论高等医学院校的创新教育

文章从创新教育的基本概念，创新教育是社会发展的需要，创新教育是医学、医学教育发展的必然，论述了高等医学院校实施创新教育的必要性；从构建创新教育新观念，教学方法的改革，课程与教材建设，教育考评制度等方面阐述了高等医学院校实施创新教育的方略。     

Alvan Feinstein and the art of consulting: how to define a research question

When thinking of a new study, the most important task is to define its goals and to choose a design to match those goals. Alvan Feinstein described how he went about consulting others on defining a research question in his book, “Clinical Epidemiology, the Architecture of Clinical Research.” In this paper, the author reminisces about how he learned and tried to apply those principles.     

Short- and long-term mortality after acute myocardial infarction: comparison of patients with and without diabetes mellitus

Aims To compare short- and long-term mortality after a first acute myocardial infarction (AMI) in patients with and without diabetes mellitus. Methods and results A nationwide cohort of 2,018 diabetic and 19,547 nondiabetic patients with a first hospitalized AMI in 1995 was identified through linkage of the national hospital discharge register and the population register. Follow-up for mortality lasted until the end of 2000. At 28 days and 5 years respectively, absolute mortality risks were 18 and 53% in diabetic men, 12 and 31% in nondiabetic men, 22 and 58% in diabetic women, and 19 and 42% in nondiabetic women. Crude mortality was significantly higher in diabetic patients than in nondiabetic patients in both men (28-day hazard ratio (HR) 1.55; 95% confidence interval (CI) 1.32–1.81, 5-year HR 2.01; 95% CI 1.84–2.21) and women (28-day HR 1.19; 95% CI 1.03–1.37, 5-year HR 1.53; 95% CI 1.40–1.67). After multivariate adjustment, risk differences became nonsignificant at 28 days, but diabetes was still associated with a significantly higher long-term mortality in both men (28-day HR 1.16; 95% CI 0.99–1.36, 5-year HR 1.49; 95% CI 1.36–1.64) and women (28-day HR 1.12; 95% CI 0.97–1.28, 5-year HR 1.39; 95% CI 1.27–1.52). The interaction between diabetes mellitus and gender did not reach significance in the analyses. Conclusion Our findings in an unselected cohort covering a complete nation show a significantly higher long-term mortality after a first acute myocardial infarction in diabetic patients. Yet, short-term mortality is not significantly higher in diabetic patients. Risks appear to be equally elevated in men and women.     

A method for combining results from several prospective epidemiologic studies

An approach to the problem of a single study lacking adequate power to examine an important question is to combine the data from several studies to allow a more powerful test of the hypothesis in question. The present paper describes a method used by the International Collaborative Group to pool data on 54,492 men aged 40-69 from 10 population studies in 7 countries to examine the association between cholesterol level and risk of death from cancer. Furthermore, there was a suggestion that the inverse association observed in some studies might be the result of an effect of undetected cancer on cholesterol level, rather than an increase in cancer risk resulting from low cholesterol levels. This paper describes the process for selection of the method used to evaluate this possibility over other potential approaches and the results obtained in the analysis of the International Collaborative Group data that support this hypothesis. This report also indicates how one might expect some of the analyses described to compare with analyses based on a discrete version of the Cox proportional hazards model.     

浙江省2005-2010年结直肠癌生存率分析

目的分析2005—2010年浙江省30个卫生监测区全人群结直肠癌患者的生存率。方法随访浙江省卫生监测区2005—2010年17 235例结直肠癌患者的生存情况,生存时间计算截至2012年12月31日,利用SURV 3.01软件计算观察生存率(OS)及相对生存率(RS)。结果结直肠癌患者1、3、5年OS分别为76.71%、58.14%、50.58%,RS为78.93%、63.48%、58.73%。其中男性RS为79.36%、63.63%、58.85%;女性RS为78.35%、63.29%、58.57%,男女性生存率差异无统计学意义(X²=1.08,P=0.298)。城市地区5年OS和RS分别为55.06%与64.09%,高于农村地区的47.59%和55.16%,差异有统计学意义(X²=85.84,P2=333.42,P<0.001)。结肠癌与直肠癌5年Rs分别为61.47%和56.45%,结肠癌患者中长期Rs高于直肠癌患者(X²=7.26,P<0.05)。结论浙江省结直肠癌生存率存在地区差异,公共卫生资源应向农村地区倾斜;影响<55岁结直肠癌患者生存率的因素有待进一步研究。     

Accelerometer-assessed light-intensity physical activity and mortality among those with mobility limitations

Background

Emerging research demonstrates that light-intensity physical activity is favorably associated with numerous health outcomes among the general population, even independent of high-intensity physical activity.

Association between dietary behavior and mortality among American adults with mobility limitations

Background

Limited research has evaluated the relationship between dietary behavior and mortality among those with mobility limitations.

医学生考试焦虑状况的调查分析

目的 了解阶段性的考试事件对学生焦虑状态的影响情况。方法 采用SAS焦虑状态自测量表评价焦虑程度，应用SPSS软件分析结果。结果 男生中有考试焦虑的占19．5％，女生占28．46％，高年级学生出现焦虑的比例高于低年级学生。结论 考试焦虑现象在医学生中普遍存在，表现出较明显的性别差异，高年级学生出现焦虑的比例高于低年级学生。     

医疗设备档案管理中创新思维的运用

目的:探讨创新思维在医疗设备档案管理中的积极作用.方法:通过查阅文献和实践经验总结,对创新思维和创新能力的实施进行科学探讨.结果:将创新内容应用于医疗设备档案管理中,为高效率利用医疗设备档案资源进行有益尝试.结论:通过对创新思维、创新能力的探讨,有望改变医疗设备档案管理滞后的现状和局面.     

论现代医疗服务质量管理的创新思维

通过对医疗服务质量管理的理念、模式、制度、组织、技术、流程、标准、机制等8个方面创新实践的分析研究,探讨新形势下医疗服务质量管理的新思维、新途径,指出医疗质量管理创新是医院适应日益激烈的市场竞争的有力武器,是达到超严质量要求的重要手段,要以创新思维为先导,拉动医疗质量管理理论与实践的永续创新,实现医疗质量持续改进目标,促进医院的可持续发展。     

以人为本创新服务 提升医疗质量内涵

为了构建和谐的医患关系，为病人提供优质服务，使科室的发展与医院的发展有机地统一起来，本文结合科室管理实际，引入人本理念，重视医患管理的和谐性和科学性，把握优质、低耗、高效服务主线，瞄准创新管理及深挖质量第一的内涵，实施提供质量满意服务全面管理等6个方面，达到了以人为本的管理机制让医疗工作可持续发展。     

Social science and medical education in Nigeria

In response to Nigeria's 'old' and seemingly intractable health problems and the emergence of a 'new' epidemiology of behaviour-related and social disorders, there is an urgent need for greater participation of social scientists in the training of front-line health care practitioners and delivery of care. This study was conducted to determine the current extent of involvement of the social sciences in Nigerian medical education. A survey was carried out in all schools/colleges of medicine in the country. Nineteen social scientists, comprising 1 anthropologist, 10 psychologists and 8 sociologists, were identified in 10 of the 12 schools. Questionnaires were sent to all of them and 12 were returned. Analyses of the data collected showed that most psychologists were affiliated with departments of psychiatry and sociologists with community health/social medicine. Psychologists spent most of their time in teaching, clinical work and research (in that order); and sociologists in teaching, research and health care delivery. Most of the social scientists perceived their work as essential in the training of medical doctors and thought that the medical school provided a good opportunity for research. But a significant number of them complained of status inequality with their medically-trained colleagues. This was regarded as one of several obstacles to greater participation of social scientists in Nigerian health care. It was suggested that while social scientists were essential in the training of health care personnel, they needed to diversify their inputs (emphasizing health promotion and disease prevention) in accordance with a broadened and socially relevant view of health and illness.     

试论医学科学技术创新

作者讨论了创新是时代的要求，是医学科学技术发展的需要。提出创新的根本在人，在人才素质：要有高尚的品德；强调实践、知识、思考的结合；要善于选择目标和抓住机遇。提出要弘扬医学科学精神，遵循医学科研的基本要求。要正确处理医学与其他科学，以及医学内部的一些关系。提出要为医学科技创新创造良好的环境条件；并讨论了阻碍医学科技创新的因素。     

No debt for medical students in Greece

BACKGROUND: Medical education in Greece is government-funded by constitution. Tuition fees are therefore not payable by students. This investigation aims to identify the sources of income of medical students in Greece. METHODS:This is a questionnaire-based analysis of a sample of 488 students who were asked to state their sources of income. RESULTS: Mean contributions to total student income are parental financial support (93.2%), part-time employment (2.4%), scholarships (2.5%) and other sources including loans (1.9%). CONCLUSION: The income of medical students in Greece is mostly dependent on parental contributions. Other sources do not represent popular options. This situation differs to that in other countries, where loans make significant contributions to the total income of medical students.     

从医学情报角度对医学科研管理的见与谏

从医学情报的角度论述了对医学科研管理的见解和建议,包括：医学情报是医学科研管理之信息源;医学情报研究是医学科研规划之基础;技术情报是战略作用之“一斑”;医学情报的效用有赖于医学科研管理之采用;医学情报的效益有赖于医学科研管理之评价;行政科学与科学行政亟待科研管理者之倡导;“资源获取能力”不应作为科研综合竞争力之指标;SCI和IF评价慎用以免对医学科研之误导;我国医学科技期刊发展是医学科研管理之难题;科学观是中医药科研管理的思想方法之根本;医学情报诚望得到医学科研管理者之理解和支持。     

联合模型介绍及在医学研究中的应用

医学随访研究中,纵向数据和生存数据往往伴随出现,并且通常相关联,对纵向数据和生存数据单独分析可能会导致有偏倚的结果。联合模型同时处理纵向数据及生存数据,能够纠正偏差,提高参数估计的效率并提供有效的推论,是目前医学研究中一个比较热门的方法。联合模型已取得较多进展,国内介绍及应用联合模型的文章较少。本文将从主要思想、基本框架、参数估计方法等方面对联合模型中的随机效应模型进行介绍,并基于R软件中程序包JM对艾滋病数据集分析,旨在阐明联合模型在处理医学随访数据中的优势,促进联合模型在临床研究中的应用。     

A focus of Fasciola hepatica in Crete without human cases

In Greece, Fasciola hepatica, the sheep liver fluke, is common in sheep but only three human cases of fascioliasis have been reported. An epidemiological study was conducted in central Crete which proved to be a focus of F. hepatica. Sheep and snails were found positive for this parasite, but none of the 205 persons tested serologically.     

Non-medicalization of medical science: Rationalization for future

As we delve into the intricacies of human disease, millions of people continue to be diagnosed as having what are labelled as pre-conditions or sub-clinical entities and may receive treatments designed to prevent further progression to clinical disease, but with debatable impact and consequences. Endocrinology is no different, with almost every organ system and associated diseases having subclinical entities. Although the expansion of these “grey” pre-conditions and their treatments come with a better understanding of pathophysiologic processes, they also entail financial costs and drug adverse-effects, and lack true prevention, thus refuting the very foundation of Medicine laid by Hippocrates “Primum non nocere” (Latin), i.e., do no harm. Subclinical hypothyroidism, prediabetes, osteopenia, and minimal autonomous cortisol excess are some of the endocrine pre-clinical conditions which do not require active pharmacological management in the vast majority. In fact, progression to clinical disease is seen in only a small minority with reversal to normality in most. Giving drugs also does not lead to true prevention by changing the course of future disease. The goal of the medical fraternity thus as a whole should be to bring this large chunk of humanity out of the hospitals towards leading a healthy lifestyle and away from the label of a medical disease condition.     

某医科大学生蠕形螨感染率及影响因素调查

目的 为了解某医科大学生面部蠕形螨的感染状况,探讨蠕形螨感染的危险因素.方法 以某医科大学的641名在校大学生为调查对象,采用透明胶带法收集样本,并进行镜检.同时,采用自行设计的问卷调查,x2检验等方法分析蠕形螨感染的相关因素.结果 受检学生641人,检出感染人体蠕形螨74人,感染率11.5％,其中男生感染率为9.7％ (26/269),女生感染率为12.9％ (48/372),差异无统计学意义(P=0.206);2011级学生的检出率为14.8％ (37/250),2012级学生的检出率为9.5％ (37/391),差异有统计学意义(P=0.039);油性或混合性肤质者感染率为13.1％比干性或中性皮肤者感染率(6.1％)高(P =0.026);感染者的感染度以轻度(1～5条)为主,占95.9％ (71/74),1人最多检出14条蠕形螨.结论 该校的蠕形螨感染率偏低.随集体宿舍生活时间的增加,感染率上升;偏油性肤质者比偏干性肤质者更容易发生感染.