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991.
针对文献检索部分教学内容抽象、枯燥、容易混淆,难以理解和掌握等问题,在分析类比含义的基础上,将类比思维应用于文献检索教学中,并结合实际教学举例阐述了类比联想在文献级别等概念中的应用和类比推理在CBM和Pub Med数据库讲解中的应用,教学实践证明类比法对重点、难点知识的讲解能够达到由浅入深、化难为易的教学效果,对提高学生分析问题、解决问题的能力和创新思维的培养具有较好效果。  相似文献   
992.
信息化建设中医疗大数据现状   总被引:2,自引:1,他引:1       下载免费PDF全文
介绍了医疗大数据的多维性、不完整性、时序性、冗余性等特点,医疗大数据主要来自医疗服务方、医疗保险方、卫生行政方、医药和医疗器械生产流通方、因特网医疗和生命科学,主要应用于药品研发、疾病诊疗、医疗保险、智能决策、个人健康管理等方面及其面临的数据整合、数据存储、数据共享、人才缺乏和隐私保护等问题的挑战。  相似文献   
993.

Background

Real time 1:1 videoconferencing (VC) has the potential to play an important role in the management of orthopaedic pathologies. Despite positive reporting of telemedicine studies uptake in clinical practice remains low. Acceptability to patients is an important element of system take-up in telemedicine and a focus towards qualitative methodology may explore the underlying reasons behind its acceptability. In this paper we have systematically reviewed qualitative studies that include evidence about patient responses to VC services in an orthopaedic setting.

Objectives

To determine whether real time 1:1 videoconferencing is acceptable to patients in an orthopaedic setting.

Data sources

MEDLINE, AMED, PsychINFO, CINAHL, SCOPUS, Cochrane Database, Evidence Search and Open Grey were searched with forwards and backwards reference screening of eligible papers.

Eligibility criteria

Qualitative studies exploring the acceptability of VC in an orthopaedic setting were included.

Study appraisal and synthesis methods

Studies were appraised using the CASP tool. A Directed Content Framework Analysis was conducted using Normalisation Process Theory.

Results

Four studies were included for review. The themes for the four studies did not overlap and did not report clinician acceptability of VC. The Directed Content Analysis of these papers using Normalisation Process Theory highlighted factors which contribute towards its acceptability.

Conclusions

All studies concluded that the use of VC was acceptable. Further qualitative research exploring both patient and clinician acceptability is required utilising a theoretical framework to allow for repeatability and generalisability.
Systematic Review Registration Number: PROSPERO CRD42015024944.  相似文献   
994.
The purpose of this Special Communication is to summarize guidelines and recommendations stemming from an expert panel convened by the National Institutes of Health, National Center for Medical Rehabilitation Research (NCMRR) for a workshop entitled The Future of Medical Rehabilitation Clinical Trials, held September 29-30, 2016, at the NCMRR offices in Bethesda, Maryland. The ultimate goal of both the workshop and this summary is to offer guidance on clinical trials design and operations to the medical rehabilitation research community, with the intent of maximizing the effect of future trials.  相似文献   
995.

Objective

To compare virtual reality (VR) combined with functional electrical stimulation (FES) with cyclic FES for improving upper extremity function and health-related quality of life in patients with chronic stroke.

Design

A pilot, randomized, single-blind, controlled trial.

Setting

Stroke rehabilitation inpatient unit.

Participants

Participants (N=48) with hemiplegia secondary to a unilateral stroke for >3 months and with a hemiplegic wrist extensor Medical Research Council scale score ranging from 1 to 3.

Interventions

FES was applied to the wrist extensors and finger extensors. A VR-based wearable rehabilitation device was used combined with FES and virtual activity–based training for the intervention group. The control group received cyclic FES only. Both groups completed 20 sessions over a 4-week period.

Main Outcome Measures

Primary outcome measures were changes in Fugl-Meyer Assessment–Upper Extremity and Wolf Motor Function Test scores. Secondary outcome measures were changes in Box and Block Test, Jebsen-Taylor Hand Function Test, and Stroke Impact Scale scores. Assessments were performed at baseline (t0) and at 2 weeks (t1), 4 weeks (t4), and 8 weeks (t8). Between-group comparisons were evaluated using a repeated-measures analysis of variance.

Results

Forty-one participants were included in the analysis. Compared with FES alone, VR-FES produced a substantial increase in Fugl-Meyer Assessment–distal score (P=.011) and marginal improvement in Jebsen-Taylor Hand Function Test–gross score (P=.057). VR-FES produced greater, although nonsignificant, improvements in all other outcome measures, except in the Stroke Impact Scale–activities of daily living/instrumental activities of daily living score.

Conclusions

FES with VR-based rehabilitation may be more effective than cyclic FES in improving distal upper extremity gross motor performance poststroke.  相似文献   
996.

Objective

To investigate response shift effects in spinal cord injury (SCI) over 5 years postinjury.

Design

Prospective cohort study observed at 1, 2, and 5 years post-SCI.

Setting

Specialized SCI centers.

Participants

Sample included 1125, 760, and 219 participants at 1, 2, and 5 years post-SCI (N = 2104). The study sample was 79% men; 39% were motor/sensory complete (mean age, 44.6±18.3y).

Interventions

Not applicable.

Main Outcome Measures

Patient-reported outcomes included the Medical Outcomes Study 36-Item Short-Form Health Survey version 2 and the Life Satisfaction-11 Questionnaire. Participant latent variable scores were adjusted for (1) potential attrition bias and (2) propensity scores reflecting risk of worse outcomes. The Oort structural equation modeling approach for detecting and accounting for response shift effects was used to test the hypothesis that people with SCI would undergo response shifts over follow-up.

Results

The study data comprised the time after FIM scores, an objective measure of motor and cognitive function, had improved and stabilized. Three latent variables (Physical, Mental, and Symptoms) were modeled over time. The response shift model indicated uniform recalibration and reconceptualization response shift effects over time. When adjusted for these response shift effects, Physical showed small true change improvements at 2- and 5-year follow-up, despite FIM stability.

Conclusions

We detected recalibration and reconceptualization response shift effects in 1- to 5-year follow-up of people with SCI. Despite stable motor and cognitive function, people with SCI are adapting to their condition. This adaptation reflects a progressive disconnection between symptoms and physical or mental health, and a real improvement in the Physical latent variable.  相似文献   
997.

Objective

To identify important sources of distress among burn survivors at discharge and 6, 12, and 24 months postinjury, and to examine if the distress related to these sources changed over time.

Design

Exploratory.

Setting

Outpatient burn clinics in 4 sites across the country.

Participants

Participants who met preestablished criteria for having a major burn injury (N=1009) were enrolled in this multisite study.

Interventions

Participants were given a previously developed list of 12 sources of distress among burn survivors and asked to rate on a 10-point Likert-type scale (0=no distress to 10=high distress) how much distress each of the 12 issues was causing them at the time of each follow-up.

Main Outcomes Measures

The Medical Outcomes Study 12-Item Short-Form Health Survey was administered at each time point as a measure of health-related quality of life. The Satisfaction With Appearance Scale was used to understand the relation between sources of distress and body image. Finally, whether a person returned to work was used to determine the effect of sources of distress on returning to employment.

Results

It was encouraging that no symptoms were worsening at 2 years. However, financial concerns and long recovery time are 2 of the highest means at all time points. Pain and sleep disturbance had the biggest effect on ability to return to work.

Conclusions

These findings can be used to inform burn-specific interventions and to give survivors an understanding of the temporal trajectory for various causes of distress. In particular, it appears that interventions targeted at sleep disturbance and high pain levels can potentially effect distress over financial concerns by allowing a person to return to work more quickly.  相似文献   
998.
目的:对比分析国内外MOOC医学课程现状,为中国学习者提供高效便捷的MOOC医学课程及远程医学教育。方法:对Coursera、edX、“中国大学MOOC”、“人卫慕课”4家平台的医学课程在数量、授课大学、授课语言、课程认证及中外MOOC医学课程的发展现状进行了对比分析。结果:中国的MOOC医学课程在数量、规模、认证方式等方面与国外还存在一定差距。结论:国内医学工作者应抓住机遇,为国内学习者提供更为便利高效的MOOC医学学习平台。  相似文献   
999.
结合学生意见和建议,总结分析了医学文献检索课教学中存在的问题,针对这些问题提出了改进教学硬件设备、改变教学方式、开通多种课后答疑和辅导途径、强化学生的信息技能、完善课程考核形式等改革措施。  相似文献   
1000.

Aim

To propose nursing clinical practice changes to improve the development of patient self‐management.

Background

Chronic obstructive pulmonary disease is one of the main causes of chronic morbidity, loss of quality of life and high mortality rates.

Introduction

Control of the disease's progression, the preservation of autonomy in self‐care and maintenance of quality of life are extremely challenging for patients to execute in their daily living. However, there is still little evidence to support nursing clinical practice changes to improve the development of self‐management.

Methods

A participatory action research study was performed in a medicine inpatient department and the outpatient unit of a Portuguese hospital. The sample comprised 52 nurses and 99 patients. For data collection, we used interviews, participant observation and content analysis.

Results

The main elements of nursing clinical practice that were identified as a focus for improvement measures were the healthcare model, the organization of healthcare and the documentation of a support decision‐making process. The specific guidelines, the provision of material to support decision‐making and the optimization of information sharing between professionals positively influenced the change process. This change improved the development of self‐management skills related to the awareness of the need for ‘change’, hope, involvement, knowledge and abilities.

Discussion

The implemented changes have improved health‐related behaviours and clinical outcomes.

Conclusion

To support self‐management development skills, an effective nursing clinical practice change is needed. This study has demonstrated the relevance of a portfolio of techniques and tools to help patients adopt healthy behaviours.

Implications for nursing and/or health policy

The involvement and participation of nurses and patients in the conceptualization, implementation and evaluation of policy change are fundamental issues to improve the quality of nursing care and clinical outcomes.  相似文献   
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