关键词： 心脏   世界   人群   大学医学中心   心血管学   阿根廷   内科学   访谈录  

摘要： 议。世界心脏大会(WCC)于2008年5月18—21日在阿根廷首都布宜诺斯艾利斯市召开,来自100多个国家约17000余人出席会本届大会的主题是“从病人到人群”。下面是记者会后对下届世界心脏联盟主席、北卡罗林那大学医学中心心血管学和内科学主任Sidney ***的访谈录。问:今年大会的主题是“从病人到人群”,请解释它的意义。您们为什么选择这一主题?[第一段]

关键词： 心血管内科学   题库软件   试题库   出版   解剖图   多层面   多功能   学生  

摘要： 由南昌大学一附院魏云峰、吕农华、郑泽琪教授主编，人民卫生出版社出版的《内科学试题库（含软件）》现已发行。该题库有内科学试题近两万道，解剖图、大体图3000幅，其中心血管内科学题4000余道，是一个多层面、立体式融教学、实践、考试为一体的多功能软件。该题库软件分为学生版与教师版，学生版既有纸质材料，又配有光盘，主要用于学生自测、自考、自学。

关键词： 中医内科学   课堂教学   质量  

摘要： 文章从完善教育制度、加强教师责任心、利用多媒体教学优势、发挥集体备课作用、调动学生主观能动性等方面,阐述了提高中医内科学课堂教学质量的必要性与可行性,具有一定的借鉴作用。

关键词： Diagnostic reasoning   Question format   Task difficulty   Non-analytic reasoning   Scheme-inductive reasoning   Hypothetico-deductive reasoning   Residents  

摘要： Background Previous studies have suggested an association between reasoning strategies and diagnostic success, but the influence on this relationship of variables such as question format and task difficulty, has not been studied. Our objective was to study the association between question format, task difficulty, reasoning strategies and diagnostic success. Methods Study participants were 13 Internal Medicine residents at the University of Calgary. Each was given eight problem-solving questions in four clinical presentations and were randomized to groups that differed only in the question format, such that a question presented as short answer (SA) to the first group was presented as extended matching (EM) to the second group. There were equal numbers of SA/EM questions and straightforward/difficult tasks. Participants performed think-aloud during diagnostic reasoning. Data were analyzed using multiple logistic regression. Results Question format was associated with reasoning strategies;hypothetico-deductive reasoning being used more frequently on EM questions and scheme-inductive reasoning on SA questions. For SA question, non-analytic reasoning alone was used more frequently to answer straightforward cases than difficult cases, whereas for EM questions no such association was observed. EM format and straightforward task increased the odds of diagnostic success, whereas hypothetico-deductive reasoning was associated with reduced odds of success. Conclusions Question format and task difficulty both influence diagnostic reasoning strategies and studies that examine the effect of reasoning strategies on diagnostic success should control for these effects. Further studies are needed to investigate the effect of reasoning strategies on performance of different groups of learners.

关键词： Drug-drug interactions   Drug interaction screening program   Internal medicine   Prevalence of drug-drug interactions  

摘要： Objective: The aim of this study was to assess potential drug-drug interactions (pDDIs) at hospital admission, during hospitalization and at discharge and to evaluate the number of pDDIs created (luring hospitalization. Methods: The medication of 851 patients was screened for pDDIs (major and moderate severity) using the screening program Pharmavista. The frequency of pDDIs per patient, per number of drugs and drug pairs was estimated. Results: During hospitalization, the frequency of major and moderate pDDIs per patient was 1.11, which was higher compared to hospital admission (0.59) or to hospital discharge (0.60). The frequency of major and moderate pDDIs per drug prescribed (13.7% vs. 9.1%) or per drug pairs analyzed (4.5% vs. 2.3%) was higher at hospital admission compared to hospital discharge. 47% of all major and moderate pDDIs at discharge were due to a medication change during hospitalization. Conclusions: Although the number of major and moderate pDDIs per patient did not increase from hospital admission to discharge, it is important to realize that 47% of all major and moderate DDIs at hospital discharge were created during hospitalization. prescribing drugs with it low risk for pDDIs as well as careful monitoring for adverse drug reactions are important Measures to minimize harm associated with DDIs. (c) 2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

关键词： In-training exam   Medical knowledge   Medical residency   Percentile score   Self-assessment  

摘要： Background Medical knowledge is essential for appropriate patient care;however, the accuracy of internal medicine (IM) residents' assessment of their medical knowledge is unknown. Methods IM residents predicted their overall percentile performance 1 week (on average) before and after taking the in-training exam (ITE), an objective and well accepted method to assess medical knowledge to study resident assessment accuracy. Ordinary least squares regression was used to study the association between the absolute accuracy of their predictions of their percentile performance on the ITE examination and their actual percentile performance. Results Ninety-three percent of our 28 residents participated. Residents were highly inaccurate in predicting their percentile performance. Only 31% had ITE scores that were within 10 points of their predictions. On average, most residents were pessimistic about their overall percentile performance with 18 (69%) underestimating their performance. Having just taken the examination and previous experience with the examination did not improve predictions of percentile performance. Conclusion IM residents did not accurately predict their own level of medical knowledge. Taking the examination and experience with previous exams does not appear to improve the ability of these IM residents to predict their performance. Residents need to be taught to rely on the results of standardized examinations such as the ITE to best assess their overall medical knowledge. The factors important for accurate self-assessment of medical knowledge in individual clinical situations remain unexplored.

关键词： Internal Medicine  

摘要： Background: Physicians often enter the workplace with substantial debt. The relationship between debt and reported career plans among internal medicine residents is unknown. Objective: To determine distributions of educational debt among internal medicine residents and associations of debt with reported career plans. Design: Cross-sectional survey using data from the annual Internal Medicine In-Training Examination Residents Questionnaire completed by U. S. categorical internal medicine residents. Setting: Categorical internal medicine residencies in the United States. Participants: 22 563 residents in their third ( final) year of residency, representing 74.1% of all eligible U. S. categorical internal medicine residents from 2003 through 2007. Measurements: Distributions of educational debt were tabulated. Proportions of residents choosing career plans were calculated for various levels of debt. Results: International medical graduates represented 48.7% of the cross section and had considerably less debt than U. S. medical graduates: 53.8% of U. S. medical graduates had debt of $ 100 000 or greater and 60.2% of international medical graduates had none. U. S. medical graduates with debt of $ 100 000 to $ 150 000 were less likely than those with no debt to choose a subspecialty career 57.5% vs. 63.5%). U. S. medical graduates with debt of $ 50 000 to $ 99 999 were more likely than those with no debt to choose a hospitalist career (8.5% vs. 6.2%), and this preference increased with increasing debt level (10.0% for those with >$150 000 debt). These associations are more pronounced for U. S. medical graduates than for international medical graduates. Limitation: The study addressed total educational debt, but not when it was incurred, and did not allow inferences related to causality. Conclusion: Educational debt is associated with differences in reported career plans among internal medicine residents.

关键词： Adult   Career Choice   Cross-Sectional Studies   Factor Analysis Statistical  

摘要： Context Shortfalls in the US physician workforce are anticipated as the population ages and medical students' interest in careers in internal medicine ( IM) has declined ( particularly general IM, the primary specialty serving older adults). The factors influencing current students' career choices regarding IM are unclear. Objectives To describe medical students' career decision making regarding IM and to identify modifiable factors related to this decision making. Design, Setting, and Participants Web- based cross- sectional survey of 1177 fourth- year medical students ( 82% response rate) at 11 US medical schools in spring 2007. Main Outcome Measures Demographics, debt, educational experiences, and number who chose or considered IM careers were measured. Factor analysis was performed to assess influences on career chosen. Logistic regression analysis was conducted to assess independent association of variables with IM career choice. Results Of 1177 respondents, 274 ( 23.2%) planned careers in IM, including 24 ( 2.0%) in general IM. Only 228 ( 19.4%) responded that their core IM clerkship made a career in general IM seem more attractive, whereas 574 ( 48.8%) responded that it made a career in subspecialty IM more attractive. Three factors influenced career choice regarding IM: educational experiences in IM, the nature of patient care in IM, and lifestyle. Students were more likely to pursue careers in IM if they were male ( odds ratio [ OR] 1.75;95% confidence interval [ CI], 1.20- 2.56), were attending a private school ( OR, 1.88;95% CI, 1.26- 2.83), were favorably impressed with their educational experience in IM ( OR, 4.57;95% CI, 3.01- 6.93), reported favorable feelings about caring for IM patients ( OR, 8.72;95% CI, 6.03- 12.62), or reported a favorable impression of internists' lifestyle ( OR, 2.00;95% CI, 1.39- 2.87). Conclusions Medical students valued the teaching during IM clerkships but expressed serious reservations about IM as a career. Students who re

关键词： 北京大学第一医院   香港大学   内科学   论坛   内分泌干扰物   舒张性心力衰竭   多系统受累   危重病例  

摘要： “2008北京一香港内科学论坛”于2008年4月11—12日在北京召开。本次大会由北京大学第一医院内科与香港大学玛丽医院内科联合举办，参会代表为来自38家医院的400余名内科医生。本次论坛以复杂、疑难的多系统受累或多学科相关的病例为切入点，对来自心血管、呼吸、肾脏、内分泌、消化、血液、风湿免疫、神经等学科的病例进行了系统分析及点评。会议还邀请丁文惠教授、Matthew Ng教授、David Ramsden教授就近年来内分泌干扰物、舒张性心力衰竭等领域内出现的新进展和新概念作了精彩的特约演讲，内容涉及内科学、病理学及医学影像学等多个相关学科。与会代表的踊跃发言使我们确信本次论坛加强了各专业学科之间的交流与沟通，对拓宽内科医师的知识面，提高复杂危重病例的诊疗水平起到了积极的作用。

关键词： 内科学   视黄醇类X受体   单核细胞   巨噬细胞   动脉粥样硬化   细胞分化  

摘要： 目的探讨视黄醇类X受体特异性激动剂9-顺式维甲酸对佛波酯诱导人单核细胞系THP-1向巨噬细胞分化的影响。方法体外培养人单核细胞系THP-1,经佛波酯诱导分化为巨噬细胞,同时给予9-顺式维甲酸对佛波酯诱导分化进行干预,通过相差显微镜观察细胞形态,MTT比色法检测细胞贴壁率,流式细胞仪检测与单核/巨噬细胞分化有关的细胞表面标志物CD11b和CD36的表达。结果9-顺式维甲酸干预后梭形、分支状细胞明显减少,与佛波酯单独作用组相比细胞贴壁率减少50%(P<0.01),细胞表面标志物CD11b和CD36分别减少50%和28%(P<0.01)。结论视黄醇类X受体特异性激动剂9-顺式维甲酸可明显抑制佛波酯诱导人单核细胞系THP-1向巨噬细胞分化。