Medical education and practic in People's Republic of China.

A dramatic adaptation of medical education to meet indigenous needs and circumstances has occurred in the People's Republic of China in the context of a highly structured health care delivery and medical referral system, entailing a reduction in curriculum length from 6 to 3 years. Although general directions and guidelines are set centrally by Peking, considerable autonomy and flexibility exist in individual schools. The innovative approaches used include training medical students in countryside and factories as well as medical schools, combining traditional Chinese and modern Western medicine, opening hospital-run medical schools, and using unconventional methods of producing medical doctors. On graduation the students generally return to the communities from which they came. Although the total number of medical graduates still falls short of national requirements, the problem of maldistribution of physicians has been alleviated in China. Medical care is now readily available in rural areas, where 80% of the population resides.     

Sleep loss and fatigue in medical training.

The effects of sleep loss and fatigue in the context of medical training is a topic that has generated considerable interest, as well as controversy, over the past two decades. The sleep deprived state in medical trainees potentially impacts on a variety of domains relevant to medical care, including performance on neurobehavioral and work-related tasks, mood and affect, learning, risk for and commission of medical errors, and the health and well-being of medical students and residents. The following review provides a summary of research conducted on this topic in the past decade, including the relation of sleep loss and fatigue to medical errors and the quality of patient care. Those few studies that have analyzed the use of operational alertness management strategies, countermeasures, and educational interventions to address and mitigate the effects of sleep loss and fatigue are also reviewed. There is clearly a need for additional research to further explore the complex interaction between sleep and fatigue and medical care, and to support the development and implementation of regulatory policies based on sound science.     

Risk stratification and venous thromboprophylaxis in hospitalized medical and cancer patients

Acute venous thromboembolism (VTE) is a serious and potentially fatal disorder, which often complicates the course of hospitalized medical patients. This is particularly true for carriers of malignant diseases. While the introduction of thromboprophylactic measures has probably affected the occurrence of postoperative VTE, there is an increasing awareness of the importance of medical conditions in determining thromboembolic events. Simple and clinically relevant risk assessment models are available to facilitate VTE risk assessment in hospitalized medical patients. Their validation in prospective studies is in progress. Randomized controlled clinical trials have consistently documented the efficacy of heparins and fondaparinux for prevention of VTE in hospitalized medical patients with a minimal haemorrhagic risk. Recognition of the incidence and clinical importance of thrombosis will probably encourage more widespread use of antithrombotic prophylaxis in medical patients and especially in some particular types of malignancies.     

2017—2020年铜陵市医疗机构消毒质量监测分析

目的 了解铜陵市医疗机构消毒质量的基本情况,为医院消毒的质量控制和院内感染的预防提供数据支持。方法 根据《医院消毒卫生标准》（GB 15982—2012）和《消毒技术规范》（2002年版）,对铜陵地区不同医疗机构不同项目进行现场采样、检测。结果 2017—2020年样品的合格率分别为99.09%、99.18%、98.83%和98.63%,总合格率是99.04%,各年度的样品合格率差异无统计学意义（χ2=0.257,P>0.05）。三级、二级、一级医院及诊所的样品合格率分别是98.54%、99.16%、98.90%、和99.18%,不同级别医疗机构间样品的合格率差异无统计学意义（χ2=0.291,P>0.05）。在手的消毒效果专项比较中,2017年一级医疗机构的合格率最低（83.33%）;2018、2019年三级医疗机构的合格率最低,分别为90.91%和88.89%。不合格项目集中在空气及医务人员手2个监测项目。结论 铜陵市2017—2020年医疗机构消毒质量保持在较好水平,但医疗机构应加强医护人员对手卫生及空气消毒质量的监测。主管部门应进行不定期检查,发现潜在风险并督促解决,进一步提升医院消毒质量。     

Suicidal ideation and suicide attempts in general medical illnesses

BACKGROUND: This study examines the association between the presence of a general medical illness and suicidality in a representative sample of US young adults. METHODS: Between 1988 and 1994, 7589 individuals aged 17 to 39 years were administered the Diagnostic Interview Schedule as part of a national probability survey. The survey collected information about lifetime suicidal ideation and suicide attempts, a checklist of common general medical conditions, and data on major depression, alcohol use, and demographic characteristics. RESULTS: Whereas 16.3% of respondents described suicidal ideation at some point in their lives, 25.2% of individuals with a general medical condition, and 35.0% of those with 2 or more medical illnesses reported life-time suicidal ideation. Similarly, whereas 5.5% of respondents had made a suicide attempt, 8.9% of those with a general medical illness and 16.2% of those with 2 or more medical conditions had attempted suicide. In models controlling for major depression, depressive symptoms, alcohol use, and demographic characteristics, presence of a general medical condition predicted a 1.3 times increase in likelihood of suicidal ideation; more specifically, pulmonary diseases (asthma, bronchitis) were associated with a two-thirds increase in the odds of lifetime suicidal ideation. Cancer and asthma were each associated with a more than 4-fold increase in the likelihood of a suicide attempt. CONCLUSIONS: A significant association was found between medical conditions and suicidality that persisted after adjusting for depressive illness and alcohol use. The findings support the need to screen for suicidality in general medical settings, over and above use of general depression instruments.     

Cardiovascular diseases and risk factors in a population-based study in The Netherlands: agreement between questionnaire information and medical records.

BACKGROUND: Since 1987 the Monitoring Project on Cardiovascular Risk Factors has been carried out in The Netherlands. The purpose of the present study was to assess the agreement between the self-reported questionnaire information that was collected in this survey on cardiovascular diseases and risk factors and information from medical records. METHODS: From 1987 to 1991, over 36,000 men and women aged 20-59 years have participated in the Monitoring Project on Cardiovascular Disease Risk Factors, a cross-sectional population-based study. We compared self-reported information on cardiovascular diseases and risk factors with the general practitioners medical records from a sample of 899 hypertensive subjects. RESULTS: The highest proportion of positive self-reports could be confirmed by the medical records for diabetes conditional on self-report of medication use for this condition (100%), and a history of hypertension conditional on the presence of blood pressure recordings in the medical records (91%). The lowest percentage of positive self-reports confirmed by medical records was a family history of myocardial infarction (3-5%). More than 80% of the negative self-reports were confirmed by the medical records for most conditions, except for history of hypertension, conditional on the presence of blood pressure recordings in the medical records (40%). The overall agreement above chance was substantial for cerebrovascular disease (kappa = 0.78) and diabetes (kappa = 0.75), moderate for myocardial infarction (kappa = 0.55), poor for myocardial infarction of the respondents' father (kappa = 0.07) and mother (kappa = 0.05), and fair to moderate for all other self-reported conditions. CONCLUSION: Agreement between self-reported information and medical records was variable. For further studies, self-reports of cardiovascular diseases and risk factors should preferably be complemented with information from other sources such as medical records.     

The role of the Pharmaceuticals and Medical Devices Agency and healthcare professionals in post-marketing safety

The development of drugs and medical devices is necessary for medical progress; however, safety measures need to be put in place to protect the health of the population. In order to ensure the safety of drugs and medical devices, it is important to determine measures for appropriate management of risks at any time during the development phase, the regulatory review and the post-marketing phase. Adverse events detected in clinical trials are limited due to the restricted numbers of patients enrolled in the trials. Therefore, it is almost impossible to predict rare serious adverse events during the post-marketing phase. The revised Pharmaceutical Affairs Act was established in Japan in November 20, 2013. The new act focuses on increased safety of drugs and medical devices. The Pharmaceuticals and Medical Devices Agency (PMDA) is the regulatory authority in Japan that promotes safety measures from the development phase through to the post-marketing phase. In the post-marketing phase, the PMDA collects information from the medical product companies and healthcare professionals, as well as instructing and advising them with regard to post-marketing safety measures for each drug and medical device. Since Japan has a national health insurance system, a new drug or a medical device is available throughout the country when the drug price or medical fee is listed in the National Health Insurance price list. Healthcare professionals in medical institutions must learn about the drugs and medical devices they handle, and should make an effort to maintain patient safety. The PMDA medi-navi is a very useful electronic mail delivery service that provides critical information for protecting patients from health hazards caused by adverse events. The ‘risk management plan’ is also important as it contains important information about safety profile and post-marketing measures of a new drug.     

AHA心肺复苏培训在医学教学中的应用效果

目的采用AHA基础生命支持课程培训模式对具有一定医学背景的医学生进行心肺复苏培训,与传统教学方法对比分析该培训方法在医学教学中的应用效果。 方法选取80名具有一定医学背景的医学生,随机分成实验组和对照组,采用问卷调查的形式对研究对象进行培训的态度、知识与技能掌握情况进行测评。 结果实验组学生培训的态度、知识、技能测评得分明显高于对照组（P<0.05）。 结论AHA心肺复苏培训能够提高医学生的心肺复苏知识和技能,帮助树立施救信心,可以进一步应用于临床医学教学中。     

Home respiratory care in remote areas and on small islands in Japan: status quo and problems]

To investigate the status quo and problems regarding home respiratory care provided by medical institutes that played a central role in mountain villages and on small islands, we distributed a questionnaire in 250 remote medical institutes. The number of respondents was 116 (46.9%). Home oxygen therapy (HOT) and home mechanical ventilation (HMV) were carried out in 83 (71.6%) and seven (6%) institutes, respectively. The results of the survey regarding HOT in the remote medical institutes revealed that: (1) a large proportion of the patients were aged; (2) there were few cases per institute; (3) a high percentage of cases with chronic obstructive pulmonary disease (COPD) as the cause were evident; (4) visiting care was being provided in a high percentage of cases; and (5) few institutes were equipped with a spirometer. Overall examination of the responses showed that HOT was prevalent even in the remote medical institutes, and could be smoothly conducted, if communication with a medical institute specializing in respiratory diseases and an emergency transfer system could be established. On the other hand, the prevalence of HMV is still low, and problems such as the establishment of a medical team system and a caregiver support system has yet to be solved.     

Prevalence and impact of medical comorbidity in Alzheimer's disease

BACKGROUND: We examined the prevalence of comorbid medical illnesses in Alzheimer's disease (AD) patients at different severity levels. We also examined the effect of cumulative medical comorbidity on cognition and function. METHODS: Analyses of data from 679 AD patients (Mini-Mental State Exam score range 0-30, mean +/- SD = 11.8 +/- 8) from 13 sites (four dementia centers assessing outpatients, four managed care organizations, two assisted living facilities, and three nursing homes) prospectively recruited using a stratification approach including dementia severity and care setting. Medical comorbidity was quantified using the Cumulative Illness Rating Scale-Geriatric. RESULTS: Across patients, 61% had three or more comorbid medical illnesses. Adjusting for age, gender, race, and care setting, medical comorbidity increased with dementia severity (mild to moderate, p <.01; moderate to severe, p <.001). Adjusting for age, educational level, gender, race, and care setting, higher medical comorbidity was associated with greater impairment in cognition (p <.001) and in self-care (p <.001). CONCLUSIONS: Despite the limitation of a cross-sectional design, our initial findings suggest that there is a strong association between medical comorbidity and cognitive status in AD. Optimal management of medical illnesses may offer potential to improve cognition in AD.     

Missed opportunities in addressing drinking behavior in medical and mental health services

BACKGROUND: Epidemiological and clinical literature point to the importance of screening for alcohol problems in medical and psychiatric settings. However, little is known about which problem drinkers seek help from those services or about the characteristics of those who have their drinking addressed. METHODS: We interviewed a probability sample of adult dependent and problem drinkers in the general population (n = 672) and consecutive admissions to chemical dependency programs in a northern California county (n = 926). We reinterviewed them 1 year later and measured medical and mental health visits and whether their drinking was addressed during the visit. RESULTS: Almost two-thirds of problem drinkers had a medical visit, and approximately one-third had a mental health visit, yet drinking was not often discussed, especially during medical visits. Many of those more likely to have a visit were not more likely to have their drinking addressed. Women and individuals older than 40 years had more medical and mental health visits [odds ratio (OR), 1.71; p < 0.001 and OR, 1.55; p < 0.001, respectively, for women; OR, 1.57; p < 0.05 and OR, 1.64; p < 0.05, respectively, for age >/=40 years], but were not more likely to have their drinking addressed in either setting, and women were less likely than men to have their drinking addressed in mental health settings (OR, 0.62; p < 0.05). Those with higher alcohol severity and those who had attended chemical dependency treatment during the previous year were more likely to have their drinking addressed in each setting. Insurance status predicted medical, but not mental health, visits and was not related to having drinking addressed in either setting. CONCLUSIONS: Drinking behavior was not routinely addressed by medical and mental health practitioners for dependent and problem-drinking men and women who presented in public and private medical and mental health settings.     

医学研究生AIDS知识、态度调查分析

1998年8～12月,在北京和河北地区各选择一所面向全国招生的医学院校,对其一年级研究生有关HIV/AIDS的知识及态度进行调查。结果表明,76.6％～89.1％的学生对AIDS的三种传播途径有正确的认识,38.6％～66.8％的学生认为日常生活等途径不会传播AIDS,对避孕套的保护作用认识模糊,医学研究生对于AIDS的了解不够,反映出目前在中国对AIDS的宣传有待加强。     

Emerging problems of medical ethics in Russia: medical practice and research

The problem of maintenance of integrity of medical profession is rarely discussed in Russia. Meanwhile the following pressing challenges emerge within the medical community in this country: tolerant attitude to violations of ethical principles and falsification in research, incompetence and deceit in practical work, wide penetration of alternative medicine and witchery into everyday medical practice, involvement of physicians in advertising and marketing of drugs, even direct selling of them by medical doctors. Medical community should urgently respond to these challenges and develop mechanisms of internal control. This can be accomplished within the framework of associations of physicians and medical professional groups. Without solution of the above problems Russian medicine would never occupy appropriate high position in the society.     

Status and tasks of neurology/psychiatry in internal military medicine

Within the internal military medicine the subject of neurology and psychiatry is relatively independent, which results from the specific demands in military medicine to the whole subject and to the peculiar practical and scientific task of military psychiatry. At the same time the neurology and psychiatry carry markedly interdisciplinary character in medical aid during medical evacuation, since it likewise participates in medical aid for injured of surgical and internal profile.In the stages of the first medical and qualified medical aid this neurological and psychiatric help must be taken over by the physicians of other specialties working there. An unrestricted neurological and psychiatric help by specialists for neurology and psychiatry can be given only at the level of the specialized medical help.     

Current trends in medical English education and the Japan College of Rheumatology International School

In light of the present revolution happening in medical education in Japan as medical schools implement new curricula to conform to global standards, there is a growing demand for more internationalization and higher quality practical medical English education. In response, many institutions including governmental organizations, universities and academic associations are moving ahead with new initiatives to adapt to these changing demands. This paper reviews the current trends and innovations in medical English education in Japan. This paper also describes one initiative by the Japan College of Rheumatology (JCR) known as the JCR International School held yearly in Karuizawa. By examining recent trends and innovations in medical English education in Japan, the most relevant and applicable can be elucidated to illuminate a path forward for improved medical English education within the JCR.     

Recipients in need of ancillary services and their receipt of HIV medical care in California

For many individuals with access to quality medical care, HIV disease is no longer a critical short term illness but a chronic condition giving rise to more clients requiring ongoing medical care. Programs funded by the federal Ryan White Comprehensive AIDS Resources Emergency Act not only provide essential medical care for these individuals but also facilitate access to medical care services. These programmes fund services, including case management, transportation, and translation assistance, that feature ongoing assistance and enable individuals to remain in the health care system. Because of the importance of maintaining the strict drug regimen, retention in care is also an important part of the overall HIV care component. This study analyzed the relationship of ancillary services and a federal health programme client's receipt of medical care and retention in the health care system. We defined a cohort in need of ancillary services in part by a questionnaire designed to identify factors relating to need. These factors included education, language, and substance use. By merging client level data files we were able to identify medical service utilization trends among the individuals in the cohort who received a high number of ancillary services (more than 11 ancillary service visits in the two-year study period, n = 138) and those who received few services (fewer than six ancillary service visits in the two-year study period, n = 132). Results suggest that the receipt of ancillary services is associated with receipt of and retention in primary medical care. We found that for federal health programme clients in need of ancillary services, a positive relationship existed between their receipt of ancillary services and their access to primary medical care (p 相似文献   

Medical Students' Recognition and Application of Geriatrics Principles in a New Curriculum

Given the aging U.S. population, it is imperative that medical students recognize and apply geriatrics principles. To address this need, in 2006, the Warren Alpert Medical School of Brown University integrated geriatrics content into a new medical school curriculum. Preclinical and clinical medical students submitted written reflective journals in response to prompts regarding the geriatrics content of the new medical school curriculum, including their didactic and clinical experiences. An interdisciplinary team used a structured qualitative approach to identify themes, including the recognition and application of geriatrics principles. Thirty medical student journalers submitted 405 journal entries. Themes regarding students' emerging understanding of geriatrics principles included a growing understanding of geriatrics principles, recognition of the importance of psychosocial factors and patient preferences in caring for older adults, recognition of the complexities of treating older adults and application of geriatric principles to clinical situations, and understanding of physicians' roles in managing the care of older adults. Medical student reflective journaling allows medical educators to obtain timely feedback on curricular innovations and helps illuminate the process by which medical students learn to recognize and apply core geriatrics principles.     

传染病医院CA电子签名系统的技术与实施

为推进医院无纸化进程,保证电子病历的法律效力、减少院内感染,本文论述了传染病医院电子签名基本概念与相关技术原理,通过部署数字证书管理、数字签名验证、电子签章和时间戳系统,将电子签名服务与医院各个系统进行安全集成,实现可靠的电子签名。建立医院统一的电子认证服务体系和业务应用安全支撑体系,保证电子病历的真实性、合法性,减少各业务环节医护人员易受感染的环节,对加强医疗管理、提高医疗效率具有重要意义。     

History of pre-academic medical education: the Gymnasium Illustre in Zerbst and the Philanthropinum in Dessau

The memory of the foundation of the Gymnasium illustre in Zerbst in 1582 includes the memory of the medical propaedeutics which belonged to the school programme there. A series of graduates from this institution later had medical professionships at famous universities. Also the Dessau Philanthropinum attempted to carry out a kind of medical propaedeutics by a corresponding planning of the instruction. The two school system characterize a development the object of which was for different reasons to form a part of the grammar school education as preparatory medical instruction, in order to guarantee in this way an undisturbed transition to the university medicine.     

Onions,myths, beliefs,fashion and reality in asthma

Some myths and unsupported beliefs about asthma are very popular and enjoy general public acceptance and fairly strong support on the Internet. Onions for cough; dairy products avoidance for asthma; and some other popular myths are reviewed, along with some other medical and mixed (popular and medical) myths comparing their popular and scientific support. Classifying medical statements as realities or unsupported beliefs is a hard and serious work nowadays addressed by Evidence Based Medicine methods, which are not devoid of the influence of medical fashion: the medical community is more prone to accept fashionable statements compared to non-fashionable or old-fashioned statements.