What has trust got to do with it? Cardiac risk reduction and family physicians' discussions of evidence-based recommendations

The management of patients through the use of evidence-based medicine has become the 'mantra' of medicine within many Western countries. Evidence-based medicine is aimed at providing the best objective, scientific care to all patients, and reducing as far as possible patients' risks of disease and complications from disease. Based on family physicians' discussions of the use of evidence-based recommendations for two cardiac diseases, this paper explores how subjectively-based trust enters into family physicians' decision to use evidence-based medicine. In addition, we show how trust influences physicians' work of recommending evidence-based medicine to patients, and physicians' perceptions of why patients follow recommendations aimed at risk reduction. We conclude that although much of the current discussion about evidence-based medicine assumes a 'rational' model of physician behaviour based on the application of the 'best objective scientific' results, subjectively-based perceptions of trust influence physician practices, and point to the need to understand the power of relational issues in influencing physician practices even when utilizing evidence-based knowledge.     

Benefits of the DICOM Structured Report

Recently, the digital imaging and communications in medicine (DICOM) standard introduced rules for the encoding, transmission, and storage of the imaging diagnostic report. This medical document can be stored and communicated with the images in picture archiving and communication system (PACS). It is a structured document that contains text with links to other data such as images, waveforms, and spatial or temporal coordinates. Its structure, along with its wide use of coded information, enables the semantic understanding of the data that is essential for the Electronic Healthcare Record deployment. In this article, we present DICOM Structured Report (SR) and discuss its benefits. We show how SR enables efficient radiology workflow, improves patient care, optimizes reimbursement, and enhances the radiology ergonomic working conditions. As structured input significantly alters the interpretation process, understanding all its benefits is necessary to support the change. Biography Rita Noumeir is a professor at the Department of Electrical Engineering of the University of Quebec, école de Technologie Superieure in Montreal. A founding member of the Imaging, Vision, and Artificial Intelligence Laboratory (LIVIA), her main research interest is the Healthcare Information Technology, specifically, Interoperability, Electronic Patient Record, Security, Information Confidentiality, and Image Processing. As a member of both Technical and Planning International IHE Radiology Committees, Dr. Noumeir took part over the last 5 years in developing many Integrating the Healthcare Enterprise (IHE) Integration Profiles in Radiology and in organizing several Integration Demonstrations. She is a cofounder of IHE Canada. Dr. Noumeir contributed to many research and development projects in collaboration with several Canadian and international companies in medical imaging and healthcare information. Currently, she collaborates with the Diagnostic Imaging Team of Canada Health Infoway to define the principles and architecture for sharing imaging information between multiple healthcare institutions. She plays a leading role in the development of this solution that is published as an IHE Integration Profile for which she is the editor. Rita Noumeir holds a Ph.D. and a Masters degree in Biomedical Engineering from école Polytechnique of Montreal specializing in Medical Imaging. She is a professional engineer, and a member of the Ordre des ingénieurs du Québec.     

几种抗艾滋病中药有效成分对解脲支原体和白色念珠菌体外抑制作用的实验研究

目的筛选对解脲支原体和白色念珠菌体外有明显抑制作用的抗H IV中药有效成分,为治疗H IV继发感染或性病奠定基础。方法以微量稀释法测定9种中药有效成分对解脲支原体和白色念珠菌的M IC50和M IC90,同时测定其中6种中药有效成分对H IV-1的EC50和TI值。结果所测药物对解脲支原体、白色念珠菌及H IV-1均有一定的抑制作用,对解脲支原体和白色念珠菌作用最好的分别是三七总皂苷、三七叶皂苷和化合物A,化合物A对H IV-1的抑制作用最好,其EC50为0.09,TI值大于10 000。结论化合物A对解脲支原体、白色念珠菌及H IV-1的抑制效果最好,值得进一步研究。     

抗结核药物所致皮疹临床特点及停药指征的探讨

目的 探讨抗结核药物所致皮疹的临床特点及停药指征.方法 对1998-2005年收治的3 082例住院结核病人中,因抗结核药物所致皮疹296例病人进行分析.结果 变态反应总发生率为10.3%,皮疹发生率为9.6%（296例）,其中单纯皮疹88例,占2.9%,皮疹伴其他系统表现一种或一种以上者208例,占6.7%;无皮疹者22例,占0.7%.皮疹病例总停药率为61.5%.结论 抗结核药物所致过敏反应多为全身性,发生过敏反应后,绝大多数单纯皮疹病人经过抗过敏处理后仍可维持原方案继续治疗,而皮疹伴有明显肝功能异常、心律失常、关节痛和过敏性休克者均需立即停用抗结核药物,并且避免再次使用.     

77例慢性心力衰竭住院病例药物治疗分析

目的:评估循证医学心血管疾病成果是否普及到小城市医疗中心.方法:采用回顾性住院病例77例分析,按年度统计对比.结果:77例次慢性心力衰竭(CHF)患者药物治疗仍以传统治疗为主,ACE抑制剂应用大幅度提高,β-受体阻滞剂应用极少,醛固酮拮抗剂未见应用.结论:循证医学成果已影响到小城市医疗中心,但推广范围及力度不够,β-受体阻滞剂是薄弱环节,靶剂量概念仍有待进一步提高.     

高等医药院校大学生健康人格培养模式研究

健康人格是个体身心顺利发展的重要保证，是大学生适应社会、充分发挥自己能力的心理基础。而目前许多高等医药院校在大学生健康人格培养方面，普遍重视不够。本文从学校、教师、失学生自身三个角度，试探索出一套适合高等医药院校大学生健康人格建立和发展的培养模式，以期为对以后的心理健康教育工作有一定的启发和指导作用。     

提高中医临床疗效的科学学检讨(连载三)

中医学的生命力在于临床疗效 ,社会对于中医学的需要也在于临床疗效。提高中医临床疗效的科学学研究 ,要以中医基础理论为依据 ,以理、法、方、药一脉相承的辨证论治为前提。造成中医临床疗效下降的问题在于“三个脱节” ,即中医学与自身文化基础脱节 ,中医临床与辨证论治脱节 ,中药与中医临床脱节。中医学正处于行将消亡的边缘 ,也处在新的突破的前夜。实事求是地进行科学、历史的反思 ,中医学完全有可能走出百年困惑 ,得到振兴和发展。     

《内经》俞、输、腧探源

《素问》用“俞”，《灵枢》用“输”与“腧”表示腧穴，三字用法基本相同。“俞”源于用船运送，“输”源于用车运送，均引申为转运气血的穴位。“腧”是“俞”的今字，其字形代表的意义最符合中医学中腧穴的含义。应以“腧”作为规范的词语，表示腧穴的各种意义。     

中医医院现代化建设的思考

从中医现代化建设方面提出了几个注意的问题:强化改革开放意识,转变旧的封闭观念;重视医、教、研协同发展;加快传统科室的改造;加速陈旧设备的更新;基础设施建设应具有超前意识;开展对外交流,引进与输出相结合。     

千捶膏配合生肌玉红膏治疗感染性伤面的临床观察

我院多年来应用千捶膏和生肌玉红膏治疗感染性伤面。千捶膏用于去腐,生肌玉红膏用于生新。据我们观察二药有较强的抗感染作用,尤其有抗绿脓感染作用。应用千捶膏可以较快地达到脱腐作用,应用生肌玉红膏可以促进肉芽增生,达到伤面早期愈合,值得推广。