关键词： 内科学   刺五加   丹参   脑梗死   疗效  

摘要： 目的为了解刺五加注射液治疗脑梗死的临床疗效。方法64例脑梗死患者随机分为治疗组和对照组。治疗组用刺五加注射液静脉点滴,疗程为15天,对照组用丹参静脉点滴,疗程30天,两组同时控制血压、血糖、血脂。结果治疗组32例中,有效30例,总有效率为93.75%,对照组32例中,有效24例,总有效率为75%。两者疗效差异具有显著性(P<0.05)。结论刺五加注射液治疗脑梗死安全、有效,适合于基层单位使用。

关键词： 缓解型多发性硬化症   治疗   睾酮   神经保护作用   加利福尼亚   内科学   Med  

摘要： 加利福尼亚大学的Rhonda ***博士及其同事在5月的《内科学档案》（Arch Intern Med，2007；64：683—688．）上报道，睾酮治疗对复发缓解型多发性硬化症男性安全，并被良好耐受。这种治疗可能提供神经保护作用。

关键词： co-morbidity   internal medicine   complexity   elderly  

摘要： Background: Although the number of elderly people is progressively increasing in the world, old and very old patients have been under-represented and understudied in trials evaluating the efficacy of chronic illness management models. The usual hospital indicators and practice guidelines do not consider the effects of complexity - co-morbidity, social support, functional and cognitive status, patient adherence to therapy, risk of adverse drug reactions - in these subjects. The aim of this observational, multi-centric cohort study was to carefully assess factors contributing to the complexity of care for patients admitted to internal medicine wards. This was done by evaluating the severity of disease and degree of stability at admission, co-morbidity, age-related impairments, and the need for discharge planning plus post-discharge support. Methods: A total of 3 86 patients from 11 internal medicine wards in Emilia-Romagna and Marche, Italy, enrolled in a given week were evaluated. At admission, the following variables were recorded: demographic characteristics, medical history, global clinical-social prognostic evaluation, co-morbidity, severity of illness, presence of shock or hemodynamic instability, coma, and frequencies and causes of unscheduled hospital re-admission. Results: Cancer, congestive heart failure, pneumonia, stroke, and chronic obstructive pulmonary disease were the most frequent primary diagnoses. The complexity of our case study was characterized by several concomitant diseases. Over 50% of the patients were considered severe or more than severe, and over 20% extremely severe, with very high co-morbidity indices and illness severity scores. Some 55% of our patients were in need of partial or total care;10% had some speech impairment, and 63% needed in-home health care after hospital discharge. Conclusions: The increasing numbers of elderly patients admitted to internal medicine departments suggests the need for a chronic illness management model, i

关键词： knowledge acquisition   in-training exam   UpToDate  

摘要： Background: Knowledge acquisition is a goal of residency and is measurable by in-training exams. Little is known about factors associated with medical knowledge acquisition. Objective: To examine associations of learning habits on medical knowledge acquisition. Design, participants: Cohort study of all 195 residents who took the Internal Medicine In-Training Examination (IM-ITE) 421 times over 4 years while enrolled in the Internal Medicine Residency, Mayo Clinic, Rochester, MN. Measurements: Score (percent questions correct) on the IM-ITE adjusted for variables known or hypothesized to be associated with score using a random effects model. Results: When adjusting for demographic, training, and prior achievement variables, yearly advancement within residency was associated with an IM-ITE score increase of 5.1% per year (95%CI 4.1%, 6.2%;p < .001). In the year before examination, comparable increases in IM-ITE score were associated with attendance at two curricular conferences per week, score increase of 3.9% (95%CI 2.1%, 5.7%;p < .001), or self-directed reading of an electronic knowledge resource 20 minutes each day, score increase of 4.5% (95%CI 1.2%, 7.8%;p=.008). Other factors significantly associated with IM-ITE performance included: age at start of residency, score decrease per year of increasing age, -0.2% (95%CI -0.36%, -0.042%;p=.01), and graduation from a US medical school, score decrease compared to international medical school graduation, -3.4% (95%CI -6.5%, -0.36%;p = .03). Conclusions: Conference attendance and self-directed reading of an electronic knowledge resource had statistically and educationally significant independent associations with knowledge acquisition that were comparable to the benefit of a year in residency training.

关键词： cardiac arrest   medical education   internal medicine   residency   critical care  

摘要： Objective: We aimed to determine internal medicine residents' perceptions of the adequacy of their training to serve as in-hospital cardiac arrest team leaders, given the responsibility of managing acutely critically ill patients and with recent evidence suggesting that the quality of cardiopulmonary resuscitation provided in teaching hospitals is suboptimal. Design: Cross-sectional postal survey. Setting: Canadian internal medicine training programs. Participants: Internal medicine residents attending Canadian English-speaking medical schools. Interventions: A survey was mailed to internal medicine residents asking questions relating to four domains: adequacy of training, perception of preparedness, adequacy of supervision and feedback, and effectiveness of additional training tools. Measurements and Main Results: Of the 654 residents who were sent the survey, 289 residents (44.2%) responded. Almost half of the respondents (49.3%) felt inadequately trained to lead cardiac arrest teams. Many (50.9%) felt that the advanced cardiac life support course did not provide the necessary training for team leadership. A substantial number of respondents (40%) reported receiving no additional cardiac arrest training beyond the advanced cardiac life support course. Only 52.1 % of respondents felt prepared to lead a cardiac arrest team, with 55.3% worrying that they made errors. Few respondents reported receiving supervision during weekdays (14.2%) or evenings and weekends (1.4%). Very few respondents reported receiving postevent debriefing (5.9%) or any performance feedback (1.3%). Level of training and receiving performance feedback were associated with perception of adequacy of training (12 = .085, p < .001). Respondents felt that additional training involving full-scale simulation, leadership skills training, and postevent debriefing would be most effective in increasing their skills and confidence. Conclusions: The results suggest that residents perceive deficits in their t

关键词： 内科学   瘦素   Gensini积分   体质指数   动脉粥样硬化  

摘要： 目的探讨冠心病患者血浆瘦素水平与冠状动脉病变程度及体质指数的关系。方法拟诊冠心病患者93例,根据冠状动脉造影结果分为对照组20例和冠状动脉粥样硬化组73例,计算各组患者的Gensini积分、体质指数,检测血浆瘦素水平,并分析瘦素水平与Gensini积分、体质指数之间的关系。结果血浆瘦素水平随Gensini积分增加而升高(P<0.05);根据Gensini积分分为1～30分组、31～90分组及>90分组,瘦素水平分别为0.61±0.15μg/L、0.77±0.13μg/L及0.93±0.13μg/L;冠状动脉粥样硬化患者血浆瘦素水平与Gensini积分呈正相关(r=0.643,P<0.01)。随体质指数的增加瘦素水平逐渐升高(P<0.05),体重正常组、超重组、肥胖组瘦素水平分别为0.59±0.17μg/L、0.75±0.16μg/L、0.89±0.11μg/L。结论冠心病患者血浆瘦素水平与冠状动脉病变程度以及肥胖显著相关,推测瘦素可能参与动脉粥样硬化的发生发展。

关键词： 兽医内科学   双语   教学  

摘要： 从开展双语教学的重要性出发,介绍了兽医内科学实施双语教学的简况、备课与授课过程、课后辅导、安排研究生参与双语教学等方面的探索,取得了较好的教学效果,最后结合本课程双语教学的体会,提出了相应的建议。

关键词： 中医内科   肺痨   教学  

摘要： 结合现今肺结核诊治的实际情况,提出目前中医治疗肺痨的意义和优势;就如何补虚培元、提高抵抗力,开阔学生视野,使其认识提高抵抗力的方法应该是很广泛的;分析教科书提到的证型尚不能包括肺结核的所有证型,试图通过对肺痨病机的补充使其得以完善;以及对如何认识中药治痨杀虫药等肺痨教学中的疑点、难点问题进行探讨。

关键词： 中医内科学   教学方法   改革  

摘要： 中医内科学是中医临床的桥梁课,它是学生在学习了中医基础理论、中医诊断学、中药学、方剂学等课程的基础上开设的,既是学习其它中医临床课的基础,又是中医临床课的入门课。因此对中医内科学掌握的好与否,直接影响到其它中医临床课的学习。如何才能使学生学好和掌握中医内科学,往往与老师的教学方法密切相关,尤其是课堂教学。笔者在中医内科学多年的教学方法探索中体会到,改革教学方法必须从多方面入手才能提高教学效果。一、温习所学知识奠定学习基础中医内科学虽是临床学科,但所要求的学科知识是多学科的综合,由于学生的基础有别,知识的深度和广度参差不齐,如果前期基础没有掌握好,学生很难学好中医内科学。老师在讲授每一病证时都必须温习与该病证相关的学科知识。如讲授肺系疾病时,必须复习肺的生理功能,肺主气、司呼吸、主宣发肃降、通调水道、主声音、开窍于鼻等,当肺的生理功能失调后则可能产生咳嗽、哮证、喘证,甚则肺失宣肃,水津不布,聚湿成痰,形成肺胀或肺癌病证。在教学中重温中基肺的生理功能,学生就易理解和掌握咳嗽、哮证的病机。并且每个病证的特点及证型特点都离不开中基、中诊知识,如感冒是以邪在肺卫为临床表现的疾病,既要讲清楚肺的生理功能,又要讲清楚卫气的...