英国医师执业注册、考试及启示

英国执业医师的注册、考试已有数百年的历史,形成了一套程序严格和行之有效的注册管理方法.文章从注册的原因、条件、种类、医师考试及其培训等方面分别阐述,并从中得到启示:(1)注重临床实践能力;(2)重视医师的医德;(3)注重专业知识培养.     

Ten years of glaucoma blindness in Fife 1990-99 and the implications for ophthalmology, optometry and rehabilitation services.

The aim of this study was to determine the characteristics of the patients in Fife who were registered as blind with a main diagnosis of glaucoma between 1990 and 1999. The case notes of 87 people were studied. The average age at registration was 78 years (S.D. = 14). By the time of first referral to hospital, more than half were already aware of visual loss. Forty-five per cent of referrals had no optometry input. Compliance with treatment was poor in at least 26% of patients. Only 44% had glaucoma surgery. There were significant findings with regard to mental health, particularly dementia, which was eventually present in 24%. At least one-third of patients had a hearing impairment. One-third of those registered as blind could have been registered earlier. However, staff from the local provider of rehabilitation and social work services for the blind were shown to have provided prompt and helpful support to 95% of those registered. Consideration should be given to the way in which elderly patients with advanced glaucoma are managed, with awareness of mental health and hearing problems and emphasis on early referral to rehabilitation services.     

城市结核病控制中的问题与对策的案例研究

目的深入地分析上海市结核病诊断治疗和管理中存在的问题，为防制决策服务。方法对上海市某区疾病预防控制中心1999—2003年期间的日常结核病报表资料进行分析。结果暂住人口结核病登记率低于本地人口，暂住人口结核病患者诊断后失访率远高于本地人口，已知治愈率远低于本地人口。暂住人口结核病患者中痰菌阳性的比例高，绝大部分是自费医疗，暂住人口大部分病人首诊不在定点医院。暂住人口结核病的防治管理亟待改善。结论要进一步控制城市的结核病流行，除了要在提高结核病发现率方面采取措施外，更重要的是改善暂住人口的结核病患者管理和规范治疗，同时户籍人口的结核病患者的诊断治疗管理也有待改善。     

三维核医学图像配准的心肌存活评价方法

目的探索建立三维核医学图像配准和融合进行心肌存活评价的定量分析方法。方法编写计算机程序,用最大互信息法将单光子发射计算机体层摄影术心肌血流灌注图像和PET心肌代谢图像进行三维图像配准,用改进的快速推进法提取心肌区域,将区域内的图像灰度作校正后融合成心肌代谢和血流灌注的差值图以伪彩色表示,用于定量分析。结果所建立的方法可以实现两种核医学心肌图像的配准、兴趣区域的提取和初步的图像融合,用该技术对实际病例作了初步尝试显示与实际情况相符。结论利用图像配准和融合的方法对心肌存活进行定量评价是可行的。     

人体医疗类干预临床试验研究方案信息与结果的国际注册原则——渥太华声明(第Ⅰ部分)

临床试验的注册在国际临床医学界已经呼吁了多年，其用意在于避免发表偏倚（一种阳性结果临床试验容易获得发表，而阴性的研究结果不容易获得发表的倾向）和选择性报告偏倚。2004年一个由80多名国际临床医学专家、杂志编辑和研究人员共同签署的声明，由6名具有国际知名度的临床试验专家起草、修订和发表了注册临床试验的宣言，即著名的《渥太华声明》。要求任何临床试验的研究方案及随后的试验结果都应当进行注册，并使公众能够获取。该声明已经翻译成英、法、日文；现由国内学者翻译的该声明在本刊发表具有重要意义，将进一步促进临床试验的规范化和质量的提高．并最终接受公众的评价。[编者按]     

中国临床试验注册和发表机制及实施说明

2006年4月16~17日在成都召开第四届亚太地区循证医学研讨会期间,中国48家医(药)学期刊和中国临床试验注册中心(Chinese Clinical TrialRegister,ChiCTR)、卫生部中国循证医学中心、循证医学教育部网上合作研究中心和ChineseCochrane Centre的代表经过充分讨论达成共识,决定共同发起创建中国临床试验注册和发表机制,并成立“中国临床试验注册和发表协作网(ChineseClinical Trial Registration and Publishing Collabo-ration,ChiCTRPC)”。这种临床医学研究管理新模式的创建和应用,将对提高中国临床试验信息透明度和质量、提高医学…     

城乡二元户籍制度下的我国劳动力市场分析

分析户口迁移政策改革的成本与收益 ,对我国劳动力市场跨地区流动进行了实证分析 ,认为实现劳动力的自由迁移不仅符合政府部门的利益而且可以减少城乡收入差距 ,实现政府的目标     

A comprehensive non‐invasive framework for automated evaluation of acute renal transplant rejection using DCE‐MRI

The objective was to develop a novel and automated comprehensive framework for the non‐invasive identification and classification of kidney non‐rejection and acute rejection transplants using 2D dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI). The proposed approach consists of four steps. First, kidney objects are segmented from the surrounding structures with a geometric deformable model. Second, a non‐rigid registration approach is employed to account for any local kidney deformation. In the third step, the cortex of the kidney is extracted in order to determine dynamic agent delivery, since it is the cortex that is primarily affected by the perfusion deficits that underlie the pathophysiology of acute rejection. Finally, we use an analytical function‐based model to fit the dynamic contrast agent kinetic curves in order to determine possible rejection candidates. Five features that map the data from the original data space to the feature space are chosen with a k‐nearest‐neighbor (KNN) classifier to distinguish between acute rejection and non‐rejection transplants. Our study includes 50 transplant patients divided into two groups: 27 patients with stable kidney function and the remainder with impaired kidney function. All of the patients underwent DCE‐MRI, while the patients in the impaired group also underwent ultrasound‐guided fine needle biopsy. We extracted the kidney objects and the renal cortex from DCE‐MRI for accurate medical evaluation with an accuracy of 0.97 ± 0.02 and 0.90 ± 0.03, respectively, using the Dice similarity metric. In a cohort of 50 participants, our framework classified all cases correctly (100%) as rejection or non‐rejection transplant candidates, which is comparable to the gold standard of biopsy but without the associated deleterious side‐effects. Both the 95% confidence interval (CI) statistic and the receiver operating characteristic (ROC) analysis document the ability to separate rejection and non‐rejection groups. The average plateau (AP) signal magnitude and the gamma‐variate model functional parameter α have the best individual discriminating characteristics. Copyright © 2013 John Wiley & Sons, Ltd.     

Joint Segmentation and Groupwise Registration of Cardiac Perfusion Images Using Temporal Information

We propose a joint segmentation and groupwise registration method for dynamic cardiac perfusion images that uses temporal information. The nature of perfusion images makes groupwise registration especially attractive as the temporal information from the entire image sequence can be used. Registration aims to maximize the smoothness of the intensity signal while segmentation minimizes a pixel’s dissimilarity with other pixels having the same segmentation label. The cost function is optimized in an iterative fashion using B-splines. Tests on real patient datasets show that compared with two other methods, our method shows lower registration error and higher segmentation accuracy. This is attributed to the use of temporal information for groupwise registration and mutual complementary registration and segmentation information in one framework while other methods solve the two problems separately.     

Evidence of favorable sleep-EEG patterns in adolescent male vigorous football players compared to controls

Sleep is crucial for psychological functioning and daily performance. Both lay and scientific opinion hold that physical activity encourages restorative sleep. However, research on this in adolescence is limited. The aim of the present study was to compare sleep-EEG patterns of vigorous exercisers and controls. Twelve adolescent male football players (14 h of vigorous exercise per week) and 12 controls (1.5 h of vigorous exercise per week) matched for gender, age (about 16 years), and educational level, took part in the study. Sleep-EEG registration was performed following a day without exercise. Sleep-EEG analyses revealed that, compared to controls, the football players showed greater sleep efficiency, shortened sleep onset latency, less awakenings after sleep onset, more stage 4, and less REM sleep. Importantly, this pattern of results emerged following a day without exercise. Moreover, vigorous football players reported better daily performance and displayed less weeknight (Sunday to Thursday) to weekend night (Friday and Saturday nights) variation. Findings suggest that for the football players, vigorous exercise seemed to lead to longer-lasting electrophysiological change in brain activity irrespective of acute bouts of exercise.