Experimental vascularized total joint autografts--a primate study

Autogenous vascularized and nonvascularized total joint transfers were studied in the hands of Macaca fascicularis monkeys. Nine second toe proximal interphalangeal joints were transferred as a vascularized free graft to the hand, and the excised finger joints were transferred to the foot as a nonvascularized free graft. The grafts were examined clinically and histopathologically at 16 weeks to 10 months. Two of the nonvascularized free grafts were amputated because of infection and necrosis. Three had chronic infections. The four surviving nonvascularized grafts demonstrated necrosis of the hyaline cartilage and degenerative changes. Of the nine vascularized joints, one developed a wound infection that required amputation, another failed at 2 weeks because of wound dehiscence, and the remaining seven survived with preservation of the hyaline articular surfaces. The experimental technique was designed to be easily applied to clinical use. A skin island is provided as a "patency/viability monitor." The extensor mechanism is included in the graft for early function.     

山西省医生对医疗保健体系及民营医疗服务的意向调查

通过对不同性质医疗机构医生关于医疗保健体系及民营医疗服务的意向性调查,旨在了解公立和私立医院医生对工作现状的满意程度,了解行医者对民营医疗及整个卫生系统的态度和评价.     

国医大师防治新型冠状病毒肺炎处方分析

目的分析目前公布的国医大师预防或治疗新型冠状病毒肺炎(COVID-19)的处方,解读其辨证思路及用药规律。方法检索国医大师公布的关于预防或治疗COVID-19的处方,检索期限自2020年1月1日至2020年2月12日。结果共9位国医大师公布了22个处方。周仲瑛、孙光荣、唐祖宣、李佃贵、金世元、王琦、熊继柏、刘祖贻共8位国医大师开具了9个预防用方,涉及中药32味,处方以益气、化湿、清热解毒为主,辅以养阴清热、疏风解表、宣肺化痰。唐祖宣、杨春波、李佃贵、孙光荣4位国医大师开具了10个治疗类处方,涉及中药61味,处方以化湿、清热、解毒为基本法则,唐老按湿邪与寒、热、毒邪分型证治,杨老依湿邪在体内的传变为辨证依据,李老专攻"湿热浊毒",孙老强调"疏风清热"。李佃贵、周仲瑛、王琦3位国医大师开具了3个香囊处方,涉及中药14味,均选用了藿香芳香化湿。结论多位国医大师积极参与防治COVID-19,对本病的病因病机认识基本一致,不论是治疗处方或是预防处方皆以益气、化湿、清热、解毒为主,结合用药频次统计,使用药物最多的是黄芪、藿香、金银花,具体证治方面则不尽相同。     

Do emergency nurses and doctors agree in their triage assessment of dyspneic patients?

ObjectivesThis study investigated the inter-observer agreement (IOA) between doctors and nurses on triaging adult ED dyspneic patients.MethodsThis was a prospective observational study comparing eight trained ED nurses with doctors. Each patient was assessed by a nurse and two doctors (1 and 2) who decided on four-point Patient Acuity Category (PAC) and triage management steps. The primary outcome was the proportion of resuscitation room escalations from consult. Secondary outcomes included proportions and IOA of assigned PAC and steps in triage management. The investigators reported IOA as the k statistic (95% CIs) and percent agreement.Data/resultsThere were 22/302 (7.3%) escalations; one from clinical deterioration. Proportions of assigned PAC status by nurses, Drs 1 and 2 were: PAC 1: 20.2–24.2%; PAC 2: 71.5–72.8%; PAC 3: 4.3–7.0%; PAC 4: 0.0–0.7%. The IOA was at least fair to moderate [k: 0.33 (0.22–0.43) to 1.00] in all steps of management except for electrocardiogram [k: 0.19 (0.10–0.27) to 0.45 (0.35–0.55)] ordering. The percent agreement ranged from 81 to 100% for all management steps except for chest Xray (66–73%) and electrocardiogram (61–71%) ordering.ConclusionTrained ED nurses were safe and managed adult dyspneic patients as well as doctors at triage.     

多元智力理论视阈下的医学信息学本硕博连读培养模式

［］本硕博连读研究生培养模式旨在培养具有原创精神和能力的研究型人才。本文从多元智力理论出发,从理论层面对本硕博连读培养模式进行阐述;结合研究生教育改革实践,从选拔标准、培养模式、过程管理、质量监控、分流淘汰机制、论文答辩以及学术成果要求等几个方面对医学信息学本硕博连读培养中的关键环节进行了分析。     

旴江医家论痰饮

"百病多由痰作祟",痰是人体水液代谢障碍所形成的病理产物,又是导致众多病证的致病因素。旴江医学著作宏富,内容丰厚,其中包括许多关于痰饮的精辟论述。对旴江主要医家有关痰饮病因、病机、辨证及防治的论述进行总结。     

以药养医机制对医院合理用药的影响及对策

本文综述了以药养医机制对医院合理用药的影响,通过数据深入分析当前医药卫生体制改革亟需解决的问题,提出了建立健全更加合理的药品价格形成机制、政府财政投入机制、补偿机制,逐步推行医药分业制度等措施,建议用更加合理的新机制取代以药养医的旧机制,促进医院合理用药。     

县级医院医生对癌痛治疗认知现状的调查及对策

目的：调查县级医院医生对癌痛治疗认知现状,并分析相应的对策。方法采用自行设计的医生癌痛治疗认知调查问卷对贵港市6家县级二级甲等医院医生进行调查。结果已培训医生对癌痛治疗基础知识、麻醉药品成瘾性、按时给药方法、吗啡类药物使用等的认知程度高于未培训医生,差异有统计学意义（P〈0.05）。结论本市县级医院医生对癌痛治疗的知识了解不够深入,建议继续加强县级医院医生对癌痛治疗的培训。     

PBL教学模式在康复科进修医生培训中的应用效果分析

目的分析PBL教学模式在康复科进修医生培训中的应用可行性,并研究其应用效果。方法我院于2012年开始全面推行进修医生的PBL教学模式,以2012年1-12月间参与康复科进修学习的32名医生作为对照组,行传统LBL教学模式（授课中心教学模式）,以2013年1-12月间参与康复科进修学习的35名医生作为研究组,行PBL教学模式（问题中心教学模式）。以问卷调查的方式统计进修医生对该教学模式的主观认可度,同时由带教医生设置试卷,考核进修医生对康复科医疗技术的掌握程度。结果 1观察组对培训模式的总主观认可率97.1%,对照组为75.0%,组间差异具备统计学意义（P〈0.05）;2两组进修医生入科成绩均值相近,差异不具备统计学意义（P〉0.05）,但观察组出科成绩平均（88.4±3.6）分,显著性优于对照组（78.6±2.9）分,组间差异具备统计学意义（P〈0.05）。结论应用PBL教学模式能够有效激发康复科医生的学习积极性,可促进其综合能力的提升,具备推广价值,值得临床采用。