乳胶粒子法检测甲胎蛋白的应用

目的:评价Latex法检测甲胎蛋白(AFP)的临床应用价值。方法:对血清标本做批内批间重复性测定试验及La-tex法与电化学发光法进行对比测定。结果:Latex法与电化学发光法检测AFP结果无显著差异,Latex法与电化学发光法平均回收率分别为95.5%和96.7%。结论:电化学发光法灵敏度、精密度高,但其仪器、试剂价格高,不适于全面推广;Latex法与电化学发光法检测AFP结果无显著差异,相关性好,快速、结果稳定,试剂便宜在全自动生化仪上检测,可广泛应用。     

The transition from tube to full oral feeding (breast or bottle) – A cue-based developmental approach

There is a growing body of evidence that strongly suggests that the optimal approach to a preterm infant's oral feeding journey should be based on their maturing behavioural cues rather than just their gestational age. This article describes attempts to introduce and develop this cue-based approach onto a level 3 neonatal unit in the West Midlands. The article discusses the research-base, staff and parent education as well as the challenges of implementing such a new approach to the oral feeding of preterm babies. It invites more research into the aspects of this approach that create the greatest challenges.     

2种不同微创手术方法治疗良性前列腺增生症的临床观察

目的:观察经尿道前列腺等离子双极电切(TUPKP)与经尿道前列腺单极电切术(TURP)治疗良性前列腺增生症患者的临床效果。方法:回顾性分析我院自2009年10月～2011年10月住院的130例良性前列腺增生症患者,随机分为实验组和对照组,每组各65例。实验组采用TUPKP,对照组采用TURP。结果:实验组和对照组术中、术后手术时间、术中出血量、术后平均住院天数、膀胱冲洗时间以及留置尿管时间,差异有统计学意义(P<0.05);实验组和对照组术后半年IPSS评分、QOL评分、残余尿和并发症等指标,差异无统计学意义(P>0.05)。结论:TUPKP与TURP治疗良性前列腺增生症患者的临床效果相当,经尿道前列腺等离子双极电切术相对更安全,值得临床推广应用。     

Investigation of nursing students' knowledge of and attitudes about problem-based learning

PurposeTo investigate nursing students' knowledge of and attitudes about problem-based learning (PBL).MethodsA total of 1200 students were surveyed at eight nursing colleges in Hunan Province.ResultsIn all, 1037 valid questionnaires were returned, for an effective return rate of 86.4%. Some 54.4% of the students learned that PBL was a pedagogical method from teachers, and 27.8% of the students had participated in PBL courses. Almost all of students (97.6%) were interested in PBL, and 66.7% of survey participants believed that students who were not good at solving problems would have difficulty in PBL courses.ConclusionNursing educators should guide students to adapt to new learning approaches, and encourage students to participate in the teaching reform to promote students' autonomous learning ability, innovation ability, and comprehensive ability.     

Forest valuation and risk

This paper aims to illustrate ways in which sources of risk can affect the valuation of a commercial plantation estate. Deterministic and stochastic analyses of a hypothetical commercial plantation estate are compared. Both are built on a long-term harvest schedule of wood flows that typifies current planning and valuation practices for large commercial plantation estates. The stochastic analyses incorporate typical systematic risks, including those associated with harvest yields, costs, prices and fire. Deterministic valuation using a market discount rate that includes a risk premium underestimates the expected value of the combined asset. Applying such a discount rate to a stochastic valuation would double count risk. Stochastic analysis forces owners to focus on a risk-free discount rate reflecting their time preference for net income flows over time, rather than using a valuer’s current discount rate. Stochastic analyses of valuations enable better assessment of the sensitivity of valuations to the impact of fire frequency, climate change, product prices in the immediate future and land prices, as illustrated in this study.     

心源性脑栓塞急性期的观察和护理

在心源性脑栓塞急性期的临床观察和护理中，应注意监测患者意识状况、生命体征，观察患者肢体供血状况，并加强基础护理，预防并发症。在护理过程中，需严格关注患者的心理状态，予以心理支持；在用药中，应遵循安全、有效、经济和个体化的伦理原则；在辅助患者进行康复训练时，要注意体谅患者，尊重患者各项权益。同时，还需对患者及其家属进行健康教育。     

Spatial accessibility to colonoscopy and its role in predicting late‐stage colorectal cancer

ObjectiveTo better determine the relationship between spatial access to colonoscopy and colorectal cancer (CRC) outcomes, our objective was to examine the agreement of the classic, enhanced, and variable two‐step floating catchment area (2SFCA) methods in evaluating spatial access to colonoscopy and to compare the predictive validity of each method related to late‐stage CRC. 2SFCA methods simultaneously consider supply/demand of services and impedance (ie, travel time).Data SourcesColonoscopy provider locations were obtained from the South Carolina Ambulatory Surgery Database. ZIP code tabulation area (ZCTA) level population estimates and area‐level poverty level were obtained from the American Community Survey. Rurality was determined by the United States Department of Agriculture''s Rural‐Urban Commuting Area codes. Individual‐level CRC data were obtained from the South Carolina Central Cancer Registry.Study DesignUsing the classic, enhanced, and variable 2SFCA methods, we calculated ZCTA‐level spatial access to colonoscopy. We assessed agreement between the three methods by calculating Spearman''s rank coefficients and weighted Kappas (Κ). Global and Local Moran''s I were used to assess spatial clustering of accessibility scores across 2SFCA methods. We performed multilevel logistic regression analyses to examine the association between spatial accessibility to colonoscopy, area‐ and individual‐level factors, and late‐stage CRC.Principal FindingsWe found strong agreement (Weighted Κ = 0.82; 95% CI = 0.79‐0.86) and identified similar clustering patterns with the classic and enhanced 2SFCA methods. There was negligible agreement among the classic/enhanced 2SFCA and the variable 2SFCA. Across all 2SFCA methods, regression models showed that spatial access to colonoscopy, rurality, and poverty level were not associated with greater odds of late‐stage CRC, though Black race was associated with late‐stage CRC across all models.ConclusionsNone of the 2SFCA methods showed an association with late‐stage CRC. Future studies should explore which elements (spatial or nonspatial) of access to care have the greatest impact on CRC outcomes.     

通识教育提升医药院校学生素质研究——基于人的全面发展的理念

通识教育是当今中国高等教育的一个热门话题,反映了人们对人才培养问题的广泛关注.在我国,一些因为交流导致的医疗纠纷,很大程度上是由于医药工作者重技能,缺综合学识所致.因此,将通识教育融入医药院校,对提升医药院校人才培养质量具有重要的作用.本文试图从通识教育的涵义出发,结合当前我国医药院校人才培养现状,谈谈如何将通识教育融入医药院校,培养厚基础、宽口径、文理交融的全面发展的高素质人才.