浅谈银屑病的病因病机

从历代医家对银屑病病因病机的论述入手,搜集相关文献,总结历代医家提出的观点,同时探讨现代医家对银屑病病因病机的认识。     

论新安医家家族链是新安医学发展的重要形式

本文指出,新安医家家族链涌现了大量的新安医家,促进了新安医学专科特色形成,有效地继承和发展了新安医学理论与临床。认为新安医家家族链是新安医学发展的重要形式,新安医家家族链形成的特殊原因主要是与新安的宗法制和文化发达有关。     

喘证古代文献研究现状

近年来的研究发现,现代医家对古代医家喘证论述的研究大致可分为两大类：其一是对某一文献或医家喘证论述的病因病机或诊治用药特色的研究;其二是对历代文献或医家喘证论述的病因病机或诊治用药特色的研究。     

清代河南荥阳医家的田野考察

目的:探讨河南历代医家的多元面相,深入理解河南历代医家的区域特点.方法:通过人类学的田野考察和个案分析方法,以河南荥阳地区为例,搜集当地现存有关清代以来荥阳医家的民间历史文献.结果:挖掘了许多清代以来河南荥阳医家的家谱、碑刻、墓志等民间历史文献,内容涉及荥阳医家的生平事迹、行医过程、医承关系、学术思想等诸多内容.结论:...     

清代岭南医家研究概述

从清岭南医家生平、医家医著、伤寒金匮类、岭南温病、岭南瘟疫史、中西医汇通、中医名著对清岭南医学的影响等方面概述了清代岭南医家的研究,并指出整理完善岭南医家的生平事迹,为研究岭南中医发展史提供参考,具有重要的意义。     

基于《赤水玄珠》探析新安医家孙一奎“外内君相”学术思想

著名新安医家孙一奎深受金元医家学术流派及相关医家的思想影响,汲取了朱丹溪、汪机等医家学术思想,撰著了《赤水玄珠》。通过探析其《赤水玄珠》总结"外内君相"学术思想、临床治疗特色等。孙氏严格地指出君火相火有天人内外之分,完善了君火相火论,对后世辨治产生了深远影响。     

玄府理论与临床应用初探

玄府理论肇源于<内经>,发扬于金元医家刘完素,散见于明清医家著作,是中医理论的重要组成部分.遗憾的是,由于玄府概念抽象、形态结构不明,长期以来,未能为医家重视.王永炎院士指出,五脏六腑皆有玄府.     

明清时期消渴病因病机框架解析

通过相关文献系统梳理明清时期论治消渴的中医理论框架结构,从病因病机方面分析总结明清医家对消渴病因病机认识的内在理论体系。明清医家对于消渴病病因的阐释多是对阴虚燥热学说的继承,对病机理论的阐释从肾阳亏虚,脾虚、胃中郁热,肝失疏泄,气血运行失常的角度出发,结合医家的临床经验,以及对明清以前的医家学术思想进行整理、传承并创新了消渴的病机理论,以首次"肝郁致消说"才形成完整的理论,观点条理清晰,见解独到,为后世医家提供了新思路。     

旴江医家对金元四大家学术思想的继承与创新初探

旴江医学作为一地域性医学概念,其在历史上名医众多,对医学的发展做出了重要贡献。从旴江医家分布的历史跨度看,大部分主要医家出现在明代及以后,其学术思想与金元四大家有诸多渊源。本文通过对龚廷贤、龚居中、谢映庐、喻昌、李元馨、张海峰和万友生等旴江医家的学术思想进行梳理,初步展示了旴江医家与金元四大家之间的学术联系。     

《中医各家学说》研究任务刍议

《中医各家学说》作为一门独立学科,无疑应有其特定的研究任务及发展方向,本文拟就此探讨如下。 一、广泛发掘历代医家的各种学说 目前已有的四个版次的教材虽然已就历代著名医家的学术思想和学术成就作了介绍,但其所涉医家非但涉及面不广,而且已介绍的医家所倡导的学说发掘也不全面,因此需要从以下三个方面进一步     

Physician supply and distribution in Georgia

Physician supply in Georgia must be considered an urgent issue. Several important points must be recognized and addressed. The lowest physicians rates are in the more rural county population groupings. The only county population grouping with a surplus of physicians is in the over 150,000 population. The majority of physicians are concentrated in the metropolitan counties. Sixteen percent of all physicians practice in the 134 counties having less than 50,000 population. The majority of physicians are in primary care specialties. Family practice is the most dominant specialty in rural areas. By the year 2000, Georgia can expect to add 5,600 physicians due to growth. By the year 2000, Georgia can expect to lose 2,600 physicians due to retirement. Family practitioners are the most uniformly distributed of the specialties examined. They are also the specialty most needed. The average age of Georgia physicians is 46. General surgeons are in the oldest average age group (50), whereas internists are in the youngest (44). Older physicians are concentrated in the more rural areas. A significant number of all physicians are over age 55. The majority of these will be retired by the year 2000. Physicians over age 65 represent 9.2% of all physicians from the survey. In Georgia, 13.6% of all physicians were Foreign Medical School Graduates. They tend to locate their practices in medically underserved areas. The specialty choices most frequently favored by FMGs are: pediatrics, internal medicine, family practice, and obstetrics/gynecology. A total of 71.2% of all physicians accept Medicare patients; 83.8% accept Medicare patients. Ninety-two percent of all obstetricians accept obstetric patients, but this participation is threatened by problems with malpractice insurance.     

论全科医生的职业教育与培养

全科医生是全科医疗的主要执行者,大力培养全科医生是我国现有卫生服务体系的迫切需要。为了培养以全科医学为核心的专业化的全科医生,做好职业规划引导是前提,加强职业道德教育是保障,加强职业能力培养是核心。     

门诊病人满意度的若干影响因素分析

目的分析影响门诊病人满意度的因素.方法对已就诊的病人是否选择医生、未选医生的原因、对医生的满意度、对医院的满意度及对医院不满意的问题进行问卷调查.结果选择医生就诊病人的满意度明显高于非选医生组的病人;不同职称医生和不同级别的医院对满意度的影响不明显;医务人员解释简单和服务态度差是影响满意度的主要因素.结论确保医生对每一病人的诊疗时间,提高服务态度是提高门诊病人对医院满意度的关键.     

Hepatitis C, diagnosis and management: a survey of practicing physicians in Hawaii

We surveyed 652 Hawaii physicians who diagnosed hepatitis C (HCV) since 1997. Less than 20% of licensed physicians have diagnosed HCV and initial estimates suggest there are 12,000 to 18,000 undiagnosed HCV cases in Hawaii. Treatment is concentrated among twelve physicians and aggressive case finding may overwhelm present resources. More primary care physicians need to participate in the detection and management of HCV.     

上海地区内科医师哮喘知识问卷调查

目的词查上海地区的内科医师对支气管哮喘发病机制、病情分级及相应的诊疗手段的掌握情况。方法通过上海市医学会哮喘组和上海市哮喘之家分发问卷至各组员单位,由参加门、急诊工作的一线医师进行填写。问卷按答题者所在科室、职称、行医年限进行分类统计。结果共124名来自本市10所二、三级医院的临床一线医师参与了问卷回答。在对全球哮喘防治创议（GINA）方案的理解和贯彻方面总体认识情况良好,对轻度持续型哮喘的分级治疗方面还有待于进一步提高,且职称为主治以上的医师在这方面认识相对较好,三级医院中对正确病情监测的概念比二级医院好。专科医师的总体认识优于普通内科医师。临床哮喘药物的使用情况方面掌握情况良好,对长效胁激动剂和白三烯受体拮抗剂的使用总体情况不容乐观,普通内科医师与专科医师存在一定差异。较新的制剂和装置即都保和准纳器的使用情况还有待于进一步改善。在有关GINA目标与困难的相关问题中。中国医师对于哮喘造成的呼吸功能障碍、哮喘症状及因此导致的生活质量下降的担忧和关注最显著,相对而言,对于哮喘住院和急诊率及药物不良反应的担忧减轻。结论加强对医师的教育工作及更广泛地推广新型药物和制刺,可能成为今后的工作重点。     

北京地区三级甲等医院急诊医师与门诊医师生存质量研究

为了了解北京地区三级甲等医院急诊医师与门诊医师的生存质量，在北京5家三级甲等医院中随机选取门、急诊医师160人，使用36条目简明量表（SF-36）进行测试，并与常规标准比较。结果显示门诊医师在精神健康项目得分较标准得分差异有统计学意义（P〈0．01）。急诊医师在一般健康状况项目得分较标准得分差异有统计学意义（P〈0．05），在精力、社会功能和精神健康项目得分较标准得分差异有统计学意义（P〈0．01）。急诊医师在一般健康状况、精力、社会功能和精神健康项目得分较门诊医师得分差异有统计学意义（P〈0．01）。可见门诊医师的生存质量明显好于急诊医师。急诊医师未处于健康状态。     

Resolving the gatekeeper conundrum: what patients value in primary care and referrals to specialists.

CONTEXT: Few data are available regarding how patients view the role of primary care physicians as "gatekeepers" in managed care systems. OBJECTIVE: To determine the extent to which patients value the role of their primary care physicians as first-contact care providers and coordinators of referrals, whether patients perceive that their primary care physicians impede access to specialists, and whether problems in gaining access to specialists are associated with a reduction in patients' trust and confidence in their primary care physicians. DESIGN, SETTING, AND PATIENTS: Cross-sectional survey mailed in the fall of 1997 to 12707 adult patients who were members of managed care plans and received care from 10 large physician groups in California. The response rate among eligible patients was 71%. A total of 7718 patients (mean age, 66.7 years; 32 % female) were eligible for analysis. MAIN OUTCOME MEASURES: Questionnaire items addressed 3 main topics: (1) patient attitudes toward the first-contact and coordinating role of their primary care physicians, (2) patients' ratings of their primary care physicians (trust and confidence in and satisfaction with), and (3) patient perceptions of barriers to specialty referrals. Referral barriers were analyzed as predictors of patients' ratings of their physicians. RESULTS: Almost all patients valued the role of a primary care physician as a source of first-contact care (94%) and coordinator of referrals (89%). Depending on the specific medical problem, 75% to 91% of patients preferred to seek care initially from their primary care physicians rather than specialists. Twenty-three percent reported that their primary care physicians or medical groups interfered with their ability to see specialists. Patients who had difficulty obtaining referrals were more likely to report low trust (adjusted odds ratio [OR], 2.7; 95% confidence interval [CI], 2.1-3.5), low confidence (OR, 2.2; 95% CI, 1.6-2.9), and low satisfaction (OR, 3.3; 95% CI, 2.6-4.2) with their primary care physicians. CONCLUSIONS: Patients value the first-contact and coordinating role of primary care physicians. However, managed care policies that emphasize primary care physicians as gatekeepers impeding access to specialists undermine patients' trust and confidence in their primary care physicians.     

Utilization of sigmoidoscopy by family physicians in Canada.

OBJECTIVE: To determine the extent to which sigmoidoscopy is used as an investigative tool by family physicians in Canada. DESIGN: Retrospective study of data from provincial and territorial health agencies for the fiscal year 1989. SETTING: Canada. PARTICIPANTS: All family physicians. MAIN OUTCOME MEASURES: Number of physicians in each province and territory who performed sigmoidoscopy (flexible and rigid), type of physician (generalist or specialist), number of procedures performed, fee schedule and number of physicians billing medicare in each province and territory. RESULTS: During the study period 3849 (15.1%) of all family physicians performed rigid sigmoidoscopy; the proportion varied from 3.4% (in Quebec) to 40.0% (in the Northwest Territories). A total of 43,914 rigid sigmoidoscopies were performed by family physicians, representing 23% of all such procedures. Flexible sigmoidoscopy was performed by 381 (1.5%) of all family physicians; the proportion varied from 0.4% (in Quebec) to 6.8% (in Prince Edward Island). A total of 5361 flexible sigmoidoscopies were performed, representing 6.0% of all such procedures. CONCLUSION: The proportion of Canadian family physicians who are using sigmoidoscopy, rigid or flexible, as a diagnostic tool is low.