加强手术室的接台管理 提高手术科室的效率

手术室是为病人提供手术及抢救的场所,是医院的重要核心技术部门。手术室的正常、高效、科学运行关系到了所有外科科室及与手术相关科室的整体效率。因此,针对目前手术科室术前等待时间过长,手术台次安排低效的情况,通过专家咨询、调查问卷、头脑风暴、六西格玛等方法就关系手术整体运转的关键环节--手术接台管理进行探讨和改革,破除制约手术科室的瓶颈,提高手术科室的效率。     

浅析硬盘数据恢复原理及方法

硬盘是最常用的存储介质之一。存储在硬盘上的数据常常因各种原因遭到破坏、丢失，从而给人们的工作和学习带来重要的影响。文章在数据恢复原理的基础上，根据数据丢失的原因，对各种硬盘数据丢失的现象提出几种常用解决方法。     

多功能泌尿检查床在输尿管下段逆行插管造影中的应用体会

目的:总结多功能泌尿检查床在输尿管下段逆行插管造影中的应用体会。方法:简述多功能泌尿检查床的性能特点,并报告198例次应用该床行输尿管下段逆行插管造影检查的临床资料。结果:196例(99%)成功,2例(1%)失败,该检查床大大提高了输尿管下段逆行插管造影的成功率。结论:多功能泌尿检查床在输尿管下段逆行插管造影中具有很大的优势,能很好地将膀胱镜下输尿管逆行插管与造影检查结合在一起。     

Operant responding for a visual reinforcer in rats is enhanced by noncontingent nicotine: implications for nicotine self-administration and reinforcement

Rationale Current conceptualizations of drug reinforcement assume that drug-taking behavior is a consequence of the contingent, temporal relationship between the behavior and drug reward. However, stimulant drugs also potentiate the rewarding effects of other reinforcers when administered noncontingently. Objectives These studies were designed to determine whether noncontingent nicotine enhances the reinforcing properties of a nonpharmacological reinforcer and whether this direct effect facilitates operant behavior within the context of a nicotine self-administration procedure. Methods Rats self-administered nicotine or food, or received noncontingent nicotine, saline, or food either with or without a response-contingent, unconditioned reinforcing visual stimulus (VS). Results Noncontingent nicotine, whether delivered as discrete injections based on a pattern of self-administered nicotine or as a continuous infusion, increased response rates maintained by the VS. There were no significant differences in responding by animals that received contingent compared with noncontingent nicotine when a VS was available. This increase was not observed in the absence of the VS or as a consequence of noncontingent food delivery. Operant behavior was equally attenuated and reinstated by the removal and subsequent replacement of contingent and noncontingent nicotine. Nicotine supported self-administration in the absence of response-contingent, nicotine-paired stimuli; however, response rates were drastically reduced compared with nicotine self-administration with the VS. Conclusions Nicotine influences operant behavior in two ways: by acting as a primary reinforcer when it is contingent upon behavior, and by directly potentiating the reinforcing properties of other stimuli through a nonassociative mechanism. Nicotine self-administration and smoking may be largely dependent upon this later action. This work was supported by National Institute on Drug Abuse research grants, DA-10464 and DA-12655. "Principles of laboratory animal care" (NIH No. 85-23, revised 1985) were followed throughout all experiments. This research was approved by the University of Pittsburgh Institutional Animal Care and Use Committee, Assurance Number A3187-01     

沙盘模拟在产科专科培训的应用初探

目的探讨沙盘模拟培训在产科专科培训应用中的可行性和有效性。 方法培训班以沙盘模拟形式对学员进行产科急危重症与助产技术培训，采用"沙盘推演—学员操作—导师点评—导师演示"的培训模式，内容包括子痫、产后出血、肩难产、阴道助产和新生儿窒息复苏。选取200名学员为研究对象，并随机分成5个团队，培训前后对学员进行理论知识和操作技能考核，根据考核标准由导师组进行打分，并对每个团队的抢救流程进行考核评分。同时培训前后发放调查问卷对培训课程进行反馈。 结果经培训后，学员的理论考核成绩(91.1±14.5)分较培训前(75.6±24.0)分明显提高，差异有统计学意义(P<0.05)。各操作模块考核前后成绩分别为：子痫(73.7±5.6)分与(90.6±3.9)分，产后出血(71.2±8.7)分与(88.9±4.8)分，阴道助产(70.1±7.9)分与(90.0±4.8)分，肩难产(74.6±5.7)分与(91.5±2.3)分，新生儿窒息(73.2±4.7)分与(91.2±2.5)分，培训后成绩明显提高，差异有统计学意义(P<0.05)。团队考核的Topsis分析结果显示，团队3在多项指标上都是最优秀的，综合排名第一名，尤其是方案设计。团队5在临床技能表现突出，在团队配合和患者沟通方面做得也比较好。团队2和团队4各项指标都表现不足。 结论团队3大部分成员来自三甲医院，经常参加产科模拟培训班，因此总体素质较高，而团队2和团队4来自基层医院的成员居多，接受培训的次数较少，因此成绩偏弱，尤其在流程、沟通和团队配合等方面，还需要加强培训。沙盘模拟培训作为一种新型的体验式培训模式，具有创新性、互动性、趣味性，并具有实战性，在产科急危重症专科培训中具有较大的发展前景。     

滋肾通窍法对血管笥痴呆患者精神量表评定的观察

目的：探讨滋肾通窍法对血管性痴呆患者精神量表评定的影响。方法：以滋肾通窍法的为代表方剂的改良三甲散免 煎颗粒每天７ｇ口服,疗程１个月,治疗２６例血管性痴呆患者,并用精神量表进行评定。结果：改良三甲散能提高患者长谷川智能量表（ＨＤＳ）、简易智力状态检查表（ＭＭＳＥ）测试总成绩和ＭＭＳＥ分项计分成绩,逆转ＨＤＳ和ＭＭＳＥ说评定的痴呆病程进展。结论：改良三甲散具有一定的益智、抗痴呆作用。     

The telltale triangle: Use of the supine cross table lateral radiograph of the abdomen in early detection of pneumoperitoneum

The most sensitive method for detecting a small pneumoperitoneum depends upon directing a horizontal x-ray beam tangential to the collection of free air. We have observed in the detection of small amounts of free intraabdominal air that the supine cross table lateral abdominal view is most valuable. Such small amounts of free intraperitoneal air collect between loops of bowel at the highest points in the peritoneal space forming typical small triangular lucencies with their bases at the peritoneal reflection.     

Evaluation of a Single Stage Nitroglycerin Tilt Table Test for Diagnosis of Neurally Mediated Syncope

The purpose of this study was to compare clinical outcomes between a single stage head-up tilt table test (HUT) with infusion of 3.44 microg/kg per hour of nitroglycerin and a conventional multistage test with infusion of nitroglycerin from 1.72 microg/kg per hour to 5.16 microg/kg per hour in five successive stages. Thirty-seven patients with recurrent syncope underwent both tests in a prospective, randomized, crossoverfashion. During single stage HUT, a positive response occurred in 24 (64.9%) patients with unexplained syncope, an exaggerated response occurred in 3 (8.1%), a negative response in 7 (18.9%), and drug intolerance in 3 (8.1%). During the multistage HUT, these percentages were 62.2%, 16.2%, 13.5%, and 8.1%, respectively. Twenty healthy control subjects were involved in both tests, One of the control subjects had a positive response to single stage HUT, and two (10%) patients to multistage HUT. The duration of the test in single stage HUT was shorter than that in multistage HUT (8.6 +/- 10.3 vs 38.6 +/- 32.1 minutes, P < 0.01). The results showed that the single stage HUT was a fairly sensitive, specific, and a time-efficient test for provoking neurally mediated syncope.     

现况调查列联表资料的SPSS分析

现况调查是流行病学的基础性研究方法，SPSS是应用广泛的国际权威统计分析软件。本文结合现况调查列联表资料实例，运用SPSS13．0软件包进行统计分析，对操作过程和结果解释予以详细说明，供广大医学科研工作者在遇到现况调查资料分析时参考。     

运用PowerShell计算行×列表χ~2检验

微软已经推出功能强大的PowerShell 1.0,并决定在未来的新操作系统中内置PowerShell,PowerShell本身具有完善的数学计算和多维数组功能,只需通过简单脚本编程就可以方便地计算医学统计中经常遇到的行×列表χ2检验问题。