THE EPIDEMIC COMMISSION OF THL LEAGUE

From the outset of the military operaLious one of the most pressing problems was the care of refugees and the danger of epidemics. The National Health Ministry and the Central Field Health Station at Nanking were wrecked by air bombing at the beginning of the war. China''s scanty resources in medical per- sonnel and equipmenr were strained to the utmost hy the needs of the Army. At the same time the invasion of large areas of China and the devastation uf numer- ous cicics and villages set up great movemenrs of pnpulation. Vast numbers of'' refugees, destitute and fleeing for their lives, became an urgent and grave pro- blem for the Chinese Government, and even for ncighbr)uring territories, not least: from a public hcalth point of view.     

Changing practice on confidentiality: further points for discussion

In the March 1982 issue of the Journal Dr Pheby, a community health doctor, was one of several writers to discuss medical confidentiality. Dr Pheby urged doctors to minimise subjective and judgmental comments in medical records and to make clear when their assessments were speculative. He also urged `vigorous reappraisal of the extent to which information about a patient needs to be circulated' to members of other disciplines, for instance, in child health practice. If doctors did not take such steps themselves legal changes might well be imposed upon them, giving patients the right of access to their medical records and perhaps making breach of medical confidentiality a criminal offence.

Mr Jacob, a lawyer, commenting on the papers by Dr Pheby and Mr Kenny, a health administrator, argued that increased legal intervention in medical ethics could quite possibly actually erode traditional medical ethical standards of confidentiality based on peer review and `the ethic of virtue'.

     

The National Library of Medicine. Evolution of a premier information center

From a small collection of medical publications in the Surgeon General's Office in 1836, the National Library of Medicine has developed into the leading repository of medical information in the world. Despite strong opposition and impediments from certain quarters, involving considerable machinations and intrigue, the determination of interested medical leaders and sympathetic members of Congress triumphed in having this remarkable institution established on the campus of the National Institutes of Health, Bethesda, Md. As a participant in many of the negotiations preceding that decision, I have happily witnessed the transformation of the Library, long housed in cramped, makeshift quarters, to its present magnificent structures in the heart of our nation's foremost medical research center. Its prodigious collection of print, audiovisual, and electronic information; its imaginative research projects; its excellent outreach program; and its innovative services and products are indispensable to all practicing health professionals, scientists, and medical educators, as well as to journalists, government officials, and others. The ultimate beneficiary, of course, is the patient.     

陈祖皋先生常用对药与角药经验

[目的]传承陈祖皋先生临床用药经验,研习其用药特色。[方法]通过复习有关本草医籍,将陈师常用对药与角药加以总结整理。[结果]完成陈师桂枝、地骨皮,桂枝、甘遂,穿山甲、皂角刺,白芥子、九香虫,黄芪、天花粉,秦艽、白蒺藜,附子、细辛、石膏,黄芪、知母、太子参等8组对药与角药的总结。陈师是一位烙有深刻师承印记的老一辈绍兴名医,从事临床工作五十余年,其临证如临阵,用药如用兵,善用对药和角药论治疾病。[结论]对药与角药是医者处方用药之主干,排兵布阵之良将。屡用方能达药,细究陈师用药经验,必将从中得到教益。     

Screening for von Hippel-Lindau disease by DNA polymorphism analysis.

OBJECTIVE--Von Hippel-Lindau (VHL) disease is a rare, inherited multisystem neoplastic disorder. There is no biochemical test available to distinguish VHL disease gene carriers from their healthy siblings. We evaluated DNA polymorphism analysis as a method for identifying disease gene carriers. DESIGN--Prospective comparison of the results of DNA analysis with a comprehensive clinical screening examination. SETTING--The Clinical Center of the National Institutes of Health. PATIENTS--Blood was collected from 182 members of 16 families with VHL disease. Forty-eight asymptomatic individuals, at risk of developing this hereditary illness (with an affected parent or sibling), were examined for occult disease at the Clinical Center of the National Institutes of Health and tested by DNA polymorphism analysis. RESULTS--DNA polymorphism analysis predicted nine disease gene carriers and 33 individuals with the wild-type (normal) allele among the 48 individuals at risk of developing VHL disease; the test was not informative in six individuals. All nine individuals predicted to carry the VHL gene had evidence of occult disease on clinical examination. There was no clinical evidence of VHL disease in 32 of 33 individuals predicted to carry the wild-type allele. CONCLUSIONS--DNA polymorphism analysis can identify individuals likely to carry the VHL disease gene among asymptomatic members of disease families. This technique serves to focus attention on those individuals who require periodic medical examination and may help to alleviate the morbidity and mortality associated with this disease.     

Physician need. An alternative projection from a study of large, prepaid group practices

To model a base level of physician demand in a managed health care system, we examined in 1983 the ratios by specialty of full-time equivalent physicians to health maintenance organization members in seven large, closed-panel health maintenance organizations, each with more than 100,000 members. The medical director of each plan was surveyed by mailed questionnaire and telephone interview to determine the plan's number of full-time equivalent physicians by specialty and members served. Out-of-plan physicians contracted by the group were included within the specialty distribution wherever possible. We compared our findings (4779.4 full-time equivalent physicians serving 4,297,790 members) with Graduate Medical Education National Advisory Committee and others' projections of physician need and supply. Based on this model and unknowns that might affect utilization, our study suggests that at least 111 physicians per 100,000 population would be necessary in a system that emphasized reduced utilization of services and that more primary care physicians would be needed than the Graduate Medical Education National Advisory Committee predicted would be available.     

I. L. Hicks

Mr. I. L. Hicks is an executive vice president of Technicon Corporation and the president of the Technicon Medical Communications Group headquartered at Santa Clara, California. Mr. Hicks has an honours degree in science and a master's degree in business administration. Prior to moving to the United States 2 years ago, Mr. Hicks held the position of regional director for an international division of Technicon, being responsible for Technicon's activities in the United Kingdom, Africa, Iran, Israel, Greece, and Turkey. He was formerly the managing director for Technicon Australia, responsible for Technicon's business in the Pacific and the Far East.     

A STATISTICAL STUDY OF 268 CASES OF TYPIIOID AND PARATYPHOID FF,VER IN ST. ANDREW'S HOSPITAL, WUSIH, FROM 1928-1934

In a review of all the typhoid fever cases in the available Chinese literature, the following summary may be given. There were 35 cases of typhoid and paratyphoid reported by Dr. H. J. Smyly of P.U.M.C. in 1920, 40 cases of typhoid fever by Dr. Lee S. Huizenga of Nanking University Hospitalin 19''3, :256 cases of typhoid fever by Dr. S. H. Zia of Peiping in 1928, and: zoo cases of typhoid and paratyphoid fever by Dr. J. H. Wylie of the Taylor Memorial Hospital at PaotiW;fu in 1930.     

Unconscious on a corner

A physician working in inner-city Washington, D.C., uses the case of Mr. W., a homeless demented patient, as the starting point for his essay on medicine's abandonment of the poor. Having stabilized Mr. W. and treated his acute condition, the hospital physicians were prepared to discharge him to the unsupervised environment of a city shelter. Hilfiker acknowledges that the needs of the poorest, most broken members of society seem overwhelming. Physicians, not knowing what to do, do nothing, and the public sector does little enough. Hilfiker identifies the "monetarization" of private medical care, the inadequacy of the public system, and the stresses and frustrations of caring for the poor as the reasons for their abandonment by the medical bureaucracy. He urges his colleagues to bring the poor into their practices, and to return to their roots as members of a "servant profession."     

中日临床医学专业水平测试的比较研究与启示

临床医学专业水平测试是我国国家医学考试中心于2020年开发,旨在检验临床专业医学生进入临床实习前是否具备本阶段应具有的医学人文素养、医学基本理论知识和技能的考试。日本自2002年开始实施了一项名为“临床医学专业实习前联合考试”的考试,该考试的考试目的、内容形式、成绩评定等方面都与我国水平测试极为相似。本文通过分析比较中日两国的考试,认为有必要借鉴日本的经验,加快推进我国临床医学专业水平测试考试成为行业准入考试的进程;并建议医学院校持续追踪临床医学专业水平测试发展动态,充分发挥该考试在促进医学生重视临床实习方面的作用;同时督促医学院校按照岗位胜任力标准建立与国家临床执业医师资格考试同标准的三级考试体系,不断提高育人质量。     

A specialty-specific approach to appraisal of audiovisual teaching materials.

The number of audiovisual teaching materials for medical audiences has enormously grown during the past 10 years. To help medical educators become aware of what is available, and to help them select useful materials the Audiovisual Review Committee was established in 1974; its members serve on a voluntary basis, meeting twice a year to review 16mm. films, videotapes, and tape-slide programs. During the period 1974-78 a total of 160 audiovisual programs were reviewed; of these 47 were highly recommended, and only 14 were judged of limited value. AVLINE, the audiovisual on-line program conducted by the National Library of Medicine at NIH, provides a data base with references to over 5000 audiovisual programs, most of which, however, are not geared to family practice needs.     

抑郁症患者的就医行为及影响因素

目的:探讨抑郁症患者认识及就医行为的影响因素。方法:按就诊先后顺序把首次在专科医院就医的抑郁症患者309例作为A组,首次在综合医院就诊的抑郁症患者303例作为B组。对2组病例进行SCL-90、HAMD、一般状况问卷调查。对2组病例患者家属进行自制量表的调查。结果:对疾病的认识与宗教信仰(P<0.05)、婚姻(P<0.01)、家庭成员(P<0.01)、疾病特点(P<0.01)相关,就医行为与年龄(P<0.05)、性格(P<0.05),就医费用(P<0.05)、医生的建议(P<0.05)、宗教信仰(P<0.01)相关。结论:抑郁症患者及家属对疾病的认识及就医行为存在误区,专科医院就诊率低。     

''The implications of medical ethics''.

Professor Goldworth takes up the cudgels in defence of the contemporary moral philosopher, who, he says, should indeed have a role in helping doctors to make clinical decisions based on philosophical theory; Mr. Thompson in his reply says that Professor Goldworth has misinterpreted his earlier argument. Mr. Thompson reiterates his view that the practice of medical ethics must begin with the professionals -- the doctors and nurses--although the philosopher could perhaps find himself part of a medical team. In these circumstances Professor Goldworth and Mr. Thompson would be in complete agreement. Both writers seem to be reflecting very clearly the ideas current in American and British climates of opinion.     

Ethnicity, self-reported illness and use of medical services by the elderly.

Analysis of ethnic differences in disease is complicated by the fact that culture has an effect on whether people identify themselves as ill and how often they use medical services. This paper cities evidence to show that use of selected medical services by older members of ethnic groups appears to be high. Although a relatively high amount of disease among minority ethnic groups partly accounts for this, additional explanations--notably, cultural perceptions of doctors and aspects of the ageing migrant''s position in society--are suggested.     

Three Decades of Research on Computer Applications in Health Care: Medical Informatics Support at the Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality and its predecessor organizations—collectively referred to here as AHRQ—have a productive history of funding research and development in the field of medical informatics, with grant investments since 1968 totaling $107 million. Many computerized interventions that are commonplace today, such as drug interaction alerts, had their genesis in early AHRQ initiatives.This review provides a historical perspective on AHRQ investment in medical informatics research. It shows that grants provided by AHRQ resulted in achievements that include advancing automation in the clinical laboratory and radiology, assisting in technology development (computer languages, software, and hardware), evaluating the effectiveness of computer-based medical information systems, facilitating the evolution of computer-aided decision making, promoting computer-initiated quality assurance programs, backing the formation and application of comprehensive data banks, enhancing the management of specific conditions such as HIV infection, and supporting health data coding and standards initiatives.Other federal agencies and private organizations have also supported research in medical informatics, some earlier and to a greater degree than AHRQ. The results and relative roles of these related efforts are beyond the scope of this review.Three decades ago, when the federal government''s National Center for Health Services Research and Development began to support research on computer applications in health care, few imagined the impact that information systems and sciences would have on medical care today. For most, the idea of a national clearinghouse of guidelines, available through a computer that sits on a home office desktop, seemed like science fiction. For a few researchers and those supporting their work, however, visions of what could become possible in the management of health care information called for development of computerized systems and the evaluation of their effects on quality, cost, and access to care.The Agency for Healthcare Research and Quality (AHRQ, from 1999) and its predecessor agencies—the National Center for Health Services Research and Development (beginning in 1968) and the Agency for Health Care Policy and Research (from 1989 to 1999)—have a rich history of funding research, development, and evaluation in medical informatics. Although the grant investments since 1968 total only $107 million ($246 million in 2000 dollars), they supported initiatives that have established a research framework for many of the computer applications now being used today.The focus of AHRQ''s early research funding in medical informatics was on acquiring patient care data and communicating patient care management information. The goal was not only to improve the quality of care, but also to achieve reductions in costs and medical personnel resource use by processing data more efficiently. Research aimed at improving communication of information was targeted at what we would call today “getting the right information to the right place at the right time.” The promise of this research was its ability to provide findings that would guide reorganization of care delivery, take advantage of the more rapid communication of necessary information, and reduce manpower needs.¹ Over time, AHRQ''s funding has emphasized the application of health services research methods to evaluations of information technology used in community health settings. This article highlights key accomplishments emerging from AHRQ''s funding that have improved the quality of patient care in studied sites and have the potential to improve health care in all settings.Other federal agencies (such as the National Library of Medicine, the Veterans Health Administration, and the Department of Defense) and private organizations (such as The John A. Hartford Foundation, The Robert Wood Johnson Foundation, and the American Hospital Association) have supported developments in medical informatics, with some having greater research expenditures and earlier histories than AHRQ. Nevertheless, it is the Agency''s contributions to medical informatics that are the focus of this study. The purpose of this article is to provide a historical perspective for understanding the benefits of past research funded by AHRQ that supports health care applications of information technology today and that foreshadows AHRQ''s medical informatics initiatives for the future.     

中西医并重,维护和增进民众健康——对《中国的中医药》白皮书的思考

基于我国目前医疗卫生事业面临的困难和挑战,以及中医药的特色和优势,国务院新闻办发布了《中国的中医药》白皮书,随后第十二届全国人民代表大会常务委员会第二十五次会议通过《中华人民共和国中医药法》.《中国的中医药》白皮书及《中华人民共和国中医药法》进一步确立了中医药在我国医疗卫生事业中的地位和作用.本文介绍了我国医疗卫生事业面临的挑战、中医理论的特点,阐述了中西医并重在维护和增进民众健康方面的作用.     

对矿山救护队员进行现场急救技能培训的研究分析

从2005年开始长期对矿山救护队员进行现场急救技能的培训及训练。根据《美国心脏学会2005年心肺复苏和心血管急救国际指南》及《FIRST RESPONDER》(7th Edition)内容要求,国家矿山医疗救护中心(煤炭总医院)经验丰富的临床医师负责讲课,并指导用CPR模拟人及模拟伤员实际操作演练。5年来分批次直接培训全国24个省、市、自治区的重点60余支矿山救护队中核心成员500余名,再通过这些救护队核心成员进行基层的培训及演练。2006年起在全国矿山救援竞赛中进行现场急救竞赛,本文笔者参与第6～8届现场急救竞赛的裁判工作。竞赛结果表明,第七和第八届竞赛中现场急救扣分均显著低于第六届(P<0.05),但第七、第八届间差异无统计学意义(P>0.05)。实践表明,因大部分矿山救援队队员来自矿工,缺乏医学知识,系统培训非常必要,以点带面的方法行之有效。     

心理健康教育对精神分裂症患者出院后遵医行为的影响

目的 探讨心理健康教育对精神分裂症患者出院后遵医行为的影响.方法 选择2015年1月至2016年6月期间江门市第三人民医院收治的48例精神分裂症患者为研究对象,根据随机数字表法将患者随机分为观察组(n=24)和对照组(n=24),对照组予常规宣教随访,观察组则联合对患者及患者家属的心理健康教育,干预时间为6个月.比较两组干预后患者家属遵医依从性和患者复发率及生活质量(WHOQOL-BRE评分)的变化.结果 干预6个月时,观察组患者家属遵医依从性评分为(6.94±2.19)分,明显低于对照组(9.01±3.28)分,患者复发率(4.17%)明显低于对照组(20.83%),差异均有统计学意义(P<0.05);观察组患者生活质量评分为(78.32±7.51)分,较干预前的(70.16±6.42)分有明显提高,且高于对照组的(71.68±7.29)分,差异均有统计学意义(P<0.05).结论 心理健康教育可以提高精神分裂症患者出院后的家属的遵医依从性,进而减少患者的复发并改善生活质量.     

Mental disorders in medical students at the University of the West Indies,Trinidad and Tobago. Audit at a doctor's practice

A series of 32 consecutive students from one medical school presenting for psychiatric treatment over a two-year period between September 1997 and August 1999 is described. The author treated 31 of these students, representing 288 visits and 312 hours. On the basis of retrospective case note reviews, the author presents demographic data, the year of medical school in which the illness began, DSM IV diagnoses, treatment modalities, time absent from University as a result of mental illness and major stressors. Of the 32 subjects, 50% were male, with ages ranging from 20 to 34 years (mean 24.9 years). Ninety-four per cent were single, and 78% were Trinidadians. Thirty-one per cent were Trinidad and Tobago National Scholars. This finding achieved statistical significance. Seventy-two per cent presented during their clinical training. The most common source of referral was from members of the Faculty of Medical Sciences (31%). Relationship issues were the most commonly identified stressors in 31% of the subjects. Mood disorders and anxiety disorders were present in 59% of the students. Pharmacotherapy was used in 75% of the students. The majority (53%) of medical students with mental disorders were absent from university for less than one month. At follow-up in July 2001, 26 (81%) of the students had graduated, three (9%) were still in medical school and three (9%) had withdrawn from medical school as a result of mental illness. The study is limited in that only those seeking assistance from one doctor's practice are described. The findings would be further explored in longitudinal studies.