应用循证医学指导儿科实习教学

目的指导实习生学会应用循证医学(evidence based medicine，EBM)来为每个病人作出最佳治疗。方法应用循证医学指导实习生的临床实践、体格检查技能、检验项目的选择。结果实习生在临床实践中了解儿科常见病的循征医学的应用，对临床表现指标的量化评估；实习生体格检查手法更新，规范；检验项目选择用最新的经过临床研究机构科学评价的为证据。结论应用循讧医学指导儿科临床实践，并非替代临床技能和实践经验，而是以此为手段，促进医学发展更完善。直觉和不严谨的临床经验，不能作为指导临床实践的全部依据，应强调来自系统研究得到的最佳证据，来指导临床实践。使临床医学从经验型向科学型转变。     

临床医学专业内科见习带教理论与实践探析

教研室在临床医学专业五年制本科内科见习带教方面主要采取了以下措施：实施教师脱产带教制;采用多种教学方法（启发式教学法、病例分析教学法、以问题为基础的教学法、多媒体教学法）;定期进行教学联系会;加强医患沟通。     

The integration of evidence based medicine and personal care in family practice

Evidence based medicine is seductive in its simplicity and few would argue with the philosophical concept. The reality of its application in primary care is rather different. It is difficult to find evidence supporting many clinical management decisions, it may be difficult to interpret evidence when it is available, and it may be difficult to apply this evidence in the consultation. Clinical decisions may be influenced at many levels through health policy, audit, protocols, and guidelines, but the individual doctor patient relationship remains at the core of general practice. Developing a culture of evidence based medicine in general practice must integrate quantitative and qualitative research, epidemiology and psychology and the skills of public health and family medicine.     

Coordinating the norms and values of medical research, medical practice and patient worlds-the ethics of evidence based medicine in orphaned fields of medicine

Evidence based medicine is rightly at the core of current medicine. If patients and society put trust in medical professional competency, and on the basis of that competency delegate all kinds of responsibilities to the medical profession, medical professionals had better make sure their competency is state of the art medical science. What goes for the ethics of clinical trials goes for the ethics of medicine as a whole: anything that is scientifically doubtful is, other things being equal, ethically unacceptable. This particularly applies to so called orphaned fields of medicine, those areas where medical research is weak and diverse, where financial incentives are lacking, and where the evidence regarding the aetiology and treatment of disease is much less clear than in laboratory and hospital based medicine. Examples of such orphaned fields are physiotherapy, psychotherapy, medical psychology, and occupational health, which investigate complex syndromes such as RSI, whiplash, chronic low back pain, and chronic fatigue syndrome. It appears that the primary ethical problem in this context is the lack of attention to the orphaned fields. Although we agree that this issue deserves more attention as a matter of potential injustice, we want to argue that, in order to do justice to the interplay of heterogeneous factors that is so typical of the orphaned fields, other ethical models than justice are required. We propose the coordination model as a window through which to view the important ethical issues which relate to the communication and interaction of scientists, health care workers, and patients.     

全面放开二孩政策后生殖医学在全科医疗中的意义和应用

人口问题是我国发展的关键问题。随着全面二孩政策的实施,有再生育需求的妇女不断增多,但随着社会压力等多种因素的影响,有再生育需求的妇女不断高龄化,而女性不孕的比例随年龄增长而上升,因此高龄不育女性成为不孕女性中最重要的组成部分。如何落实全面二孩政策,帮助不孕夫妇(尤其是高龄不孕夫妇)实现再生育愿望成为一个新的挑战。专科医院由于地域及数量限制,已然无法满足不孕症患者的咨询及诊疗需求。而全科医生立足社区,是为个人、家庭与社区提供全面服务的医生,在维护社区人民健康中起到举足轻重的作用。但目前有关不孕及辅助生殖技术(assisted reproductive technology,ART)的知识及技术还局限于专科医院,服务社区的全科医生所掌握的该方向的知识及技术不足,不能满足不孕患者需求。如果全科医生能了解有关不孕及辅助生殖技术知识,及时对患者状况进行有效监测,提供相关咨询服务,同时疏导患者心理,并将患者推荐至专业的生殖医学机构接受更有效的治疗,便可以在全面二孩政策的执行中充当重要角色,为全面二孩政策的推广及实施打下坚实的基础。本综述系统性地探讨了临床实用的不孕及辅助生殖技术,并梳理出相关知识,目的是使全科医生重视并了解生殖医学,满足社区中不孕患者诊疗及咨询需求。      

针灸与中医在加拿大的立法、教育和行医概况

主要介绍了针灸与中医在加拿大的立法、教育与行医概况以及基于此的展望与建议。从立法而言,针灸中医的立法规管尚未成立国家水平的统一规范管理,其管理水平均为省级内,正式由省政府批准的立法规管仅限于少数省份(卑诗省、阿尔伯塔省、魁北克省和安大略省),其余省份大多通过针灸中医协会来规管。从教育而言,学校的经营模式多为个体办学,规模较小,资源有限,无法授予学位,数目各省差异大。教育的管理与规范虽多属于省级水平内,但已经成立全加拿大中医高校教育联盟。继续教育的项目涵盖较广泛,多注重实用性,教员多来自美国。从行医情况而言,中医针灸基本覆盖了加拿大的各个省份,大多在私人诊所开展,诊所门诊量因人而异,其诊疗设备参差不齐。建议:1)设立国外立法规管咨询委员会或成立海外中医针灸立法规管联盟,提供海外中医针灸发展与立法规管的建议,可颁发相应的证书。2)倡导中医针灸教育的标准化,包括制定统一的国际化教材、教员的准入标准、本科教育、研究生教育以及继续教育的标准化。     

循证医学与循证实习

借鉴循证医学理论，提出“循证实习”模式，强化实习医生在临床实习中对疾病诊断和治疗的主动求证过程，以掌握临床思维分析方法，达到实习目的。