Common Speech Problems Encountered in General Practice

The authors consider speech and communication in the light of whole patient care and point out that defects may be signs and symptoms of underlying organic disease. They describe the four classifications of speech disorders—articulation, rhythm, voice and language, with an indication of the speech therapy required and duration of treatment. Special emphasis has been given to those speech problems which are seen by the family physician; these are usually of the articulation group. A short discussion of stuttering and aphasia is given. Emphasis is put on the direction of treatment by the physician and the use of well-qualified personnel as members of the rehabilitation team.     

消化内科学双语教学问题探讨

目的:了解目前消化内科学双语教学的效果及存在的问题,从而进一步改进教学方法,提高教学质量.方法:对我院2007级七年制的医学生进行了消化专业病历分析双语考试及相关的问卷调查,了解学生医学知识掌握的情况及存在的问题.结果:问卷调查中大部分学生认可双语教学方法,认为其对自身未来的发展、自主学习及沟通交流能力的培养有着重要的作用.双语笔试答卷中,学生对消化内科常见疾病的名称、诊断、并发症等知识均能准确、熟练地双语回答.但同时也暴露了知识掌握的灵活性差、书本知识不能与临床知识有机结合等问题.结论:双语教学值得推广,但为了提高教学质量,应进一步改进教学方法,并调整课堂上英语授课的内容及比例.     

Educating Internists in Emergency Medicine

The education of internists in emergency medicine needs to be thoughtfully planned by those involved in their education. Objectives for their emergency medicine rotation include the recognition and initial treatment of true medical and surgical emergencies, clinical experience with and knowledge of common acute primary care problems, the ability to handle several patients with problems having different degrees of urgency, effective use of consultants in the follow-up and management of difficult patients and a knowledge of and clinical experience with the prehospital care system. A curriculum should be designed to give the resident a core of didactic material in addition to supervised clinical experience. The rotation should be evaluated by both residents and faculty from internal medicine and emergency medicine to determine if it is accomplishing the objectives set forth.     

急诊医疗中医用粘合剂的研究进展

医用粘合剂是能够应用于医疗范畴的一类具有一定生物相容性和高度粘合力的医学材料;并已得到广泛的关注和研究。本文对当前急诊医疗中医用粘合剂的分类、各类粘合剂的作用机理、特点及应用范畴、医用粘合剂复合生物材料构成复合物的基础和应用研究现状等做一回顾及评价,并对未来医用粘合剂的研究和发展趋势进行了展望。     

Cercaria orospinosa Encountered in the Snail Melanopsis praemorsa L. from a Mountain Stream in Turkey

Cercaria orospinosa is the only cercaria shed by Melanopsis praemorsa snails in Savanda stream, Turkey. Magnitude of infestation of snails by this cercaria was correlated with size of the snails and strength of the water current. The highest degree of infestation occurred in June, while in winter it was reduced to zero. The cercariae were released from rediae, which were found in the hepatopancreas of the snails.     

Emergency Medicine: Ultrasonography in Blunt Abdominal Trauma

The Council on Scientific Affairs of the California Medical Association presents the following inventory of items of progress in emergency medicine. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of these items of progress in emergency medicine that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Emergency Medicine of the California Medical Association, and the summaries were prepared under its direction.     

医疗纠纷对医师防御性医疗行为影响的实证研究

目的 描述和分析医疗纠纷对医师防御性医疗行为的影响。方法 以河北省某医院的375名临床医师为调查对象,利用Mann Whittney U法和多元逐步回归分析等方法对数据进行统计分析。结果 82.9%的医生表示医患纠纷对诊疗工作的影响非常大或较大,临床医生的防御性医疗行为平均得分高达14.8分,最近2年亲身遭遇过医疗纠纷的患者防御性医疗行为得分高于未遭遇过医疗纠纷的患者。结论 面对越来越大的医疗纠纷和诉讼压力,临床医生普遍采取防御性医疗行为,且防御性医疗行为的程度较高。医生的医疗纠纷遭遇是防御性医疗行为严重程度的独立影响因素。     

基于临床路径的医师防御性医疗行为测量与分析

目的 提出具有较高可行性、效度和信度的防御性医疗行为测量工具和方法,了解医师防御性医疗行为的类型、数量和分布。方法 以河北省某医院的110例脑出血住院患者为例,以临床路径为基础,应用病历回顾性评判法对医师的防御性医疗行为进行测量和分析。结果 医师采取了多种类型的防御性医疗行为,内科治疗和外科手术治疗患者的防御性医疗分别占全部检查化验费的24.6%和21.1%。结论 研究提出的防御性医疗行为测量方法具有较高的科学性,但仍需进一步完善;医疗纠纷和诉讼压力导致医师产生了各种类型的防御性医疗行为,而且较为程度较为严重。     

Problems Encountered in the Culture of Isolated Pollen of a Burley Cultivar of Nicotiana tabacum

Pollen isolated from anthers of a Burley cultivar of N. tabacumby an anther homogenization procedure failed in culture to retainviability and produce plantlets even when isolation was precededby 14 d of anther preculture. By surgical manipulation of anthersprior to their culture it was shown that pollen viability wasvery sensitive to injury caused to the anther wall. Plantletscould be obtained however by culture of anthers in which oneor both pollen sacs had been carefully opened along the dehisenceline (DL). The somewhat lower yield of plantlets from such antherscompared to that from intact anthers is considered to resultnot from any change in the atmospheric environment of the pollenas a result of opening the pollen sac but from the inabilityin every case to keep the incisions strictly along the dehiscenceline. Pollen isolated from 14 d precultured anthers by this DL techniquewas able to yield plantlets when cultured in a simple definedmedium. However DL-isolated grains from 4 d precultured anthersfailed to retain viability in culture. It is concluded that pollen of this cultivar suffers severeinjury when isolated by the homogenization method and that thiscan be overcome by the DL technique. However conditions of culturehave not been established which reproduce for this cultivarthe nutritional conditions operating within the anther duringits early period in culture and which are essential to plantletformation.     

Health Transformation Project and Defensive Medicine Practice among Neurosurgeons in Turkey

Background

The term “Defensive” medicine was coined in the early 1970′s and has been an important topic of scientific investigation and professional debate ever since.

Objective

The aim of this study was to investigate the characteristics of defensive medicine, its reasons, and the extent to which it is practiced in the Turkish health care system. This is the first national survey to study the practice of defensive medicine among neurosurgeons in Turkey.

Methods

The present cross-sectional study on defensive medicine assessed neurosurgeons registered at the Turkish Neurosurgical Society, who are actively working in various centers and hospitals within the Turkish health care system. A 40-question survey was adapted from existing measures described in the literature and was completed by a total of 404 neurosurgeons, representing 36.7% of the neurosurgeons registered at the Turkish Neurosurgical Society.

Results

Seventy-two percent of the participants in the current study reported practicing defensive medicine. This practice was mainly reported among inexperienced neurosurgeons (74.4%). Most were younger than 40 years of age (75.2%), working in state hospitals/universities (72.7%), and living in the Marmara region (38%). Respondents reported engaging in defensive medicine by avoiding high-risk surgery (62.6%), ordering additional imaging studies (60.9%) and laboratory tests (33.7%), and referring patients to consultants (31.2%). Most participants consider every patient as a potential threat in terms of a medical lawsuit (68.3%) and do not believe the courts can distinguish malpractice from complications (89.6%).

Conclusion

Concerns and perceptions about medical liability lead neurosurgeons to practice defensive medicine. By avoiding high-risk surgery, ordering unnecessary diagnostic tests, and referring the patients to consultants, neurosurgeons try to minimize the risk of malpractice and protect themselves from legal risks, resulting in higher healthcare expenditure and longer treatment periods.     

对医疗抢救立法中医疗特权相关问题的思考

医疗紧急情况下基于对患者的保护赋予的医疗特权,在病人自主理念深入的今天受到各种抵抗,而我国在医疗抢救立法方面对于医疗特权的法律法规标准并不统一,这也为医疗执业者的实践带来困难。探讨医疗特权行使的合法性标准,并提出构建第三方的社会支持系统或许能为弱势人群的医疗抢救提供更多的人道主义救援。