医师资格考试技能操作中手卫生要求研究

目的：研究《国家医师资格考试实践技能应试指南：临床执业医师》中部分无菌操作技术对手卫生步骤的要求与《医务人员手卫生规范》中规定的差异。方法选取“技能应试指南”中换药与拆线、吸痰术、导尿术、动静脉穿刺术、胸腔穿刺术、腹腔穿刺术、腰椎穿刺术、骨髓穿刺术共8项无菌操作技术要求,与“手卫生规范”中的规定进行比对。结果8项无菌操作技术中提及洗手的仅有3项,提及需要戴无菌手套的有6项,而没有提及需要卫生手消毒;并且在戴无菌手套之前同时提及洗手的仅有1项。结论“技能应试指南”中部分无菌操作手卫生步骤要求与“手卫生规范”中不一致,从根源上导致医师在教育培训不同阶段的学习存在不一致。建议考试组织部门在编制指南时应参考国家相关规定,用一致的标准来规范医务人员诊疗行为。     

明清诸名医对脾胃学说发展之概略

明清时期,脾胃学说在理论与实践上均有重大发展。除温病学派、温补学派外,尚有不少名医家,如戴思恭、缪希壅、龚延贤、李用粹、傅青主、唐容川等都对脾胃学说有进一步发展。     

基于知识图谱构建和定性访谈法探析张忠德教授辨治间质性肺病临床特征与方药规律＊

目的 构建个性化知识图谱技术和定性访谈法结合，进一步挖掘张忠德教授辨治间质性肺疾病临证特征与用药规律。方法 采用回顾性分析，系统收集张忠德教授广东省中医院门诊2010年8月至2020年8月治疗间质性肺疾病病历，按照诊断标准、纳入标准、排除标准，严格筛选后，通过广东省中医院大数据挖掘团队中医药大数据智能处理与知识服务系统进行数据挖掘分析，并通过多元化视觉定性访谈法，将定量与定性分析有效结合。结果 共筛选出347首方，共141味药物，常用药物频次 ≥ 84次的药物有10味，其中党参、麦芽、黄芪、紫菀、白术等为核心用药，通过症状与药物推理知识地图显示，党参、炒麦芽、黄芪、大枣、太子参、山萸肉、巴戟天等为主要治疗用药；临证遣方用药知识关联分析，得知咳嗽、耳鸣、心悸、水肿、头痛、胸闷、恶寒等为多见，针对咳嗽，首选紫苏子、橘红、桂枝等温肺降气通阳之品等；频繁聚集显示，常用药对炒麦芽-炒白术、黄芪-党参、黄精-菟丝子、前胡-紫菀、炙枇杷叶-浙贝母等；聚类分析结果得到4组关系密切的聚类新药物组合；以脾为中轴，肺肾共扶为主的“平调五脏论”，分期阶梯辨治间质性肺疾病。结论 张忠德教授认为间质性肺疾病，虚实夹杂为多见，应从肺、脾、肾着手，采用平调五脏论分期阶梯辨治，用药配伍精简，以和为贵，以平为期。     

浅析《症因脉治》中脾主运化理论

《症因脉治》是明代医家秦昌遇所撰的临床型医书。脾者,乃仓廪之本,气血生化之源。通过对脾主运化观点的阐释,说明脾主运化的重要性。根据本书特点并结合《症因脉治》中的症、因、脉、治4个方面对脾主运化理论进行探讨,同时结合诸贤附论与临床实践阐明对脾主运化的理解。     

Exploring the safety measures by doctors on after-hours house call services

Background

Aggression against doctors involved in after-hours house calls (AHHC) is widely perceived to be high. It is, however, unclear how doctors who perform this service manage the risk of aggressive patients during home visits.

Aims

The aim of this paper is to explore if and how doctors manage the risk of violence against them during AHHC.

Methods

A survey was designed and administered to all 300 Australian-based doctors engaged in AHHC under the National Home Doctor Service (NHDS). The survey was conducted from September 2014 to November 2014.

Results

There were 172 responses (57.3 per cent). Only 43 per cent of respondents adopted personal protective measures. The remaining 57 per cent had none; of those 6 per cent had never considered protective measures, and 31.8 per cent were aware of the risk of violence, but were unsure of what to do. Measures adopted include the use of chaperones/security personnel (34.1 per cent), dependence on surgery policies (31.2 per cent), de-escalation techniques (15.2 per cent), panic buttons (7.2 per cent), personal alarms (6.1 per cent), and others (6.5 per cent). Females were more likely to adopt personal protective measures than males (OR 4.94; p<0.01; CI 1.70–14.34), and Australian-trained doctors were less likely to do so relative to overseas-trained doctors (OR 0.35; p=0.04; CI 0.12–0.99).

Conclusion

Just over half of the doctors involved in AHHC took no precautions against aggressive attacks while on duty, and nearly one-third relied on the policies of their employing surgeries.     

Exploring the experiences of EU qualified doctors working in the United Kingdom: A qualitative study

This qualitative study of 23 doctors from other EU member states working in the UK highlights that, contrary to media reports, doctors from other member states working in the UK were well prepared and their main motivation to migrate was to learn new skills and experience a new health care system. Interviewees highlighted some aspects of their employment that work well and others that need improving. Some interviewees reported initially having language problems, but most noted that this was resolved after a few months. These doctors overwhelmingly reported having very positive experiences with patients, enjoying a NHS structure that was less hierarchical structure than in their home systems, and appreciating the emphasis on evidence-based medicine. Interviewees mostly complained about the lack of cleanliness of hospitals and gave some examples of risk to patient safety. Interviewees did not experience discrimination other than some instances of patronising and snobbish behaviour. However, a few believed that their nationality was a block to achieving senior positions. Overall, interviewees reported having enjoyable experiences with patients and appreciating what the NHS had to offer.     

Knowledge and attitudes of family doctors,dermatologists, and endocrinologists on sun exposure and vitamin D

Objectives: Vitamin D is an important component of bone metabolism. Skin cells synthesize vitamin D when exposed to the sun. However, prolonged sun exposure damages the skin and increases the risk for skin cancer. The objective is to evaluate and compare the attitudes and recommendations of family doctors, dermatologists, and endocrinologists on exposure to the sun and vitamin D.

Methods: In a cross-sectional study, a questionnaire was completed by personal interview in a study population of 78 family doctors, 21 dermatologists, and 22 endocrinologists.

Results: On a scale of 1–10, the mean score for recommendations to reduce sun exposure was 4.7 for dermatologists, 4.2 for endocrinologists, and 6.4 for family doctors (p < 0.001). Family doctors recommended a mean daily exposure to the sun of 67.4 min compared to 41.4 by dermatologists, and 47.1 by endocrinologists (p = 0.007). Dermatologists and endocrinologists were more likely to recommend protective measures such as hats and long sleeves during sun exposure than family doctors (p < 0.0001). There were no statistically significant differences between male and female doctors for the entire study population.

Conclusions: There is little consensus among these medical practitioners, whether specialists or primary care doctors, concerning sun exposure. Further studies should evaluate the optimal duration and intensity of sun exposure and doctors’ recommendations should be based on the findings.     

多元智力理论视阈下的医学信息学本硕博连读培养模式

［］本硕博连读研究生培养模式旨在培养具有原创精神和能力的研究型人才。本文从多元智力理论出发,从理论层面对本硕博连读培养模式进行阐述;结合研究生教育改革实践,从选拔标准、培养模式、过程管理、质量监控、分流淘汰机制、论文答辩以及学术成果要求等几个方面对医学信息学本硕博连读培养中的关键环节进行了分析。