声音

"要让医生实现执业‘自由行’,首先要给医生松绑。我建议医师执照管理参照机动车驾驶证的管理方式,可以在一个地点注册、考核,但是在全国范围内放开行医,取消医疗机构单点注册的限制,这样就可以扫清医师多点执业的法律障碍,深入推进医疗人事制度改革。"针对多点执业政策,全国人大代表、无锡市人民医院副院长陈静瑜认为,只要是医生,在哪里都能行医。     

医患关系的经济学分析

从经济学角度,探讨了医患关系及其经济行为,分析了医患关系持续恶化的经济学原因,为缓解医患关系提供建设性意见与建议。     

结直肠癌患者幽门螺杆菌感染与高胃泌素血症及环氧合酶-2的相关性研究

目的观察结直肠癌患者幽门螺杆菌(Hp)感染情况,探讨Hp与高胃泌素血症及环氧合酶-2(COX-2)的相关性,为制定控制感染对策提供依据。方法选择2009年12月-2013年12月在医院治疗的结直肠癌患者121例,另选择同期来医院进行经结肠镜检查,并且未发现明确的消化道疾病患者98例临床资料,采用酶联免疫吸附法检测其抗Hp IgG水平,并采用放射免疫分析法和免疫组织化学染色法检测胃泌素和COX-2水平变化,数据采用统计软件SPSS17.0进行分析。结果结直肠癌患者Hp阳性率、高胃泌素血症发生率及COX-2阳性率分别为70.2%、52.9%和62.8%,均明显高于对照组的12.2%、15.3%和9.2%,差异有统计学意义(P<0.05);结直肠癌患者Hp阳性与肿瘤发生部位、TNM分期和淋巴结转移明显相关,差异有统计学意义(P<0.05);结直肠癌Hp阳性患者高胃泌素血症发生率及COX-2阳性率分别为64.7%、89.4%,均明显高于Hp阴性患者的25.0%、38.9%,两组比较差异均有统计学意义(P<0.05)。结论结直肠癌患者Hp阳性率明显升高,并且与高胃泌素血症发生及COX-2表达相关,为揭示结直肠癌的病因和制定新的治疗策略提供了理论依据和思路。     

芪芍桂朴方治疗幽门螺旋杆菌相关性胃炎的临床研究

目的:研究芪芍桂朴方内服联合穴位敷贴治疗幽门螺旋杆菌(Hp)相关性胃炎的临床效果。方法:按照治疗方案不同将我院收治的86例Hp相关性胃炎患者分为实验组46例和对照组40例,实验组给予芪芍桂朴方联合穴位敷贴治疗。对照组患者给予奥美拉唑+克拉霉素+阿莫西林三联疗法治疗,连用4周。比较两组患者治疗后主要症状积分水平、临床疗效以及Hp根除率。结果:实验组患者治疗后主要临床症状(胃脘疼痛、上腹不适、恶心呕吐、饥不欲食)积分均显著低于对照组,实验组患者Hp根除率(89.13%)显著高于对照组(52.50%)。结论:芪芍桂朴方内服联合穴位敷贴可显著改善Hp相关性胃炎患者临床症状,提高Hp根除率。     

聚焦于改善医患关系的继续医学教育探讨——巴林特小组介绍及启示

巴林特小组是培训医生从精神动力学的视角关注和思考医患关系的一种训练方法。小组在组长的带领下,聚焦于案例报告者面临的医患关系困扰展开病例讨论,所有组员为案例报告者提供安全的、支持性的氛围,并阐述自己对于事件本身的深刻理解,提出建设性的问题和评论。案例报告者通过组员提供的不同视角和观点,发现自己的盲点,从中获益。除讨论形式外,组长也可以根据小组现场呈现出的医患关系和心理学动力做出"雕塑",即案例报告者和组员共同用身体语言、个体之间的位置关系代表现实中的医患关系,将隐形的人际关系可视化,一般会带来更直接的问题解决和更震撼的内心体验。巴林特小组有助于医护人员解决自己的心理问题、提高医患沟通技巧、在医护人员之间建立起有效的互动和支持,尤其在改善医患关系方面具有突出成效。因此,可以作为继续医学教育的新形式、新内容在我国医疗卫生领域推广应用。     

Primary gastric lymphoma

AIM: The purpose of this review is to describe the variousaspects of primary gastric lymphoma and the treatmentoptions currently available. METHODS: After a systematic search of Pubmed, Medscape and MDconsult, we reviewed and retrieved literature regarding gastric lymphoma. RESULTS: Primary gastric lymphoma is rare however, the incidence of this malignancy is increasing. Chronic gastritis secondary to Helicobacterpylori(H pylon) infection has been considered a major predisposing factor for MALT lymphoma.Immune histochemical marker studies and molecular biology utilizing polymerase chain reaction have facilitated appropriate diagnosis and abolished the need for diagnostic surgical resection. Advances in imaging techniques including Magnetic Resonance Imaging (MRI) and Endoscopic UItrasonography (EUS) have helped evaluation of tumor extension and invasion.The clinical course and prognosis of this disease is dependent on histopathological sub-type and stage at the time of diagnosis. Controversy remains regarding the best treatment for early stages of this disease. Chemotherapy, surgery and combination have been studied and shared almost comparable results with survival rate of 70-90%. However, chemotherapy possesses the advantage of preserving gastric anatomy.Radiotherapy alone has been tried and showed good results.Stage ⅢE, IVE disease treatment is solely by chemotherapy and surgical resection has been a remote consideration. CONCLUSION: We conclude that methods of diagnosis and staging of the primary gastric lymphoma have dramatically improved. The modalities of treatment are many and probably chemotherapy is superior because of high success rate,preservation of stomach and tolerable complications.     

Clinical role and importance of fluorescence in situ hybridization method in diagnosis of H pylori infection and determination of clarithromycin resistance in H pylori eradication therapy

H pylori is etiologically associated with gastritis, gastric and duodenal ulcers, gastric adenocarcinoma and mucosa-associated lymphoid tissue （MALT） lymphoma. Eradicating H pylori may convert rapidly the outcome of related diseases with the use of more accurate diagnostic molecular tests. Indeed some of the tests cannot give the evidence of current infection; H pylori can be detected by noninvasive and invasive methods, the latter requiring an endoscopy. Eradication failure is a big problem in Hpylori infection. Recently, clarithromycin resistance in H pylori strains is increasing and eradication therapy of this bacterium is becoming more difficult. Molecular methods have frequently been applied besides phenotypic methods for susceptibility testing to detect clarithromycin resistance due to mutations in the 2143 and 2144 positions of 23S rRNA gene. Fluorescence in situ hybridization （FISH） method on paraffin embedded tissue is a rapid, accurate and cost-effective method for the detection of H pylori infection and to determine clarithromycin resistance within three hours according to the gold standards as a non-culture method. This method can also be applied to fresh biopsy samples and the isolated colonies from a culture of Hpylori, detecting both the culturable bacillary forms and the coccoid forms of Hpylori, besides the paraffin embedded tissue sections. This technique is helpful for determining the bacterial density and the results of treatment where clarithromycin has been widely used in populations to increase the efficacy of the treatment and to clarify the treatment failure in vitro.     

幽门螺杆菌空泡毒素的研究进展

幽门螺杆菌（Ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ，Ｈｐ）已被证实是慢性胃炎和消化性溃疡的重要致病菌，但其致病机理尚不清楚。目前已发现的毒力因子有多种，其中研究最多的是空泡毒素在致病性中的作用。有文献报道，大约５０％的Ｈｐ分离株体外可产生空泡毒素，并且...     

沟通的魅力

在我们店,有一名叫"孙猜"的员工,她总带给大家许多的奇思妙想——因为她的"运气"似乎总是那么好:在某时某刻,会突然来了那么一位顾客,开口就是千元保健品大单,孙猜"轻松"搞定!骄人的业绩令人羡慕不已……殊不知,天底下所有的运气,其实都是留给有准备的人的。那么,孙猜到底做了那些别样"准备"呢?三言两语快乐速递孙猜是个爽朗大方的美丽姑娘,关联销售是她手中的一张"王牌"!然而除此之外,"三言两语·快乐速递"更是     

癌症患者家属的健康状况及心理干预调查

目的 探讨癌症患者家属的健康状况及心理干预效果。方法 通过对2013年9~11月福建省16家三级甲等综合医院的220名癌症患者家属进行问卷调查,并对其中208名癌症患者家属实施心理干预,总结调查结果。结果当得知患者患癌症时,97.7%(215/220)患者家属的健康状况很不好,表现食欲不振、夜不能寐、焦虑、紧张等。94.5%(208/220)的患者家属有心理干预需要,由医生和护士根据家属的需要实施心理干预;1个月后重测,81.4%(179/220)患者家属在身心上的不良反应减轻,与干预前比较,差异有统计学意义(P<0.05)。结论 癌症患者家属的健康状况不容乐观,对癌症患者家属实施心理干预后,可减轻家属的心理压力,降低护患纠纷发生率,使其保持良好的健康状况,并能以最佳状态照顾患者的饮食起居,最大限度地发挥家庭的支持功能,有利于患者积极配合治疗,减轻患者不良情绪,减少危险因素发生。