军队研究型医院建设中全科医师培养工作的探索

研究型医院是军队医院管理的重大理论创新和实践创新,是全面建设现代卫勤的有机组成部分,既是长期的战略目标,又是紧迫的现实任务,而全科医师作为军队研究型医院的重要人才力量,对军队研究型医院建设有着重要的作用。本文结合建设军队研究型医院与全科医师培养工作,着重就促进军队研究型医院全科医师培养工作提出思考。     

全科医师培训中在线学习社区建设

全科医师规范化培训已经在我国逐步开展和完善,"互联网+"概念下的现代医学教育是全科医学教学的趋势.依据全科医学发展的趋势,在全科医学教学改革实践中率先在网络自主学习平台基础上升级完善在线学习社区,有助于提高全科医师培训的质量.介绍全科医师在线学习社区的优点和问题,并从教学形式、学习方法、网络自主学习、社交能力四个方面探讨,在线学习社区在全科医师培训中的建设与探索.     

《卫生化学》课程研究型教学方法与成效研究

摘要:目的 探讨研究型教学对本科学生《卫生化学》课程学习行为和成效的影响。方法 以医学高等教育预防医学专业《卫生化学》专业基础课程为例,采用准实验设计,分别进行传统讲授式教学和研究型教学,对2种教学实践的学习成效及行为进行比较。结果 研究型教学下有更好的学业成绩（t = 3.071,P ＜0.05）;有更多学习时间投入（t = 2.254,P ＜0.05）,更多合作学习时间（t = 5.845,P ＜0.05）;传统教学学生更多看教师PPT进行学习（t = 2.740,P ＜0.05）,研究型教学下学生更多使用老师推荐的课外网络学习资源（t = 2.960,P ＜0.05）;基础知识课后学习方式与传统教学的差异是更多与同学探讨（t = 5.510,P ＜0.05）或寻求帮助（t = 2.550,P ＜0.05）。结论 研究型教学对自主探究能力的培养与知识学习并不冲突,学生可以通过自主学习实现更佳的学习成效。研究型教学能够激发学生更多学习投入,自主进行扩展性知识探究,以及更多的合作学习。     

我国分级诊疗的现状及思考

通过分析当前分级诊疗发展态势提出改进建议,如改善医院环境、加强全科医师培养、促进医保无缝对接、改进信息平台建设等,最终实现区域内医疗资源共享和分级诊疗顺利推行。     

创建研究型医院的思考

本文总结医院按照创建"研究型医院"的先进理念和总体目标,以"研究型科室"建设和"研究型人才"培养为抓手,着力抓好"研究型医院"筹划和建设的经验和体会。     

基层全科医师培训实践探讨

<正>随着医疗知识和技术快速发展，全科医师需要不断学习和拓展医疗技能，才能跟上时代的步伐。近年来，针对实践教学不够规范、专业知识基础薄弱等问题，安徽省广德市中医院作为当地全科医师培训和实践基地，在政策指导下，对广德市部分基层全科医师进行定期培训和教育，取得了一定成效。笔者总结广德市中医院在全科医师培养方面的经验和做法，提出改进建议。     

全科医师医院感染相关知识及技能培养模式的探讨

目的探讨全科医师医院感染相关知识及技能培养模式的改革与创新,以期降低社区感染率。方法选取医院实习的全科医师作为研究对象,以2010年7月-2011年1月实习的189名全科医师为对照组,以2011年7月-2012年1月实习的195名全科医师作为观察组;对照组采取传统方式进行带教与培训,观察组采取自行设计符合卫生部全科医师培训要求的培养模式进行社区带教管理;对比两组考核结果,评估培养新模式的优劣并提出改进方法。结果对照组189名医师的综合实习成绩评定合格162名,合格率为80.4%,观察组195名医师合格183名,合格率为93.8%,组间比较差异有统计学意义(P<0.05);观察组全科医师实习后医院感染相关知识和技能得分分别为(92.1±7.5)分和(90.3±9.4)分,对照组分别为(84.4±9.3)分和(81.1±11.9)分;两组比较差异均有统计学意义(P<0.05);观察组全科医师对各项满意度调查其满意度均明显高于对照组(P<0.05)。结论采取自行设计符合卫生部全科医师培训要求的培养模式进行社区带教管理,全科医师考核成绩明显得到提高。     

综合性医院全科医学科建设与全科医师培训探讨

2016年，国家卫生计生委人事司继续举办全科医生师资培训班，并依托浙江大学医学院及其附属医院在全科医学方面的优势资源，借助浙江大学继续教育学院优良的培训平台，策划了一系列理论与实践相结合的精品全科医生师资培训课程。本刊特约授课专家，将“综合性医院全科医学科建设与全科医师培训”“、巴林特小组在全科医师中的运用”等精品课程形成文章，分享给读者。     

创新发展模式 提供精品服务——徐汇区斜土街道社区卫生服务中心介绍

徐汇区斜土街道社区卫生服务中心前身是创建于1937年的“伯达利产科医院”，2004年由原日晖医院（二级乙等）改制为社区卫生服务中心。目前是复旦大学护理学院及公共卫生学院教学基地、中华医学会健康管理学分会社区健康管理实习基地、上海市全科医师及中医类别全科医师培养社区实习基地。     

模拟诊疗培训在全科医师人文教育中的意义

生物-心理-社会医学模式对医疗服务和医患沟通提出了更高的要求。然而,令人遗憾的是,全科医师培训的学员在临床实践中缺乏独立接诊病人的机会,所以如何提高全科医师的医患沟通能力,在看病的同时注重"看人",是全科医师教育中值得关注和解决的问题。该文探讨了苏州市立医院作为国家卫生部(原)全科医师培养基地通过模拟诊疗培训,提升全科医师人文素质的做法与体会。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.