提高中医临床疗效的科学学检讨(连载三)

中医学的生命力在于临床疗效 ,社会对于中医学的需要也在于临床疗效。提高中医临床疗效的科学学研究 ,要以中医基础理论为依据 ,以理、法、方、药一脉相承的辨证论治为前提。造成中医临床疗效下降的问题在于“三个脱节” ,即中医学与自身文化基础脱节 ,中医临床与辨证论治脱节 ,中药与中医临床脱节。中医学正处于行将消亡的边缘 ,也处在新的突破的前夜。实事求是地进行科学、历史的反思 ,中医学完全有可能走出百年困惑 ,得到振兴和发展。     

Asbestos disease in sheet metal workers: proportional mortality update

This paper, updating the findings of an earlier study, provides additional evidence that sheet metal workers in the construction trades are at increased risk for asbestos-related disease. A proportional analysis of cause of death among 331 New York sheet metal workers found a significantly elevated PMR for lung cancer (PMR = 186). In addition, there were six deaths attributable to mesothelioma (three classified as lung cancer deaths) and three death certificates mentioned asbestosis or pulmonary fibrosis, although none of these three deaths were attributed to these diseases.     

Parenchymal and pleural fibrosis in construction workers.

Exposure to mineral dust was studied among construction workers (N = 437) with the aid of a questionnaire and a chest X-ray examination of the lungs. The results of the questionnaire showed that 81% of the construction workers had been exposed to asbestos. Exposure had occurred in all of the occupational groups studied. Pleural plaques and/or lung fibrosis (ILO greater than or equal to 1/1) were found in 26% of the examined workers; the prevalence varied from 18 to 40% among the various occupational groups. Comparison with a representative sample of the Finnish male population from another investigation indicates that the frequency of lung fibrosis (ILO greater than or equal to 1/1) is at least two times higher among the examined construction workers than among the general population. It seems likely that exposure to asbestos dust can be considered an etiological factor for an appreciable number of the X-ray findings.     

胰RNA对离体瘤细胞的杀伤作用及其机制的探讨

在体外培养瘤细胞的实验中,胰RNA提取物对艾氏腹水瘤细胞及其他瘤细胞(S_(180),P_(88),H_(22))有杀伤作用。在胰RNA提取物中,对瘤细胞具有杀伤作用的活性物质不是性凝集素样多糖类物质或能透过半透膜的小分子化合物,而是具有二级结构的低分子RNA。     

Teaching Culturally Appropriate Care: A Review of Educational Models and Methods

The disparities in health care and health outcomes between the majority population and cultural and racial minorities in the United States are a problem that likely is influenced by the lack of culturally competent care. Emergency medicine and other primary-care specialties remain on the front lines of this struggle because of the nature of their open-door practice. To provide culturally appropriate care, health care providers must recognize the factors impeding cultural awareness, seek to understand the biases and traditions in medical education potentially fueling this phenomenon, and create a health care community that is open to individuals' otherness, thus leading to better communication of ideas and information between patients and their health care providers. This article highlights the rationale for and current problems in teaching cultural competency and examines several different models implemented to teach and promote cultural competency along the continuum of emergency medicine learners. However, the literature addressing the true efficacy of such programs in leading to long-lasting change and improvement in minority patients' clinical outcomes remains insufficient.     

新形势下中学与大学学生党建衔接工作的思考

在青年学生中吸收优秀分子已成为高校党组织发展工作的重要组成部分,最近几年来,高中党建工作也不断发展。了解青年学生党建现状,更好地利用中学党建工作成果,提出了做好衔接工作的现实意义及对策措施。     

Advancing Nursing Practice with a Unit-based Clinical Expert

Objective: To explore patterns in the practice of nursing and patient outcomes.
Design: Qualitative field research.
Population, Sample, Setting: Populations were critical care nurses and critically ill adult patients in the 10-bed medical critical care unit of a 900-bed teaching hospital. A convenience-purposive sample of 27 nurses and 31 patients was studied in 1985.
Methods: Six months of participant observation, unstructured interviews, and the constant comparison method of grounded theory.
Findings: Markedly different patterns were found in expert and nonexpert practice. The substantive theory of conversion helped explain how the majority of nonexpert nurses advanced their practice. The metaphor of catalyzed conversion captures how a unit-based expert nurse serves as a catalyst to advance the practice of nonexperts. Presence, defined as the way of being within a given clinical context, differentiated nurses.
Conclusions: (a) Expert and nonexpert practices are substantively different, (b) Expert and nonexpert practice results in different patient outcomes, (c) Conversion helps explain changes in nonexpert practice.
Clinical Implications: A unit-based expert nurse can increase patient-focused care.     

学生视域下的医学院校大学英语课程思政教学资源库建设研究

目的 探索医学生团队对大学英语思政教学资源的发掘与整合,并建设医学院校大学英语课程思政教学资源库,为医学生英语教学与思政教育的融合提供可行性经验。方法 对某医学院校1 030名学生进行问卷调查,并采用SPSSAU统计软件对调查结果进行分析,了解学生对英语教学与思政教育融合的态度与需求、大学英语思政教学资源库的建设方式,以及资源的呈现方式和类型。基于问卷结果、教材主题、教学模块与学生专业,采用内容分析与归类法,建设符合医学生期望的大学英语思政教学资源库。数据均以占比百分率的形式呈现。结果 ①836名学生认为大学英语有必要与思政教育融合,希望通过日常生活（731人）、医学背景知识（664人）、社会实践（622人）、新闻时事（604人）等相关的视频、音频建设思政资源库,并以“教师讲授+课堂讨论”（528人）的形式引导学生学习上述资源。②根据教材主题匹配问卷结果中的思政融入点,根据单元模块内容进一步细化思政融入点为普适性与医学专属思政教学元素两类,最终建成了医学院校大学英语思政教学资源库。结论 好的课程与资源是师生共研共建的。     

军队卫生学任职教育思考与对策分析

为适应新形势下军队院校备战打赢的教育总要求,本文通过分析当前军队卫生学任职教育存在的主要问题和原因,结合外军任职培训教育的经验和做法,提出了加强军队卫生学任职教育的总体思想;并结合军医大学任职教育现状和实际,从师资队伍、课程建设、信息化建设、教学方法和考核模式等方面进行了针对性的对策分析,以期为更好地开展军队卫生学任职教育提供指导和帮助。     

全科医学与睡眠医学如何协同发展

全科医学和睡眠医学作为国内目前新兴的两个临床学科,两者在学科建设过程中存在着诸多交集,互补性强,在学科发展和人才培养上存在一定的交叉融合。中国专科医师培训认证制度在人才培养方面为全科医师从事睡眠医学工作开辟了道路,使其有良好的协同发展的基础及必要性。本文分析了目前中国全科医学与睡眠医学两者学科协同发展的基础及学科协同共建的必要性,介绍了南京医科大学附属无锡人民医院在全科医学与睡眠医学学科共建方面取得的经验,并邀请相关专家就目前存在的问题进行讨论。