Dissertations / Theses on the topic '臨床例'

背景 屈指肌腱腱鞘炎，叉稱扳機指、彈響指，屬於中醫「傷筋」、「筋辨」範疇 。本病好發於拇指 、中指、無名指，患者女性多於男性，中老年發病較多 。本病是由於各種原因造成屈指肌腱在腱鞘內長時間、反復過度的機械性摩擦，出現纖維結締組織增生、粘連、增厚，或過度勞累、受涼，導致血瘀停滯，經脈受阻不能濡清養經筋而發為本病 。 目的 本文將從文獻研究及臨床病例報告兩方面，了解本病的診療情況。於文獻研究方面，重點探討成人屈指肌腱腱鞘炎的診斷、檢查及治療方法，更著重從療效、復發、不良事件發生三方面探討各種類療法，從中了解屈指肌腱腱鞘炎的各種診療方法並找出更準確、更快捷、更方便的診治方法。於臨床病例報告方面，分享自己和跟診病例的經驗和體會，從而學習、了解本病 。 方法 本文將從文獻統計及臨床病例報告兩方面，重點探討成人屈指肌腱腱鞘炎的診斷、檢查及治療方法。 （一）文獻研究 於數據庫中搜索文獻，並篩選及分類，把所需文獻分為實驗研究文獻和臨床研究文獻。於臨床研究文獻中根據一定的納入／排除標準選用相關文獻，然後分為診斷／ 檢查與治療兩部分作統計，得出療效、復發、不良事件發生的相關統計結果，最後根據統計探討相關診斷／檢查與治療方法 。 （二）臨床病例報告 於臨床時遇到此類患者的病例報告。跟據記錄臨床表現及治療結果作出報告和總結。 結果 （一）文獻研究 數據庫中沒有本病的實驗研究文獻，亦僅有少量文獻的內容包括專項檢查及影像學檢查。 在統計療法方面時，針刀類和手術治療的治愈率普遍較高，而針刀類、手術治療的復發率最低，沒有不良事件發生率的比較 。 （二）臨床病例報告 收錄了四個臨床病例，本病早期、中期、後期均有最少一個病例。整體而言，針灸加推拿治療對屈指肌腱腱鞘炎有一定的療效。尤其針對其疼痛，效果較明顯，但是對於減輕彈響、交鎖現象則效果不大。雖然從文獻中知道針刀治療療效不錯，但對操作者的要求較高，如對病位解剖有深入認識、了解操作原理、如何避免不 良事件發生。 結論 因為針刀類和手術治療的治愈率最高和復發率最低，故於多種療法中為最佳的療法。從臨床研究文獻之中，發現有很多有待發掘的方向，如客觀化研究、不同等級療效研究等。於臨床病例中，針灸、推拿對屈指肌腱腱鞘炎的疼痛、活動受限有一定的療效，但對彈響、交鎖則療效不大 。

碩士
國立台北師範學院
教育政策與管理研究所
92
A Study of an Elementary School Principal’s Conducting Clinical Supervision： Taking Example by Taipei County Happy Elementary School Abstract This research aims to explore an elementary school principal’s experience and reflections in conducting clinical supervision on one of the school’s teachers. The standard methods and procedures of clinical supervision were strictly followed. Suggestions made in this research are based on the faithfully recorded process and results of the clinical supervision. Research methods include observation of participation, interview, and literature analysis. Data were collected through long-term classroom observation, interview, and literature review to help solve the key issues and achieve desired results. Primary objectives of this research are: 1. Understand the problems emerged in the process of clinical supervision. 2. Explore the key factors involved in clinical supervision. 3. Analyze any change and development caused by clinical supervision. 4. Formulate concrete conclusions and suggestions on clinical supervision for principals. Major findings and conclusions are as follows: 1.Clinical supervision is one of the most important forms of instructional supervision and is indeed conducive to the improvement of teaching. Yet the majority of teachers in elementary and junior high schools in Taiwan lack the knowledge of clinical supervision. 2.The three phases of clinical supervision are kick-off meeting, classroom observation, and feedback meeting. The procedures have to be concise, clear, and easy to understand to produce valid results. 3.Clinical supervision has standard methods and procedures. Sufficient knowledge of instructional supervision on the part of the principal is required to conduct effective clinical supervision. 4.Clinical supervision is laborious and time-consuming; hence the principal who already suffers from a huge workload should not overlook the importance of time management. 5.Clinical supervision should take the form of cooperation rather than instruction. 6.The principal must take the teacher’s need into account and choose appropriate tools when conducting clinical supervision. 7.Three factors work tremendous influence on clinical supervision: individual, school, and the society. The factors are complicated and correlating. 8.The principal and the teacher have gained better control of the key elements in teaching after experiencing clinical supervision. They take delight in pursuing the top teaching quality. Their ability of self-reflection has also improved. 9.The major development and growth on the part of the teacher after clinical supervision are the enhancement of the concept of teaching through research and discussion, and the better understanding of the self and the students through analysis. 10.The major development and growth on the part of the principal after clinical supervision is enabling the principal to realize the ideals of education, establish confidence in leadership, apply the theories of clinical supervision, enhance interpersonal and communication skills, have better management of time, and develop mastery of information technology facilities. 11.It is feasible for the principal to conduct clinical supervision personally. The example in the research can serve as a reference for the establishment of school’s instructional supervision strategies. Concrete suggestions are made based on the findings to serve as a reference for education administration agencies, teacher training institutions, schools, principals, and teachers. Several directions of future research are also pointed out. Key Words: instrumental supervision, clinical supervision, professional growth

碩士
國立中正大學
資訊管理學系
92
Abstract Because the change of medical environment , the severe competition of medical market , the raising of consummer sense , the increasing of manage cost, lead to the crisis of management of many hospitals in recently years. Then the National Health Insurance NHI program was launched in 1995 , for the unappropriate wast of medical resources , the Bureau National Health Insurance BNHI changed medical payment system from fee for services to case payment to globral budget , with the fixed budget to pay the medical expenses in order to make the balance of income and outcome . In fixed income situation , many pospitals induce many different policies of managerment expected to reduce the cost of managerment , to increase the efficiency of medical care , to promote the quality of medical care . It’s recognized that the imprementation of clinical pathway in america is the best one . The progress of information technology make midicine and information closely that produce ‘medical informatics’ . Evidence-Based- Medicine EBM appling scientific spiritual , assistanted with information technology , which enphasis patient centered medical model oriented from medical problem . It’s purpose is to use scientific method to judge which medical knowledge can provide assured evidence to establish clinical guideline and then promote the guality of medicine . This research uses medical records in a medical institute’database as sample , focus on the experiment of data mining technique appling on medical praactice . By means of data mining technique and Bayesian network , we can present the information in some sort of order , and find out medical behavior models of same disease for the reference to establish clinical pathway . We also expect that the classification of clinical pathway would be more efficient and flexible , so that we can maintain the medical quality , reduce medical cost and become the useful reference for the managerment of medical institute .