网络及数字病理资源在病理住院医师培训和继续教育中的应用

网络为计算机和信息交流带来了巨大的变革,逐渐成为世界范围内的信息交流工具,加之数字病理资源的开发和逐渐普及使其成为病理住院医师培训和继续教育中的有益辅助工具。本文分析了互联网及数字病理资源在病理住院医师培训及低年资医生继续教育中的优点及其具体应用,并列举了一些对病理住院医师培训非常有帮助的医学和病理学专业网站,希望能够在传统教学模式的基础上,利用现代化的信息学技术对以形态学为主的病理学专业住院医师培训提供必要的辅助。网络及数字病理资源的广泛使用,将会成为病理住院医师规范化培训的有益补充,缩短不同级别医院低年资病理医师继续教育的差距。     

放射诊断学精品课程的建设与探索

精品课程是教育部质量工程的重要组成部分之一,本文总结了国家级精品课程放射诊断学的建设经验,介绍了其在学科建设、专业建设中的基础作用和对人才培养质量的重要意义,并进一步探讨其可持续发展的思路。     

Developmental needs and early childhood education: evolutionary,my dear Watson

Examining the processes of natural selection, described by Darwin in The Origin of Species, casts light on our own species’ fundamental needs and on the far greater role that early childhood educators can play in their fulfillment. The second section of this paper analyzes how our fundamental needs emerge in a sequence underpinned by the processes of natural selection (goodness‐of‐fit, variation and replication), are thus developmental in a new sense and are fulfilled only as organisms interact with their immediate environment. The subsequent section presents a model of how, in accordance with natural selection, adults can practise collaborative behaviors that facilitate this developmental sequence throughout life. The fourth section shows how early childhood educators who practise this model in interaction with their immediate environment (which includes parents) help to fulfill the fundamental needs and increase the internal resources of all participants—themselves, parents and children. Substantiating evidence comes from the author’s studies.     

Human Cytochrome P450 Family 4 Enzymes: Function,Genetic Variation and Regulation

The microsomal cytochrome P450 (CYP) family 4 monooxygenases are the major fatty acid ω-hydroxylases. These enzymes remove excess free fatty acids to prevent lipotoxicity, catabolize leukotrienes and prostanoids, and also produce bioactive metabolites from arachidonic acid ω-hydroxylation. In addition to endogenous substrates, recent evidence indicates that CYP4 monooxygenases can also metabolize xenobiotics, including therapeutic drugs. This review focuses on human CYP4 enzymes and updates current knowledge concerning catalytic activity profiles, genetic variation and regulation of expression. Comparative differences between the human and rodent CYP4 enzymes regarding catalytic function and conditional expression are also discussed.     

利用人事档案开发医院人力资源信息管理系统

在医院发展技术化和国际化的大背景下,人力资源管理显得越来越重要。搭建起标准化、规范化、网络化的人力资源管理信息化工作平台,其前提是确定人力资源管理提升规划方案,重点是人力资源管理系统化。在医疗改革中,必须坚持以人为本,利用好人事档案开发出人力资源管理信息系统。     

公立医院人力资源配置竞争力及问题研究

人力资源配置实际上是用人的艺术,强调人才是一类重要的资源,根据人才的不同能力在不同岗位上进行分配,最大程度发挥人才的价值。当前因为经济水平的不断提升,新医疗体制改革越来越深入,公立医院需要承受非常大的压力。在人力资源配置上,公立医院具有一定竞争力,但同时也存在一些问题,医院必须保持较高的竞争意识,保证人力资源的合理配置,才可以确保医院始终具备良好的竞争力,保证可持续的发展。     

Phagocytosis and production of reactive oxygen species by peripheral blood phagocytes in patients with different stages of alcohol-induced liver disease: effect of acute exposure to low ethanol concentrations

BACKGROUND: In rodents, the development of alcoholic liver disease (ALD) after chronic alcohol feeding was shown to depend on the activity of enzymes that are necessary for production of reactive oxygen species (ROS) in phagocytes. The aim of this study was to determine the formation of ROS by resting and challenged phagocytes of patients with different stages of ALD in the presence of ethanol concentrations commonly found in the blood of alcohol abusers. PATIENTS AND METHODS: The release of ROS and the phagocytosis of bacteria by neutrophils and monocytes obtained from 60 patients, who were categorized in three groups due to the severity of ALD, were compared to that of 28 healthy controls. ROS release by these phagocytes was measured after challenging with endotoxin and the addition of ethanol (22 and 44 mM). RESULTS: Resting neutrophils but not monocytes from patients with severe stages of ALD produced significantly more ROS than those of healthy controls. Basal values of ROS production from neutrophils correlated closely to markers of the severity of ALD. ROS formation was depressed dose-dependently by ethanol in the healthy controls but not in alcohol abusers. CONCLUSIONS: Changes in the ROS metabolism of phagocytes found in this study might contribute to both the development of ALD and the impaired immune response occurring in patients with severe ALD.     

ICU危重患者院内转运的循证实践研究

正院内转运(intra-hospital transport,IHT)是指患者在住院期间,在该医疗单位的不同医疗区域之间进行转运,是一项不可避免的重要措施[1]。医疗不良事件是指在临床诊疗活动中以及医院运行过程中,发生的任何可能影响患者诊疗结果、增加患者的痛苦和负担、可能引发医疗纠纷或医疗事故以及影响医疗工作的正常运行和医务人员人身安全的因素和事件[2]。院内转运常见不良事件有输液管道脱落或堵塞、供氧中断、窒     

Health workforce governance: Processes,tools and actors towards a competent workforce for integrated health services delivery

A competent health workforce is a vital resource for health services delivery, dictating the extent to which services are capable of responding to health needs. In the context of the changing health landscape, an integrated approach to service provision has taken precedence. For this, strengthening health workforce competencies is an imperative, and doing so in practice hinges on the oversight and steering function of governance. To aid health system stewards in their governing role, this review seeks to provide an overview of processes, tools and actors for strengthening health workforce competencies. It draws from a purposive and multidisciplinary review of literature, expert opinion and country initiatives across the WHO European Region's 53 Member States. Through our analysis, we observe distinct yet complementary roles can be differentiated between health services delivery and the health system. This understanding is a necessary prerequisite to gain deeper insight into the specificities for strengthening health workforce competencies in order for governance to rightly create the institutional environment called for to foster alignment. Differentiating between the contribution of health services and the health system in the strengthening of health workforce competencies is an important distinction for achieving and sustaining health improvement goals.     

Estimación del coste hospitalario del cáncer colorrectal en Cataluña

ObjectiveTo assess the hospital cost associated with colorectal cancer (CRC) treatment by stage at diagnosis, type of cost and disease phase in a public hospital.MethodsA retrospective analysis was conducted of the hospital costs associated with a cohort of 699 patients diagnosed with CRC and treated for this disease between 2000 and 2006 in a teaching hospital and who had a 5-year follow-up from the time of diagnosis. Data were collected from clinical-administrative databases. Mean costs per patient were analysed by stage at diagnosis, cost type and disease phase.ResultsThe mean cost per patient ranged from 6,573 Euros for patients with a diagnosis of CRC in situ to 36,894 € in those diagnosed in stage III. The main cost components were surgery-inpatient care (59.2%) and chemotherapy (19.4%). Advanced disease stages were associated with a decrease in the relative weight of surgical and inpatient care costs and an increase in chemotherapy costs.ConclusionsThis study provides the costs of CRC treatment based on clinical practice, with chemotherapy and surgery accounting for the major cost components. This cost analysis is a baseline study that will provide a useful source of information for future studies on cost-effectiveness and on the budget impact of different therapeutic innovations in Spain.