建立我国神经内科专科医师培养和资质认证制度

改革开放后，随着人民生活水平的提高，社会对医疗水平的要求也日渐增高。高质量的社会医疗水平需要专业、细致的行业分工，而专科医师的出现是顺应这种社会卫生服务新需求的必然。神经内科系统疾病是高发性疾病，神经内科病种的复杂性使得神经内科专科医师的培养极为重要。国内目前尚无规范的神经内科专科医师培养体系，     

北京神经外科学院专科医师培训的实践与探索

不断提高神经外科的整体水平,培养适应新世纪需要的神经外科专科医师,谋求为13亿人健康服务,使神经外科迈向世界先进行列,这是当代神经外科工作者的历史使命和社会责任.专科医师培养和准入制度是国际医学界公认的医学生毕业后教育制度,我国从20世纪90年代初全面推行该培训体系和制度,但尚未建立统一、规范、完整的神经外科专科医师培训体系和准入标准.为了全面培养和提高我国神经外科专科医师的水准,建立与国际标准接轨的神经外科专科医师培训制度和准入制度体系,在王忠诚院士倡导和呼吁下,在卫生部及北京市政府的支持下,北京神经外科学院于2004年6月成立,作为卫生部神经外科专科医师培训试点,学院当年成立、当年招生,迄今已迈入第8个年头,现将所做工作做一回顾与总结.     

儿童神经外科医师的专科培训探讨

正随着临床医学的不断深入发展,临床专科医师的培训成为一项必要的和复杂的系统工程;世界各主要发达国家都已经建立了符合各自国情的一套完整的专科医师培养体系。我国在不断完善临床住院医师正规培训的基础上,已经开始临床专科医师的正规化培训。本文通过介绍美国对于儿童神经外科医师的专科培训情况,分析我国儿童神经外科专科医师培训的现状并提出相关的建议。     

神经内科住院医师病历书写规范化培训探索

病历书写是住院医师规范化培训的基础.掌握神经内科疾病的病历书写和诊疗思路是住院医师必经的临床训练.结合首都医科大学宣武医院神经内科对住院医师培训的实践和经验,我们认为病历书写从基础到专病,从集中到个体化循序渐进的培训和考核、监控方法,有助于神经内科医师临床思维能力培养和临床水平的提高.     

神经内科住院医师诊治重症卒中临床能力培训的探索

卒中是神经内科常见病,重症患者具有并发症多、致残率和致死率高的特点。为了提高其抢救成功率,应该对神经内科住院医师进行神经专科知识和重症医学知识综合能力的培训,作为国家级神经科教学基地,我院神经内科在这方面进行了多年探索和经验积累。     

差异化培养结合多种教学法在脑血管病亚专科医师培养中的运用

目的 探讨差异化培养结合多种教学法对不同基础的脑血管病亚专科医师的培训效果。 方法 选取2015年1月-2017年12月在复旦大学附属华山医院培养的96名脑血管病亚专科医师，根据 不同的脑血管病亚专科临床工作时间、学历、职称、医院等级以及导师初评分为初级、中级和高级3组， 针对性地采用差异化教学培养模式。采用学员自评和导师评价综合评估教学效果，评价等级分为好、 较好、一般、较差和差5个等级。 结果 初级、中级和高级组的“好”评率分别为81.8%、71.4%和72.7%，平均75.3%±4.3%，无“一 般”“较差”和“差”评。差异化培养结合多种教学方法具有“因才施教”、阶梯性、系统性和全面性 的特点。 结论 在现实存在的参差不齐水准的脑血管病亚专科医师中，差异化培养结合多种教学方法的教 学模式可达到较好的亚专科医师培训效果。     

提高神经内科住院医师规范化培训质量的体会

神经内科规范化培训专业基地不仅承担神经内科的规范化培训人员的培训,同时承担 来自内科、精神科、急诊科等多个相关科室人员的关于神经病学内容的培训工作。为提高培训质量, 需明确各类规范化培训人员的来源,根据其轮转目的和时间的不同,因地制宜进行教学;需制定并 实行规范的培训管理制度,进行岗前培训,采用多种教学方式进行专业培训,将人文素质的培养融入 日常工作,并持续改进,最终实现培养高层次医师、提高医疗质量的目标。     

中国医师协会第七届神经内科医师大会通知

<正>为进一步推动我国神经内科事业的发展、促进我国神经内科专业医护人员临床技能的提高,中国医师协会、中国医师协会神经内科医师分会拟定于2014年6月19-22日在重庆市国际会展中心召开"中国医师协会第七届中国神经内科医师大会"。"中国医师协会第七届神经内科医师大会"是中国医师协会的年度学术盛会,遵循"贴近临床、行业培训、维权管理"的理     

北京神经外科学院2008年招生信息

北京神经外科学院是经卫生部批准的、我国第一所神经外科专科医师培训学院,它以首都医科大学附属北京天坛医院和北京市神经外科研究所作为临床和应用研究培训基地,是集教学、临床、科研、人才培养和学术交流为一体的神经外科专业学术机构。其核心任务是神经外科专科医师培训,同时作为卫生部开展专科医师培训和准入制度改革的试点单位。     

医联体模式下神经内科专科培训基层医务人员模式的探索

随着医联体的建立及分级诊疗政策的推进,医联体内三级医院的医师去社区医院出诊及 指导社区医师成为普遍现象。在上级医院与基层社区医院医师的联系中,如何更有效地提高医联体 内基层医务人员的整体医疗水平成为迫切需要解决的问题。北京大学第三医院针对基层神经内科专 业医务人员的特点和需求,制订针对性培训方案,建立了以基层医务人员为中心的多模式神经专科培 训。通过培训,使医联体内基层医务人员独立诊治神经内科常见病的水平的得到提升,对神经内科 少见病、疑难病有了更深入的了解。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -