校内服务性实训基地建设与运行模式的探索

高等卫生职业教育担负着培养高素质相关医学人才的重任,而校内实训基地的建设是完成这一重任的重要保障.本文以苏州卫生职业技术学院创建校内服务性实训基地为例,诠释了校内服务型实训基地的内涵、有效运作模式,并提出了校内服务性实训基地的5个基本特征.     

癫痫持续状态大鼠海马中食欲素受体1随时间演变的规律

目的探讨癫痫持续状态后癫痫模型大鼠海马中食欲素受体1(orexin receptor-1,OX1R)随时间演变的规律。方法实验3月龄雄性Wistar大鼠100只,体质量250~400 g,随机分为实验组(KA组)和对照组(NS组),实验组采用海人酸(kainic acid,KA)腹腔注射诱导大鼠癫痫持续状态的模型,在癫痫持续状态30 min后终止发作,分别于终止发作后4 h、1 d、1周、1个月、2个月处死大鼠,对照组腹腔注射0.9%氯化钠注射液,处理同实验组,随后行免疫组化染色和Western-blot方法检测OX1R的变化。结果两种检测方法均提示实验组(KA组)和对照组(NS组)随着鼠龄(3~5个月)的增加,海马内OX1R表达均随呈上升趋势,在各个时间点KA组海马各区OX1R的表达均高于NS组,但两组差异无统计学的意义(P>0.05)。结论在癫痫持续状态大鼠及对照组大鼠中,海马CA1区、CA3区及齿状回(dentate gyrus,DG)OX1R的表达与癫痫发作无相关性,但随着鼠龄的增长海马各区OX1R的表达均随时间呈增多趋势,提示随鼠龄增加海马OX1R表达逐渐增多。     

Changes in rates of autopsy-detected diagnostic errors over time: a systematic review

Context  Substantial discrepanies exist between clinical diagnoses and findings at autopsy. Autopsy may be used as a tool for quality management to analyze diagnostic discrepanies. Objective  To determine the rate at which autopsies detect important, clinically missed diagnoses, and the extent to which this rate has changed over time. Data Sources  A systematic literature search for English-language articles available on MEDLINE from 1966 to April 2002, using the search terms autopsy, postmortem changes, post-mortem, postmortem, necropsy, and posthumous, identified 45 studies reporting 53 distinct autopsy series meeting prospectively defined criteria. Reference lists were reviewed to identify additional studies, and the final bibliography was distributed to experts in the field to identify missing or unpublished studies. Study Selection  Included studies reported clinically missed diagnoses involving a primary cause of death (major errors), with the most serious being those likely to have affected patient outcome (class I errors). Data Extraction  Logistic regression was performed using data from 53 distinct autopsy series over a 40-year period and adjusting for the effects of changes in autopsy rates, country, case mix (general autopsies; adult medical; adult intensive care; adult or pediatric surgery; general pediatrics or pediatric inpatients; neonatal or pediatric intensive care; and other autopsy), and important methodological features of the primary studies. Data Synthesis  Of 53 autopsy series identified, 42 reported major errors and 37 reported class I errors. Twenty-six autopsy series reported both major and class I error rates. The median error rate was 23.5% (range, 4.1%-49.8%) for major errors and 9.0% (range, 0%-20.7%) for class I errors. Analyses of diagnostic error rates adjusting for the effects of case mix, country, and autopsy rate yielded relative decreases per decade of 19.4% (95% confidence interval [CI], 1.8%-33.8%) for major errors and 33.4% (95% [CI], 8.4%-51.6%) for class I errors. Despite these decreases, we estimated that a contemporary US institution (based on autopsy rates ranging from 100% [the extrapolated extreme at which clinical selection is eliminated] to 5% [roughly the national average]), could observe a major error rate from 8.4% to 24.4% and a class I error rate from 4.1% to 6.7%. Conclusion  The possibility that a given autopsy will reveal important unsuspected diagnoses has decreased over time, but remains sufficiently high that encouraging ongoing use of the autopsy appears warranted.      

骨肿瘤辅助诊断系统临床知识库的建立

目的：建立骨肿瘤辅助诊断系统的知识库。方法：通过对骨肿瘤知识的归纳总结，结合模糊理论和数据库技术，采用知识的混合表示法。结果：建立起符合临床医生诊断过程的知识库原型。结论：提出了一种用数据库技术＋逻辑程序设计技术完成知识混合表示的方法。     

精准医学知识库的构建

根据“精准医学本体和语义表示标准”,构建了“精准医学知识库”及“精准医学知识库管理与共享平台”。该精准医学知识库体系具有标准规范、信息全面、开放共享、用户友好以及动态更新等特点,将全面支撑精准医学基础研究和临床应用,填补了国内精准医学知识库领域的空白。     

PCPA失眠大鼠不同时间皮质前额叶ATP水平变化及酸枣仁汤的干预作用

目的 研究氯苯丙氨酸(PCPA)诱导的失眠大鼠前额皮质三磷酸腺苷(ATP)不同时间水平变化情况,探讨酸枣仁汤(SZRD)的干预机制.方法 大鼠分为正常对照组(不做任何操作),SZRD对照组(第1、2、3天腹腔注射蒸馏水,第4～10天蒸馏水灌胃),空白对照组,模型组,SZRD治疗组,五羟色氨酸(5 HTP)组,5-HTP+-SZRD组.采用连续3d腹腔注射PCPA的方法建立大鼠失眠模型,各组在实验的第4、5、6、8、10天分别取大鼠前额叶皮质,采用高效液相色谱法(HPLC)检测各组大鼠不同时间前额皮质ATP水平.结果 模型组大鼠实验第4、5、6、8、10天ATP水平显著下降,与空白对照组比较差异有统计学意义(P＜0.01);SZRD治疗组第4、5、6、8、10天ATP水平较模型组逐渐升高,差异有统计学意义(P＜0.05,P＜0.01);SZRD对照组前额叶皮质ATP水平与空白对照组比较差异无统计学意义(P＞0.05);空白对照组和正常对照组比较,前额皮质ATP水平差异无统计学意义(P＞0.05);5-HTP组与SZRD对照组、5-IITP+ SZRD组之间比较差异也无统计学意义(P＞o.05).结论 SZRD与5-HTP本身对正常大鼠前额皮质ATP水平变化无显著影响,SZRD对前额皮质ATP的作用出现在PCPA所致失眠后.     

知识经济时代图书馆文献信息服务工作的变革

作为知识宝库,有着发展经济雄厚资本的图书馆,应该怎样摆正自己的位置,变革自己的的工作,使其与知识经济时代相适应,是当前图书馆界从理论上探讨的重要课题.     

An experimental transformation of a large expert knowledge base

An experiment is described in which a significant part of the INTERNIST knowledge base for diagnosis in internal medicine is translated into an EXPERT model. INTERNIST employs the largest and broadest knowledge base of all the medical consultation systems that have been developed in recent years. EXPERT is a general system for designing consultation models. The translated model shows reasonable competence in the final diagnostic classification of 431 test cases. There are differences in the internal representation and reasoning strategies of the two systems. However, when a knowledge base has been encoded in a relatively uniform manner, this experiment demonstrates the feasibility of transfer of knowledge between large-scale expert systems.     

继续教育对基层医生慢性阻塞性肺疾病认识水平的影响

目的了解基层医生掌握慢性阻塞性肺疾病（COPD）相关知识的现状,比较不同教育模式对基层医生掌握COPD知识水平的影响。方法2007年12月采用不记名闭卷笔试的方法对北京市10个城近郊区共372名基层医生进行COPD知识问卷调查。内容包括：慢性阻塞性肺疾病的定义、诊断、流行病学特征、危险因素;COPD稳定期、急性发作期临床表现;COPD非药物治疗;COPD药物治疗。结果本次调查共收回合格答卷372份,总分平均50．1分,及格率42．5％。基层医生对定义和危险因素、非药物治疗掌握较好,通过率分别为67．7％和67．5％。而对临床表现和药物治疗掌握较差,药物治疗的通过率仅为19．9％。不同教育方式对基层医生掌握COPD知识影响很大。强化教育组的总成绩67分;通过率73．3％,均明显优于普通教育组和未受教育组。结论我国基层医院医生对于COPD临床知识与技能十分欠缺,迫切需要加强COPD知识教育。强化教育模式可显著提高基层医师的COPD知识水平,应加以普及、推广。     

The use of in-hospital physician services for acute myocardial infarction. Changes in volume and complexity over time

Changes between 1972 and 1982 in the use of in-hospital services were studied for 164 patients admitted with acute myocardial infarction. Resource use was measured in constant 1982 dollars adjusted for differences in clinical severity of the patients. Although average length of stay decreased by almost 40% during this period, the number of physician services doubled and total physician costs increased almost threefold. The increase in physician costs was due primarily to the use of complex diagnostic technologies and to the provision of coronary artery bypass graft surgery. The results of this study suggest that as hospital costs are constrained by prospective payment, physician costs may continue to rise as new diagnostic and therapeutic services are introduced into practice and as more care is shifted to the outpatient setting.     

浅谈知识经济时代继续医学教育的内涵

文章分析了知识经济时代新技术的特点,阐述继续医学教育的内涵,即如何掌握和运用信息,引导医务工作者树立创新意识,传播医学技术伦理.     

Clinical problem-solving skills of internists trained in the problem-oriented system

In the study reported here, the authors test the hypothesis that internists completing residencies in a highly structured, problem-oriented residency program approach clinical problem-solving differently than do internists whose residencies were not problem-oriented. The vehicle for the study was the certifying examination of the American Board of Internal Medicine (ABIM) in 1978, 1979, and 1980. Performance on patient management problems (PMPs) and multiple-choice questions was analyzed for candidates for ABIM certification whose residency had been problem-oriented, for candidates whose residencies had been classified as nonproblem-oriented, and for the national pool of U.S. medical graduates. Internists trained in the problem-oriented residency program achieved significantly higher PMP scores than did the national pool in two of the three years and on true-false questions in one of the years. No differences were detected between the problem-oriented group and their nonproblem-oriented colleagues.     

利用知识库实现对心脏MR图像的自动分割

目的 研究如何实现对心脏ＭＲ图像的自动化分割问题。方法　通过对图像特征参数的训练,从而有效提取和利 用先验知识。结果　实现对心脏ＭＲ图像的自动化分割。结论　通过提取和利用心脏ＭＲ图像的先验知识,能够很好地 实现心脏分割算法的自动化。     

视频案例在高校法律基础知识教学中的应用研究

视频案例教学法是高校法律基础知识课教学中一种比较有效的教学方法。在教学实践中运用视频案例教学法时,教师不仅要重视合适案例的选择,而且要注意对课堂教学过程的有效控制。     

Effectiveness over time of varicella vaccine

Context  Reports of outbreaks of varicella in highly immunized groups have increased concern about the effectiveness of varicella vaccine. Objective  To assess whether the effectiveness of varicella vaccine is affected either by time since vaccination or by age at the time of vaccination. Design  Case-control study conducted from March 1997 through June 2003. Setting  Twenty different group practices in southern Connecticut. Participants  Case subjects, identified by active surveillance of all practices, consisted of 339 eligible children 13 months or older who were clinically diagnosed as having chickenpox and who also had a polymerase chain reaction (PCR) test result that was positive for varicella-zoster virus DNA. For each case subject, 2 controls were selected, matched by both age and pediatric practice. Main Outcome Measures  The effectiveness of the vaccine, especially the effects of time since vaccination and age at the time of vaccination, adjusted for possible confounders. Results  Although the adjusted overall effectiveness of the vaccine was 87% (95% confidence interval, 81%-91%; P<.001), there was a substantial difference in the vaccine's effectiveness in the first year after vaccination (97%) and in years 2 to 8 after vaccination (84%, P = .003). The vaccine's effectiveness in year 1 was substantially lower if the vaccine was administered at younger than 15 months (73%) than if it was administered at 15 months or older (99%, P = .01), although the difference in effectiveness overall for children immunized at younger than 15 months was not statistically significantly different than for those immunized at 15 months or older (81% vs 88%, P = .17). Most cases of chickenpox in vaccinees were mild. Conclusions  Although varicella vaccine is effective, its effectiveness decreases significantly after 1 year, although most cases of breakthrough disease are mild. If administered at younger than 15 months, the vaccine's effectiveness was lower in the first year after vaccination, but the difference in effectiveness was not statistically significant for subsequent years.      

军队卫生学、流行病学知识库及网站的建立

顺应信息化军事医学的发展的要求,通过建立军队卫生学、流行病学知识库和网站,为基层部队卫生防病工作提供基础信息支持。全面收集军队卫生学、流行病学资料,进行整理分析,采用Microsoft SQL SERVER数据库技术和ASP设计程序和网站。实现军队卫生学、流行病学相关知识的快速查询和了解。建立的军队卫生学、流行病学知识库和网站具有界面友好,简单易用,检索查询方便等特点,不仅能为部队基层的卫生技术人员提供信息支持和决策依据,而且对部队在应对突发的重大卫生事件上能够起一定的参考作用。