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2015 in hematology and thromboembolism. Dr. Mark Crowther in an interview with Dr. Roman Jaeschke: part 1. 2015血液学和血栓栓塞。马克·克劳瑟博士与罗曼·杰斯克博士的访谈:第一部分。
Pub Date : 2016-12-22 DOI: 10.20452/pamw.3776
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引用次数: 0
Internal medicine: I cannot live without you as you are my destiny. 内科:我不能没有你,因为你是我的命运。
Pub Date : 2016-12-22 DOI: 10.20452/pamw.3741
1060 Some time ago, Professor Anetta Undas, Editor­ ­in ­Chief of the Polish Archives of Internal Medicine and Professor Jacek Imiela, national consultant in internal medicine, invited me to write about my life as an internist and the role of internal med­ icine in today’s world of narrow specialization. My adventure with internal medicine started a long time ago during my medical education. As a 3rd­grade medical student, I went to Montreal in Canada. It was 30 years ago. I had a chance to do my clinical summer practice with wonderful physicians, including Dr. Stefan Horny, in sev­ eral places in the province of Quebec. When I crossed the doors of the Polish ­Canadian Wel­ fare Institute in Montreal, which was a home to elderly Poles requiring medical and nursing assis­ stance, I was asked about my practical achieve­ ments and skills acquired during my studies. This was followed by a sort of a practical exam in in­ ternal medicine as well as some theoretical exam in English. The staff at the Institute was fluent in English and French. Finally, I was accepted and I was told that I could assisst Dr. Horny in his du­ ties as a physician in the Institute. Dr. Horny offered me a possibility for clinical practice at an internal medicine ward in the Re­ gional Hospital in Salaberry ­de ­Valleyfield in Quebec. I was very excited at the opportunity to learn more, to improve my English and learn some French, as well as to discuss different symptoms, diagnoses, and treatment plans. However, it was also a tough time for me as a nonnative speaker of English. In order not to lose such an opportuni­ ty, I was trying to do my best and spent much of my summer holidays in the hospital or in the In­ stitute. I was also lucky to spent some time in Royal Victoria Hospital, Montreal, not only in an internal medicine ward but also inthe operat­ ing rooms where I assissted during cardiac sur­ geries and other procedures, such as parathyre­ idectomy. My stay in Canada was very rewarding in terms of improving my medical knowledge as well as my English­ and French­speaking skills. FORUM FOR INTERNAL MEDICINE
1060 .不久前,波兰内科档案总编辑Anetta Undas教授和国家内科顾问Jacek Imiela教授邀请我写一篇关于我作为内科医生的生活和内科医学在当今专业化狭窄的世界中的作用的文章。我的内科学之旅在很久以前我接受医学教育的时候就开始了。作为一名三年级的医学生,我去了加拿大的蒙特利尔。那是30年前的事了。我有机会在魁北克省的几个地方,与包括斯蒂芬·霍尼医生在内的优秀医生一起进行临床暑期实习。当我走进位于蒙特利尔的波兰-加拿大福利研究所(Polish - canadian well - fare Institute)的大门时,有人问我在学习期间获得的实际成就和技能。这所研究所是为需要医疗和护理援助的波兰人提供服务的。接着是一种内科实践考试和一些英语理论考试。研究所的工作人员精通英语和法语。最后,我被录取了,我被告知我可以作为一名医生在研究所协助60多岁的霍尼博士。Horny医生给了我一个在魁北克Salaberry - de - valleyfield地区医院内科病房进行临床实践的机会。我很兴奋有机会学到更多的东西,提高我的英语和学习一些法语,以及讨论不同的症状,诊断和治疗方案。然而,作为一个非英语母语者,那段时间对我来说也很艰难。为了不失去这样的机会,我尽力做到最好,暑假的大部分时间都是在医院或研究所度过的。我也很幸运地在蒙特利尔的皇家维多利亚医院度过了一段时间,不仅在内科病房,而且在手术室协助进行心脏手术和其他手术,如甲状旁腺切除术。我在加拿大的逗留非常值得,不仅提高了我的医学知识,还提高了我的英语和法语能力。内科医学论坛
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引用次数: 0
Abernethy malformation type I (congenital absence of the portal vein) in a patient with chronic kidney disease. 慢性肾脏疾病患者的先天性门静脉缺失I型畸形。
Pub Date : 2016-12-22 DOI: 10.20452/pamw.3729
1012 as well as immunological markers were negative. On the basis of electroencephalography and head computed tomography (CT), the patient was di‐ agnosed with nonconvulsive epilepsy (treated with valproic acid). An abdominal CT scan re‐ vealed polysplenia (FIGURE 1A) and the absence of the portal vein (FIGURE 1B). It also showed that the splenic and intestinal venous blood flowed via the splenic and mesenteric veins to the in‐ ferior vena cava and to the left renal vein with‐ out passing through the liver (FIGURE 1C). On por‐ tovenography with the occlusion test (FIGURE 1D), the liver was not perfused with portal blood and the superior mesenteric vein and splenic vein did not join to form confluence (abernethy malfor‐ mation type IB). A 31 ‐year ‐old male patient with chronic membra‐ noproliferative glomerulonephritis (confirmed by biopsy) treated with immunosuppression (steroids, cyclosporine, mycophenolate mofetil) was admitted to the hospital due to nephrotic syndrome with chronic kidney disease stage 3 and coma (rigid pupils with bilateral Babinski sign). Blood tests revealed elevated concentra‐ tions of ammonia (288 μmol/l), serum creati‐ nine (258 μmol/l), urea (31.2 mmol/l), serum albumin (27 g/l), alanine aminotransferase (37 U/l), aspartate aminotransferase (30 U/l), biliru‐ bin (24 μmol/l), γ‐glutamyltranspeptidase (138 U/l), cholinesterase (3678 U/l), ceruloplasmin (0.26 g/l), and alkaline phosphatase (205 U/l). Se‐ rological markers for hepatitis A, B, C, G viruses, CLINICAL IMAGE
1012及免疫指标均为阴性。根据脑电图和头部计算机断层扫描(CT),诊断为非惊厥性癫痫(丙戊酸治疗)。腹部CT扫描显示多脾(图1A)和门静脉缺失(图1B)。它还显示脾脏和肠静脉血通过脾静脉和肠系膜静脉流入下腔静脉和左肾静脉,并通过肝脏流出(图1C)。在静脉造影和闭塞试验(图1D)中,肝脏没有门静脉灌注,肠系膜上静脉和脾静脉没有连接形成汇合处(IB型畸形)。一名31岁男性慢性膜非增殖性肾小球肾炎(活检证实)患者接受免疫抑制治疗(类固醇、环孢素、霉酚酸酯),因慢性肾病肾病肾病综合征合并3期昏迷(双侧巴宾斯基征瞳孔僵硬)入院。血液检查显示氨(288 μmol/l)、血清生成酶(258 μmol/l)、尿素(31.2 mmol/l)、血清白蛋白(27 g/l)、丙氨酸转氨酶(37 U/l)、天冬氨酸转氨酶(30 U/l)、胆红素(24 μmol/l)、γ -谷氨酰转肽酶(138 U/l)、胆碱酯酶(3678 U/l)、铜蓝蛋白(0.26 g/l)和碱性磷酸酶(205 U/l)的浓度升高。A、B、C、G型肝炎病毒的血清学标志物,临床影像
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引用次数: 2
Forum for internal medicine: opinions and controversies. 内科论坛:意见与争议。
Pub Date : 2016-12-22 DOI: 10.20452/pamw.3743
1062 The lack of internists, or rather their relative shortage, is a progressive and, even worse, irre‐ versible phenomenon. This is undoubtedly due to the dynamic development of specializations de‐ riving from traditional internal medicine. The said specializations are attractive not only for finan‐ cial reasons, but also by virtue of the well ‐earned prestige enjoyed by their holders among both fel‐ low professionals and patients. In this context, a specialist in internal medicine is recognized as a physician whose competences, and hence skills, are not clearly specified. Such a specialist is per‐ ceived this way not only by their own profession‐ al community, but also by patients. Nowadays, there is a belief and a consequent expectation among patients that they qualify for specialist treatment every time they suffer from any symptom or ailment. My 40‐year long clini‐ cal experience has given me the impression that the subjective well ‐being of a patient is based on the frequency of their visits to a specialist, and not on objective treatment effects which translate into the broadly taken improvement of life quali‐ ty. I presume that this is associated with substan‐ tial deficiencies in the society’s health education, which is based on the premise that health should be regarded from a holistic and quality ‐oriented perspective. It could therefore be concluded that there is no part to be played by an internal dis‐ eases specialist within medicine as a domain so grossly divided into specialties. However, the mir‐ ror image of this conclusion is the fact that it is in such a highly branched medicine that a stable role should be occupied by an experienced physician, who is able to draw final conclusions based on in‐ formation obtained from individual specialists. Adopting such a solution would entail the re‐ evaluation of the role of an internal medicine spe‐ cialist with respect to 2 central processes: diag‐ nostics and treatment. Thus, within the structure of a hospital, an internist should be the person responsible for planning the diagnostic process. Through referring patients to relevant specialists FORUM FOR INTERNAL MEDICINE
1062 .内科医生的缺乏,或者更确切地说,内科医生的相对短缺,是一个渐进的,甚至更糟糕的,不可逆转的现象。毫无疑问,这是由于传统内科医学专业的动态发展。上述专业之所以具有吸引力,不仅是因为经济原因,还因为他们的持有者在自我感觉低下的专业人员和患者中享有良好的声誉。在这种情况下,内科专家被认为是其能力和技能没有明确规定的医生。这样的专家不仅被他们自己的专业团体,而且也被患者这样看待。如今,患者中有一种信念和随之而来的期望,即每当他们出现任何症状或疾病时,他们都有资格接受专科治疗。我40年的临床经验给我的印象是,病人的主观幸福感是基于他们去看专家的频率,而不是客观的治疗效果,后者转化为生活质量的广泛改善。我认为这与社会健康教育的实质性缺陷有关,这是基于健康应该从整体和质量为导向的角度来看待的前提。因此,可以得出结论,内科疾病专家在医学领域中没有发挥作用,因为医学领域被划分为多个专业。然而,这一结论的反义词是,在这样一个高度分支的医学中,一个稳定的角色应该由经验丰富的医生担任,他能够根据从个别专家那里获得的信息得出最终结论。采用这样的解决方案需要重新评估内科专家在两个核心过程中的作用:诊断和治疗。因此,在医院的结构中,内科医生应该是负责规划诊断过程的人。通过将患者转介给相关的内科专家论坛
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引用次数: 1
Validation of the Polish version of the Duke University Religion Index (PolDUREL). 杜克大学宗教索引(PolDUREL)波兰版的验证。
Pub Date : 2016-12-22 DOI: 10.20452/pamw.3721
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引用次数: 8
The internal medicine in crisis: the analysis of causes and proposed changes. 危机中的内科:原因分析及改革建议。
Pub Date : 2016-12-22 DOI: 10.20452/pamw.3747
1068 intensity and nature, depending on the country which it encompasses; however, most frequently, the attention is called to general specialties, such as pediatrics, general surgery, and in particular internal medicine. There are 5 criteria defining “medical specialty in crisis”. The lack of proper candidates interested in training related to a giv‐ en area of medicine, the difficulties in finding em‐ ployees, excessive workload due to the limited number of employees in a doctors’ team, the sal‐ ary considered by the doctors as too low and lim‐ ited possibilities for additional income, low qual‐ ity of professional life.1 The experiences of the countries that have sim‐ ilar health care structure as Poland indicate that the causes of the crisis of medical specialties, such as internal medicine, stem from 3 different areas. Within the first area, namely the health care sys‐ tem and its affiliations, the following problems can be noticed: insufficient funding for the med‐ ical procedures performed in internal diseases units, the payer not taking into account the com‐ plexity of the care provided in internal diseases units, and no continuation of specialist inter‐ nal medicine care in an outpatient department.2 Those issues are of particular importance if we consider the extended human longevity and mul‐ tiple morbidities that intensify at an older age. Other problems within the system include short‐ age of training spots, an issue which is not given enough attention, as well as training programs for specialists that were not particularly interesting. The second group of causes underlying the cri‐ sis are the issues related to hospital management with the preference being placed on the profit‐ able narrow specialty units and the elimination of the cost of intensive internal diseases units. Another problem in this area is the lack of proper task planning and a clear definition of responsi‐ bilities, which would make it possible for medical personnel to feel more comfortable at work and to properly address the patient’s needs. The fact that due to the economic reasons the hiring of Introduction For at least 20 years now, we have been observing a continued crisis of some of the medical specialties that are important for the society’s health. This problem is of varying FORUM FOR INTERNAL MEDICINE
1068强度和性质,取决于它所涵盖的国家;然而,最常见的是,关注被称为普通专科,如儿科,普通外科,特别是内科。定义“危机医疗专业”有5个标准。缺乏对特定医学领域相关培训感兴趣的合适人选,很难找到合适的员工,医生团队中员工数量有限导致工作量过大,医生认为工资太低,增加收入的可能性有限,职业生活质量低卫生保健结构与波兰相似的国家的经验表明,内科等医学专业危机的原因来自三个不同的领域。在第一个领域,即卫生保健系统及其附属机构中,可以注意到以下问题:在内科病房进行医疗程序的资金不足,付款人没有考虑到内科病房提供的护理的复杂性,门诊部门没有专科内科护理的延续如果我们考虑到人类寿命的延长和随着年龄的增长而加剧的多种疾病,这些问题就显得尤为重要。系统内的其他问题包括培训时间短,这是一个没有得到足够重视的问题,以及对专家的培训计划不是特别有趣。造成危机的第二组原因是与医院管理有关的问题,即优先考虑有利可图的狭窄专科病房和消除重症内科病房的成本。这方面的另一个问题是缺乏适当的任务规划和明确的职责定义,这将使医务人员在工作中感到更舒适,并适当地解决病人的需求。事实上,由于经济原因,至少20年来,我们一直在观察一些对社会健康很重要的医学专业的持续危机。这个问题是不同论坛的内科医学
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引用次数: 1
The role of an internal medicine specialist in the health care system: going back to the past? 内科专家在卫生保健系统中的作用:回到过去?
Pub Date : 2016-12-22 DOI: 10.20452/pamw.3749
1074 doctors. It may be good for the doctors but it is definitely not good for the patients. The obser‐ vations coming from the cardiological examina‐ tions are not positive. What is disturbing is not only the lack of basic knowledge in the area of in‐ ternal diseases but also the more frequent lack of knowledge about cardiology outside the field in which the person taking the exam works. We hear excuses like “I work in a hemodynamics laborato‐ ry and that is why my knowledge of echocardiog‐ raphy is limited.” Such a narrow specialty has its pros. Performing numerous procedures the ma‐ jority of doctors (but not all) achieves true mas‐ tery in their field. On the other hand, with this approach we provide treatment for example for coronary arteries instead of for a coronary heart disease, and certainly not for a patient suffer‐ ing from a coronary heart disease. This is a dan‐ gerous tendency, especially that we come in con‐ tact with older and older patients suffering from multiple diseases. If we stick to the cardiocentric approach, we can make mistakes. A doctor who does not have sufficient knowledge either does not see the problem or prefers not to see it if he does not know the solution for it. That is why the system of consultations is developing. But here we come across another problem, in order to ask for a consultation one has to notice the prob‐ lem and describe it. And how should one do this without knowing the significance of wheezes over the lung fields or what the symptoms of fluid in the peritoneal cavity are or what the erysipelas looks like? Specialist consultations, whose value cannot be questioned in some situations, must not be treated as a fundamental method of diag‐ nostics and treatment. Such a method prolongs the diagnosis time, is certainly inconvenient for the patient, especially if it happens in an outpa‐ tient clinic and the patient has to move between different places where the consultations are pro‐ vided and in the end this is an expensive course of action. What is more is that such a situation very often leads to polypharmacy and the associated I have no doubts that an internal medicine doc‐ tor should be a key figure in the health care sys‐ tem. One ‐degree specialties that have been imple‐ mented for the last few years have led to the very fast but at the same time very narrow training of FORUM FOR INTERNAL MEDICINE
1074名医生。这对医生来说可能是好事,但对病人来说肯定不是好事。心脏科检查的观察结果为阴性。令人不安的不仅是缺乏外部疾病领域的基本知识,而且更常见的是缺乏参加考试的人工作领域以外的心脏病学知识。我们经常听到这样的借口:“我在血液动力学实验室工作,这就是为什么我对超声心动图的了解有限。”这样一个狭窄的专业也有它的优点。大多数医生(但不是全部)在他们的领域取得了真正的成就。另一方面,用这种方法,我们提供治疗,例如冠状动脉,而不是冠心病,当然不是患有冠心病的病人。这是一种危险的趋势,特别是当我们接触到患有多种疾病的老年患者时。如果我们坚持以心脏为中心的方法,我们可能会犯错误。没有足够知识的医生要么看不到问题,要么在不知道解决办法的情况下不愿看到问题。这就是协商制度正在发展的原因。但是这里我们遇到了另一个问题,为了寻求咨询,一个人必须注意到问题并描述它。如果不知道肺部喘鸣的重要性或者腹膜腔积液的症状或者丹毒是什么样子,人们该怎么做呢?在某些情况下,专家会诊的价值不容置疑,但不应将其视为诊断和治疗的基本方法。这种方法延长了诊断时间,对病人来说当然是不方便的,特别是如果它发生在门诊诊所,病人必须在不同的地方之间移动,提供咨询,最终这是一个昂贵的行动过程。更重要的是,这种情况经常导致多种用药和相关的我毫不怀疑内科医生应该是卫生保健系统的关键人物。过去几年实施的单一学位专业导致了非常快速但同时非常狭窄的内科论坛培训
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引用次数: 1
The 2016 World Thrombosis Day in Poland. 2016年波兰世界血栓日。
Pub Date : 2016-12-22 DOI: 10.20452/pamw.3767
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引用次数: 0
Dawn and dusk of internal medicine: a view of a qualified oncologist and hematologist. 内科的黎明与黄昏:一位合格的肿瘤学家和血液学家的观点。
Pub Date : 2016-12-22 DOI: 10.20452/pamw.3731
1040 An internal medicine specialist! When I received my diploma from the Rector of the Medical Acade‐ my of Warsaw, Professor Jan Nielubowicz, I knew that achieving this professional status had been a dream of mine and many of my colleagues. For years the internal medicine specialist has been a symbol of the highest level of medical profession as he could treat all diseases which affect the in‐ ternal organs in a human body. During 30 years of my doctor’s practice, I had a chance to witness the enormous progress that took place in med‐ icine, but at the same time also the lowering of prestige and social faith in a doctor who is only an internal medicine specialist. In the meantime, the doctor training system has changed as well as the system for financing medical services. Nar‐ row specialties are now preferred in those areas. Both in Poland and abroad we are observing the aging of societies and the increased number of diseases affecting a single person. For several de‐ cades now we have been observing the epidemics of the cardiovascular system diseases and differ‐ ent types of cancer. Epidemiologists estimate that within the next 50 years different types of cancer will have become the major cause of mortality in Poland. Right now in Poland over 150 000 new cancer cases are diagnosed yearly, out of which over 90 000 patients die within the same year and the number of deaths is increasing from year to year. The main killers of the Polish people current‐ ly are: lung cancer, colorectal cancer, breast cancer, prostate cancer but also gastric cancer, pancreatic cancer, ovarian cancer, head and neck cancer. This FORUM FOR INTERNAL MEDICINE
内科专家!当我从华沙医学院院长Jan Nielubowicz教授那里拿到毕业证书时,我知道,获得这一专业地位一直是我和我的许多同事的梦想。多年来,内科专家一直是医学专业最高水平的象征,因为他可以治疗所有影响人体外部器官的疾病。在我30年的行医生涯中,我有机会见证了医学的巨大进步,但同时也见证了内科专家的声望和社会信任度的下降。与此同时,医生培养制度和医疗服务融资制度也发生了变化。在这些地区,现在首选的是新兴专业。无论是在波兰还是在国外,我们都看到社会老龄化和影响一个人的疾病数量增加。几十年来,我们一直在观察心血管系统疾病和不同类型癌症的流行。流行病学家估计,在未来50年内,不同类型的癌症将成为波兰死亡的主要原因。目前,波兰每年诊断出15万多例新的癌症病例,其中9万多名患者在同一年死亡,死亡人数每年都在增加。目前波兰人民的主要杀手是:肺癌、结直肠癌、乳腺癌、前列腺癌,还有胃癌、胰腺癌、卵巢癌、头颈癌。这是内科医学论坛
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引用次数: 1
Pol Arch Med Wewn becomes Pol Arch Intern Med.
Pub Date : 2016-12-22 DOI: 10.20452/pamw.3769
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引用次数: 0
期刊
Polskie Archiwum Medycyny Wewnetrznej
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