中国神经外科住院医师规范化培训计划(建议案)

神经外科住院医师培训计划是神经外科医师成长的必由之路，也是改变我国目前专科医师培训混乱状况的有效方法。我们提出神经外科住院医师培训计划建议案，供同行专家参考，并期待能一同为该计划付诸实施而努力。本建议案是依据我国目前的医学教育体制制定的为期5～6年的住院医师逐步成长计划，希望能对我国神经外科医师的规范化培训有所帮助。     

Developing a neurology training program in Honduras: a joint project of neurologists in Honduras and the World Federation of Neurology

One of the major barriers to the provision of quality care for patients with neurological disorders in developing countries is a low ratio of neurologists per inhabitants, the World Health Organization recommends one neurologist per 100,000. In 1998 Honduras had one neurologist per 325,000 inhabitants and all the neurologists were trained outside the country. The Education Committee of the World Federation of Neurology (WFN), in collaboration with the Postgraduate Direction of the National Autonomous University of Honduras, the Honduran Neurological Association, and the Honduran Secretary of Health helped establish the country's first Neurology Training Program in 1998. This program was established using a problem- and epidemiological-oriented methodology with oversight by an external WFN review board. By 2006 the program has resulted in a 31% increase in the national neurologist ratio per inhabitant, significantly improved the quality of patient care and promoted research in the neurosciences. The Honduras Neurology Training Program has provided a valuable model for other developing countries with similar needs for neurological care. Based on this Honduras experience, members of the Education Committee of the WFN have established guidelines for neurology training programs in developing countries.     

Planning for the future in psychiatric training: The place of the chronic care program

The challenge of chronic illness faced by the field of psychiatry presents the profession with an opportunity to grow and reformulate its perspectives. This challenge is at the interface of training, clinical care, and scientific investigation. It is at the level of the community based system that the needs of each sphere can be addressed. It is incumbent upon the profession to mold scientific rigor into our training programs. For the psychiatrist of tomorrow it will no longer be sufficient to be just a first rate clinician. He must also be a well educated person, broadly informed on social and cultural issues. He must have a serious respect for knowledge and the process by which it is achieved. He must be well read and conversant with the pertinent literature of the profession. The must be able to objectively assess patients, data and differential outcomes of treatment with an awareness of unresolved issues, an openness of mind and a willingness to experiment and to modify therapeutic approaches. Lastly, the resident should be able to enter the profession with an awareness that he is a link in a legacy of ever expanding horizons of knowledge, forming a continuity between past and future. His integrated skills as clinician and scientist are essential to the progressive understanding and treatment of psychiatric disorder.     

Neuroinflammation: a need to understand microglia as resident cells of the developing brain

Neuroinflammation and microglia as the resident immune cells of the brain has garnered a significant amount of interest with regards to brain injury and neurotoxicology. Much of this interest and research has been focused on responses in the adult brain with little attention paid to the role of these cells during development. The available data suggests that one must view microglia and their processes during development somewhat differently. In addition, modification to microglia during development may lay a framework for subtle to significant changes in the susceptibility of the mature brain to secondary insults. A number of these point are now being raised for consideration.     

Psychiatric resident dismissal: a national survey of training programs

The authors report on a nationwide survey of psychiatric residency training directors who responded to a questionnaire designed to elicit information on the magnitude of the problem of unacceptable performance by residents. One hundred six program directors reported on 5,591 internship or residency positions from 1981 to 1985. A total of 184 residents (3.3%) were prematurely terminated or persuaded to resign; departmental deliberations were held on an additional 139 residents (2.5%). Reasons for dismissal and indications during the selection process that a trainee might prove problematic are discussed. A provocative finding was that 37% of terminated residents were accepted into other psychiatry training programs.     

Letter to the Editor: Better evidence for safety and efficacy is needed before neurologists prescribe drugs for neuroenhancement to healthy people

Abstract

A patient (Case 1) with an unusual delusional misidentification syndrome (DMS), in the context of dementia and Parkinson's disease, is reported. Neuropsychological assessment revealed wide-ranging abnormalities in visual and facial processing. Semantic function, however, retained greater preservation. These findings support neuroanatomical evidence of increased right hemisphere pathology in DMS. Finally, classification of Case 1's DMS variant is discussed, with particular reference to a new categorizing system.     

Cognitive training in the elderly: a randomized trial to evaluate the efficacy of a self-administered cognitive training program

ABSTRACT

Objectives: To evaluate the efficacy of a self-administered cognitive training program for improving cognition in normal elderly persons.

Method: A multisite, randomized control, double-blind trial was conducted with 28 experimental participants (M_age = 70.7 ± 8.89) and 28 active controls (M_age = 74.4 ± 9.39). Treatment conditions: experimental intervention (EI) consisted of three modules: (1) executive functioning, (2) memory, and (3) emotion training. Active control (AC) consisted of word searches, reading short stories, and answering multiple-choice questions. Treatments were self-administered one hour/five days a week for four weeks. Pre-and post-training neuropsychological outcome measures were utilized as determinants of program success.

Results: Compared to the AC group, the EI group displayed significant gains on targeted executive (p = .002) and memory (p < .001) composites, but not the emotion (p = .105) composite. Training-induced benefits were also observed for the EI group on untrained items within global cognition (BCRS, p = .002) and functional abilities (DAD, p < .001; FRS, p = .042). The percentage of participants who showed reliable performance improvements was greater for the EI than AC on executive (55.5% vs. 12.5%), memory (55% vs. 19.5%) and functional (41% vs. 7.5%) ability. Participant recruitment and compliance rates were enhanced by the involvement of a physician.

Conclusion: Results support the efficacy of self-directed cognitive training in reliably improving cognitive and functional abilities in normal older adults. While physicians are critical in enhancing the delivery of regimented treatment, the present study illustrates the potential for self-directed prophylactic training in deterring the development of cognitive decline.     

Reminiscences of a training director and the future of training programs

Psychiatric education in the United States has undergone vast changes during the past 40 years, from a classical psychoanalytic model to an evidence-based neurobiological paradigm. Training standards, set by the Accreditation Council for Graduate Medial Education, have brought more scientific rigor to the training of young psychiatrists, but the danger of losing the psychotherapeutic skills provided in the past by long-term psychodynamic supervision is of concern to many psychiatric educators. A model for evaluating competence in psychodynamic psychiatry is discussed and postgraduate psychoanalytic training is encouraged.     

Better evidence for safety and efficacy is needed before neurologists prescribe drugs for neuroenhancement to healthy people

In this paper we question the guidance offered to neurologists by the Ethics, Law and Humanities Committee of the American Academy of Neurology (Larriviere, Williams, Rizzo & Bonnie, 2009) on how to respond to requests for "neuroenhancement": the use of pharmaceuticals to enhance cognitive function in cognitively normal people. The guidance assumes that the benefits of using neuroenhancers will prove to outweigh the risks in the absence of any evidence that this is the case. However, the principle of nonmaleficence dictates that the use of these drugs by healthy people should not be condoned before reliable evidence for their short and long term safety and efficacy is at hand. The proposed ethical framework for neuroenhancement prescribing also neglects the broader social implications of condoning such practices. The adoption of these guidelines by neurologists could have adverse social and medical effects that need to be more carefully considered.     

Residency training: challenges and opportunities in preparing trainees for the 21st century.

The future will see increased medicalization of psychiatry and will demand changes in training that better prepare residents for the realities of practice in a sustained period of physician shortage. Residency programs will need to move from the current apprenticeship model of training to competency-based programs built on the CanMEDS 2000 articulation of physician roles. Training will need to focus on evidence-based treatments, more efficient models of health care delivery, more attentive tracking of resident clinical work, and more reliable and standardized methods of evaluating resident competencies.     

一种组合式远程康复训练机器人的研制：适用性及其安全性

背景：国内对康复机器人的研究起步比较晚,辅助型康复机器人的研究相对较多,而康复训练机器人的研究相对较少,医工跨学科的结合有待加强,国内的康复器械远远不能满足市场对智能化、人机工程化的康复机器人的需求。 目的：针对国内康复专家少而患者较多这一问题,将遥操作机器人技术与康复医疗器械相结合,以期研制一种基于力反馈的组合式远程康复训练机器人系统。 方法：充分考虑到患者的安全性,采用磁流变阻尼器加上直流电机的模式,设计了一种组合式机械臂,将遥操作机器人技术应用于肢体残障者的康复训练,使患者可以根据康复治疗师的远程设定进行康复锻炼,并将虚拟现实技术与康复训练相结合,把枯燥的康复训练变成轻松有趣的游戏。 结果及结论：该系统的服务对象是上肢有运动障碍的患者,通过对机械臂的拆卸和组合,可给患者提供康复需要的不同训练模式和治疗方案;运用计算机网络技术可使患者根据康复医师的远程设定进行康复训练;身临其境的虚拟现实技术显著提高了康复训练的积极性与效果。实验结果表明,所研制的远程康复训练机器人系统具有良好的适用性和安全性。     

Restoration of competency to stand trial: a training program for persons with mental retardation

This article describes the development and use of a formal training tool for restoration of competency in clients with mental retardation who are incompetent to stand trial. The program was developed at Eleanor Slater Hospital within the Rhode Island Department of Mental Health, Retardation and Hospitals. This article describes the development of The Slater Method, the training tool format, the procedure for use of the Slater Method, and the duration of treatment to restore competency to stand trial in clients with mental retardation. Although the developmentally disabled population is not limited to persons with mental retardation, we have used the phrase mental retardation instead of developmentally disabled because the judicial system more commonly uses mental retardation.