关于中医基础理论重点学科建设问题的讨论

基础理论学科的知识创新与重点学科的建设工作密切相关，知识创新的技术平台建设主要依赖于学科发展方向、学术带头人、学科人才梯队和运行管理机制的建设。关注学术发展动态。拟定高起点、高水平的学科发展方向；根据科学发展趋势，选拔开拓进取、勇于创新的学科带头人；瞄准科学前沿，建立多层次、结构优化的学科人才梯队；创新管理模式，实行科学化运行机制和管理体制是保障知识创新的前提和基础。     

中国乡级计划生育服务站技术服务提供及服务能力跨地区分析

目的根据2001年全国计划生育和生殖健康调查资料,对我国东、中、西部三大经济地区乡级计划生育服务站的技术服务提供及服务能力进行跨地区比较分析。方法全国抽样调查,采用分层、三阶段、概率比例抽样方法。对776个计划生育服务站和负责人采用观察与询问的方式进行问卷调查。结果全国农村样本点乡站放置和取出宫内节育器年均258.5例次,开展女性绝育术年均38.5例次,实施人工流产术年均29.6例次,三地区间差异有统计学意义(P<0.05)。开展男性绝育术和皮下埋植术年均分别为10.4例次和2.5例次,三地区间差异无统计学意义(P>0.05);在样本点中,95%(737/776)的乡站有B超设备,其中B超服务用于宫内节育器检查和妇科疾病诊断的乡站比例分别为69.5%(509/737)和55.0%(405/737);提供常见妇科疾病诊治、产前检查、不育症诊治的比例分别为84.1%、76.8%和25.4%,提供性病诊治比例为19.5%;提供妊娠试验、血尿便常规检查和宫颈涂片的比例分别为91.4%、18.6%和9.8%。精液检查比例为3.5%;提供短效、长效和速效口服避孕药的比例分别为95.6%、89.7%和71.3%。提供紧急避孕药的比例为24.7%。提供避孕套的比例为97.8%;能提供咨询服务的乡站比例75.6%,设有“悄悄话”室乡站的比例为52.1%;提供术后和产后随访服务的比例分别为85.4%和38.3%。结论全国农村样本点乡站在提供计划生育手术服务、发放避孕药具,以及围绕着生育、节育和不育开展力所能及的生殖保健服务方面已经具备相当能力,但各地的技术服务提供和服务能力发展并不均衡,东、中、西部地区的差别明显。表明我国基层计划生育服务站改革已是一种必然趋势,改革的方向应遵照国家人口计生委关于服务站建设的总体发展格局对乡站进行优化和整合。只有改革才能加快乡站服务能力建设,才能提高服务水平,才能适应客观需求,才能让广大农村育龄群众得到满意的服务。     

关于血液透析机维护和管理中需要注重的问题

随着医疗卫生事业的飞速发展，大量高科技电子设备不断涌现，是技术密集．知识密集、资金密集的产品，而血液透析机无论是国产还是进口的设备，（进口占比侧大），均属高科技机电一体化医电产品，并且采用微机技术．自检报警功能多，操作相对复杂，而不同产地（不同型号其操作方法和日常维护方法也不同着重阐述了透析机供电和透析掖的配制和血液透析机的维护与保养和维修。     

管理学课程教学创新探讨

管理学是研究管理活动的科学知识体系，是一门综合性应用学科，具有科学性和艺术性。针对管理学在新形势下不断呈现出的特点，探讨了管理学课程的教学目标、教学内容及教学方法应该作出的调整和创新。     

创建中医基础理论精品课程的思路与举措

通过加强师资培养,建设合理梯队;加强教材建设,选用精品教材;深化教学改革,重在方法创新;加强效果评价,注重总结分析;加强网络建设,开创自学平台5个方面,阐述了创建中医基础理论精品课程建设的思路,并强调了精品课程建设的重要性和长期性.     

Paradoxical brain embolism shadowing massive pulmonary embolism

Patent foramen ovale is frequently observed in the general population. In case of massive pulmonary embolism, the sudden increase in the right heart cavity's pressure may cause a right-to-left shunting across this foramen, which could be associated with conflicting outcomes. Herein, we report a case of reversible cardiac arrest preceded by seizures, and followed by hemodynamic stability without any vasopressor. A brain CT-scan showed a limited ischemic stroke. Initial echocardiographic assessment revealed an acute cor pulmonale and a right-to-left intracardiac shunt across a large patent foramen ovale, suggesting the diagnosis of massive pulmonary embolism that was lately confirmed by a multidetector CT-angiography. Anticoagulation therapy was rapidly complicated by a hemorrhagic transformation of the ischemic stroke leading to a fatal outcome. This case illustrates the double-edged circulatory effect of shunting across a patent foramen ovale in case of massive pulmonary embolism: it may have limited circulatory failure but caused in the meanwhile a fatal paradoxical brain embolism.     

Atrial Fibrillation Clinics in Canada: A Nationwide Project Report

The increased prevalence of atrial fibrillation (AF) has led to specialized AF clinics (AFCs) to facilitate management of AF patients. In this article we report on outpatient AFCs in Canada, which is essential to health policies required to standardize the performance of existing AFCs and help design new AFCs. We surveyed 14 clinics in 5 provinces; 100% provided responses to a detailed questionnaire on clinic processes and care practices. Fourteen care maps were analyzed, and 5 models of care were identified; 4 were specific to AFCs. An online survey with 49 questions included items on: (1) process before visit; (2) process at visit; (3) patient education provided; (4) outreach; and (5) specific clinic information. Clinicians’ advice to patients on self-care items such as: (1) amount of alcohol and (2) caffeine intake; (3) exercise activity; (4) stressful events; (5) “when to go to the emergency department”; and (6) lifestyle changes, were evaluated to assess consistency in practice. There were moderate variances in clinicians’ advice to patients in 5 of 6 self-care items. The 1 item that had 100% consistent practice recommendation was when to go to the emergency department. A guideline-based clinical assessment checklist (CAC) was piloted to obtain feedback on its usability in real-world practice; revisions finalized the “simplified CAC” for AF care encompassing 35 data points with rationale. There was 100% positive feedback on its ability to provide baseline elements in AF care. When validated, a “simplified CAC” can facilitate a standardized clinical assessment tool in clinical practice.