关键词： 内科学   二甲基精氨酸   一氧化氮合酶抑制物   动脉粥样硬化   冠状动脉疾病  

摘要： 目的检测冠心病患者血中内源性一氧化氮合酶抑制物非对称二甲基精氨酸(ADMA)的水平,探讨ADMA与冠心病的关系及其临床意义。方法随机选择37例冠心病患者(男31例,女6例,年龄62.0±10.3岁)和18例正常人(男9例,女9例,年龄55.0±9.8岁),分别作为冠心病组和对照组,均经选择性冠状动脉造影确定冠状动脉有无病变及病变程度,并以高效液相色谱法测定血清中非对称二甲基精氨酸、对称性二甲基精氨酸和L精氨酸的含量,同时应用全自动生物化学分析仪测定其血脂水平。结果冠心病组血清中一氧化氮合酶抑制物非对称二甲基精氨酸水平较对照组明显增高(3.24±1.45μmol/L比2.03±1.12μmol/L,P<0.01);冠心病组血清中的内源性非对称二甲基精氨酸含量随着冠状动脉病变的加重略有增高的趋势,与对照组比较有显著性差异(P<0.01);冠心病组与对照组之间的对称性二甲基精氨酸和L精氨酸的含量无明显差异(对称性二甲基精氨酸1.98±2.19μmol/L比1.27±1.44μmol/L,P>0.05;L精氨酸100.0±48.6μmol/L比107.9±49.1μmol/L,P>0.05);相关分析表明,冠心病组血清非对称二甲基精氨酸含量与血脂、年龄、体质指数间无相关性(P>0.05),与冠状动脉病变程度有相关性(r=0.28,P<0.05)。结论内源性一氧化氮合酶抑制物非对称二甲基精氨酸的异常增高与冠心病发病有关;非对称二甲基精氨酸含量增高可能是冠心病的一项独立危险因素。

关键词： Internal Medicine   Schools   Medical   Training   Future   内科学   院校   医学   schools   Medical   career   graduate   medical school   Internal Medicine   physician assistant  

摘要： It is the year 2025. During the past 20 years, internal medicine as a discipline continued to become less prestigious, less respected, and more fragmented. As fewer medical students chose internal medicine as a career, residency programs began to close. Those that remained open rilled with fewer graduates of US medical schools but filled with more US citizens who graduated from international medical schools, more graduates of osteo-pathic medical schools, and more foreign graduates of international medical schools. Due to lack of adequate remuneration and a shift of primary care provision from generalist physicians to nurse practitioners and physician assistants, training in general internal medicine as a patient care specialty ceased. Generalist internal medicine careers have been replaced by tracks designed to foster health services research or academic careers; internal medicine training graduates subspecialty physicians

关键词： education   medical   health care quality   diabetes mellitus   outcome assessment   registries  

摘要： BACKGROUND Disease registries, audit and feedback, and clinical reminders have been reported to improve care processes. OBJECTIVE To assess the effects of a registry-generated audit, feedback, and patient reminder intervention on diabetes care. DESIGN Randomized controlled trial conducted in a resident continuity clinic during the 2003-2004 academic year. PARTICIPANTS Seventy-eight categorical Internal Medicine residents caring for 483 diabetic patients participated. Residents randomized to the intervention (n=39) received instruction on diabetes registry use;quarterly performance audit, feedback, and written reports identifying patients needing care;and had letters sent quarterly to patients needing hemoglobin A1c or cholesterol testing. Residents randomized to the control group (n=39) received usual clinic education. MEASUREMENTS Hemoglobin A1c and lipid monitoring, and the achievement of intermediate clinical outcomes (hemoglobin A1c < 7.0%, LDL cholesterol < 100 mg/dL, and blood pressure < 130/85 mmHg) were assessed. RESULTS Patients cared for by residents in the intervention group had higher adherence to guideline recommendations for hemoglobin A1c testing (61.5% vs 48.1%, p=.01) and LDL testing (75.8% vs 64.1%, p=02). Intermediate clinical outcomes were not different between groups. CONCLUSIONS Use of a registry-generated audit, feedback, and patient reminder intervention in a resident continuity clinic modestly improved diabetes care processes, but did not influence intermediate clinical outcomes.

关键词： internal medicine   COPD   respiratory medicine  

关键词： Collaborative care   Communication   Interprofessional teamwork  

摘要： An abundance of evidence suggests that communication in interprofessional healthcare teams is a complex endeavour. Even relatively simple communication processes involving information work - the gathering, storage, retrieval and discussion of patient information - may be fraught with pitfalls, and yet teams manage to conduct their daily information work, often with a high degree of effectiveness. In this article, we explore one commonplace dimension of information work - the use of patient charts to foster collaborative decision-making and care enactment - towards building an elaborated understanding of how teams innovate in the face of daily complexities in their information work processes. Drawing on results from an ethnographic study of team communication in two internal medicine inpatient wards, we describe the nature and use of patient charts, analyze recurrent problems, and explore adaptive strategies for carrying on team information work in the face of daily barriers.

关键词： residency selection   grading system   selection criteria  

摘要： Background and Purpose: Since October 2003, a new licensing regulation for doctors exists in Germany. Due to this reform medical students obtain individual grades for each clinical subject. At the end of 2006, these grades appeared in the students' leaving certificates for the first time. As the significance of these grades concerning their influence on selection criteria is still very uncertain, the aim of this study was to further investigate criteria for residency selection focusing on the evaluation of the new grades. Methods: The importance of selection criteria was assessed by an electronic questionnaire based on a five-point Likert scale (1 = unimportant;5 = critical). The questionnaire was sent to 7,766 members of the German Society of Internal Medicine in May 2006. 897 questionnaires were returned (11.6%): 133 heads of department, 158 senior physicians, 269 specialists, and 337 residents. 43% of the respondents were involved in the selection process. Results: Factors ranking as most important for respondents involved in residency selection included personally knowing an applicant, e. g., after a rotation ( mean 4.1;standard deviation 1.3), and personal recommendations from colleagues ( 3.8 +/- 1.2). High emphasis was also placed on social commitment and additional skills. Concerning the grades given according to the old licensing regulation for doctors, the final grade of the Medical Licensing Examination ( 3.5 +/- 1.1) and the grade of the Medical Licensing Examination step 3 ( 3.4 +/- 1.1) were ranked as important. Regarding the new licensing regulation for doctors, 38% of the respondents ( 3.0 +/- 1.2) considered the individual grades more important than the results of the Medical Licensing Examination step 2. 49% of the respondents stated, that the grade D ("sufficient") in internal medicine would be an exclusion criterion when selecting residents ( 3.3 +/- 1.3). Conclusion: Whether the results are representative of all physicians involved in the select

关键词： trends   admissions   internal medicine wards  

ISBN: (纸本)9787561439128

ISBN: (纸本)9787308057479

关键词： 医学工作者   科学杂志   中国科学引文数据库   中文科技期刊全文数据库   国际   中国期刊全文数据库   国家教育部   国外医学