关键词： 中山大学附属第一医院   学科带头人   肾脏   内科   国家科学技术奖励大会   国家科学技术进步奖   健康   发病机制  

摘要： 2007年2月27日,2006年度国家科学技术奖励大会在北京举行。广东19个获奖项目中,广东省特聘教授—珠江学者,中山大学附属第一医院副院长,中山大学肾脏研究所所长,附属第一医院肾内科学科带头人余学清教授主持的《肾小球疾病免疫发病机制及治疗干预系列研究》获国家科学技术进步奖二等奖。他领导的团队研究了终末期肾衰竭的主要病因肾小球疾病的免疫发病机制,并进行干预治疗。成果显示在部分细胞因子作用下,通过p38MAPK、NF-kB及CaN等信号调控,MΦ在肾组织聚集、增生和活化,导致炎症持续和放大。抑制炎症细胞浸润及增生是"改进的CTX静脉冲击疗法"的主要疗效机制。成果发表论文93篇,其中SCI收录14篇,被国际期刊引用341次,研究成果被国内近100家单位应用,获发明专利1项,全国优秀博士学位论文奖1篇,临床研究方案已被全国高等医学院校统编教材《内科学》第五、六版应用。成果总体水平达国际先进,部分领域达到国际领先。

关键词： 内科学   动脉粥样硬化   通心络   白细胞介素1   单核细胞趋化蛋白1   炎症反应   小型猪  

摘要： 目的探讨通心络对白细胞介素1β介导的小型猪冠状动脉早期炎症反应及内膜增殖的抑制作用及可能机制。方法24头小型猪随机均分为假手术组、模型组和通心络组。假手术组和模型组喂养普通饲料,通心络组喂养普通饲料＋通心络[1 g/（kg.d）]。2周后麻醉行左侧开胸手术,选择左前降支及回旋支近端管腔外径近似相同的两处节段进行仔细分离,假手术组在血管外膜包裹吸附生理盐水的纸巾,模型组和通心络组包裹吸附白细胞介素1β（2.5μg）的纸巾,术后继续以上喂养方法。2周后采用冠状动脉造影观察各组管腔狭窄情况。造影结束后处死动物,截取包裹血管段,进行病理学检查,并采用逆转录聚合酶链反应,测定各组手术处理血管段单核细胞趋化蛋白1、P选择素、E选择素、细胞间粘附分子1和血管细胞粘附分子1 mRNA的表达。结果冠状动脉造影显示,模型组冠状动脉管腔20%~30%狭窄,病理学检查可见模型组内膜增殖、炎性细胞浸润,平滑肌细胞内膜下迁移。通心络组管腔狭窄程度、内膜增殖及炎性细胞浸润现象较模型组明显减轻。逆转录聚合酶链反应示通心络组单核细胞趋化蛋白1、P选择素、E选择素、细胞间粘附分子1和血管细胞粘附分子1 mRNA表达强度低于模型组（P〈0.05）。结论通心络对白细胞介素1β诱导的冠状动脉炎症反应及内膜增殖具有明显的抑制作用。通过抑制细胞因子和粘附因子的表达可能是其主要作用途径。

关键词： 内科学   循环系统   临床教学  

摘要： 目的探讨循环系统疾病临床教学的形式和方法。方法通过分析临床教学的困难和特点,在临床工作中不断总结临床教学的实践经验。结果总结和探索了一些内科学循环系统临床教学中值得推广应用的方式方法。

关键词： 医学高等专科学校   教研室主任   内科学   山东   深度昏迷   救护车   急诊科   无病史  

摘要： “沂蒙精神能救人” 2007年4月，李德香从早上忙到下午，刚刚回到家，还没来得及进门，手机就响了——急诊科救护车接回一位“三无”男患者，已深度昏迷，无病史可鉴，请你马上回医院会诊。

ISBN: (纸本)9787308054690

关键词： physician house calls   medical education   internal medicine residents  

摘要： Physician house calls are an important but underused mode of delivering health care to a growing population of homebound elderly patients. One major barrier to internal medicine physicians making house calls is a lack of training in this setting. This article describes a needs assessment survey of residents from nine internal medicine residency programs for a house call curriculum that combines a longitudinal clinical experience with Internet-based learning. Implementation of the curriculum was begun in July 2006, and data will be collected and results evaluated for at least 2 years. Several educational outcomes from the intervention are anticipated, including increased learner knowledge of house call medicine, improved learner confidence in making house calls, and program director satisfaction with the curriculum. This early work lays the foundation for determining the effect of a carefully designed curriculum on the number of practicing internists with the skills, knowledge, and attitudes necessary to meet the growing need for physician house calls.

关键词： ward round   triadic interactions   nurse-patient communication   nurse-physician communications   RIAS   Internal Medicine   physician-patient communication  

摘要： Objective: Describe the content and of mode of patient-physician-nurse interactions during ward-rounds in Internal Medicine. Methods: In 267/448 patients, 13 nurses, and 8 physicians from two wards in General Internal Medicine 448 interactions on ward rounds were tape recorded by observers. After exclusion of interactions with more than three participants (N = 150), a random sample of 90 interactions was drawn. Data were analysed with a modified RIAS version that allowed for the registration of a third contributor and for the assessment of the direction of a communicative action (e.g.: nurse -> patient, etc.). Furthermore, time spent per individual patient was registered with a stop-watch. Results: A total of 12,078 utterances (144 per ward round) were recorded. Due to problems with the comprehensibility of some interactions the final data set contains 71 ward round interactions with 10,713 utterances (151 per ward round interaction). The average time allotted to an individual patient during ward-rounds was 7.5 min (range: 3-16 min). The exchange of medical information is the main topic in physicians (39%) and nurses (25%), second common topic in patients (28%), in whom communicative actions like agreement or checking are more common (30% patients/25% physicians/22% nurses). Physicians and patients use a substantial number of communicative actions (1397/5531 physicians;1119/ 3733 patients). Patients receive about 20 bits of medical or therapeutic information per contact during ward-rounds. Conclusions: If ward rounds serve its the central marketplace of information nurses' knowledge is under-represented. Further research should try to determine whether the quality of patient care is related to a well balanced exchange of information, to which nurses, physicians, and patients contribute their specific knowledge. Practice implications: Given the fact that in-patients in Interna Medicine usually present complex problems, the exchange of factual information, expectation

关键词： board certification   certifying examination   in-training examination   medical education   medical knowledge   prediction   predictive validity   residents  

摘要： Babbott et al discuss the Internal Medicine In-Training Examination (IM- ITE) as a formative assessment of medical knowledge during residency training. It is designed as a low-stakes examination, the IM-ITE specifically targets a post-graduate year (PGY)-2 resident's level of knowledge. They assert that most programs offer IM-ITE yearly to all residents; on average, more than 92% of residents in internal medicine programs complete this examination each year.

关键词： Internal Medicine  

摘要： A letter to the editor is presented in response to the article "Changes in career decisions of internal medicine residents during training," by Colin P. West and Joseph C. Kolars in the previous issue.

关键词： Internal Medicine  

摘要： Background: Limits on resident work hours are intended to reduce fatigue-related errors, but may raise risk by increasing transfers of responsibility for patients. Objective: To examine changes in outcomes for internal medicine patients after the implementation of work-hour regulations. Design: Retrospective cohort study. Setting: Urban, academic medical center. Patients: 14 260 consecutive patients discharged from the teaching (housestaff) service and 6664 consecutive patients discharged from the nonteaching (hospitalist) service between 1 July 2002 and 30 June 2004. Measurements: Outcomes included intensive care unit utilization, length of stay, discharge disposition, 30-day readmission rate to the study institution, pharmacist interventions to prevent error, drug-drug interactions and in-hospital death. Results: The teaching service had net improvements in 3 outcomes. Relative to changes experienced by the nonteaching service, the rate of intensive care unit utilization decreased by 2.1% (95% Cl, -3.3% to -0.7%;P = 0.002), the rate of discharge to home or rehabilitation facility versus elsewhere improved by 5.3% (Cl, 2.6% to 7.6%;P < 0.001), and pharmacist interventions to prevent error were reduced by 1.92 interventions per 100 patient-days (Cl, -2.74 to -1.03 interventions per 100 patient-days;P < 0.001). Teaching and nonteaching services had similar changes over time in length of stay, 30-day readmission rate, and adverse drug-drug interactions. In-hospital death was uncommon in both groups, and change over time was similar in the 2 groups. Limitations: The study was a retrospective, nonrandomized design that assessed a limited number of outcomes. Teaching and nonteaching cohorts may not have been affected similarly by secular trends in patient care. Conclusions: After the implementation of work-hour regulations, 3 of 7 outcomes improved for patients in the teaching service relative to those in the nonteaching service. The authors found no evidence of adverse