诸葛亮形象新论

《三国演义》中的诸葛亮,是中国古代小说人物画廊里的＂贤相＂形象。作者虽然极力讴歌他的＂忠＂和＂智＂,但仍然表现了他在用人上的诸多失误。如对关羽的放纵,造成华容道曹操脱逃和荆州失守;对李严的姑息导致六出祁山劳而无功;对魏延的诬害使得内部矛盾激化。分析诸葛亮用人失误的原因,恰是他尽＂忠＂恃＂智＂的结果。再探究形成诸葛亮＂忠＂、＂智＂性格特征的深层原因,我们就会发现,这是中国封建社会从政文人特殊的政治地位和悲剧性的社会角色使然。中国封建社会的从政文人,没有独立的社会地位,只能依附统治者,将自身价值的实现寄托于明君的知遇。于是,既要依附于人,又想被他人依附的尴尬心态,既要受制于人,又想制服他人的双重人格,就构成了从政文人共有的扭曲心理。诸葛亮的用人失误,正是这种扭曲心理所造成的行为偏失。在他身上,不仅熔铸了历代封建文人的思想感情,反映了他们的追求和抱负,而且还深入挖掘了从政文人内心的痛苦和无奈,真实再现了他们的尴尬心态和双重人格。《三国演义》中的诸葛亮是中国封建社会从政文人的典型形象。     

应用教育测量法分析南京医科大学五年制临床医学专业部分试卷质量

目的：分析试卷命题中存在的问题及其原因并提出相关建议．为今后教学改革及题库建设提供科学依据。方法：应用教育测量学对南京医科大学五年制临床医学专业2003～2005级病理学和药理学（代表基础医学课程）、妇产科学和内科学（代表临床课程）试卷的质量进行统计分析。结果：各年级四门课程信度系数都达到了0．6分以上,且91．7％在0．7分以上,显示了较高的信度．但是难度普遍中等偏低,区分度不高。结论：在未经教育测量学原理指导的试题编制状态下．该校临床医学专业基础课和临床专业课部分课程考试试题存在一些问题,表现为信度仍有一定的提升空间。部分试题的难度、区分度不符合命题原则,需做整改或者淘汰,题库需进行不断的更新与维护。     

“五字诀”优化骨髓穿刺培训体系

骨髓穿刺术是临床常用的四大穿刺术之一,对相关疾病的诊断、治疗和预后有重要意义,但其对操作者理论、技能和心理素质的要求均较高。医学实习生刚刚接触临床,如按照以往的方式教学,熟练掌握骨穿技术需要较长时间。作者以独创的“骨穿五字诀一净准好直快”为核心,实施循证教学,突破了以往的教学瓶颈,在大规模培训中取得了良好的效果。     

西部地区新型农村合作医疗个人筹资方式比较及选择

探索高效、快捷的个人筹资方式是解决新型农村合作医疗筹资难的关键所在。目前新农合筹资方式尽管多样化,但西部地区新农合个人筹资方式主要是“上门收取”方式。在新农合进入全面覆盖的阶段,西部地区在个人筹资方式的选择上应本着人性化、多样化、高效化、便利化等原则。     

城乡医疗保障制度一体化研究

公平和正义是社会保障制度价值的核心理念,也是衡量一个国家或地区社会保障制度能否充分和真正发挥作用的重要衡量因素。在新医改背景下,"人人公平享有健康保障"成为医疗保障制度建设进程中的一个重要目标,而推动城乡医疗保障制度一体化,进而实现三项医保制度整合衔接是实现这一目标的途径。下一步要重点完善社会医疗保障制度的运行环境;努力保障流动参保人员的就医权益,完善基本医疗保险关系转移接续;整合经办资源,强化管理体制统一化;确定合理的筹资补偿机制,强化财政补贴机制。     

我国公共医疗卫生服务定价机理与价值补偿研究——基于供需双方价值补偿的视角

我国公共医疗卫生服务供给遵循市场价格机制与契约治理规则,整个供给流程存在产权委托代理链和价值补偿链。资金流包括卫生费用筹集和医疗服务消费价值补偿两个方向,需方医疗卫生总费用由政府公利、社会共济和个人付费的多元分摊机制承担;医疗机构等供方通过财政补助和医疗服务事业收入获得成本补偿和合理收益。在医疗保险等第三方偿付机构的介入下,多方利益主体之间的博弈带来“公域”部门道德风险和“私域”部门市场失灵问题,其激励源于行政分权和财政分权改革。规范各参与主体的效用目标,加强监管,整合城乡医疗保障制度,对提高医疗服务利用率、增进社会公平有积极意义。     

Rubella Susceptibility and Immunization in a University Population: Experience,Strategy, and Policy

Abstract

Despite the availability of a safe and effective vaccine, rubella continues to occur in the United States. In recent years 70% of all cases have occurred in college aged individuals. Since 1978 the University of Rochester has required all entering students to have either rubella immunization or rubella serology. Compliance with this requirement has been excellent and has resulted in an increase in the rubella immunization rate from 52% to 71 %. Of those obtaining serology, the overall susceptibility rate (HI titer < 1:16) was 18%. Less than half of susceptible women accepted immunization, and few susceptible men sought immunization. College entry is a logical time to define an individual's rubella status.     

Effects of Aerobic Training on Primary Dysmenorrhea Symptomatology in College Females

Abstract

“Single-Dose Therapy for Cystitis in Women: A Comparison of Trimethoprim-Sulfamethoxazole, Amoxicillin, and Cyclacillin,” Thomas M. Hooton et al. We evaluated single-dose regimens of trimethoprim-sulfamethoxazole, amoxicillin, and cyclacillin as treatment for acute cystitis in 38 women. The trial was prematurely stopped because of frequent treatment failures. At two days after treatment, all 13 patients given trimethoprim-sulfamethoxazole were cured, while four (31%) of the 13 given amoxicillin and four (33%) of 12 given cyclacillin had persistent bacteriuria. At two weeks, 11 (85%) of 13 patients given trimethoprim-sulfamethoxazole, six (50%) of 12 given amoxicillin, and three (30%) of ten given cyclacillin were cured. One patient with positive results of antibody-coated bacteria testing who was treated with cyclacillin had signs and symptoms of acute pyelonephritis three days after treatment, and two patients treated with amoxicillin and one treated with trimethoprim-sulfamethoxazole converted antibody-coated bacteria test results from negative to positive after therapy. We conclude that single-dose treatment of cystitis in unselected women with cyclacillin and amoxicillin may result in low cure rates and that progression to acute pyelonephritis may occur following ineffective single-dose therapy. (Journal of the American Medical Association 1985;253:387-390.)     

The Boric Acid Powder Treatment of Vulvovaginal Candidiasis

Abstract

This double blind comparison of fourteen daily intravaginal gelatin capsules containing 600 mg of boric acid powder versus identical capsules containing 100,000 units of nystatin diluted to volume with cornstarch found vulvovaginal candidiasis albicans cure rates for boric acid to be 92% seven to ten days after treatment and 72% at thirty days, whereas the nystatin cure rates were 64% at seven to ten days and 53% at thirty days. Speed of alleviation of signs and sumptoms was similar with both drugs. There were no untoward side effects, and cervical cytology was not affected. In vitro studies found boric acid to be fungistatic and its effectiveness to be unrelated to pH. Blood boron analyses indicated little absorption from the vagina and a half life of less than 12 hours. A 30% follow-up of 2,030 nonstudy patients revealed wet mount and symptom cure rates of 93% within two weeks and 88% within four weeks. Patient acceptance was better than with “messy” vaginal creams, and self-made boric acid powder capsules are inexpensive, 31¢ for fourteen, compared with costly, commonly prescribed medication.     

电子病历在医院应用中的几个问题简析

计算机技术和网络技术的不断发展,使得电子病历在医院得到了广泛的应用。但是在应用中还存在诸如法律证据、数据标准、安全与隐私保护、海量存储和人员素质等问题。因此,健全法律法规、统一数据标准、选择合适的存储技术、开发安全及隐私保护技术、加快人才培养成为了当前推广电子病历所应采取的主要措施。电子病历作为医院数字化系统发展的方向无疑将稳定得到推进。