那他霉素粗粉精制工艺优化

目的 优化那他霉素粗粉精制工艺,提高其精粉质量。方法 采用正交对比试验方法,对那他霉素粗粉溶解剂、粗粉溶液浓度、结晶溶液pH、淋洗挖洗影响、挖洗剂种类等精制工艺条件进行优化。结果 成功开发了那他霉素粗粉的精制优化工艺,即：粗粉溶解剂为75%甲醇-水溶液、粗粉溶液浓度为(25000±1000)u/mL、结晶溶液pH为6.0~7.0、结晶后沉淀需要用75%丙酮-水溶液淋洗后再挖洗,该工艺制备的那他霉素精粉纯度高达99.84%、收率可达94.05%,杂质含量为0.2%。结论 那他霉素粗粉精制工艺经优化后,大幅提高了精粉质量,且工艺稳定可行,可用于放大生产。     

Quality of diabetes care predicts the development of cardiovascular events: results of the QuED study

Background and aimIn the context of the QuED Study we assessed whether a quality of care summary score was able to predict the development of cardiovascular (CV) events in patients with type 2 diabetes.Methods and resultsThe score was calculated using process and intermediate outcome indicators (HbA_1c, blood pressure, low-density lipoprotein cholesterol, microalbuminuria) and ranged from 0 to 40. Overall, 3235 patients were enrolled, of whom 492 developed a CV event after a median follow-up of 5 years. The incidence rate (per 1000 person-years) of CV events was 62.4 in patients with a score ≤10, 54.8 in those with a score between 15 and 20, and 39.8 in those with a score >20. In adjusted multilevel regression models, the risk to develop a CV event was 89% greater in patients with a score of ≤10 (rate ratio [RR] = 1.89; 95% confidence interval [CI] 1.43–2.50) and 43% higher in those with a score between 10 and 20 (RR = 1.43; 95% CI 1.14–1.79), as compared to those with a score >20. A difference between centers of 5 points in the mean quality score was associated with a difference of 16% in CV event risk (RR = 0.84; 95% CI 0.72–0.98).ConclusionOur study documented for the first time a close relationship between a score of quality of diabetes care and long-term outcomes.     

基于 BPR 医学实习管理系统的设计与开发

针对临床实习教学管理中存在的问题,设计开发了基于 Web 的医学实习管理系统。该系统以业务流程再造（business process reengineering,BPR）思想为指导,使用 ROR 敏捷开发框架进行系统设计与开发。系统使用后满意度调查结果显示：实习管理系统的八项满意度指标的平均分为3．29～3．71,说明使用者对系统的整体满意度较高。该系统改变了以往以医院为主导、学校间接参与的管理模式,从真正意义上实现了“教务处—学院—医院”三方管理,提高了临床实习管理效率。     

高职院校食品安全检测课程教学实践改革探索

食品安全检测课程的教学改革具有重要意义,在教学中既要强化学生的食品安全意识和社会责任感,也要培养学生与社会需求对接的实际操作能力.食品安全检测课程的教学改革主要采取将理论教学与实验教学相结合的手段,改革以学校和课堂为中心的传统人才培养模式,设计与实施各实践教学环节,实施理实一体化的教学方式.以高职医学院校食品安全检测实践课程为探索对象,以职业能力培养为重点,阐述食品安全检测课程对实践教学及过程进行控制,减少教学过程中教与学的随机性,极大提升学生的学习和研究兴趣.     

正交试验法优选桃红四物汤醇提工艺

目的：优选桃红四物汤的醇提工艺。方法：以总黄酮含量和浸膏得率为考察指标,以乙醇浓度、乙醇用量、提取时间、提取次数为考察因素,采用正交试验优选桃红四物汤的最佳醇提工艺。结果：桃红四物汤的最佳醇提工艺为加6倍量80％乙醇提取三次,每次1．5h。结论：优选出的桃红四物汤的醇提工艺合理、稳定,可为其工业化生产提供参考。     

舒心病房护理流程优化的探究和分析

目的：对静脉输液流程优化在舒心病房中的应用效果进行分析。方法建立流程管理组,并采取优化措施,对护理人员进行培训,监督反馈优化后流程执行情况。结果在药液核对分配时间、肝素封管时间以及换液时间方面,优化前后有明显差异(P<0.05)。流程优化以后,病房整体满意度为93.75%(75/80)、输液满意度为96.25%(77/80)。结论在对舒心病房输液流程进行优化以后,加强输液环节质量,使患者满意度得以提高,缩短患者等待时间。     

操作技能直接观察评估在全科医学科毕业实习中的应用效果研究

背景　操作技能直接观察评估（DOPS）是评估者通过直接观察学生技能操作的过程即时给予评估和反馈,是一种具有教学功能的形成性评价工具,能够客观、全面地评估学生的学习过程。将DOPS引入全科医学专业教学评价具有重要意义。目的　探讨在全科医学科毕业实习中应用DOPS进行形成性评价的意义和效果。方法　于2018年9-10月,采用整群抽样方法选择中国医科大学2013级七年制临床医学专业学生72例为研究对象。采用随机数字表法将72例学生随机分为试验组和对照组,每组36例。试验组和对照组学生均安排在中国医科大学附属第一医院全科医学科病房参加为期1周的实习;实习结束后,进行为期1周的临床实践。对照组的临床实践操作技能培训采用传统带教方法,试验组在1周的临床实践过程中开展2次DOPS形成性评价,两组由相同教师授课。轮转结束时,应用小型临床评价演练（Mini-CEX）、临床技能操作评分、理论考试及问卷调查法进行教学评价。结果　试验组学生的理论考试成绩与对照组比较,差异无统计学意义（P>0.05）。试验组和对照组学生的临床技能操作得分分别为（76.67±6.20）、（72.50±7.66）分,组间差异有统计学意义（P<0.05）。两组Mini-CEX成绩比较：试验组学生体格检查、人文关怀、沟通技巧、整体表现得分高于对照组,差异有统计学意义（P<0.05）。DOPS临床操作时间为（11.32±1.76）min,反馈时间为（13.14±2.21）min,合计时间为（24.46±1.97）min。>80%的学生认为DOPS有利于发现自身操作中的小问题、有助于感受到教师的重视和关怀、可行性强、可以提高操作技能、培养人文素养和交流沟通能力。结论　在全科医学科毕业实习中开展DOPS作为形成性评价可以有效提高学生临床技能操作和Mini-CEX成绩,改善教学效果。     

Alcohol-related effects on automaticity due to experimentally manipulated conditioning

Background: The use of alcohol is associated with various forms of automatic processing, such as approach tendencies and attentional biases, which may play a role in addictive behavior. The development of such automaticity has generally occurred well before subjects perform tasks designed to detect them. Although it seems plausible that this development involves some form of alcohol‐related conditioning, this process is not usually included in the experimental procedure. Methods: The development of automaticity involving alcoholic or nonalcoholic stimuli was experimentally manipulated via a conditioning task. Subjects were presented with pairs of stimuli from a set of 4 stimuli: 2 pictures of alcoholic beverages, and 2 pictures of nonalcoholic beverages. One of the alcoholic and 1 of the nonalcoholic beverages was associated with reward, the other stimuli with punishment. Subjects had to learn to select the rewarded stimuli from pairs of 1 rewarded and 1 punished stimulus. The task, thus experimentally established reward versus punishment stimulus–response–outcome associations, for alcoholic and for nonalcoholic stimuli. Subsequently, a cued reversal task was used to test automaticity involving alcoholic versus nonalcoholic, and rewarded versus punished stimuli. Results: An association was found between heavier drinking and an alcohol‐related conditioning bias: heavier drinkers had more difficulty overcoming a conditioned response when it involved selecting a previously punished nonalcoholic stimulus over a previously rewarded alcoholic stimulus. Conclusions: The study provided novel information on secondary reinforcement involving alcoholic stimuli: heavier drinkers may more easily develop automaticity related to alcohol‐reward contingencies. This may have implications for interventions and the interpretation of findings concerning alcohol‐related automatic processing.     

Selection of criteria for assessment of occlusal acceptability

There is no general agreement on criteria that could be applied to distinguish between orthodontically acceptable and non-acceptable occlusions after the completion of dental development. The aim of the present study was to analyse morphological and functional features that could be used as an index to define an acceptable occlusion in young adults. Three expert panels representing specialists in orthodontics and stomatognathic physiology participated in a modified Delphi method. Each panel responded to a questionnaire concerning the usefulness of various occlusal features, and a set of characteristics was selected on the basis of the responses; thereafter, applicability of the chosen characteristics and their cutoffs for an acceptable-non-acceptable dichotomy was tested clinically. To obtain a consensus level of 100%, the last panel session was completed with a group discussion. Assessments made using the morphological criteria were compared with those made with the dental health component of the Index of Orthodontic Treatment Need. The selected morphological characteristics consisted of overjet, overbite, canine relationship, crossbite, scissors bite and midline deviation. The functional evaluation comprised assessments of discrepancy between the centric relation and the intercuspal position, working- and non-working-side contacts and protrusion contacts. The dental health component and our morphological criteria showed different sensitivity to contact point displacements, interdigitation in buccal segments and increased overbite. This study provides a set of morphological and functional indicators reflecting the current consensus opinion of Finnish professionals. Further studies are needed to analyse the reproducibility of assessment of the characteristics included.     

达芬奇机器人手术配合流程再造及效果评价

目的 优化达芬奇机器人手术配合流程,提高工作效率.方法 收集2013年1月至2013年9月,在我院实施的达芬奇机器人手术236例.对手术配合流程进行再造,对流程再造前后手术医师、手术室护士的满意度,开台时间采用1检验和x2检验统计分析.结果 流程再造后,开台时间与流程再造前比较,存在统计学差异（P＜0.05）.手术医师、手术室护士的满意度较再造前提高（P＜0.05）.结论 达芬奇机器人手术配合流程再造有利于提高手术室的工作效率.