全球医学教育最低基本要求:从梦想到现实

医学作为一种全球职业,必然有它共同的核心价值观、核心专业知识和技能。基于这样的认识,近年国外不少全国性或国际性医学教育组织对医学教育共同标准的设置进行了探讨。这些标准大体上可以规范为“过程标准”和“内容标准”,后者侧重于界定“结局评价”的结果,是更为本质的教育评价方法。1999年成立的国际医学教育专门委员会(IIME)致力于制定一套全世界医生都必须达到的“全球医学教育最低基本要求”(GMER),然后通过在一些国家的试验运行总结改进,最终达到向全球医学教育界推广,以确保医学教育质量。     

肿瘤治疗体系逻辑思想的研究

目的　针对当前肿瘤治疗机制存在不足 ,研究探索新的肿瘤治疗机制。方法　根据《肿瘤失控学说的反向思考》一文所提出的“肿瘤是机体在某种特定条件下建立起来的正常需要性调节”的理论 ,系统地阐述肿瘤治疗的新体系。结果　提出了“机体———肿瘤生长信息传递途径———肿瘤”是治疗肿瘤的三个重要环节。降低机体对肿瘤的需要性调节将成为肿瘤治疗首要目标 ,它扭转了过去以肿瘤局部治疗为主的治疗观念。结论　符合肿瘤生物学特征的新治疗体系是保护正常细胞 ,降低或减少机体对肿瘤细胞的需要等。     

最低装量检查法改进的探讨

目的对原有最低装量检查法进行改进,使其更具有操作性,更符合一些特殊制剂的特殊要求。方法采用比重法、容量替代法、容量加和法,分别对溃疡糊、水晶膏、氧化锌搽剂进行最低装量检查。结果原先无法进行的最低装量检查有了可行的方法。结论改进后的方法可靠、操作性强。     

网络课堂教学环境下教育者与学习者的素质分析

通过对网络课堂教学环境下教育者和学习者的素质分析,介绍了传统课堂教学环境和网络课堂教学环境的区别、网络课堂教学环境的要求和如何提高教育者和学习者的素质等问题.     

X线机容量保护电路的故障检修

F78-Ⅲ型X线机在摄影过程中，开机后或开机曝光一两次后，机器过载，曝光不能进行，关机后重新开机，机器恢复正常，之后又重复出现此故障现象。由上述现象初步判断容量保护电路有故障。     

Current determination of lithium-induced minimum sodium requirement in rats

Lithium administration raises the minimum sodium requirement of the organism. Lithium treated-rats drink spontaneously a hypertonic sodium chloride solution and thereby protect themselves against the toxic effects of lithium. In the present paper it was studied whether the consumption of sodium chloride can be used as a quantitative measure of the sodium requirement. Rats given different amounts of lithium with food for about 2 months were given free access to water and a 0.46 M NaCl solution, and the 24-h intake of the latter was followed. It was found that the consumption of hypertonic sodium chloride increased with the lithium dosage and the serum lithium level. The consumption showed the following characteristics: (a) It was sufficient to prevent death from lithium poisoning. (b) When access to hypertonic sodium chloride was discontinued for 48 h, the rats lost body weight; the body weight was reestablished within 1 h when the rats again had access to sodium chloride solution. (c) When sufficient amounts of sodium were given with the food, the lithium-treated rats drank no more sodium chloride solution than did the control rats. (d) When lithium administration was discontinued, the consumption of sodium chloride solution fell within 10 days to the control level. (e) The lithium-treated rats developed polyuria, but this was not the cause of the extra intake of sodium chloride. (f) The lithium-treated rats did not drink more of the hypertonic sodium chloride solution than was necessary to cover the minimum sodium requirement. The results indicate that the intake of hypertonic sodium chloride solution can, in fact, be used as a measure of the minimum sodium requirement in lithium-treated rats.     

全球医学教育最低标准与课程改革的思考

对照全球医学教育最低标准的具体内容,结合新世纪社会经济转型、医学模式转变等对高等医学教育的客观影响,对现有的高等医学教育教学内容与课程体系进行了剖析,提出以优化教学内容和课程体系为中心的系列教学改革措施,为培养适应未来需要的"五星"级医疗服务专门人才奠定必要的基础。     

Adverse effect of high added sugar consumption on dietary intake in American preschoolers

OBJECTIVES: To assess the effect of Dietary Reference Intakes (DRI)-recommended added sugar intake levels on nutrient and food group consumption by preschoolers. STUDY DESIGN: This was a cross-sectional study of 2- to 5-year-olds in the United States Department of Agriculture Continuing Survey of Food Intake by Individuals (CSFII), 1994 to 1996, and 1998 (n = 5437). Main food sources of added sugar were established. For five categories (< or =10% energy from added sugar, 11% to 15%, 16% to 20%, 21% to 25%, and >25%), mean nutrient and food group consumption and proportion of children not meeting the DRI were ascertained. The nonparametric test for trend indicated significance of changes. Analysis was stratified by age (2- to 3-year-olds versus 4- to 5-year-olds), and survey design corrected to maintain the nationally representative character of the data. RESULTS: The majority of children consumed less than 25% of energy from added sugar; the main sources were fruit and or soft drinks and desserts. Increasing added sugar consumption was paralleled by decreasing nutrient and food group intakes and increasing proportions of children with intakes below the DRI. Calcium intake was insufficient in large proportions of children consuming 16% or more from added sugar. CONCLUSIONS: In preschoolers, the new DRI for added sugar are reason for concern. Further research is needed to investigate the effects of the DRI on diet quality, body weight, and health status in young children.     

Good practice in consent

Informed parental consent reminds the health professional to respect parent autonomy with respect to their infant's health care. It involves at least four elements: information, assessment of understanding, assessment of capacity, and freedom to choose. Critical issues are training of staff, timing of approach, and quality and presentation of information. In the newborn period, additional problems include parental distress and competence, consent for research into emergency treatments (exceptions to this are proposed below); screening for future disease, circumcision and withdrawing intensive care are considered as special cases. Variation in practice and policies in European neonatal units is described.     

Pathophysiologic basis for growth failure in children with ichthyosis: an evaluation of cutaneous ultrastructure, epidermal permeability barrier function, and energy expenditure

OBJECTIVE: Because an impaired epidermal permeability barrier is present in many of the ichthyoses, we examined the contribution of barrier failure to caloric requirements in children with ichthyosis and growth failure. STUDY DESIGN: Transepidermal water loss (TEWL) and ultrastructural parameters of the permeability barrier were evaluated in 10 hospitalized children with ichthyosis and growth failure. Nutritional intake, resting energy expenditure, and calories lost as heat of evaporation were determined. RESULTS: Mean basal TEWL rates were markedly elevated in all study patients in comparison to the expected upper limit of normal (39.6+/-20.6 vs 8.7 mL/m(2) per hour). The severity of abnormalities in the ultrastructure of permeability barrier-related structures, assessed semiquantitatively, correlated significantly to mean basal TEWL rates (P <.001). Total body daily TEWL was elevated (746 +/- 468 vs 209 mL/d), resulting in a caloric drain of 433 +/- 272 kcal/d (21 +/- 9.8 kcal/kg per day) through heat of evaporation. Nutrient intake exceeded requirements in all, but resting energy expenditure exceeded predicted in 5 of 6 patients and correlated significantly with mean basal TEWL rates (P <.005). CONCLUSIONS: A defective permeability barrier in children with ichthyosis can result in ample chronic losses of water and calories to impair growth.