A University/Community Hospital Family Practice Residency Program

A residency program associated with a major university has many obvious advantages. On the other hand, a residency program located in an area of health manpower shortage is a major advantage to that community. This paper describes the development of a university affiliated family practice residency in the Mojave Desert of Southern California. It reports that it is possible to form a successful alliance between a medical center and a rural community, bringing increased primary care to the community, upgrading the quality of medicine practiced in the community and augmenting the staff of the local hospital without sacrificing training for the family practice residents. Furthermore, the residency program can become financially self-sufficient.     

品管圈活动在提高住院药房工作质量中的探索与实践

???? 在住院药房进行品管圈活动推进工作,通过系统培训,按照品管圈活动的主要步骤实施,即主题选定、现状把握、目标设定、解析、对策拟定与实施、效果确认、作业标准化等。病区对住院药房投诉频次由改善前的平均8.4次/天降到3.9次/天,病区药学服务质量得到明显改善,提高了病区对住院药房工作的满意度,工作人员的软环境也得到了相应改善。     

Residency effects in animal contests

The question of why territorial residents usually win asymmetrical owner-intruder contests is critical to our understanding of animal contest evolution. Game theory suggests that, under certain conditions, residency could be used as an arbitrary means of contest settlement in a manner analogous to tossing a coin. Key empirical support for this idea is provided by a study on the speckled wood butterfly (Pararge aegeria); however, this result has proven controversial. We show conclusively that residency does not serve as an arbitrary cue for contest settlement in this species. By means of a series of manipulative experiments, conducted on two phenotypically divergent populations of P. aegeria, we also rule out the recently presented alternative that contests are settled due to resource-correlated asymmetries in thoracic temperature. Our results instead suggest that more intrinsically aggressive males accumulate as residents and continue to win due to the self-reinforcing effect of prior winning experience. Truly arbitrary contest settlement may be rare or non-existent in the wild.     

Mini-CEX 在住院医师培养中的应用现状

住院医师培养制度现已逐步在中国各城市开始实施,住院医师培养最主要的目标是培养临床能力合格的医师。对住院医师临床能力的评估,最好的方式应该是在临床的实践工作中的给予评估。Mini-CEX(Mini-Clinical Evaluation Exercise)是在传统的CEX基础上,发展出的一套用来评估住院医师临床技能并具有教学功能的测评工具,包括观察和评价住院医师的知识、技能、态度和主治医师的适时反馈。Mini-CEX为一种迷你型的多次重点式评估,在门诊、急诊或住院等临床例行工作中均可以开展,具备相当可靠的信效度和极好的便利性。Mini-CEX具有一个参与双方的信息及时反馈。应用Mini-CEX能增强评估的科学性,并能促进学习和培训。Mini-CEX作为目前医学教育体系中应用最广泛的一种评估手段之一,受到了国内外医学教育工作者的关注,并开始逐渐引入我国。Mini-CEX将在中国住院医师培养制度中发挥非常重要的作用。     

Mini—CEX在住院医师培养中的应用现状

住院医师培养制度现已逐步在中国各城市开始实施,住院医师培养最主要的目标是培养临床能力合格的医师。对住院医师临床能力的评估,最好的方式应该是在临床的实践工作中的给予评估。Mini—CEX（Mini-Clinical Evaluation Exercise）是在传统的CEX基础上,发展出的一套用来评估住院医师临床技能并具有教学功能的测评工具,包括观察和评价住院医师的知识、技能、态度和主治医师的适时反馈。Mini-CEX为一种迷你型的多次重点式评估,在门诊、急诊或住院等临床例行工作中均可以开展,具备相当可靠的信效度和极好的便利性。Mini—CEX具有一个参与双方的信息及时反馈。应用Mini．CEX能增强评估的科学性,并能促进学习和培训。Mini-CEX作为目前医学教育体系中应用最广泛的一种评估手段之一,受到了国内外医学教育工作者的关注,并开始逐渐引入我国。Mini-CEX将在中国住院医师培养制度中发挥非常重要的作用。     

Residency Duration and Shelter Quality Influence Vibratory Signalling Displays in A Territorial Caterpillar

Residents are more likely to win territorial disputes than intruders. One explanation for this prior resident advantage is that residents place a higher value on the resource and are therefore more motivated to win. Although value asymmetry models of animal contests often assume that contestants use information about resource value, information on the proximate cues affecting territorial behaviour is often lacking. We use a simple model system – territorial behaviour in the masked birch caterpillar (Drepana arcuata) to identify factors that affect territorial behaviour. Late instar caterpillars occupy solitary silken leaf shelters, which they defend against wandering conspecifics with a vibratory display. We evaluated how a caterpillar identifies itself as the owner and the factors that influence a resident's motivation to signal. To do so, we conducted three experiments between size‐matched residents and intruders to assess how residency duration and shelter quality independently affected territorial displays during the early stages of a contest. Experiment 1 (Time Exp.) demonstrated that resident signalling rates increase with increased duration on the leaf prior to introducing the intruder. Residents also signal more than intruders after residency periods of 1–3 min and longer, demonstrating that residents gather information about resource value shortly after occupying a leaf. Experiment 2 (Squatter Exp.) aimed to disentangle the effects of time on the leaf and silk accumulation. Squatters (individuals in a shelter made by another) placed for 1–3 min on a leaf containing a full silk shelter signalled more to intruders than did caterpillars placed on a fresh leaf for 1–3 min. Experiment 3 (Shelter Removal Exp.) showed that residents whose shelters had been removed signal less than those occupying an intact shelter, despite an equal length of time investing in them. Our experiment is the first to covary both prior residency duration and territory quality, and we find that the motivation of caterpillars to signal is a function of both of these attributes.     

2011 年度住院药房退药情况的调查及分析

目的:通过调查分析2011年度我院住院药房退药情况,加强药品的监督管理,促进合理用药.方法:分别统计外科,内科,妇产科,五官科,特需医疗科及其他科室的退药种类及数量和退药中数量较高的药品种类进行综合分析.结果:总退药比例占全部用药量的19.44％.总领药数和总退药数之间呈正相关(分别为r=0.971,P=0.001),其中退药量最大的科室为外科,退药量排名靠前的药品种类为抗生素类药品.结论:减少退药根本在于提升医师职业技能和职业素养,同时建立长久有效的制度和机制,以避免产生不必要的退药情况.     

The Resident's View of Residency Training in Canada

In the view of residents in their last year of specialty training, the Fellowship is now becoming the operative standard for obtaining hospital privileges in urban centres and they felt that this implied that the two standards, the Certificate and the Fellowship of the Royal College, were not achieving the purpose for which they were designed. Although 80% of the residents intended to write the Fellowship, few viewed a year in a basic science department or in research as of intrinsic value in terms of their future practice.The examinations of the Royal College were the subject of criticism, most residents feeling that the examinations did not test the knowledge and ability gained in training. Most expressed a desire for ongoing evaluation during the training period.Service responsibilities were generally regarded as too heavy.Despite the criticism of both training and examination, most residents felt that their training had provided them with the experience and background they needed to practise as specialists.