军医大学住院医师规范化培训实践

本文结合第三军医大学近几年住院医师规范化培训工作实践,深入分析当前军队住院医师规范化培训中存在的突出矛盾和问题,并从完善质量标准、加强基地建设、强化军事素质、培训学位衔接等方面对深化军队住院医师规范化培训进行探讨,以进一步提高培训质量,促进军队医院的建设发展。     

Nutritional and pulmonary function assessment in patients with chronic obstructive lung disease

This investigation was undertaken to determine the prevalence and degree of malnutrition among patients with chronic obstructive pulmonary disease and to determine if a relationship exists between nutritional assessment parameters and pulmonary function. Thirty-seven patients admitted for the treatment of chronic obstructive pulmonary disease to a respiratory care unit of a Veterans Administration facility were studied. Nutritional status was evaluated using anthropometric measurements, laboratory data and immunologic assay. Deficits in anthropometric measurements were frequent and severe in this group of patients. Furthermore, our data demonstrated that patients with a forced vital capacity <30% of predicted value had significantly reduced lean body mass as measured by the mid-arm muscle circumference (p<0.05). Investigation of the nutritional status of patients with chronic obstructive pulmonary disease using controlled nutrition intervention trials may elucidate the relationship of nutritional state to pulmonary function in this group of patients.     

社区家庭医生团队服务模式实践探索

家庭医生制度是我国社区卫生服务向纵深发展的重要举措.在武汉市某社区卫生服务中心开展家庭医生团队服务模式实践,总结家庭医生团队服务的经验,找出实施中存在的困难和问题,并提出相应措施和政策建议.     

营养教育对广州市小学生营养知识·态度·行为的影响

目的了解和提高小学生营养知识水平,培养小学生健康的饮食习惯.方法抽取广州市城区8所小学10～12岁小学生共1600名进行营养知识、态度、行为(KAP)调查,对其中4所小学的800名小学生在调查基础上进行针对性营养知识教育(教育组),以其余4所小学的学生800名为对照组,对教育效果进行评估.结果营养教育后,学生的营养知识水平明显提高,教育组知道蛋白质、碘、铁、钙的食物来源及蔬菜水果提供的主要营养素的学生比对照组分别高21.3%,14.1%,13.7%,9.0%,26.5%(P＜0.05);学生食物选择及消费趋于合理,教育组学生早餐食物选择中牛奶、鸡蛋所占比例分别比对照组高9.8%,15.6%(P＜0.05);学生挑食、偏食、零食行为改善.结论营养教育能提高小学生的营养知识水平,改善其营养醒为.营养知识进入课堂是受学生欢迎的营养教育形式.     

The Expert Patients Programme: a paradox of patient empowerment and medical dominance

Self-care is seen as a key element in managing resource demand in chronic disease and is also perceived as an empowering right for patients. The Chronic Disease Self-Management Programme developed in the USA has been adopted in a number of countries and in the UK has been as adapted as the Expert Patients Programme. However, despite its potential as a lay-led empowering initiative, the Expert Patients Programme has been criticised as perpetuating the medical model and failing to reach those in most need. This paper revisits a critique of the Expert Patients Programme, and drawing upon a qualitative study seeks to explore whether the Expert Patients Programme enables empowerment or replicates traditional patterns of the patient-professional relationship. A grounded-theory approach was adopted utilising focus groups, in-depth interviews and participant observation. Data were analysed through the constant comparative method and the development of codes and categories. Conducted in the relatively affluent area of the south-east of England, this paper draws on data from 66 individuals with a chronic illness who were knowledgeable, active and informed. The study revealed a number of characteristics common to expert patients that were linked to a systematic, proactive and organised approach to self-management, a clear communication style and the ability to compartmentalise emotion. The study included participant observation of an Expert Patients Programme and a professional-led self-management course. The paradoxical nature of the Expert Patients Programme was revealed, for whilst there was evidence that it reinforced the medical paradigm, there was a concurrent acknowledgement and support for the subjective experience of living with a long-term condition. Furthermore, whilst the policy emphasis has been on individual empowerment within the Expert Patients Programme, there is some evidence that it may be triggering a health consumer movement.     

某医学院学生营养知识、态度、行为调查

目的了解医学院学生的营养知识、态度和行为（KAP）,为营养教育提供科学依据。方法对随机抽取的某医学院学生486人进行自行设计营养KAP问卷调查,分析其KAP评分。结果全部学生平均得分为34．82±4．53分,仅占总分的75．7％。男生营养KAP总评分为33．76±5．25,女生总评分为35．21±4．17,女生营养KAP总评分高于男生（P〈0．01）,男生不及格率为24．8％（32／129）,女生不及格率为10．4％（37／357）,男生营养KAP不及格率高于女生（P〈0．01）。男生优秀率为44．2％（57／129）,女生优秀率为55．5％（198／357）,女生营养KAP总分优秀率高于男生（P〈0．05）。高年级的营养知识、营养态度、饮食行为和总评分分别为12．73±2．41、8．16±2．03、14．65±1．66和35．54±4．03,低年级的营养知识、营养态度、饮食行为和总评分分别为12．06±2．79、8．02±2．34、14．31±1．81和34．40±4．75。结论医学生营养知识较缺乏,应加强医学生营养教育,促使其改变不良饮食行为,促进医学生的健康。     

Patient Self-Care and Caregiver Contribution to Patient Self-Care of Chronic Conditions: What Is Dyadic and What It Is Not

ObjectivesSelf-care of chronic conditions involves both patients and their informal caregivers and therefore might be considered as a dyadic phenomenon. Nevertheless, empirical evidence supporting a dyadic construct is unavailable. This study aimed to explore the existence of a dyadic construct in self-care maintenance, monitoring, and management in patients affected by chronic conditions and their informal caregivers.MethodsThis study used a cross-sectional design. We used the Self-Care of Chronic Illness Inventory and the Caregiver Contribution to Self-Care of Chronic Illness Inventory, which measure patient self-care and informal caregivers’ contribution to self-care maintenance, monitoring and management. Exploratory Structural Equation Modeling was performed to verify the existence of dyadic latent constructs in each scale in patients and informal caregivers.ResultsA convenience sample of 493 patients and informal caregivers, with a mean age of 76.47 and 52.76 years, respectively, was studied. In the self-care maintenance scales, 2 correlated factors (r = 0.34, P < .001) were identified, indicating the presence of a dyadic second-order construct. In addition, 2 factors that were not correlated (r = 0.11, P = .064) were identified in the self-care monitoring scales, indicating the absence of a dyadic construct. Finally, we found a 3-factor model in the self-care management scales composed of both patient and caregiver items, indicating a dyadic first-order construct.ConclusionsKnowing which care behaviors are dyadic in chronic conditions is important for tailoring interventions to improve self-care. Self-care maintenance and management would benefit from dyadic interventions, while self-care monitoring would not. The results of this study may illuminate future theoretical and scientific developments in dyadic care of chronic illness.     

营养教育对中学生健康知识态度行为的影响效果评价

目的评价营养教育对中学生健康知识、态度和行为的影响,为探讨有效的营养健康教育方法提供依据。方法采取整群随机抽样的方法,抽取平顶山市4个区8所中学学生共4430名,进行营养知识、态度、行为调查。将学生分为营养教育组和对照组,对2118名营养教育组学生进行针对性营养宣教,并比较教育前后的效果。结果营养教育后,学生营养KAP明显提高,知道高血压与摄入食盐过多有关的人由46.3%上升为53.5%;70.0%的学生认为很有必要进行营养教育;教育组谷类、薯类、豆类消费增加人数分别较对照组高2.5,2.6和2.8个百分点。结论营养教育能提高中学生的营养知识,改善其态度及行为;营养知识讲座和营养咨询是受中学生欢迎的教育形式。     

基层医院实施医师规范化培训的实践与思考

通过健全的组织制度管理、不断完善的培训方案,针对不同对象,实施多元化培训模式、差别培训,完成专业技术及临床决策能力培训。科学、规范的医师培训使其成为医院的优秀员工,认同医院文化,并在行动上与医院的目标保持一致。     

常州市武进区开展家庭医生签约服务实践和思考*

世界上有超过50个国家推行了全科(家庭)医生制度,我国也将家庭医生签约服务作为医改的战略性举措之一,在开展家庭医生签约服务工作的过程中,常州市武进区形成了一定的实践经验和工作成效,也面临着相应的问题和症结,对此,文章提出要统一思想认识、注重基层医务人员培养、引进及挽留、建立和完善签约服务绩效考核机制、开展形式多样的签约服务主题宣传活动、突出重点,鼓励创新、完善签约服务信息系统建设,以期为家庭医生签约服务实践和工作的推进提供参考。     

安徽理工大学学生营养知识、态度与膳食行为

目的了解大学生营养知识、态度与膳食行为现况,为开展营养健康教育提供依据。方法采用自编调查问卷,对安徽理工大学在校学生1 075名的营养知识、态度与膳食行为进行抽样调查。结果学生营养知识得分为(32.84±11.43)分,其中男、女生得分差异有统计学意义。此外,学生正确营养态度及膳食行为形成率均不高,不吃早餐、吃零食等行为较普遍。结论多数学生缺乏必要的营养知识,普遍存在不合理的膳食行为,但有较好的健康饮食意识,愿意接受更多的营养知识并改正不良的饮食习惯。应加强对大学生营养知识的宣传教育,纠正不良饮食行为。     

Future Doctors' Perceptions about Incorporating Nutrition into Standard Care Practice

Objective: The increasing prevalence of chronic disease has been largely attributed to long-term poor nutrition and lifestyle choices. This study investigates the attitudes of our future physicians toward nutrition and the likelihood of incorporating nutrition principles into current treatment protocols.Methods: Setting: The setting of this study was an Australian university medical school. Subjects: Subjects including year 1–4 students (n = 928) in a 4-year medical bachelor, bachelor of surgery (MBBS) degree program. Students were invited to participate in a questionnaire based on an existing instrument, the Nutrition in Patient Care Attitude (NIPC) Questionnaire, to investigate their attitudes toward nutrition in health care practices.Results: Respondents indicated that “high risk patients should be routinely counseled on nutrition” (87%), “nutrition counseling should be routine practice” (70%), and “routine nutritional assessment and counseling should occur in general practice” (57%). However, despite overall student support of nutritional counseling (70%) and assessment (86%), students were reluctant to perform actual dietary assessments, with only 38% indicating that asking for a food diary or other measure of dietary intake was important.Conclusion: These findings demonstrate that future physicians are aware of the importance of considering nutrition counseling and assessment. However, students are unlikely to adequately integrate relevant nutritional information into their treatment protocols, evidenced by their limited use of a basic nutritional assessment. This is potentially the result of a lack of formal nutrition education within their basic training.     

The Science and Practice of Micronutrient Supplementations in Nutritional Anemia

Nutritional anemia is the most common type of anemia, affecting millions of people in all age groups worldwide. While inadequate access to food and nutrients can lead to anemia, patients with certain health status or medical conditions are also at increased risk of developing nutritional anemia. Iron, cobalamin, and folate are the most recognized micronutrients that are vital for the generation of erythrocytes. Iron deficiency is associated with insufficient production of hemoglobin. Deficiency of cobalamin or folate leads to impaired synthesis of deoxyribonucleic acid, proteins, and cell division. Recent research has demonstrated that the status of copper and zinc in the body can significantly affect iron absorption and utilization. With an increasing number of patients undergoing bariatric surgical procedures, more cases of anemia associated with copper and zinc deficiencies have also emerged. The intestinal absorption of these 5 critical micronutrients are highly regulated and mediated by specific apical transport mechanisms in the enterocytes. Health conditions that persistently alter the histology of the upper intestinal architecture, expression, or function of these substrate‐specific transporters, or the normal digestion and flow of these key micronutrients, can lead to nutritional anemia. The focus of this article is to review the science of intestinal micronutrient absorption, discuss the clinical assessment of micronutrient deficiencies in relation to anemia, and suggest an effective treatment plan and monitoring strategies using an evidence‐based approach.     

Nutritional Factors in the Etiology and Treatment of Pressure Sores

No abstract available for this article.     

培养住院医师的实践与思考

总结了80年代以来我国培养住院医师的实践,把我国培养医师的制度与发达国家培养医师的制度进行比较,指出我国医师培养制度存在的主要问题是“铁饭碗”基础上的拔苗助长培养方式,提出了以后十年的改革方向。     

L-精氨酸强化膳食营养对慢性阻塞性肺病营养不良患者的作用

目的评价L-精氨酸强化膳食营养对慢性阻塞性肺病(COPD)营养支持的作用。方法对30例COPD患者进行营养支持治疗，总能量摄人为静息能量消耗(REE)的1．5倍，其中蛋白质占20％，脂肪：30%，碳水化合物50％。A组12例为精氨酸治疗组，每日口服L-精氨酸10g3次／d，B组18例为对照组。结果营养支持后，A组肱三头肌皮褶厚度、前白蛋白、体脂等营养参数较B组明显改善，呼吸肌力显著提高，REE显著下降；A组的免疫指标较B组改善更显著；A组住院费较B组低。结论L-精氨酸不仅可改善COPD的营养、免疫状况和呼吸肌力量，而且能显著降低患者的能量消耗，达到强化营养支持的效果，同时可改善预后，减少医疗费用。     

Clinical and Translational Science Awards and Community Engagement: Now Is the Time to Mainstream Prevention into the Nation's Health Research Agenda

Although much attention is devoted to the slow process of cutting-edge “bench science” finding its way to clinical translation, less attention is paid to the fact that basic prevention messages, tests, and interventions never find their way into communities. The NIH Clinical & Translational Science Awards program seeks to address a broad mission of improving health, including both speeding up the incorporation of basic science discoveries throughout the clinical research pipeline and incorporating concerns of communities and practices into research agendas. The preventive medicine community now has an important opportunity to marry their mission of promoting and expanding prevention in communities to the nation's medical research agenda. This article suggests opportunities for collaboration.