浅谈全科医生转岗培训超声医学教学体会

全科医生转岗培训是现阶段中国全科医学教育的重要内容.在超声教学过程中应始终贯彻全科医学理念,明确超声培训要求,精选教学内容,根据学生特点,灵活运用多种教学方法,更好地完成全科医生转岗培训超声医学教学任务.     

太原地区学分制全科医生转岗培训学员的现状调查

<正>全科医生是基层卫生服务的主力,全科医生制度建设关乎分级诊疗格局的建立,关乎医改的成败,关乎人民群众的健康利益。我市于2017年5月首批对县级及以上医疗卫生机构拟从事全科医学工作的临床专业执业医师进行学分制转岗培训,该项目是我省现有全科医生培养方式的有效补充。本研究对太原地区首批学分制全科医生转岗培训学员进行了调研,旨在了解学员的基本情况、对培训的需求及分析影响培训的主要因素,为制定下一步全科医生转岗培训计划     

全科医生社区实践基地建设的探讨

根据我国目前的社会经济、卫生事业、医学教育事业的实际情况,发展社区卫生服务所需的全科医生,不可能完全由本科医学生毕业后经全科医学教育而来,更多的是基层医院的专科医生经培训转型成为全科医生,因此,全科医生的培训工作任重而道远。从2000年开始浙江省全面开展全科医师培训工程,包括全科住院医师规范化培训、全科医生转岗培训、全科骨干医师培训”。根据《浙江省住院医师规范化培训基地认定办法（试行）》和《浙江省住院医师规范化培训基地管理办法（试行）》的通知精神,培训基地分为临床培训基地和社区实践基地,社区实践基地不设培训学科,与临床培训基地的全科医学学科共同承担住院医师规范化培训的社区实践任务。     

西藏自治区全科医生转岗培训现状调查

为贯彻落实深化医药卫生体制改革和公立医院改革试点精神,为进一步加强我区基层医疗卫生人才队伍建设,提高医疗技术水、根据卫生部与西藏自治区卫生厅签署的"深化医药卫生体制改革任务责任状"任务和卫生部《全科医生规范化培训试行办法》,我区自2010年起在卫生厅的领导下举办了三期全科医生转岗培训班。     

热点聚焦

<正>全面放开二孩"儿医荒"如何缓解日前,国家卫计委办公厅印发《2015年儿科医师转岗培训方案》,要求做好相关专业医师转岗儿科医师的培训工作,转岗医师培训后由省级卫生计生行政部门组织考核,考核合格并符合相关条件的,转岗为儿科执业医师,《医师执业证书》执业范围变更为儿科专业。此举被业内解读为卫生系统为全面放开二孩做准备,其缓解儿科医生短缺的政策效用值得期待。     

病理学实验教学中关于案例式教学的应用探讨

病理学实验是开展全科医生培训的关键,教学中结合理论和实际,建立学生的临床思维能力,是教学活动的重要环节.本文主要介绍案例教学法在病理实验教学中的意义,并且提出病理教学模式与临床教学模式的结合要点和施行步骤,主要目的是结合理论知识和基础知识,使学生的理论分析能力得到提升.     

胸外科学大班课教学的经验与体会

胸外科是医学中病种多、专科性强,涉及呼吸、循环、消化等多个系统,是一门对专业知识要求很高的学科.事实上,由于其临床疾病的复杂性,胸外科一直是临床教学的难点,如何提高教学效果,是每个从事临床教学的胸外科医生关心的问题,作者在这方面做了一些探索,取得了良好的教学效果,现报道如下.     

全科医生的临床判断概述

全科医生最基本的任务之一就是识别病人的疾患,在这方面他们比专科医生涉及的范围更广泛,而很少使用高技术辅助手段,这意味着全科医生需要更多地强调物理诊断、临床思维或判断能力,并在其中渗透生物-心理-社会医学方法.因此全科医生的临床判断尤为重要,本文就全科医生的临床判断作一概述.     

探讨妇产科临床教学面临的问题与对策

临床教学在医学教育系统中具有重要的作用,应切实提高教员的临床教学能力,加强实习生临床思维能力培养。本文从目前妇产科教学的现状及问题出发,总结妇产科临床教学的方法,分析其未来发展方向,及妇产科临床实习带教面临的问题,总结提高妇产科临床实习带教质量的措施。针对临床教学中面临的诸多问题,通过总结多年临床教学经验,提高了妇产科临床实习带教质量,也提高了教员的临床教学及实习生临床思维能力。     

辩证思维在消化内科临床教学中的应用

辩证思维在临床诊断中具有重要作用,在临床教学中辩证思维能力的培养对于学生将来的成长具有重要意义。该文笔者结合自身的临床和教学体会,从四个方面阐述了在消化内科临床教学中如何运用辩证思维去思考问题、解决问题,以期通过该文初步探讨辩证思维在消化内科临床教学中的应用,同时希望在临床实践中能自觉运用之。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.