Psychiatry as ideology in the USSR.

This paper was given as a talk at the Venice Biennale on 9 December 1977. It was part of a symposium on "The Freedom of Science--Problems of Science of Scientists in Eastern Europe". Dr Bloch details some of the problems of psychiatry and its vulnerability to improper use and thus the dilemmas which must ensue in day to day practice. He looks at psychiatry in the USSR and the system within which Soviet psychiatrists must work. The Communist Party and career advancement for psychiatrists would appear to be closely related and it is suggested that, in all probability, the majority of psychiatrists are as perturbed at the misuse of their profession as their Western colleagues, but act compliantly out of fear. Severe punishments have been imposed on those psychiatrists who have dared to speak out against the régime and the system as operated. Dr Bloch concludes by urging Western psychiatrists to do all they can to help their Soviet colleagues to initiate a return to an independent and automous psychiatric profession.     

骨科学临床见习教学中医学生临床思维能力的培养

临床见习是医学生向医生转变的第一步，是临床医学教学的重要组成部分。临床见习阶段的教学不仅是对医学知识的深化，更是对医学临床思维能力的培养，其教学效果直接关系到医学生以后的实习和工作。中山大学附属第一医院黄埔院区骨科在总结以往见习教学经验的基础上，结合骨科学见习的特点，从教学内容、教学方法、教学形式等各环节突出了医学生临床思维能力的培养，取得了良好的效果。     

A scheduling model for hospital residents

When medical students finish their school they must go through a horrendous apprenticeship known as hospital residency to be able to practice medicine. During residency, they work at least 16-hr a day, 5-days a week, with 2 or 3 nights on-call. These can turn into 36-hr shifts. This means that many patients are being treated by exhausted novices, who are therefore much more likely to make mistakes. It was one such mistake, leading to the death of a New York woman, which led to serious attempts to reforming working hours of residents. In this paper, we developed a decision model which attempts to schedule residents based on the requirements of the residency program as well as the desires of residents as to days-off, weekends, on-call nights, etc.     

储雾罐辅吸普米克、喘康速防治年幼儿哮喘的临床研究

探讨储雾罐辅吸普米克、喘康速防治5岁以下小儿哮喘的疗效及其对EC等的影响。60例6个月～5岁哮喘儿以储雾罐辅吸普米克200μg/次,2～3次/日,喘速康0.25mg/次,按需吸入。3～4周后,随症状好转,普米克量渐减,以100～200μg/日维持,总疗程1年。随机取同期30例患儿口服舒喘灵(或氨茶碱)和强的松(0.5mg/kg.d)治疗。症状缓解后渐减量停服。危重者两组均给氟美松静滴2～3天。随访观察1年以上,记录发作次数、程度、用药情况等,综合判定疗效。观察组58例完成临床观察。监控21例,显效26例,好转9例,无效2例,总有效率为98.55%,对照组依次为5、10、11和4例及86.67%(x~2=10.74,P<0.01)。EC和ECP水平观察组于治后6个月明显下降,但仍高于正常。储雾罐辅吸普米克、喘康速是防治年幼儿哮喘的疗效好而安全的疗法。疗程至少1年以上。     

Sexually transmitted disease among homosexuals

During the last 10 years the health care needs of homosexuals have been receiving increasing attention. However, in their attempts to provide health care to this group, physicians must be familiar with the various lifestyles of homosexuals and the types of infection to which they are susceptible. This paper summarizes the results of recent studies and proposes guidelines for the prevention and treatment of sexually transmitted disease among homosexuals.     

Calcium supplementation and postmenopausal bone loss

A series of 103 early postmenopausal women completed a questionnaire about their dietary calcium intake and were then divided into three groups: those with an intake below 550 mg/day, those with an intake between 550 and 1150 mg/day, and those with an intake above 1150 mg/day. Thereafter they were given a daily supplement of 500 mg calcium for two years and had their bone mineral content measured every three months. Any changes found were taken as an estimate of bone calcium balance. All three groups showed a similar fall in bone mineral content over the two years, indicating that a calcium intake of 1000-2000 g daily is ineffective in preventing bone loss in the early menopause.     

Acupuncture Treatment of Abdominal Pain

Case History Mr. Li, a university student aged 23 years, paid his first visit on July 16, 2001, with the chief complaint of abdominal pain for one day. The patient stated that one day before when it happened to be the weekend, he got abdominal pain after supper, which went worse gradually and caused him to roll all over in bed. The pain was slightly alleviated half an hour later after he had taken some pain killers. Upon inquiry, the patient said that because of their newly graduation from the university, he and his classmates were so excited that they went to have a sumptuous lunch with alcoholic drinks. And in the evening he ate again a delicious supper cooked for him by his mother, after which he continued to have some fruit and dessert.     

Integrating research into the clinic. What evidence based practice means to the practising podiatrist

This paper is the first in a series of three aimed at introducing clinicians to current concepts in research, and outlining how they may be able to apply these concepts to their own clinical practice. It has become evident in recent years that while many practitioners may not want to become actively involved in the research process, simply keeping abreast of the burgeoning publication base will create new demands on their time, and will often require the acquisition of new skills. This series introduces the philosophies of integrating what sometimes may appear to be abstract research into the realities of the clinical environment. It will provide practitioners with an accessible summary of the tools required in order to understand the research process. For some, it is hoped this series may provide some impetus for the contemplative practitioner to become a more active participant in the research process. This first paper addresses how the evidence based practice (EBP) revolution can be used to empower the individual practitioner and how good quality evidence can improve the overall clinical decision making process. It also suggests key strategies by which the clinician may try to enhance their clinical decision making process and make research evidence more applicable to their day to day clinical practice.     

科技期刊如何面对市场细分

近年来 ,期刊的读者定位一改传统的“大众化”模式 ,日益“小众化” ,期刊市场也由此进一步细分 ,涌现出一批占有较大市场份额的名刊、大刊。期刊尤其是文化生活类期刊的这种市场细分走势 ,给长期处于低迷不前的科技期刊带来了突围的可能性。科技期刊应紧跟时代步伐 ,重新思索和调整自身刊物的市场定位 :一、贴近大众 ,追求实用性 ,直接为生产服务 ;二、创办英文期刊 ,与国际接轨 ,继而强占国际市场 ;努力开拓新兴学科、交叉学科的期刊市场 ,增强期刊的时代感 ;三、走专科化、专题化、多版化的发展道路。     

How to handle informed consent in longitudinal studies when participants have a limited understanding of the study

Empirical findings from a Swedish longitudinal screening study show that many of the research subjects had a limited understanding of the study. Nevertheless they were satisfied with the understanding they had and found it sufficient for informed continued participation. Were they wrong? In this paper, it is argued that the kind of understanding that is morally required depends partly on the kind of understanding on which the research subjects want to base their decisions, and partly on what kind of knowledge they lack. Researchers must ensure that the information process is not flawed and that participants receive the information they want. To achieve this, new information efforts may be needed. Researchers must also ensure that research subjects have knowledge about aspects of importance to them. Lack of understanding may, however, be the result of conscious choices by research subjects to disregard some of the information because it is not important to them. Such choices should normally be respected.     

术前访视可有效缓解病人恐惧情绪

目的：探讨术前访视可有效缓解病人恐惧情绪。方法：选择100例中、下腹部择期手术病人,年龄20～50岁。每组50例。观察组（Ⅰ组）术前一天对病人进行访视,与病人进行面对面的交谈,让病人讲出对手术中的顾虑与想法,与此同时,测量病人的血压、脉搏、呼吸等生命体征。对照组（Ⅱ组）,术前不与病人交谈,只测生命体征。结果：通过术前一天对病人进行访视,病人进入手术室后,心态平稳,情绪稳定,既无恐惧感,又无陌生感,病人入手术室时测血压、脉搏、呼吸与术前所测的生命体征基本相同。Ⅱ组血压、脉搏、呼吸明显升高。两组P〈0．05,有显著意义。结论：术前访视病人,明显使病人情绪稳定,有利于手术的顺利进行。     

微创血肿引流术治疗高血压性脑出血的死亡原因分析

目的回顾分析微创血肿引流术治疗高血压性脑出血的死亡原因分析。方法对28例高血压脑出血患者进行锥颅血肿引流术，其中20例血液破入脑室的合并腰穿脑脊液排放治疗。结果术后1天死亡6例，2天死亡10例，5天死亡8例，7天死亡4例。结论微创血肿引流术合并腰穿脑脊液排放治疗高血压性脑出血应掌握手术适应症，注意手术方法，以及手术后处理。     

精神病专科门诊病案管理

目的精神病专科医院的门诊病案需要长期保存是它的特殊性。我院门诊病案保存时限最长已达60年仍在使用,库存340,000份,日门诊量1000余人,意味着每日建立新的门诊病案与查找病案次数。近年来,不少患者因伤残评定、医疗保险而查找首次门诊病案,充分证实门诊病案的作用。由于忽略对门诊病案质量的重视,管理上存在疏漏,示踪流通不畅,病案重号或丢失,给查找和利用带来困难,影响患者使用,造成医患纠纷。因此,加强门诊病案质量管理不可忽略。     

新时期军队医院对外医疗有偿服务

随着全国卫生医疗体制改革的深入和卫生医疗市场机制的逐步完善以及人们对健康观念的不断转变，军队医院要想在未来的医疗市场竞争中处于有利的地位，就必须摆脱军队医院现行市场运作机制的不利因素，扬长避短，积极地参与到地方医疗市场的竞争中去，建立完善的适应市场经济发展要求的对外医疗有偿服务运营机制。     

美多丽-P与阿托品眼液散瞳后电脑验光对比研究

目的:探讨美多丽- P在儿童散瞳验光中的实用价值。方法:对180例屈光不正儿童患者,按年龄分为4岁～7岁和8岁～12岁两组,先予美多丽- P散瞳,然后用TOPCON- 710 0电脑验光初测,再用1%阿托品眼液每日2次,连用3d后再用同一电脑验光仪验光,对比分析屈光度变化。结果:美多丽- P散瞳后球镜均值、等效球镜均值与阿托品比较差异有显著性(P<0 .0 5 ) ,柱镜均值与轴向均值与阿托品比较差异无显著性(P>0 .0 5 )。结论:12岁以下儿童屈光检测美多丽- P仍不能取代阿托品,可作为儿童散光检测,筛选弱视、预防弱视有积极的作用。     

Attitudes and practices of primary care physicians in the management of elevated serum cholesterol levels.

We conducted a telephone survey of 102 randomly selected Ottawa family physicians to determine their attitudes and practices regarding the treatment of hypercholesterolemia. Of the 102, 56% routinely measured serum cholesterol levels in all their patients over the age of 30 years, and 24% did so for patients in more restricted age ranges. The level at which they started dietary therapy averaged 6.95 mmol/L (270 mg/dl); for 25% it was less than 6.22 mmol/L (240 mg/dl). The level at which they started drug therapy averaged 8.9 mmol/L (345 mg/dl); for only 15% was it 7.23 mmol/L (280 mg/dl) or less. Two-thirds were unable to give numerical values to the serum cholesterol levels at which they started diet therapy, and 38% used the upper limits of laboratory normal values as an indication to start therapy. Our findings contrast markedly with results reported for US family physicians, who treat hypercholesterolemia much more aggressively. The variability in practices must be addressed if public campaigns to lower serum cholesterol levels are to be undertaken.     

A geriatric day hospital: the Sunnybrook experience.

A review of the first 7 years of experience with the geriatric day hospital at Sunnybrook Medical Centre in Toronto revealed the following about the patients attending the day hospital during that time: most were 60 to 79 years old; over 85% attended 1 or 2 days a week; more than two thirds lived with a spouse or relatives; and more than half had diseases of the circulatory system or mental disorders. The day hospital offers a varied therapeutic program while easing the demands on the energy and time of the patient's spouse or family and thus helps the elderly to remain in the community rather than live in an institution. The experience at Sunnybrook has shown that geriatric day hospitals can be a valuable component of the broad spectrum of integrated services and programs that must be developed to provide adequate health care for the growing number of older people in our population.     

医疗纠纷主管人员志愿服务实践及其体会

工作价值感缺失和压抑的工作环境使医疗纠纷主管人员的健康问题日益突出。由于他们每天面对情绪激动的纠纷患者或者家属,经常产生急躁、厌烦情绪,难以感受到工作的成就感。医疗纠纷主管人员通过参加医院组织的志愿者服务,直接服务于患者、在满足患者需求的同时,感受助人过程带来的愉悦和心灵慰籍,可以有效化解郁闷、厌烦等不良心境、对做好纠纷调解处理工作和缓解压力具有实际帮助。是缓解压力、调整心态的有效方法,值得同仁体验和推广。     

浅谈网络环境下医院图书馆服务功能的转变

本文分析了网络环境下读者需求的变化,探讨了医院图书馆随之在服务职能、服务水平和自身职业素养方面进行转变和提高的必要性。通过树立“服务第一,读者第一”的思想,强化服务意识,和提高现代信息服务水平,从而准确、高效地为读者提供信息服务,以满足信息时代的读者需求。医院图书馆的专业化信息服务对促进医院的医疗、教学、科研,以及实现医院可持续发展具有重要的意义。     

Changes in undergraduate attitudes toward medical ethics

To detect any change in medical students' attitudes toward medical ethics, students from the same class were given a questionnaire on their first day of medical school and again near the end of their fourth year of study. The results showed a strong shift away from the students' initial expectations that they would rely on specialists or scholarly sources in the future; the need for a medical ethics course in the curriculum, while still felt, was less important to them by the fourth year. The reasons for these changes were not apparent, for the students' levels of knowledge and perceptions of the role of ethics in medicine in the first and fourth years did not differ. It is recommended that medical school faculty actively reinforce the initially positive attitudes of students during clinical supervision.