检验医学实验教学中的辩证法

将内因与外因、局部与整体、一般与特殊、量变与质变、认识论与方法论等唯物辩证法哲学范畴和观点应用于医学检验形态学实验教学中,融知识传授与哲学观渗透于一体,不断提高学生的学习兴趣和分析问题、解决问题的能力,同时培养学生的科学辩证思维,用科学的态度和方法指导工作、学习,逐步成为具有创新精神和实践能力的高素质应用型检验医学人才。     

Influence of analytical and biological variation on the clinical interpretation of seminal parameters

Quality assurance in semen analysis has been questioned recently in this journal. Based on the limited capacity of seminal parameter in the determination of fertility, the authors advocated abandoning methods of quality assurance in semen analysis for clinical situations. In this article, we explore arguments as to why quality assurance in semen analysis for clinical use is not 'a waste of time'. Imprecision and within-subject biological variations are the two major components involved in the dispersion of seminal parameter results obtained by analysis of a semen sample from an individual. As within-subject biological variation is constant across geography, time and population, imprecision is a very important factor in the quality of laboratory test results. We analyse this influence on various seminal parameters and observe that there is an amount of error that can be tolerated without invalidating the medical usefulness of seminal parameter determination. However, there is a maximum allowable analytical error above which the medical usefulness of seminal parameter results is invalidated. The level of performance required to facilitate clinical decision-making is termed quality specification. We comment on different strategies to define the maximum allowable analytical error.     

关于高职高专医学院校《物理》课程教学的探讨

物理学作为医学院校开设的一门重要的基础课程,不仅是学习后继课程的基础,也是培养学生科学素质,提高人才质量的重要学科。本文结合目前医学院校学生特点,从评估学生已有知识、提高学生学习兴趣、采取多种教学方式等方面来探讨如何提高医学院校《物理》课程的教学质量,以培养具有一定物理学基础知识的高素质医学人才。     

Evidence-based medicine and tort law

Recent statutes and legal decisions have been aimed at bettering the quality of tort-law decisions by substantively improving "expert" testimony. However, in analogy to the experience of physicians attempting to upgrade medical practice using the principles of evidence-based medicine, lawyers and the courts have found it much easier to describe ideal science than to actualize it. This is particularly so in a system (the Law) that has traditionally not been very discerning about scientific rigor, and which has established procedural priorities that are often incompatible with strict scientific standards. This overview will examine the American tort system from an evidence-based perspective. We include a discussion of standards that could be used for "outcomes analysis" in the Law; recognition and classification of errors made by the courts themselves; the relationship between medical errors, "negligence," and standard of care; and the problem of reconciling the rights of plaintiffs with medical-scientific facts. We also consider selected impediments to developing a legal system that is capable of consistently reaching evidence-based decisions concerning complex scientific information, including pathologic interpretation of tissue specimens.     

Scientific support for emerging countries--introduction to activities of a company

Medical care cost per capita in developing countries is significantly low, only 1/100 of that of developed countries. In these countries, treatment comes first, without sufficient clinical testing. In emerging countries, on the other hand, economic growth increases medical care cost, enabling more clinical testing; however, in many cases, quality control is not sufficiently performed for economic and technical reasons. To promote evidence-based medical care, it is important to promote high-quality clinical testing in these countries. To do so, our company has provided 400 scientific documents in 17 languages. We have also held 49 scientific seminars in 10 countries, with more than 10,000 participants, to share the latest medical information. We especially focus on supporting the standardization and promotion of external quality control to improve the quality of clinical testing. To support the standardization of hematology testing in China, we set up an environment for the international standard method of blood cell counting, in 2002 for the organizer of an external quality assessment program, and in 2011 for an agency responsible for practical tests of medical equipments. We have also been supporting national external quality assessment programs since 1998, first in Thailand and now including the Philippines and Mongolia. For external quality assessment programs in these countries, we applied the approach shown by Japanese doctors and medical technologists in their effort for accuracy improvement. We believe the experience and knowledge of Japan can be utilized to support developing and emerging countries.     

Development of patient satisfaction questionnaire in allergic rhinitis]

Recent suggestions emphasize the importance of assessing medical care outcomes from the point of view of both professional opinion and patient's subject like patient satisfaction as well as quality of life. Self-administered questionnaires are often used as an instrument for this purpose. When compared with quality of life, there is less useful questionnaire for patient satisfaction. Accordingly, we here aimed to develop the questionnaire, which is disease-specific, comprehensive, simple, clinically available and satisfied psychometric validation study. The items were collected from patients and satisfaction-related literature's review, and the total 20 were selected finally from them after excluding inadequate or overlapped items. Then, we conducted validation study in 214 subjects sampled randomly from 603 patients with Japanese cedar pollinosis who had visited clinics in 2003 by mailing self-administered questionnaire in spring, 2004. The response rate was 65.3%. In factor analysis, items were divided into four domains such as doctor-patient relationship, treatment outcome, geniality in hospital and convenience of medical service. The former two domains were the most correlated well with patient satisfaction. The quality of this questionnaire such as responsiveness, reliability, construct validity, convergent/discriminate validity, and clinical validity satisfied international standard. Thus, it was verified that our newly developed questionnaire is a useful and scientific tool for examination of patient satisfaction with medical care in allergic rhinitis.     

Reflections on relevance: Psychotherapy and Psychosomatics in 2004

Relevance of an article is a highly desirable yet hardly predictable quality at the time of its publication. Article relevance is frequently measured by the impact factor of the journal where the article is published. Furthermore, impact factor, citation index and citation analysis are used as a measure of research progress and scientific wealth of a nation. The wisdom and significance of this approach to relevance is debatable and thus discussed here. In 2004, Psychotherapy and Psychosomatics published a variety of articles which, in the author's view, are clinically relevant. Several selected clinically relevant issues reviewed in this article include: the conceptualization of fibromyalgia as a stress disorder; the psychosocial impact and psychosocial interventions in cancer; the impact of alexithymia on patient care; the possible relationship between depression and nutrition (namely intake of folate and pyridoxal phosphate); the significance of hypercoagulability in panic-like anxiety; the questionable value of single isomer drugs, and the relevance and adequacy of clinimetrics versus psychometrics in clinical research. The reviewed issues seem to be relevant to clinical practice, research or both, but also to our critical thinking, and the critical review of the developments in psychiatry and psychology.     

医学科技论文影响力相关因素分析

目的探讨医学科技论文影响力的相关因素方法采用回归分析方法,研究安医大附院1996-2003年间1146篇科技论文影响力与作者背景、论文来源等因素之间的关系。结果影响因子、是否为基金或成果论文,以及作者是否入选人才培养对象、是否承担课题等9个因素与论文影响力有明显的相关性,其中影响因子、是否为基金或成果论文、论文发表年限和作者学历,不仅与论文是否被引用有关,而且影响着论文被引频次和自引他引倾向。结论论文影响力的提高,不仅需要科研管理部门引导科技人员在高影响因子期刊发表科技论文,更需要从人才培养、学位教育、项目和成果管理等诸方面去努力,只有建立起一支具有良好素质和有所作为的科技队伍作支撑,才能从根本上保证论文水平和论文影响力的稳步提高。     

Issues of research in medicine

Research in medicine is liable to all rules and standards that apply to research in other natural sciences, since medicine as a science and service fully meets the general definition of science: it is a common, integrated, organized and systematized knowledge of mankind, whereby physician--being more or less aware of doing so-- in his daily activities applies scientific thinking and scientific methods. The procedure of problem solving in scientific work and in medical practice is characterized by many similarities as well as variation. In scientific research, the observation of some phenomenon that cannot be explained by the known facts and theories is followed by making a hypothesis, planning and carrying out experimental investigation resulting in some data. Interpretation of these data then provides evidence to confirm or reject the hypothesis. In medical practice, quite a similar procedure is followed; the initial examination of a patient, when his condition cannot be explained by the data thus obtained, is identical to the observation of a phenomenon which cannot be explained by the known facts; working diagnosis would correspond to making the hypothesis; and experimental investigation would compare to laboratory and other diagnostic studies. The working diagnosis is accepted or rejected depending on these results. Of course, there also are differences in the problem solving procedure between scientific research and daily medical practice. For example, in research a single hypothesis is posed, a single experiment with successive testing and/or repeats is performed, whereas in medical practice several hypotheses are made, multiple studies are concurrently performed to reject current hypotheses and to make new ones. Scientific investigation produces an abundance of systematic data, whereas in medical practice target data are being generated, yet not systematically. Definitive decision making also differs greatly, as in scientific research it only ensues from conclusive evidence, whereas in medical practice definitive decision is made and therapeutic procedures are performed even before reaching final evidence. The general strategy of work and research in medicine can be briefly described by four principles, i.e. good knowledge of one's own work; continuing upgrading of one's own work in collaboration with respective institutions (laboratories, university, and research institutes); implementation of standard, up-to-date and scientific methods most of the time; and publishing work results on a regular basis. This strategy ensures constant progress and treatment quality improvement while allowing due validation and evaluation of the work by the society. Scientific research is based on the pre-existing knowledge of the problem under study, and should be supervised, systematic and planned. Research produces data that may represent some new concepts, or such concepts are developed by further data processing. In research, scientific procedure includes a number of steps that have to be made to reach a new scientific result. This procedure includes (a) thinking about a scientific issue; (b) making a scientific hypothesis, i.e. the main objective of the study; (c) research ethics; (d) determination of sources and mode of data collection; (e) research performance; (f) collection and analysis of all research data; (g) interpretation of results and evidence; and (h) publications. The next section of this chapter brings an example of scientific research in the field of medicine, where the procedures carried out during the research are briefly described; other chapters of this supplement deal with statistical methodology used on processing the data obtained in the study, which is most frequently employed in scientific work in the field of medicine.     

Effectively incorporating selected multimedia content into medical publications

Until fairly recently, medical publications have been handicapped by being restricted to non-electronic formats, effectively preventing the dissemination of complex audiovisual and three-dimensional data. However, authors and readers could significantly profit from advances in electronic publishing that permit the inclusion of multimedia content directly into an article. For the first time, the de facto gold standard for scientific publishing, the portable document format (PDF), is used here as a platform to embed a video and an audio sequence of patient data into a publication. Fully interactive three-dimensional models of a face and a schematic representation of a human brain are also part of this publication. We discuss the potential of this approach and its impact on the communication of scientific medical data, particularly with regard to electronic and open access publications. Finally, we emphasise how medical teaching can benefit from this new tool and comment on the future of medical publishing.     

Incentive for a shift from modern scientific medicine to integrative medicine

Medicine has been evaluated in recent years both quantitatively and qualitatively. Contemporary medicine has been assumed to be conceptually based on modern science. However, there is a problem that quantity and quality are hard to evaluate using only scientific parameters. It is, therefore, the aim of this article to emphasize that the quantity and quality of medicine need to be evaluated not only from the standpoint of modern scientific medicine but also in terms of integrative medicine. Integrative medicine is postulated to be comprehensive in its fundamental doctrine, emphasizing a holistic approach including technical, artistic, social, religious, philosophical, and ethical elements. However, in evaluating carefully and seriously actual performance, it was noted that contemporary medicine has been giving greater emphasis to aspects of integrative medicine where increasing concern is paid to patients' personal preferences, as indicated by their quality of life. An incentive for a shift from exclusively scientific to integrative medicine, which started as early as the 1970s, is revival emotion toward a prime modality of medicine. Part of this article was presented at the 43rd annual meeting of the Japanese Society for Artificial Organs on December 1, 2005     

The interface of genomic information with the electronic health record: a points to consider statement of the American College of Medical Genetics and Genomics (ACMG)

Disclaimer: This statement is designed primarily as an educational resource for medical geneticists and other clinicians to help them provide quality medical services. Adherence to this statement is completely voluntary and does not necessarily assure a successful medical outcome. This statement should not be considered inclusive of all proper procedures and tests or exclusive of other procedures and tests that are reasonably directed to obtaining the same results. In determining the propriety of any specific procedure or test, the clinician should apply his or her own professional judgment to the specific clinical circumstances presented by the individual patient or specimen. Clinicians are encouraged to document the reasons for the use of a particular procedure or test, whether or not it is in conformance with this statement. Clinicians also are advised to take notice of the date this statement was adopted, and to consider other medical and scientific information that becomes available after that date. It also would be prudent to consider whether intellectual property interests may restrict the performance of certain tests and other procedures.     

虚拟现实技术在医学中的应用

虚拟现实是一门新兴的学科 ,它在医学上已经得到了广泛的应用。本文从虚拟人、虚拟人同真实人体数据的融合以及虚拟的远程医疗系统三个方面介绍了虚拟现实在医学上的应用 ,并从对计算能力的要求、软硬件等方面介绍了医学虚拟现实背后的图形学支持。最后 ,对现有的分布式 VR系统做了一个简要的介绍。     

加强医学物理实验教学条件建设提高人才培养质量

医学物理学是把物理学的原理和方法应用于人类疾病的预防、诊断、治疗和保健的一门交叉学科,在高等医学院校又是一门重要的基础课。医学物理学作为一门完整的课程教学体系,实验教学是其不可分割的重要组成部分。而实验又作为医学物理学习和研究的一种基本方法,对提高教学质量和学生创新能力的培养起着至关重要的作用。它不仅使学习医学物理知识的感性材料能够有效地获得,加深理解医学物理概念和规律形成的过程,学会使用基本仪器并独立进行实验的方法和技能的过程,更是使学生的创新意识、创新思维、创新能力得到培养,也是进一步培养学生的科学研究方法和科学态度的重要手段。换句话说,医学物理实验课程教学不仅关系到本门课程的教学和学习,还关系到相关课程的学习,特别是对学生后续课程的学习及实践能力、创新能力的培养都会产生重要影响。因此,为适应新形势,我校应在开放医学物理实验室、改革实验课程、创新教学手段、加强实验人员培训、网络化管理等方面进行改革,把科学研究全面渗透到本科教学中去,充分发挥实验教学在创新型人才培养中的作用,也为教学方法研究、教师科研及学生科技创新创造良好的环境。     

The South American medical communities in the genesis of the tropical medicine: construction and circulation of knowledge on American leishmaniasis in the beginning of the twentieth century

This article aims to demonstrate how researchers from different South American countries took part in the process of globalisation of the tropical medicine paradigm, through research on leishmaniasis found in this region. The main objective of the present article is to highlight the role of these researchers, as well as of their scientific institutions, in a global history of tropical medicine which surpassed European borders and its imperialistic practices. At the same time, it will be identified the renewal of the tropical medicine paradigm in the South American context. During the beginning of the twentieth century, leishmaniasis became an important health issue in tropical areas, whereas the mere usage of the repertoire of the medical knowledge, produced in Europe up until that time, revealed itself as an insufficient instrument to help solve the problem. Hereupon, this matter was, above all, an open discussion, which required great skills and refined techniques of tropical medicine for its study. For this reason, it enabled the members of the regional medical communities to establish vigorous communication channels with medical centres, located in other continents, that had already been giving much deserved importance to leishmaniasis as an exciting scientific theme.     

Communication in context: new directions in communication research

By focusing attention almost exclusively on a single encounter, researchers have adopted a rather restricted view on studying communication in health care. After all, communication does not take place in a vacuum but is influenced by the context in which it takes place. We would therefore strongly recommend to broaden the perspective of communication research. In this respect, four lines of investigation are proposed, each guided by different theories. In the first, context is determined by the goals or targets aimed at by both parties in the medical encounter. The second concerns the context of time, referring to the influence of previous and future medical encounters. The third is set up around the organizational context in which an interaction takes place and the last defines context by looking at a medical encounter as a meeting between two multifaceted parties. Studying a medical encounter in its broader context is expected to provide answers to intriguing questions such as why health care professionals do not always act in conformity with the general approved standards of high quality communication and how the factor time span can be used more effectively in the medical encounter. Eventually, a broader context view will bridge the existing gap between theory and practice.     

Web of science: a unique method of cited reference searching

The number of times an article is acknowledged as a reference in another article reflects its scientific impact. Citation analysis is one of the parameters for assessing the quality of research published in scientific, technology and social science journals. Web of Science enables users to search current and retrospective multidisciplinary information. Parameters and practical applications evaluating journal and article citation characteristics available through the Science Citation Index are summarized.     

构建培养高素质创新型医学人才的开放性实验教学平台

随着医学教育观念的转变和创新教育模式的发展,培养高素质的医学创新型人才已经成为各高等医科院校的目标定位.实行开放性实验教学、促进学生科研创新能力的培养已成为目前各高校教学改革的共同趋势.本文对我校几年来实施开放性实验教学、建立开放性实验教学公共平台的具体做法进行了初步的总结与回顾,以期抛砖引玉,并为国内同行在培养高素质创新型医学人才的改革实践中提供一点借鉴作用.