以循证医学为纲,在外科见习中开展PBL教学

循证医学和PBL两者的基础都是从最初的问题开始进行延伸。无论是诊断还是治疗,医疗决策中引发的问题是两者解决的根本。在外科见习教学中以PBL教学方法为基础,辅以循证医学的理念,能够充分满足和锻炼学生循证医学技能的要求,激发学生主动学习的积极性,有助于培养学生学习外科学的临床思维。     

澳大利亚John Murtagh全科病案研究(二十二)——画在纸上的噩梦

全科医生看到的是患者和症状，专科医生看到的是器官和病灶。Murtagh教授在这个案例中告诉我们，全科医生要把目光从面前的患者身外再看远一些，要关注患者的家庭和社会环境。从一个患儿的噩梦中，作者注意到了家庭发展史、移民家庭特征、家庭关系、出生次序等对患儿心理和行为的影响。同时，作者介绍了在全科医学服务中使用面质、画梦、心理辅导、组织患者与家庭成员讨论等心理学服务技术。     

Acknowledging the weather-health link.

The impact of weather on health is generally overlooked by physicians. Possible reasons for this include lack of training and insufficient awareness of the significant body of research on human biometeorology. The authors argue that, in the absence of clearly demonstrable causal connections, statistical associations between weather phenomena and health problems should be enough to influence clinical practice. Physicians in Germany make use of daily bulletins from the national weather service to advise patients on the management of common health problems that seem to be exacerbated by certain weather conditions. The authors urge Canadian doctors to follow the lead of their European colleagues by increasing their awareness of the relation between weather and health.     

独生与非独生子女家庭环境量表调查对照研究

目的：为评价我国独生子女家庭环境积累资料．方法：应用家庭环境量表中文版（FES－CV）第三次修订本，对临沂市某中学四个不同年级的四个班中282名学生进行了家庭环境调查，将其中84名独生子女及随机抽取85份非独生子女有效问卷的调查结果比较分析．结果：独生子女组的亲密度、情感表达、独立性、知识性、娱乐性5因子分显著低于中国常模；独立性和成功性两因子分显著低于非独生子女组。独生子女组中，家长共同主持家政者的控制性因子分显著低于一人主持家政者；父母高文化组的独立性和知识性两因子分显著高于父母低文化组的家庭．结论：所测区域范围内现行的独生子女家庭环境有待改善，中国常模也应进一步扩大样本和区域范围．     

Diabetic microvasculopathy: the renal-retinal link

Manifestations of diabetic microvasculopathy are protean. Graded increases in the severity are recognised in both nephropathy and retinopathy. This study was undertaken with 100 patients of type 2 diabetes mellitus to evaluate how far these graded increments could be linked at each stage and in each patient. The renal parameters studied were the various accepted levels of albuminuria; the retinopathy parameters ranged from normal retina to severe proliferative stages. Corresponding grades were proposed and altered, if required, to reach the best possible correlation. The correlation was attempted though the common link of mean glomerular filtation rates at each level and the concordance of either parameter grade in an individual patient. The correlations of the mean glomerular filtration rate for all propositions of severity were significant. However, there was significant variability of the parameters in an individual patient. This was more with less severe grades but diminished with increased duration. The predictive value of one lesion for the other was low in cases with shorter duration and less severe grades. Probably, shorter duration patients have an interplay of both genetic factors and the assault of the risk factors while in longer duration patients the cumulative risk exposure play the dominant role.     

"以症状为主线,以问题为中心"教学新模式的实践与探索

为了主动适应培养全面素质型人才的教育目标，我院在临床医学本科97年级和98年级学员中进行“以症状为主线，以问题为中心、以大纲为基础、以案例为引导”新教学模式的实践探索；调整了课程内容与结构，重视能力培养．突出素质教育；建立教学规范化体系，完善教学安排，配套教学材料；尝试研讨式教学方法，推行启发诱导．激发学员能动性，收到了明显效果。     

Only the best: medical student selection in Australia

Selection processes for medical schools need to be unbiased, valid, and psychometrically reliable, as well as evidence-based and transparent to all stakeholders. A range of academic and non-academic criteria are used for selection, including matriculation scores, aptitude tests and interviews. Research into selection is fraught with methodological difficulties; however, it shows positive benefits for structured selection processes. Pretest coaching and "faking good" are potential limitations of current selection procedures. Developments in medical school selection include the use of personality tests, centralised selection centres and programs to increase participation by socially disadvantaged students.     

Excess demand meets excess supply as referral companies link Canadian patients, US hospitals

As waiting lists turn "touching it out" into a treatment option in Canada, more patients are willingly paying for prompt medical care in the US. Thanks to managed care and increased competition, the cost of care south of the border is dropping and referral brokers can often offer discounted prices to Canadians. Milan Korcok reports that American facilities are actively soliciting medical business from Canadians who have grown frustrated at having to wait for hospital beds, test, referrals and treatment.     

Successful Thalamotomy Using External Markers Only

The correlation between target centres for thalamotomy as determined by external markers or by the use of air studies was shown to be extremely close in eight patients undergoing pneumoencephalography. The site of the external markers was calculated in relation to the auriculoorbital and interaural planes, and a simple guide to aid in the placement of the markers was devised. Two cases are reported, one of parkinsonism and one of multiple sclerosis with intention tremor, in whom thalamotomy was carried out using external markers only. In both cases an excellent result was achieved. The value of this new method lies in the elimination of pneumoencephalography, the most unpleasant part of the operation of thalamotomy for movement disorders.