开展读书报告活动深化医学教学改革

在对八年制医学教育的教学改革中,本教研室连续2年开展读书报告活动。教师介绍读书报告的书写要求和方法,并教授学生文献检索和利用网络资源的技巧和方法,学生利用业余时间查阅文献、通过小组讨论明确读书报告的题目和研究方向,最终完成读书报告的撰写,该活动促进了学生多种能力的培养。     

略论电子病历原始性问题

我国某些医院已在应用电子病历,电子病历原始性问题随之产生。为充分认识和切实解决这一问题,在阐述电子病历优缺点的同时,指明了电子病历原始性认定的难点及标准,进而提出了六种确保电子病历原始性的技术措施。     

Biopsy-proven Streptococcus suis-associated Infectious Glomerulonephritis

A 64-year-old Japanese man who worked at a butcher shop was hospitalized for a fever, headache, and deafness. We diagnosed him with sepsis and meningitis caused by Streptococcus suis infection. The patient''s renal function declined rapidly, and hemodialysis was performed temporarily. A renal biopsy was performed, and the renal function tended to improve with antimicrobial therapy. This case seemed rather similar to one of staphylococcal-associated nephritis in that it showed mesangial proliferative nephritis with immunoglobulin A deposition, even though the nephritis was caused by streptococci. Similarly, intramembranous electron-dense deposits were characteristic findings. We present new findings of an in vivo renal biopsy in a case of S. suis-associated glomerulonephritis.     

Monitoring Emerging Diseases of Fish and Shellfish Using Electronic Sources

New and emerging fish and shellfish diseases represent an important constraint to the growth and sustainability of many aquaculture sectors and have also caused substantial economic and environmental impacts in wild stocks. This paper details the results of 8 years of a monitoring programme for emerging aquatic animal diseases reported around the world. The objectives were to track global occurrences and, more specifically, to identify and provide advanced warning of disease threats that may affect wild and farmed fish stocks in the UK. A range of electronic information sources, including Internet newsletters, alerting services and news agency releases, was systematically searched for reports of new diseases, new presentations of known pathogens and known diseases occurring in new geographic locations or new host species. A database was established to log the details of key findings, and 250 emerging disease events in 52 countries were recorded during the period of study. These included 14 new diseases and a further 16 known diseases in new species. Viruses and parasites accounted for the majority of reports (55% and 24%, respectively), and known diseases occurring in new locations were the most important emerging disease category (in which viruses were dominant). Emerging diseases were reported disproportionally in salmonid species (33%), in farmed populations (62%) and in Europe and North America (80%). The lack of reports from some regions with significant aquaculture or fishery production may indicate that emerging diseases are not being recognized in these areas owing to insufficient surveillance or testing or that these events are being under‐reported. The results are discussed in relation to processes underpinning disease emergence in the aquatic environment.     

动脉用药多西他赛致严重过敏反应一例

病史摘要患者女,46岁。既往身体健康,无药物过敏史。于2010年11月18日诊断为宫颈鳞癌。根据2002年AJCC癌症分期标准[1],TNM分期为ⅢA期。于2010年11月23日行双侧子宫动脉栓塞化疗术(卡铂400 mg、丝裂霉素10 mg、表柔比星50 mg、碘化油4 ml),于2011年1月18日至2月16日行适     

STAFFING PATTERNS

Unsolved staffing pattern issues are viewed in the current context of funding pressures, third party payment, and management necessity for program and cost projections. Relevant factors are mustered for consideration with their implications. Use of differentiated skill levels and response as well as development of departmental services mandate are considered. The author also shares his experientially derived throughts on staff ratio to certain institutional assignments.     

A Baffling Hyperpyrexia

Thanks to the medical revolutions of the past half century, we have attained a remarkable understanding of health and disease, of diagnosis and therapy. Future generations will undoubtedly be intensely interested in the men and women whose work produced these revolutions. The ability to record their thought processes through the techniques of “oral history” can provide invaluable insights. It is in this belief that HOSPITAL PRACTICE is presenting a series of interviews conducted by cardiologist Allen B. Weisse, Professor of Medicine at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School. They were originally published in 1984 as Conversations in Medicine: The Story of Twentieth-Century American Medicine in the Words of Those Who Created It (New York University Press, Washington Square, New York). Following is the interview with surgeon Owen H. Wangensteen, conducted in the fall of 1980.     

Temporal arteritis

Abstract

Objective: To assess rates of diagnosis and antihyperglycemic dose adjustment in patients with moderate to end-stage renal impairment (RI) and type 2 diabetes mellitus (T2DM). Methods: Retrospective database analysis using GE Centricity Outpatient Electronic Medical Records. Patients aged ≥ 18 years with evidence of T2DM (International Classification of Diseases, Ninth Edition, Clinical Modification codes 250.x0 and 250.x2) between January 1, 2000 and June 30, 2009, and ≥ 12 months of data after identification were selected. Moderate to end-stage RI was evaluated using a formula-derived estimated glomerular filtration rate (eGFR) based on serum creatinine (SCr). Patients were classified as moderate (eGFR, 30–59 mL/min/1.73 m²), severe (eGFR, 15–29 mL/min/1.73 m²), or end-stage (eGFR, < 15 mL/min/1.73 m²), per the National Kidney Foundation guidelines, based on the first-observed SCr test. Among patients with a physician diagnosis, the time to diagnosis was reported. Dose adjustment was reported for patients receiving metformin and sitagliptin. Predictors of progression to end-stage RI based on logistic regressions were examined. Results: 35.2% of patients with T2DM had evidence of moderate to end-stage RI. Of these patients, 20% had a chart-documented physician diagnosis (range, 16% [moderate RI] to 66% [end-stage RI]). Patients with moderate or severe RI had a physician diagnosis mean of 253.4 (standard deviation [SD], 584.5) and 86.9 (SD, 417.4) days, respectively, after the eGFR calculation indicating RI. Patients with end-stage RI had a physician diagnosis mean of 83.6 (SD, 399.2) days before the eGFR calculation. After the eGFR calculation, 15.1% and 0.1% of patients with orders for sitagliptin and metformin, respectively, received doses of the drug appropriate for their degree of RI. Among patients with moderate or severe RI, appropriate diagnosis of RI was associated with significantly lower odds of progressing to end-stage RI (odds ratio, 0.200; 95% confidence interval, 0.188–0.213). Conclusions: Renal impairment is common but often undetected in patients with T2DM. Patients with a documented RI diagnosis have lower odds of progression to end-stage RI. Metformin and sitagliptin are frequently used at inappropriate doses in patients with RI. Further analyses to understand the clinical and economic consequences of these findings are needed.     

双语教学中常用的语言信号词

双语教学要求教师不断提高其英语应用能力,本文介绍双语教学中用于介绍主题、转换和链接、突出重点、强调差异、复述及总结时常用的语言信号词或句式,以供双语教师参考。