Homophobia among psychiatric residents, family practice residents and psychiatric faculty.

As the number of AIDS cases has continued to increase, psychiatric research has focused on the victims of this disease. Little has been written about the caregivers and the impact that their attitudes have on patients. There have been a few studies measuring attitudes of health care providers to homosexuals and AIDS patients, but to the best of our knowledge, none have looked at the attitudes of psychiatrists or residents in psychiatry. Psychiatric residents, family practice residents and psychiatric faculty in a medium-sized Canadian medical school completed a questionnaire measuring attitudes toward homosexuals. We report on the results of this questionnaire and comment on the impact of the attitudes of health care professionals on the quality of patient care.     

A survey of undergraduate teaching of clinical neurology in the United Kingdom 1990.

A comprehensive questionnaire survey of undergraduate teaching of clinical neurology in the United Kingdom has demonstrated the following points. Eight of the 28 medical schools do not provide a clinical attachment for all students. Clinical attachments tend to be either full time for four weeks or part time for six weeks. Students' exposure to sufficient patients with the common neurological conditions, with chronic neurological disability and particularly with acute neurological emergencies, is often deficient. Clinically based teaching, in the ward and clinic, remains highly valued. Neurological teaching tends to fail in schools where the ratio of clinical students to neurology consultants is greater than 28:1.     

神经内科脑卒中单元的临床教学实践

脑血管病具有高发病率、高复发率、高致残率和高病死率的特点,日益威胁人民健康,已成为我国城乡居民死亡第一病因。脑血管病作为医院神经科病房中最为常见的疾病之一,已经成为神经病学临床的必修课。因此,脑血管病的教学应在神经病学教学工作中占主要的地位。目前,脑血管病患者的救治主要在卒中单元中进行,卒中单元是为患者提供多学科联合服务的治疗平台,它的发展使得脑卒中的治疗科学化、系统化,由此卒中单元的临床教学也应该形成系统化的独特模式。     

神经内科住院医师规范化培训存在的问题与教学 改进

住院医师是医院人才梯队建设的基础,合理地安排培训工作,提高青年医师综合素质,对 培养高层次医学人才至关重要。宣武医院作为北京市首批神经内科住院医师规范化培训基地,近5年已 为社会培育出120名住院医师,取得北京市住院医师规范化培训合格证书。以宣武医院神经内科近5年 培训实践为例,探讨神经内科规范化培训的现状和管理实践,为持续改进培训工作提供参考。     

网络与实践相结合模式在神经内科教学中的应用

目的 探讨血浆β-淀粉样蛋白40（Aβ40）、Aβ42 及磷酸化tau 蛋白（p-tau）对老年广泛性脑 萎缩（GBA）的诊断价值及与认知功能的相关性。方法 回顾性选取2018 年5 月至2019 年1 月湖北省荆 门市第二人民医院神经内科收治的125 例老年GBA 患者,根据是否合并认知功能障碍（CFI）分为GBACFI 组57 例与GBA-NCFI 组68 例,另选取130 名体检健康者为对照组,测定所有研究对象血浆Aβ40、 Aβ42 及p-tau 水平,根据简易智力状态检查量表（MMSE）将GBA-CFI 组分为重度CFI 组（≤ 9 分,n=14）、 中度CFI 组（10～20 分,n=19）、轻度CFI 组（≥ 21 分,n=24）,分析血浆Aβ40、Aβ42 及p-tau 水平与老年 GBA 患者CFI 的关系及对老年GBA 合并CFI 的诊断价值。采用Pearson 相关分析Aβ40、Aβ42 与p-tau 水 平的相关性,采用多因素Logistic 回归分析老年GBA 患者CFI 的影响因素。采用受试者工作特征（ROC） 曲线分析Aβ40、Aβ42 及p-tau 水平对老年GBA 合并CFI 的诊断价值。结果 GBA-CFI 组血浆Aβ40、 Aβ42、p-tau 水平明显高于GBA-NCFI 组、对照组［分别为（910.33±275.76）μg/L 比（798.28±272.73）、 （667.10±240.63）μg/L,（89.81±18.32）μg/L 比（69.39±14.39）、（47.84±14.88）μg/L,（80.21±18.89）ng/L 比（58.84±16.20）、（21.52±10.53）ng/L;均P ＜ 0.05］,GBA-NCFI 组血浆Aβ40、Aβ42、p-tau 水平明显高 于对照组（均P＜0.05）。GBA-CFI组CFI患者血浆Aβ40、Aβ42、p-tau水平随着CFI加重而提升［ 重 度、中度、轻度分别为：（1134.21±162.20）、（950.97±247.72）、（747.56±250.47）μg/L;（107.71±8.92）、 （95.79±12.28）、（74.62±13.73）μg/L;（104.71±8.21）、（84.52±5.07）、（62.51±10.14）ng/L;均P ＜ 0.05］。 Pearson相关性分析显示,GBA-CFI组血浆Aβ40、Aβ42与p-tau水平呈正相关（r=0.715、0.655,均P＜0.05）。 多因素Logistic回归分析结果显示,高水平Aβ4（0 OR=1.653,95%CI：1.186～2.302）、Aβ4（2 OR=1.064, 95%CI：1.027～1.103）、p-tau（OR=1.080,95%CI：1.040～1.121）为老年GBA 患者CFI 发生的危险因素（均 P ＜ 0.05）。ROC 曲线分析结果显示,血浆Aβ40+Aβ42+p-tau 水平诊断老年GBA 的曲线下面积（AUC） 明显大于Aβ40、Aβ42、p-tau 单独诊断（均P＜ 0.05）,敏感度、特异度、准确度也较Aβ40、Aβ42、p-tau 单 独诊断增加。结论 老年GBA 患者血浆Aβ40、Aβ42、p-tau水平明显提升,与CFI发生密切相关,联合 检测能提升老年GBA 诊断价值。     

Trends in psychiatric practice, 1965-1980

The authors compare the results of a study of the practice activities of psychiatrists conducted in 1979-1980 with one conducted in 1965. Although office-based practice has remained the core activity of the profession, psychiatrists in 1979 had a greater tendency to divide their time among multiple practice sites and activities during the work week. As a consequence, the percentage of practitioners working part-time in a variety of organized care settings has increased substantially. These findings support a view of psychiatry as a profession that is far more diversified than it was 15 years ago. The authors discuss major factors affecting trends in psychiatric practice.     

Trends in the prevalence of cerebral palsy in Northern Ireland, 1981-1997

We describe trends in the prevalence of cerebral palsy (CP) by birthweight group, and in the severity of motor impairments and presence of associated intellectual impairment, in Northern Ireland from 1981 to 1997 (n=909; 510 males, 399 females; total population 415,936 live births) using data from a population-based register of CP. Children with suspected CP or who died before 1 year of age and those with CP of postneonatal origin were excluded. Prevalence of CP was 2.2 per 1,000 live births without significant change over time. Among very-low-birthweight (<1,500 g) live births, prevalence was 44.5 per 1,000 (95% confidence interval 32.3-59.8) from 1994 to 1997, with evidence of a statistically significant decline in prevalence since the mid- to late 1980s accompanied by a decrease in the severity of motor impairment and likelihood of intellectual impairment. Among moderately-low-birthweight (1,500-2,499 g) children there was weaker evidence of a peak prevalence in the late 1980s. Prevalence among normal-birthweight infants did not change significantly, but outcome in terms of severity of motor impairment and intellectual impairment improved in the 1990s. Occurrence of bilateral spasticity from 1994 to 1997 was associated with greater severity and likelihood of intellectual impairment for normal-birthweight individuals than for low- or very-low-birthweight individuals.     

Cerebral palsy in Malta 1981 to 1990

Of 55200 Maltese children born in the Mediterranean islands of Malta and Gozo in the birth years 1981 to 1990 inclusive, 134 fitted the case definition of cerebral palsy (CP). Children were allocated to prenatal, perinatal, and postnatal groups according to strict criteria and to various CP syndromes using the Swedish classification. The study was undertaken between 1994 and 1996 and the period prevalence rate was calculated. The control group comprised 134 children who were matched for sex and born immediately before or after the index subjects in the same hospital. Data related to risk factors were extracted from medical records and collected by interview with parents/carers. Unadjusted odds ratios (OR) with 95% confidence intervals for a range of risk factors were calculated. For risk factors with a relatively high prevalence in the population, such as prematurity and low birthweight, ORs were calculated from case-control data. For low-prevalence risk factors, such as breech presentation and multiple pregnancy, ORs were calculated against the whole population data for the 10-year birth cohort. The prevalence rate of CP in the geographically defined, stable population of the Maltese islands was similar to that in the UK and higher than that for Sweden, but the rates for different types of CP were markedly different from most developed countries, with a higher rate of spastic tetraplegias. Risk factors were as expected and similar to those reported from other developed countries. The study shows a strong social gradient with a higher than expected proportion of CP in children of unskilled manual workers.     

基于以问题为导向的复杂病例推理的中西医结合临床带教实践

临床带教不应是一种固定的、封闭的模式,其教学指导思想应当是开放的,通过不断吸收新的教学经验,从而不断地充实和发展。基于以问题为导向的教学(problem-based learning,PBL)方法,建立复杂病例推理的临床带教模式,并应用于中医神经内科学疾病的临床教学中,可以改进临床带教方法,丰富带教手段,提高教学质量。在带教过程中,带教老师针对神经内科复杂疾病和疑难疾病的隐蔽性及推理性,指导学生发现患者病史和体征中隐藏的蛛丝马迹以及实验室检查的微小异常,这些都可能成为诊断的关键点。通过PBL,不仅推广了中西医结合诊治神经内科疾病的理念,而且提高了辨病与辨证相结合的中西医结合诊治神经内科疾病的水平。     

PBL在神经内科见习教学中的应用

以问题为基础的学习(PBL)是基于临床问题为基础、以学生为中心的教学方式.探讨PBL教学法在神经内科见习教学中的应用,分析了PBL教学在神经内科见习课中的优越性及存在问题.期望在神经内科见习教学中拓宽思路,寻找适合于医学生进入临床初期阶段培养的方法,以提高临床教学质量,达到培养高级医学人才的目的.     

Management vs. interpretation: teaching residents to listen

It is possible to teach residents to listen psychodynamically within pressured clinical systems that are organized around brief management interventions without changing the structure of the training program to create "selected psychotherapy cases." Two case vignettes illustrate the amount of psychodynamic data that can be elicited from a time-limited clinical assessment. Focusing on the psychodynamics of social systems and the subtle ways in which patients and clinicians become involved with each other during assessment meetings can allow trainees to grasp unconscious functioning, projective identification, transference/countertransference, and interpretation. This perspective opens a way of thinking that illuminates the patient's struggles, reduces the need for management by helping the patient take charge of his or her treatment, and opens possibilities for both patient and trainee to improve their capacity to listen, both to themselves and to the human systems that surround them.