基于主诊医师负责制的住院绩效考核模式探讨

目的 建立主诊医师负责制下的住院绩效分配新模式,以适应医药分开改革的新要求.方法 探索基于医疗成果产出的岗位绩效管理考核和分配新制度,重点激励各主诊医师组医疗产出的工作量和工作难度,促使各主诊医师组增加服务量、提高技术水平和诊治疾病的难度.结果 以某科室各主诊医师组为例,从科室管理、团队建设、学科发展、工作效率等角度分析医改前后的转变.结论 重点激励分配制度,逐步被医务人员所接受,并取得较为明显的成效.     

Effects of TRH and TRH-like peptide pGLU-HIS-GLY-NH(2) on adrenocortical cell proliferation in rats

The effects of three peptides—colon mitosis inhibitor (CMI), its amide, and thyroliberin (TRH)—on the adrenocortical cell proliferation were studied. As an index of cell proliferation, the incorporation of bromodeoxyuridine (BrDU) into adrenocortical cell nuclei was used. It was found that: Twelve hours after the injection, only CMI-amide significantly increased the total number of BrDU-immunopositive cell nuclei per equatorial section of the adrenal cortex. This mitogenic effect was observed separately for the entire section, zona glomerulosa, and zona fasciculata. TRH stimulated the cell proliferation of the adrenal cortex 24 h after the injection. Its mitogenic effect was observed for entire section and zona glomerulosa. These findings suggest that these two related peptides, TRH and CMI-amide, should be considered as growth factors for the adrenal cortex.     

Recommendations of the Spanish Antibiogram Committee (COESANT) for selecting antimicrobial agents and concentrations for in vitro susceptibility studies using automated systems

Automated antimicrobial susceptibility testing devices are widely implemented in clinical microbiology laboratories in Spain, mainly using EUCAST (European Committee on Antimicrobial Susceptibility Testing) breakpoints. In 2007, a group of experts published recommendations for including antimicrobial agents and selecting concentrations in these systems. Under the patronage of the Spanish Antibiogram Committee (Comité Español del Antibiograma, COESANT) and the Study Group on Mechanisms of Action and Resistance to Antimicrobial Agents (GEMARA) from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and aligned with the Spanish National Plan against Antimicrobial Resistance (PRAN), a group of experts have updated this document. The main modifications from the previous version comprise the inclusion of new antimicrobial agents, adaptation of the ranges of concentrations to cover the EUCAST breakpoints and epidemiological cut-off values (ECOFFs), and the inference of new resistance mechanisms. This proposal should be considered by different manufacturers and users when designing new panels or cards. In addition, recommendations for selective reporting are also included. With this approach, the implementation of EUCAST breakpoints will be easier, increasing the quality of antimicrobial susceptibility testing data and their microbiological interpretation. It will also benefit epidemiological surveillance studies as well as the clinical use of antimicrobials aligned with antimicrobial stewardship programs.     

镇痛阿片样药物和穴位电刺激对机体的效应

３８例具有疼痛症状的患者在合谷穴接受ＴＥＮＳ（穿皮电神经刺激）或电针治疗。将４２只小鼠分为６组：①度冷丁组，②颅痛定（阿片样中草药）组，③急性吗啡戒断（ＡＭＷ）组，④吗啡戒断加电针（ＭＷ＋ＥＡ）组，⑤ＭＷ无ＥＡ（ＭＷ－ＥＡ），⑥对照组。以钾离子透入法测痛阀。依ＡＮＡＥ－点型（Ｆ）或ＣＤ４淋巴细胞亚群检测细胞中介免疫（ＣＭＩ）。以免疫酶组织化学显示ｃＡＭＰ及ｃＧＭＰ免疫反应性（ＩＲ）。结果表明患者的ＴＥＮＳ镇痛及细胞中介免疫的效应均与ＥＡ的效应相似。小鼠的镇痛效应为吗啡＞度冷丁＞颅痛定＞电针或颅痛定，而细胞中介免疫的效应为ＥＡ＞颅痛定＞度冷丁或吗啡。ＡＭＷ组的小肠ｃＡＭＰ－ＩＲ增加而ｃＧＭＰ－ＩＲ相对减弱，ＥＡ能调控ｃＡＭＰ－ＩＲ及ｃＧＭＰ－ＩＲ趋向正常水平。     

A systematic review of evidence for the role of inflammatory biomarkers in bipolar patients

Bipolar disorder (BD) is a neuropsychiatric disorder that is characterized by a phasic course of affective episodes interspersed with a euthymic state. Epidemiological, clinical, genetic, post-mortem and preclinical studies have shown that inflammatory reactions and immune modulation play a pivotal role in the pathophysiology of BD. It is conceptualized that biomarkers of inflammation and immune responses should be employed to monitor the disease process in bipolar patients. The objective of this systematic review is to analyse the inflammatory markers involved in human studies and to explore each individual marker for its potential clinical application and summarize evidence regarding their role in BD. A systematic review of human studies to measure inflammatory markers was conducted, and the studies were identified by searching PubMed/MEDLINE, PsycINFO, EMBASE, and Web of Science databases for peer-reviewed journals that were published until September 2015. In this review, we included peripheral markers, genetic, post-mortem and cell studies with inflammatory biomarker analysis in BD. One hundred and two (102) papers met the inclusion criteria. The pro-inflammatory cytokines were elevated and the anti-inflammatory cytokines were reduced in BD patients, particularly during manic and depressive phases when compared to the controls. These changes tend to disappear in euthymia, indicating that inflammation may be associated with acute phases of BD. Even though there are promising findings in this field, further clinical studies using more established detection techniques are needed to clearly show the benefit of using inflammatory markers in the diagnosis, follow-up and prognosis of patients with BD.     

重庆市医学生心身健康状况的调查

摘要:目的　医学生的心身健康状况既有一般大学生的共性,又有其特殊性。本文探讨医学生的心身健康状况,以了解医学学习和专业发展是否对其心身健康有更好的指导作用,从而为医学生心身健康状况的促进提出针对性的建议。方法　采用康奈尔医学指数（Cornell Medical Index,CMI）对重庆市两所医科大学的医学生的心身健康状况进行测量并进行统计分析。结果　心身健康的总体水平（t＝-5.02,P＜0.0001）、躯体健康（t＝-4.50,P＜0.0001）及精神健康（t＝-4.71,P＜0.0001）方面均是男生高于女生;不同年级学生的心身健康总体水平（F＝2.70,P＝0.0297）和精神健康水平（F＝2.76,P＝0.0268）有统计学差异,其中大一学生的心身健康状况最好,大二学生的心身健康状况最差,大三、大四处于中间状态;医学生心身健康问题最多的前五位问题分别是不适应、眼与耳、生活习惯、神经过敏、消化系统。结论　医学院校对大二学生及女生应给予更多的关注,并且适度增加课外集体活动,减轻学习压力,开阔心胸,发挥医学专业特长,切实促进医学生心身健康。     

In vitro susceptibility of isolates of Scytalidium spp. from superficial lesions against posaconazole

Scytalidium spp. is a dematiaceous fungi that has been frequently reported from tropical to semi subtropical regions. We distinguish two pathogenic species: S. dimidiatum and S. hyalinum which is an homologous non-pigmented mutant of S. dimidiatum. This keratinophilic mold may produce superficial disease (skin, nails) indistinguishable from dermatophytes. In Martinique, this pseudodermatophyte could represent more than 50 % of onychomycosis. Contrary to dermatophytes, the clinical response of Scytalidium spp. are typically very poor and topical treatment or systemic agents ineffective. To evaluate the potential efficacy of the new antifungal agent posaconazole, we tested in vitro 12 clinical isolates of Scytalidium spp. (seven S. dimidiatum and five S. hyalinum) against posaconazole by Etest method. For the totality of the isolates, the minimum inhibitory concentrations (MICs) were low: MICs less or equal to 0.25 microg/ml (maximum MICs of 0.25 microg/ml for S. dimidiatum and 0.032 microg/ml for S. hyalinum). These in vitro efficacy suggest that the new agent posaconazole may be a future alternative treatment.     

Exploration of the relationship between frequency of illness, attrition from alcohol treatment, neuropsychological status and field dependence

One hundred thirty-nine male veterans receiving treatment for alcoholism were administered the Cornell Medical Index (CMI), neuropsychological tests comprising the Brain Age Quotient (BAQ) and the Group Embedded Figures Test (GEFT). Patients endorsing items on scale J (frequency of illness) of the CMI comprised a frequently ill group (27%) with the remaining patients comprising an infrequently ill group (73%). The frequently ill group patients were more likely to drop out of treatment, obtain lower BAQ scores and appear more field-dependent on the GEFT. Treatment attrition of frequently ill patients might be less if their individualized treatment plan involved greater structure consistent with their field dependent orientation and impaired neuropsychological status.