小儿头孢菌素致抗生素相关性腹泻64例分析

目的了解头孢菌素导致抗生素相关性腹泻的基本情况。方法对64例头孢菌素致抗生素相关性腹泻进行临床观察。结果本组头孢菌素致抗生素相关性腹泻以6个月～3岁年龄组发生率最高。其中第3代头孢菌素所致抗生素相关性腹泻的腹泻程度重于第1代。临床表现和实验室检查均缺乏特异性。结论头孢菌素致抗生素相关性腹泻比较常见,应引起临床医师在用药时的重视。     

青年医师如何看待医疗纠纷

作者针对青年医师面对医疗纠纷的困惑,从各角度分析了医疗纠纷的成因,指出应以正向心态对待医疗纠纷。     

乳腺癌术后双肺及骨转移

疾病的正确诊断和合理治疗是患者和医务工作者共同的心愿。在广东省人民医院肿瘤中心，吴一龙教授指导临床医生应用循证医学理论进行肿瘤的多学科综合治疗，开展临床病例讨论。讨论会上各学科共同围绕一个病例或一个病种进行会诊，临床、病理、B超、放射影像等资料齐全。除相关科室提前准备的中心性发言外，到会人员各抒己见，气氛热烈。参会人员受益匪浅，提高了对疑难病例的诊治水平。为了将他们的诊治经验传播出去，让更多的临床医生获益，我刊开辟“循证病例讨论”栏目，希望广大医务工作者关注此栏目。[编者按]     

Development and evaluation of an allocation committee to distribute community placements on an equitable basis between universities: Our experience with the University Placement Allocation Committee

The present paper outlines the development and evaluation of an allocation committee to distribute community placements on an equitable basis between universities. Although based on our experience in South Australia with the University Placement Allocation Committee (UPAC), the primary goal is to outline the steps that would be useful if placement coordinators at other universities in Australia decided to establish and maintain an allocation committee. A survey of field supervisors was also conducted and field supervisors endorsed UPAC as a constructive mechanism for allocating community placements.     

The structure of memorized knowledge in students and clinicians: an explanation for diagnostic expertise

This paper provides for the first time evidence of a consistent difference in the memory structures of novice and expert clinicians. The diagnostic performance of first- and third-year clinical medical students, senior house officers, registrars and consultants on four clinical problems in general medicine was studied. Comparisons were made of all diagnostic interpretations offered and the forceful features (personally important pieces of information which act as a key to particular memory structures which in turn give rise to the clinical interpretation) from which these were derived. Results demonstrate that the numbers of interpretations made and the numbers of forceful features identified did not differ significantly between groups (P greater than 0.05). However, the actual interpretations made in three out of four cases, and the actual forceful features identified in all cases, did differ significantly between groups (P less than 0.05). The numbers of interpretations made by all groups were large and demonstrated enormous variability. Highly individualized multiple responses to clinical information are associated with easy diagnoses. We conclude that there is no difference between groups of differing clinical experience in the breadth of thought but that there are marked differences in the precise content and structure of thought. This allows coherent explanation of variation in diagnostic expertise with clinical experience. The significance of the findings is discussed.     

Assessment of postoperative pain: impact of clinical experience and professional role

Background: Unrelieved postoperative pain is still reported to be a rather common clinical problem which may be related to inadequate routines for pain assessment. Therefore, the aim of the study was to describe strategies used by experienced and less experienced nurses and physicians in their assessment of postoperative pain and to relate different approaches, clinical experience, and professional role to the accuracy of the pain ratings.
Methods: Data collection was based on repeated interviews with nurses (n=30) and physicians (n=30) in connection with clinical pain assessments (n=180) including VASscoring
Results: Commonly used strategies in the pain assessment were: - how the patient looks, - what the patient says, - the manner of talking, and - past experience of similar circumstances. The mean VAS-score given by the patients (6.1±21.1) was significantly (P<0.001) higher than that rated by the staff members (4.9±21.2). Nurses as well as physicians overestimated low and underestimated high levels of pain indicated by the patients. The accuracy of the ratings by nurses, especially by more experienced ones (≤10 years in nursing), was found to be less precise than that of physicians. The pain assessment of these very experienced nurses was characterized by a systematic underestimation.
Conclusions: The present study emphasizes a need for definition of more precise strategies for clinical postoperative pain assessment which better take into consideration the pain experiences and needs of individual patients     

Application of fluorescence in situ hybridization techniques in clinical genetics: use of two alphoid repeat probes detecting the centromeres of chromosomes 13 and 21 or chromosomes 14 and 22, respectively

Two cloned DNA fragments, one derived from an alpha satellite subfamily common to chromosomes 13 and 21, and the other derived from a similar subfamily common to chromosomes 14 and 22, have been used as biotinylated probes in in situ hybridization studies. Under high stringency conditions, chromosome specific centromeric labelling can be obtained. The applications of this technique in clinical situations are illustrated on metaphases from a fetus with trisomy 21, a fetus with trisomy 13, and a child with clinical features of cat-eye syndrome.     

电动秋千的研制及其在前庭功能研究中的应用

本文介绍了带转椅的电动秋千的研制及其使用,包括其工作原理、结构与控制系统的设计、主要技术性能及其在前庭功能与空间运动病研究中的应用。多年的实验证明,这台电动秋千设计合理,技术指标先进,使用性能良好,是研究前庭功能和空间运动病的实用设备。     

An analysis of paediatric diagnostic decision-making: how should students be taught?

This study assesses the relative importance of history, examination and investigations in paediatric diagnosis, in the Paediatric Out-patient Department of the Central Middlesex Hospital, London, by means of a questionnaire-based record of 94 consecutive referrals. A diagnosis identical to the final diagnosis was made in 76% of referrals after taking a history. The general practitioner had proposed a diagnosis in 45% in the referral letter. Clinical examination changed the diagnosis in only 15% but increased diagnostic confidence in 33%. Ninety-one per cent of cases were diagnosed without recourse to investigations. Forty-two per cent of children referred had investigations performed. In the majority of paediatric cases the provisional diagnosis reached after taking a history was identical to that after examination or results of investigations were known. Although examination provided a final diagnosis in only 15% of all cases it played an important role in adding confidence in 33%. More educational effort should therefore be directed at clinical history-taking skills and the subsequent purpose of examination.     

胰岛素泵的临床应用进展

综述了胰岛素泵在不同类型及不同情况糖尿病病人中的应用,列举了胰岛素泵临床应用中的常见问题。