网络环境下学术期刊的著作权及其保护

介绍了作为学术期刊著作权人的期刊社或期刊的主办单位所享有的以期刊为整体的著作权及邻接权,探讨了网络环境下学术期刊的著作权被侵权的多种情况,提出了网络环境下学术期刊的著作权保护策略。     

《中国医院知识仓库》期刊全文库检索功能存在的问题和改进建议

探讨和总结了《中国医院知识仓库》（CHKD）期刊全文数据库中存在的问题和不足,并对解决这些问题提出了具体的建议。     

社区卫生服务中心业务骨干导师制培养方案研究

人才资源是第一资源,培养有志于社区卫生服务的业务骨干,是实现《2009—2011年深化医药卫生体制改革实施方案》提出的今后3年的阶段性工作目标,即“到2011年,基本医疗保障制度全面覆盖城乡居民,基本医疗卫生可及性和服务水平明显提高,居民就医费用负担明显减轻,‘看病难、看病贵’问题明显缓解”的关键。只有相关利益者特别是广大社区卫生服务工作者充分认识到深化人才培养模式改革的重要性、必要性和紧迫性,社区卫生服务的人才培养才能迈出坚实的步伐。本文就社区卫生服务中心业务骨干导师制培养方案进行了有益的研究。     

Papillary lesions of the breast diagnosed by core needle biopsy: 71 cases with surgical follow-up

Background

Papillary breast lesions comprise a spectrum of histopathologic diagnoses ranging from benign papillomas to papillary carcinomas. There is ongoing controversy regarding the management of papillary lesions diagnosed by core needle biopsy (CNB). Some authors advocate observation of papillary lesions when the CNB is benign, while others recommend surgical excision of all papillary lesions. The current study assessed the adequacy of CNB in evaluating papillary breast lesions.

Methods

A search of the pathology database at our institution identified 122 papillary lesions diagnosed by CNB. The study population consisted of 71 papillary lesions that were subsequently surgically excised.

Results

Of the 71 papillary lesions excised, 8 were malignant, 16 were atypical, and 47 were benign at the time of CNB. Of the 47 papillary lesions thought to be benign, 13 (28%) revealed atypia and 4 (9%) revealed malignancy upon surgical excision. Of the 13 atypical papillary lesions on CNB, 7 lesions (54%) were associated with malignancy upon excision. Slightly over half the upgrades were due to finding atypia or malignancy in the tissue surrounding the papillary lesion. The total rate of upgrades from the CNB diagnosis to the excisional diagnosis was 38%.

Conclusions

When a core biopsy of a papillary lesion is encountered, there is a strong likelihood of discovering atypia or malignancy in the index lesion or in close proximity. Therefore, surgical excision should be performed to avoid missing a malignancy and to allow for accurate breast cancer risk assessment that can impact survival and decisions regarding chemoprevention.     

Education and training of medical technologists in Italy

The role and figure of biomedical laboratory technologists have undergone important changes over the past decades. The increasingly complex functions and responsibility of biomedical laboratory technologists both require an updated education and training process. Here, we describe the current situation in Italy regarding the education of biomedical laboratory technologists and the results of a survey conducted in 28 universities. A significant variability between the different universities was observed regarding both the teaching subjects and the distribution of credits among the different courses. The results of this survey highlight that a greater uniformity in the distribution of credits and a better balance among teaching sectors might be advisable.     

Educational intervention is effective in improving knowledge and confidence in surgical ethics-a prospective study

Background

Professionalism and ethics are Accreditation Council for Graduate Medical Education (ACGME) core competencies, but there is little evidence regarding the effectiveness of ethics education.

Methods

General surgery residents at the University of Pittsburgh completed questionnaires measuring attitudes and knowledge about surgical ethics before and after four 60-minute, faculty-facilitated seminars implementing the American College of Surgeons ethics curriculum.

Results

Most residents experienced ethical challenges at least once every rotation: competition of interests (75%), professional obligations (75%), confidentiality (83%), truth telling (88%), surrogate decision making (91%), and end-of-life issues (100%). The educational intervention increased both knowledge about surgical ethics (P = .013) and confidence in dealing with competition of interests (P = .001), professional obligations (P = .011), truth telling (P = .013), confidentiality (P = .011), end-of-life issues (P = .007), and surrogate decision making (P = .052). Most residents recommended the American College of Surgeons text for future use (84%), considering ethics education a “standard” part of residency training (70%).

Conclusions

Focused instruction using the American College of Surgeons ethics curriculum can effectively improve both knowledge and confidence about surgical ethics.     

Herausforderungen an die Ausbildung in Onkologiepflege in Europa

Zusammenfassung Die Europäische Gesellschaft für Onkologiepflege hat die Initiative für eine Entwicklung durch Schulung der Onkologiepflegenden ergriffen, indem sie den Schulungsbedarf analysiert, ein Curriculum für eine Nachdiplomweiterbildung in Onkologiepflege erstellt hat und indem sie die Praxis ins Zentrum des Lernens stellt, wie etwa das mit der Praxis verbundene Thema TITAN oder die Entwicklung einer Aus- und Weiterbildung für die Pflege von älteren Personen. In mancher Hinsicht eröffnen sich derzeit im Gesundheitswesen enorme Möglichkeiten für die Onkologiepflege, dies nicht nur infolge der verbesserten Überlebenschancen und Behandlungen, sondern auch deshalb, weil im Rahmen der Bologna-Vereinbarung die berufliche Aus- und Weiterbildung generell geprüft und geregelt wird.     

Accuracy and Underestimation of Malignancy of Breast Core Needle Biopsy: the Florence Experience of Over 4000 Consecutive Biopsies

Breast core needle biopsy (CNB) is used for sampling breast lesions in both the screening and diagnostic context. We present the accuracy of breast CNB from a consecutive series of 4035 core biopsies, using methods that minimise selection and verification bias. We calculate accuracy and underestimation of malignancy for both automated (14G) and directional vacuum-assisted (11G) CNB performed under stereotactic or sonographic guidance. Overall sensitivity of CNB is 94.2% (92.9–95.5%) and specificity is 88.1% (86.6–89.6%), positive and negative predictive values are 84.8% (82.9–86.7%) and 95.6% (94.6–96.6%), respectively. In sampling microcalcification, the overall underestimation of malignancy is 26.6% (22.9–30.3%): underestimation is significantly higher for automated CB relative to VAB (χ² _{(df = 1)} = 8.90 , P = 0.002), the absolute difference in underestimation being 14% (5–23%); sensitivity is higher for VAB than automated CB (χ² _{(df = 1)} = 3.28, P = 0.06) but specificity is significantly higher for automated CB (14G) relative to VAB (11G) (χ² _{(df = 1)} = 6.37, P = 0.01), and the overall accuracy of the two methods is similar. Sensitivity of CNB improved with experience (over time and in relation to caseload). Accuracy was not substantially affected by lesion palpability or image-guidance method, and was similar for both masses and calcification but lower for lesions depicted as distortions on mammography. Inadequacy was very low and decreased with greater operator caseload, and was not associated with core gauge or image-guidance method. False negatives occurred in 4.4% (3.4–5.4%) of cases, and where core histology was benign but discordant with (suspicious) imaging and/or clinical findings the likelihood of malignancy was 33.1% (18.5–47.7%), emphasising the importance of correlating all test information in breast diagnosis.