如何书写好内科病历

病历是医疗活动的原始记录或历史记载,是最准确,可信的记录.在现代医院管理中,病历作为医疗活动信息的主要载体,不仅是医疗、教学、科研的第一手资料,而且也是综合评价医院医疗质量、技术水平、管理水平的依据.即病历质量好坏体现医生的学术和品德,体现医院的管理水平和医疗质量.病志书写的水平,是一位医生理论基础、技术水平、临床经验、表达能力、逻辑思维的综合检验.然而现在有些病历,特别是大医院的病历质量不高的原因是工作太忙,病人太多.下级医师对疾病特点了解不够,概念不清楚.上级医师要养成习惯把您心里想的思路说出来,以提问的方式讲更好,这样对下级医生的印象会更深,同时也可以掌握他们是否理解正确了,督促下级医生平时的学习,始终要抓三基三严,强调临床基本功.本文把内科病历书写中的常见问题一一列出,并具体指导如何改进.     

如何书写好内科病历

病历是医疗活动的原始记录或历史记载,是最准确,可信的记录。在现代医院管理中,病历作为医疗活动信息的主要载体,不仅是医疗、教学、科研的第一手资料,而且也是综合评价医院医疗质量、技术水平、管理水平的依据。即病历质量好坏体现医生的学术和品德,体现医院的管理水平和医疗质量。病志书写的水平,是一位医生理论基础、技术水平、临床经验、表达能力、逻辑思维的综合检验。然而现在有些病历,特别是大医院的病历质量不高的原因是工作太忙,病人太多。下级医师对疾病特点了解不够,概念不清楚。上级医师要养成习惯把您心里想的思路说出来,以提问的方式讲更好,这样对下级医生的印象会更深,同时也可以掌握他们是否理解正确了,督促下级医生平时的学习,始终要抓"三基三严",强调临床基本功。本文把内科病历书写中的常见问题一一列出,并具体指导如何改进。     

Twin Inc.

This paper presents an account of how human spontaneous embryonic chimeras are formed. On the prevalent view in the philosophical literature, it is said that chimeras are the product of two embryos that fuse to form a new third embryo. We call this version of fusion synthesis. In contrast to synthesis, we present an alternative mechanism for chimera formation called incorporation, wherein one embryo incorporates the cells of a second embryo into its body. We argue that the incorporation thesis explains other types of chimera formation, which are better understood, and is more consistent than synthesis with what is known about embryological development. Incorporation also has different implications than synthesis and so avoids the philosophical puzzles that are often said to accompany embryonic chimera formation—puzzles which pose problems to the human embryo’s persistence from fertilization to the fetal stage of human development.     

How intelligence and education contribute to substance use: Hints from the Minnesota Twin family study

In old and even middle age, there are associations between physical health and both intelligence and education. This may occur because intelligence and/or education exert effects on lifestyle choices that, in turn, affect later health. Substance use is one aspect of lifestyle choice in young adulthood that could play such a role. The effects of intelligence and/or education on substance use could be direct and environmental, or indirect due to the presence of confounding genetic and shared family influences. We used the Minnesota Twin Family Study to distinguish these effects in males and females at age 24. In contrast to prevailing expectations, there were moderately negative direct nonshared environmental effects of both IQ and education on both smoking and drinking in both males and females. That is, controlling for family background effects in the form of both genetic and shared environmental influences, both higher IQ and greater education were associated with greater alcohol and nicotine use. These effects were accounted for by alcohol and nicotine use at age 17. Our results suggest that genetic and family-culture variables confound the associations between intelligence and education and substance use in young adults, rendering them indirect. Further research is needed to understand the roles of IQ and education in alcohol and nicotine use and their relative impacts on physical health throughout the lifespan.     

Young Children's Motivation to Read and Write: Development in Social Contexts

In a 3-year longitudinal, mixed-method study, 67 children in two schools were observed during literacy activities in Grades 1–3. Children and their teachers were interviewed each year about the children's motivation to read and write. Taking a grounded theory approach, content analysis of the child interview protocols identified the motivations that were salient to children at each grade level in each domain, looking for patterns by grade and school. Analysis of field notes, teacher interviews, and child interviews suggests that children's motivation for literacy is best understood in terms of development in specific contexts. Development in literacy skill and teachers' methods of instruction and raising motivation provided affordances and constraints for literate activity and its accompanying motivations. In particular, there was support for both the developmental hypotheses of Renninger and her colleagues (Hidi & Renninger, 2006 Hidi, S. and Renninger, K. 2006. The four-phase model of interest development.. Educational Psychologist, 41(2): 111–127. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]) and of Pressick-Kilborne and Walker (2002) Pressick-Kilborn, K. and Walker, R. 2002. “The social construction of interest in a learning community.”. In Sociocultural influences on motivation and learning, Edited by: McInerney, D. and Van Etten, S. 153–182. Greenwich, CT: Information Age Publishing.  [Google Scholar]. The positions of poor readers and the strategies they used were negotiated and developed in response to the social meanings of reading, writing, and relative literacy skill co-constructed by students and teachers in each classroom. The relationship of these findings to theories of motivation is discussed.     

Novels as Social Media: How Literature Helped Shape Notions of Sexual Liberation

In the historiography of sexual liberation, the role of cultural artefacts like novels and films has either been taken for granted or not received much attention at all. This article discusses these cultural dimensions of sexual liberation, using the Netherlands as a case study, arguing that these dimensions are important to research in order to better understand the (self-)fashioning of a sexually liberated subject. The seemingly close ties between literature and societal transformations in the sixties is remarkable and points to the function of literature in the 1945–1980 period, when novels functioned as an important social platform for broaching moral controversies and articulated seminal cultural repertoires for identity construction. The article analyses the ways literature functions in Dutch cultural memory of the sexual revolution nowadays, and looks at the specific historical constellation and literary culture that provided important channels for the spreading of new ideas in the 1960s. Guiding questions to investigate the specificities of this literary culture and its function in articulating and disseminating notions of sexual liberation are: what are the functions ascribed to writers and their works in sexual transformations of the 1960s/70s? To what extent are these transformations captured in terms of national identity, or do they travel across national borders? What role do they play in cultural memory, nationally and internationally?     

Twin similarity in cardiovascular stress response

Cardiovascular (CV) responses to laboratory stressors were measured in 12 pairs of identical and 21 pairs of fraternal adult male twins. For this study, blood pressure and heart rate were measured during a mental arithmetic task and the Cold Pressor Test. The analyses of cardiovascular responses to these stressors were designed to test for the presence of a genetic component in cardiovascular reactivity in an adult sample of twins aged 54-64 years. The results suggest that certain measures of cardiovascular reactivity to laboratory stressors may be heritable for both physical and psychological stressors. The possible role of this genetic component in the etiology and course of coronary heart disease is discussed.