关键词： Grade   Internal Medicine   Cancer cells grading system   Clinical   Patient observation  

摘要： Background: Evaluation methods within and across clerkships are rapidly evolving, including greater emphasis or frameworks for descriptive evaluation and direct observation of competence. Purpose: The purpose of this study is to describe current evaluation methods, use of the Reporter-Interpreter-Manager/Educator (RIME) framework, and grade assignment by internal medicine clerkship directors. Methods: In 2005, the Clerkship Directors in Internal Medicine surveyed its 109 institutional members. Topics included evaluation methods and grade contribution, use of evaluation sessions and/or RIME, and grade assignment (criterion referenced or normative). Results: Response rate was 81% (88/109). The evaluation methods were as follows: teachers' evaluations, 93% (64% of grade);National Board of Medical Examiners subject examination, 81% (25% of grade);faculty written exam, 34% (14% of grade);objective structured clinical examinations, 32% (12% of grade);direct observation, 22% (7% of grade). RIME is used by 42% of respondents. Many clerkship directors (43%) meet with teachers to discuss student performance. Criterion-referenced grading is used by 59%, and normative grading is used by 27%. Unsatisfactory grades are given for examination failures (72%), unprofessional behavior (49%), poor clinical performance (42%), and failure to meet requirements (18%). Conclusions: Internal medicine clerkship directors emphasize description and observation of students. RIME and discussions with teachers are becoming commonplace.

关键词： behavioural counselling   controlled educational trial   evaluation   physical activity   Pressure System Model   primary care  

摘要： Systematic reviews point to inconclusive evidence that counselling patients in a primary care setting is effective in increasing adults' physical activity (PA) levels. This study evaluates the impact of an innovative physician counselling programme on physicians' PA counselling behaviour and their patients' PA levels. A controlled educational study conducted at six Yale School of Medicine hospitals. Sixty-five internal medicine residents and 316 primary care patients were randomized to intervention or control groups. Intervention physicians participated in five interactive sessions outlining details of the Pressure System Model, while control physicians received usual residency training. Intervention and control patients' PA levels and residents counselling behaviour were assessed using a validated questionnaire and compared pre- and post intervention. Data analysis was performed using paired t-tests and repeated measures ANOVA. At 6-month follow-up intervention, patients' PA levels increased significantly from baseline (1.77 +/- 0.84;P = 0.0376). A similar pattern was observed after 12 months (1.94 +/- 0.98;P = 0.0486). Control patients' PA did not change significantly from baseline at 6 or 12 months (0.35 +/- 1.00;P = 0.7224 and 0.99 +/- 1.52;P = 0.5160, respectively). At 12 months, intervention residents provided PA counselling 1.5 times more than they did at baseline (P < 0.05) compared with no significant changes in the control group. The present study has shown that providing residents with a practical tool, enabling them to deal with patients' barriers and previous failure in behavioural change, is efficacious in increasing PA levels of adult patients.

关键词： 内科学  

ISBN: (纸本)7533740157

摘要： 本书从门诊和病房两方面介绍内科领域各主要专业的疾病，突出了门诊、急诊和病房处理疾病的不同性和连续性。

关键词： curriculum aspects   Evaluation   Surveys   Internal Medicine   guiding characteristics  

摘要： Background: The 4th-year internal medicine subinternship (subI), with its strong emphasis on experience-based learning and increased patient responsibilities, is an important component of undergraduate medical education. Discussions have begun amongst educational leaders on the importance of standardizing curriculum and evaluation tools utilized during the subinternship. Purpose: The objective of this survey was to describe the current state of educational practices regarding the subI curriculum, use of Clerkship Directors in Internal Medicine (CDIM) curricular guidelines, evaluation methodologies, and subintern call frequency and duty hours. Methods: The survey was a part of the CDIM annual survey sent to 109 institutional members in 2005. The subinternship survey included 17 questions that addressed the prevalence of formal curricula in the subinternship, use of CDIM curricular guidelines and resources, and the evaluation tools utilized for assessment of the subinternship. Two questions examined the call frequency and duty hours of the subinterns. Results: Eighty-eight members responded (81%). Of the respondents, 37% have a formal curriculum and 35% used CDIM curricular guidelines for the suhinternship. More than half of the respondents agreed that the curricular guide helped organize their subI rotations (53%), and 48% agreed that it enhanced the quality of subI education. A global rating summative evaluation form (56%) was the most commonly used evaluation tool in the subinternship. Objective Structured Clinical Examinations(1-3) (1%) and Mini-Clinical Evaluation Exercise (mini-CEX)(4) (2%) were much less utilized during the subinternship. The respondents expressed an interest in the development of a standardized exam (47%) and clinical assessment tools such as the mini-CEX (59%). The vast majority of IM subinterns participate in 3 to 9 calls per rotation and spend less than 80 hr in the hospital per week. Conclusions: A formal curriculum is offered in slightly

关键词： 内科学   急性脑血管病   应激性高血糖   胰岛素强化治疗  

摘要： 目的探讨短期胰岛素强化治疗对急性脑血管病并发应激性高血糖的临床疗效。方法将216例急性脑血管病并发应激性高血糖患者随机分为常规治疗组和胰岛素强化治疗组，每组108例。常规治疗组对应激性高血糖不作治疗，胰岛素强化治疗组采用短期胰岛素强化治疗，严格控制血糖在4．0～6．1mmol／L，治疗观测期为7d，期满后对比分析两组的临床疗效。结果胰岛素强化治疗组神经功能缺损程度较常规治疗组显著降低，胰岛素强化治疗组治疗后基本痊愈率和显著好转率明显高于常规治疗组，不良转归率显著低于常规治疗组（P〈0.05）。结论急性脑血管病并发应激性高血糖时采用短期胰岛素强化治疗能提高患者的治愈率，减轻伤残程度，提高患者的生活质量，降低死亡率，对改善急性脑血管病预后有重要临床意义。

关键词： 学术论坛   海峡   口腔内科  

摘要： 经中华医学会批准,厦门市口腔医院和厦门市医学会主办,《临床口腔医学杂志》编辑部协办的'海峡西岸(海西)口腔内科学术论坛'(第一届)将于2008年7月18～22日在厦门召开。

关键词： 血浆纤维蛋白原   内科学   脂蛋白(a)   心血管病患者   正常对照组   医学杂志   蛋白活性   血小板膜  

摘要： 20080009老年心血管病患者纤维蛋白原和脂蛋白(a)水平与血小板膜糖蛋白活性的表达/叶玲丽…//中华老年医学杂志.-2007,26(11).-834~835患者组男女各30例血浆纤维蛋白原(FG)分别为(3.85±0.61)g/L和(4.12±0.76)g/L(冯克劳斯法),均显著高于正常对照组40例(男女各20例)的(2.85±0.39)g/L(P

关键词： 内科学   经皮冠状动脉介入治疗   药物支架   雷帕霉素   紫杉醇  

摘要： 目的通过分析冠状动脉支架置入后造影复查的影像资料,寻找不同支架再狭窄的特点。方法入选行冠状动脉病变介入治疗后造影复查的846处病变,对再狭窄病变行再狭窄形式分析。结果裸支架和药物支架再狭窄中支架近端局限性再狭窄分别占5.69%和33.67%(P=0.000),而支架内弥漫性再狭窄分别占29.27%和9.18%(P=0.000),弥漫性狭窄累及支架两端的分别为20.33%和6.12%(P=0.003),闭塞性再狭窄发生率分别为9.76%和10.20%(P=0.912)。雷帕霉素及其衍生物释放支架和紫杉醇释放支架再狭窄支架边缘局限性再狭窄分别为47.06%和25.00%(P=0.037),支架内弥漫性狭窄分别为1.96%和16.67%(P=0.018)。结论药物支架改变了支架再狭窄模式,弥漫型转为局限型;闭塞性再狭窄时药物支架以支架近端闭塞为主,裸支架以支架内闭塞为主;紫杉醇药物释放支架弥漫性再狭窄发生率较雷帕霉素释放支架有所增加。

关键词： 桑白皮汤   心痹   千金苇茎汤   苇茎汤   基本病机   加味桔梗汤  

摘要： A1型题1哮证发作的主因是A外邪B饮食C情志D伏痰E风邪考题解析:哮证的基本病理变化以痰为主,其伏藏于肺,成为发病的"夙根",在此基础上,如遇气候突变、饮食不当、情志失调、劳累等多种诱因,而引起发作。

关键词： 内科学   超声波扫描术   组织追踪和应变率成像   腹主动脉运动特征   冠状动脉疾病  

摘要： 目的利用组织追踪和应变率成像检测腹主动脉位移、应变和应变率等运动特征,并与冠状动脉病变程度的关系进行分析。方法应用GE Vivid 7超声诊断仪,对70例健康人(对照组)及69例冠心病患者(冠心病组)进行腹主动脉位移、应变和应变率检测。冠心病组患者以冠状动脉病变支数分为单支病变组和多支病变组2个亚组。结果冠心病组患者腹主动脉前后壁位移、后壁最大应变、前壁应变率s、后壁应变率s、e、a与对照组比较差异均有显著性。单支与多支冠脉病变组比较,腹主动脉前后壁位移、应变、应变率差异均有显著性。结论腹主动脉位移、应变和应变率对冠心病具有预测价值,其变化与冠状动脉病变严重程度相一致。