一线全科医生视角下对新技术如何融入社区信息系统并服务家庭医生签约的思考

我国的家庭医生签约服务正在如火如荼地进行着，目前关于家庭医生签约的评价、见解、效果反馈的研究多来自管理专业、经济学专业、公共卫生专业的学者，尚缺乏来自签约主体之一的医务人员的视角。本文将从一线全科医生即家庭医生签约服务执行者的视角，阐述现阶段基层医疗信息系统服务家庭医生签约的现状，并对其中存在的问题和可能的解决办法进行探讨。     

头皮针联合循经毛刺法治疗迟发性放疗后舌下神经麻痹一例

迟发性放疗后舌下神经麻痹以伸舌不居中,患侧舌肌萎缩为主要症状,常伴有构音障碍、局部感觉障碍等。因本病临床表现易与特发性面神经麻痹、中枢性面神经麻痹等周围神经病变相混淆,临床上常出现误诊误治风险。现将浙江省中西医结合医院确诊的1例迟发性放疗后舌下神经麻痹病史、体征及刘芳主任医师通过头皮针联合循经毛刺法治疗本病经过,结合相关文献进行分析总结,以此为本病临床诊治提供参考。     

Abdominal Obesity and Its Attribution to All-cause Mortality in the General Population with 14 Years Follow-up: Findings from Shanxi Cohort in China

Objective This study aimed to assess the association of waist circumference(WC) with all-cause mortality among Chinese adults.Methods The baseline data were from Shanxi Province of 2002 China Nutrition and Health Survey. The death investigation and follow-up visit were conducted from December 2015 to March 2016. The visits covered up to 5,360 of 7,007 participants, representing a response rate of 76.5%. The Cox regression model and floating absolute risk were used to estimate hazard ratio and 95% floating CI of death by gender and age groups(≥ 60 and 60 years old). Sensitivity analysis was performed by excluding current smokers; participants with stroke, hypertension, and diabetes; participants who accidentally died; and participants who died during the first 2 years of follow-up.Results This study followed 67,129 person-years for 12.5 years on average, including 615 deaths. The mortality density was 916 per 100,000 person-years. Low WC was associated with all-cause mortality among men. Multifactor-adjusted hazard ratios(HR) were 1.60(1.35–1.90) for WC 75.0 cm and 1.40(1.11–1.76) for WC ranging from 75.0 cm to 79.9 cm. Low WC( 70.0 cm and 70.0–74.9 cm) and high WC(≥ 95.0 cm) groups had a high risk of mortality among women. The adjusted HRs of death were 1.43(1.11–1.83), 1.39(1.05–1.84), and 1.91(1.13–3.22).Conclusion WC was an important predictor of death independent of body mass index(BMI). WC should be used as a simple rapid screening and predictive indicator of the risk of death.     

Are postoperative drains necessary with the Karydakis flap for treatment of pilonidal sinus? (Can fibrin glue be replaced to drains?) A prospective randomized trial

Purpose  

Different surgical techniques for pilonidal disease have been described in the literature. In this study, our aim was to evaluate the influence of routine cavity drainage in the Karydakis flap technique.     

The Hospital Bed and the General Practitioner: A Pilot Study of Two Practices with Respect to Hospital Bed Usage and Patient Management

Fourteen hundred randomized patient records of two urban practitioners covering a one-year period were studied. The two practitioners represented two very different types of general practice. Dr. A was an active staff member of a teaching hospital; Dr. B confined his work to office and home visits.

The age, marital status, occupation, diagnoses, and patient management were coded on IBM cards, and the data analyzed with the aid of a computer program.

The findings indicate that over 90% of patients seen by both practitioners were managed entirely from their offices. Dr. A admitted 41 (5.9%) of the 700 patients seen and referred 24 (3.4%); Dr. B admitted no patients and referred 44 (6.3%). These and other findings suggest that the role and function of the urban general practitioner is changing rapidly in this era of specialization.

     

中医类别全科医生特设岗位计划实施现状及对策研究

背景　自2013年起,国家通过实施全科医生特设岗位计划,引导和鼓励优秀医疗卫生人才到基层医疗卫生机构从事全科医疗工作,逐步解决基层全科医生紧缺和无执业医师问题。目前对中医类别全科医生特设岗位计划实施现状的调研相对较少。目的　了解中医类别全科医生特设岗位计划的实施现状,推进基层中医药人才队伍建设。方法　2019年7月1-20日,在实施全科医生特设岗位计划工作的14个省中采用整群随机抽样的方法,随机抽取970个乡镇卫生院的行政负责人和258例中医类别特岗全科医生进行问卷调查;抽取4名县级中医药主管部门领导、4名县中医院领导、8名乡镇卫生院院长、16名中医类别特岗全科医生进行小组访谈。结果　参与网络调查的970家乡镇卫生院中,793家（81.8%）认为中医技术人员短缺,915家（94.3%）认为特设岗位计划在本院具备适应性,851家（87.7%）认为特设岗位计划有必要扩大规模。参与网络调查的258例中医类别特岗全科医生中,173例（67.0%）学历为专科及以下;112例（43.4%）年薪酬5万元以下;主要困难及诉求分别为接受继续医学教育培训（94.2%,243/258）、解决编制（91.1%,235/358）、提高工资待遇（73.6%,190/258）、工作中有上级医师指导（64.3%,166/258）等;255例（98.8%）认为在乡镇卫生院设置特设岗位计划有必要,249例（96.5%）认为有扩大规模必要。参与访谈的4名县级中医药主管部门领导、4名县中医院领导、8名乡镇卫生院院长、16名中医类别特岗全科医生代表都主张扩大特岗计划实施规模。结论　中医类别全科医生特设岗位计划充实了乡镇卫生院,受到了基层卫生部门和患者好评,但受聘中医类别全科医生学历偏低、待遇不高、职业发展受限、培训机会少等问题突出。应加快推进全科医生特设岗位计划试点工作,扩大覆盖面;强化继续教育,加大投入力度,解决医生切身利益,保障基层对中医全科人才的需求。     

普外科汉语大课教学课前发放相关英文病例摘要并课堂讲解教学方法的探讨

笔者在医学七年制外科汉语大课教学实践中尝试采用课前发放并课堂讲解英文病历摘要,同时对重要词汇标注英式与美式音标的教学新方法,并对这一教学方法作相关问卷调查.结果显示,绝大多数学生对此方法持肯定态度.本文就该教学方法作简要讨论,以有助于今后的医学全英语教学.     

A Study of Three Groups of Urban Men from the General Population with Different Alcohol Habits and Drug Use and Their Serum Levels of Liver-related Enzymes and Haematological Variables

A sample of 200 men from the general population was investigated concerning alcohol consumption in relation to laboratory findings. The relation between symptoms of alcoholism (subjective relative loss of control over drinking, blackouts and morning drinks) and the alcohol consumption was also studied. The subjects were divided into three groups: (I) a group with low alcohol consumption without symptoms of alcoholism, (II) an intermediate group with low, moderate or high alcohol consumption and one or more alcohol symptoms and (III) a heavy-drinking group with two or more symptoms. The heavy-drinking group had significantly higher serum bilirubin, aspartate amino-transferase (ASAT), creatine kinase and lactate dehydrogenase values than the other two groups. Gamma-glutamyl transpeptidase (GGT) showed no relation to alcohol consumption. The use of liver-metabolized drugs was investigated. Ten of the 53 heavy drinkers were taking such drugs, because of illness, and the other 43 were not. The heavy drinkers taking drugs showed pathological laboratory values throughout, in contrast to the subjects of the other subgroups. Serum GGT was high in the drug-using groups but was not significantly elevated in the groups taking only alcohol and no drugs.     

创建尖端人才的神圣殿堂--南京军区南京总医院博士后科研工作站建设的探索与实践

南京军区总医院2000年在全国首批申报设立了博士后科研工作站,并积极探索博士后研究站培养、开发高层次人才的新路子,构建新世纪人才高地,取得了许多成功经验。     

锐意进取 砥砺前行 树立县级公立医院楷模——访江阴市人民医院院长杨惠光

一、挑战与机遇我国自古将山南水北谓之"阳",山北水南谓之"阴",毗邻山水的城市总是多一份灵性,在江苏省南部有这样一座城市,她枕山负水,襟带三吴,处于"苏锡常"金三角的几何中心。当"神舟"飞天,是这里的海上测量基地为飞船保驾护航,"蛟龙"入海,我国自主研发的载人潜水器在这里启程远征。这就是连续9年荣膺"全国经济百强县"第一名的江苏省江阴市。     

妇产科患者术后吸氧预防恶心呕吐的效果研究

目的：探讨对妇产科术后患者给予氧气吸入预防恶心呕吐的效果。方法：选择本科在硬膜外麻醉及全麻下手术后患者287例,随机分为对照组（143例）和研究组（144例）,对照组给予常规护理,研究组除给予常规护理外还予以鼻导管吸氧4h,观察两组术后24h恶心呕吐的发生情况。结果：研究组术后恶心呕吐的发生率明显低于对照组,两组间差异有显著性意义（P〈0.05）。结论：对妇产科手术后患者给予氧气吸入4h,能明显降低术后恶心呕吐的发生率。     

哮喘患者诱导痰白细胞介素-17A与基质金属蛋白酶-9水平测定及其意义

目的测定不同严重程度支气管哮喘患者诱导痰上清液白细胞介素17A（IL-17A）、基质金属蛋白酶-9（MMP-9）、白细胞介素-8（IL-8）的水平,探讨气道慢性炎症的特点及可能机制。方法按标准纳入慢性持续哮喘患者41例：健康对照者15例,采用诱导痰技术对痰炎性细胞进行分类并采用酶联免疫吸附测定（ELISA）法检测痰上清液IL-17A、IL-8、MMP-9水平,并进行相关性分析。结果重度组患者诱导痰中性粒细胞比值[（62．6±15．7）％]与正常对照组[（26．3±10．3）％]、轻度组[（42．3±18．7）％]及中度组[（46．1±14．3）％]比较差异均有统计学意义（P〈0．01或0．05）;重度哮喘患者嗜酸性粒细胞比值[（8．2±3．9）％]与轻度组[（4．9±3．4）％]及对照组[（1．0±0．8）％]比较增高（P〈0．01或0．05）,与中度组[（5．4±3．3）％]比较差异无统计学意义（P〉0．05）;诱导痰上清液IL～17A水平轻度组[（154±91）pg／ml]和对照组[（55±23）pg／ml]与重度组[（262±162）pg／ml]比较差异有统计学意义（P〈0．05）,且各组哮喘患者与正常对照组比较均增高（P〈0．01）;重度组MMP-9水平[（451±251）ng／ml]与轻度、中度组患者[（166±99）ng／ml,（189±110）ng／ml]及对照组[（158±109）ng／ml]比较差异均有统计学意义（P〈0．01）;轻度、中度和重度哮喘患者诱导痰IL-8水平[（387±227）pg／ml,（390±194）pg／ml,（480±217）pg／ml]与健康对照者[（203±104）pg／ml]比较差异有统计学意义（P〈0．01）。诱导痰中性粒细胞比值与IL-17A、IL-8、MMP-9呈正相关（r=0．323,P〈0．05;r=0．493,P〈0．01;r=0．344,P〈0．01）。结论中性粒细胞浸润性气道炎症是重度持续性哮喘的重要特征,IL-17A、IL-8、MMP-9构成的复杂炎症介质网络可能是气道损伤的关键机制之-。     

2015至2018年骨科伤口感染患者病原菌分布及耐药性分析

目的对骨科伤口采样培养,进行病原菌分布和耐药情况分析,为临床合理使用抗菌药物提供依据。方法回顾性分析本院骨科2015年至2018年送检伤口分泌物的细菌培养及药敏结果。结果2835份标本中,细菌培养阳性516例,阳性率为18.20%;其中格兰阴性杆菌291例,占56.40%,主要为铜绿假单胞菌、阴沟肠杆菌、大肠埃希菌、肺炎克雷伯菌。革兰阳性球菌212例,占41.09%,主要为金黄色葡萄球菌、溶血性葡萄球菌、粪肠球菌;真菌13例,占2.51%。金黄色葡萄球菌对多种抗菌药物敏感率良好,其中对利奈唑胺、替加环素、替考拉宁和万古霉素的敏感率达到100%,革兰阴性杆菌中铜绿假单胞菌和肺炎克雷伯菌的耐药情况良好,但对大肠埃希菌和阴沟肠杆菌的耐药情况较严重,对多种抗菌药物的耐药率达50%,特别是阴沟肠杆菌对头孢类抗菌药物的耐药率可达100%。结论骨科感染患者的病原菌分布情况复杂,耐药形势仍很严峻,应采取更加积极有效的措施控制耐药菌的增多与传播。     

神经系统疾病患者血清和脑脊液髓鞘碱性蛋白及其抗体的ELISA定量研究

用简易的髓鞘碱性蛋白（ＭＢＰ）及其抗体（Ａｎｔｉ－ＭＢＰ）酶联免疫吸附定量测定（ＥＬＩＳＡ）法对６组共３３７例神经系统疾病患者进行检测，其中脊髓压迫症（ＣＭＰ）３６例，多发性硬化（ＭＳ）３３例，脑血管疾病（ＣＶＤ）３４例，中枢神经系统感染性疾病（ＩＤ）３１例，癫痫（ＥＰ）１６１例和其他神经系统疾病（ＯＮＤ）４２例。结果显示：ＣＭＰ、ＭＳ．ＣＶＤ、ＩＤ和ＥＰ５组血清ＭＢＰ均值明显高于ＯＮＤ组（Ｐ＜０．０１），其中又以急性外伤所致脊柱骨折伴截瘫为主（３３例）的ＣＭＰ患者血清ＭＢＰ值最高，与ＭＳ组比较Ｐ＜０．０５，与ＣＶＤ、ＩＤ和ＥＰ组比较Ｐ＜０．０１。ＣＶＤ患者ＣＳＦＭＢＰ均值也明显高于ＯＮＤ组（Ｐ＜０．０５）。本法检测６组血清和ＣＳＦ的Ａｎｔｉ－ＭＢＰ含量差异不显著（Ｐ＞０．０５）。     

Prognostic Nutritional Index Associates with the Severity of Silicosis: A Study from a Tertiary Class A Prevention and Treatment Institute for Occupational Diseases in China

<正>Pneumoconiosis is a group of heterogeneous fibrotic lung diseases caused by inorganic mineral dust and includes coal workers’pneumoconiosis and silicosis.Silicosis involves diffuse or nodular interstitial pulmonary fibrosis caused by exposure to asbestos or silica dust.China is thought to have the highest number of silicosis cases,with 6,000 new cases reported annually^[1].Currently,the clinical diagnosis and monitoring of silicosis relies mainly on a history of occupational e...