系统论在内科见习教学中的应用

系统论是研究系统的一般模式、结构和规律的学问。系统论的出现,使人类思维方式发生了深刻变化,并促进着各门科学的发展。内科学是临床医学中的核心学科,临床医学诊断与治疗的共性思维,集中表达在内科学中;在临床实践中,内科疾病也最为常见,学好内科学对学习、掌握其他学科非常重要。临床见习教学是培养临床医学生向一名合格医生转变的第一步,是非常重要的医学教育过程。本文就系统论及系统论在内科见习教学中的应用进行了较广泛深入的讨论。     

妇幼保健机构单体多院区管理模式的探索和实践

单体多院区模式是公立医院未来发展的方向.此研究选取安徽省妇幼保健院为研究对象,从系统论视角,按照系统思维,从系统的层次性、整体性及动态性等方面对单体多院区管理模式进行探索和实践,为后疫情时代卫生行政部门、妇幼保健机构及综合医院等对单体多院区管理提供借鉴.     

谈医学逻辑学 第六章 创造性医学思维方法(二)

一、医学系统思维的基本概念普通系统论认为,自然界和人类社会的任何事物都是一个有序的,统一的整体系统。用于揭示和认识这个整体系统的要素、结构、层次、功能、发展和运动的规律的方法,叫做系统方法。这种方法在思维领域里,被称为系统思维方法。系统思维认为,在世界上、宇宙间每一个具体的整体,无论大小、繁简,都称     

营养支持治疗胃肠道肿瘤的研究进展

胃肠道肿瘤为常见恶性肿瘤,对患者健康和生命安全造成严重的威胁。胃肠道肿瘤患者容易发生营养不良,进而降低患者生存质量,对患者身心健康造成直接的影响。本文综述了胃肠道肿瘤患者营养支持治疗在不同阶段的现状,以便对胃肠道肿瘤患者尽早进行营养评估及实施营养支持治疗,避免患者由于营养问题而导致病情发生进展。本文从营养不良含义、类型、发生原因入手,以不同营养支持治疗的优缺点为重点,并对不同胃肠道肿瘤患者不同营养支持治疗方法和效果进行综述,为胃肠道肿瘤患者营养支持治疗提供可靠的依据,明确胃肠道肿瘤患者与营养支持治疗的相关性,降低并发症发生率,提升胃肠道肿瘤患者的治疗效果及生存质量。     

鞍区肿瘤的显微手术治疗

鞍区肿瘤以垂体瘤、颅咽管瘤、脑膜瘤等良性肿瘤多见，手术切除是最佳治疗手段。但鞍区空间狭小，解剖结构复杂。鞍区有肿瘤时，其毗邻重要结构：视神经、视交叉、下视丘、垂体柄多受压、移位甚至发生粘连、变性，手术中稍有不慎即可使上述结构受损，而发生一系列严重并发症，甚至危及生命。我科自1996-07～2003-03对133例鞍区肿瘤患者进行显微手术治疗，取得了满意治疗效果，现总结报告如下。     

以急腹症为表现的卵巢恶性肿瘤临床分析及文献复习

妇科急腹症是妇产科急诊患者中较常见病症之一，以急性腹痛为主要临床症状，其病情变化复杂，治疗方法也随病情相异而各不相同，因此术前诊断及鉴别诊断具有重要的临床意义。妇科恶性肿瘤因其有广泛转移、粘连，且肿瘤增大迅速，活动度下降，不易扭转，因此发生急腹症的情况比较少见，查阅文献发现缺乏大样本研究，多为个案报道，且多在术前诊断为卵巢良性肿瘤扭转或破裂，术后诊断为恶性生殖细胞肿瘤。     

JC型聚焦超声肿瘤治疗系统的原理分析

JC型聚焦超声肿瘤治疗系统是由我国自行研究开发生产的，具有知识产权的大型综合肿瘤专用治疗设备，为肿瘤患者又提供了一种新的治疗手段。本文从系统的组成原理、工作原理和控制电路实现原理三个方面，对该系统进行较为全面的阐述，有助于操作人员或工程技术人员加深对该系统的认识和了解。     

内毒素／肿瘤坏死因子单克隆抗体与肝功能衰竭

内毒素是肝功能衰竭和多器官系统功能衰竭的重要原因，肿瘤坏死因子是内毒素致肝损害的关键细胞因子之一。应用内毒素／肿瘤坏死因子单克隆抗体治疗，为肝功能衰竭及其并发症的防治展示新的前景。     

妇科恶性肿瘤患者围手术期心理护理体会

女性生殖系统的肿瘤占全邵肿瘤的1／5。女性生殖器官各邵位均可发生肿瘤，其中以子宫和卵巢的肿瘤为多见，而外阴、阴道和输卵管的肿瘤较少。妇科恶性肿瘤的治疗，目前仍以手术、放射及化学药物治疗为主，根治性手术，手术范围大，失血多，并发症难以避免，放射与化疗的副反应亦较大。因此，对护理的要求更加严格。与此同时，心理治疗与护理对恶性肿瘤患者尤为重要。我科自2004年1月以来，共收住16位妇科恶性肿瘤患者，其中有6例因病情及经济条件等原因放弃治疗，10例患者接受了手术根治和化学药物治疗，并在围手术期根据各自心理特征，针对恶性肿瘤患者常见心理反应，给予心理护理，激发患者潜在生存意识，提高机体抗病能力，树立战胜疾病信心，积极配合治疗，收到良好效果，现总结如下：     

卵巢肉瘤的诊治现状

卵巢肉瘤是非常罕见的妇女生殖道恶性肿瘤，多数发生在单侧卵巢，体积较大，实性多见。术前诊断率低，超声检查，CT和核磁共振对卵巢肉瘤的诊断有一定的参考价值，确切的诊断依赖术后病理。卵巢肉瘤目前尚无可靠的肿瘤标记物，除了血清CA125可升高外，术后标本的免疫组化检测也可呈现某些蛋白的阳性染色。目前采用卵巢癌的FIGO分期系统。治疗以手术为主，术后联合放疗或化疗。化疗方案的选择及患者对化疗的反应，与肿瘤的病理类型及临床分期密切相关。手术分期是影响其预后的重要因素。     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.