临床医学专业留学生临床实习现状分析与思考

来华留学生临床医学专业本科教育（英文授课）项目，是国家留学生教育体系的重要组成部分，提高来华留学生的教学质量是国家医学院校教学中的重要课题之一。通过总结和分析首都医科大学附属北京天坛医院临床医学专业留学生在院内的实习现状，探索加强留学生实习管理的有效措施，推动临床医学专业留学生临床教学的规范化进程，培养出更多高质量的临床医学专业留学生，对于来华留学生的成长是一个非常有意义的课题。     

Traffic Engineering and Occupational Therapy: A Collaborative Approach for Future Directions

Swedish legislation and international norms emphasize society's obligation to ensure general accessibility. The possibility of independent outdoor mobility, transportation, and travel are as important for individuals with reduced functional capacity as for other members of society, but today their mobility is limited. The aim of this article is to outline a novel field for research collaboration between occupational therapy and traffic planning and engineering, focusing on person-environment relationships with an explicit orientation towards advantages to society. Target groups are elderly people and individuals with impairments, and their relation to public transportation provided by society, in terms of general accessibility. Topical research from both disciplines is presented and synthesized, leading to the formulation of joint research questions. The collaborative approach presented increases the potential for continuing, comprehensive, and stable growth of knowledge. The intention is to assist the legislative process in the development of society, leading to a more efficient use of available economic resources. The ultimate objective of future research projects will be to gain knowledge that will facilitate improvements in public health.     

军队医院病案首页血液检查填写缺陷分析

目的了解病案首页血液检查HbsAg、HCV-Ab、HIV-Ab及血型的填写质量,有针对性的制定解决对策。方法运用PowerBuilder程序,提取某院2012年9-11月3106份出院病人病案首页及检查结果中,HbsAg、HCV-Ab、HIV-Ab及血型各项数据并查找缺陷,分析缺陷原因,制定干预措施。结果 3106份病案首页中142份存在缺陷,缺陷率4.57%,有90.14%的问题为检验结果为"阴性"或"阳性"而病案首页却填写"未查"。干预后再提取某院2013年1-3月2435出院病人病案首页及检查结果,其中28份存在缺陷,缺陷率降低为1.15%。结论加强各级质控,强化医生责任意识、法律意识,研发相关软件,是降低病案首页HbsAg、HCV-Ab、HIV-Ab及血型填写缺陷的有效方法。     

基于中医临床证候探讨新型冠状病毒肺炎在岭南地区的疫性特点

目的:通过分析广东省第二人民医院收治的新型冠状病毒肺炎(以下简称新冠肺炎)患者的临床资料,从中医临床证候探讨该病在岭南地区的疫性特点,更好地指导临床辨证治疗。方法:收集广东省第二人民医院收治的36例新冠肺炎患者的临床资料,其中输入病例20例,本地病例16例,分析全部病例、输入病例和本地病例的临床资料和证候特点。结果:新冠肺炎患者年龄分布较广,平均年龄45岁,以男性居多,55.56%的患者为外地输入病例,44.44%的患者为本地感染病例。全部病例证型以湿邪郁肺型和邪热壅肺型为主,分别占44.44%和38.89%;91.67%的患者呈现“湿”的病理特点,72.22%的患者呈现“热”的病理特点。其中输入病例证型以湿邪郁肺型为主,占65.00%,100%的患者呈现“湿”的病理特点,55.00%呈现“热”的病理特点;本地病例证型以邪热壅肺为主,占56.25%,93.75%的患者呈现“热”的病理特点,81.25%呈现“湿”的病理特点。结论:本次疫病在岭南地区的疫性属于以湿邪和热邪为主导的“湿热疫”,病机特点为湿热并重;输入性病例多表现为以湿邪为患的“湿疫”,有化热的趋势和倾向,病机特点为湿重于热;本地病例多表现为以热邪为主的“温热疫”,病机特点为热重于湿。此次新冠肺炎不同地区存在不同疫性的可能,辨证和治疗要遵守三因制宜的原则。     

Changes in the National Endovascular Management of Femoropopliteal Arterial Disease: An Analysis of the 2011–2019 Medicare Data

PurposeTo describe national trends in the utilization of endovascular approaches (including balloon angioplasty, atherectomy, and stent placement) for the management of femoropopliteal peripheral arterial disease (PAD).Materials and MethodsThe Medicare Physician/Supplier Procedure Summary dataset containing 100% of Part B claims was interrogated for years 2011–2019. The Current Procedural Terminology codes specific for femoropopliteal angioplasty, stent placement, and atherectomy were used to create summary statistics for utilization by year, place of service (hospital inpatient, hospital outpatient, and office-based laboratory), and provider specialty (cardiology, radiology, and surgery).ResultsThe use of atherectomy increased from 34,732 (33%) procedures in 2011 to 75,435 (53%) procedures in 2019, and atherectomy became the dominant treatment strategy for femoropopliteal PAD. The relative utilization of stent placement (36,793 [35%] to 28,899 [20%]) and angioplasty only (34,398 [32%] to 38,228 [27%]) decreased concomitantly from 2011 to 2019. By 2019, the use of atherectomy was twofold higher in office-based laboratories than in the outpatient hospital setting (44,767 and 20,901, respectively). Treatment strategy varied by provider specialty in 2011 when cardiologists used atherectomy most frequently (17,925 [43%]), whereas radiologists used angioplasty alone (5,928 [6%]) and surgeons stented (18,009 [37%]) most frequently. By 2019, all specialties utilized atherectomy most frequently (29,564 [59%] for cardiology, 10,912 [58%] radiology, and 33,649 [47%] surgery).ConclusionsThe national approach to endovascular management of femoropopliteal PAD has changed since 2011 toward an implant-free strategy, including a multifold increase in the use of atherectomy. Discordant rates of atherectomy use between the ambulatory hospital and office-based settings highlight the need for comparative effectiveness studies to guide management.     

Association between first oral examination characteristics and dental treatment needs in privately insured children: A claims data analysis

BackgroundEarly childhood caries (ECC) remains the most common, preventable infectious disease among children in the United States. Screening is recommended after the eruption of the first tooth, but it is unclear how the age at first dental examination is associated with eventual restorative treatment needs. The authors of this study sought to determine how provider type and age at first dental examination are associated longitudinally with caries experience among children in the United States.MethodsDeidentified claims data were included for 706,636 privately insured children aged 0 through 6 years as part of the nationwide IBM Watson Health Market Scan (2012-2017). The authors used Kaplan-Meier survival analysis to describe the association between the age of first visit and restorative treatment needs.ResultsA total of 21% of this population required restorative treatment, and the average age at first dental examination was 3.6 years. A multivariable Cox proportional hazards model showed increased hazard for restorative treatment with age at first dental visit at 3 years (hazard ratio, 2.05; 95% CI, 1.97 to 2.13) and 4 years (hazard ratio, 3.99; 95% CI, 3.84 to 4.16).ConclusionThe high proportion of children requiring restorative treatment and late age at first dental screening show needed investments in educating general dentists, medical students, and pediatricians about oral health guidelines for pediatric patients.Practical ImplicationsCommunicating the importance of children establishing a dental home by age 1 year to parents and health care professionals may help reduce disease burden in children younger than 6 years.     

大学生的人工流产现状、认知与态度调查分析

目的:了解大学生的人工流产现状、认知与态度。方法:采用随机抽样,对福建924名在校大学生进行无记名问卷调查。结果:有人工流产经历的占有过性经历的10.3%,其中有7人(25.9%)不是在正规医疗场所进行人工流产。大学生对负压吸引术(17.8%)、钳刮术(38.3%)的知晓率较低,知道人工流产可能引起宫颈和宫腔粘连、盆腔感染、宫外孕等疾病的人不到一半。有250人(27.0%)对朋友的人工流产经历表示不同程度的介意,对伴侣的人流经历有表示介意多达880人(95.2%),显示出大学生在思想上比较介意人流经历,并且对不同对象双重标准的矛盾心理。男生对人工流产的认知度和宽容度均低于女生,有性经历者对人工流产的认知度低于无性经历者,而宽容度却高于无性经历者。大学生渴望通过学校生殖健康课和社区教育得到相关知识。结论:大学生在人工流产方面的认知有较大欠缺,需要学校、社区、家庭进行系统科学的教育以降低大学生人工流产发生率。     

新型冠状病毒肺炎疫情期间发热门诊的护理管理

新型冠状病毒肺炎疫情防控期间,发热门诊作为疾病诊治的重点部门,其防护工作是保障医护人员安全工作的重中之重,防护用品的使用、诊治流程以及呼吸机操作等环节的护理管理均要严格规范化、科学化。     

Effect of transspinal direct current stimulation on afferent pain signalling in humans

Anodal transspinal Direct Current Stimulation (tsDCS) has been suggested as a means to treat neuropathic pain by reducing pain signalling/processing and Laser Evoked Potentials (LEPs) likewise as a method to evaluate such reduction. However, results in previous studies are disagreeing. To evaluate these claims using rigorous methodology, LEPs were evoked from hands and feet in healthy volunteers. The N2 potential and three psychophysic parameters (general- and pinprick pain, warmth) were used to evaluate the signalling and appreciation of pain respectively. This was made at three time points; at baseline, directly- and 30 min after low thoracic tsDCS (20 min, 2.5 mA, cathode on shoulder). The study was randomized, cross over, double blinded and placebo controlled.At the group level, low thoracic anodal tsDCS produced reduced perceptions of all three tested pain qualities from the foot (p < 0.05 – p < 0.001). These reductions began during stimulation and became more pronounced during the 30 min after its cessation (p < 0.05 – p < 0.01). The LEP parameter alteration mirroring these changes was latency prolongation (p < 0.05 – p < 0.001) whereas amplitude reductions were in par with placebo stimulation. Similar but less pronounced and only transient (during stimulation, p < 0.05 – p < 0.001) changes, were seen for hand stimulation. The interindividual variation was large.The findings indicate that anodal tsDCS may become a technique to treat neuropathic pain by reducing pain signalling/processing and LEPs likewise a method to evaluate such reduction.