实践表现的自我评估:美国内科委员会实践改善教育活动

为了评估美国内科委员会(American Board of Internal Medicine,ABIM)开展的实践改善单元(Practice Improvement Module,PIM)教育活动的效果,以及参与心脏疾病预防PIM教育活动的专科医师临床实践改善的表现,美国内科委员会进行了一项以自我指导为基础的观察研究.     

Comparison of chronic exposures received by radiation workers using different biological end‐points with the doses recorded by TLD

The frequency of different biological end‐points such as translocation, dicentrics (DC) and micronuclei (MN) was studied in 14 radiation workers and 21 non‐radiation workers. The average frequencies for different types of aberrations were significantly higher in radiation workers compared to those of respective aberrations in non‐radiation workers. Out of 14 radiation workers, eight subjects showed a dose above the detection limit as per translocation and seven subjects as per DC frequency and no patient showed a dose above the detection limit as per MN frequency. Regression analysis carried out between the recorded doses according to Thermo Luminescence Dosimeter (TLD) and the dose estimated as per translocation frequency gave a correlation coefficient of 0.32, whereas that obtained with TLD dose and the dose estimated as per DC was 0.81. When the correlation was made between the TLD dose, which was above 0.15 Gy (the detection limit for translocation), and the dose estimated as per translocation frequency in these subjects, a correlation coefficient of 0.98 was found. A similar analysis between the TLD dose above 0.5 Gy (the detection limit for DC) and the dose estimated as per DC frequency in these subjects, a correlation coefficient of 0.26 resulted. This paper discusses the reasons for the poor correlation obtained between TLD dose and dose estimated as per DC and MN frequency.     

1－（2，6－二甲基苯氧基）－2－（3，4－二甲氧基苯乙氨基）丙烷盐酸盐对兔血小板胞浆游离钙浓度的影响

１－（２，６－二甲基苯氧基）－２－（３，４－二甲氧基苯乙氨基）丙烷盐酸盐对兔血小板胞浆游离钙浓度的影响夏敬生，罗湘，曾繁典（同济医科大学临床药理研究室，武汉４３００３０）１－（２，６－二甲基苯氧基）－２－（３，４－二甲氧基苯乙氨基）丙烷盐酸盐［１－（...     

Duodenal Mucosal T Cell Subpopulation and Bacterial Cultures in Acquired Immune Deficiency Syndrome

Enteric infections, chronic diarrhea frequently with no obvious etiology, and weight loss cause major morbidity and mortality in acquired immune deficiency syndrome (AIDS). Alterations in mucosal immunity may explain the increased incidence of enteric infections, and contamination of the upper small intestine with bacteria may be the cause of weight loss observed in these patients. To test this hypothesis we studied the mucosal T lymphocyte subset in duodenal mucosal biopsies in 14 AIDS and seven control patients. Duodenal fluid was also cultured for aerobic and anaerobic bacteria. There was a significant decrease among leu-3a T cells (helper/inducer) subset in AIDS. The proportion of mucosal T cells reacting with leu-2a (cytotoxic/suppressor) was significantly increased in AIDS patients. These patients also had a significant reversal of the normal mucosal helper/suppressor T cell ratio. There was no change in the number of leu-7 cells (cells mediate natural killer and antibody-dependent cellular cytotoxicity) as compared to controls. All patients with diarrhea and three of five patients without diarrhea had bacteria in their duodenal fluid. Mean number of organisms was 4.5 X 10(4)/ml. Cultures were negative in all control subjects. The results reveal that the abnormalities of T cell subpopulation in the blood of AIDS patients also occur in their duodenal mucosa. This immunological abnormality is associated with the bacterial colonization of upper gastrointestinal tract which may explain the diarrhea and weight loss observed in majority of our patients. The results also indicate that increased incidence of enteric infections in AIDS may be explained on the basis of altered mucosal immunity.     

A prospective controlled trial of computerized decision support for lipid management in primary care

OBJECTIVES: This study aimed to assess the uptake and effect in primarycare of a computerized decision support system (DSS) for themanagement of hyperlipidaemia. METHOD: A prospective controlled trial was conducted in 25 practicescovering a population of 150 000 in the city of Birmingham.The Primed system, a specialist developed, rule based DSS forgeneral practice, was introduced prospectively after a 3-monthbaseline data collection. The main outcome measures were ninemonths' data on prescribing of lipid lowering agents; use oflaboratory tests; and referrals to secondary care for the investigationof hyperlipidaemia. RESULTS: System use was lower than expected. A shift was observed towardsrequests for appropriate follow-up of previously abnormal lipidresults and a greater emphasis on full lipid profiles, in linewith the DSS guidelines. Referrals showed a 55% decrease onthose expected (NS). The prescribing evaluation revealed a largevariation between practices, but no significant alteration followingsystem use. Views of users favoured decision support as a concept,but criticised technical problems with the system. CONCLUSIONS: Greater integration of DSS software and practice based datahandling systems is needed. The mode of data capture, and henceboth the content and form of knowledge representation, in DSSmust take greater account of the primary care consultation processif such systems are to be of use to practitioners. Keywords. Computerized decision support, hyperlipidaemia, primary care, prospective controlled trial.