全科医学社区实习基地的建设

1999年 1 2月卫生部在北京召开了全国全科医学教育工作会议 ,明确指出毕业后全科医师规范化培训是我国全科医学教育的核心 ,住院医师培训是我国培养全科医师的主要途径 ,并同时颁发了《全科医师岗位培训大纲》和《全科医师规范化培训大纲》。此后 ,根据有关文件的精神 ,北京、浙江等地开始招收本科毕业生参加为期 4年的全科医学住院医师训练 ,同时也招收在职基层医生参加全科医学转型培训。要培养全科医师首先要做好宣传动员工作 ,让医学生和医务人员充分了解全科医师的特征和作用 ,吸引他们积极参加全科医学住院医师培训。其次 ,要做好全科…     

全科医学与家庭医学

继 198 9与 1993年两度在北京举行的国际全科医学研讨会之后 ,1999年 3月 6～ 11日在台北市召开了海峡两岸家庭医学 /全科医学学术研讨会 ,台湾地区出席会议代表 12 0 0人 ,大陆地区出席会议代表 6 2人 ,这次会议有力地推动了我国全科医学的发展 ,促进了我国医疗改革的深化进行。从全科医学到家庭医学 [1 ]全科医学 (General　 Practice)在欧洲已有数百年的历史 ,历来居欧洲医疗体系的主导地位 ,目前英国有 90 %以上的人口实行全民健康保险制度 ,推行全科医学和全科医师制度 ,在本世纪初 ,美国的全科医师制度还位居医疗体系的主体部分 ,191…     

全科医学教育的现状与展望

全科医学是一门以初级卫生保健和社区医疗服务为目的的医学专科,经过多年的发展,全科医学逐渐形成了整体的医学观,现代的医学服务模式,独特的医疗方法、服务内容与艺术,为社区居民提供连续性、综合性和个体化的医疗服务．全科医生是全科医疗服务的提供者,全科医疗是以解决社区常见健康问题为主要目的的基础医疗服务．我国自2000年开始启动全科医师规范化培训和岗位培训,至今已形成以高等医学院校的全科医学知识教育,全科医师规范化培训为重点的临床医学专业毕业后医学教育,以及全科医师岗位培训所构成的我国全科医学的培养模式．     

中国和澳大利亚全科医学体系的比较与启示

目的 通过实地考察澳大利亚全科医学体系的实际情况,并与国内全科医学现状进行比较,为我国全科医学的发展提出了新的理念和措施,以期发挥借鉴和参考作用。 方法 派遣一名全科医学的在读硕士及一名已参加社区卫生服务工作的全科规范化培养已毕业学员,在澳大利亚悉尼大学参加为期7周的全科医学强化学习和实地考察,内容包括参加全科学术讲座、澳大利亚皇家全科医师协会参观、全科医学诊所见习、参观综合医院及护理院、参观医学生全科专业课程及考核等方式,比较分析澳大利亚和中国全科医学体系的异同。 结果 中国和澳大利亚全科医学在分级诊疗中扮演的角色、全科医学人才培养模式、全科医师自我认同、晋升途径及相关职业考核制度等方面存在差异。 结论 在我国目前全科医学发展的基础上,进一步完善转诊的程序、加强全科医师与专科医师之间的联系、加强全科医师与养老院之间的合作、增加综合医院全科门诊的比重、在临床专业本科期间开始全科医学专业课程、加强医患沟通能力的培养、学习并借鉴澳大利亚全科的诊疗思维、丰富课堂及见习中的教学模式、科学调整医疗保险考核的指标、优化医师晋升制度、鼓励全科医师参与合作型科研计划、进一步推进多点执业、鼓励优秀医师主动选择全科医学专业方向。      

我国全科医学教育培训现状与思考

20世纪80年代末,全科医学的概念正式引入中国。从2世纪90年代初开始,全国一些省市开始进行全科医学的传播及全科医疗的试点和研究工作,但是缺乏规范和统一管理1997年《中共中央、国务院关于卫生改革与发展的决定》做出了“加快发展全科医学,培养全科医生”的重要决策1998年卫生部等10部委下发了《关于发展城市社区卫生服务的若干意见》,1999年召开全国全科医学教育工作会议,下发了《卫生部关于发展全科医学教育的意见》,出台了《全科医师规范化培训大纲》和《全科医师岗位培训大纲》,对全科医学教育的目标、发展原则、措施和培训标准等要求…     

关于发展全科医学教育社会认同问题的思考

从提高全科医学社会认同的角度,探讨在中国发展全科医学教育所面临的问题,并提出改进建议。作者认为,全科医学教育在中国发展缓慢,与社会对全科医学的认同度不够有很大关系。应着力加强就发展全科医学对我国医疗资源节约,医疗服务系统效率提高意义的宣传,增加政府对全科医学的认同和支持;应加快在三级医院建立全科医学科及对全科医师采用与专科医学一致的晋升和考核体系,以实现医学界对全科医学的真正接纳;应营造多元化的学习环境和学习方式,加强全科医学专业知识继续教育支持系统的建设,提高全科医师的服务水平以赢得民众的认同和信赖;应注重社会责任感的培养以实现全科医师的自我认同。只有社会认同度的提高,全科医学教育才能走上良性循环和快速发展的快车道。     

日本全科医学教育及其医疗服务现状研究

目的 探索与我国社区卫生服务发展相适应的、以能力为本的全科医学住院医师培训实施方案.方法 采用文献研究、实地调研和访谈法,研究国内外全科医学住院医师的培训现状和需求.结果 本研究依据全科医学基本原则、特征和社区全科医师工作要求提出我国社区全科医师的核心能力要求.另外,本研究还制订了由9个培训模块构成的、以能力为本的全科医学住院医师培训实施方案.结论 本实施方案适合我国社区卫生服务发展.鉴于我国全科医学住院医师培训工作仍处于试点阶段,以能力为本的住院医师培训实施方案有助于提高培训质量,为逐步建立和完善全科医学住院医师培训制度提供参考.     

广东省全科医学岗位培训现状

自1996年广东省开展了全科医学岗位培训的探索与实践，广州市、深圳市和佛山市试点工作走在全国前列。截至2005年底，广东省已累计开展了全科医学岗位培训60期，培训全科医师5165名，参加省内全科医学岗位培训统考通过率达90％以上。广东省全科医学岗位培训的实践对全国全科医学岗位培训有一定的借鉴意义，     

全科医学教育如何实现可持续发展

为使全科医学教育实现可持续发展,必须建立起全科医学教育的可持续发展运行机制.充分认识全科医学教育的作用和地位,是持久发展的动力;依托高等学校办学,发挥高校优势是加速全科教育发展的关键;加强全科医学课程建设,促进学科自身发展,是全科医学教育的生长点;精心营造全科医学教育支持环境,制定相关配套政策,加大宣传力度,纠正社会对全科医学和全科医师的偏见,是全科医学教育可持续发展的保障.     

全科医学住院医师培训实施方案的探索与实践

目的 探索与我国社区卫生服务发展相适应的、以能力为本的全科医学住院医师培训实施方案.方法 采用文献研究、实地调研和访谈法,研究国内外全科医学住院医师的培训现状和需求.结果 本研究依据全科医学基本原则、特征和社区全科医师工作要求提出我国社区全科医师的核心能力要求.另外,本研究还制订了由9个培训模块构成的、以能力为本的全科医学住院医师培训实施方案.结论 本实施方案适合我国社区卫生服务发展.鉴于我国全科医学住院医师培训工作仍处于试点阶段,以能力为本的住院医师培训实施方案有助于提高培训质量,为逐步建立和完善全科医学住院医师培训制度提供参考.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.