医学领域的信息革命

信息技术革命对医学领域的渗透，引起医学思维方式的变化，也使传统医疗模式受到巨大冲击，发展了网上医院、远程医疗、全科医学和家庭医学。信息技术的发展极大促进了医学诊疗技术和生物科学的进步，同时也使医疗领域面临着前所未有的困扰和严峻挑战。全社会应该对此进行更深入的思考。     

信息技术与医学课程整合的体会

在以网络和计算机为核心的信息技术高速发展的今天,在医学教育领域,信息技术与医学课程整合是一个发展的新阶段,也是医学课程教育教学领域的一场深刻变革,还是深化学科教学改革的根本途径。然而若是信息技术与医学课程整合不能在科学的理论指导下进行,有效的整合是难以实现的。本文在全面理解医学教育信息化的内涵、特征的基础上,从医学教育信息化的角度审视信息技术与医学课程整合的途径,以期为整合中存在的问题提供解决方法,为整合的实施指明方向。     

推动高压氧医学的发展——在临床实习中开设高压氧医学知识讲座的尝试

高压氧医学是一门较为年轻的临床医学分支学科,现已广泛用于临床各科疾病的治疗,显示了良好的疗效,具有十分广阔的发展前景。但是在目前的教育体制下多数临床医师不具有高压氧知识,从某种程度上阻碍了高压氧医学的发展。采用多媒体和互动学习方式在临床本科生实习阶段开设高压氧知识讲座,一方面开拓了学生视野,取得了预期效果,另一方面对高压氧医学的发展有促进作用。     

信息革命对医学衍进的冲击

新世纪信息技术向医学领域不断渗透,引起医学思维方式的变化,促进了医学诊疗技术和生物医学的巨大进步。信息网络技术的兴起对传统医疗模式产生了冲击,发展了网上医院,远程医疗及全科医学、家庭医学。同时信息社会中的医疗领域也面临着前所未有的困扰和严峻挑战。     

我国职业医学研究现状及进展

近半个世纪来的科学进步与社会发展，不仅促使基础医学突飞猛进，推动临床医学迅速发展，而且也使预防医学不断进展。职业医学既是临床医学的一个学科，也是预防医学的一个分支。展望21世纪，我国的职业医学在跟踪国民经济由东向西的快速发展，不断适应经济全球化及社会新的需求和汲取基础、临床与预防医学的新进展后，必将在其学科领域和应用技术方面发生巨大的变化，取得丰硕的成果。     

浅谈现代医学影像学在临床合理应用

自伦琴发现Ｘ射线 1 0 0多年来 ,放射学在医学领域是最年轻的学科。从简单常规的诊断发展到今天众多的医学影像学 ,特别是放射技术与计算机相结合 ,产生了ＣＴ、ＭＲＩ、ＤＳＡ等系列新设备 ,由平片发展到了体层成像、数字化、三维仿真重建阶段[1] 。尤其是影像诊断与介入放射学结合构建了诊治兼备的又一临床学科 ,使传统的放射诊断发生了量和质的变化 ,它的临床应用之广泛、发展之迅速、检查及治疗项目之多 ,是其它学科所不及的。本文就现代影像学的临床合理应用问题略述如下。　　现代医学影像学包括以下几个方面 :①普通Ｘ线成像 ,包括Ｘ…     

整合医学发展应始于急诊和重症医学

时代需要整合医学。将急危重症医学进行整合改革,将相关领域最先进的理论和临床技能渗透及融合到疾病的急危重症阶段的新医学学科,必将有益于大量急危重症及多脏器病变患者的治疗。以患青为本,选择性学科整合,选择性学科细分,是科学发展和与时俱进的必然趋势。     

医学影像学教学改革初步探讨

医学影像在20世纪是医学领域中知识更新最快的学科之一.从第一张X线片的诞生,到CT、MRI、介入放射学等的影像技术、影像诊断和影像治疗的相继问世,医学影像学经历了一个飞速的发展过程.医学影像学作为一门实践性很强的学科,是介于基础医学和临床医学之间的桥梁学科.     

医学社会学的研究对象、内容和基本观点

一门学科的性质是由其特定的理论范畴,尤其是研究对象和内容来确定的。医学社会学的研究对象与内容从学科创建至今已有了很大变化,从总的发展趋势看,其研究的范围已越来越广,涉及的领域也越来越多,这也是本文重新探讨医学社会学研究对象和研究内容的重要原因之一。１医学社会学研究对象与内容的历史演变 从学科性质看,医学社会学与健康社会学、卫生社会学等基本上是同义语。某一学科研究对象与内容的变化,既反映了人类认识的变化,同时也是学科发展的重要标志。当然,由于各国的文化背景、社会制度、健康水平和文化素养也会有差异,…     

对数字医学基本概念和内涵的理解与认识

论述了数字医学产生与发展的背景与形成过程,在此基础上探讨了数字医学的基本概念与内涵。认为：数字医学是信息社会发展进程中应运而生的新兴学科,它是医学与信息学、电子学、生物学、管理学、机械工程学、工程物理学等诸多学科相交叉的前沿科学：数字医学应用技术涉及信息技术、数字技术、通信技术、微电子技术、新材料技术、先进制造技术等多种高新技术,这些技术与医学相结合,形成了以数字化技术为核心的数字医疗检测技术、数字医疗诊断技术、数字医疗治疗技术、数字医疗监控技术和数字医疗康复技术等,它们全方位渗透到基础医学、临床医学、预防医学、康复医学等各个学科,使传统医学理论方法、工作模式和运行机制等都发生了翻天覆地的变化,并将医学推进到一个前所未有的新高度。     

Language barriers to informed consent and confidentiality: the impact on women's health

Obtaining informed consent and maintaining confidentiality are critical to the way we practice medicine and remain a crucial part of our medicolegal responsibility to the patient and to society. Nevertheless, little attention has been paid to these topics in populations who may have limited English proficiency. Despite research suggesting that language barriers have direct effects on health and health care delivery, many health care settings do not provide professionally trained interpreters to patients who need them. This is clearly a challenge that will only grow as our nation becomes more diverse. Perhaps nowhere is this issue more significant than in women's health, given the very personal and sensitive nature of the medical exams and interventions. As health care providers, we must conduct and facilitate research on how language barriers compromise quality of care, and we must advocate for systems and policy change.     

EBM and the health of Indigenous Australians

Implementing evidence-based medicine (EBM) in primary healthcare for Indigenous people will usually involve increasing services, particularly those for chronic conditions. As shown by the example of diabetes care, there are significant organisational, educational, economic, cultural and structural barriers to implementing EBM in many Indigenous communities. Many of these barriers could be reduced by better-organised service delivery systems at the community level, greater numbers of Indigenous health professionals and greater advocacy for healthy public policy by health services. There is evidence that delivering evidence-based primary healthcare, particularly for chronic diseases, can improve health outcomes in Indigenous communities. There is a need for more investment in strategies to implement EBM and evidence-based public health in Indigenous settings.     

Barriers to using clinical decision support in ambulatory care: Do clinics in health systems fare better?

ObjectiveWe quantify the use of clinical decision support (CDS) and the specific barriers reported by ambulatory clinics and examine whether CDS utilization and barriers differed based on clinics’ affiliation with health systems, providing a benchmark for future empirical research and policies related to this topic.Materials and MethodsDespite much discussion at the theoretic level, the existing literature provides little empirical understanding of barriers to using CDS in ambulatory care. We analyze data from 821 clinics in 117 medical groups, based on in Minnesota Community Measurement’s annual Health Information Technology Survey (2014-2016). We examine clinics’ use of 7 CDS tools, along with 7 barriers in 3 areas (resource, user acceptance, and technology). Employing linear probability models, we examine factors associated with CDS barriers.ResultsClinics in health systems used more CDS tools than did clinics not in systems (24 percentage points higher in automated reminders), but they also reported more barriers related to resources and user acceptance (26 percentage points higher in barriers to implementation and 33 points higher in disruptive alarms). Barriers related to workflow redesign increased in clinics affiliated with health systems (33 points higher). Rural clinics were more likely to report barriers to training.ConclusionsCDS barriers related to resources and user acceptance remained substantial. Health systems, while being effective in promoting CDS tools, may need to provide further assistance to their affiliated ambulatory clinics to overcome barriers, especially the requirement to redesign workflow. Rural clinics may need more resources for training.     

Remote Indigenous Australians with cataracts: they are blind and still can't see

Aboriginal and Torres Strait Islander people are three times more likely than non-Indigenous Australians to report vision loss due to cataracts, but are four times less likely to have cataract surgery. To increase access for Aboriginal and Torres Strait Islander people to cataract surgery, we need to identify the barriers to current services and trial strategies to overcome these barriers. Barriers to cataract surgery exist at the health service, community and individual level. Health service factors include infrastructure, cost, and provision of interpreters, escorts and transport. Community factors include social support, perceptions about the success of surgery, and beliefs about the causes of cataracts. Individual factors include ignorance that cataracts can be cured, fear of surgery or poor outcome, and comorbidity. Strategies proven to increase uptake of cataract surgery in other countries could be trialled in remote Australia.     

来华留学生病理生理学教学之探析

为提高来华留学生病理生理学教学质量,促进我国医学教育与国际接轨,现以本校留学生为例进行分析发现,留学生的来源和特点、授课教师英语水平、课程体系等制约着留学生对病理生理学学习兴趣和教学质量的提高,并从提高教师胜任力、采用多元化教学模式、注重科研和实践能力培养等方面提出相应的解决对策,这将为留学生病理生理学的教学提供有价值的参考.     

金纳米颗粒在肿瘤显像和治疗领域中的应用

随着纳米技术的发展,各种纳米级物质在生物医学领域的应用层出不穷,尤其是金纳米颗粒(GNP)正逐步涉足肿瘤显像及治疗领域。分子水平的GNP可以克服生物屏障,优先汇聚于肿瘤细胞中,并且能携带探测信号或治疗物质,通过与各种肿瘤特异性标志物相耦联能够特异性识别肿瘤细胞,同时利用GNP的特殊物理特性,将对肿瘤的诊断、治疗和监测带来新的突破。     

Bioethics in the public square: reflections on the how

As bioethics gains more prominence in public policy debates, it is time to more fully reflect on the following: what is its role in the public square, and what limitations relate to and barriers impede its fulfilment of this role? I contend we should consider the how of bioethics (as a policy influencer) rather than simply focus on the who or what of bioethical enquiry. This is not to suggest considerations of latter categories are not important, only that too little attention has been paid to parallel or resulting policy involvement-involvement that will require specialised skills and knowledge that we can develop with a proactive (vs reactive) stance. Moreover, and equally critically, this how of public policy involvement will require more transparency regarding influences (eg, philosophical, ideological, cultural, socio-political) on what bioethicists bring to the table and what constituency base each represents-a humility as to the scope of one's role. In this vision, bioethics is not one single person or belief system for a policymaker to call to guide or give support to a position; rather, it offers tools-formed and utilised by a diverse disciplinary range of individuals-to help guide ethical analysis of biomedical endeavours, with the goal of infusion and diffusion of ethical enquiry and prioritisation in health policymaking, and greater humility among bioethicists who inform this discussion.     

Strategic approaches to the development of Australia's future primary care workforce

Shortages in, and maldistribution of, the primary health care workforce will continue to limit access to health care. The current health reform proposals and policies recognise workforce development as a priority, but only partially address the barriers to improvement. In particular, there will need to be more systematic development of interdisciplinary education within primary health care services, and funding to support this.     

北京市某近郊区居民身体活动情况及其影响因素

目的：分析北京市通州区居民的身体活动情况及其影响因素,为今后有针对性地实施身体活动干预和相关政策的制定提供参考。方法： 以北京市通州区18岁及以上居民为调查对象,共纳入研究7 319人。采用自行设计的调查问卷,该问卷基于健康信念模式设计,信效度良好。以6和10千步当量为是否达到身体活动量的判断标准,采用多因素Logistic回归分析方法探究居民身体活动的影响因素。结果： 北京市通州区居民日均身体活动总量的中位数为9.1千步当量,四分位数间距为（3.8, 20.4）,平均每日身体活动总量达到6和10千步当量的比例分别为63.7%和47.7%;工作或家务类、交通类以及休闲类身体活动量的中位数分别为4.0、1.0和 0.0千步当量;占身体活动总量的比例分别为61.7%、18.3%和20.1%;8.6%（626/7 318）的居民不进行任何形式的中等强度或高强度的身体活动;基于健康信念模式共产生5个因子,累积贡献率为63.7%;身体活动量在文化程度、年龄、性别、自我效能、提示因素、主观和客观障碍间差异具有统计学意义(P<0.05)。女性、高年龄组、低文化程度的人群身体活动量多;自我效能感越高,提示因素,主观和客观障碍越少,身体活动量越多。结论： 居民整体的身体活动水平尚可,主要以工作或家务类活动为主。男性、18~29岁和大学/大专及以上学历的人群是重点干预人群,今后需根据不同人群的具体情况制定相应的干预策略,重点是提高居民的自我效能感,降低身体活动主观和客观障碍,并倡导居民积极参加休闲锻炼,以提高居民整体的健康水平。     

The patient-physician relationship. Teaching the human dimensions of care in clinical settings

Despite repeated calls to emphasize the humanistic dimensions of care during medical education, these are few known techniques for effective teaching of humanism. We describe the barriers that inhibit humanistic teaching and suggest pragmatic teaching methods to overcome such barriers and teach humanistic care in clinical settings. We began by asking participants at a conference on patient-physician communications sponsored by the American Academy on Physician and Patient in June 1998, "What can we do in the patient's presence to improve and teach the human dimensions of care? Please provide one or more examples of approaches you found to be effective." We augmented this information with suggestions from a number of colleagues in other settings. In a series of iterations, we analyzed all their suggestions to identify key teaching methods. We found that barriers to teaching humanism largely consist of elements of the informal and hidden curricula in medical schools. We then defined methods to help teachers overcome these barriers. Specific methods fall into the 3 categories of taking advantage of seminal events, role modeling, and using active learning skills. We believe that formal courses and other well-motivated endeavors that take place away from patients fail to foster humanistic care. In contrast, we present pragmatic teaching methods that can be used in the fast-paced setting of the clinical environment.