关键词： 内科学   冠心病   低密度脂蛋白   高敏C反应蛋白   氧化型低密度脂蛋白  

摘要： 目的比较血清氧化型低密度脂蛋白、高敏C反应蛋白水平在不同类型冠心病中的差异。方法检测了82例冠心病患者(急性冠状动脉综合征42例、稳定型心绞痛20例和陈旧性心肌梗死20例)和22例正常对照者血清氧化型低密度脂蛋白、高敏C反应蛋白、高密度脂蛋白胆固醇、总胆固醇和高密度脂蛋白胆固醇水平,并比较各指标水平在不同类型冠心病中的差异。结果血清氧化型低密度脂蛋白水平在冠心病组明显高于对照组(62.5±24.8μg/L比42.3±17.9μg/L,P<0.05),在急性冠状动脉综合征组明显高于稳定型心绞痛组和陈旧性心肌梗死组(68.9±23.4μg/L比41.5±21.3μg/L和50.5±21.6μg/L,P<0.05);血清高敏C反应蛋白水平在冠心病组明显高于对照组(15.58±4.32mg/L比6.94±1.93mg/L,P<0.05),在急性冠状动脉综合征组明显高于稳定型心绞痛组和陈旧性心肌梗死组(19.31±1.43mg/L比10.29±1.01mg/L和9.56±1.72mg/L,P<0.05);血清低密度脂蛋白胆固醇水平在冠心病组明显高于对照组(3.46±1.11mmol/L比2.87±+0.82mmol/L,P<0.05),但在急性冠状动脉综合征组与稳定型心绞痛组和陈旧性心肌梗死组差异无显著性(3.64±0.85mmol/L比3.06±1.23mmol/L和3.40±1.35mmol/L);血清总胆固醇/高密度脂蛋白胆固醇比值在冠心病组明显高于对照组(3.46±1.11比2.87±0.82,P<0.05),在不同类型冠心病中亦有差异(P<0.05)。结论血清氧化型低密度脂蛋白和高敏C反应蛋白水平及总胆固醇/高密度脂蛋白胆固醇比值在冠心病不同类型中有差异,可能为诊断冠心病的指标。

关键词： 内科学   踝臂指数   动脉硬化   动脉粥样硬化   危险因素  

摘要： 目的了解踝臂指数与动脉硬化及其危险因素的关系。方法对174例住院患者行选择性冠状动脉造影,用冠状动脉病变血管的数量和Gensini积分系统评价冠状动脉病变的严重程度。并进行踝臂指数测定、眼底动脉检查及动脉硬化的危险因素分析。结果冠状动脉正常组与冠状动脉病变组踝臂指数差异显著(P<0.001),冠状动脉造影积分和踝臂指数的Pearson积距相关系数为-0.768(P<0.001),冠状动脉造影积分越高,踝臂指数越低。眼底动脉正常组与眼底动脉病变组踝臂指数差异显著(P<0.001),眼底动脉病变越严重踝臂指数越小。眼底动脉正常组与眼底动脉病变组冠状动脉造影积分差异显著(P<0.001),眼底动脉病变越严重冠状动脉造影积分越高。以踝臂指数<0.9为二分类变量做Logistic回归分析,发现踝臂指数与年龄、性别、甘油三酯、低密度脂蛋白、吸烟量、糖尿病和遗传因素相关。结论踝臂指数是动脉硬化的一个简便可靠的预测因素,低踝臂指数与传统的动脉硬化危险因素如年龄、性别、甘油三酯、低密度脂蛋白、吸烟量、糖尿病和遗传因素有相关性。

摘要： 2008年全国内科学(肿瘤专题)新进展学习班由中华医学会主办,拟于2008年9月上旬举办,共5天,学习期满授予学员国家级Ⅰ类继续教育学分10分【项目编号:2008-03-10-117(国)】。内容:肿瘤过继免疫治疗进展、非小细胞肺癌的早期诊断及治疗进展、小细胞肺癌的靶向治疗、淋巴瘤的诊断与治疗、头颈部肿瘤的内科治疗、大肠癌肝转移的内科治疗、食道癌的诊治进展、胃癌内科治疗进展、骨肉瘤

关键词： United States Medical Licensing Examination (USMLE)   Internal Medicine In-Training Examination (IM-ITE)   medical knowledge   assessment   random effects modeling  

摘要： BACKGROUND: Little is known about the associations of previous standardized examination scores with scores on subsequent standardized examinations used to assess medical knowledge in internal medicine residencies. OBJECTIVE: To examine associations of previous standardized test scores on subsequent standardized test scores. DESIGN: Retrospective cohort study. PARTICIPANTS: One hundred ninety-five internal medicine residents. METHODS: Bivariate associations of United States Medical Licensing Examination (USMLE) Steps and Internal Medicine In-Training Examination (IM-ITE) scores were determined. Random effects analysis adjusting for repeated administrations of the IM-ITE and other variables known or hypothesized to affect IM-ITE score allowed for discrimination of associations of individual USMLE Step scores on IM-ITE scores. RESULTS: In bivariate associations, USMLE scores explained 17% to 27% of the variance in IME-ITE scores, and previous IM-ITE scores explained 66% of the variance in subsequent IM-ITE scores. Regression coefficients (95% CI) for adjusted associations of each USMLE Step with IM-ITE scores were USMLE-1 0.19 (0.12, 0.27), USMLE-2 0.23 (0.17, 0.30), and USMLE-3 0.19 (0.09, 0.29). CONCLUSIONS: No single USMLE Step is more strongly associated with IM-ITE scores than the others. Because previous IM-ITE scores are strongly associated with subsequent IM-ITE scores, appropriate modeling, such as random effects methods, should be used to account for previous IM-ITE administrations in studies for which IM-ITE score is an outcome.

关键词： graduate medical education   residency   ACGME   competency  

摘要： BACKGROUND: There are no nationwide data on the methods residency programs are using to assess trainee competence. The Accreditation Council for Graduate Medical Education (ACGME) has recommended tools that programs can use to evaluate their trainees. It is unknown if programs are adhering to these recommendations. OBJECTIVE: To describe evaluation methods used by our nation's internal medicine residency programs and assess adherence to ACGME methodological recommendations for evaluation. DESIGN: Nationwide survey. PARTICIPANTS: All internal medicine programs registered with the Association of Program Directors of Internal Medicine (APDIM). MEASUREMENTS: Descriptive statistics of programs and tools used to evaluate competence;compliance with ACGME recommended evaluative methods. RESULTS: The response rate was 70%. Programs were using an average of 4.2-6.0 tools to evaluate their trainees with heavy reliance on rating forms. Direct observation and practice and data-based tools were used much less frequently. Most programs were using at least 1 of the Accreditation Council for Graduate Medical Education (ACGME)'s "most desirable" methods of evaluation for all 6 measures of trainee competence. These programs had higher support staff to resident ratios than programs using less desirable evaluative methods. CONCLUSIONS: Residency programs are using a large number and variety of tools for evaluating the competence of their trainees. Most are complying with ACGME recommended methods of evaluation especially if the support staff to resident ratio is high.

关键词： clubbing   significance   prevalence   internal medicine  

摘要： Background: Clubbing remains an amazing clinical sign. Its strong association with serious disease is still a clinical enigma. Moreover, the significance of diagnosing clubbing is not well established. The aim of our study was to evaluate prevalence, aetiology and clinical significance of clubbing in a department of general internal medicine. Patients and methods: During one year (1511 admissions), all patients with digital clubbing assessed by determining ratio of the distal phalangeal depth (DPD) to the interphalangeal depth (IPD) and with the presence of Swamroth sign were included. Fifteen patients were diagnosed with clubbing (10 males and 5 females). They underwent complete physical examination, pulmonary CT-scan, bone scintigraphy, blood gas analysis and were compared with 86 matched controls. Results: Aetiology were renal cell carcinoma, pulmonary arteriovenous malformation, AIDS, inflammatory pseudo-tumour of the lung, adenocarcinoma of unknown origin in one case and in one case, Pet-scan suspected neoplasia but histology was not obtained. In 9 cases, no aetiology was found. Bone scan was normal in 14 cases and revealed periostitis in one case (idiopathic clubbing). Compared to control group, there was no difference in blood gas analysis but emphysema was more often present in patients with clubbing (P < 0.01). No patient without aetiology developed cancer in the one year follow-up. Conclusion: Clubbing is present in 1% of admission in a department of general internal medicine and is associated in nearly 40% with serious disease. In 60% of cases, aetiology is not identified but follow-up do not disclosed cancer. (c) 2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

关键词： Internal Medicine residents   quality improvement   practiced-based learning and improvement   systems-based practice   practice improvement module  

摘要： INTRODUCTION/AIM: Standard curricula to teach Internal Medicine residents about quality assessment and improvement, important components of the Accreditation Council for Graduate Medical Education core competencies practiced-based learning and improvement (PBLI) and systems-based practice (SBP), have not been easily accessible. PROGRAM DESCRIPTION: Using the American Board of Internal Medicine's (ABIM) Clinical Preventative Services Practice Improvement Module (CPS PIM), we have incorporated a longitudinal quality assessment and improvement curriculum (QAIC) into the 2 required 1-month ambulatory rotations during the postgraduate year 2. During the first block, residents complete the PIM chart reviews, patient, and system surveys. The second block includes resident reflection using PIM data and the group performing a small test of change using the Plan-Do-Study-Act (PDSA) cycle in the resident continuity clinic. PROGRAM EVALUATION: To date, 3 resident quality improvement (QI) projects have been undertaken as a result of QAIC, each making significant improvements in the residents' continuity clinic. Resident confidence levels in QI skills (e.g., writing an aim statement [71% to 96%, P <.01] and using a PDSA cycle [9% to 89%, P <.001]) improved significantly. DISCUSSION: The ABIM CPS PIM can be used by Internal Medicine residency programs to introduce QI concepts into their residents' outpatient practice through encouraging practice-based learning and improvement and systems-based practice.

关键词： career choice   education   medical   undergraduate   medical students   workforce  

摘要： BACKGROUND: Experienced medical student educators may have insight into the reasons for declining interest in internal medicine (IM) careers, particularly general IM. OBJECTIVE:To identify factors that, according to IM clerkship directors, influence students' decisions for specialty training in IM. DESIGN:Cross-sectional national survey. PARTICIPANTS:One hundred ten institutional members of Clerkship Directors in IM. MEASUREMENTS:Frequency counts and percentages were reported for descriptive features of clerkships, residency match results, and clerkship directors' perceptions of factors influencing IM career choice at participating schools. Perceptions were rated on a five-point scale (1 = very much pushes students away from IM careers;5 = very much attracts students toward IM careers). RESULTS:Survey response rate was 83/110 (76%);80 answered IM career-choice questions. Clerkship directors identified three educational items attracting students to IM careers: quality of IM faculty (mean score 4.3, SD = 0.56) and IM rotation (4.1, SD = 0.67), and experiences with IM residents (3.9, SD = 0.94). Items felt most strongly to push students away from IM careers were current practice environment for internists (mean score 2.1, SD = 0.94), income (2.1, SD = 1.08), medical school debt (2.3, SD = 0.89), and work hours in IM (2.4, SD = 1.05). Factor analysis indicated three factors explaining students' career choices: value/prestige of IM, clerkship experience, and exposure to internists. CONCLUSIONS:IM clerkship directors believe that IM clerkship experiences attract students toward IM, whereas the income and lifestyle for practicing internists dissuade them. These results suggest that interventions to enhance the practice environment for IM could increase student interest in the field.

关键词： practice-based learning   systems-based practice   quality of care   preventive cardiology   internal medicine residency  

摘要： BACKGROUND: Few studies have systematically and rigorously examined the quality of care provided in educational practice sites. OBJECTIVE: The objectives of this study were to (1) describe the patient population cared for by trainees in internal medicine residency clinics;(2) assess the quality of preventive cardiology care provided to these patients;(3) characterize the practice-based systems that currently exist in internal medicine residency clinics;and (4) examine the relationships between quality, practice-based systems, and features of the program: size, type of program, and presence of an electronic medical record. DESIGN: This is a cross-sectional observational study. SETTING: This study was conducted in 15 Internal Medicine residency programs (23 sites) throughout the USA. PARTICIPANTS: The participants included site champions at residency programs and 709 residents. MEASUREMENTS: Abstracted charts provided data about patient demographics, coronary heart disease risk factors, processes of care, and clinical outcomes. Patients completed surveys regarding satisfaction. Site teams completed a practice systems survey. RESULTS: Chart abstraction of 4,783 patients showed substantial variability across sites. On average, patients had between 3 and 4 of the 9 potential risk factors for coronary heart disease, and approximately 21% had at least 1 important barrier of care. Patients received an average of 57% (range, 30-77%) of the appropriate interventions. Reported satisfaction with care was high. Sites with an electronic medical record showed better overall information management (81% vs 27%) and better modes of communication (79% vs 43%). CONCLUSIONS: This study has provided insight into the current state of practice in residency sites including aspects of the practice environment and quality of preventive cardiology care delivered. Substantial heterogeneity among the training sites exists. Continuous measurement of the quality of care provided and a better under

关键词： 临床医学  

ISBN: (纸本)9787030219695

摘要： 本书分为10篇，包括呼吸系统疾病、循环系统疾病、消化系统疾病、泌尿系统疾病、血液系统疾病、传染病、风湿免疫性疾病、内分泌与营养代谢性疾病、神经系统疾病与神经症、急性中毒。