探索中国医学研究之路跻身世界科学之林

医学是当今世界上最为复杂的一门学科,传统医学是从无数次的反复临床实践和不断挫折失败中吸取教训,总结成功的经验,再上升为理论指导实践.数千年医学发展经历了传统医学、实验医学和现代系统医学发展等阶段.21世纪以来,现代医学获得极大发展.在研究层次上,向微观和宏观发展,分子医学和临床医学并进;学科体系上,学科分科与交叉融合并进.     

Ketamine and midazolam sedation for pediatric gastrointestinal endoscopy in the Arab world

AIM: To evaluate the safety and effectiveness of intravenous ketamine-midazolam sedation during pediatric endoscopy in the Arab world.METHODS: A retrospective cohort study of all pediatric endoscopic procedures performed between 2002-2008 at the shared endoscopy suite of King Abdullah University Hospital, Jordan University of Science & Technology, Jordan was conducted. All children were > 1 year old and weighed > 10 kg with American Society of Anesthesiologists class 1 or 2. Analysis was performed in terms of sedation-related complications (desaturation, respiratory distress, apnea, bradycardia, cardiac arrest, emergence reactions), adequacy of sedation, need for sedation reversal, or failure to complete the procedure.RESULTS: A total of 301 patients (including 160 males) with a mean age of 9.26 years (range, 1-18 years) were included. All were premedicated with atropine; and 79.4% (239/301) had effective and uneventful sedation. And 248 (82.4%) of the 301 patients received a mean dose of 0.16 mg/kg (range, 0.07-0.39) midazolam and 1.06 mg/kg (range, 0.31-2.67) ketamine, respectively within the recommended dosage guidelines. Recommended maximum midazolam dose was exceeded in 17.6% patients [34 female (F):19 male (M), P = 0.003] and ketamine in 2.7% (3 M:5 F). Maximum midazolam dose was more likely to be exceeded than ketamine (P < 0.001). Desaturation occurred in 37 (12.3%) patients, and was reversible by supplemental oxygen in all except 4 who continue to have desaturation despite supplemental oxygen. Four (1.3%) patients had respiratory distress and 6 (2%) were difficult to sedate and required a 3rd sedative; 12 (4%) required reversal and 7 (2.3%) failed to complete the procedure. None developed apnea, bradycardia, arrest, or emergence reactions.CONCLUSION: Ketamine-midazolam sedation appears safe and effective for diagnostic pediatric gastrointestinal endoscopy in the Arab world for children aged > 1 year and weighing > 10 kg without co-morbidities.     

Improving medical communication: Skills for a complex (and multilingual) clinical world

It has been reported that suboptimal communication represents the largest source of preventable error during acute medical care. Because a significant proportion of ongoing care relies heavily on verbal communication, it is incumbent on clinicians to develop, hone and maintain these skills in the interests of their patients and, at the same time, contribute to a more reliable and patient-focused health care system. This review briefly discusses why communication matters, practical strategies from both inside and outside clinical medicine, the implications of poor translation and the state of medical communication in Canada.The ability to communicate can be one of the clinician’s greatest assets… or greatest liabilities. Suboptimal communication appears to be the largest source of preventable medical error during acute clinical care (1–4) and ‘the most important but least accomplished aspect of quality care’ (5–7). Verbal communication (between physicians and patients, families and surrogate decision makers) is also the means by which we coordinate (or fragment) ongoing care, bolster (or impair) teamwork and generate (or erode) trust (1–7). Therefore, being an expert clinician means becoming an expert communicator (2–11). Our ‘verbal dexterity’ should match our procedural dexterity and factual knowhow (4).Clinical medicine previously focused on scientific discovery and technological advancement. However, medicine is also a complex social system (1–8). Therefore, we also need to make a ‘science of reducing complexity’, a ‘science of managing uncertainty’ and a ‘science of working in teams’ (12). If we define communication as ‘sharing, uniting, or making understanding common’ (2–4), then this skill is essential to create a more reliable and patient-focused system (3,13). The present review outlines the importance of medical communication. It also offers practical strategies for practitioners eager to help patients who are unable to communicate fully due to knowledge, illness or language barriers.     

增强病历书写质量防范医疗纠纷

病历书写是医院医疗工作的基本内容之一,病历文书的质量体现了一个医院的医疗质量和医疗技术水平,更体现了一位医务工作者的综合素质。同时,随着社会法制的不断健全、人们法制意识的不断提高,病历已经成为了重要的法律依据。