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When viewed under a microscope, the liver is seen as large network of units called hepatic lobules. The hepatic lobule is very small and looks like a six-sided cylinder.
The lobule itself is surrounded by connective tissue and has 5 to 7 clusters of vessels around its edges. These vessels include a branch of the portal vein, a branch of the hepatic artery, and a bile duct.
A central vein runs through the middle of the lobe and is surrounded by cords of liver cells that radiate out in all directions. Between these cords are wide thinwalled blood vessels called sinusoids. All of the blood drains into a hepatic vein which then circulates throughout the body.
Normal human cells can also become foreign invaders. When an organ such as a liver is transplant (moved) form one person to another, cells from the transplanted organ are seen as enemy invaders by the immune system of the person receiving the organ. The cells of the transplanted organ set off an immunological attack. Killer T cells and antibodies rush to the site, causing organ rejection, and the organ dies. Physicians solve this problem in part with medicines that suppress, or slow down, the immune system.
Hospitals in London could face a future staffing crisis as overseas nurses consider heading to work elsewhere, a study has revealed.
Research by the Royal College of Nursing (RCN) and the King's Fund think-tank showed that four out of 10 overseas nurses in the capital admitted that they were thinking about leaving the NHS to take up jobs in other countries.
The study also found that two-thirds of Filipino nurses working in London - one of the largest overseas nursing staff groups - were considering quitting the UK to work in the US.
Report author Prof James Buchan said: "The NHS and independent health care sectors rely heavily on overseas nurses to deliver health care - without them, parts of the health service would collapse.
"They perform a crucial and valuable role but our survey shows the NHS is playing a high risk game by relying on these overseas staff to commit long term to the NHS.
"Many of these nurses are considering leaving the NHS and that would pose real problems.
"It's clear the NHS needs to up its efforts to grow its own workforce to ensure we have the right number of nurses for the future."
The study involved almost 400 nurses from more than 30 different countries who were also asked about why they chose to work in the UK and how long they intended to stay.
While the UK has banned active recruitment from many developing countries to the NHS, the research found there was still evidence of "back-door recruitment".
Many nurses said they had initially worked for private sector employers in the UK before moving to the NHS soon after completing an adaptation course.
if patient-centered medicine is to become a widespread reality in academic medical centers, educational initiatives must include reform of the medical record. the medical record is part of the hidden, or informal, curriculum of medical school and residency that defines for students and residents the essential ingredients of competent medical care. whatever its merits, the conventional, problem-oriented medical record (pomr) is a pathology-oriented record that helps perpetuate a disease-focused, biomedical model of practice
patient-centered medicine requires a patient-centered medical record (pcmr), one that addresses the person and perspective of the patient as competently as it addresses the patient's disease. the author proposes a pcmr that includes a concise, upfront patient profile; speaks of "chief concerns," not "chief complaints"; makes patient perspective a captioned component of the history of present illness; replaces the pomr's formula soap (subjective, objective, assessment, plan) with hoap (history, observations, assessment, plan); includes important patient perspectives on the problem list; and calls for additional, written attention to the person and perspective of the patient throughout the course of medical care
以病人为中心的医学就要有一份以病人为中心的医疗记录(pcmr)，它的对象是人。它要用主要问题来取代主诉;hoap(history, observations, assessment, plan)来取代soap(subjective, objective, assessment, plan)…。
patient-centered records can guide and teach clinicians at every level of training and experience to practice patient-centered medicine. moreover, such records can also provide measurable evidence that this teaching has been successful.