舒心病房护理流程优化的探究和分析

目的：对静脉输液流程优化在舒心病房中的应用效果进行分析。方法建立流程管理组,并采取优化措施,对护理人员进行培训,监督反馈优化后流程执行情况。结果在药液核对分配时间、肝素封管时间以及换液时间方面,优化前后有明显差异(P<0.05)。流程优化以后,病房整体满意度为93.75%(75/80)、输液满意度为96.25%(77/80)。结论在对舒心病房输液流程进行优化以后,加强输液环节质量,使患者满意度得以提高,缩短患者等待时间。     

马齿苋鲜品凝胶剂制备及其对小鼠湿疹的初步作用

目的 制备马齿苋鲜品凝胶并考察其对小鼠急性湿疹的治疗效果。方法 采用正交试验设计,以卡波姆-940、丙二醇的浓度及pH值为考察因素,以卡波姆凝胶剂基质考察评分标准评分,筛选优化处方,制备马齿苋鲜品凝胶。观察马齿苋鲜品凝胶的抑菌作用,及其对小鼠急性湿疹的治疗效果。结果 经优化,马齿苋凝胶处方为卡波姆-940 0.7%,丙二醇10%,pH 6.5。抑菌结果显示,马齿苋鲜品凝胶对金黄色葡萄球菌、大肠杆菌均有抑制作用。对小鼠急性湿疹的治疗结果显示,马齿苋鲜品凝胶可抑制湿疹皮肤组织的炎症反应,显示出较好的治疗效果。结论 通过正交试验筛选出优化处方,并观察到马齿苋鲜品凝胶对小鼠急性湿疹有治疗作用。     

操作技能直接观察评估在全科医学科毕业实习中的应用效果研究

背景　操作技能直接观察评估（DOPS）是评估者通过直接观察学生技能操作的过程即时给予评估和反馈,是一种具有教学功能的形成性评价工具,能够客观、全面地评估学生的学习过程。将DOPS引入全科医学专业教学评价具有重要意义。目的　探讨在全科医学科毕业实习中应用DOPS进行形成性评价的意义和效果。方法　于2018年9-10月,采用整群抽样方法选择中国医科大学2013级七年制临床医学专业学生72例为研究对象。采用随机数字表法将72例学生随机分为试验组和对照组,每组36例。试验组和对照组学生均安排在中国医科大学附属第一医院全科医学科病房参加为期1周的实习;实习结束后,进行为期1周的临床实践。对照组的临床实践操作技能培训采用传统带教方法,试验组在1周的临床实践过程中开展2次DOPS形成性评价,两组由相同教师授课。轮转结束时,应用小型临床评价演练（Mini-CEX）、临床技能操作评分、理论考试及问卷调查法进行教学评价。结果　试验组学生的理论考试成绩与对照组比较,差异无统计学意义（P>0.05）。试验组和对照组学生的临床技能操作得分分别为（76.67±6.20）、（72.50±7.66）分,组间差异有统计学意义（P<0.05）。两组Mini-CEX成绩比较：试验组学生体格检查、人文关怀、沟通技巧、整体表现得分高于对照组,差异有统计学意义（P<0.05）。DOPS临床操作时间为（11.32±1.76）min,反馈时间为（13.14±2.21）min,合计时间为（24.46±1.97）min。>80%的学生认为DOPS有利于发现自身操作中的小问题、有助于感受到教师的重视和关怀、可行性强、可以提高操作技能、培养人文素养和交流沟通能力。结论　在全科医学科毕业实习中开展DOPS作为形成性评价可以有效提高学生临床技能操作和Mini-CEX成绩,改善教学效果。     

Alcohol-related effects on automaticity due to experimentally manipulated conditioning

Background: The use of alcohol is associated with various forms of automatic processing, such as approach tendencies and attentional biases, which may play a role in addictive behavior. The development of such automaticity has generally occurred well before subjects perform tasks designed to detect them. Although it seems plausible that this development involves some form of alcohol‐related conditioning, this process is not usually included in the experimental procedure. Methods: The development of automaticity involving alcoholic or nonalcoholic stimuli was experimentally manipulated via a conditioning task. Subjects were presented with pairs of stimuli from a set of 4 stimuli: 2 pictures of alcoholic beverages, and 2 pictures of nonalcoholic beverages. One of the alcoholic and 1 of the nonalcoholic beverages was associated with reward, the other stimuli with punishment. Subjects had to learn to select the rewarded stimuli from pairs of 1 rewarded and 1 punished stimulus. The task, thus experimentally established reward versus punishment stimulus–response–outcome associations, for alcoholic and for nonalcoholic stimuli. Subsequently, a cued reversal task was used to test automaticity involving alcoholic versus nonalcoholic, and rewarded versus punished stimuli. Results: An association was found between heavier drinking and an alcohol‐related conditioning bias: heavier drinkers had more difficulty overcoming a conditioned response when it involved selecting a previously punished nonalcoholic stimulus over a previously rewarded alcoholic stimulus. Conclusions: The study provided novel information on secondary reinforcement involving alcoholic stimuli: heavier drinkers may more easily develop automaticity related to alcohol‐reward contingencies. This may have implications for interventions and the interpretation of findings concerning alcohol‐related automatic processing.     

Selection of criteria for assessment of occlusal acceptability

There is no general agreement on criteria that could be applied to distinguish between orthodontically acceptable and non-acceptable occlusions after the completion of dental development. The aim of the present study was to analyse morphological and functional features that could be used as an index to define an acceptable occlusion in young adults. Three expert panels representing specialists in orthodontics and stomatognathic physiology participated in a modified Delphi method. Each panel responded to a questionnaire concerning the usefulness of various occlusal features, and a set of characteristics was selected on the basis of the responses; thereafter, applicability of the chosen characteristics and their cutoffs for an acceptable-non-acceptable dichotomy was tested clinically. To obtain a consensus level of 100%, the last panel session was completed with a group discussion. Assessments made using the morphological criteria were compared with those made with the dental health component of the Index of Orthodontic Treatment Need. The selected morphological characteristics consisted of overjet, overbite, canine relationship, crossbite, scissors bite and midline deviation. The functional evaluation comprised assessments of discrepancy between the centric relation and the intercuspal position, working- and non-working-side contacts and protrusion contacts. The dental health component and our morphological criteria showed different sensitivity to contact point displacements, interdigitation in buccal segments and increased overbite. This study provides a set of morphological and functional indicators reflecting the current consensus opinion of Finnish professionals. Further studies are needed to analyse the reproducibility of assessment of the characteristics included.     

达芬奇机器人手术配合流程再造及效果评价

目的 优化达芬奇机器人手术配合流程,提高工作效率.方法 收集2013年1月至2013年9月,在我院实施的达芬奇机器人手术236例.对手术配合流程进行再造,对流程再造前后手术医师、手术室护士的满意度,开台时间采用1检验和x2检验统计分析.结果 流程再造后,开台时间与流程再造前比较,存在统计学差异（P＜0.05）.手术医师、手术室护士的满意度较再造前提高（P＜0.05）.结论 达芬奇机器人手术配合流程再造有利于提高手术室的工作效率.     

The process of cognitive behaviour therapy for chronic fatigue syndrome: Which changes in perpetuating cognitions and behaviour are related to a reduction in fatigue?

Objective

Cognitive behaviour therapy (CBT) can significantly reduce fatigue in chronic fatigue syndrome (CFS), but little is known about the process of change taking place during CBT. Based on a recent treatment model (Wiborg et al. J Psych Res 2012), we examined how (changes in) cognitions and behaviour are related to the decrease in fatigue.

Methods

We included 183 patients meeting the US Centers for Disease Control criteria for CFS, aged 18 to 65 years, starting CBT. We measured fatigue and possible process variables before treatment; after 6, 12 and 18 weeks; and after treatment. Possible process variables were sense of control over fatigue, focusing on symptoms, self-reported physical functioning, perceived physical activity and objective (actigraphic) physical activity. We built multiple regression models, explaining levels of fatigue during therapy by (changes in) proposed process variables.

Results

We observed large individual variation in the patterns of change in fatigue and process variables during CBT for CFS. Increases in the sense of control over fatigue, perceived activity and self-reported physical functioning, and decreases in focusing on symptoms explained 20 to 46% of the variance in fatigue. An increase in objective activity was not a process variable.

Conclusion

A change in cognitive factors seems to be related to the decrease in fatigue during CBT for CFS. The pattern of change varies considerably between patients, but changes in process variables and fatigue occur mostly in the same period.     

Appropriate treatment planning method for field joint dose in total body irradiation using helical tomotherapy

Total body irradiation (TBI) using helical tomotherapy (HT) has advantages over the standard linear accelerator-based approach to the conditioning regimen for hematopoietic cell transplantation. However, the radiation field has to be divided into two independent irradiation plans to deliver a homogeneous dose to the whole body. A clinical target volume near the skin increases the skin surface dose; therefore, high- or low-dose regions arise depending on the set-up position accuracy because the two radiation fields are somewhat overlapped or separated. We aimed to determine an adequate treatment planning method robust to the set-up accuracy for the field joint dose distribution using HT-TBI. We calculated treatment plans reducing target volumes at the interface between the upper and lower body irradiations and evaluated these joint dose distributions via simulation and experimental studies. Target volumes used for the optimization calculation were reduced by 0, 0.5, 1.0, 2.0, 2.5, and 3.0 cm from the boundary surface on the upper and lower sides. Combined dose distributions with set-up error simulated by modifying coordinate positions were investigated to find the optimal planning method. In the ideal set-up position, the target volume without a gap area caused field junctional doses of up to approximately 200%; therefore, target volumes reduced by 2.0–3.0 cm could suppress the maximum dose to within 150%. However, with set-up error, high-dose areas exceeding 150% and low-dose areas below 100% were found with 2.0 and 3.0 cm target volume reduction. Using the dynamic jaw (DJ) system, dose deviations caused by set-up error reached approximately 20%, which is not suitable for HT-TBI. Moreover, these dose distributions can be easily adjusted when combined with the intensity modulation technique for field boundary regions. The results of a simulation and experimental study using a film dosimetry were almost identical, which indicated that reducing the target volume at the field boundary surface by 2.5 cm produces the most appropriate target definition.     

Optimal Planar Flow Network Designs for Tissue Engineered Constructs with Built-in Vasculature

Convective delivery of nutrients is important to enhance mass transport within tissue engineered (TE) products. Depending on the target tissue, an ideal TE product will have an integrated microvasculature that will eliminate mass transport limitations that can occur during product growth in vitro and integration in vivo. A synthetic approach to develop microvasculature involves development of network designs with efficient mass transfer characteristics. In this paper, utilizing a planar bifurcating network as a basis, we develop an approach to design optimal flow networks that have maximum mass transport efficiency for a given pressure drop. We formulated the optimization problem for a TE skin product, incorporating two types of duct flow, rectangular and square, and solved using a generalized reduced gradient algorithm. Under the conditions of this study, we found that rectangular ducts have superior mass transport characteristics than square ducts. Microvascular area per volume values obtained in this work are significantly greater than those reported in the literature. We discuss the effect of network variables such as porosity and generations on the optimal designs. This research forms the engineering basis for the rational development of TE products with built-in microvasculature and will pave the way to design complex flow networks with optimal mass transfer characteristics.     

以能力培养为导向的生物药剂学实验教学改革

现阶段生物药剂学与药物动力学实验教学以统一性教学为主,重知识传授、轻能力培养,考核方式以结果为导向,不注重过程,学生缺少实验反思机会。本文从分析产生这些问题的原因入手,提出通过活化理论课堂,改革实验教学模式,内容和考评方式,拓展课后课堂等多环节,提高教学效果,培养学生的综合科研素质和科研创新能力。