欢迎订阅《中华胃肠外科杂志》

中华胃肠外科杂志是由中国科协主管,中华医学会和中山医科大学共同主办的国内唯一的胃肠外科专业学术期刊.主要刊登胃肠外科和相关学科的基础理论、临床研究和实验研究成果与进展;以普通外科和胃肠外科以及相关专业的临床、科研、教学的高、中级医师为主要读者对象;办刊宗旨是全面系统地反映我国胃肠外科领域的学术动态和国内外最新进展,以促进我国胃肠外科的学科发展和学术交流.     

欢迎订阅《中华胃肠外科杂志》

中华胃肠外科杂志是由中国科协主管、中华医学会主办、中山医科大学承办的国内唯一的胃肠外科专业学术期刊。主要刊登胃肠外科和相关学科的基础理论、临床研究和实验研究成果与进展 ;以普通外科和胃肠外科以及相关专业的临床、科研、教学的高、中级医师为主要读者对象 ;办刊宗旨是全面系统地反映我国胃肠外科领域的学术动态和国内外最新进展 ,以促进我国胃肠外科的学科发展和学术交流。本刊为季刊 ,大 16开 ,6 4页 ,每季度末月 2 5日出版。每期定价 6 5 0元。邮发代号为 46 185。欢迎到当地邮局订阅。欢迎订阅《中华胃肠外科杂志》$中华胃…     

联合培养骨科专科医师的初步尝试

专科医师培养制度是世界发达国家和地区为培养专科医师而制定的一套规则和方法，其目的是培养能为社会提供安全可靠的专科服务的医生。我国医疗卫生改革中的一个重要方面即是逐步建立起适合我国国情的专科医师培养制度。我院通过与香港骨科医学院合作，在联合培养骨科专科医师方面进行了一系列有益的尝试，并取得了不错的成绩。     

青年医师健康发展相关因素的调查分析

目的找出影响青年医师健康成长相关因素,以创造更有利于青年医师健康发展的条件。方法采用问卷调查法,对柳州市区医院及周边县级医院临床第一线青年医师就职业态度、价值观取向、生活经济状况与政治需求、对医院及医师管理的参与意识四个方面做了详细的调查。结果青年医师健康发展受自身的职业态度、价值观取向、生活经济状况与政治需求和医院管理者的管理水平等多种因素的影响。结论探析青年医师健康发展的相关因素,以进行分阶段、有计划、定目标地系统培养,是培养21世纪新型医师人才的需要。     

“长城优秀青年医师奖”参评条件

“长城优秀青年医师奖”：长城会是中国心血管医生与国际交流的窗口,是专业研究、学术交流、培养青年专业医师和推出杰出人才的平台,如果您有独特的思维、精湛的研究、流畅的文笔,如果您是从事心血管领域或相关学科基础与临床工作的医师、研究人员及在职研究生,“长城优秀青年医师奖”就是您的舞台。     

“长城优秀青年医师奖”参评条件

“长城优秀青年医师奖”：长城会是中国心血管医生与国际交流的窗口,是专业研究、学术交流、培养青年专业医师和推出杰出人才的平台,如果您有独特的思维、精湛的研究、流畅的文笔,如果您是从事心血管领域或相关学科基础与临床工作的医师、研究人员及在职研究牛,“长城优秀青年医师奖”就是您的舞台。     

规范呼吸专科培养工作,完善专科医师培养制度

医学学科的发展有赖于人才的培养 ,说到底学科的竞争实质上是人才的竞争。从这个意义上讲 ,尽快规范呼吸专科医生的培养要求和方案是促进呼吸学科发展的最重要的基础工作 ,可以毫不夸张地说 ,今天的呼吸专科医生培养水平如何 ,则决定了今后我们呼吸学科发展的前途和命运。专科医师的培养是继住院医师培养、医师资格考试、临床医师继续教育法对临床医师进行深入培养的一项系统工程 ,有目标、有计划、有要求、有管理、有考核地将一名普通内科医师 ,培养成为一名基础扎实、知识面广、专业特点鲜明的呼吸专科医师 ,对于我国呼吸学科发展将产生极…     

医学教育学制学位与专科医师的培养

一、概况 专科医师培养属毕业后教育，是指临床医学专业本科以上毕业生完成医学院校教育后，在经过认可的培训基地中以住院医师的身份接受以提高临床能力为主的系统、规范的培训过程，使住院医师达到某一临床专科所需的基本理论、基本知识和基本技能要求，成为能独立从事某一专科临床医疗工作的专科医师。建立专科医师培训制度是医学科学发展和医学人才成长规律的必然要求，是适应我国加入WTO医学人才培养和管理与国际接轨的需要，使培养高素质、精医术医学人才，提高医疗服务水平的重要途径。     

对我国老年医学专科医师培养途径与模式的粗浅认识

随着我国进入老龄化社会,建立一支为之服务的老年医学医师队伍是保证老年人医疗健康服务的基础.但如何培养并建立起这支既能满足老年社会的基本医疗需求又能兼顾老年医学学科发展的队伍是摆在我们面前的重要任务.从内科高年住院医师中选拔高素质人才,进行现代老年医学相关专科培训,同时建立一支多学科老年医学临床工作团队,从临床上培养老年医学专科医师是一种可行的培养模式;另外建立导师制,从科研与个人职业发展方向两方面给予指导是培养高层次老年医学领军人才的可借鉴模式;将这些培养模式与社区医师培养相结合,使老年医学专科人才资源延伸到社区是快速培养我国老年医学医师队伍的可能方式.     

心外科住院医师规范化培训工作的难点及对策

<正>专科医师制度是国家卫生行政执法对医师的临床医疗活动进行规范管理的制度,该制度在欧美等发达国家已有100多年的历史,它使专科医师的培养更具科学性、规范性和系统性[1]目前,专科医师制度在我国尚处于试点阶段,其中专科医师培训是专科医师制度的重要组成部分[2],探讨     

Organization of future training in bariatric gastroenterology

A world-wide rise in the prevalence of obesity continues. This rise increases the occurrence of, risks of, and costs of treating obesity-related medical conditions. Diet and activity programs are largely inadequate for the long-term treatment of medically-complicated obesity. Physicians who deliver gastrointestinal care after completing traditional training programs, including gastroenterologists and general surgeons, are not uniformly trained in or familiar with available bariatric care. It is certain that gastrointestinal physicians will incorporate new endoscopic methods into their practice for the treatment of individuals with medically-complicated obesity, although the longterm impact of these endoscopic techniques remains under investigation. It is presently unclear whether gastrointestinal physicians will be able to provide or coordinate important allied services in bariatric surgery, endocrinology, nutrition, psychological evaluation and support, and social work. Obtaining longitudinal results examining the effectiveness of this ad hoc approach will likely be difficult, based on prior experience with other endoscopic measures, such as the adenoma detection rates from screening colonoscopy. As a longterm approach, development of a specific curriculum incorporating one year of subspecialty training in bariatrics to the present training of gastrointestinal fellows needs to be reconsidered. This approach should be facilitated by gastrointestinal trainees' prior residency training in subspecialties that provide care for individuals with medical complications of obesity, including endocrinology, cardiology, nephrology, and neurology. Such training could incorporate additional rotations with collaborating providers in bariatric surgery, nutrition, and psychiatry. Since such training would be provided in accredited programs, longitudinal studies could be developed to examine the potential impact on accepted measures of care, such as complication rates, outcomes, and costs, in individuals with medically-complicated obesity.     

Performance standards in bariatric surgery

A bariatric surgeon is a fully trained general or gastrointestinal surgeon who has demonstrated specialized knowledge in the management of patients who suffer from morbid obesity and its complications. In addition to appropriate formal surgical training, preceptorships with experienced surgeons, preferably members of international bariatric societies, are highly desirable. Active participation in meetings of these societies, continuing medical education and knowledge of the current literature are necessary to maintain the required skills to treat these complex patients. Bariatric surgery should be performed at institutions that provide the necessary equipment, facilities and support systems for this particular population. When analysing outcomes of obesity surgery, long-term weight loss reports should include the number of patients followed and the time period of follow-up. Complications and re-operations should be presented, as well as modifications of techniques when various operations are compared. Weight loss should not be the only criterion used to define success or failure. Objective assessment of improvement in medical conditions related to obesity, and reliable measurements of quality of life after surgery should also be included in the final outcome analysis.     

胃肠外科的发展趋势和面临的挑战

近年来,得益于医疗观念的更新和医疗器械、药物等相关领域的进步,胃肠外科取得了巨大的发展。在诊疗理念方面,胃肠外科正由专业化走向规范化和多学科团队协作模式。在诊疗技术方面,微创理念、分子生物学和数字技术得到了广泛的应用,并取得了良好的效果。然而随着自然和社会环境的变化,患者的人群特征和疾病谱也发生了显著的改变,这也成为当代胃肠外科必须应对的新挑战。     

Endoscopic biliopancreatic investigations and therapy

The management of most biliopancreatic diseases benefits from endoscopic treatment. Forty years after the first endoscopic cannulation of the ampulla of Vater, the overall effectiveness and safety of endoscopic retrograde cholangiopancreatography (ERCP) can be evaluated using the quality assurance programs that have recently been developed for gastrointestinal endoscopy, including ERCP. Such evaluation does not mean simply reporting therapeutic success and complication rates; rather, it involves a complex analysis of the entire gastrointestinal unit, of the medical practises, and of patient satisfaction. The overall quality of ERCP has been analysed and many quality deficits identified, even in referral centres. Training for such a specialised procedure is difficult and expensive. Competence in ERCP requires as many as 200 ERCP procedures. Quality assurance programs can help to improve the overall quality of endoscopic practise, including training of young endoscopists.     

Other considerations: Perspective and obligations of our societies and governmental organizations

Recurrent episodes of transmitted infection during gastrointestinal endoscopy have resulted in heightened visibility of the various organizations providing education, guidance, and regulatory oversight for endoscopes and the practice of endoscopy. They include the Food and Drug Administration, the Centers for Disease Control and Prevention, state health departments, accrediting organizations, and national medical societies representing practitioners and nurses. The Food and Drug Administration is responsible for ensuring the safety of manufacturer's products, without constraining the availability of critical medical services, such as gastrointestinal endoscopy. Their ongoing oversight of postmarket surveillance studies, and the results of such studies, will significantly influence the expectations for reprocessing in years to come. As a nonregulatory body, the Centers for Disease Control and Prevention primarily provides investigational expertise pertaining to infectious outbreaks and guidance to the medical industry regarding best practices, with input from the medical experts in their Hospital Infection Control and Professional Advisory Committee. National societies of nurses, reprocessing professionals, and physicians all provide education and guidance to the field, each with viewpoints ostensibly protective of patients and their membership. The Association for the Advancement of Medical Instrumentation, which publishes standards detailing the proper production quality for medical instruments and the procedures in which they are used, is in the midst of rewriting their guidance for reprocessing of gastrointestinal endoscopes. Despite reservations about process, Advancement of Medical Instrumentation deliberations emphasize the original guidance of the Spaulding Criteria for sterilization of semicritical devices, including endoscopes, when feasible and practicable. This is likely the future state for reprocessing in gastrointestinal endoscopy.     

Clinical gastroenterology--luxury or standard of service in gastroenterology?

Gastroenterology is one of the important specialities in internal medicine. The reform of the training curriculum for internal medicine and the reimbursement for inpatient and outpatient services in gastroenterology threatens the existence of internal medicine and gastroenterology in Germany, too. The capacity for training in internal medicine and gastroenterology is reduced by a decrease in the number of hospital beds in academic and community training centres. The concentration on gastrointestinal endoscopy in outpatient gastroenterology will be a result of an increasing demand for gastrointestinal endoscopy services and the decreasing number of gastroenterology clinics, respectively. Therefore, clinical gastroenterology as a core service in gastroenterology will be steadily eliminated. This development will diminish clinical gastroenterology to gastrointestinal endoscopy by eliminating the clinical services for chronic gastroenterological conditions such as, e.g., IBD, chronic hepatitis, reflux disease, IBS and functional dyspepsia. In this way gastroenterology looses its central role in health care services in specialised internal medicine. In 2003 the American Gastroenterological Association position paper: "Training the Gastroenterologist of the Future: the Gastroenterology Core Curriculum" was published. It has emphasised the role of clinical gastroenterology in medical training and medical services, too. Clinical gastroenterology consists of an array of several disciplines, e.g., GI physiology, GI research, infectious diseases, hepatology, oncology and gastrointestinal endoscopy, which all contribute to the effectiveness and efficiency in health care service. Financial incentives and better prospects of leading positions for young gastroenterologists in clinical gastroenterology have to be accomplished in order to nourish clinical gastroenterology in Germany. The German Association of Gastroenterology should negotiate with the responsible authorities for the addition of clinical gastroenterological services to the reimbursement by the EBM2000plus. The section of Gastroenterology of the German Association of Internists will provide sustained support to the achievement of this goal.     

Training simulators in digestive endoscopy

Advanced techniques, optimal patient care, and quality management are currently important topics in clinical medicine. The increasing numbers of minimally invasive procedures being carried out in gastroenterology and surgery, and the effects of the learning curve on complication rates with various procedures, have given rise a recently debate on training standards. Public awareness and increasing legal pressure to show and document competence have further contributed to the importance of training in interventional medicine. Although evidence-based medicine is rapidly becoming the gold standard for treatment modalities, responsibility for education-including the theoretical background, as well as acquiring and refining manual skills in gastrointestinal endoscopy--is still a matter for the individual physician. Practical skills are routinely acquired by practicing on patients, initially under the supervision of a senior endoscopist. The development of new endoscopy simulators has brought out the debate whether training in basic manual skills is better obtained outside the patient. This paper presents an overview of the training simulators currently available and issues associated with them.     

急性上消化道出血救治研究现状

急性上消化道出血为临床常见急症,近几年来国内关于急性上消化道出血急救推荐指南、共识不断更新,但由于我国地域医疗水平及医疗资源发展的不均衡,急救体系尚待健全,院内快速多学科合作模式有待完善.急性上消化道出血救治应遵循“降阶梯”思维,应建立规范的诊治流程.2020年春季启动的中国急性上消化道出血急诊救治快速通道建设,将对规...     

Historical aspects on the development of angiology in Germany

Clinical angiology is mainly concerned with vessels and disorders of circulation which can be detected and appraised with clinical methods. The arteries and veins of the limbs as well as the major extracranial arteries supplying the brain are primarily involved. The consequences of a peripheral arterial disease were initially recognized as being due to disorders of blood flow only in their most severe forms. A certain correlation of organic arterial alterations with the clinical finding was first made possible by angiography. Initially, both surgeons and internists directed their attention to this new field. However, since only surgery could offer therapeutic measures promising success, angiology could not become established in internal medicine. Deviating from this general development, Ratschow in Germany and in German-speaking countries and regions was able to create the precondition for an internal medical angiology and to attract the clinical and scientific interest of young internists in this field. The development of modern angiology, which began in the 1950s with the introduction of reconstructive arterial operations hence encountered surgical and internal medical activities in German-speaking countries. In parallel with the improvement in the methods of surgery, the internist angiologists developed thrombolysis and catheter recanalization (angioplasty) into efficient methods of treatment. In addition, the purely conservative techniques of therapy (training, vasoactive substances, rheological methods, medical prophylaxis) as well as noninvasive diagnostics were improved. The ideal concept which is aspired to at present and which has already been put into practice in many places consists in constructive collaboration of internal medical angiology and reconstructive vascular surgery, if possible with the assistance of vessel-oriented radiology.     

Functional bowel disorders in inflammatory bowel disease

Patients with IBD in remission often have ongoing gastrointestinal symptoms that are related to active inflammation. It is now apparent that functional gastrointestinal disorders may overlap with IBD and increase morbidity and diminish the quality of life of patients. Recognition and treatment of functional symptoms that may be the result of IBD are crucial in the appropriate medical management of these patients.