以服务为导向构建医师征信平台的思考

借助信息化的手段,以医师定期考核为契机,以服务为导向构建医师征信平台,借助政府主管部门、监管机构、办医主体、医疗机构以及社会监督的力量,切实做好医师队伍的管理。     

Remaking surgical socialization: Work hour restrictions, rites of passage, and occupational identity

We examine how a policy aimed at improving patient safety by limiting residents’ work hours brought with it an unintended and unexamined consequence: altered socialization due to modified rites of passage during residency that endangered the stereotypical “Surgical Personality” and created a potential rift between the occupational identities of surgical residents who train under duty hour regulations and those who trained before they were imposed. Through participant observation occurring between June 2008 and June 2010, in-depth interviews (n = 13), and focus groups (n = 2), we explore how surgical residents training in four U.S. hospitals think about the threats that the shift from unrestricted to restricted duty hours creates for their claims of competence and professionalism. We identify three types of resident responses: (1) neutralizing statements that deny any significant change to occupational identity has occurred; (2) embracing statements that express the belief that a changed and more balanced occupational identity is needed; and (3) apprehensive statements that expressed fear of an altered occupational identity and an anxiety about readiness for individual practice.     

Developing Strategies for On-Call Staffing: A Working Guideline for Safe Practices

Effective on-call clinical staffing is critical to providing perioperative services to patients requiring emergency surgical care. Without careful monitoring of continuous work hours and hours worked per week, staffing practices can adversely affect the ability of personnel to function and provide care. Managers and perioperative personnel must carefully evaluate their on-call schedule to ensure the provision of safe medical care for their patients. Perioperative leaders at two hospitals partnered to create a safety guideline for on-call staffing practices, which includes zone guides for determining workload intensity. This guideline has served to help managers evaluate the general safety of their staffing plan and identify on-call practices that may need improvement or support in their areas of responsibility. Key recommendations from the guideline can help perioperative managers at other facilities establish clinical staffing plans and on-call practices that are safe and effective.     

随机尿 晨尿 24 h尿视黄醇结合蛋白/尿肌酐与24 h尿蛋白的相关性研究

目的研究用肌酐校正随机尿、晨尿、24h尿视黄醇结合蛋白（UaBP）后与24h尿蛋白（UP）定量的相关性。方法收集泌尿内科住院或门诊患者同一天内随机尿、晨尿和24h尿标本,分别测定三种不同类型尿液中的视黄醇结合蛋白（RBP）、肌酐（Cr）以及UP含量,其中晨尿和随机尿的结果分别以肌酐比值表示。结果24hURBP与24hUP的相关性为0．955（P=0．000）;随机尿、晨尿URBP与24hURBP的相关系数分别为0．663、0．707（P=0．000）,与24hUP的相关系数分别为0．673、0．738（P=0．000）,其结果经尿肌酐校正后与24hUP的相关系数分别为0．792、0．880（P=0．ooo）。结论晨尿、随机尿URBP／UCr比值与24h尿蛋白有良好的相关性,且标本收集方便易行。     

继续医学教育学分管理系统在医院的开发与应用

目的：实现医院卫生专业技术人员学分管理的信息化来提高继续医学教育的管理质量和效率。方法：设计和开发学分管理系统并投入应用，评价其实际功效。结果：该系统可根据医院规范化学分管理项目(包括学习进修、发表论文、参加学术会议和讲座、参与课题、编写著作教材、获奖科技成果等)和学分分值．对原始数据进行统计并生成报表．也可按照各种条件进行查询。结论：该系统不但操作简便、实用性强，大大提高了医院医教管理部门对医护人员学分管理的质量和效率，而且规范化强、通用性好．适合于各级医院用于各类卫生专业技术人员的学分管理。     

当代大学生道德教育的重要课题--论优秀传统文化的诚信教育价值

博大精深、历史悠久的中国优秀传统文化是道德教育的宝贵资源，是诚信教育的生动教材。从优秀传统文化中发掘诚信教育的价值，是当代大学生道德教育的重要课题。     

前列腺素E_1治疗老年性高血压肾病的临床疗效观察

目的　观察前列腺素E1 (PGE1 ,凯时 )对老年性高血压肾病的临床疗效。方法　 6 1例老年性高血压肾病患者随机分为治疗组 ( 31例 )和对照组 ( 30例 ) ,治疗组在对照组治疗的基础上给予凯时2ml( 10 μg) +生理盐水 10ml静脉推注 ,1日 1次 ,共 4周 ,观察 2组治疗前后及组间相关指标的变化。 结果　治疗组患者 2 4小时尿白蛋白排泄率 ( 2 4hUAER)、尿 β2 微球蛋白 ( β2 MG)、血肌酐及尿素氮均较治疗前明显下降 (P <0 .0 1或P <0 .0 5 ) ,且与对照组治疗后相比亦有显著性差异 (P均 <0 .0 5 )。无严重不良反应发生。结论　凯时是治疗老年性高血压肾病一种安全、有效的药物之一。     

谈谈继续医学教育学分制

对继续医学教育学分制实施过程中出现的问题进行阐述，提出对策和具体的解决办法。指出，只有不断总结经验，完善管理，落实到位，才能真正搞好继续医学教育学分制工作。     

Twenty four hour ambulatory blood pressure monitoring: a new tool for determining cardiovascular prognosis

Twenty four hour ambulatory blood pressure monitoring (24-H ABPM) plays an important part in the management of subjects with suspected and confirmed disorders of blood pressure regulation. This article reviews the prognostic significance of various aspects of the 24-H ABPM and describes the authors experience in Chesterfield. Over the course of 12 month period from 1 August 2002, 1264 subjects had 24-ABPM. A total of 1187 (93.91%) subjects were included in this study, with mean age of 59.30 years and male:female ratio was 46%: 54 %. Fifty two (4.38%) of the subjects had all of the seven features associated with an adverse prognosis. Only 82 (6.90%) subjects had none of the seven adverse prognostic features with the remainder having one or more adverse prognostic features.     

The validity of a structured interactive 24-hour recall in estimating energy and nutrient intakes in 15-month-old rural Malawian children

This study aimed to compare the nutritional intake values among 15-month-old rural Malawian children obtained by weighed food record (WFR) with those obtained by modified 24-hour recall (mod 24-HR), and to develop algorithm for adjusting mod 24-HR values so as to predict mean intake based on WFRs. The study participants were 169 15-month-old children who participated in a clinical trial. Food consumption on one day was observed and weighed (established criterion) by a research assistant to provide the estimates of energy and nutrient intakes. On the following day, another research assistant, blinded to the direct observation, conducted the structured interactive 24-hour recall (24-HR) interview (test method). Paired t-tests and scatter-plots were used to compare intake values of the two methods. The structured interactive 24-HR method tended to overestimate energy and nutrient intakes (each P < 0.001). The regression-through-the-origin method was used to develop adjustment algorithms. Results showed that multiplying the mean energy, protein, fat, iron, zinc and vitamin A intake estimates based on the test method by 0.86, 0.80, 0.68, 0.69, 0.72 and 0.76, respectively, provides an approximation of the mean values based on WFRs.