The polity of academic medicine: Status of faculty governance

How should academic medical departments be governed? Models of governance span a wide spectrum between autocracies, in which important decisions are made by a single individual, to democracies, in which each member enjoys a voice in decision making. Despite the fact that more participatory governance models are the norm in practice settings outside of academia, many academic physicians seem to take an autocratic model more or less for granted. In fact, however, most medical schools and universities do not mandate a governance system that vests authority in a powerful chairperson, and departments frequently enjoy more latitude than they suppose in determining how to govern themselves. Because an organization’s effectiveness is powerfully influenced by its governance structure, academic physicians should give serious consideration to this subject, to ensure that academic medicine is well prepared to meet the many challenges now before it     

循证医学在介入治疗中的应用

循证医学强调,任何医疗卫生决策必须依据当前最好的、可获得的科学研究证据,结合决策者或临床医生自己的专业技能和经验,考虑决策对象或患者的需求和愿望,将三者有机地结合做出科学、合理的决策.本文对循证医学的概念和实质,循证实践的步骤以及Cochrane协作网做了介绍,对循证医学、临床流行病学和系统综述三者之间的关系进行了阐述,并简要描述了当前循证医学在介入治疗中的应用及存在的问题.     

基于系统论的军事医学解析

系统理论是进行战略研究的一个重要方法.军事医学具备系统的主要特征.军事医学系统的结构具有开放性和层次性等特征,军事医学系统的功能呈现整体性和不确定性特征,军事医学在演化过程中则具备线性与非线性、自组织与他组织、涌现性等三大动力学特征.     

中国重症医学发展之路——专科重症与综合重症及多学科的借鉴、融合、共同提高

综合重症与专科重症有着各自独立的发展路线,在急危重症的救治中发挥着重要作用.综合重症的优势在于对各种重症横向、广泛的研究,强调在整体治疗理念的指导下,平衡各个功能不全脏器之间的关系.专科重症的优势在于对某个专科或者专病进行纵向、深入的研究,强调在专科理论的指导下,专业化地解决某个重症的主要矛盾.当前,重症医学面临的最大挑战是如何避免惯性思维.综合重症需要向专科重症学习,不断加深对各专业领域的探索,以便在处理专科重症时更加得心应手.专科重症也需要向综合重症学习,不断强化整体救治观念,以便优化利用各种救治资源,提高专科重症的救治效果.综合重症和专科重症的互相借鉴、融合和共同提高,将最终使双方获益,使专科重症医学的治疗宽度更广,综合重症医学的治疗深度更深.各自独立的专科重症、专病重症之间也需要互相联合,共同为重症医学学科体系填补新的内涵.     

Nuclear medicine practice in Japan: A report of the 5th nationwide survey in 2002

The Subcommittee on Survey of Nuclear Medicine Practice in Japan has performed a nationwide survey of nuclear medicine practice every five years since 1982 to provide detailed information on its current status. METHODS: Questionnaires were sent to every institution known to the Japan Radioisotope Association to provide nuclear medicine examinations. The questionnaires address the number and kind of nuclear medicine examinations performed as well as the kind and dose of the radiopharmaceuticals used during the month of June 2002. The annual number of total or specific examinations was then estimated. RESULTS: Of the institutions sent questionnaires, 1,204 were for in vivo study, 124 were for in vitro study, and 36 were for positron emission tomography (PET) study. Out of these, 95.8% answered them. A total of 1,697 gamma cameras were installed in 1,160 facilities, of which 50% were dual-head cameras. The estimated total annual number of examinations expressed by the number of administered radiopharmaceuticals was 1.60 million, similar to that of the previous survey (1997). The frequency of study with single photon emission computed tomography (SPECT) increased to 40%, from 30% in the previous survey. The scintigraphy most frequently performed was bone (35%), followed by myocardium (24%) and brain perfusion (12%). All showed a continuous increase over the past 20 years. Tumor imaging, however, fell from third to fourth place. The most commonly used radiopharmaceutical for each scintigraphy was 99mTc-HMDP for bone, 201Tl-chloride for myocardium, 67Ga-citrate for tumor, and 123I-IMP for brain. A total of 29,376 PET studies were performed yearly. Among them, 18F-FDG rapidly increased 3.7-fold. 131I therapy for thyroid cancer and hyperthyroidism was conducted yearly in 1,647 and 3,347 patients, respectively. A total of 31.35 million in vitro radioassays were carried out yearly, the number of which has been decreasing continuously since 1992. CONCLUSIONS: It was proved that the content of nuclear medicine practice in Japan has changed in the past five years. This report might be useful for understanding the current trends of nuclear medicine practice in Japan.     

医学博士学位论文中的实验设计及数据分析错误辨析

目的：对医学博士学位论文进行初步调查，以了解医学博士学位论文中误用统计学方法的情况。方法：通过查阅部分高水平科研单位的医学博士学位论文，对这些论文中存在的实验设计及数据分析方面的错误进行辨析，并给出其正确的实验设计及对应的资料分析方法。结果：在查阅的使用过统计学方法的150篇论文中，发现有92篇论文存在统计学方面的错误，占61．3％。结论：博士学位论文中统计学方法误用的现象比较严重，应引起有关单位研究生、研究生导师及单位领导的高度重视。     

干细胞资源库信息管理系统的建立及在转化医学中的应用

转化医学、干细胞技术、信息技术等多学科的交叉和融合发展促使干细胞成为21世纪最具发展前景的技术。随着信息技术在干细胞行业的广泛应用以及转化医学在临床研究的快速发展,干细胞资源库信息管理系统逐渐被广泛重视。该系统综合管理干细胞资源库的日常工作和临床应用,为转化医学的查询、治疗、反馈及总结提供了有效平台。     

Nuclear medicine practice in Japan: a report of the sixth nationwide survey in 2007

Objective  The Subcommittee on the Survey of Nuclear Medicine Practice in Japan has performed a nationwide survey of nuclear medicine practice every 5 years since 1982 to provide detailed information on its present status. Methods  Questionnaires were sent to all institutions known to the Japan Radioisotope Association to conduct nuclear medicine examinations. The questionnaires addressed the number and kind of nuclear medicine examinations performed as well as the kind and dose of the radiopharmaceuticals used during the month of June 2007. The annual number of total or specific examinations was then estimated. Results  Of the institutions sent questionnaires, 1219 were for in vivo study, 49 for in vitro study, and 212 for positron emission tomography (PET) study. Of these, 92.2% provided answers. A total of 1569 gamma cameras were installed in 1119 institutions, of which 70% were dual-head cameras. The estimated total annual number of in vivo examinations expressed by the number of administered radiopharmaceuticals was 1.41 million, representing a decrease of 11.5% when compared with that of the previous survey (2002). The frequency of study with respect to single-photon emission computed tomography (SPECT) slightly increased to 42.3% from 39.9% in the previous survey. The most frequently performed scintigraphy was bone (38.3%), followed by myocardium (26.2%) and brain perfusion (14.1%). Brain perfusion scintigraphy slightly increased, whereas tumor scintigraphy decreased by one-half when compared with the previous survey. The most commonly used radiopharmaceutical for each scintigraphy was ^99mTc-HMDP for bone, thallium-201 (²⁰¹Tl)-chloride for myocardium, gallium-67 (⁶⁷Ga)-citrate for tumor, and technetium-99m-ethylcysteinate dimmer (^99mTc-ECD) for brain. The number of PET institutes increased from 36 to 212. ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG)-PET dramatically increased 14.8-fold during the past 5 years. Radionuclide therapy also increased. ¹³¹I therapy for thyroid cancer and hyperthyroidism was conducted yearly in 2373 and 4146 patients, respectively. A total of 13.1 million in vitro radioassays were carried out yearly, the number of which has been decreasing continuously since 1992. Conclusions  It was proved that the content of nuclear medicine practice in Japan has changed considerably in the past 5 years. Namely, ¹⁸F-FDG-PET and radionuclide therapy increased. This report might be useful for understanding the present trends of nuclear medicine practice in Japan.     

一种新的哲学思考：军事医学系统论

论文研究目的是构建军事医学系统论.作者研究提出了军事医学系统论的概念,构建军事医学系统论的意义,初步研究勾划了军事医学的系统环境、系统结构、系统功能、系统特征、系统演化等.     

Relationship of participation in specific sports to academic performance in adolescents: A 2-year longitudinal study

Physical activity is considered a promising behavior to improve cognitive function and academic performance in adolescents. As evidence on the relationship of specific sports activity is not conclusive, this study aimed to determine the longitudinal relationships of different sports to academic performance in adolescents and evaluate the cardiorespiratory fitness mediation effect of these sports. We focused on the demands of complex motor skills and the differences between individual sports vs team sports. Four hundred and sixty-three 7th-grade students (227 girls and 236 boys) were followed up over 2 years. Data regarding participation in sports activities, types of sports activities, academic performance, and cardiorespiratory fitness were obtained at baseline and after a 2-year follow-up. Structural equation modeling revealed that participation in all sports activity was positively associated with improvement of academic performance from baseline to follow-up, and that these associations were mediated by cardiorespiratory fitness gains. Participation in sports activities that require more complex motor skills and individual sports activity was directly associated with an improvement of academic performance from baseline to follow-up. Furthermore, quitting sports activities was negatively associated with academic performance via a reversal in cardiorespiratory fitness gains. These findings indicate that participation in specific sports may have significant benefits for academic performance in adolescents. Although these relationships are presumably mediated by cardiorespiratory fitness, sports activities that require more complex motor skills and individual sports participation may be directly related to academic performance. Considering that quitting sports activities reversed these benefits, sustained participation in sports is important for academic success.     

Visual demonstration of aliasing in planar nuclear medicine imaging: The importance of correct collimator selection by nuclear medicine practitioners

Aliasing artefact is an imaging distortion phenomenon experienced in a wide variety of medical imaging modalities. This case report illustrates its occurrence during planar gamma camera nuclear medicine imaging under non-clinical conditions using experimental incorrect selection of collimators. In accordance with provision of an optimal service, nuclear medicine practitioners are recommended to have sufficient technical expertise along with knowledge of gamma camera operation. The purpose, construction and interaction of collimators used during planar imaging are presented herein with specific regards to the aliasing phenomenon. Furthermore, this case report recommends the careful planning of worklists to avoid frequent collimator changes to reduce the risk of human error.     

The 11 March 2004 Madrid terrorist attacks: the importance of the mortuary organisation for identification of victims. A critical review

On the morning of 11 March 2004, Madrid lived the worst terrorist attack in its modern history, resulting to 191 people killed and more than 1,800 injured. The attacks evidenced a series of significant deficiencies in forensic task planning, especially in using standardised post-mortem data forms and gathering ante-mortem medical and dental data, responsible for the delay in identifying corpses in the worst state, which had to wait for DNA analysis. Fortunately, the ultimate result can be considered satisfactory, given the rapid response of the forensic team in examination and identification of the large number of victims (80% of the victims were identified within 40 h), consequence of a good mortuary organization in the Pavilion 6 of the Madrid Trade Fair (IFEMA), the professional fervor whereupon the different involved professionals acted, some personal initiatives and the good general state of most of the corpses.     

Efficacy of clinical gait analysis: A systematic review

The aim of this systematic review was to evaluate and summarize the current evidence base related to the clinical efficacy of gait analysis. A literature review was conducted to identify references related to human gait analysis published between January 2000 and September 2009 plus relevant older references. The references were assessed independently by four reviewers using a hierarchical model of efficacy adapted for gait analysis, and final scores were agreed upon by at least three of the four reviewers. 1528 references were identified relating to human instrumented gait analysis. Of these, 116 original articles addressed technical accuracy efficacy, 89 addressed diagnostic accuracy efficacy, 11 addressed diagnostic thinking and treatment efficacy, seven addressed patient outcomes efficacy, and one addressed societal efficacy, with some of the articles addressing multiple levels of efficacy. This body of literature provides strong evidence for the technical, diagnostic accuracy, diagnostic thinking and treatment efficacy of gait analysis. The existing evidence also indicates efficacy at the higher levels of patient outcomes and societal cost-effectiveness, but this evidence is more sparse and does not include any randomized controlled trials. Thus, the current evidence supports the clinical efficacy of gait analysis, particularly at the lower levels of efficacy, but additional research is needed to strengthen the evidence base at the higher levels of efficacy.     

Percutaneous treatment of pyogenic liver abscess: A critical analysis of results

Nineteen patients who had pyogenic liver abscesses underwent percutaneous treatment assisted by computed tomography. Percutaneous drainage was performed with Fr 8-14 catheters in 12 patients and percutaneous aspiration in 7 patients. A solitary abscess was present in 15 patients and multiple abscesses were present in 4. The average drainage duration was 26 days. Successful treatment was obtained in 16 of 19 (84%) cases. One abscess recurred and was cured by repeat drainage. Two patients died. Reviewing 14 reports from the literature with a total of 252 patients treated percutaneously, an overall success rate of 77% and a mortality rate of 6% was found.     

心率变异性分析的新指标及其在航空医学中的应用

目的通过对２４ｈ心率变异性（ＨＲＶ）谱成分极低频（ＶＬＦ）、低频（ＬＦ）与高频（ＨＦ）功率之间的关系进行回归分析，探讨回归方程各参数的病理生理意义及其在飞行员心功能鉴定中的价值。方法对象为健康女飞行员３０名、年龄相当的男飞行员３０名、可疑冠心病飞行员８例、确诊的冠心病人２０例。采用２４ｈ全信息动态心电图仪。分析指标：ＶＬＦ（０．００３Ｈｚ～０．００４Ｈｚ）、ＬＦ（０．０４Ｈｚ～０．１５Ｈｚ）、ＨＦ（０．１５Ｈｚ～０．４０Ｈｚ）和总体平均功率（０．００３Ｈｚ～０．４０Ｈｚ，ＴＦ），回归分析各频率间的关系，并进行ｔ检验。结果①ＶＬＦ和ＬＦ与ＨＦ均呈显著负相关；ＶＬＦ与ＨＦ的相关系数值（ｒ）显著大于ＬＦ与ＨＦ的相关系数值。②ＶＬＦ和ＬＦ与ＨＦ回归方程的斜率（Ｂ）、相关系数（ｒ）以及ＨＦ值均表现为夜间大于白天，女性大于男性，健康飞行员大于冠心病人。结论ＶＬＦ可能反映交感神经系统活性；ＶＬＦ或ＬＦ与ＨＦ回归方程的斜率可反映交感神经系统与副交感神经系统的均衡性，相关系数可反映二者的拮抗性与协调性。女飞行员的夜间迷走神经活性高于男性飞行员；冠心病人可表现有交感神经系统与副交感神经系统的协调性降低，以及迷走神经活性受损     

The Clinical Practice of Interventional Radiology: A European Perspective

The purpose of this study was to determine the current clinical environment in which interventional radiology (IR) is practiced throughout Europe. A survey, comprising 12 questions on IR clinical practice, was sent to 1800 CIRSE members. Members were asked to return one survey per department. Two hundred seventy-four departments returned completed questionnaires, 22% from the United Kingdom (n = 60), 11% from Germany (n = 30), 8% from Austria (n = 23), and the remainder spread over Europe. Experts, with more than 10 years of IR experience, comprised 74% of the survey group. Almost one-third of the radiologists dedicated more than 80% of their clinical sessions to IR alone (27%; n = 75), with two-thirds practicing in a university teaching hospital setting (66%; n = 179). Few institutions have dedicated IR inpatient hospital beds (17%; n = 46), however, to compensate, day case beds are available (31%), IR admitting rights are in place (64% overall, 86% for in-patients, and 89% for day cases), and elective IR admissions can be made through other clinicians (87%). IR outpatient clinics are run at 26% of departments, with an average of two sessions per week. Dedicated nurses staff the majority of IR suites (82%), but clinical junior doctors are lacking (46%). Hospital management’s refusing access to beds was the most commonly cited reason for not developing a clinical IR service (41%). In conclusion, there is marked variation across European centers in the current practice of IR. Half do not have dedicated junior doctors and only a small minority have inpatient hospital beds. If IR is to be maintained as a dedicated clinical specialty, these issues need to be addressed urgently.     

Exploring effects of a natural combination medicine on exercise‐induced inflammatory immune response: A double‐blind RCT

Traumeel (Tr14) is a natural, combination drug, which has been shown to modulate inflammation at the cytokine level. This study aimed to investigate potential effects of Tr14 on the exercise‐induced immune response. In a double‐blind, randomized, controlled trial, healthy, untrained male subjects received either Tr14 (n = 40) or placebo (n = 40) for 24 h after a strenuous experimental exercise trial on a bicycle (60 min at 80%VO_2max). A range of antigen‐stimulated cytokines (in vitro), white blood cell count, lymphocyte activation and apoptosis markers, and indicators of muscle damage were assessed up to 24 h following exercise. The area under the curve with respect to the increase (AUC_I) was compared between both groups. The Tr14 group showed a reduced exercise‐induced leukocytosis and neutrocytosis (P < 0.01 for both), a higher AUC_I score of antigen‐stimulated IL‐1β and IL‐1α (absolute and per monocyte, all P < 0.05), a lower AUC_I score of antigen‐stimulated GM‐CSF (P < 0.05) and by trend a lower AUC_I score of antigen‐stimulated IL‐2 and IL‐4 as well as a higher AUC_I score of antigen‐stimulated IL‐6 (all P < 0.1). Tr14 might promote differentiated effects on the exercise‐induced immune response by (a) decreasing the inflammatory response of the innate immune system; and (b) augmenting the pro‐inflammatory cytokine response.