/
5. Shibuya, K., Misawa, S., Nasu, S., Sekiguchi, Y., Beppu, M., Iwai, Y., Mitsuma, S., Isose, S., Arimura, K., Kaji, R., Kuwabara, S. (2014). Safety and efficacy of intravenous ultra-high dose methylcobalamin treatment for peripheral neuropathy: a phase I/II open label clinical trial. Internal Medicine, 53(17), 1927-1931. https://doi.org/10.2169/internalmedicine.53.1951 Retrieved from https://www.jstage.jst.go.jp/article/internalmedicine/53/17/53_53.1951/_article

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bmc medicine 在 LOVENARUKO Youtube 的最佳解答

By LOVENARUKO

2013-12-19 13:10:15 有 1,388 人看過有 14 人喜歡

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