Gross anatomy: An outdated subject or an essential part of a modern medical curriculum? Results of a questionnaire circulated to final-year medical students

Final-year undergraduate medical students were given a questionnaire on the gross anatomy curriculum they had experienced in their first year at medical school 5 years earlier. They were asked to evaluate the relevance of the dissection course, lectures and seminars in gross anatomy for clinical courses, clerkships, and everyday practical work on the ward. About two-thirds of the students found the time spent on 10 different regions in anatomy to be adequate, and a considerable number of students would have liked even more details. The vast majority expressed a wish to repeat topographical anatomy during their clinical teaching. Furthermore, ～75% of the students showed interest in short, specialized dissection courses during the clinical curriculum. Medical students just before graduation ranked gross anatomy with the dissection course and integrated clinical topics as a keystone for their clinical courses. The results of such surveys should be taken into consideration when discussing modification to teaching gross anatomy or arguing about a balanced dissection course. © 1993 Wiley-Liss, Inc.     

Relationship between muscle fatigue and oxygen uptake during cycle ergometer exercise with different ramp slope increments

Summary The surface electromyogram (EMG) from active muscle and oxygen uptake ( ) were studied simultaneously to examine changes of motor unit (MU) activity during exercise tests with different ramp increments. Six male subjects performed four exhausting cycle exercises with different ramp slopes of 10, 20, 30 and 40 W · min^–1 on different days. The EMG signals taken from the vastus lateralis muscle were stored on a digital data recorder and converted to obtain the integrated EMG (iEMG). The was measured, with 20-s intervals, by the mixing chamber method. A non-linear increase in iEMG against work load was observed for each exercise in all subjects. The break point of the linear relationship of iEMG was determined by the crossing point of the two regression lines (iEMG_bp). Significant differences were obtained in the exercise intensities corresponding to maximal oxygen uptake ( ) and the iEMG_bp between 10 and 30, and 10 and 40 W · min –1 ramp exercises (P < 0.05). However, no significant differences were obtained in and corresponding to the iEMG_bp during the four ramp exercises. With respect to the relationship between and exercise intensity during the ramp increments, the -exercise intensity slope showed significant differences only for the upper half (i.e. above iEMG_bp). These results demonstrated that the and at which a nonlinear increase in iEMG was observed were not varied by the change of ramp slopes but by the exercise intensity corresponding to and the iEMG_bp was varied by the change of ramp slopes. In addition, the significant differences in the exercise intensity slopes for the upper half of the tests would suggest that the recruitment patterns of MU and/or muscle metabolic state might be considerably altered depending upon the ramp slope increments.     

The flexor function of the m. pronator teres in man: a quantitative electromyographic study

Summary The muscle pronator teres was studied by surface electromyography during elbow flexion in a horizontal plane. The forearm was in semi-pronation and movement was performed at various velocities. A quantitative comparison was made between pronator teres activity and two main elbow flexors, biceps brachii and brachioradialis.The mean timing of the onset of activity was constant: biceps brachii was activated first followed by pronator teres and brachioradialis, and the lower the velocity of flexion, the earlier was the onset of biceps brachii activity.There was a linear relationship between the integrated EMG from each muscle and the work done. However, this relationship was less exact for pronator teres and brachioradialis at low values of work, a finding which opens questions about the generality of this relationship and about the muscle equivalent concept.Pronator teres appears to participate in elbow flexion besides its role in pronation.Despite similar anatomical peculiarities, pronator teres does not behave in the same way as anconaeus or popliteus and, above all, it is not the sole muscle active in slow movement. Thus, all the stocky mucles lying close to an articulation do not behave in the same way.     

Effects of spontaneously chosen crank rate variations on electromyographic responses in sub-maximal arm exercise in inexperienced subjects

The aim of the present study was to compare electromyographic responses during arm exercises with a crank rate chosen spontaneously (T_S) or set at 20% below or above (T_–20, T₊₂₀) the spontaneously chosen crank rate (SCCR). Ten male physical education students performed arm exercises with intensities ranging from 20% to 80% of maximal power. Muscular activity levels were analysed for the biceps brachii and the triceps brachii muscles using integrated rectified surface electromyography (iEMG). All values were presented as the mean and standard deviation. During T_S, the sum of iEMG for the two muscles studied was significantly (P<0.05) lower than during T₊₂₀ for each power output. No significant differences were observed in iEMG values between T_S and T_–20. The hypothesis that SCCR relates to a minimisation of muscle activation during an upper body exercise was not confirmed. Variations superior or inferior to a 20% increase of the iEMG responses do not influence it. Moreover, the selection of crank rates depends on the power output and the SCCR increased significantly (P<0.05) with increasing power output.     

Effects of a second bout of maximal eccentric exercise on muscle damage and electromyographic activity

This study examined whether a second bout of maximal eccentric exercise performed 3 days after the first exercise bout would produce further changes in muscle damage and electromyographic activity (EMG). Male students (n=26) were randomly assigned to experimental 70 (EX70; n=9), experimental 30 (EX30; n=8), and control (CON; n=9) groups. The initial exercise was 30 maximal voluntary isokinetic eccentric contractions (MAX1) on non-dominant elbow flexors at 60° s⁻¹ (1.05 rad s^-1). The EX70 and EX30 groups performed a second bout of 70 and 30 eccentric contractions (MAX2), respectively, 3 days after MAX1. Upper arm circumference , range of motion , strength, integrated EMG (IEMG), and mean power frequency (MPF) were measured before, immediately after, and once a day for 9 days after MAX1. Plasma creatine kinase (CK) activity and muscle soreness were assessed before and for 9 days after MAX1. Total work, work per contraction, IEMG, and MPF were also recorded during MAX1 and MAX2. All indicators of muscle damage changed following MAX1 for each group (P<0.05), but no indicators of additional damage (P>0.05) were apparent after MAX2 for either the EX70 or EX30 groups. IEMG (P=0.03) and MPF (P=0.04) were lower for MAX2 compared with MAX1 for both the EX30 and EX70 groups. It is concluded that performing a second bout of eccentric exercise with damaged muscles 3 days after the initial bout does not produce further damage or retard recovery, even when the second bout of exercise is more strenuous. EMG findings were consistent with reduced activation of fast-twitch motor units during the second eccentric bout. These results may be interpreted as evidence of a neural protective mechanism. Electronic Publication     

中西医结合治疗老年慢性肾功能衰竭

目的观察中西医结合治疗老年慢性肾功能衰竭的临床疗效.方法老年慢性肾功能衰竭病人57例,随机分为治疗组和对照组.对照组用常规西药治疗,治疗组在上述治疗基础上加用降压排毒饮和中药灌肠,观察治疗前后血压、尿素氮、血肌酐、内生肌酐清除率及血脂变化.结果治疗组经治疗后血压、尿素氮、血肌酐、胆固醇、甘油三酯显著下降,而内生肌酐清除率、高密度脂蛋白上升;对照组除血压略下降,其他无显著变化,两组比较,有显著差异,P＜0.01.结论中西医结合疗法在降压、降脂、改善肾功能方面,均显著优于对照组.     

The reimagination of sustainable integrated care in Ontario,Canada

Purpose/settingTo encourage clinical and financial efficiency, the Canadian province of Ontario initiated an integrated care program – Integrated Funding Models (IFMs) that required collaboration and coordination across acute and post-acute care sectors. This research shows how program implementers went beyond policy-makers’ original designs, to make integrated care sustainable for chronic diseases.MethodsForty-five interviews were conducted with program participants at three chronic disease programs, as well as with policymakers. Interviews were conducted over two phases; during early implementation in 2016, and as programs matured in 2018. Data were analyzed through a cultural constructivist lens to understand how participants shaped programs.FindingsParticipants desired greater accountability and control. Participants in the first program wanted localized control over decision-making. In the second, participants initiated greater control over financial uncertainty. In the third program, hospital participants sought greater control over community care. Participants across programs simultaneously wanted integrated care to be expanded holistically, spatially, and temporally for patients, extending the length of care, and expanding the spaces in which care was provided. Findings also suggest a gap between program implementers’ and policymakers’ conceptualizations of integrated care.ConclusionThis work shows how IFMs were reimagined in ways that transcended their original conceptualization as spatially and temporally delimited initiatives aimed at improving coordination and efficiency. It has practical implications for those facing sustainability challenges in other contexts.     

What components are important for effective healthcare alliance governance? Findings from a modified Delphi study in New Zealand

Alliance governance is a form of governance developed in industry settings and more recently applied to healthcare. The core idea behind alliance governance is to involve the many stakeholders in the system to collaboratively develop a joint programme that promotes an integrated and whole of systems approach to care. Little is known about the model in healthcare, nor what those involved in an alliance should be focused upon. Using a modified Delphi method, this research presents a set of components that research participants agreed should underpin development of an effective alliance governance arrangement.These characteristics include a systems perspective—a truly shared governance protocol based on a shared vision and a common purpose; performance measurement—collecting and using real-time data that depicts the realities of an end-to-end system to establish better and more achievable goals based on alliance performance; a relational perspective to promote trust, respect and collaboration amongst alliance members, who historically have been competing for contracts and resources; structural changes that enable and promote a shared governance system; and, finally, equity and inclusion to ensure a diverse alliance which promotes diversity of ideas, and involvement of all stakeholders in the decision making process. This research is relevant to policymakers seeking to develop effective alliance-type arrangements as well as to those involved in the practice of alliance governance.     

生大黄用于急性出血坏死型胰腺炎治疗的临床探讨

目的　探讨生大黄用于急性出血坏死型胰腺炎治疗的可行性。方法　对 4 1例急性出血坏死型胰腺炎随机分为两组 :治疗组 2 2例 ,在常规治疗 (包括善得定的应用 )的基础上 ,给予生大黄 2 0克胃管内给药 ,每日 3～ 4次 ;对照组 1 9例给予常规治疗。结果　治疗组 2 2例 ,出现并发症 5例 ,占 2 2 .7%,死亡 2例 ,病死率 9.1 %;治疗期间出现肠麻痹 2例 ,占 9.1 %,肠蠕动恢复时间平均 3天。对照组 1 9例 ,出现并发症 1 3例 ,占 68.4 %,死亡 2例 ,病死率 1 0 .5 %,治疗期间出现肠麻痹者 7例 ,占 3 6.8%,肠蠕动恢复时间平均 5天。两组患者发生并发症概率有显著差异性 ( P <0 .0 0 5 )。出现肠麻痹的概率差异有显著性 ( P <0 .0 5 )。结论　生大黄对于促进肠蠕动、解除肠麻痹、减低肠管内压力、抑制胰酶的释放、抗感染、加快体内毒素的排泄、改善胰腺微循环和改善全身血液循环起着重要的作用。在减少急性出血坏死型胰腺炎的并发症方面有良好的功效     

中西医结合治疗成人股骨头缺血坏死120例

采用中西医结合疗法 ,经皮股骨头内减压引流、靶血管脉冲式加压药物灌注、髂内动脉部分血管栓塞灌药和口服中药治疗成人股骨头缺血坏死 12 0例。通过 12～ 36个月的随访观察 ,髋关节疼痛缓解率为 92 5 0 % ,关节活动度改变率为 96 67% ,DSA检查血管增加达 88 33% ,CT、X线片股骨头骨质改变占 5 5 83%。综合疗效优于任何单项治疗