Teaching Culturally Appropriate Care: A Review of Educational Models and Methods

The disparities in health care and health outcomes between the majority population and cultural and racial minorities in the United States are a problem that likely is influenced by the lack of culturally competent care. Emergency medicine and other primary-care specialties remain on the front lines of this struggle because of the nature of their open-door practice. To provide culturally appropriate care, health care providers must recognize the factors impeding cultural awareness, seek to understand the biases and traditions in medical education potentially fueling this phenomenon, and create a health care community that is open to individuals' otherness, thus leading to better communication of ideas and information between patients and their health care providers. This article highlights the rationale for and current problems in teaching cultural competency and examines several different models implemented to teach and promote cultural competency along the continuum of emergency medicine learners. However, the literature addressing the true efficacy of such programs in leading to long-lasting change and improvement in minority patients' clinical outcomes remains insufficient.     

脊髓纵裂分型治疗的疗效分析

目的探讨脊髓纵裂分型治疗的疗效。方法对1978年5月至2006年11月收洽的有完整资料的121例单管型及双管型脊髓纵裂患者的病历资料进行回顾性分析，并通过临床神经功能评分及胫后神经皮层体感诱发电位（FTNCSEP）P40波峰监测，评价其手术及非手术治疗的疗效。结果所有患者均得到随访，随访时间6个月～15年，平均2年6个月。96例双管型患者中手术治疗86例，术后观察和随访发现24例痊愈、22例有明显改善、28例有一定改善、12例无明确效果，临床神经功能评分及PTNCSEP术后有明显改变，尤其是以疼痛为主诉的患者恢复最为明显，手术总有效率为86％；10例双管型患者未行手术治疗，随访发现临床症状无明显改善且有加重趋势。单管型患者25例，手术治疗16例，术前、术后临床神经功能评分及胛NCSEP无明显变化；未手术治疗的9例，随访时上述指标亦无明显变化。结论双管型脊髓纵裂患者脊髓损害重且呈进行性加重，精细的手术治疗可以使大多数患者症状得到缓解，终止神经进行性损伤，确诊后应尽早手术。单管型脊髓纵裂患者脊髓损害轻，无须手术探查。     

Advancing Nursing Practice with a Unit-based Clinical Expert

Objective: To explore patterns in the practice of nursing and patient outcomes.
Design: Qualitative field research.
Population, Sample, Setting: Populations were critical care nurses and critically ill adult patients in the 10-bed medical critical care unit of a 900-bed teaching hospital. A convenience-purposive sample of 27 nurses and 31 patients was studied in 1985.
Methods: Six months of participant observation, unstructured interviews, and the constant comparison method of grounded theory.
Findings: Markedly different patterns were found in expert and nonexpert practice. The substantive theory of conversion helped explain how the majority of nonexpert nurses advanced their practice. The metaphor of catalyzed conversion captures how a unit-based expert nurse serves as a catalyst to advance the practice of nonexperts. Presence, defined as the way of being within a given clinical context, differentiated nurses.
Conclusions: (a) Expert and nonexpert practices are substantively different, (b) Expert and nonexpert practice results in different patient outcomes, (c) Conversion helps explain changes in nonexpert practice.
Clinical Implications: A unit-based expert nurse can increase patient-focused care.     

血清IGFBP-3、PDGF及bFGF联合检测对多囊卵巢综合征患者妊娠结局的预测价值

目的 探究血清胰岛素样生长因子结合蛋白-3(IGFBP-3)、血小板来源生长因子（PDGF）及碱性成纤维细胞生长因子（bFGF）联合检测对多囊卵巢综合征（PCOS）患者妊娠结局的预测价值。方法 选取2021年5月—2022年12月在沧州市中心医院接受治疗的150例PCOS孕妇作为PCOS组,另选取同期在该院产检健康的90例孕妇作为对照组。比较两组血清IGFBP-3、PDGF及bFGF水平;根据PCOS组孕妇的妊娠情况分为妊娠结局良好组119例和妊娠结局不良组31例,统计PCOS患者妊娠结局情况并比较血清IGFBP-3、PDGF、bFGF水平;绘制受试者工作特征（ROC）曲线分析血清IGFBP-3、PDGF和bFGF对PCOS的预测价值。结果 PCOS组血清IGFBP-3水平低于对照组（P <0.05）,PDGF、bFGF水平均高于对照组（P <0.05）。妊娠结局不良组血清IGFBP-3水平低于妊娠结局良好组（P <0.05）,PDGF、bFGF水平均高于妊娠结局良好组（P <0.05）。ROC曲线分析结果显示,血清IGFBP-3、PDGF、bFGF水平预测PC...     

广州地区围产儿脏器重量及大小测量的研究

目的　探讨广州地区围产儿脏器重量及大小的发育规律 .方法　选择 6 2 5例胎龄准确的单胎 ,除外明显浸软、IUGR、水肿儿、巨大胎、有胸腹水者 ,新生儿除外先天性心脏病及有明显疾病的脏器 .根据胎龄分为 6组 ,分别测量围产儿体重、身长和各脏器重量、长度 .进行统计分析 .结果　胰腺、肺发育最早 ,肾脏与肺发育最快 ,出生后脑增长最少而胰腺增长最快 ,肠变异最大等规律 .结论　围产儿脏器资料用于围产儿病理研究有一定意义     

广州市至灵学校167名学员智残原因的调查分析

本文以广州市至灵学校（智低）167名学员为研究对象，完成智力测验、体格检查和染色体分析．并且追溯围产期和出生后的种种异常．询查智力低下的家族史。综合分析有关资料，显示围产期的某些不利因素、遗传与先天疾病，以及婴幼儿中枢神经系统疾病是主要的发病原因。从而指出，加强优生咨询、重视围产期保健、提高产前诊断和产程中的监护水平、早期防治胎婴儿中枢神经系统损伤和疾病等，是降低智残儿发生率的重要措施。     

羊水过少对不良围产期结局的影响及其治疗

目的 探讨羊水过少对不良围产期结局的影响及其治疗。方法 对羊水过少104例临床资料进行分析。结果 羊水过少组胎儿生长受限、妊娠高血压疾病、妊娠期肝内胆汁淤积症的发生率较对照组明显增高，差异有显著性（P〈0．01）。延期妊娠、胎儿畸形发生率较对照组增高（P〈0．05）；胎儿宫内窘迫、羊水粪染、剖宫产率明显增高（P〈0．01），新生儿窒息的发生率增高（P〈0．05）。结论 羊水过少可造成不良围产结局，一经确诊应积极处理。     

高龄产妇并发妊娠期高血压疾病对围生期结局的影响

目的探讨孕高龄产妇并发妊娠期高血压疾病对围生期结局的影响。方法对43例35岁或以上的妊娠期高血压疾病孕妇（观察组）进行了回顾性分析并与同期分娩的35岁以下的妊娠期高血压疾病孕妇238例（对照组）作对照分析。结果观察组子痫前期、子痫的发生率与对照组比较差异有非常显著性（P〈0.01）;观察组胎盘早剥、HELLP综合征、妊娠高血压心脏病等严重并发症的发生率与对照组比较无显著性差异（P〉0.05）;观察组早产、胎儿生长受限、围产儿死亡的发生率比对照组高,差异有显著性（P〈0.05）;新生儿窒息、胎儿窘迫的发生率两组比较,差异无显著性（P〉0.05）,观察组剖宫产率较对照组明显增加,两组间差异有显著性（P〈0.05）。结论高龄产妇并发妊娠期高血压疾病病情重,对母儿危害大,恰当的围产期管理并适时终止妊娠是治疗成功的关键。     

Influence of perinatal malnutrition on adult physiological and behavioral reactivity in rats

A series of experiments examined the behavioral and pituitary-adrenal response to novelty of perinatally malnourished rats tested as adults after nutritional rehabilitation begun at weaning. Neither the behavioral measures of ambulation, rearing and defecation, nor the plasma corticosterone response to a brief exposure to an open field differentiated the previously malnourished subjects from controls. Similar to controls, previously malnourished subjects were also capable of displaying a graded corticoid elevation to environments increasingly different from the home cage. However, exploratory behavior, as measured by head-dip frequency and duration in the hole-board, was reduced in the previously malnourished rats. Although latency and amount of fluid consumed in a novel environment did not differ, previously malnourished rats were unable to use the cues associated with a consummatory behavior to modulate the pituitary-adrenal response to novelty. Thus, perinatal malnutrition does not influence either the behavioral or physiological activational response to novel stimulation but appears to alter the ability of the animal to use a consummatory behavior to modulate this response.