Mental state,physical strength,intelligent cycle and their relationship with epilepsy

Patientsfeelimpatientbecausetheycouldnotpredicttheonsettimeofepilepsy．Ifonsettimeofepilepsycouldbepreciselypredicted，thendrugadministrationanddisabilityofpreventionwillbecomeavailable．In１８７９，Echevarrzafoundonsettimeofepilepsyisdistributedaccordingtosomerules．Inrecentyears，scientistsperformalotstudiesinvolvingcytologyandmolecularbiologyofepilepsy．Clinicaldataindicatedonsetofepilepsyhascloserelationwithbiologicalrhythmsuchasawakeandsleepcycleandmenstrualcycle．Theobjectiveofthisstudy…     

Structured training of ENT Specialist Registrars in the out‐patient clinic and theatre

The aims of this paper are to evaluate the training in out‐patients and in theatre after the recent changes in SpR training. A postal questionnaire was sent to 191 Specialist Registrars (SpRs) in England and Wales and 57 were returned (30%). There were temporal bone facilities within the hospital for 53 SpRs but only three used them because there were no temporal bones. Surgical training was more satisfactory than out‐patient training. Fewer general clinics and more specialized clinics are required, and consultant supervision is still patchy and needs attention.     

Meaning and normativity in nurse–patient interaction

Abstract It is a fundamental assumption in nursing theory that it is important for nurses to understand how patients think about themselves and the contexts they are in. According to modern theories of hermeneutics, a nurse and a patient must share the same concepts in order to communicate beliefs with the same content. But nurses and patients seldom understand medical concepts in exactly the same way, so how can this communicative aim be achieved in interaction involving medical concepts? The article uses a theory of concepts from recent cognitive science and philosophy of mind to argue that nurses and patients can share medical concepts despite the diversity of understanding. According to this theory, two persons who understand medical language in different ways will nevertheless possess the same medical concepts if they agree about the normative standards for the applications of the concepts. This entails that nurses and patients normally share medical concepts even though patients’ conceptions of disease and illness are formed in idiosyncratic ways by their social and cultural contexts. Several practical implications of this argument are discussed and linked to case studies. One especially important point is that nurses should seek to make patients feel comfortable with deferring to a medical understanding. In many cases, an adequate understanding of patients presupposes that nurses manage to do this. Another implication is that deference‐willingness to normative meaning is not equivalent to the actual application of concepts. Deference‐willingness should rather be thought of as a pre‐communicative attitude that it is possible for patients who are not fully able to communicate to possess. What is important is that nurses and patients have the intention of conforming to the same meaning.     

吡酮酸类抗菌药物的研究Ⅷ.1-对氟苯基-6-氟-1,4-二氢-4-氧-7-(1-哌嗪)噌啉-3-羧酸及其类似物的合成和构效关系

为探讨构效关系,合成了1-对氟苯基-6-氟-1,4-二氢-4-氧-7-(1-哌嗪)噌啉-3-羧酸及其喹啉、萘啶、吡啶[2,3-C]哒嗪环系类似物16个。测定了对大肠杆菌的MIC。用Hückel分子轨道理论(HMO)方法计算了四个母体环上电子密度。结果表明:环中氮的位置对药效团——3位羧基和4位羰基氧原子上电子密度的影响较大而影响其抗菌活性。喹啉、萘啶两环系的3位羧基和4位羰基氧原子上的电子密度较高,其体外抗菌活性较高;而噌啉及吡啶[2,3-C]哒嗪两环系的电子密度较低,其体外抗菌活性较低甚至消失。     

Expressed emotion in children: associations with sibling relationships

Objective   To investigate the reliability and validity of the expressed emotion (EE) measure, the Pre-school Five Minute Speech Sample (PFMSS), in child-to-child sibling relationships.
Method   A total of 106 boys aged 7–11 were recruited from 12 mainstream primary schools in North Wales. The children completed the PFMSS regarding their sibling and two self-report measures of sibling relationship: the Sibling Relationship Questionnaire (SRQ) and a Child Visual Analogue Scale (CVAS). The parents of 60 participants completed the Strengths and Difficulties Questionnaire regarding the behavioural problems of the participating child and his younger sibling.
Results   The PFMSS demonstrated good inter-rater and code–recode reliability. The significant associations between EE dimensions such as relationship, positive comments and critical comments with various components of the SRQ and CVAS provided support for the concurrent validity of the PFMSS. Significantly higher levels of Conflict and Rivalry and significantly lower levels of Warmth/Closeness on the SRQ were reported by children with high EE, demonstrating good discriminant validity for the PFMSS. There was no significant association between the child's EE profile and the behavioural difficulties of both siblings as reported by parents.
Conclusions   The study found that the PFMSS is a valid and reliable measure of child EE. Future research is needed to clarify the concurrent validity of the warmth and initial statement components of the measure as well as the association between EE dimensions and behaviour.     

Lucian Leape on Patient Safety in U.S. Hospitals

PURPOSE: To describe and discuss the status of patient safety in U.S. hospitals. METHODS: Personal interview. This report is part of a series of discussions with a leading expert on patient safety. FINDINGS AND CONCLUSIONS: Some improvements have been made in the past 10 years. But changes have not been adequate. Continuing barriers include the punitive environment in hospitals, physicians' denial of the scope of the problem, lack of national leadership, and lack of systems thinking.     

Slow-wave photic stimulation relieves patient discomfort during esophagogastroduodenoscopy

Background and Aim: Although pretreatment with a sedative drug is effective in relieving pain during esophagogastroduodenoscopy (EGD), such drugs can cause significant side‐effects. The aim of this study was to examine the effect of slow‐wave photic stimulation on discomfort and/or pain felt during EGD. Methods: Forty consecutive patients (25 men and 15 women) who underwent diagnostic EGD in our hospital were included in the study. Twenty patients received photic stimulation for 25 min, and underwent electroencephalographic recording, in addition to the usual premedications. Twenty control patients received the same treatment but without photic stimulation. All patients evaluated the discomfort/pain felt during endoscopy against a five‐grade scale in comparison with what they had experienced in their previous examination. Results: Patients with an improved discomfort/pain score were 18/20 and 3/20 in the treated and control groups, respectively. Overall comparison of pain scores between both groups was significant (P < 0.0001). The proportion of slow‐wave activity recorded in patients’ electroencephalograms significantly increased in the treated group compared to control values (36.6 ± 6.8% vs 29.1 ± 3.4%, P < 0.001). There was a close correlation between the degree of discomfort/pain felt during endoscopy and the proportion of slow‐wave activity (P < 0.001). Conclusion: Slow‐wave photic stimulation shows promise as a treatment for relieving the discomfort and/or pain felt by patients undergoing EGD.     

移情对建立新型医患关系伦理模式的利与弊

在现代社会这样一个转轨时期，医患矛盾越来越突出，如何缓和医患关系、建立新型医患关系伦理模式成为大家共同关心的课题。作者从移情的角度入手，阐述了新型医患关系伦理模式的内涵，分析了移情对于缓和医患关系有哪些有利之处与不利之处，并提出了如何适度利用移情的方法，使其发挥最大作用。     

老年患者不稳定性股骨转子间骨折的术式选择

目的探讨不同的内固定方式在老年患者不稳定性股骨转子间骨折治疗中的应用。方法参照Evans分型,85例老年患者股骨转子间骨折,不稳定性77例,稳定性8例,分别应用不同内固定治疗,其中Gamma钉20例、重建钉25例、动力髋部螺钉(DHS)和动力髁部螺钉(DCS)40例。结果术后随访79例,均获得骨折愈合,愈合时间4～7个月,平均5.2个月,其中大于5°髋内翻者有12例。根据患者骨折愈合、关节活动、主观感觉与生活能力恢复等因素制定疗效评定标准,优良率为84.8%(67例)。未发生因本手术所致内科合并症加重或患者死亡。结论髋内翻是老年患者不稳定性股骨转子间骨折内固定术后的主要并发症。Evans分型对选择内固定具有指导意义。结合老年患者骨质疏松情况,针对不同骨折类型选用适当的内固定器械,可以提高不稳定性转子间骨折的疗效。     

师生关系之于医患关系的暗合与影响--兼论医学生医患平等意识与医患沟通能力的培养

师生关系与医患关系在人际交往的价值取向、人际交往的主要形式以及关系双方的不平衡性等方面都存在着暗合之处.因此,今日的师生关系对未来医患关系有着直接的影响和作用.教师应该通过平等的师生关系和良好的师生沟通,来培养医学生未来的医患平等意识与医患沟通能力.