培养大批合格全科医师、推进分级诊疗制度是深化医药卫生体制改革和实施"健康中国战略"的关键举措.我国全科医学历经30 余年的发展,在人才队伍建设、培养体系建立、服务模式探索、科学研究开展等方面取得显著成效,但由于起步晚、基础差,目前仍面临全科医学人才数量与质量有待提升、师资队伍与培养模式有待优化、分级诊疗制度落实不到位、科研项目申请渠道不畅通、职业吸引力低下等挑战.建议多措并举,提高全科医师培养质量和人才数量,以正确的舆论引导大众转换就医观念,增设全科医学科研专项、拓宽科研通道,改革激励与晋升机制、增强职业吸引力,促进全科医学持续发展.

From February 1 to April 30, 2021, 48 general practice resident physicians in the First Affiliated Hospital of Naval Medical University were randomly divided into study group and control group with 24 in each group. The common comorbidities of the community-dwelling elderly, namely diabetes, diabetic retinopathy and osteoporosis were selected as teaching cases. The residents in control group received conventional teaching, while the scenario simulation teaching model of multicomorbity co-treatment was applied for the study group. The teaching effect, satisfaction and self-efficacy scores were compared between two groups. After training, the knowledge levels, the mastery of referral indicators and the performance of fundus ophthalmoscopy in the study group were significantly better than those in the control group ( t=2.27, 6.34, 4.09; P<0.05). They were (80.96±11.27) vs. (73.96±10.09), (10.33±2.41) vs. (6.38±1.88), (70.27±10.44) vs. (63.50±7.98), and students′ satisfaction and self-efficacy evaluation were higher than those of the observation group (all P<0.05). It is suggested that the simulation teaching of multi-disease co-treatment scenario is more beneficial than the traditional teaching to improve the comprehensive care ability of standardized training physicians in general practice for patients with chronic disease.

目的 探讨不同培养模式对海军全科规范化培训(简称规培)医师科研能力培养的效果.方法 选取 2019、2021 年医院全科医学科接受规范化培训的 76 名海军规培医师为研究对象,试验组 34 名学员实施海军全科科研能力培养模式,对照组 42 名学员实施常规海军全科规范化培训培养模式,比较试验组和对照组学员在不同培养模式下理论知识水平、科研能力自我评价、文章发表情况.结果 试验组和对照组学员一般资料比较差异无统计学意义(P>0.05).试验组和对照组学员理论知识成绩比较,差异无统计学意义(P>0.05).在科研能力自我评价中,试验组学员在问题发现能力、文献查阅能力、科研设计能力方面与对照组比较,差异均有统计学意义(P<0.05).2 组学员发表论文量比较,差异无统计学意义(P=0.29).结论 海军全科规培医师科研能力培养模式对规培学员发现科研问题、查阅文献及科研设计方面的培养具有优势.

背景 肺癌与糖尿病(DM)均是随年龄增长发病率增高的常见病,临床上二病共存的现象越来越常见,DM可能对肺癌的发生、发展产生影响.目的 探讨DM对肺癌患者无进展生存期(PFS)的影响.方法 收集2006-12-01至2016-12-31于第二军医大学附属长海医院呼吸内科及胸外科住院治疗的肺癌合并DM患者189例(DM组)及肺癌不合并DM患者198例(对照组)的临床资料.按照年龄<65岁和≥65岁进行亚组分析.绘制不同特征患者PFS生存曲线,采用Cox回归模型分析分析肺癌患者PFS的影响因素.结果 DM组男性、≥65岁、有吸烟史、有其他合并症患者比例高于对照组(P<0.05).<65岁DM亚组的男性、有吸烟史、有其他合并症患者的比例高于<65岁对照亚组(P<0.05).DM组患者中位PFS〔11.0个月,95％CI(8.7,13.3)个月〕长于对照组〔9.0个月,95％CI(7.8,10.1)个月〕(χ2=4.197,P=0.040).<65岁DM亚组患者PFS〔11.0个月,95％CI(8.5,13.5)个月〕长于<65岁对照亚组〔7.0个月,95％CI(6.9,9.1)个月〕(χ2=7.257,P=0.007).≥65岁DM亚组患者中位PFS〔11.0个月,95％CI(6.5,15.5)个月〕与≥65岁对照亚组中位PFS〔12.0个月,95％CI(6.0,18.0)个月〕比较,差异无统计学意义(χ2=0.058,P=0.809).Cox回归模型分析结果 显示,年龄、分期、治疗方案是肺癌患者PFS的影响因素(P<0.05),DM与分期是<65岁肺癌患者PFS的影响因素(P<0.05),分期与治疗方案是≥65岁肺癌患者PFS的影响因素(P<0.05).结论 合并DM是肺癌患者PFS的影响因素,尤其对于<65岁肺癌患者PFS有益.

The etiology and pathogenesis of histiocytic necrotizing lymphadenitis (HNL)is still unknown now. It is mainly manifested as refractory fever,regional lymphadenopathy with or without tenderness and transient leucopenia. As its clinical manifestations,laboratory and imaging findings have no specific characteristics,it is easily be misdiagnosed as lymphoma,systemic lupus erythematosus or other kinds of diseases. Histopathological examination and immunohistochemistry are the main methods to confirm the final diagnosis. Here we reported the diagnostic procedure of a case of HNL with hemophagocytic syndrome. The patient manifested as persistent high fever,neck lymph nodes swollen combined with tenderness,weight loss, and nonresponse to antibiotic treatment. Moreover,18 F-FDG PET-CT examination showed generalized lymphadenopathy,SUV max up to 20. 4,so he was highly suspected with malignant lymphoma. However,the neck lymph node biopsy confirmed it was HNL,and bone marrow cytology prompted hemophagocytic cells increased. The above data made this case a final diagnosis as HNL complicated with hemophagocytic syndrome.

Rationale: Tongue metastasis from lung cancer is extremely rare, and the prognosis of these patients is rather poor. Patient concers: A 56-year-old man was found a 4-cm cavity lesion in the left upper lobe, which was initially misdiagnosed as tuberculosis. Diagnoses: A case of lung squamous cell carcinoma that metastasized to the base of a patient's tongue. Intervations: We send the biopsy of the lung and the tongue lesions for gene sequencing. Outcomes: He received systemic chemotherapy, but continued to have pain at the base of his tongue and died 7 months later. Lessons: From sequencing data, mutations in KRAS proto-oncogene, GTPase (KRAS), phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), and tumor protein p53 (TP53) were found in the tumor biopsy of the patient. All of these were indicators of poor prognosis.