医生技术档案的建立与应用

医生技术档案的建立是医疗质量管理工作的有益尝试。从资料来源、评价标准、评价内容等方面进行回顾,指出医生技术档案具有覆盖面广、项目齐全、内容科学、组织严密、考核兑现等特点,并就其在医疗质量管理工作中的应用与存在问题进行了分析。

临床医生技术等级评价在心血管医院的实证分析

目的 探讨临床医师等级评价系统在心血管专科医院实施的合理性和可行性。方法 深圳市医管中心参照美国RBRVS,在深圳市孙逸仙心血管医院心脏内外科实施了临床医生技术等级评价测试。结果 心内科主治医师5人,等级评价对应1~3级2人,4级1人,5~6级2人,主任医师8人,等级对应7~8级5人,5~6级3人,住院医师和副主任医师职称完全对应等级评价结果;心血管外科等级评价对应7~8级医师基本为主任医师,评价为5~6级的包含了各职称级别的医师。结论 美国RBRVS基本适用于心脏内外科临床技术评价,以等级评价为基础的绩效薪酬改革具有一定可行性,但受到原有职称评定体系的影响,评价系统中对加、减分项目以及并发症校正因子等需要进一步调整。

关于建立医生技术档案管理系统的探讨

探讨医生技术档案管理的新模式，健全和完善医生考核体系，该系统的建立，使医生的个人信息全面、统一、集中，便于信息的更新与补充，简化了工作程序，提高了工作效率，客观地反映了每位医生的工作绩效，为综合评价医生的工作业绩提供依据，并为晋升、职称评定提供较为完整的资料，具有客观性、科学性和实用性。

25所医院为团以上干部服务对医生服务态度与技术信任度调查

目的 研究军队医院为团以上干部服务力度、保障内容与对医生服务态度和技术的信任度。方法 组织2416名团以上干部对辖属25所医院进行在医疗工作上作出总体评体、对医生服务态度满意度、医生技术信任度的评价。结果 对医院在医疗工作上的总体评价：满意、较满意率A1、A2医院为69．55％，N1～N8医院为57．62％，H1～H15医院为50．73％。对医生服务态度满意率为65．85％，对医生技术信任度为56．83％。结论 调查的内容具有问题反应的真实性，满意度、信任度均达不到要求。通过三年医德医风建设，不仅满意度达到了规定标准，且25所医院全部通过了军区的检查验收，辖属医院得到了快速全面的发展。

基于解耦子波和优化神经网络的大坝变形预测

针对提高神经网络对大坝变形的预测能力,在对Murtagh提出的、小波与神经网络相结合的、用于复杂时间序列预测的“三阶段”策略进行改进的基础上,发展了一个解耦子波和优化神经网络优势联合的预测模型。首先,利用冗余Haar小波变换的拟小波包特性提出了基于能量谱主峰重构的动力解耦空间构建技术,并将其替代“三阶段”策略中的第1阶段,从而为神经网络的应用创建了良好的平台;再者,利用最优脑外科医生进行网络结构修剪,建立了神经网络自身优化的“优化–时新窗”技术,并将其替代“三阶段”策略中的第2阶段,从而优化了神经网络的内部环境。改进后的模型增强了对复杂动力系统的适应和处理能力。在大坝变形预测应用中,多个评价指标说明,该模型的性能比“三阶段”策略有显著提高。

开拓创新,勇担责任,把病人利益放在首位

医务工作者在科研方面要具有开拓创新、勇于探索的精神,要善于发现问题,经常以发散性思维考虑问题。同时,医生是一个治病救人的神圣职业,但也是一个风险很大的职业。医生要勇于承担责任,始终保持职业热情,尤其是年轻医生在成长过程中,一是向老师学习,向书本学习;二是触类旁通,开拓新路;三是临床、科研、教学相结合。在救治病人过程中,除靠药物进行治疗外,最重要的是帮助病人树立战胜病魔的信心,以乐观的心态来接受治疗,维系生命健康。

负压吸引器治疗自发性气胸的医疗纠纷个案分析

当胸膜因病变或外伤破裂时,胸膜与大气沟通,气流便进入胸腔形成胸膜腔积气称为气胸(pneumothorax).治疗气胸的原则主要在于尽早排除气体、缓解症状、促使肺复张、防止复发,因而,快速、准确地选择治疗措施对气胸的治疗极为关键.本文对1例因采用负压吸引器治疗自发性气胸而引发医疗纠纷案例进行分析.

Hemi-hepatectomy in pediatric patients using two-surgeon technique and a liver hanging maneuver

AIM： To evaluate the efficacy of the two-surgeon technique with the liver hanging maneuver （LHM） for hepatectomies in pediatric patients with hepatoblastoma. METHODS： Three pediatric patients with hepatoblastoma were enrolled in this study. Two underwent right hemi-hepatectomies and one underwent a left hemihepatectomy using the two-surgeon technique by means of saline-linked electric cautery （SLC） and the Cavitron Ultrasonic Surgical Aspirator （CUSA; Valleylab, Boulder, CO） and the LHM. RESULTS： The mean operative time during the parenchymal transections was 50 rain and the mean blood loss was 235 g. There was no bile leakage from the cut surface after surgery. No macroscopic or microscopic-positive margins were observed in the hepatic transections. CONCLUSION： The two-surgeon technique using SLC and CUSA with the LHM is applicable to even pediatric patients with hepatoblastoma.

A remote control training system for rat navigation in complicated environment

A remote control system has been developed to deliver stimuli into the rat brain through a wireless micro-stimulator for animal behavior training. The system consists of the following main components： an integrated PC control program, a transmitter and a receiver based on Bluetooth （BT） modules, a stimulator controlled by C8051 microprocessor, as well as an operant chamber and an eight-arm radial maze. The micro-stimulator is featured with its changeable amplitude of pulse output for both constant-voltage and constant-current mode, which provides an easy way to set the proper suitable stimulation intensity for different training. The system has been used in behavior experiments for monitoring and recording bar-pressing in the operant chamber, controlling rat roaming in the eight-arm maze, as well as navigating rats through a 3D obstacle route. The results indicated that the system worked stably and that the stimulation was effective for different types of rat behavior controls. In addition, the results showed that stimulation in the whisker barrel region of rat primary somatosensory cortex （SI） acted like a cue. The animals can be trained to take different desired turns upon the association between the SI cue stimulation and the reward stimulation in the medial forehrain bundle （MFB）.

Five-plane lancet needle design for soft PVC phantom tissue cutting

Lancet needle, having three planes at the tip to generate a sharp lancet point, is the most common needle tip geometry and used for medical procedures. This research presents two five-plane lancet needle designs, the five-plane lancet needle with two back bevels （FLN-B） and five-plane lancet needle with two front bevels （FLN-F）, to study the effects of two additional bevel planes on the reduction of soft tissue cutting force. Mathematical models to calculate the inclination angle and rake angle along the cutting edges of FLN-B and FLN-F are developed. By using the grinding process, the prototype FLN-B and FLN-F needles are fabricated. And their inclination and rake angles along the cutting edges are investigated and compared to that of regular lancet needle. Needles insertion tests were conducted on soft PVC phantom which mimics the soft tissue. The initial peak insertion force and steady-state cutting force during needle insertion were identified, and the effect of cutting edge on needle soft tissue cutting force was studied. Compared to lancet needle, FLN-B and FLN-F both have higher inclination and rake angles at the tip cutting edge, could reduce the initial peak needle insertion force and tissue cutting forces, and thus can efficiently cut the soft tissue for medical applications.

Medicinal Solid Fermentation Engineering of Chinese Traditional Medicinal Fungal

Medicinal solid fermentation technology of fungal was unique within the traditional Chinese medicine （TCM） and one of the oldest bio-pharmaceutical technology in the history, for example, the production of medicated leaven named ＂Shenqu＂, the history of which had continued for more than 1,500 years. These kinds of productions were widly used and had a close relationship with TCM. The development of this technology had through stages of ＂yeast production＂, ＂solid culture＂, ＂solid fermentation＂, and nowadays toward a series engineering of solid fermentation with promising prospects. The author described the development of its history briefly, and the representative products and the characteristics of production process of every stage, respectively. This research focused on taking ＂Trametes robinioplila fermented substance＂, ＂T. robinioplila ＆ A. membranaceus fermented substance＂ and ＂T. wilfordii Hook.f. ＆ G. lucidum fermented substance＂ as examples to introduce R ＆ D ideas and important findings of＂common fermentation＂ and ＂bi-directional fermentation＂ which were recommended as studying hotspots. There were many unique and important functions in the fields of TCM about all kinds of＂fermentation substances＂. It is infered that there may exist some other innovate technologies such as ＂Multi-fungal fermentation＂, ＂Special elements fermentation＂, etc. which are remained to be researched and developed continuely. All kinds of＂fermentation substances＂ are looked forward to show unique and important roles in the fields of TCM.

The love of a beloved hapatologist,Dr. Rudi Schmid

Dr. Schmid was a former dean of the University of California, San Francisco School of Medicine and a liver specialist whose early studies of porphyrins led to several significant fundamental discoveries. He was the first to demonstrate that there were different forms of porphyria. He also developed the first experimental model for hepatic porphyria, a model that for many years was used for most of the work in this field and cited in hundreds of papers. His contributions were recognized when he was awarded the 1990 Friedenwald Medal by the American Gastroenterological Association, its most coveted award for lifetime achievement.

Fertility preservation in female cancer patients

Cancer is not rare in younger women of reproductive age therefore the preservation of fertility among them has become a significant concern due to aggressive cancer therapy they must undergo.Today different strategies for fertility preservation are available in patients at risk.However,many of these available techniques are still experimental and have limited clinical experience.Under ethical principle,better interdisciplinary cooperation between clinicians and patients,appropriate counseling and further research on cryopreservation and transplantation techniques may enhance their success to preserve fertility of young cancer victims.In this article,the existing and emerging fertility preserving strategies in young cancer female as well as their safety and ethical issues are discussed.

Quantum Dots for Cancer Research:Current Status,Remaining Issues,and Future Perspectives

Cancer is a major threat to public health in the 21st century because it is one of the leading causes of death worldwide.The mechanisms of carcinogenesis,cancer invasion,and metastasis remain unclear.Thus,the development of a novel approach for cancer detection is urgent,and real-time monitoring is crucial in revealing its underlying biological mechanisms.With the optical and chemical advantages of quantum dots(QDs),QD-based nanotechnology is helpful in constructing a biomedical imaging platform for cancer behavior study.This review mainly focuses on the application of QD-based nanotechnology in cancer cell imaging and tumor microenvironment studies both in vivo and in vitro,as well as the remaining issues and future perspectives.

Research of the Mechanism of Enhancing Biological Treatment by Chitosan

Chitosan of different molecular weight （M. W. ） was added into SBR bioreactor to treat domestic wastewater. From comparison of treatment efficiency, sludge activity, sludge structure etc., we revealed the mechanism that chitosan enhanced the biological treatment function of activated sludge. The results proved that, chitosan is certain to restrain the reaction of activated sludge, but it do improve the structure of sludge floes and increase the treatment efficiency of activated sludge. The bigger the M. W. of chitosan is, the better the efficiency of enhancing biological treatment can be.

Regenerative medicine technology applied to gastroenterology:Current status and future perspectives

This special issue of World Journal of Gastroenterology has been conceived to illustrate to gastroenterology operators the role that regenerative medicine(RM) will have in the progress of gastrointestinal(GI) medicine.RM is a multidisciplinary field aiming to replace,regenerate or repair diseased tissues or organs.The past decade has been marked by numerous ground-breaking achievements that led experts in the field to manufacture functional substitutes of relatively simple organs.This progress is paving the ground for investigations that aims to the bioengineering and regeneration of more complex organs like livers,pancreas and intestine.In this special issue,the reader will be introduced,hand-in-hand,to explore the field of RM and will be educated on the progress,pitfalls and promise of RM technologies as applied to GI medicine.

Simulation training in contemporary obstetrics education

AIM: To investigate the use of the Gaumard's Noelle S550.100 Maternal and Neonatal Simulators for teaching forceps delivery.METHODS: Twenty two(n = 22) resident physicians were enrolled in a simulation course on operative forceps deliveries. The physicians enrolled in the course were all part of an accredited Obstetrics and Gynecology residency program and ranged in their training from post graduate year(PGY) 1-4. Each participant received simulation based teaching on the indications, contraindications, proper application, delivery and removal of forceps by a single teacher. The Gaumard's simulator and Simpson forceps were used for this course. Statistical analysis using SPSS statistical software was performed after the completion of the simulation training program. A paired student t-test was performed to compare the cohort's mean pretest and post simulation training scores. Follow up skills assessment scores at one month, 3 mo and 6 mo were compared to thebaseline pretest score using a paired student t-test. RESULTS: There was statistically significant improvement in the post simulation training performance evaluations compared to the pretest, 13.7(SD = 3.14) vs 7.9(SD = 4.92), P < 0.05. Scores at 1 mo, 3 mo, and 6 mo were compared to the pretest score and showed retention of skills: 4.6(SD = 5.5, 95%CI: 2.21-7.07), 4.4(SD = 5.2, 95%CI: 2.13-6.70), and 5.6(SD = 4.8, 95%CI: 3.53-7.75) points, respectively. There were statistically significant differences between residents by post graduate training year on pretest scores, however these differences were not present after simulation training. Pretest scores for PGY 1, 2, 3, 4 were 3.5(SD = 2.27, 95%CI: 2.13-5.00), 7.25(SD = 6.70, 95%CI: 1.50-13.00), 10.75(SD = 1.5, 95%CI: 9.50-12.00), 12.17(SD = 2.57, 95%CI: 10.33-14.00). After simulation training PGY 1 residents did as well as well as the upper level residents. Posttest mean test scores for PGY 1, 2, 3, 4 were 13.75(SD = 1.49, 95%CI: 12.75-14.63), 10.25(SD = 0.24, 95%CI: 4.25-14.00), 15.00(SD = 1.16, 95%CI: 14.00-16.00), 15.17(SD = 0.75, 95%CI: 14.67-15.67). CONCLUSION: Our simulation based training program not only produced short term gains, but participants were able to retain the skills learned and demonstrate their knowledge months later.

Software Architecture and Prototype for Supporting Medical Prescription Adherence Using SMS Services

Barriers to medication adherence among patients have been shown to have significant impact on service quality and cost in the healthcare system. To minimize this impact, many in the healthcare industry are highly interested in supporting prescription adherence among patients. They believe that information technology in general, and mobile technology in particular, can help in developing medical practices that can be highly conducive to high rates of prescription adherence by enhancing communication between patients and healthcare providers. To this end, a number of pharmacy management benefit companies plan to adopt SMS （Short Message Service） communication to reach their customers given the wider acceptance of SMS messaging among mobile phone users. However, most of these pharmacies are reluctant to purchase service agreements from SMS aggregators without a complete understanding of user, service and business requirements related to SMS messaging. Hence, many are in dire needs for prototypes of SMS servers that can help them define and refine these requirements before committing to costly agreements with SMS aggregators. This paper describes such a prototype for a pharmacy benefit management company located in the southeast of the United States.

Molecular Therapy and Prevention of Liver Diseases

Molecular analyses have become an integral part of biomedical research as well as clinical medicine. The definition of the genetic basis of many human diseases has led to a better understanding of their pathogenesis and has in addition offered new perspectives for their diagnosis, therapy and prevention. Genetically, human diseases can be classified as hereditary monogenic, acquired monogenic and polygenic diseases. Based on this classification, gene therapy is based on six concepts: (1) gene repair, (2) gene substitution, (3) cell therapy, (4) block of gene expression or function, (5) DNA vaccination and (6) gene augmentation. While major advances have been made in all areas of gene therapy during the last years, various delivery, targeting and safety issues need to be addressed before these strategies will enter clinical practice. Nevertheless, gene therapy will eventually become part of the management of patients with various liver diseases, complementing or replacing existing therapeutic and preventive strategies.