关键词： Internship and Residency   Adult   Analysis of Variance   Clinical Competence   Female   HIV Infections   Health Knowledge   Attitudes   Practice   Humans   Internal Medicine   Male   Medical Staff   Hospital   Research Support   Non-U.S. Gov't   Taiwan  

摘要： Having contact and interacting with HIV/AIDS patients has long been recognized as a means for improving AIDS-related knowledge and attitudes among physicians and hence for increasing their intention to provide AIDS care. To investigate the impact of one-month residency training in an AIDS inpatient unit on internal medicine residents, this quasi-experimental, pre-post, two-group study, conducted from April 2000 to April 2001, used questionnaires. At follow-up, residents who received training in the AIDS unit ( experimental group) were significantly more knowledgeable about HIV/AIDS, had more positive attitudes and greater intention to care for HIV-infected patients than residents who did not receive this training (control group). Results suggest that a one-month AIDS residency training intervention can effectively enhance residents' HIV-related knowledge, attitudes and intention to care for patients infected with HIV.

关键词： 内科学   医药卫生人员   技术培训   习题  

ISBN: (纸本)756410483X

摘要： 本书是《医疗机构医务人员三基训练指南——内科》的配套习题集，题型有名词解释、选择题、填充题、问答题。本书可作为医疗机构医务人员业务培训辅导用书。

关键词： Bina   data warehouse   mortality   trend   internal medicine  

摘要： Background: Epidemiological studies are useful both for investigating possible etiologic factors and for determining the extent of health provisions required. In an attempt to improve the quality of care, we have analyzed the trends of admissions to the four internal medicine wards in a community hospital in Israel. Methods: Data was collected on admission to all of the internal medicine wards of Hasharon Hospital, Rabin Medical Center, Petach-Tikva, Israel, from 1999 to 2004, including discharge diagnosis, duration of stay, and mortality. The data source was the "Bina" data warehouse system of Clalit Health Services. Results: The yearly admission rate was 10,482 +/- 386. Ninety-six percent of the admissions were of Jews and 3% were of Arabs. Most of the patients were older than 75 years (43.1%);23.6% were between 65 and 74 years of age. The readmission rate was 7.4% within 1 week and 16.3% within 1 month. The three most common discharge diagnoses, not including pre-existing illnesses, were: coronary artery disease-related (21.9%), heart failure (5.4%), and pneumonia (5.6%). The average duration of stay was 4.6 +/- 0.1 days. Patients admitted for newly diagnosed malignancy, pneumonia, or CVA had a longer duration of stay (7.1, 6.8, and 6.5 days, respectively). There was a steady decline in mortality from 4.5% in 1999 to 4.2% in 2004. Conclusion: In the 5-year period studied, there was a changing trend in mortality rate, hospital duration rate, and patient age. (C) 2006 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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。