A resident's internal medicine practice

The decision-making experience of residents in a primary care internal medicine training practice was examined. The patient population provided residents appropriate training opportunities but the experience of many residents making decisions about prevalent primary care problems was often inadequate. The residents' evaluation of their educational experience with patients suggests that several elements of patient care affect their ability to learn. These include the occurrence of diseases in their patients, opportunities to treat and follow patients, the chance to use diagnostic procedures, and the option of reviewing their care with supervisors and consultants or through reading. The results of this study and the current understanding of the development of clinical judgment are discussed as arguments for evaluating internal medicine training programs in part by examining the content of residents' decision-making opportunities in their ambulatory patient practices.     

The patient room

Of all the advances that hospitals are making in the delivery of care, nowhere is the impact felt more drastically than in the patient room. Even as room decor grows cozier and more home-like, dazzling new technology is bringing the future directly to the bedside, giving clinicians the power to monitor patients more carefully and giving patients more control over their own experience. Creating flexible, comforting rooms that can accommodate ever-changing technology, that encourage loved ones to spend more time with patients, and that allow staff to work more efficiently is a challenge for hospital planners, one that they are confronting with ingenuity and finesse.     

浅谈供应室回收间管理

供应室是医院的后勤保障科室，它不但承担了全院各项工作所需器械、用具的供应，还集中了物品回收、清洗、消毒、灭菌、保管、发放等工作。而回收间是供应室第一窗口，是使用后医疗用品回收处理的第一站，其工作质量关系到医院感染的预防、控制效果。为此，笔者就回收间的管理浅谈如下观点。     

上海市闵行区居民抗菌药物合理使用知识、态度和行为调查

目的了解上海市社区居民对使用抗菌药物的知识、态度和行为现况,为全科医师的社区健康教育工作提供依据。方法 2012年12月—2013年1月采用便利抽样方法,抽取200名社区居民作为调查对象,以问卷调查的形式,调查并分析社区居民对使用抗菌药物的知识、态度和行为状况。计量资料比较采用t检验,P0.05为差异有统计学意义。结果对于抗菌药物的种类、名称方面回答正确的社区居民有156人(78.0%)。知识得分为(2.39±1.36)分,得分率为39.83%;态度得分为(4.87±2.13)分,得分率为54.11%;行为得分为(2.89±1.16)分,得分率为57.80%。不同学历社区居民的知识[(2.01±1.20)、(2.89±1.39)分]、态度[(4.31±1.89)、(5.62±2.22)分]得分比较,差异均有统计学意义(均P0.05);不同性别社区居民的知识[(11.73±4.30)、(9.04±3.67)分]、态度[(2.94±1.35)、(2.01±1.22)分]、行为[(5.74±2.12)、(4.26±1.93)分]得分比较,差异均有统计学意义(均P0.05)。结论全科医生应采取针对性措施,加强抗菌药物的政策法规、适应证、合理用法用量等基础知识的健康教育,注意针对不同人群采用不同的沟通方式,着重发挥家庭医生责任制的长处,在日常工作中重点着眼于居民不良用药行为的纠正。     

江苏省居民医疗保健支出的实证分析

随着经济发展和生活水平的提高,人们对健康的关注逐步增强。从江苏省的发展现状来看,居民人均医疗保健支出逐年增加,医疗保健支出占消费性支出的比重不断提高。本文研究表明,人均收入水平、教育水平以及医疗服务水平对江苏省居民医疗保健支出有显著影响,而新型农村合作医疗对于解决农村居民的医疗需求更具成效性和必需性。为进一步提高居民总体的健康水平,江苏省应进一步提高居民收入水平;继续推行教育的普及化,切实提高全民教育水平;完善公共医疗服务设施,提高医疗服务水平;进一步推进农村合作医疗体制建设,提高农村医疗保障水平。     

Assessing resident's knowledge and communication skills using four different evaluation tools

PURPOSE: This study assesses the relationship between 4 Accreditation Council for Graduate Medical Education (ACGME) outcome project measures for interpersonal and communication skills and medical knowledge; specifically, monthly performance evaluations, objective structured clinical examinations (OSCEs), the American Board of Family Practice in-training examination (ABFP-ITE) and the Davis observation code (DOC) practice style profiles. METHODS: Based on previous work, we have DOC scoring for 29 residents from the University of California, Davis Department of Family and Community Medicine. For all these residents we also had the results of monthly performance evaluations, 2 required OSCE exercises, and the results of 3 American Board of Family Medicine (ABFM) ITEs. Data for each of these measures were abstracted for each resident. The Pearson correlation coefficient was used to assess the presence or lack of correlation between each of these evaluation methods. RESULTS: There is little correlation between various evaluation methods used to assess medical knowledge, and there is also little correlation between various evaluation methods used to assess communication skills. CONCLUSION: The outcome project remains a 'work in progress', with the need for larger studies to assess the value of different assessment measures of resident competence. It is unlikely that DOC will become a useful evaluation tool.     

广西河池市居民卫生环境与卫生行为调查

目的 了解壮族地区城市与农村居民伤寒发病与卫生环境及卫生行为的关系。方法 采用统一调查表,逐户调查广西河池市金城江镇(城市)及东江镇(农村)所有常住居民。结果 共调查了研究现场的住户39,050户,人口135,737人。96,7％城市居民住户使用自来水,农村只有74．9％;有98.2％城市住户使用冲水厕所,农村只有42,6％;有饮用开水习惯的住户,城市为91．2％,农村只73．1％;饭前便后有洗手习惯的住户．城市为89．3％～94．7％,农村只有54．3％～60．6％。在城市73.4％的住户屋内放置垃圾桶,而农村只有29.4％。结论 城市居民的卫生环境与卫生行为明显较农村为好;引起伤寒传染病暴发流行的危险因素仍普遍存在;对高危人群接种伤寒疫苗是控制伤寒最有效措施。     

与世界同步 推动房颤学术发展

目前,心脏方面的疾病是危害人们健康的头号杀手,全球都在为战胜和攻克心血管病进行着不懈的努力和抗争。前不久,"第二届心房颤动国际在线论坛"新闻发布会在北京市五洲大酒店丁香厅隆重举行。发布会上,我国著名心血管专家胡大一教授、杨延宗教授和马长生教授与部分媒体就房颤学术领域所关心的问题展开了热烈的讨论。     

The operating room of the future

Advances in computer technology will revolutionize surgical techniques in the next decade. The operating room (OR) of the future will be connected with a laboratory where clinical specialists and researchers prepare image-guided interventions and explore the possibilities of these techniques. The virtual reality is linked to the actual situation in the OR with the aid of navigation instruments. During complicated operations the images prepared preoperatively will be corrected during the operation on the basis of the information obtained peroperatively. MRI currently offers maximal possibilities for image-guided surgery of soft tissues. Simpler techniques such as fluoroscopy and echography will become increasingly integrated in computer-assisted peroperative navigation. The development of medical robot systems will make possible microsurgical procedures by the endoscopic route. Tele-manipulation systems will also play a part in the training of surgeons. Design and construction of the OR will be adapted to the surgical technology, and include an information and control unit where preoperative and peroperative data come together and from where the surgeon operates the instruments. Concepts for the future OR should be regularly adjusted to allow for new surgical technology.