Dysfunctional response preparation and inhibition during a visual GoNogo task in children with two

5免责声明该临床应用指南并非意在作为诊治发声障碍的唯一来源，而是通过提供循证框架帮助临床医生制定策略。

“指南”并非意在代替临床判断或建立适用于所有个体的方案，提供的也可能不是诊断和治疗的唯一途径。

随着医学的发展和科技进步,临床指征和“指南”作为在特定条件下的临时建议,并非绝对。

“指南”并非命令，不应作为医疗的法定标准。

负责任的医生会根据患者表现出的所有情况做出合适的治疗决定。

遵循“指南”也难以确保在所有情况下患者的治疗都是成功的。

美国耳鼻咽喉头颈外科学会强调这些临床指南不应被认为包含所有合适的治疗决定或保健方法,也不应被认为排斥其他以获得相同结果为目的的治疗决定或方法。

6指南作者专家组组长和作者Robert J.Stachler,副组长和作者David O.Francis,方法学专家和作者Seth R.Schwartz,作者Cecelia C.Damask，作者Ger-manP Digoy'HeleneJ Hrouse'Sco t J.McCoy,作者Daniel R.Ouellette,作者Rita R. Patel,作者Charlss（Charlie）W.Reavis,作者LibbyJ Smith'Marsha l Smith'Steven W.Strode,作者Peak Woo,作者和美国耳鼻咽喉头颈外科学会联络官Lorraine C.Nnacheta7参考文献（略）［摘译自:Stachler RJ,Francis DO,Schwartz SR,et al.Clinical practice guideline：hoarseners（dyspho­nia）（update）executive summary./.Otolaryngol­ogy—Head and Neck Surgery,2018,158:409..（2018—12—14收稿）（本文编辑李翠娥）美国《声嘶（发声障碍）临床实践指南》解析$*王路1陈臻#李湘平3蒋家琪#魏春生2/1广东省肇庆市高要区中医院耳鼻喉科（肇庆526100）；2复旦大学附属眼耳鼻喉科医院耳鼻喉科；3南方医科大学南方医院耳鼻咽喉头颈外科DOI:103969*jissn1006—7299201904026美国耳鼻咽喉头颈外科学会（AAO—HNSF）2018年3月初在Otolaryngology Head and Neck Surgery杂志上发布了最新《声嘶（发声障碍）临床实践指南,该指南由耳鼻咽喉头颈外科、言语病$国家自然科学基金（海外及港澳学者合作研究）（81329001）与国家自然科学基金青年项目（81400452）联合资助通讯作者:陈臻（Email:zhenchenl204@）理学、职业嗓音、老年医学、神经内科、儿科、护理等领域的15位专家合作撰写，从发声障碍的定义、流行病学、诊断、治疗等方面提供循证医学证据与建议，旨在加强对发声障碍的诊断，促进恰当的治疗方案和结果评估。

Randomised clinical trial:Bifidobacterium bifidum MIMBb75 significantly alleviates irritable bowel syndrome and improves quality of life––a double-blind,placebo-controlled studyS.Guglielmetti*,D.Mora*,M.Gschwender &K.Poppà*Department of Food Science and Microbiology(DiSTAM),Universita` degli Studi di Milano,Milan,Italy. Director of the nutritional study, practising physician,Munich, Germany.àMaster of Science in Molecular Biotechnology.Correspondence to:Dr S.Guglielmetti,Department of Food Science and Microbiology (DiSTAM),Universita`degli Studi di Milano,Via Celoria2,Milan20133, Italy.E-mail:simone.guglielmetti@unimi.itPublication dataSubmitted7February2011First decision22February2011 Resubmitted1March2011 Accepted1March2011EV Pub Online21March2011SUMMARYBackgroundRecent research suggests that an imbalance of the intestinal microbiota and a dysfunctional intestinal barrier might trigger irritable bowel syndrome (IBS).As probiotics have been reported to restore the intestinal microbiota and the gut barrier,the therapeutic potential of probiotics within IBS became of strong interest.AimTo assess the efficacy of Bifidobacterium bifidum MIMBb75in IBS. MethodsA total of122patients were randomised to receive either placebo(N=62) or MIMBb75(N=60)once a day for4weeks.The severity of IBS symp-toms was recorded daily on a7-point Likert scale.ResultsMIMBb75significantly reduced the global assessment of IBS symptoms by )0.88points(95%CI:)1.07;)0.69)when compared with only)0.16(95% CI:)0.32;0.00)points in the placebo group(P<0.0001).MIMBb75also significantly improved the IBS symptoms pain⁄discomfort,distension⁄bloat-ing,urgency and digestive disorder.The evaluation of the SF12sum scores showed a significant gain in quality of life within the bifidobacteria group. Furthermore,adequate relief was reported by47%of the patients in the bif-idobacteria and only by11%of the patients in the placebo group (P<0.0001).Overall responder rates were57%in the bifidobacteria group but only21%in the placebo group(P=0.0001).MIMBb75was well toler-ated and adverse events were not different from placebo.ConclusionsBifidobacterium bifidum MIMBb75effectively alleviates global IBS and improves IBS symptoms simultaneously with an improvement of quality of life.Considering the high efficacy of MIMBb75in IBS along with the good side-effect profile,MIMBb75is a promising candidate for IBS therapy.Aliment Pharmacol Ther2011;33:1123–1132ª2011Blackwell Publishing Ltd1123 doi:10.1111/j.1365-2036.2011.04633.xAlimentary Pharmacology and TherapeuticsINTRODUCTIONIrritable bowel syndrome(IBS)is a common gastrointes-tinal functional disorder,diagnosed through the Rome III criteria.1Abdominal pain,flatulence and bloating are common IBS symptoms for which no endoscopic,bio-chemical or radiological cause is verifiable.IBS affects 15–20%of the population,with a highly increasing ten-dency in industrial nations.2–4The pathophysiology of IBS is yet only partly understood.Recent research sug-gests that an imbalance of the intestinal microbiota with a significant reduction of bifidobacteria and a dysfunc-tional intestinal barrier with subsequent bacterial translo-cation may contribute to the development of IBS and its symptoms.5–9As probiotics have been reported in several studies to restore the intestinal microbiota and gut barrier as well as hinder bacterial translocation,the therapeutic potential of probiotics in IBS has become of strong interest.10,11 However,the efficacy of probiotics is strongly strain specific and only certain strains might be able to improve IBS and its symptoms.12–14The ability of spe-cific strains to adhere well to intestinal cells may play a pivotal role in altering the intestinal microbiota and increasing the intestinal barrier,which might be of sig-nificant value especially in the treatment of IBS.Gugliel-metti et al.were able to show in a Caco-2cell line that the adherence of B.bifidum MIMBb75,which was iso-lated from a faecal sample of a healthy adult,was signifi-cantly better than that of well-studied commercial probiotics.15,16Taking into consideration the pathophys-iology of IBS and the role of adherence of probiotics regarding the restoration of the intestinal microbiota as well as of the gut barrier,B.bifidum MIMBb75might be effective for IBS treatment.As the conventional medical treatment of IBS is unsatisfactory,we have evaluated the efficacy of B.bifidum MIMBb75in IBS in a double blind, placebo-controlled multi-centre study.PATIENTS AND METHODSStudy populationPatients were recruited in several physician centres in Bavaria,Germany from principal investigators and by advertisements.The nutritional study protocol has been presented to the Ethics Committee of the Bavarian Chamber of Physicians.For inclusion,subjects aged between18and68years with mild to moderate IBS (Rome III criteria)have been considered.Individuals with inflammatory organic gastrointestinal disease,sys-temic diseases,cancer,autoimmune diseases,diabetes,known lactose intolerance or immunodeficiency,known further abdominal surgery except appendectomy,being older than50years and having had a positive sigmoidos-copy or coloscopy within the last5years,diagnosed hyperthyroidism,use of antipsychotics or systemic corti-costeroids for at least3months prior to study start, major psychiatric disorder,coeliac disease or pregnancy had been excluded.Study designThis study was performed as a prospective,multi-centre, randomised,double-blind,placebo-controlled,two-arm nutritional study.Throughout the study,patients recorded their global IBS symptoms on a daily basis as well as individual IBS symptoms using a patient diary.Additionally,patients have been questioned at a physician site for IBS symp-toms(visit2–4)and quality of life(visit3and4). Physician visits took place at screening,after2weeks (run-in phase),after6weeks(end of treatment)and after8weeks(end of wash-out phase)(Figure1).After the patients have given their written informed consent,they qualified for the screening examination on day1(visit1),which included a complete medical his-tory and physical examination.A blood sample was taken for analysis in a central laboratory,including a pregnancy test.At the screening visit,patients were instructed to maintain their eating and life style habits throughout the study.A patient diary was handed out. At the second visit(day15),diaries were reviewed. Patients who had at least2days with mild to moderate pain during the second week of run-in and who fulfilled all inclusion criteria and who did not violate any of the exclusion criteria were1:1randomised to receive either B. bifidum MIMBb75or placebo.The treatment was Visit1Visit2Visit3Visit4EndoftreatmentEndofstudyRandomisationScreening(ICF)Treatment Wash out Run inWeek 1Week 2Week 3Week 4Week 5Week 6Week 7Week 8 Figure1|Study schematic.S.G u g l i e l m e t t i e t a l.1124Aliment Pharmacol Ther2011;33:1123–1132ª2011Blackwell Publishing Ltdallocated according to a computer-generated blocked ran-domisation list with a block size of4.The block size was not disclosed to the investigators.During the intervention period,patients received either one probiotic capsule daily over a4-week period or an identical appearing placebo. The allocation was blinded to both patients and site staff. At the end of the treatment phase(visit3,day43), investigators collected the unused study product and empty sachets to confirm compliance.Diaries were col-lected and reviewed.After the nutritional supplement-free wash-out phase (visit4,day57),a complete physical examination was performed and a blood sample was taken.Bisacodyl and Loperamid were allowed as rescue medi-cation.Other probiotics and medications that might influ-ence the efficacy of the study product were not allowed.Probiotic preparationBifidobacterium bifidum MIMBb75was isolated from the faecal sample of a healthy adult.Bifidobacterium bifidum is a species that is commonly detected in the faeces of healthy adults and infants.Several strains of B.bifidum have been observed to adhere very well to human intesti-nal cell lines.Guglielmetti et al.showed that BopA,a surface pro-tein,is directly involved in the adhesion to Caco-2 cells.15BopA has been found in several strong adhesive B.bifidum strains,indicating that BopA might be an indicator of strong adherence.Additionally B.bifidum MIMBb75showed considerably more adhesion to the Caco-2monolayer in the presence of fucose and man-nose and less when B.bifidum MIMBb75grew in Oxgall bile salts compared with standard environmental condi-tions.The colonisation strategy of this bacterium could be influenced by several factors varying along the gastro-intestinal tract,such as the presence of specific sugars and bile salts and the pH,likely supporting adhesion of B.bifidum MIMBb75to distal sites of the gut.16 Nutritional supplement was prepared under good manufacturing process(GMP)conditions.Bifidobacterium bifidum MIMBb75was grown in a protein-rich liquid growth medium,harvested through centrifugation, stabilised,freeze-dried,milled and sieved.The dry powder bacteria were mixed with an excipient andfilled into uncoated capsules of1·109cfu.Placebo capsules appeared identical and contained maltodextrin. Endpoint definitionsThe prospectively defined primary efficacy variable was the subject’s global assessment of IBS symptoms using a 7-point Likert scale.Patients were asked to answer the daily question‘If you consider your IBS symptoms(e.g. abdominal pain⁄discomfort,distension⁄bloating,urgency, bowel habit)in general,how have you been affected by these symptoms during the last24h?’Possible answers ranged from0(not at all),1(very mild),2(mild),3 (moderate),4(strong),5(very strong)to6(intolerable). Secondary efficacy variables included‘abdominal pain⁄discomfort’,‘distension⁄bloating’and‘urgency’, recorded on the same7-point Likert scale.The individual symptom scores were additionally combined into a com-posite symptom score as the arithmetic mean of three individual symptom scores.Furthermore,the number of bowel movements,feeling of incomplete bowel evacua-tion and intake of other medications were reported daily in the diary.At the end of the treatment and again at the end of the study,physicians questioned the patients regarding the global assessment of efficacy,tolerability as well as digestive disorder(‘bowel movement satisfaction’).Effi-cacy was assessed by the following question:‘Please con-sider how you felt during the4week treatment regarding your overall well-being,and symptoms of abdominal discomfort⁄pain and altered bowel habit. Compared with the way you usually felt before taking the study medication,how would you rate your relief of symptoms during the last4weeks?’Possible answers were:‘completely relieved(1),considerably relieved(2), somewhat relieved(3),unchanged(4)or worse(5)’.Both ‘completely relieved’and‘considerably relieved’were defined as‘adequate relief’.Health related quality of life was assessed by the use of the SF-12questionnaire prior to the treatment and at the end of the treatment.Adverse events were recorded throughout the study and the global assessment of tolerability was questioned at physician boratory values and vital signs were examined at the screening visit and at the end of the study.Statistical methodsSample size estimation.A reduction of the subject’s global assessment(SGA)of at least20%on the7-point Likert scale was considered as a relevant treatment effect. Based on published data,17a difference of0.6points in the SGA of IBS symptoms between B.bifidum MIMBb75 and placebo on the7-point Likert scale was anticipated (e.g.3.0in the placebo group and2.4in the bifidobacte-ria group).Standard deviation was estimated with 1.0 using the same data.With these assumptions,a Wilcoxon-R a n d o m i s e d c l i n i c a l t r i a l:B.b ifid u m M I M B b75i n I B SAliment Pharmacol Ther2011;33:1123–11321125ª2011Blackwell Publishing LtdMann–Whitney test with a two-sided significance level of a=0.05and a power of1)b=0.8,a sample size of47 patients per group was required.With an estimated drop-out rate of15–20%after randomisation,110rando-mised patients were planned and132patients were recruited to account for possible withdrawals prior to the start of the study.Statistical analysisThe primary objective of this study was to prove a signif-icant reduction of the SGA of general IBS symptoms at the end of the treatment in the bifidobacteria group vs. placebo.The SGA was calculated for each subject as arithmetic mean at baseline,during the treatment period and during the wash-out phase.To account for possible differences in the baseline values,the change from base-line calculated as mean score during4weeks of treat-ment minus mean score during the run-in phase(week 1–2)was defined as primary target criterion.The non-parametric Van Elteren test stratified by study centres was used for the comparison of treatment arms.P<0.05 was considered statistically significant.The primary analysis was based on the intent-to-treat population where all successfully randomised patients were included.Missing post-baseline values were imputed by the baseline value for the primary target cri-terion and these patients were evaluated as nonrespond-ers(n=1during treatment,n=3during wash-out phase).An additional per protocol analysis was per-formed for supportive purposes.Descriptive analyses of secondary target criteria were based on available data.Treatment differences were tested by the use of the nonparametric Wilcoxon test for continuous variables or by Fishers exact test for binary variables.All P-values are two-sided.Secondary efficacy variables included response based on a50%rule of symptom relief during the treatment (at least improvement in2of4weeks within the treat-ment period and improvement defined as at least one-point reduction from baseline).All statistical analyses were performed using SAS ver-sion9.1.3for windows,SAS Institute Inc.,Cary,NC, USA.RESULTSSubjectsA total of132patients were included into the study and 122patients were successfully randomised to receive either placebo(N=62)or B.bifidum MIMBb75 (N=60).All randomised patients were analysed for intent to treat(N=122).One patient with no post-randomisation visit was excluded from the analysis of adverse events.A total of103patients(49placebo,54 B.bifidum MIMBb75)were examined as per protocol (Figure2).Baseline characteristicsIn terms of baseline characteristics,there were no signifi-cant differences between the groups;21%were classified as diarrhoea-predominant IBS(23%in the bifidobacteria group,19%in the placebo group),20%as constipation-predominant IBS(15%in the bifidobacteria group,24% in the placebo group)and58%as alternators(62%inGlobal populationn = 132 Randomised populationn = 122End of Study n = 60 (ITT)End of Studyn = 59 (ITT)Not meeting inclusioncriteria (n = 10)Allocated to placebo group n = 62 (ITT)Allocated to verumgroup n = 60 (ITT)Premature with drawal(n = 1)Premature with drawal (n = 1)Protocol deviation (n = 1)Figure2|Diagram of studyflow.Verum,B.bifidum MIMBb75.S.G u g l i e l m e t t i e t a l.1126Aliment Pharmacol Ther2011;33:1123–1132ª2011Blackwell Publishing Ltdthe bifidobacteria group,55%in the placebo group)with no significant differences between the bifidobacteria and the placebo group.Demographics were well balanced between the treat-ment groups with about67%female patients and mean weight of71kg corresponding to a BMI of24.The aver-age age of patients was41years in the placebo group and37years in the bifidobacteria group(Table1). Subject’s global assessment of IBS symptomsThe primary endpoint was the reduction of the SGA of IBS symptoms on the subject’s global assessment diary. Bifidobacterium bifidum MIMBb75significantly improved global IBS symptoms by)0.88points(95%CI: )1.07;)0.69)(from2.95in the run in phase to2.07in the treatment phase)compared with only)0.16points (95%CI:)0.32;0.00)(from2.79in the run in phase to 2.63in the treatment phase)in the placebo group (P<0.0001)using the7-point Likert scale.The evalua-tion of the SGA on a weekly basis showed a significant benefit for patients within the bifidobacteria group for every single week starting the second week of treatment till the end of the study(Figure3).Secondary endpointsSecondary endpoints included changes in IBS symptoms–‘pain⁄discomfort’,‘distension⁄bloating’,‘urgency’,‘number of bowel movements’and‘feeling of incomplete evacuation’–on a seven-point Likert scale.Bifidobacterium bifidum MIMBb75showed a significant reduction of pain⁄discomfort by)0.82points(95%CI:)1.01;)0.63) vs.)0.18(95%CI:)0.35;)0.01)in the placebo group (P<0.0001),and distension⁄bloating by)0.92points (95%CI:)1.15;)0.69)vs.)0.21(95%CI:)0.37;)0.05)in the placebo group(P<0.0001)during the treatment.The reduction persisted during the wash-out phase.Urgency was significantly reduced by)0.67points(95%CI:)0.86; )0.48)vs.)0.21(95%CI:)0.35;)0.07)in the placebo group(P=0.0001)during the treatment but not during the wash-out phase.No effects could be detected for fre-quency of bowel movement and feeling of incomplete bowel evacuation(Figure4).The evaluation of the IBS symptoms pain⁄discomfort and distension⁄bloating on a weekly basis showed a sig-nificant benefit for patients within the bifidobacteria group compared with placebo for every single week beginning the second week of treatment till the end of the study.A significant difference in urgency between the bifidobacteria and the placebo group was shown between week4and6(Figures5and6).Bowel movement satisfaction(digestive disorder) decreased from3.89to2.44in the bifidobacteria group vs.3.69to3.47in the placebo group(P=0.0002)after treatment.The reduction persisted during wash-out phase(2.33in the bifidobacteria group vs.3.47in the placebo group,P<0.0001).Table1|Demographic characteristics of the ITT-populationPlacebo Bifidobacteriumbifidum MIMBb75N(%)or meanÆs.d.N(%)or meanÆs.d.N=122(62+60)Age40.98Æ12.8036.65Æ12.42 Female gender41(66)41(68) Height(cm)169.50Æ8.75170.78Æ9.47 Weight(kg)70.79Æ15.5470.45Æ16.02 BMI24.60Æ5.1924.02Æ4.45 IBS type[N=122(61+60)]Diarrhoeapredominant12(19)14(23)Constipationpredominant15(24)9(15) Alternating type34(55)37(62)R a n d o m i s e d c l i n i c a l t r i a l:B.b ifid u m M I M B b75i n I B SAliment Pharmacol Ther2011;33:1123–11321127ª2011Blackwell Publishing LtdComposite scoreA composite score was calculated for the IBS symptoms pain ⁄discomfort,distension ⁄bloating and urgency.During the run in phase,the score was comparable in both groups.The patients within the bifidobacteria group significantly benefited from the consumption of B.bifi-dum MIMBb75vs.placebo.The composite score improved from 2.68at baseline to 1.88after treatment inthe bifidobacteria group and from 2.56at baseline to 2.37after treatment in the placebo group ()0.80in the bifidobacteria group;)0.20in the placebo group;P <0.0001).This improvement was also preserved dur-ing the wash-out phase ()0.85in the bifidobacteria group;)0.31in the placebo group;P <0.0001).Treatment respondersOverall responders were defined as patients experiencing an improvement of the average weekly score of at least 1point on the Likert scale for the primary parameter (SGA of IBS symptoms)in at least two of the 4weeks treatment period (50%rule).Abdominal pain responders were defined using the same 50%rule for at least one point average improvement for the assessment of ‘pain ⁄discomfort’.Overall responder rates were 57%in the bifidobacteria group and only 21%in the placebo group (P =0.0001).The difference between the treat-ment arms was only a little bit less pronounced when considering only the symptom ‘pain ⁄discomfort’where responder rates were calculated to be 48%in the bifido-bacteria and only 24%in the placebo group (P =0.008)(Figure 7).Global efficacy at physician siteThe overall assessment of efficacy was significantly better in the bifidobacteria group compared with placebo.At the end of treatment,43%of the patients in the bifido-bacteria group achieved adequate relief compared with only 8%in the placebo group (P <0.0001).At the endS GAP a i n /d is co m f o rtD is t e ns i on /b l oa t i ngU rg en c yC om p os i te s co rePlaceboB. bifidum MIMBb75S y m p t o m s c o r e0–0.2–0.4–0.6–0.8–1Figure 4|Comparison of the reduction of IBS symp-toms (B.bifidum MIMBb75vs.placebo)on mean score changes from baseline to treatment phase.S .G u g l i e l m e t t i e t a l .1128Aliment Pharmacol Ther 2011;33:1123–1132ª2011Blackwell Publishing Ltdof the study,adequate relief was reported for 47%in the bifidobacteria and 11%of the patients in the placebo group (P <0.0001;Figure 8).Health-related quality of lifeThe evaluation of the SF12sum scores showed a signifi-cant gain in quality of life within the bifidobacteria group.Physical health sum improved from 47.89at baseline to 51.80after treatment in the bifidobacteria group and from 47.33to only 48.85in the placebo group.Physical health sum significantly changed by 3.99in the bifidobacteria group and by only 1.08in the placebo group compared with baseline (P =0.0185).Mental health sum improved from 45.53at baseline to 51.11after treatment in the bifi-dobacteria group and from 47.01to only 48.29in the pla-cebo group.Mental health sum significantly changed by 5.78in the bifidobacteria group and by only 1.58in the placebo group compared with baseline (P =0.0083).Adverse eventsOnly 36adverse events were reported with suspected relation to the study product,13in the placebo and 23in the treatment group,but no significant differences could be detected in the side-effects profile of B.bifidum MIM-Bb75vs.placebo (Tables 2and 3).Additionally,no severe adverse events have been recorded in either group.DISCUSSION AND CONCLUSIONThis randomised,double blind,placebo-controlled study indicates that B.bifidum MIMBb75has beneficial effects in the treatment of IBS.In this study,B.bifidum MIMBb75significantly improved global IBS as well as its related symptoms such as pain ⁄discomfort,distension ⁄bloating and digestive disorders compared with placebo.Moreover,B.bifidum MIMBb75also significantly improved the qual-ity of life.These benefits persisted within the consump-tion-free wash-out phase.Overall responder rates were predominantly high with 57%in the bifidobacteria group compared with only 21%in the placebo group (P =0.0001).At the end of the study,adequate relief was reported for 47%in the bifidobacteria and only 11%of the patients in the placebo group (P <0.0001).Up to date,several studies have examined the effects of probiotics on IBS and its symptoms.13,14,18,19However,only a few could show a significant benefit.Additionally,to our knowledge,no probiotic strain could show to signif-icantly alleviate irritable bowel syndrome and simulta-neously improve the quality of life.While some studies might have missed to show efficacy due to small sample size and randomisation errors,several different probiotic strains did repeatedly show no significant improvement in IBS.20–24Recently,Brenner et al.(2009)published a systematic review of randomised controlled trials (RCTs)aimed at the evaluation of the efficacy,safety and tolerabil-ity of probiotics in the treatment of IBS.A total of 16RCTs were included in the analysis.Of those,exclusively one Bifidobacterium strain showed efficacy for the improve-ment of IBS symptoms in two appropriately designed studies.4Apart from inappropriate study design,in our opinion,these findings could be attributed to the fact that the efficacy of probiotics is strongly strain specific and that only few strains might be able to show efficacy in IBS.No study to date could prove unambiguously the mode of action of probiotics,which can be clearly linked to the improvement of IBS and its symptoms.Several studies have observed altered intestinal microbiota with a signifi-cant lack of bifidobacteria 25,26and a dysfunctional intes-tinal barrier in IBS patients.These studies have been supported by the fact that a normalisation of the lactuloseOverall responder806040202157B. bifidum MIMBb75Placebo % p a t i e n t sFigure 7|Overall responders during treatment (ITT).Adequate relief% p a t i e n t s504540353025201510504347811End of studyEnd of treatmentPlaceboB. bifidum MIMBb75Figure 8|Adequate relief after treatment (ITT).R a n d o m i s e d c l i n i c a l t r i a l :B .b i fid u m M I M B b 75i n I B SAliment Pharmacol Ther 2011;33:1123–11321129ª2011Blackwell Publishing Ltdbreath test,which suggests the presence of small intestinal bacterial overgrowth or an increased number of enteric microorganisms,is highly correlated with a significant reduction of IBS symptoms.27It has been stated that the imbalance of the microbiotic composition may lead to a different fermentation pattern,especially with increased hydrogen production resulting in bloating.28,29Addition-ally,gut mucosal barrier disruption has been proven to be associated with bacterial translocation and inflamma-tory conditions.4–6It seems likely that only specific strains are able to restore an imbalanced intestinal micro-biota and gut barrier,however,further research is needed to investigate if the positive effects of B.bifidum MIM-Bb75can be attributed to this mode of action.There are several limitations of this study.First of all, the study population was not large enough for a sub-group analysis of IBS subtypes.We could therefore not show whether some IBS-subtypes would benefit more from the consumption of B.bifidum MIMBb75than others.To prove whether some subgroups might benefit more,a larger study might be useful.The study popula-tion has mild to moderate IBS symptoms as evidenced by the indicated SGA-baseline values.A further study should be aimed at the examination whether the patientsTable2|Summary of reported adverse events with suspected relationship by system organ class(SOC)GroupPlacebo B.bifidumMIMBb75AllN%N%N% Visit SOC3Gastrointestinal disorders75412521953 General disorders and administration site conditions1813All86212522056 4SOCGastrointestinal disorders5388351336General disorders and administration site conditions1413Investigations1413Skin and subcutaneous tissue disorders1413All53811481644 All131002310036100Table3|Incidence of adverse events at visit3–4by preferred term(occurrence of more than2%)B.bifidumMIMBb75Placebo T otalPN(%)N(%)N(%)Abdominal distension354776 1.0000 Abdominal pain232343 1.0000 Abdominal pain upper3512430.3645 Constipation2312320.6187 Diarrhoea3512430.3645 Frequent bowel movements3500320.1188 Nausea3500320.1188 All P values by Fishers exact test.S.G u g l i e l m e t t i e t a l.1130Aliment Pharmacol Ther2011;33:1123–1132ª2011Blackwell Publishing Ltdwith severe IBS symptoms will profit in the same way as those with mild to moderate symptoms or whether these patients are more refractory to this treatment. Additionally,the duration of the study was perhaps short at4weeks.It would be of specific value to explore whether patients benefit more from a longer consump-tion of B.bifidum MIMBb75.Finally,the observation that patients still benefit during the consumption-free wash-out phase is of significant value and requires fur-ther investigation(for longer follow-up).In conclusion,the beneficial effects of B.bifidum MIMBb75in improving global IBS as well as its symp-toms along with the good side-effect profile suggests that this probiotic strain has the potential as an effective alternative to current treatment options.ACKNOWLEDGEMENTSDeclaration of personal interests:None.Declaration of funding interests:This study was funded by Naturwohl Pharma GmbH,Mu¨nchen,Germany.Initial data analyses were undertaken by Dr.Karl Fehnle,who is an employee of Algora Gesellschaft fu¨r Medizinstatistik und Vertriebs-systeme mbH,received funding from Naturwohl Pharma GmbH.REFERENCES1.Longstreth GF,Thompson WG,CheyWD,Houghton LA,Mearin F,SpillerRC.Functional bowel disorders.Gastro-enterology2006;130:1480–91.2.Madden JA,Hunter JO.A review of therole of the gut microflora in irritablebowel syndrome and the effects ofprobiotics.Br J Nutr2002;88(Suppl1): S67–72.3.Silk DB,Davis A,Vulevic J,Tzortzis G,Gibson GR.Clinical trial:the effects of a trans-galactosaccharide prebiotic onfaecal microbiota and symptoms inirritable bowel syndrome.AlimentPharmacol Ther2009;29:508–18.4.Brenner DM,Moeller MJ,Chey WD,Schoenfeld PS.The utility of probioticsin the treatmet of irritable bowelsyndrome:a systematic review.Am JGastroenterol2009;104:1033–49.5.Pimental M,Chow EJ,Lin HC.Eradication of small intestinal bacterialovergrowth reduces symptoms ofirritable bowel syndrome.Am JGastroenterol2000;95:3503–6.6.Zeng J,Li YQ,Zuo XL,Zhen YB,YangJ,Liu CH.Clinical trial:effect of activelactic acid bacteria on mucosal barrierfunction in patients with diarrhea-predominant irritable bowl syndrome.Aliment Pharmacol Ther2008;28:994–1002.7.Marshall JK,Thabane M,Garg AX,et al.Intestinal permeability in patients withirritable bowel syndrome after a water-borne outbreak of acute gastroenteritisin Walkertin,Ontario.Aliment Pharma-col Ther2004;20:1317–22.8.Kassinen A,Krogius-Kurikka L,Ma¨kivuokko H,et al.The fecal microbi-ota of irritable bowel syndrome patients differs significantly from that of healthy subjects.Gastroenterology2007;133:24–33.9.Ma¨tto¨J,Maunuksela L,Kajander K,et position and temporal stabilityof gastrointestinal microbiota in irritablebowel syndrome–a longitudinal studyin IBS and control subjects.FEMSImmunol Med Microbiol2005;43:213–22.10.Alvares-Olmos MI,Oberhelman RA.Probiotic agents and infectious diseases:a modern perspective on a traditionaltherapy.Clin Infect Dis2001;32:1567–76.11.Salminen S,Isolauri E,Salminen E.Clinical uses of probiotics for stabilizingthe gut mucosal barrier:successfulstrains and future challenges.AntonieVan Leeuwenhoek1996;70:347–58.12.Fanigliulo L,Comparato G,Aragona G,et al.Role of gut microflora and probiot-ic effects in the irritable bowel syn-drome.Acta Biomed2006;77:85–9.13.O’Mahony L,McCarthy J,Kelly P,et al.Lactobacillus and bifidobacterium inirritable bowel syndrome:symptomresponses and relationship to cytokineprofiles.Gastroenterology2005;128:541–51.14.Kajander K,Hatakka K,Poussa T,Fa¨rk-kila¨M,Korpela R.A probiotic mixturealleviates symptoms in irritable bowelsyndrome patients:a controlled6-monthintervention.Aliment Pharmacol Ther2005;22:387–94.15.Guglielmetti S,Tamagnini I,Mora D,et al.Implication of an outer surfacelipoprotein in adhesion ofbifidobacterium bifidum to caco-2cells.Appl Environ Microbiol2008;74:4695–702.16.Guglielmetti S,Tamagnini I,MinuzzoM,et al.Study of the adhesion of bifido-bacterium bifidum MIMBb75to humanintestinal cell lines.Curr Microbiol2009;59:167–72.17.Whorwell PJ,Altringer L,Morel J,et al.Efficacy of an encapsulated probiotic Bif-idobacterium infantis35624in womenwith irritable bowel syndrome.Am JGastroenterol2006;101:1581–90.18.Williams EA,Stimpson J,Wang D,et al.Clinical trial:a multistrain probioticpreparation significantly reducessymptoms of irritable bowel syndrome ina double-blind placebo-controlled study.Aliment Pharmacol Ther2008;29:97–103.19.Guyonnet D,Chassany O,Ducrotte P,et al.Effect of fermented milk containingBifidobacterium animalis DN-173010onthe health-related quality of life andsymptoms in irritable bowel syndrome inadults in primary care:a multicentre,randomized,double-blind,controlledtrial.Aliment Pharmacol Ther2007;26:475–86.20.Marteau P.Probiotics in functionalintestinal disorders and IBS:proof ofaction and dissecting the multiple mech-anisms.Gut2010;59:285–6.21.Bausserman M,Michail S.The use ofLactobacillus GG in irritable bowel syn-drome in children:a double-blind ran-domized control trial.J Pediatr2005;147:197–201.22.Niv E,Naftali T,Hallak R,Vaisman N.The efficacy of Lactobacillus reuteriATCC55730in the treatment of patientswith irritable bowel syndrome—a doubleblind,placebo-controlled,randomizedstudy.Clin Nut2005;24:925–31.23.Kim HJ,Vazquez Roque MI,CamilleriM,et al.A randomized controlled trialof a probiotic combination VSL#3andplacebo in irritable bowel syndrome withbloating.Neurogastroenterol Motil2005;17:687–96.24.Sen S,Mullan MM,Parker TJ,et al.Effect of Lactobacillus plantarum299vR a n d o m i s e d c l i n i c a l t r i a l:B.b ifid u m M I M B b75i n I B SAliment Pharmacol Ther2011;33:1123–11321131ª2011Blackwell Publishing Ltd。

当代医学英语2关注健康课后答案当代医学英语2旨在培养学生良好的英语学习习惯，提升学生英语的综合运用能力，使英语学习不只是单纯的背诵记忆等单一功能。

在教学中教师要引导学生形成良好的阅读习惯与理解能力，并且要注重培养他们的语言交际能力，从而使他们能够将所学知识运用于实际生活中。

目前我国已经进入老龄化社会，老人生活质量下降以及营养失衡都是引起老年人死亡的主要原因。

然而当今我国社会人口老龄化速度也越来越快。

作为中国唯一一个人口过亿而没有发生老龄化问题的国家，老龄化对我国未来经济增长与社会稳定也产生了很大影响……因此，为了改善我国老年人的生存质量。

作为一名英语教师需要不断学习和提高自己的专业技能以更好地帮助学生走向未来而不仅仅是“纸上谈兵”，同时在教学过程中需要提高学生应对医学问题并进行准确表达方法的能力、用多种方式表达所学知识并将它们灵活运用于实际生活中！让我们来看看当代医英2课堂上有哪些答案吧。

1.对于脑卒中，首先应进行脑卒中相关认知和症状的诊断，再由专业医生进行指导。

请回答 A。

在这一节的学习中，我主要想强调的是：卒中患者是不能在家进行康复治疗的。

这一节的学习了脑卒中相关认知和症状的诊断，同时还让我们了解了在家进行康复治疗(probability integration)对于脑卒中患者的重要性(probability integration)对脑卒中患者进行康复治疗时可以起到很好地作用(retropositive)。

这一节我们学习了当患者在家进行康复治疗时，应该怎么进行康复治疗(probability integration)。

在这一节的学习中，我向学生们展示了如何通过一些简单、快速、直观、有效而且简单易操作的方法来帮助患者进行康复治疗(probability integration)。

其中包括了如何通过言语训练或者其他手段来改善患者在家中康复治疗所带来的一些问题……因此，在这一节的学习中，我向学生们介绍了通过什么样的方法可以提高老年人在家中康复治疗所带来的一些问题和机会……这一节是通过使用 probability integration这个词在我们脑海里构建一个完整图来让学生们理解什么是“居家康复”这个词的含义并让学生们能够更好地理解这一行为对于一个健康老人所带来哪些好处。

呼吸困难呼吸困难〔Dyspnea〕是指病人主观上感到周围空气缺乏、呼吸费力；客观上表现为呼吸活动用力，同时伴呼吸频率、深度与节律异常，严重者出现鼻翼扇动、张口抬肩、端坐呼吸、发绀等，辅助呼吸肌也参与活动。

一．病因引起呼吸困难的主要原因是呼吸系统和循环系统疾病。

1．呼吸系统疾病〔1〕呼吸道阻塞如喉、气管、支气管的炎症、水肿、异物、肿瘤，支气管哮喘、慢性阻塞性肺气肿等。

〔2〕肺部疾病如肺结核、肺炎、肺淤血、肺水肿、肺不张、肺梗死、弥漫性肺间质疾病等。

〔3〕胸壁、胸廓、胸膜疾病如胸壁外伤炎症、严重畸形、自发性气胸、胸腔积液、胸膜广泛粘连等。

〔4〕神经肌肉病变如急性多发性神经根神经炎、脊髓灰质炎、重症肌无力、药物所致呼吸肌麻痹等。

〔5〕膈肌活动受限如膈肌麻痹、胃扩张、大量腹水、腹腔内巨大肿瘤等。

2．循环系统疾病：如急性左心功能衰竭、右心功能衰竭、心肌病、心包炎、肺栓塞等。

3．中毒：如一氧化碳、吗啡、有机磷中毒、氰化物中毒、糖尿病酮症酸中毒等。

4．血液系统疾病：如重度贫血、高铁血红蛋白血症、硫化血红蛋白血症等。

5．神经精神因素：如颅脑外伤、脑出血、脑膜炎、脑炎、癔症及精神因素等。

二．发生机制与临床表现1．肺源性呼吸困难因呼吸系统疾病引起通气和〔或〕换气功能障碍，致缺氧和〔或〕二氧化碳潴留所致。

临床上分为三种类型：〔1〕吸气性呼吸困难是因喉、气管、大支气管的狭窄与阻塞所致，临床表现特点为吸气费力，吸气时间明显延长，常伴有干咳及高调的吸气性喉鸣音，严重者于吸气时出现胸骨上窝、锁骨上窝、肋间隙明显凹陷，称为“三凹征〞。

〔2〕呼气性呼吸困难是因肺泡弹性减弱和〔或〕小支气管痉挛狭窄、炎症阻塞所致，见于支气管哮喘，慢性阻塞性肺气肿。

临床表现特点为呼气费力，呼气时间明显延长而缓慢，常伴哮鸣音。

〔3〕混合性呼吸困难是因肺部病变广泛或胸腔病变压迫肺组织使呼吸面积减少，影响换气功能所致，见于重症肺炎、重症肺结核、大量胸腔积液、自发性气胸等。

（整理）ICU常⽤评分系统.ICU的评分系统重症患者病情危重，时间紧迫，需要医⽣早期发现、早期识别，尽快采取⼲预措施，以免延误病情。

ICU的评分系统可以给临床提供量化、公平的指标，⽤以评价疾病严重程度。

ICU常⽤的评分系统有：⾮特异性病情严重程度评分，如APACHE II，TISS；多脏器功能障碍病情评分，如MODS，SOFA，LODS；特定器官功能障碍评分，如RANSON，RAMSAY等。

⼀、APACHE(acute physiology and chronic health evaluation)急性⽣理与慢性健康评分：此评分是由Knaus于1981年建⽴第⼀代，1985年提出APACHE II，⾄2005年推出第四代。

APACHE II因为简便可靠，设计合理，预测准确，免费，⽬前使⽤最为普遍。

作为重症患者病情分类和预后的预测系统，分值越⾼，表⽰病情越重，预后越差，病死率越⾼。

APACHE II由A项、B项及C项三部分组成。

A项：急性⽣理学评分，共12项。

B项：即年龄评分，从44岁以下到75岁以上共分为5个阶段，分别评为0-6分。

C项：即慢性健康评分。

APACHE可动态评价医疗措施的效果，评估病情，预测预后。

⼆、TISS治疗⼲预评价系统（therapeutic intervention scoring system）是由Cullen 1974年建⽴，⽬的是对重症患者进⾏分类，确定医疗护理的劳动强度，以便安排⼯作量。

每⽇同⼀时间由⼀名观察者收集资料，确认是否为前24⼩时内完成的治疗措施，总分应与病情⼀致，如与APACHE等没有⼀致，应检讨是否治疗措施适当，不得重复记分，对同⼀⽬的进⾏的多项⼲预，记录最⾼分。

三、MODS评分（multiple organ dysfunction score）多脏器功能障碍评分Marshall于1995年提出，Richard 2001年改良。

其参数少，评分简单，对病死率和预后预测准确。

低频重复经颅磁刺激联合智能运动反馈训练对恢复期脑卒中患者上肢运动功能的影响作者：吴李秀俞坤强戴梦圆周敏亚来源：《中国现代医生》2021年第19期[關键词] 低频重复经颅磁刺激;智能运动反馈训练;脑卒中;上肢运动功能[中图分类号] R743.3 [文献标识码] B [文章编号] 1673-9701（2021）19-0112-04Impacts of low-frequency repetitive transcranial magnetic stimulation combined with intelligent motor feedback training on motor function of upper extremity in patients with stroke at recovery stageWU-Lixiu YU Kunqiang DAI Mengyuan ZHOU MinyaDepartment of Rehabilitation，the Second Peop le′s Hospital of Lishui，Lishui 323000，China[Abstract] Objective To investigate the impacts of low-frequency repetitive transcranial magnetic stimulation （rTMS） combined with intelligent motor feedback training on motor function of upper extremity in patients with stroke at recovery stage. Methods A total of 200 patients with stroke admitted to the Second People′s Hospital of Lishui during the recovery stage from January 2018 to December 2019 were prospectively selected as the research subjects and were randomly divided into the control group （n=100） and the observation group （n=100）. The control group was given conventional rehabilitation training，while the observation group was given low frequency rTMS combined with intelligent motor feedback training. The muscle strength of upper extremity，passive stretch strength of upper extremity，function recovery of upper extremity and incidence of adverse events of the two groups before and after treatment were observed and compared. Results Before treatment，the differences in the muscle strength of upper extremity，passive stretch strength of upper extremity，and function of upper extremity between the two groups were not statistically significant （P>0.05）. After treatment，the grades of muscle strength of upper extremity，muscle strength of wrist extension，and muscle strength of wrist flexion on the affected side in the observation group were significantly improved，which were superior to those in the control group.The passive stretch strength of upper extremity was significantly decreased and lower than that of the control group. The FMA and MBI scores were significantly higher than those in the control group，with statistically significant differences （P[Key words] Low frequency repetitive transcranial magnetic stimulation; Intelligent motion feedback training; Stroke;Motor function of upper extremity脑卒中是临床常见疾病，具有起病急、发展快、预后差等特点，患者抢救不及时可导致死亡，而幸存者大多也存在语言、认知、吞咽功能、运动等障碍，上肢运动功能障碍是运动功能障碍中较为常见的一种，患者大多表现为上肢活动受限或功能丧失，严重影响患者日常生活能力[1-3]。

人们不喜欢开会的原因英语作文全文共3篇示例，供读者参考篇1Why People Don't Like MeetingsMeetings are a core part of organizational life, but very few people actually enjoy them. As a student, I've had to attend countless meetings for group projects, club activities, and other collaborations. From my experience, meetings tend to be dreadful experiences that leave participants feeling drained, unproductive, and frustrated. In this essay, I'll explore some of the key reasons why people, including myself, generally dislike meetings.Inefficient Use of TimeOne of the biggest gripes people have about meetings is that they are a colossal waste of time. Poorly planned and unstructured meetings inevitably lead to rambling discussions, off-topic tangents, and a lack of concrete outcomes. I've been in meetings that dragged on for hours without any clear purpose or resolution. Time is a precious commodity, especially for busy students juggling classes, assignments, extracurriculars, andother responsibilities. Having to sit through a meandering, unproductive meeting can feel like a maddening exercise in futility.Disorganized and Lack of LeadershipEffective meetings require strong leadership and a clear agenda. Unfortunately, many meetings suffer from a lack of direction and poor facilitation. A common scenario is meetings starting late due to scheduling conflicts, no one taking charge to guide the discussion, and people talking over each other in a chaotic manner. As a student, I've experienced numerous meetings that devolved into shapeless discussions with no real owner or person responsible for keeping things on track. This lack of organization and structure is incredibly frustrating and makes meetings feel aimless and pointless.Too Many MeetingsIn today's overly collaborative work environments, meetings seem to breed more meetings. It's not uncommon for my group to have a meeting about another meeting we need to schedule. This constant cycle of meetings can make one feel like they are simply going from one meeting prep session to the next status update meeting with no time for actual work to get done. The proliferation of meetings has led to a phenomenon known as"calendar bankruptcy" where people's schedules are so saturated with meetings that there's little time left for focused individual effort. As a student already stretched for time, the excess of meetings is draining and demoralizing.Group Dynamics and DysfunctionsMeetings are a hotbed for group dysfunctions to emerge.I've witnessed meetings get derailed by dominant personalities who monopolize discussions, shy individuals who don't speak up, feuding members who bicker with each other, and the general tendencies towards conformity and groupthink. Even in meetings with my closest friends, there always seems to be at least one person who goes on tangents or doesn't let others voice their opinions. These dysfunctional group behaviors make meetings incredibly uncomfortable and unpleasant experiences.Physical and Mental FatigueSitting through back-to-back meetings can be mentally and physically draining, especially for students. I've had days where I've been in meetings for hours on end, staring at screen after screen, struggling to remain engaged. By the end, I'm mentally exhausted, physically sore from lack of movement, and struggle to recall what was discussed or accomplished. The fatigue from endless meetings saps motivation, creativity, and productivity. Asa student, I need rejuvenating breaks between meetings to reset and recharge.While meetings are often unavoidable for collaborating on projects, assignments, and activities, their current implementation is problematic. From poor time management and lack of leadership to dysfunctional group behaviors and personal fatigue, meetings are a source of frustration and dread for many students like myself. Perhaps with better training on how to run effective meetings and more judicial use of meeting time, they can become more palatable. But for now, I'm sure I speak for many of my classmates in saying I truly dislike the typical meeting experience on college campuses.篇2Why People Dread MeetingsIt's Monday morning, and I'm gearing up for another week of classes, assignments, and extracurricular activities. But before I can even start my day, I get a notification reminding me of the dreaded weekly club meeting scheduled for later that afternoon. Just the thought of it makes me want to groan. Meetings are supposed to be a productive way to collaborate and get things done, but more often than not, they end up being a waste oftime that leaves everyone feeling drained and frustrated. But why exactly do people dislike meetings so much?One of the biggest complaints about meetings is that they often lack a clear purpose and agenda. Have you ever been in a meeting where the discussion meanders aimlessly, with no real goals or direction? It's like being stuck on a road trip without a map or a destination. People start zoning out, checking their phones, or doodling in their notebooks as the meeting drags on. Without a focused agenda, it's easy for meetings to turn into rambling sessions that accomplish little to nothing.Even when there is an agenda, meetings can still feel like a colossal time-waster if they're poorly organized or poorly run. I've been in meetings where the organizer shows up late, the necessary materials or technology aren't prepared, or key decision-makers are absent. These hiccups not only waste everyone's time but also undermine the perceived importance and professionalism of the meeting itself.Another major reason why people dread meetings is because of the ever-dreaded "meeting rambler" – that one person who just loves the sound of their own voice and monopolizes the conversation. You know the type: they go off on tangents, repeat themselves ad nauseam, and generally suckall the oxygen out of the room. Meanwhile, everyone else is sitting there, silently cursing them for hijacking the meeting and preventing any real progress from being made.Speaking of progress, many people find meetings frustrating because they often feel like they're just spinning their wheels without any tangible results or action items. You spend an hour or more discussing a particular issue, but by the end, nothing has been decided, and no one has been assigned any tasks or next steps. It's like running on a treadmill – you're expending a lot of effort, but you're not actually going anywhere.Of course, no discussion of the downsides of meetings would be complete without mentioning the dreaded "meeting marathon" – those days where you're scheduled forback-to-back meetings with barely any time to breathe in between. Not only are these marathons mentally and physically draining, but they also make it nearly impossible to get any actual work done. By the time the last meeting rolls around, you're so burnt out and unfocused that you might as well have been playing video games all day.But perhaps the biggest reason why people dread meetings is because of the opportunity cost involved. Every minute spent in a meeting is a minute that could have been spent doing actual,productive work. When you're a student juggling classes, assignments, extracurriculars, and maybe even a part-time job, time is an incredibly precious commodity. Being stuck in a pointless or poorly run meeting can feel like a colossal waste of that limited time – time that could have been better spent studying, working on a project, or simply recharging and taking a much-needed break.Now, don't get me wrong – meetings can be useful when they're well-planned, well-run, and include the right people. But far too often, they fall short of that ideal, leaving participants feeling frustrated, unproductive, and resentful of the timethey've lost.So, what's the solution? For starters, organizers need to be more mindful about scheduling meetings and ensuring that they're truly necessary. Before sending out that calendar invite, ask yourself: "Could this be accomplished via email or a quick chat instead?" If a meeting is deemed essential, create a clear agenda and stick to it, assign a facilitator to keep things on track, and be respectful of everyone's time by starting and ending promptly.Participants also have a role to play in making meetings more effective. Come prepared, stay focused, and be willing topolitely call out tangents or unnecessary digressions. And if you find yourself in a meeting that's clearly going nowhere, don't be afraid to speak up and suggest tabling the discussion until a later date when it can be approached more productively.At the end of the day, meetings are a necessary evil in many workplaces and organizations, including student clubs and groups. But by being more mindful and intentional about how we approach them, we can minimize their negative impact and make them more efficient and effective. After all, no one wants to look back on their college years and realize that they spent more time in pointless meetings than actually learning, growing, and enjoying the full university experience.篇3Why People Hate MeetingsMeetings are pretty much unavoidable in any professional setting. Whether it's a daily standup, a weekly team sync, or a monthly all-hands, we've all been stuck in meetings that seem to drag on forever without any clear purpose or outcome. As a student gearing up to enter the workforce, I can already feel the dread setting in at the thought of endless meetings clogging upmy calendar. But why exactly do people hate meetings so much? In this essay, I'll explore some of the key reasons.Lack of Preparation and Clear ObjectivesOne of the biggest culprits behind unproductive meetings is the lack of a clear agenda and objectives. Have you ever been invited to a meeting with just a vague title like "Team Sync" or "Q3 Planning" and no other context provided? Entering a meeting blind, with no understanding of what it's supposed to accomplish, is a surefire way to waste everyone's time. Without a concrete plan and desired outcomes, meetings can quickly devolve into rambling discussions that go off on tangents and yield few meaningful results.Poor Time ManagementEven when a meeting does have an agenda, poor time management can still derail productivity. We've all experienced that meeting that was scheduled for an hour but could have easily been wrapped up in 20 minutes. Or the meeting that starts late because people trickle in whenever they feel like it. These issues stem from a lack of respect for others' time and an inability to keep discussions focused. When time is mismanaged, meetings overstay their welcome and attendees start zoning out, defeating the whole purpose.Too Many PeopleThere's a fine line between having enough people in a meeting for diverse perspectives, and having so many people that it becomes chaotic. Excessive meeting attendees often leads to more digressions, repetition, and overall loss of focus. Decisions get bogged down by everyone weighing in, and the meeting drags on as people await their turn to speak up. It's essential to be judicious about who really needs to be present –not everyone on the team may need to attend every single meeting.Technology IssuesIn today's age of remote and hybrid work, technology is both a blessing and a curse when it comes to meetings. While video conferencing tools have enabled meetings to happen regardless of location, they've also introduced their own host of issues. Laggy connections, audio problems, and general technical difficulties frequently disrupt the natural flow of conversation and lead to miscommunication or frustration. Not to mention awkward situations like two people talking over each other because of audio delays. Meetings can quickly turn into "Can you hear me now?" nightmares.Disengaged ParticipantsEven with the right preparation and technology, a meeting will still fall flat if attendees are zoned out or multitasking the whole time. We've all been guilty of pulling up our inbox or slack during a dull meeting to try and be "productive" whiletuning out. But this fragmented attention means you'll likely miss important points and be unprepared to contribute when called upon. Disengaged attendees can bring the whole meeting's energy down and prolong discussions that could have been resolved efficiently with everyone present.At the end of the day, meetings are necessary for teams and organizations to share information, make decisions, and align on priorities. However, the way they are typically conducted leads to frustration, fatigue, and a general sense that they are a waste of time. As I prepare to enter my professional career, I hope to be part of the solution by practicing good meeting habits – creating clear agendas, sticking to timeboxes, limiting attendees to those who truly need to be there, and most importantly, remaining fully engaged and present. While meetings may never be fun, following best practices can at least make them tolerable and productive. Otherwise, we're all just stuck zoning out, counting down the minutes until we can finally get back to real work.。