关键词： internship and residence, organisation & administration   education, medical, graduate, organisation & administration   personnel administration, hospital   hospital records   time factors   curriculum   United States  

摘要： OBJECTIVE The acquisition of data on resident duty hours has been largely dependent on self-report surveys collected in the surgical literature. We sought to implement and describe a simple method for monitoring internal medicine resident duty hours by using time-cards. DESIGN In 2002, internal medicine residents on a 3-site academic programme were asked to track their duty hours using time-cards prior to the implementation of system changes according to duty hours reform. SETTING An academic internal medicine residency programme in the USA. RESULTS Of participating residents (n = 41), 93% worked at least 1 shift longer than 30 hours, 29% worked an average of more than 80 hours per week, and 56% had less than 1 day off per week. No residents were on call more than once every third day. CONCLUSIONS This study describes the findings and challenges of using time-cards to track duty hours, and shows that many internal medicine residents on this programme were, before implementation of duty hours reforms, in violation of duty hours regulations.

关键词： physician-patient communication   health risk   motivational interviewing   counseling  

摘要： BACKGROUND: As behavioral health risks account for the major causes of preventable morbidity and mortality in the United States, national guidelines recommend that physicians routinely screen patients for risk factors, and counsel as appropriate. OBJECTIVES: To assess the scope of health risk screening and characterize the communication content of counseling for health behavior change in 2 general internal medicine practices. DESIGN AND PARTICIPANTS: We studied video tapes of 125 new patient visits to General Internists affiliated with academic medical centers in Chicago, IL (70%) and Burlington, VT (30%). All videotapes were content analyzed to examine (1) the incidence and outcome of screening for diet, exercise, tobacco, alcohol, drugs, sex, seatbelt use, helmet use, firearms, smoke detectors, and sun exposure;(2) the content of counseling for at-risk behaviors, with a focus on 11 counseling tasks associated with health behavior change. RESULTS: Patient age in these 125 initial visits ranged from 22 to 85 years. Within the 91 visits that included at least 1 screening attempt, there were a total of 361 distinct screening discussions (mean = 3.9, SD = 2.2, range = 1 to 9). Seventy-four (20.5%) of the 361 screening discussions revealed an at-risk behavior. On average, 2.4 of the 11 counseling tasks were accomplished for each of the 74 behavioral health risks (SD = 2.2, range 0 to 9);only education about the problem (56.8%) and general advice about the solution (62.2%) were evident in more than half of the counseling attempts. CONCLUSIONS: This observational study reveals that communication tasks associated with successful counseling were relatively infrequent occurrences during initial visits in 2 primary care practices.

关键词： Delivery of Health Care   Integrated   Internal Medicine   Mental Disorders   卫生保健提供   联合   内科学   精神障碍   模型   组织管理   精神病学   Qualification(factory)   Integrate   Psychiatry   Delivery of Health Care   Health Care   Mental Disorders   Internal Medicine  

摘要： This article describes the range of options for integrating medicine and psychiatry, with a focus on the advantages and limitations of each model. The models were developed in different countries with specific health care cultures. This article illustrates the range of in and outpatient options as currently practiced, with case reports from practitioners when possible, and describes qualifications for practicing in each model, the settings, the patient populations, the relevant financial issues, and the advantages and disadvantages of practicing in each model. It closes with comments on the next steps for advancing integrated care and the barriers to be overcome.

关键词： Internal Medicine   With frequency   Patient Care   Does transfer   nationalsurvey  

摘要： Background: Transfer of responsibility for patient care between physicians is a key process in the care of hospitalized patients. Systems of transfer management and transfer frequency may affect clinical outcomes. Methods: To characterize the systems by which patient information is transferred ("signed out") between resident physicians in internal medicine residency programs and to determine the impact of recently enacted resident work-hour regulations on the frequency of transfers, we mailed a self- administered survey to chief residents at 324 accredited US internal medicine residency programs outside of New York State. The main outcome measures were sign-out practices, skills training, and transfer frequency. Results: Surveys were returned from 202 programs (62%). Transfer systems varied among and within institutions: 55% did not consistently require both a written and an oral sign-out at transfers of care, 34% left sign-out to interns alone, and 59% had no means of informing nurses that a transfer had taken place. In addition, 60% of the programs did not provide any lectures or workshops on sign-out skills. After work-hour regulations were instituted, transfers of care for a hypothetical patient increased by a mean of 11% (from 7.0 to 7.8 transfers;P <.001) during a Monday-Friday hospitalization. A member of the primary team was in the hospital for 47% of the hospitalization. Conclusion: Although transfers of care are increasingly frequent, few internal medicine residency programs have comprehensive transfer of care systems in place, and most do not provide formal training in sign-out skills to all residents.

关键词： 中医内科学   胸痹   心痹   肺痹   质疑  

摘要： 新世纪全国高等中医药院校规划教材《中医内科学》（北京：中国中医药出版社，2003）把“胸痹”病归属于心系证病章节。但是，胸痹是以胸部憋闷，甚则作痛，喘息咳唾，呼吸不利等症状为主，病位在上焦，与心肺关系非常密切，且与肝脾相关，并不单纯属于心系疾病。故不宜在教材中将胸痹单纯归于心系证病。本文就胸痹的理论学术渊源、临床实际意义、现代对胸痹主方的研究等方面进行论述，以期学者共同探讨。

关键词： 内科学   冠心病   对氧磷酶   丙二醛   超氧化物歧化酶   乙酸苯酯法   高密度脂蛋白  

摘要： 目的探讨冠心病患者血清对氧磷酶1活性及其与冠心病之间的关系。方法选择冠状动脉造影确诊的冠心病患者106例和非冠心病组62例,用乙酸苯酯法和比色法分别测定两组血脂、血清对氧磷酶1活性、超氧化物歧化酶及丙二醛含量,并进行对比分析。结果冠心病组血清中对氧磷酶1活性和超氧化物歧化酶水平分别为113±64μkat/L和43.8±8.2 kU/L,均较对照组降低(134±72μkat/L和63.4±5.7 kU/L)(P<0.05);而丙二醛含量较对照组升高(9.4±1.8μmol/L比4.1±0.5μmol/L,P<0.01)。对氧磷酶1活性与高密度脂蛋白和超氧化物歧化酶水平呈正相关,与丙二醛水平呈负相关。冠状动脉狭窄者对氧磷酶1活性较无狭窄者明显减低(P<0.001),2、3支血管病变者较1支血管病变者对氧磷酶1活性降低(P<0.05)。结论冠心病患者血清对氧磷酶1活性降低,低对氧磷酶1活性与冠心病严重程度有关。

关键词： 内科学   胆固醇酯转运蛋白抑制剂研究进展   综述   胆固醇酯转运蛋白抑制剂   高密度脂蛋白胆固醇   动脉粥样硬化  

摘要： 升高高密度脂蛋白胆固醇水平是降低动脉粥样硬化危险的一个可能的有益治疗靶标。胆固醇酯转运蛋白抑制剂虽然能有效升高高密度脂蛋白胆固醇水平,但目前对其是否能有效减少动脉粥样硬化的危险程度尚不明确。

关键词： 医学教育   教学改革   内科学   日本   中国   特点   课程设置   实践性教学  

摘要： 日本医学教育的特点是学制长,课程设置全面,安排合理,强调“问题解决型”教学和创造性思维及科研能力培养。我国内科学的课程的教学改革,应重视实践性教学环节、重视跨学科研究、重视自学、重视研究能力的培养,从而达到基础→临床→再基础→再临床不断深入的教学目的,不断提高我国医学教育的水平。

关键词： 内科学   阿托伐他汀对醛糖还原酶表达及内膜增生的抑制作用   FISH原位杂交   阿托伐他汀   醛糖还原酶   内膜增生   再狭窄  

摘要： 目的研究醛糖还原酶在大鼠再狭窄血管中的表达,探讨醛糖还原酶表达与内膜增生之间的关系,以及阿托伐他汀对醛糖还原酶表达及内膜增生的抑制作用。方法24只健康雄性SD大鼠,随机分成手术未干预组、假手术组及阿托伐他汀组,每组8只。用通气—干燥法损伤手术未干预组及阿托伐他汀组中的右侧颈总动脉,左侧颈总动脉作为对照。分别于第7天及14天处死动物,HE染色以观察内膜及中膜增生情况,并计算内膜和中膜面积及其比值,FISH原位杂交及免疫组织化学检测醛糖还原酶及核因子κB的表达。结果术后第7天损伤侧血管内膜增生明显,第14天内膜增生进一步加重,对照血管无明显增生。阿托伐他汀组血管内膜面积、内膜与中膜面积比值明显低于手术未干预组(P<0.05或P<0.01)。醛糖还原酶及核因子κB在损伤侧血管中的表达明显强于对照侧。阿托伐他汀组醛糖还原酶及核因子κB的表达明显低于手术未干预组(P<0.05或P<0.01)。结论醛糖还原酶可能参与了大鼠颈动脉损伤后内膜增生及再狭窄的形成。阿托伐他汀可抑制血管内膜增生及再狭窄的形成。阿托伐他汀可能是通过抑制醛糖还原酶及核因子κB而抑制再狭窄的形成。

关键词： 规划教材   中医内科学   探讨  

摘要： 我们在使用普通高等教育“十五”国家级规划教材《中医内科学》(简称新规划教材)过程中发现一些值得研究改进的问题,对这些问题已经进了一定的探讨,为了在教学中能更准确地讲解《中医内科学》的相关内容,有必要对一些问题进行进一步探讨。一、鉴别诊断存在的问题1.疾病的鉴别与辨证相混淆疾病的鉴别诊断是不同疾病因某些临床表现相近或相同而需要进行鉴别,而辨证是同一疾病的不同的证候间的鉴别,两者针对的对象不同,应在不同标题下进行讲解,但教材将其内容合二为一,统归属于症证鉴别。如咳嗽病的病证鉴别的1、2条分别为咳嗽特点的鉴别和咯痰特点的鉴别,实际上该内容应当归属于辨证要点。在辨证要点中除辨外感内伤、辨虚实外,当细辨咳嗽和咯痰的特点,来充实外感与内伤及虚与实的具体内容,这样的辨证要点具有实际的辨证价值,使辨证要点不致于列为形式,对咳嗽的各证候的掌握具有实际的指导意义。如风寒袭肺证,是证辨证属外感及实证,其咳嗽的特点为白天多于夜间,咳声重着而急剧,咯痰的特点为清稀色白量多,这样便掌握了外感袭肺的主要临床特征。同样肺阴亏耗证,其咳嗽的特点为多发于午后或黄昏,干咳,咳声短促,或伴声嘶,咯痰的特点为无痰或少痰而粘或痰中带血丝。可见证候的鉴别...