扩张型心肌病患者恶性室性心律失常与心率变异性关系分析

目的:了解扩张型心肌病患者恶性心律失常(MVA)与心率变异性(heart rate variability,HRV)的关系,探讨扩心病患者体内自主神经变化的临床意义。方法:选择扩心病患者48例作为研究对象,同时按照年龄配对,取48例正常者作为对照组,对其行24小时动态心电图检查,依据其是否出现恶性心律失常分为恶性室性心律失常(MVA+)组及单纯扩张型心肌病(MVA-)组,分析组间HRV的差异。结果:与对照组比较,单纯扩张型心肌病(MVA-)组HRV时域指标(SDNN、SDANN、RMSSD)均有降低(P<0.05)L与(MVA-)组相比,恶性室性心律失常(MVA+)组HRV相关指标进一步降低(P<0.05)。结论:自主神经功能异常是扩张型心肌病患者恶性心律失常的重要危险因子,可能可以用HRV预测其发生恶性心律失常危险性。     

The Effect of an Individualized Practice-Based CME Program on Physician Performance and Patient Outcomes

The Professional Competence Assurance Program (PROCAP) is an individualized educational program that examines physicians'' performance in ambulatory practice. It uses medical record review to identify deficiencies in the care process that guides development of the educational intervention. Medical care is reassessed one year later. This program was used with 51 private practitioners to assess the care of 1,229 hypertensive patients. The educational program included a computer printout comparing one physician''s performance with that of peers, readings targeted to management problems, and a conference call or group seminar with an expert stressing issues relevant to each physician''s performance. Postintervention assessment showed that physicians prescribed beta-blockers (P<.01) and vasodilators (P<.01) more often. Improvement (P<.05) occurred in the control of diastolic blood pressure (≤90 mm of mercury) and in several other criteria. These results show that well-designed, individualized continuing medical education addressing specific deficiencies can change physicians'' performance and patients'' intermediate outcome.     

哈尔滨市综合医院病人用药安全管理现状研究

运用分层随机抽样的方法,在哈尔滨市抽取5家三级和5家二级综合医院作为研究对象,在药品监管组织与规制、药品储存与养护、医嘱管理、药品的调配和分发、给药、用药安全监测、安全文化建设等7个方面进行了病人用药安全管理现状调查研究。发现了病人用药安全管理存在的薄弱环节,分析了问题产生的原因并且提出相应的改进措施,为提高医院药品安全管理水平,保障病人用药安全提供了理论依据。     

Relation between the Yersinia phage and bacteriophages isolated from the environment

The bacteriophage designated RD2 has been isolated from the sewage in Rostov-on-Don city and studied. The morphology of bacteriophage particles and the biological properties of the bacteriophage make it related to the plague bacteriophage isolated by D'Errel. The molecular masses of the compared bacteriophages are almost identical being 26.4 +/- 0.4 Md for RD2 and 24.7 +/- 0.2 Md for D'Errel bacteriophage. The DNAs of the bacteriophages share 80% of homology and possess 15 nonhomologous regions scattered along the genomes. The phages are serologically related. The DNAs of both bacteriophages give the similar pattern of hydrolysis by restriction endonuclease EcoRV, but have the different sensitivity to many other restriction endonucleases. The protein specter of bacteriophage RD2 contains 18 polypeptides (11 minor ones), while the one of D'Errel bacteriophage contains 7 polypeptides similar in molecular mass with the polypeptides of RD2. The bacteriophage RD2 cannot be considered one of the plague causative agents of bacteriophages since the region where it has been isolated has a long epidemiological and epizootical record of absence of plague.     

The Physician of the Future

The good physician of the future will need to master not only the basic and traditional medical skills but many new concepts and techniques as well. He will need to be, as always, a compassionate and intelligent man. If he is to retain his status as a healer in the eyes of his patients, he will have to be fully aware of what is happening in the social and technological environment, or he will run the risk of being relegated to the position of a high-grade technician.He will have new physical tools and new thinking tools to help him. To understand and use these, and also to understand the technical world of the future, he will need a sound knowledge of the physical sciences and some fluency in the language of modern mathematics.