美国针灸中医教育概况

针灸中医教育是中医事业的重要组成部分,通过对它的起源、发展、历史背景、针灸立法、针灸管理机构的探讨,可更好地了解美国的针灸和中医的现况.这对中国发展海外教育与合作、制定海外交流和发展策略有一定的参考价值,也为各国中医教育提供了信息平台.在过去的40年中,美国针灸教育经历了上世纪70年代的起步期,80年代的增长期,90年...     

Quality of life and everyday activities in patients with primary biliary cirrhosis

Primary biliary cirrhosis (PBC) is generally a slowly progressive disease that may lead to cirrhosis and liver failure. However, patients with PBC often suffer from a variety of symptoms long before the development of cirrhosis that include issues of daily living that have an impact on their work environment and their individual quality of life. We therefore examined multiple parameters by taking advantage of the database of our cohort of 1032 patients with PBC and 1041 matched controls. The data were obtained from patients from 23 tertiary referral centers throughout the United States and from rigorously matched controls by age, sex, ethnicity, and random-digit dialing. The data showed that patients with PBC were more likely than controls to have significant articular symptoms, a reduced ability to perform household chores, and the need for help with routine activities. Patients with PBC rated their overall activity similar or superior to that of controls; however, more of them reported limitations in their ability to carry out activities at work or at home and difficulties in everyday activities. PBC cases also more frequently reported limitations in participating in certain sports or exercises and pursuing various hobbies; however, they did not report significant limitations in social activities. In a multivariable analysis, household income, a diagnosis of systemic lupus erythematosus, limitations in work activities, a reduction in work secondary to disability, and church attendance were independently increased in PBC cases with respect to controls. CONCLUSION: Our data indicate that the quality of life of patients with PBC in the United States is generally well preserved. Nevertheless, patients with PBC suffer significantly more than controls from a variety of symptoms that are beyond the immediate impact of liver failure and affect their lifestyle, personal relationships, and work activities.     

How accurate are faculty evaluations of clinical competence?

Objective:To determine the degree and sources of variability in faculty evaluations of residents for the American Board of Internal Medicine (ABIM) Clinical Evaluation Exercise (CEX). Design:Videotaped simulated CEX containing programmed resident strengths and weaknesses shown to faculty evaluators, with responses elicited using the openended form recommended by the ABIM followed by detailed questionnaires. Setting:University hospital. Participants:Thirty-two full-time faculty internists. Intervention:After the open-ended form was completed and collected, faculty members rated the resident’s performance on a five-point scale and rated the importance of various aspects of the history and physical examination for the patient shown. Measurements and Main Results:Very few of the resident’s strengths and weaknesses were mentioned on the openended form, although responses to specific questions revealed that faculty members actually had observed many errors and some strengths that they had failed to document. Faculty members also displayed wide variance in the global assessment of the resident: 50% rated him marginal, 25% failed him, and 25% rated him satisfactory. Only for performance areas not directly related to the patient’s problems could substantial variability be explained by disagreement on standards. Conclusions:Faculty internists vary markedly in their observations of a resident and document little. To be useful for resident feedback and evaluation, exercises such as the CEX may need to use more specific and detailed forms to document strengths and weaknesses, and faculty evaluators probably need to be trained as observers. Received from the Fellowship Program in General Internal Medicine, Departments of Medicine, Walter Reed Army Medical Center, Washington, D.C., and the Uniformed Services University of the Health Sciences, Bethesda, Maryland. Presented at the Tenth Annual Meeting of the Society of General Internal Medicine, April 30, 1987, San Diego, California. Supported in part by the Department of Clinical Investigation, Walter Reed Army Medical Center. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.     

Reverse Gear: Cairo’s Dependence on a Disappearing Paradigm

The global increase in population projected over the next 45 years (median estimate 2.4billion) is approximately equal to the world population in 1950 (2.5 billion)[1]. Yet instead ofraising global concern, economists are focusing on relatively small reductions in populationpredicted in some rich countries, and many demographers have switched to the study ofageing. By 2004 the rate of global population growth had fallen to 1.3 percent, but theabsolute annual increase (83.1 million more births …     

巨大或多发性先天性黑色素细胞痣：1008例患者中神经皮肤黑色素细胞增多症的发生率

背景:目前尚缺乏大样本量的巨大先天性黑色素细胞痣(LCM N)或多发性先天性黑色素细胞痣(M CM N)患者中神经皮肤黑色素细胞增多症(NCM)的相关资料。目的:本文报道了1008例LCM N或M CM N患者中NCM和其他并发症的发生率。方法:评价来自Nevus Network提供的LCM N或M CM N志愿者数据     

Progress and peril: examining antibiotic resistance and systemic contaminants

As part of its ongoing mission to inform and support trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH), in conjunction with the Health and Environmental Funders Network (HEFN), held a day-long Issue Dialogue on two important environmental health issues: antibiotic resistance and systemic contaminants. Experts and advocates from many organizations came together to discuss concerns and opportunities, as well as current and potential roles for health philanthropy. This Issue Brief brings together key points from the day's discussion with factual information on environmental health drawn from a background paper prepared for the participants.     

Contaminant Loading in Drainage and Fresh Water Used for Wetland Management at Stillwater National Wildlife Refuge

Throughout the western United States, studies have identified various detrimental effects of contaminants to aquatic biota from the use of agricultural drainage water for management of arid wetlands. However, little is known about the relative contributions of contaminant loading from pollutants dissolved in water compared with those carried by drifting material (e.g., detritus) associated with drainage water. Consequently, we determined loading rates for contaminants dissolved in water and those incorporated by drifting material for drainage (Diagonal Drain) as well as fresh (S-Line Canal) water used for wetland management at Stillwater National Wildlife Refuge (SNWR), Nevada during the early, middle, and late periods of the irrigation season (June through mid-November) in 1993. We found loading rates for trace elements throughout the irrigation season were almost entirely (> 98%) associated with contaminants dissolved in the water rather than incorporated by drift. Although drift contributed little to the total loading for trace elements to SNWR wetlands, contaminant concentrations were much greater in drift compared with those dissolved in water. Loading rates for dissolved As, B, Hg, and total dissolved solids (TDS) differed among periods for the Diagonal Drain. Along the Diagonal Drain, loading rates for dissolved As, B, Hg, Mo, unionized ammonia (NH₃-N), TDS, and Zn differed among its three sampling sites. B was the only trace element with differences in loading rates for drift among periods from the Diagonal Drain. In contrast, loading rates for As, B, Cr, Cu, Hg, Se, and Zn in drift differed among periods for the S-Line Canal. Along Diagonal Drain, loading rates in drift for B (middle and late periods), Cr, Cu, and Zn differed among sites. Hg (xˉ ≥ 12.0 ng/L) and NH₃-N (xˉ ≥ 0.985 mg/L) dissolved in water as well as B (xˉ ≥ 97.4 μg/g DW) and Hg (xˉ ≥ 0.461 μg/g DW) in drift from the Diagonal Drain and S-Line Canal exceeded screening levels (SLs) for protection of aquatic biota throughout the irrigation season. Dissolved As (xˉ ≥ 0.0426 mg/L) in water from the Diagonal Drain during all periods exceeded the SL for protection of aquatic biota. Dissolved B (xˉ = 1.03 mg/L) in water from the Diagonal Drain during the early period exceeded the SL for protection of aquatic biota. Received: 18 September 1997/Accepted: 5 February 1998