关键词： 内科学   冠状动脉瘤   冠状动脉造影  

摘要： 目的利用较大样本冠状动脉造影资料分析国人冠状动脉造影的人群中冠状动脉瘤的检出率、病因、临床特点和预后。方法回顾性研究分析1993年12月至2006年12月8628例成年人冠状动脉造影资料,将检出的冠状动脉瘤进行总结和分类,并与国内外文献进行比较。结果8628例行冠状动脉造影术的人群中,共检出冠状动脉瘤80例,检出率为0.927%,其中男性61例,女性19例。冠状动脉瘤检出率在男女性别之间无显著性差异(P>0.01)。好发部位依次为右冠状动脉、左前降支和左回旋支;有心绞痛病史者72例,42例合并心肌梗死;同时存有冠状动脉狭窄≥50%的病人72例;瘤体内发现血栓61例;瘤体发生于单支冠状动脉者63例,2支者6例,3支并左主干者6例;无一例瘤体破裂。本病可引起心肌梗死等严重临床后果,抗血小板、抗凝及血运重建可明显改善预后。结论国人成年人冠状动脉瘤是冠状动脉粥样硬化的一个少见的亚类或变异型,非一个独立临床疾病,动脉瘤和狭窄通常是共有的。动脉瘤内常有血栓,易引起心肌梗死,如不积极干预,则愈后较差。

关键词： 医学教育   考试   临床实习医师  

摘要： 目的了解临床实习医师对“考站式”临床实践考试形式的态度,评价该考试方法的效果。方法自拟《内科学实习临床实践考试改革调查表》,对2005年期间参加考试的220名临床实习医师进行问卷调查。结果在各考站考试能否考核出学生的真实水平的调查中,应答者的肯定率为病史问诊和病例分析站76.4%,胸片和心电图站82.1%,体检站73.8%。68.2%的人认为病史问诊和病例分析考核评分公正,23.2%持否定态度;71.8%应答者认为胸片和心电图考核评分公正;69.8%认为体检考核评分公正。在考试合理性方面,应答者中79.9%的人赞成病史问诊和病例分析采用口试,59.2%赞成胸片和心电图考试采用现场判读形式,77.1%赞成体检采用人体实际操作。结论临床实习医师对“考站式”方法持肯定态度,这一考试方式基本能够公正评估医学生的临床实践能力。用“考站式”方法代替传统的床边考试形式,作为一种临床技能评估新方式是可行的。

关键词： 内科学   瘦素   瘦素受体   患者,慢性心力衰竭   预后  

摘要： 目的观察慢性心力衰竭患者血清瘦素和可溶性瘦素受体变化及其对慢性心力衰竭患者短期预后的影响。方法测定120例慢性心力衰竭患者和30例正常对照者的血清瘦素和可溶性瘦素受体水平。测定后对慢性心力衰竭患者进行随访,随访期限为8～12月,终点事件包括死亡和因心力衰竭加重再入院。预后分析采用Ka-plan-meirer预后分析和Cox回归模型分析。结果慢性心力衰竭组的血清瘦素和可溶性瘦素受体水平均较对照组增高(分别为12.4±3.0比6.3±2.0μg/L,P<0.01;42.40±10.0比25.6±10.7μg/L,P<0.01)。不同心功能分级慢性心力衰竭患者血清瘦素水平无统计学差异(Ⅱ级、Ⅲ级和Ⅳ级心功能患者分别为14.0±1.6μg/L、12.8±1.0μg/L和10.8±1.3μg/L;P>0.05)。Kaplan-meirer预后分析结果发现低瘦素水平患者的生存曲线明显优于高瘦素水平组(P<0.05),COX回归模型分析发现瘦素水平对慢性心力衰竭患者近期预后有预测价值(标准回归系数为0.112,P>0.05)。结论慢性心力衰竭患者的血清瘦素、可溶性瘦素受体水平升高。血清瘦素水平对慢性心力衰竭患者的近期预后有预测价值。

关键词： 内科学   经皮桡动脉穿刺   老年心脏病   勃起功能障碍   冠状动脉造影   临床分析   周围型肺癌   糖尿病病人  

摘要： 20070345老年肺结核球12例误诊为周围型肺癌临床分析/潘零星…∥中国全科医学.-2006,9(22).-1885~1886收治老年结核球34例中误诊12例(35%),12例均行胸部X线及肺部CT检查,病灶直径2.0~5.5cm;病灶内有钙化灶、周围卫星灶、伴胸膜反应、边缘呈分叶状、有毛刺或偏心空洞等表现。误诊1d~6月。结果:4例术后抗痨3个月病灶消失,8例确诊后治愈。认为误诊多因临床表现不典型、过分依赖OT试验、对X线胸片表现缺乏全面客观分析或仅凭痰涂片阴性就否定肺结核。综合临床及影像特点有利于两病鉴别,诊断仍不明确且担心延误治疗者可剖胸探查。参9(陈志)20070346氨茶碱在肾上腺素无效心脏骤停患者中应用的临床研究/董林…∥实用临床医学.-2006,7(10).-33~35对在该院内心脏骤停发作的46例,平均54.3岁,随机分A组20例于心脏骤停后心肺复苏时予肾上腺素2~5mg/次,3~5min可重复;如无效时予氨茶碱0.25~0.5g/次,静脉快推,3~5min可重复,最大剂量1.0g。B组26例单用肾上腺素。其它复苏用药两组相同。结果:治疗后恢复心电活动、恢复自主循环A组各16例(80%)、1...

关键词： Elderly   Difficult hospital discharge   Complexity   Comprehensive multidimensional assessment   Shared care  

摘要： Objective: Investigate the prevalence of difficult hospital discharges (DHD), describe clinical and social patients' characteristics as potential reasons for discharge delays in an internal medicine ward and implement tailored post-discharge care. Methods: During the year 2005 we analysed, in a middle-sized country hospital, all the patients for which some delay for discharge, owing to their whole complexity, was presumable. Comprehensive multidimensional assessment, clinical-social risk score, specific needs of care, mean of stay and outcomes were evaluated. Results: 68.5% of DHD patients were >= 80 years old, with 3.8 the mean number of diseases per patient;57.5% presented a loss of autonomy (ADL) just before acute deterioration;80% were functionally and/or cognitively impaired. Only 5% had suitable family support;5.1% were living at a nursing home;2% were living alone. The most frequent causes of admission were stroke, cognitive impairment-dementia, cardiovascular diseases, fractures and cancer. Mean length of stay was 12 days. Fifty-two percent of patients were discharged home, 30% were admitted to a long-term care facility, 1% to hospice and 17% died during their hospital stay. Conclusions: The aim of "coordinated care" (i.e., targeting "at-risk" patients with assessment of medical, functional, social and emotional needs;provision of optimal medical treatment, self-care education, integrated services, monitoring of progress and early signs of problems) is to improve health outcomes and reduce costs. More than 80% of DHDs patients, with specific tailored programmes, may be discharged from hospital, with satisfactory solutions for them and their families.

关键词： Clinical practice   Internal medicine   Tumour markers   Guidelines   Positive predictive value   Decision-making process  

摘要： Objective and background: In the last 35 years tumour markers (TM) have gained currency in clinical practice. However, in the light of indications by international guidelines, their use is often unjustified. Our aim was to quantify the use of some of the most common TM, assessing their appropriateness and their efficacy in an Internal Medicine Unit. Methods: In the three Internal Medicine Units of the Department of Internal Medicine of Policlinico of Modena we have carried out a retrospective analysis of the assessment of the main TM (CEA, CA19.9, CA 125, CA 15.3, NSE). The analysis was divided into two distinct phases: (I) quantitative phase, in order to assess the scale of the problem in economical terms;(II) qualitative phase, in order to assess the efficacy of the tests and the appropriateness of their use. Results: (I) At last one of the considered TM was requested in 5102 out of the 8253 admitted patients (62%) (period 2001-2003). The trend was similar in all three units examined. (II) The qualitative analyses revealed: (1) the most common motivation for their use (79%) was diagnostic, mostly prior to any other test;(2) a mere 5% of the requests were appropriate according to the international literature;and (3) TM showed a low positive predictive value when used for diagnosis in an unselected population such as that of an Internal Medicine unit. Conclusions: The results of our study showed that TM determination represents an overall cost for Internal Medicine units and that there is a high inappropriateness in their use compared to what it is suggested by international guidelines. Though the TM is a low-cost test when used correctly, it seems an unnecessary expense if not adequately incorporated into the decision-making process.

关键词： 内科学  

ISBN: (纸本)753843528X

摘要： 本书系统地介绍了内科常见疾病的病因、发病机理、临床表现、辅助检查、诊断和治疗等，内容丰富，科学使用，具有较高的使用价值。

关键词： 医药、卫生   内科学  

摘要： 本书作者根据多年来在院内外诊断疑难病症的精深体会，针对内科领域的诊断难点和具体问题，阐述在特殊情况下的分析方法，既是经验的精髓，又是思路的指导。另也收录一些相关的内科临床病例(理)讨论和近年认识的新综合征。

关键词： ambulatory care   computers   epidemiology   errors, medication   physicians   prescribing  

摘要： Purpose. A pilot study was conducted to characterize the epidemiology of prescribing errors, comparing those that occurred pre- to postimplementation of an electronic prescribing system;this article describes the results of the study during the pre-implementation phase, when a handwritten prescription process was still in place. Summary. A retrospective review of 1411 prescriptions that were handwritten during a five-month time frame was used to identify and characterize medication errors and potential medication errors. The review was conducted in an internal medicine clinic in a large health system that was preparing to implement an electronic prescribing system. The first phase was the implementation of a basic system-one that facilitated the writing of a more complete and legible prescription. The second phase consisted of adding more sophisticated clinical decision support (CDS) capabilities. Three data sources were reviewed: the handwritten prescription, the electronic health record and the prescription as it had been entered into the pharmacy computer system. Almost 28% of the prescriptions evaluated contained one or more errors or potential errors. Over 90% of the errors were potential errors. Only 0.2% of the errors caused patient, harm. Nonclinical errors (illegibility, missing information, wrong dose) may be affected by a basic electronic prescribing system, and clinical errors (drug-disease interaction, contraindication of a drug) may be affected only when more sophisticated levels of CDS programming are added. Conclusion. Potential prescribing errors occurred frequently but few reached the patient or caused harm. The most severe errors were those that may be reduced by the implementation of an electronic prescribing system with CDS capabilities.