安氏Ⅱ~1类错颌拔牙矫治对牙弓宽度稳定性的影响

目的:分析拔牙矫治后安氏Ⅱ类1分类错颌患者牙弓宽度的变化规律,为临床矫治提供参考。方法:选择采用减数上颌2个第1前磨牙及下颌2个第2前磨牙进行固定正畸治疗的患者30例,分别测量矫治前、矫治后和矫治后1年3个时期尖牙间、前磨牙间、磨牙间3个部位的宽度值,观察比较样本治疗期间、随访期间以及全程3个时期牙弓3个部位的宽度变化,进行统计分析。结果:(1)矫治后,上颌尖牙间宽度增大,随访期间轻度减小,但仍比治疗前增大;上颌前磨牙间宽度和上、下颌第1磨牙间宽度治疗后明显减小,随访时轻度的增大,但比治疗前减小;下颌尖牙间宽度和第1前磨牙间宽度的变化不显著。(2)各期上下颌尖牙间宽度、前磨牙间宽度、磨牙间宽度变化的比较有统计学差异。结论:采用减数上颌2个第1前磨牙及下颌2个第2前磨牙矫治后,对患者尖牙间宽度、前磨牙间宽度、磨牙间宽度有不同程度的影响。     

Changes in medical student attitudes as they progress through a medical course.

OBJECTIVES: To explore the way ethical principles develop during a medical education course for three groups of medical students--in their first year, at the beginning of their penultimate (fifth) year and towards the end of their final (sixth) year. DESIGN: Survey questionnaire administered to medical students in their first, fifth and final (sixth) year. SETTING: A large medical school in Queensland, Australia. SURVEY SAMPLE: Approximately half the students in each of three years (first, fifth and sixth) provided data on a voluntary basis, a total of 385 students. RESULTS: At the point of entry, minor differences were found between medical students and first year law and psychology students. More striking were differences between male and female medical students, suggesting early socialization had a substantial impact here. CONCLUSIONS: Results indicate that substantial changes in attitude have developed by the beginning of fifth year with little change thereafter. Gender difference persisted. Some difference in ethical attitudes were found when groups of different ethnic backgrounds were compared. The impact of a move to a graduate medical course, which gives high priority to ethics within a professional development domain, can now be evaluated.     

Relationships between performance in medical school and first postgraduate year

Data from a longitudinal study of Jefferson Medical College graduates were analyzed to determine levels of clinical competence in the first postgraduate year and relationships between postgraduate ratings and performance during medical school. Ratings were obtained on knowledge, data-gathering skills, clinical judgement, and professional attitudes from the hospitals in which the graduates received their training. Significant relationships were found among three levels of performance in medical school and postgraduate ratings and in all four competence areas. Relationships were strongest at the highest and lowest performance levels. It is concluded that in a substantial number of cases good and poor performance in the first postgraduate year can be predicted on the basis of information already available to the medical school faculty.     

全科医学生的专业认同感现状及其影响因素分析

目的 了解全科医学专业农村免费订单定向学生(以下简称定向生)和全科医学专业非定向学生(以下简称非定向生)的专业认同感现状及其影响因素.方法 编制面向全科医学生的专业认同感调查问卷,问卷包括4个维度:专业认知、专业情感、专业学习行为、专业匹配.选取西北地区某医学类地方高校,通过校园一卡通大数据系统,分阶段分层次随机抽取大...     

Foundation Programme Impact on Junior Doctor Personality and Anxiety in Northern Ireland

Objectives

The main objectives of this study were to assess personality traits and levels of anxiety in Foundation Year 2 (F2) doctors during the foundation doctor training programme in the Northern Ireland Deanery (NIMDTA).

Methods

A prospective survey-based study was conducted for all F2 doctors attending the mandatory generic skills programme at NIMDTA. Anxiety was measured using the State-Trait Anxiety Inventory (STAI) while personality was assessed using the IPIP-NEO questionnaire. These previously validated questionnaires were completed at the start and again at the end of the F2 year.

Results

147 (M=65, F=82) and 106 (M=55, F=51) F2 doctors completed questionnaires at both time points. STAI scores suggested a moderate level of anxiety amongst both male and female doctors at baseline and at the end of the academic year. There was no difference between gender for either parameter (Baseline-State: 34.0 vs. 36.0, p=0.48 and Trait: 39.0 vs. 40.5, p=0.33) (End-State: 41.0 vs. 36.0, p=0.14 and Trait: 42.0 vs. 40.5, p=0.78). IPIP-NEO scores for F2 doctors were consistently higher in the Accommodation (93.9 & 92.3) and Consolidation (88.8 & 87.6) personality factors and lower in the Neuroticism factor (66.3 & 65.9) at both assessment time-points. Female F2 doctors scored significantly higher in the accommodation factor at the end of the academic year when compared to their male counterparts (88.0 vs. 94.0, p<0.001). There was no difference between the genders for the other personality factors at the end of the year (p>0.09).

Conclusion

This first cohort of F2 doctors were exposed to many emerging changes in their training which did not appear to have any detrimental effect on their anxiety levels or personality profiles and suggests that junior doctors may not be affected by external influences or changing educational environments.Keywords>: Anxiety, Doctor, Foundation, Personality, Programme     

A New School of Medicine Is Born in Quebec

The new Faculty of Medicine at the University of Sherbrooke accepted its first 32 students in September 1966. The four major objectives of the school are: (1) medical education with emphasis on learning rather than teaching; (2) research in three major fields of endeavour: basic, clinical and medico-social sciences; (3) optimum patient care; and (4) service to society. A new Health Sciences Centre houses the Medical School, 1 420-bed hospital and multidisciplinary laboratories, and eventually will contain the paramedical schools, including a School of Nursing Sciences. The three major divisions of the Faculty are basic, clinical and medico-social sciences. The curriculum of the first two years is correlated and integrated within the “block” system, with participation from all three divisions.     

Whose information is it anyway? Informing a 12-year-old patient of her terminal prognosis

OBJECTIVE: To examine students' attitudes and potential behaviour towards informing a 12-year-old patient of her terminal prognosis in a situation in which her parents do not wish her to be told, as they pass through a modern medical curriculum. DESIGN: A cohort study of students entering Glasgow University's new medical curriculum in October 1996. METHODS: Students' responses obtained before year 1 and at the end of years 1, 3, and 5 to the "childhood leukaemia" vignette of the Ethics in Health Care Survey Instrument (EHCI) were examined quantitatively and qualitatively. Analysis of the students' multichoice answers enabled measurement of the movement towards professional consensus opinion. An analysis of their written justifications for their answers helped to determine whether their reasoning was consistent with professional consensus and enabled measurement of changes in knowledge content and recognition of the values inherent in the vignette. Themes on the students' reasoning behind their decision to tell the patient or not were also identified. RESULTS: Unlike other vignettes of the EHCI in which autonomy was a main theme, few students chose the consensus answer before year 1 and there was no significant movement towards consensus at any point during the course. In defence of their decision to withhold information, the students expressed strong paternalistic opinions. The patient's age was seen as a barrier to respecting her autonomy. CONCLUSIONS: It is important to identify students' perceptions on entry to medical school. Transformative learning theory may provide the basis for an approach to foster doctors who consider the rights of young people. Small-group teaching is most conducive to this approach. The importance of positive role modelling is also emphasised.     

Ocular Surface Changes in Primary Open Angle Glaucoma with Long Term Topical Anti Glaucoma Medication

Background

Topical life long anti glaucoma medication forms the mainstay of treatment of primary open angle glaucoma. Their long term usage can cause changes in conjunctival epithelium.

Methods

Hundred cases of primary open angle glaucoma were divided into four groups of 25 patients each. Each group was put on Timolol, Pilocarpine, Brimonidine and Latanoprost respectively. Ocular surface changes were monitored using Schirmer''s test, tear film break up time (BUT) and conjunctival impression cytology.

Result

Altered Schirmer''s test value was seen in 40% of patients and reduced tear film BUT values in 26%, at the end of one year. These changes were more in patients treated with timolol. Changes in conjunctival cytology such as decrease in goblet cell density, squamous metaplasia and presence of inflammatory cells were seen in significant number of patients at the end of one year treatment. There was direct relation of duration of treatment to various ocular surface changes.

Conclusion

Ocular surface changes are seen in significant number of patients of primary open angle glaucoma at the end of one year follow up with topical anti glaucoma therapy. Conjunctival impression cytology is a non invasive technique to monitor these changes.Key Words: Primary open angle glaucoma, Ocular surface changes, Goblet cell density, Squamous metaplasia     

意大利影像医学教学和临床模式特点与启示

意大利影像专业人员的培养模式分为医师与技师两类。六年制临床医学专业学生毕业后进入影像专科培训,考核合格才能成为影像医师;影像技师则来源于三年制影像技术专业本科毕业生。医学院学习期间每年均设置医学基础理论课、人文实践活动和临床实习;继续教育则以讲座、病例讨论等多种形式进行。影像科医师需熟练掌握各种影像技术,在不同检查室轮转工作,除急诊外的患者均采用预约制。通过分析意大利影像医学教学与临床模式的特点,提出了重视影像专业课程设置改革,全面推行早期接触临床;同时改进影像专业医师培养模式,提高其临床工作能力的建议。     

2008～2010年我院质子泵抑制剂应用分析

目的：评估我院质子泵抑制剂（PPIS）的应用情况。方法：采用限定日剂量（DDDs）法,对2008～2010年我院PPIS的用药频度、购药金额进行统计。结果：我院PPIS的品种基本固定,购药金额等逐年增长;各品种使用频度略有更替,但变化幅度不大。结论：我院PPIS使用数量及金额逐年增加,应用基本合理,但仍存在一些不合理的用药现象。     

深圳社区慢性病防治队伍现状及建设对策的探讨

目的了解社区慢性病防治专业人员现状,探讨如何加强社区慢性病防治专业队伍人才建设,提高慢性病防治水平。方法随机抽样调查深圳市社区卫生服务中心55名慢性病防治工作专业人员的基本情况,包括年龄、学历、专业、职称、工作稳定情况、编制类型。结果55名慢性病防治专业人员年龄构成:20～岁6人,30～岁45人,55～岁4人;学历构成:本科30人,专科9人,中专16人;专业构成:临床医疗50人,公共卫生3人,护理2人;职称构成:高级职称21人,中级职称23人,初级职称11人;工作稳定情况:频繁变更3人,每年更换3人,两年以上变更49人;编制类型:正式在编12人,聘用43人。结论社区卫生服务中心慢性病防治专业技术人员存在学历参差不齐、职称低、专业人员少、正式工少、基本素质较差的特点。因此,卫生行政部门应采取稳定队伍、短期培训、在职学习等方式,培养一只基本素质强、专业水平高的队伍,提高社区慢性病防治水平。     

不同肝功能分级患者非转流下原位肝移植术中血流动力学及氧代谢的变化

目的:研究不同肝功能分级患者在非转流原位肝移植手术(orthotopic liver transplantation ,OLT)过程中血流动力学及氧代谢参数的变化趋势.方法:40例肝病患者全麻下行OLT,常规麻醉诱导后放置Swan-Ganz导管监测平均肺动脉压(mean pulmonary artery pressure, mPAP)、中心静脉压(central venous pressure, CVP)、肺毛细血管楔压(pulmonary capillary wedge pressure, PCWP)和心排血量(cardiac output, CO).分别于诱导后30 min(T1)、门静脉阻断即刻(T2)、阻断30 min(T3)、开放10 min和60 min(T4、T5)及术毕(T6)监测血流动力学指标并记录心排血量指数(cardiac index, CI)、每搏指数(stroke volume index, SVI)、外周(system vascular resistance index, SVRI)和肺血管阻力指数(pulmonary vascular resistance index, PVRI);同时在以上各时点取桡动脉及肺动脉血行血气分析并计算氧供(oxygen delivery,DO2)和氧耗(oxygen consumption,VO2).结果:Child C级患者各时点mPAP及T1和T2时的CVP均高于Child A级和B级患者.所有患者门静脉开放后的PCWP均显著高于开放前,其中Child C级PCWP在T1,T2和术毕较Child A级和B级患者高.Child C级患者T1时SVRI和T3时PVRI显著低于Child A级患者.患者术中DO2均超过1 000 mL/min,VO2均低于正常值并于术毕恢复.结论:不同Child分级肝病患者,术中血流动力学呈高排低阻型,术中过高的PCWP和CVP与临床表现不一致.不同肝功能分级患者术中VO2低于正常值,并于术毕恢复正常.     

医学影像技术学教学思路与探讨

介绍了医学影像技术学教学中,要突出影像专业学科特点,注意专业课程的扩充与删减,强化"三基"训练,并适当穿插相关实例,进行多样化讲解,以及在医学影像人才培养中应突出"高起点、高要求、高标准"以适应培养具有综合素质的高级人才等问题.     

河南省在业人口文化素质与经济发展分析

目的：分析河南省在业人口文化素质及对经济发展的影响。方法：应用SAS软件对河南省第3、4及5次人口普查资料和相关资料进行分析。结果：2000年河南省在业人口中,受过大专及以上教育的占3．35％,与1990年相比提高了近2倍;与1990年相比,科研人员的比重提高了13倍多;在业人口人均国民生产总值为8792元。结论：河南省在业人口文化素质不断提高,但与全国相比．河南省在业人口文化素质偏低,经济运行效率不高。     

When is a maternal death a maternal death? A review of maternal deaths at the Mercy Maternity Hospital, Melbourne

The limiting of the reporting of maternal deaths to those that are included in the criteria of the World Health Organization excludes deaths which yield useful information for further improvements in clinical performance. In this series of 22 maternal deaths, six deaths would have been excluded from reporting: one "direct" obstetric death of pre-eclampsia; one "indirect" death as a result of renal and cardiac failure; two deaths as a result of postnatal depression which led to suicide three and four months postpartum, respectively; and two deaths of cancers, where diagnostic delay may have been a result of the coexistent pregnancy. The importance of primary pulmonary hypertension, cardiomyopathy and psychiatric illness is emphasized. We endorse the recent recommendation of the International Federation of Gynaecology and Obstetrics (FIGO) that all maternal deaths that occur more than 42 days after the end of a pregnancy should be assessed for possible relationships with childbirth, and suggest that a time limit of one year would include all deaths that are worthy of scrutiny.     

Medical student attitude toward seeking professional psychological help.

To explore the antecedents of emotional distress among physicians, the authors investigated the relationship between year in medical school and student attitude toward seeking professional psychological help. The sample consisted of 489 students at the University of Southern California School of Medicine. Since a cross-sectional approach was employed a classical regression analysis was used to control for possible differences in the variables of sex, age, contact with psychotherapy, and specialty choice. Differences in male and female responses prompted separate analyses. For women, no attitudinal changes were noted during medical school. For men, a significant positive change in attitude was noted between the students of years one and two, as compared with students of years three and four. Results were contrary to findings in the literature. Several possible explanations are discussed.     

Pelvic examination teaching: linking medical student professionalism and clinical competence

The Professional Patient teaching program is an essential part of assuring competency in the performance of the pelvic examination and professional behaviors. Through a series of integrated teaching sessions from the first year reproductive anatomy laboratory, the second year basic clinical pelvic examination teaching program, to the third year teaching program, students perform at an enhanced level of clinical competency and professional behavior. A Professional Patient commented: "We create a safe environment where medical students not only learn the clinical portion of the exam, but also focus on the patient as the primary source of information on patient comfort. Students receive immediate feedback from us and have ample opportunity to ask questions about aspects of the clinical pelvic examination or doctor/patient communication skills. We guide them, teach them, and help them prepare for examinations with other patients who will not be as open or in tune with their bodies as we are."     

鼻咽癌原发灶乏氧和动态的变化及临床意义

目的分析初治鼻咽癌治疗前原发灶乏氧和治疗中、治疗末的动态变化及其与肿瘤消退的关系。方法62例患者分别于治疗前、中、末行头部^99Tc^m-4,9-二氮3,3,10,10-四甲基十二烷-2,22-二酮二肟（^99Tc^m-HL91）乏氧显像及CT模拟扫描。（1）采用目测法和半定量法的放射性计数比（T^＋／N）分析三个时段原发灶的乏氧状况及动态变化;（2）分析治疗前乏氧程度及治疗过程的动态变化与肿瘤消退的关系。结果目测法显示治疗前56例乏氧阳性,治疗中、末分别有8例和19例转为阴性;半定量法显示同-病例治疗前、中、末T^＋／N值逐渐降低（F=109．073,P=0．000）。治疗前重度乏氧（T^＋／N≥1．52）者治疗中、末肿瘤消退率均明显低于轻度乏氧（T^＋／N〈1．52）者（P=0．019和0．000）和乏氧阴性者（P=0．038和0．000）,其治疗中、末T^＋／N值的变化与相应时段肿瘤消退率呈正相关趋势（r=0．587,P=0．003和r=0．655,P=0．001）。结论初治鼻咽癌原发灶乏氧随治疗的进程逐渐减轻或消失。治疗前乏氧程度及其在治疗中的变化与肿瘤的消退速度相关。     

肾-骨髓联合移植诱导免疫耐受患者外周血B淋巴细胞重构的动态特点及其意义

目的：探讨外周血B淋巴细胞在肾-骨髓联合移植诱导免疫耐受患者中重构的动态特点,为进一步阐明B淋巴细胞在器官移植免疫耐受建立中发挥的作用提供实验依据。方法：5例尿毒症患者（患者编码分别为Pt.A、Pt.B、Pt.C、Pt.D和Pt.E）应用诱导治疗后行肾-骨髓联合移植,术后免疫抑制剂逐渐撤除。应用流式细胞术检测患者移植术前及术后外周血B淋巴细胞数量及其亚群分布,比较不同时间点B淋巴细胞的动态变化,并利用下一代基因测序技术分析免疫球蛋白重链可变区（IGHV）的分布状态。结果：除1例患者（编码为Pt.C）移植肾早期丧失功能,其他4例患者纳入研究。Pt.A、Pt.B和Pt.D均在术后1年左右外周血B细胞计数基本恢复术前水平,Pt.E外周血B淋巴细胞重构延迟。在B淋巴细胞重构过程中,伴随有高频度的CD20+CD24^high CD38^high过渡性B淋巴细胞出现,并表现为多样性的细胞克隆图谱。移植术后约6个月时患者外周血均检测出CD20+CD27+记忆性B淋巴细胞的优势亚群。通过计算术后各时点IGHV多样性指数发现,所有肾-骨髓联合移植患者术后182d时点的IGHV基因序列的香农指数（SDI）明显低于术前（P=0.004）,术后1年左右逐渐恢复。不同时点B细胞IGHV基因序列的体细胞突变检测,除了Pt.B,其他患者IGHV基因序列的体细胞突变率在术后182d时点明显升高（P=0.032）。结论：肾-骨髓联合移植患者外周血中存在体细胞突变的记忆性B淋巴细胞,此类B细胞亚群在免疫耐受诱导中发挥潜在作用。     

上海市健康管理类专业人才培养需求现况调查及对策分析

目的 对上海市各级医疗机构的健康管理类人才需求现状进行调研分析。 方法 采取多阶段PPS抽样调查法对全市100家机构进行问卷调查。 结果 ①在岗基本情况:人才学历分布是以“本科为主”最高比例(68.33%),相关在岗人数以“1～2名”占最高比例(53.8%);相关岗位前3位专业分别是“临床医学”(64.4%)、“护理”(33.8%)、“卫生管理”(22.2%)。②人才要求:学历要求前3位分别是“本科为主”(53.3%)、“根据需要录用不同学历”(38.9%)、“录用大专”(15.6%);证书要求前3位分别是“大学英语四六级证书”(84.4%)、“岗位职业资格证书”(68.9%)、“计算机类证书”(31.1%);最看重的要素前3位分别是“专业技能”(100.0%)、“性格随和,有亲和力”(84.4%)、“学习成绩”(46.7%)。③人才培养需求:未来可设岗位前3位分别为“健康管理师”(84.4%)、“医疗秘书”(68.9%)、“医疗保险管理”(15.6%);需具备的职业能力前3位分别为“健康评估等”(92.2%)、“信息化建设与应用”(84.4%)、“医疗保险基础管理”(68.9%);未来3年内对健康管理专业人才需求量是“5～6名”占最高比例(61.5%)。 结论 建议在培养规模、专业定位、核心技能培养方面立足创新,优化上海市健康管理类本科专业人才培养质量。