医学生境外短期交换项目的管理与思考

医学生境外短期交换,即境外临床选修课程是医学教育国际化的必然趋势,是培养解决全球卫生问题能力的重要途径之一,也是医学教育的必要补充.本文概述了国内外医学生境外短期交换项目对医学生成长所起到的积极作用,分析了北京大学医学部学生境外短期交换的现状,并就项目执行中存在的问题提出了相应的对策,希望对项目的健康持续发展有所帮助.     

托盘关联在基本药物核注核销过程中的应用

目的查找影响基本药物核注核销效率的因素,并提出解决办法。方法在生产线上增加后置工位,后置工位扫描托盘码,以建立大箱码与托盘码的关联关系。出库时直接扫描托盘码即可出库。结果使用托盘关联后,提高了基本药物核注核销的效率。     

Enhancing the quality of care for patients with breast cancer: Seven years of experience with a Dutch auditing system

Background

Hospitals in the Midwestern part of the Netherlands carried out a clinical audit to monitor the quality of breast cancer care during the years 2002-2008. Compliance with the National Guideline was investigated together with improvement in quality over time.

Methods

Patients with a malignancy of the breast (including ductal carcinoma in situ) participated in this study. Nine quality indicators were evaluated over the years. In 2004 and 2005 the hospitals also carried out an intervention project aimed at improvement of the efficiency of both the diagnostic process and the surgical treatment.

Results

At the end of the project all nine indicators showed significant improvement compared to the start of the project. Discussion of treatment strategy in a multidisciplinary breast cancer team took place more often before surgery (83% versus 56%) as well as after surgery (98% versus 70%). The National Guideline for maximum waiting times was met more often for the outpatient clinic (74% versus 61%), time to diagnosis (92% versus 82%), and surgical treatment (52% versus 34%). More sentinel node procedures were performed successfully (92% versus 69%), and for more patients more than 10 lymph nodes were evaluated in case of axillary lymph node dissection (85% versus 58%). More patients had definitive surgical treatment consisting of one surgical intervention (87% versus 75%), and left the hospital within 7 days after hospital admission (98% versus 66%).

Conclusion

The clinical audit contributed to improvement of the quality of breast cancer care in the Midwestern part of the Netherlands between 2002 and 2008.     

双休日“免费号”情况调查与思考

目的了解双休日试行免挂号费的周门诊量变化情况,为加强门诊管理提供依据。方法对医院信息系统数据库中的2007年1月～8月与2006年1月～8月门诊量、门诊收入、入院人数数情况按周进行分类统计,并通过走访医师、导医、挂号员、病人了解情况。结果某医院双休日实行免挂号费后门诊量增长明显,但存在虚高现象,原因也比较多。结论双休日免挂号费政策深受群众欢迎,但要高度重视免费号所带来的门诊量虚高现象,改进双休日免挂号费的管理制度,加强监管。     

Correspondence of closest gradient Voxels—A robust registration algorithm

A robust, automatic volume registration algorithm based on intensity gradients is presented. This algorithm can successfully perform registrations under conditions of unrelated intervolume voxel intensities, significant object displacements, and/or significant amounts of missing data. It also allows the user to visualize the registration convergence, clearly illustrating any source of registration errors. This algorithm consists of a matching algorithm based on iteratively finding the correspondence of the closest voxels containing a high three-dimensional intensity gradient magnitude. This algorithm was tested by registering T2-weighted MR volumes that had undergone varying displacement transformations to simultaneously acquired proton-density volumes. These transformations involved rotations of up to 25° followed by translations of up to 25 mm along the axis of rotation. For all registrations, the mean registration error was less than one-fifth of a voxel and the mean registration time was less than 30 minutes. In conclusion, this algorithm is shown to be a powerful method of sequence-independent MR volume registration that is simple to both use and understand.     

Benefits, challenges, and registerability of the polypill.

Guidelines for the management of cardiovascular disease (CVD) stress the importance of treating global risk, rather than individual risk, factors. Patients at high cardiovascular (CV) risk, for example, benefit from a combination of aspirin, antihypertensive agents, lipid-lowering drugs, and possibly folic acid. As the number of medications that a patient requires increases, adherence and compliance to therapy are likely to decrease. The use of affordable, multiple-target, fixed-combination 'polypills', which concomitantly reduce multiple risk factors without increasing the pill burden or the risk of adverse effects, has the potential to improve CV risk factor management, thereby reducing the incidence of CVD. This review discusses the benefits of the polypill and the challenges and requirements for its success and registerability. Discussions with regulatory bodies are required in order to obtain some 'balance' between an overcautious registration approach and the potentially large public health benefits that are likely to arise from the use of polypills.     

国外区域医疗服务信息平台建设与发展现状分析

对国际上区域医疗信息化建设中起步早、发展历史久、建设项目成功率相对较高的9个国家的医疗体制、经济环境、信息化环境、开发主体、投资及补偿机制等进行了比较,并重点对区域医疗信息化建设步骤和发展策略进行了讨论,分析得出了国外区域医疗信息化建设的现状、各国采用的共同举措、区域医疗信息化成功的关键因素等,并结合我国国情,提出了促进我国区域医疗信息化建设发展的建议.     

深圳市光明新区越南归侨老年人的抑郁水平及影响因素

目的：了解深圳市越南归侨老年人抑郁症状发生情况及其影响因素,为社区干预方案提供依据。方法采用分层随机整群抽样方法,抽取5个村符合条件的246名越南归侨老年人进行问卷调查,评定其抑郁水平、社会支持和日常生活能力等,并对各指标之间的相关性进行分析。结果本组归侨老年人中116名无抑郁,85名轻度抑郁,45名中重度抑郁;不同年龄、性别、居住方式、既往职业、生活来源、经历过土地征收,自评经济、自评健康、自评家庭地位、社会支持、日常生活能力与负性生活事件刺激量特征分布老年人的抑郁水平构成不同。结论独居、女性、生活来源不靠自己、自评健康较差、失去土地等归侨应作为社区抑郁干预优先对象,为经历负性生活事件及时提供心理支援等是社区干预重点内容。     

Current and future perspectives on the TARGET system: the registration system for Glivec® established by the JSH

Since hematology is a highly specialized field, an individual physician may not have much direct treatment experience with a given disease. Therefore, the Japanese Society of Hematology (JSH) has discussed establishing a registry of hematologic disorders, in order to contribute to improving the quality of treatments and clinical outcomes in this field. As a first step, the Timely and Appropriate Registration System for GLIVEC Therapy (TARGET), a registration system for chronic myeloid leukemia (CML) patients treated with imatinib, was established in October 2003. We present the preliminary results of the first 4 years’ experience with this system. CML patients treated with imatinib in Japan were registered through the website and the patient’s clinical course, including parameters and events like imatinib dose, blood counts, adverse events, and efficacy were recorded in months 1, 3, 6, 9, and 12 and then every 6 months thereafter. By September 2007, 862 patients from 176 hospitals were registered. Follow-up period was 0–54 months, and 127 patients were followed-up for more than 36 months. Based on these cumulative data, present imatinib treatment trends were analyzed and safety and efficacy were compared with international trial data. The part of content in this article was presented in the Joint Annual Conference of the 68th Japanese Society of Hematology (JSH) and the 48th Japanese Society of Clinical Hematology (JSCH) in Fukuoka (Japan) at 7 October 2006. Other participants in the TARGET system are listed in the Appendix.     

加强医学留学生人文教育的途径探索

通过对当下医学留学生的人文教育现状的分析,引出了其在适应医学模式转变、完善知识结构、健全品格三方面的重要性.并在此基础上提出了加强医学留学生人文教育的途径：医学专业教学应渗透人文教育;优化针对医学留学生的人文课程设置;积极开展人文教育隐性课程;融人文教育于医学实践.