Calcium-channel blockers and beta blockers: advantages and disadvantages of combination therapy in chronic stable angina pectoris

In electrophysiologic studies we have previously shown that the calcium-channel blockers nifedipine, verapamil, and diltiazem have different actions on the atrioventricular node: nifedipine has no evident effect at a dose of 7.5 micrograms/kg of body weight intravenously, whereas verapamil (0.15 mg/kg) and diltiazem (0.25 mg/kg) both prolong the AH interval significantly and terminate or slow reciprocating atrioventricular tachycardia involving the atrioventricular node alone or in association with an accessory pathway. None of the calcium-channel blockers tested influenced intraventricular conduction, but all increased the sinus rate. Since these properties suggested that it would be safer to combine nifedipine, rather than verapamil and diltiazem, with beta-adrenergic blockers in the treatment of ischemic heart disease, we tested this combination for efficacy and safety. Our previous results have now been reviewed, and they show that according to both subjective and objective criteria, nifedipine adds benefits to the action of propranolol in the management of chronic stable angina pectoris. No adverse effects were seen in our series, and beneficial influences were noted in patients with elevation of blood pressure. Side effects reported by others and said to arise from the interaction between nifedipine and beta blockers are analyzed, and prudence is suggested before the combination, or indeed any negative inotropic agent, is given to patients with impaired left ventricular function. The previous reports cannot be taken to indicate that nifedipine has a greater tendency to produce adverse effects in this combination than does the beta-adrenergic blocker.     

Digital versus conventional implant impressions for partially edentulous arches: An evaluation of accuracy

Statement of problem

To the authors’ knowledge, while accuracy outcomes of the TRIOS scanner have been compared with conventional impressions, no available data are available regarding the accuracy of digital scans with the Omnicam and True Definition scanners versus conventional impressions for partially edentulous arches.

PBL结合循证医学在研究生牙体牙髓教学中的应用

目的：探讨基于问题学习法（PBL）结合循证医学在研究生牙体牙髓教学中的应用效果。方法将42名研究生随机分为PBL＋EBM教学组和单纯PBL组,教学结束后对教学效果进行评价。结果 PBL＋EBM组在实践能力考试成绩、提高科研和自主创新能力、增加理论和临床的结合、提高文献检索、评价与利用能力、提高牙体牙髓病诊疗能力方面优于PBL组。结论 PBL结合循证医学运用于研究生牙体牙髓教学中,可以促进研究生的自我知识更新,进而提高科研及自主创新能力。     

硕士研究生分子生物学实验教学改革实践

分子生物学实验是医学院校硕士研究生的一门重要课程。通过更新优化教学内容（重视科研设计、增设综合性大实验、更新实用新技术）、改进教学模式（强调实验前准备、教师资格及研究生素质培养）、完善考核方式（实验报告与实验总结、平时成绩与实验操作相结合）,收到了良好的教学效果。     

以“产学研联合培养研究生”为契机推进医院研究生教育的发展

本文以新疆维吾尔自治区人民医院为例,讨论了研究生培养的主要方面,包括医院研究生管理、教学硬件设施、导师和研究生培养模式。通过医院研究生培养的相关变化说明产学研联合培养研究生可以促进医院健全研究生管理体制、改善教学基础设施、加强师资队伍建设、改革研究生培养模式,从而有效提高研究生的培养质量,推进医院研究生教育工作的发展,培养适应社会经济发展需要的高层次创新性医学人才。     

基于素质优先原则下中西医结合临床专业硕士研究生临床培养模式的探索

临床医学专业的硕士研究生教育是我国研究生教育改革的方向之一,它是对已经经历系统的医学基础知识教育学习和进行了专科技能培养的优秀医学人才的进一步具有针对性的培养和教育,是我国培养具有较强专业技能和较好专业知识的高层次医学人才的教育。对于我国的医学教育而言,临床专业硕士研究生的培养进一步向科研型与临床型分立以及复合型的医学人才格局迈向崭新的一页。其中偏重临床工作能力的专业性硕士研究生是临床教学单位的主要培养和发展方向。因此,针对我国高等医学教育的发展方向和培养模式,如何才能提高临床医学专业硕士研究生的基本工作能力是每个研究生培养单位值得思考的问题。我们面临的工作不但包括全面提高临床医学专业硕士研究生的整体素质,而且要对研究生的毕业后就业、学科的良性发展均有较好的效果。     

NCCN临床实践指南在胃癌外科进修医师培训中的应用

【目的】应用和评估美国国家综合癌症网络肿瘤临床实践指南（National Comprehensive Cancer Network,NCCN）在指导进修医师临床教学中的作用。【方法】对2012—2013年在我科进修学习的36名胃癌专科医师采用基于胃癌NCCN指南的教学方式进行培训。通过比较培训前后进修医师对胃癌外科核心概念掌握程度以及进行培训后问卷调查来评价胃癌NCCN指南在胃癌外科临床诊治过程中的作用。【结果】培训前后进修医师胃癌外科核心概念测试成绩提高80％。接受培训的进修医帅认为基于NCCN指南的培训能够提高他们学习医学文献的技能。【结论】基于NCCN指南的培训能够改进进修医师胃癌外科能力。需要进一步强调NCCN指南在进修医师培训中的作用。     

Health consumers' experiences in Australian critical care units: postgraduate nurse education implications

Aim: To explore critical care patients and families experiences and seek their input into nurses' postgraduate educational preparation and practice. Background: There is an inconsistency in the expected standard of practice to ‘qualify’ Australian critical care nurses. There has also been a lack of health consumer input in the development of postgraduate course curriculum and content. Method: Following institutional ethics committee approval, purposive sampling was used to select participants for focus groups and individual interviews who had experienced intensive care or coronary care. Findings: Seventeen participants provided data which created two main thematic categories; the role of the critical care nurse and; minimum practice standards for postgraduate critical care course graduates. Both physical patient care and socio‐emotional support of patients and family were identified as important for the critical care nurse role. The level of socio‐emotional support provided by nurses was reported to be inconsistent. Components of socio‐emotional support included communication, people skills, facilitating family presence and advocacy. These components were reflected in participants' concepts of minimum practice standards for postgraduate critical care course graduates; talking and listening skills, relating to and dealing with stressed people, individualizing care and patient and family advocacy. Conclusion: Health consumers' views emphasize that socio‐emotional skills and behaviours need to be explicitly described in postgraduate critical care nursing course curricula and instruments developed to consistently assess these core competencies.     

PARTICIPATION AND NEEDS AMONG MEMBERS OF THE ROYAL AUSTRALIAN COLLEGE OF OPHTHALMOLOGISTS

A survey of Australian Ophthalmologists in relation to Continuing Education and related issues was carried out in 1979-80. 53% of College members responded. A small multi-choice question paper tested the level of competency of the group. Age, geographic distribution, and type of practice were recorded and related to presently available continuing education facilities. Future needs are assessed and questions raised regarding the direction of continuing education in the future. The level of ophthalmic knowledge appears to be satisfactory but decreases with age, along with attendance at education programmes. 25% of ophthalmologists consider themselves isolated. Future programmes should consider these factors. Views on undergraduate, general practitioner and community education are also summarised.