The anatomy of the human genome: a neo-Vesalian basis for medicine in the 21st century.

Since 1956, the anatomy of the human genome has been described on the basis of chromosome studies, gene mapping, and DNA sequencing. The gross anatomy of Andreas Vesalius, published in 1543, played a leading role in the development of modern medicine. The objective of this article is to show that knowledge of genomic anatomy is having a comparably strong and pervasive influence on all of medicine. The research revealing human genome anatomy is reviewed. The insight provided by genome anatomy has brought about shifts of focus, both in research and in the clinic, eg, from genomics to proteomic and from the individually rare, single-gene disorders to common disorders. Genomic anatomy permits medicine to become more predictive and preventive. At the same time, diagnosis and treatment are rendered more sensitive, specific, effective, and safe. Hazards in misuse and misunderstanding of the information exist. Education of both the public and health professionals is vital if the full benefits of neo-Vesalian medicine are to be realized.     

GUEST EDITORIAL NEEDLESS .NEEDLES

Modern scientific medicine rightly dep.recates the old-time blood- letting of occidental medicine and acupuncture of oriental medicine. At the same time we do well to scrutinize carefully what many doctors and clinics are pawning off nowadays on the public of China in the name of modern scientific medicine. F''or the present the Chinese public, aware of the ineffectiveness of many formerly used methods of treatment is perchance overly credulous of anything that is promulgated as the product of modern science. Nevertheless this state of affairs cannot continue to last for lorg if present practises of physicians in China remain unaltered and nothing is done to reduce the excessive cost of medical care and in- ''crease its effectiveness.     

医学人才培养与现代医学模拟技术

时代在进步,医务人员自身医学伦理素养不断提高,病人自我保护意识不断增强,医学生临床实习日渐遥远。现代医学模拟技术再现真实临床环境,通过与医学理论知识有机结合、培训医学生及在职医务人员临床操作技能、全面培养职业医师素养,成为将医学生培养成及在职医务人员继续教育的必备教学、培训工具。     

疾病蛋白质组学研究进展

在人类基因组草图完成的后基因组时代,生命科学面临的最重要任务之一将是对人类基因的注释与确认,即人类基因组中约1/3的基因及其功能有待于蛋白质水平上的揭示与确认。其中,在功能蛋白质组领域内,疾病蛋白质组学在医学和生物制药方面具有发现新分子药靶、生物标志物的巨大的潜力。本文对疾病蛋白质组学在国外、国内研究现状及目前所存在的问题、发展趋势等几方面作简要概述。     

An ambulatory medical education program for internal medicine residents

Teaching the fundamentals of ambulatory medicine has many well known difficulties. An education program with specific topics covered and modeled after continuing medical education programs for practicing physicians was instituted for residents in a university hospital clinic and was evaluated. The program was effective in improving the residents' knowledge, in enhancing their attitudes toward the clinic, and in improving their performance of influenza vaccinations. No adverse effects of the program were found. This approach, in which a curriculum is carefully defined and participation of the house staff is required, makes the ambulatory medical education process more accountable for what is taught.     

Getting new evidence into medicine

The rate of transfer of the knowledge gained from health and medical research into evidence-based practice is determined by many factors. Preconditions for the uptake of new evidence are the availability of good evidence, ready access to the evidence, a supportive organisational environment, and effective mechanisms for promoting knowledge uptake. Evidence-based medicine is being promoted in Australia by a body of enthusiastic clinicians, public health practitioners and consumer advocates, supported by initiatives from national, State and local healthcare services and professional bodies. The short to medium term future of evidence-based medicine in Australia is likely to be shaped by three major factors: a reduction in cost and technical barriers which limit access to computerised databases; a trend towards shared decision-making between clinicians and patients; and increased demand for information to fill the gaps in research-based evidence on specific problems.     

Evaluation of ambulatory care training by graduates of internal medicine residencies

In 1984, 154 physicians who had completed residencies in internal medicine at 15 major teaching hospitals in 1982 evaluated their residency training in ambulatory care. A majority of the physicians would have liked more experience in practical areas related to career planning and office management, more input from subspecialties such as orthopedics and dermatology, greater knowledge about the management of psychosocial problems, and more information about exercise and nutrition. Although many physicians also wanted more time devoted to several other topics, less than 20 percent recommended spending less time on 26 of the 27 topics being evaluated. Since these recommendations are similar to those reported in evaluation studies published over the past 25 years, it appears that training programs in internal medicine have not been successful in restructuring their curricula to meet many of the needs of practicing physicians.     

The human genome project and international health

The authors see the human genome project as a "public good" in the best sense. They optimistically describe the medical benefits that the developed and the developing worlds will experience when the principal goal of the genome project, to assist medical researchers in their assault on disease, is realized. Watson and Cook-Deegan also summarize current genome projects around the world, touch upon the broad social implications of genome research, and emphasize the international nature of the genome mapping effort.     

美国新毕业家庭医生寻找产科相关工作的体验

背景　足够的产科家庭医生对于确保患者获取必需的产科服务至关重要。然而,既往研究表明执业范围包含产科的家庭医生数量正在逐年减少,如今从事新生儿接生工作的家庭医生不到10%。目的　旨在探究希望将产科纳入其执业范围的新毕业家庭医生如何发现和选择工作,并进一步了解当前就业形势对家庭医生的执业范围,特别是产科、新生儿接生方面的影响。方法　于2017年进行问卷调查和定性访谈的混合方法研究。对美国家庭医生进行电子问卷调查并在目的性子抽样后对这些医生进行深度半结构化电话访谈。问卷调查总结了家庭医生未从事产科工作的原因,为进一步明确选择从事产科工作的家庭医生的具体情况,采用基于群体的沉浸式方法来转译定性访谈的结果。本研究向2 098例毕业于2014-2016年并希望从事新生儿接生工作的美国家庭医学专业实习医生发送调查问卷,回复1 016份,回复率48.43%,其中56例接受了电话访谈。结果　问卷调查结果显示,未能找到工作范围包含产科的工作是希望从事产科工作的家庭医学毕业生未从事该工作的主要原因。定性访谈结果显示,家庭医生通常通过人脉关系或人才招聘的途径找到产科相关工作,并根据地理位置偏好、家庭义务及生活方式要求等个人考虑因素做出选择。同时,求职过程和择业决策也受到工作结构、执业特点及缺乏产科相工作经验等因素的限制。结论　虽然个人意向决定大部分医学生的工作选择,但其选择仍受到多种不可控因素限制,特别是家庭医学工作提供产科相关工作的能力。美国毕业医学生从医院实习生到执业医师的转变同时影响着毕业生的求职选择和医疗机构患者寻求医疗服务的质量。因此,了解就业情况对家庭医生就业范围的影响方式,有助于进一步明确如何协助家庭医生在其希望从事的范围内工作并对其进行相应协助,从而确保每一个家庭可以获得更好的医疗服务。     

Academic medicine as a public trust

Academic medicine is entrusted by society with the responsibility to undertake several important social missions toward improving the health of the public, including education, patient care, and research. This trust is given implicit authority by generous public funding and considerable autonomy. Medical academia can take pride in its successes, manifested by a premier scientific establishment, the development and use of sophisticated medical technologies and drugs, and the recent dramatic declines in death rates from heart disease and stroke. Academic medicine, however, has been relatively unresponsive to a number of vexing public problems, including skyrocketing expenditures for medical care, substandard indexes of population health, uneven quality of care, an unfavorable geographic and specialty mix of physicians, and widespread disability from long-term medical and psychiatric problems. Although there are many cogent reasons why academic medicine has chosen to define its task relatively narrowly (the nature of its funding successes, the intractability of the social problems, and the attractiveness of the biomedical model), the central issue is how well academic medicine is fulfilling its responsibilities to the public. To the degree that academic medicine defines its central mission narrowly, it may violate its implicit social contract and jeopardize its primary source of financial support. Alternatively, in recognition of its public responsibilities, academic medicine can choose to expand its current activities to be more responsive to the health concerns of the general population.     

Infection control.

"Universal precautions" and "strict infection control procedures" have become health-care facility as well as household terms. However, not much time has been given to explaining the specifics of exactly what they are or how and when they should be applied. The purpose, therefore, of this article is to review these specifics for practicing physicians, regardless of their specialty.     

Embryonic stem cell research in Iran: status and ethics

Various successes in regenerative medicine by therapeutic cloning have given rise to expectations that treatments will soon be developed for incurable diseases. But using embryonic stem cells for this purpose raises many ethical dilemmas including those about the beginning of human life. Arguments concerning stem cell research and therapeutic cloning in different countries are influenced by both the religious and bioethical traditions which dominate in these cultures. This article examines how these traditions have influenced stem cell research in Iran through an account of scientific advances and the development of regulations on embryonic stem cell research in Iran.     

开展“调研兴趣小组”活动提升公共卫生学生专业能力

为了探索“调研兴趣小组”第二课堂实践活动对提高公共卫生专业学生调查研究能力的可行性和有效性,相关教师尝试建立调研实践学习平台,选拔感兴趣的公共卫生专业学生参加。让学生早接触专业实践,面向社会、面向社区、面向人群开展调研活动。经过4年的实践,相关成果表明,该实践活动提高了学生公共卫生调研实践能力,值得进一步研究和推广。     

试谈青年医学科研人员思想品德的培养

作者在长期的医学科研管理工作实践中,深感当代青年医学科研人员,不仅要有才智和科研能力,更重要的是要具有良好的道德品质修养。在今后的医学科研工作中,对青年医学科研人员来说,除了在学术水平、研究能力等业务素质方面的培养提高外,更重要的是要注重科研道德品质的培养。     

Research output of Australian general practice: a comparison with medicine, surgery and public health

OBJECTIVES: To compare the productivity of Australian general practice in terms of research publications with the productivity of other medical disciplines. DESIGN: A survey of Australian general practice, medicine, surgery and public health publications carried out by manual searching of specific journals and an electronic search of the US National Library of Medicine's "PubMed" database. MAIN OUTCOME MEASURES: The number of original research publications by Australian general practitioners, physicians, surgeons and public health physicians during 1999; the relative publication rate of Australian general practice, medicine, surgery and public health over the period 1990-1999. RESULTS: Of original research articles published in 1999, GPs authored 65% (17/26) in Australian Family Physician and 3% (3/90) in the Medical Journal of Australia; physicians published 4% and 37%, respectively. The electronic search identified 54 research articles relating to Australian general practice published in 1999 in 21 different journals, only two of which were primary care journals. Over the period 1990-1999, there was a publication rate of one general practice [discipline] article per 1000 GPs in practice per year. Corresponding rates for medicine, surgery and public health were 105/1000, 61/1000 and 148/1000, respectively. CONCLUSIONS: There is considerable disparity between the level of research output of general practice and that of the disciplines of medicine, surgery and public health. If we are to have effective general practice research, we urgently need to develop research skills, a supportive infrastructure and a culture that nurtures research.     

中药治疗人与犬乳腺癌的临床和实验研究概况

综合近年来文献可知,中药治疗乳腺癌取得了一定进展,本文对中药治疗人乳腺癌、犬乳腺癌的临床应用和实验研究进展进行对比和总结,从中药成方加减、中药提取物、中药有效成分等几个方面总结中药治疗乳腺癌的途径和方法,揭示中药治疗乳腺癌的作用机制。通过人、犬乳腺癌的中药临床和实验研究对比,使二者互为借鉴,为犬乳腺癌的中药临床治疗提供思路,为人乳腺癌的中药研发提供研究基础和重要模型。     

民国中医期刊《寿世医报》

《寿世医报》是民国时期苏州中医师陈焕云创办的中医期刊。该期刊的创办主要是为了向民众宣传中医知识,提高地方公共防疫能力。为了解该刊的编辑特点和历史价值,本文通过对该刊创刊背景、撰稿人员组成、办刊宗旨、期刊内容和主编陈焕云医学思想的考察,发现《寿世医报》虽然出身民间,但得到了众多名医支持;内容面向民众,却始终突出学术,是一份实用性很强的中医学术期刊;陈焕云是中医坚决的捍卫者,不仅在中医临床方面颇有见地,而且对中医的发展,也有不少科学的见解。《寿世医报》反映了20世纪30年代中医期刊的主要特点,是研究民国时期江苏地区中医历史的重要文献资料之一;同时它又是中医抗争的舞台之一,为后人展示了当时中医自强图新的历史过程,具有一定的文献和历史价值。该刊的成功不仅得益于民国时期中医从业者打破门户之见,团结协作,还因于苏州优越的地理、人文环境以及主编深厚的国学基础和中医素养。     

济南市城乡结合部居民代谢性疾病及相关知识知晓率调查

了解济南市城乡结合部居民既往患者遵医情况及对代谢性疾病基本知识的知晓情况，为制定该类地区居民的代谢性疾病防制策略和措施提供依据。方法:采用现况研究的方法，选择济南市城乡结合部两个具有代表性的居委会，对年龄≥35岁的居民进行问卷调查及相关指标测定。结果:所调查的394位居民中，代谢性疾病的知晓率为37.0%，对代谢性疾病相关知识完全不知晓者占20.8%；125例既往代谢性疾病患者中有104例（83.2%）曾经服过药，仅57例（45.6%）按医嘱规律服药；患者不规律服药的原因中，自认为无大碍者所占比例最高，为47.2%；多因素分析表明，文化程度是影响居民代谢性疾病知识知晓情况的主要因素。结论：城乡结合部居民对代谢性疾病知识的认知及治疗现状不容乐观，通过提高居民的文化程度促进知识的普及，加强居民的健康教育势在必行。     

The human genome project. Prospects and implications for clinical medicine

The recently initiated human genome project is a large international effort to elucidate the genetic architecture of the genomes of man and several model organisms. The initial phases of this endeavor involve the establishment of rough blueprints (maps) of the genetic landscape of these genomes, with the long-term goal of determining their precise nucleotide sequences and identifying the genes. The knowledge gained by these studies will provide a vital tool for the study of many biologic processes and will have a profound impact on clinical medicine.