城市医疗救治体系在应对公共卫生事件中的管理实践与思考

医疗救治体系是公共卫生体系建设的重要组成部分 ,建立和完善医疗救治体系对于提高收治率、降低病死率 ,缓解公共卫生危机具有直接而关键的作用。该文总结回顾了上海在防治SARS期间医疗救治工作的组织与管理 ,简要介绍了上海构建突发公共卫生事件医疗救治体系的基本思路     

医学美学与美容医学的整体学科研究

回顾医学美学与美容医学形成独立的学科系统的十多年来的发展历程，认为这个新兴学科在“整体学科”方面还存在一些学术问题有待人们进一步探讨。并认为，所谓“整体学科研究”是遵循该学科发展的内在规律所进行的各项研究的总和，是该学科发展的灵魂。学者们的任务在于：通过“整体学科研究”寻求其学科内在规律，经一代代同道有志者坚持不懈的努力，达到学科完善的目的。     

电子时代的医学图书馆馆员和循证医学

简要阐述了循证医学的概念及其基本特点,探讨了电子时代循证医学对于医学图书馆员的要求,同时提出了电子时代医学图书馆员应该具备的知识和技能.     

基于混合遗传算法的心脏病决策支持系统研究

将遗传算法和 BP算法相结合 ,建立了一个基于混合遗传算法的心脏病决策支持系统来鉴别诊断五种常见心脏病 (冠心病 ,高血压性心脏病 ,风湿性心脏病 ,慢性肺原性心脏病和先天性心脏病 )。一个含有 35 2份心脏病的数据库用来构建和测试了该系统。实验结果表明 ,构建的系统对这五种心脏病均有较好的诊断识别率 ,系统的平均识别准确性达 90 .6 % ,各疾病的用户准确性和程序准确性均大于 85 .0 % ,表现出良好的心脏病的临床诊断决策支持能力     

Outcome of a conservative approach in severe ulcerative colitis.

BACKGROUND: Severe ulcerative colitis is potentially life threatening even though a policy of intensive medical management and early colectomy in recent years reduced mortality to almost zero. However, colectomy, with or without ileal-anal anastomosis, has its own problems (morbidity, pouchitis, cuffitis) and no reliable prognostic index of surgical outcome has been developed. Intravenous steroids are still the mainstay of medical therapy but their maximal duration before stating a 'treatment failure' has not been defined. AIM OF THE STUDY: To evaluate the effectiveness, safety and outcome of an intensive medical approach in a series of patients with severe ulcerative colitis. PATIENTS AND METHODS: One hundred and forty-nine episodes of severe ulcerative colitis in 115 patients admitted to a Gastroenterology Unit in a 7-year period were retrospectively evaluated. Intravenous glucocorticosteroids--methylprednisolone 1 mg/kg/day--and topical steroids were administered, and supportive treatments with intensive monitoring were extended to all the patients. Second-line strategies for steroid-refractoriness were prolonged glucocorticosteroids treatment, oral ciclosporin, infliximab or surgery. RESULTS: The median number of Truelove criteria at admission was 3 (range 2-5), median CRP 34 mg/l (range 10-196). Median follow-up after discharge was 49 months. In 84 (57%) episodes an early response was noted, while 65 (43%) did not respond within 10 days to the standard steroid treatment. In the non-responders group, 28 patients went into remission with a prolonged steroid treatment (slow responders); 15 patients were treated with ciclosporin (eight responders) and 6 with infliximab (four responders). A total of 24 colectomies was performed in this group of patients (in 21 cases within 30 days from admission). Slow responders showed lower albumin levels (P = 0.02), higher cumulative dose of glucocorticosteroids in the year prior to admission (P = 0.02) and higher age (P = 0.03), in comparison with early responders. Major complications were noted in four episodes which responded to medical treatment. Disease-related mortality was zero. CONCLUSIONS: Medical treatment and use of second-line therapies were effective in the present series of patients. A group of slow responders has been identified and, if an intensive medical monitoring is guaranteed, steroids can be safely prolonged after the first 10 days of treatment. Cumulatively, about 80% of the patients responded to short-term medical treatment, only 5% of the patients underwent colectomy in the follow-up period. Major adverse events were recorded in four patients, who had recovered completely after adequate medical treatment.     

高等医学院校艺术隐性课程探究

隐性课程是当前课程理论研究领域十分关注的课题，近年来的教育实践表明，艺术课程对促进学生的全面发展具有深刻的影响。本文论述了隐性课程的特征和构成要素，阐述了艺术隐性课程的价值功能，并提出了医学院校实现艺术隐性课程的有效措施。     

一个医学生眼里的医学伦理学教育

主要通过医学生的视角，从教学内容、教学方法等方面谈了对医学伦理学教育的感受和一些建议，并通过医学生的声音反映医学伦理学教育的成果以及存在的一些问题。     

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目的　探讨医用创面封闭胶在减少肝切除术后肝断面渗血中的价值。方法　 2 0 0 2年 5～ 11月采用信封法将 60例接受肝切除术的病人随机分为医用胶组 (A组 ,n =3 0 )和对照组 (B组 ,n =3 0 )。A组在肝断面彻底止血后滴注医用创面封闭胶 ,B组则不用。测定术后第 1、2、3d腹腔引流液中红细胞 (RBC)数和血红蛋白 (Hb)量。结果　A、B两组术后腹腔引流液中的RBC数和Hb量均以第 1d为高峰 ,显著高于第 2、3d(P <0 0 5) ,其中A组术后第 1d腹腔引流液中RBC数及Hb量均显著低于B组 (P <0 0 5) ,只相当于B组第 2d的水平。A组主要并发症发生率低于B组 ,但差异无统计学意义 (P =0 0 7)。结论　医用创面封闭胶可有效抑制肝切除术后早期的肝断面渗血 ,有助于降低术后并发症的发生率