PBL教学在医学影像技术专业见习教学中的应用

目的 探讨基于问题的学习（PBL）教学模式在医学影像技术专业学生见习教学中的应用效果。方法 选取2018 年3 月～2019 年6 月温州医科大学仁济学院2015 级和2016 级60 名医学影像技术专业本科生作为研究对象,以抽签法随机分组,其中PBL 组26 名,对照组34 名。教学结束后对两组学生进行考核和问卷调查,评价教学效果。结果 两组理论知识考核比较,差异无统计学意义（P=0.792）,实践操作知识考核PBL 组优于对照组（P=0.041）;PBL 组在提升学生学习兴趣（P=0.036）、提高自学能力（P=0.003）、医患沟通能力（P=0.004）、影像操作思维能力（P=0.023）和科研思维能力（P=0.005）方面优于对照组,在加深课堂知识理解方面PBL 组与对照组比较,差异无统计学意义（P=0.842）。结论PBL 应用于见习教学模式,有助于提升医学影像技术专业学生综合素质,获得较好的教学效果。     

Do maternal attributions play a role in the acceptability of behavioural interventions for problem behaviour in children with autism spectrum disorders?

The present study explored the relationship between parental attributions and treatment acceptability of behavioural interventions for problem behaviour in children with autism spectrum disorders (ASD). Mothers of children with ASD aged 3–9 years (N = 139) completed survey measures that assessed demographics, parental attributions, treatment acceptability of parent-focused and child-focused behavioural interventions, severity of their child's disruptive behaviour, and severity of their child's ASD symptoms. The results showed that parental attributions of parent-referent stability, but not the other attributional dimensions, negatively predicted treatment acceptability of a parent-focused behavioural intervention, even when severity of disruptive behaviour was statistically controlled. Conversely, no associations were found between any attributional dimension and treatment acceptability of a child-focused behavioural intervention. Preliminary analyses also revealed that mothers’ ratings of the severity of their child's disruptive behaviour were significantly negatively associated with the acceptability of both parent-focused and child-focused behavioural interventions. The findings have potential implications for professionals to identify and challenge distorted attributions of parent-referent stability to promote parental acceptance of a parent-focused behavioural intervention for problem behaviour in children with ASD.     

SYFSA: A framework for Systematic Yet Flexible Systems Analysis

Although technological or organizational systems that enforce systematic procedures and best practices can lead to improvements in quality, these systems must also be designed to allow users to adapt to the inherent uncertainty, complexity, and variations in healthcare. We present a framework, called Systematic Yet Flexible Systems Analysis (SYFSA) that supports the design and analysis of Systematic Yet Flexible (SYF) systems (whether organizational or technical) by formally considering the tradeoffs between systematicity and flexibility. SYFSA is based on analyzing a task using three related problem spaces: the idealized space, the natural space, and the system space. The idealized space represents the best practice—how the task is to be accomplished under ideal conditions. The natural space captures the task actions and constraints on how the task is currently done. The system space specifies how the task is done in a redesigned system, including how it may deviate from the idealized space, and how the system supports or enforces task constraints. The goal of the framework is to support the design of systems that allow graceful degradation from the idealized space to the natural space. We demonstrate the application of SYFSA for the analysis of a simplified central line insertion task. We also describe several information-theoretic measures of flexibility that can be used to compare alternative designs, and to measure how efficiently a system supports a given task, the relative cognitive workload, and learnability.     

The relation of parental practices and self-conceptions to young adolescent problem behaviors and substance use

The object of the present research was to examine the role of parenting practices for young adolescent psychosocial adjustment and self-regulation problems. The sample included 287 sixth- and seventh-grade subjects from intact families. The participants completed a questionnaire that measured variables including family interaction, parental involvement in children's activities, parental support, joint decision-making, and monitoring of children's behavior. Children's involvement with friends, after-school activities, school achievement, and self-reported externalizing behaviors (problem behaviors, cigarette and alcohol use) were also measured. Self-concept domains (scholastic competence, social acceptance, and behavioral conduct) were assessed with Harter's Self-Perception Profile. The findings indicated that self-conceptions of positive behavioral conduct and higher parental monitoring of children's activities were consistently negatively related to young girls' and boys' behavior problems and substance use. Parental monitoring was higher for girls and for younger children. Lower monitoring was also related to children's pattern of after-school activities that were connected to at-risk behavior. Parental involvement and supervision of children's day-to-day activities seem particularly important in socializing children's behavior at the time of early adolescence.     

腹主动脉瘤腔内修复术中输送器回撤困难的处理对策

目的:探讨腹主动脉瘤(AAA)腔内修复术(EVAR)中输送器回撤困难的原因处理对策。方法:回顾性分析2008年1月—2016年4月305例行EVAR的AAA患者临床资料,分析术中输送器回撤困难发生的原因及相应对策。结果:305例患者中,共21例(6.89%)出现输送器回撤困难,其中复杂AAA 18例,非复杂AAA 3例;分体式支架修复17例,一体化支架修复4例,差异均有统计学意义(85.7%vs.14.3%;81.0%vs.19.0%,均P0.05)。18例出现回撤困难复杂AAA患者均存在瘤颈严重扭曲,其中7例存在2个以上连续扭曲瘤颈,2例扭曲同时伴有短瘤颈;在所有存在扭曲瘤颈的患者中,有2个以上连续扭曲瘤颈患者回撤困难的发生率最高(P0.05)。21例回撤困难情况通过综合运用相关处理对策均成功解决。结论:复杂AAA的EVAR发生输送器回撤困难情况并不少见,尤其是存在2个以上连续扭曲瘤颈的更易发生,通过综合运用相应对策可有效处理。     

我国药品生产企业个例药品不良反应收集现状及其思考

分析我国药品生产企业个例药品不良反应监测能力不足、上报意识不强等现状,借鉴美国、欧盟药品生产企业收集个例药品不良反应方法和经验,探讨既符合我国法律法规要求,又适应国内药品生产企业实际情况,能够切实可行的提高生产企业个例药品不良反应收集水平的对策。     

父母及教师对学龄前儿童行为问题评估的一致性及差异研究

背景 儿科医生经常面临父母和教师对孩子行为问题报告不一致的情况,但既往关于父母和教师对学龄前儿童行为问题评估的研究较少。 目的 调查重庆市主城区学龄前儿童行为问题的现状,探讨父母及教师对学龄前儿童行为问题评估的一致性及差异。 方法 于2018年6月,采用分层整群抽样法,在重庆市主城区幼儿园抽取学龄前儿童2 698例。儿童家长填写Conners父母用症状问卷（PSQ）,教师填写Conners教师量表（TRS）,比较基于PSQ和TRS的行为问题检出情况。 结果 最终纳入问卷被有效回收的学龄前儿童2 660例（98.59%）。基于PSQ的儿童行为问题检出率为14.47%（385/2 660）,男童高于女童〔17.91%（245/1 368）比10.84%（140/1 292）,P<0.001〕;基于TRS的儿童行为问题检出率为4.44%（118/2 660）,男童亦高于女童〔6.29%（86/1 368）比2.48%（32/1 292）,P<0.001〕。PSQ中,男童在学习问题、心身问题、多动指数上的检出率高于女童（P<0.05）;TRS中,男童在品行问题、多动指数上的检出率高于女童（P<0.05）。PSQ中,男童在品行问题、学习问题、冲动-多动问题、多动指数4个因子上的得分高于女童（P<0.05）;TRS中,男童在品行问题、多动问题、注意力不集中-被动问题、多动指数4个因子上的得分高于女童（P<0.05）。Spearman秩相关分析结果显示：在男童中,TRS中品行问题、注意力不集中-被动问题、多动指数得分与PSQ中品行问题、学习问题、冲动-多动问题、多动指数得分呈正相关,TRS中多动问题得分与PSQ中品行问题、冲动-多动问题、多动指数得分呈正相关（rs值为0.056~0.113,P<0.05）,TRS中多动问题得分与PSQ中焦虑问题得分呈负相关（rs=-0.059,P<0.05）;在女童中,TRS中各因子得分与PSQ中各因子得分无相关关系（P>0.05）。 结论 家长反映的学龄前儿童行为问题检出率较教师高,家长及教师对学龄前儿童行为问题的评估虽然存在一定差异,但在品行问题、多动方面的评估一致性较好。     

以患者为中心以问题为导向的外科护理学课间见习带教方法的探讨

目的探讨以患者为中心，以问题为导向的外科护理学课间见习带教方法和效果。方法对本校护理专业四年级35名学生分5组进行为期1周的课间见习带教。按照深入病房，准备患者；分配学生，主管患者；指导评估，发现问题；引导看书，分析问题；确定方案，解决问题；组织查房，评价效果的程序组织外科护理学课间带教；制订多元化评价指标评定成绩的方法。结果本阶段护理课间见习阶段，学生主管患者48例；经过护理评估后提出的护理诊断75条；制订的护理措施204条；患者健康问题得到解决的有51条占68．0％，部分解决的有20条占26．7％，没有解决4条占5．3％。学生整体护理报告的优良率为95．4％；患者对学生的满意率为90．0％；在《外科护理学》期末考试中，接受新带教方法学生的成绩明显高于接受传统带教法的学生（P〈0．01）。结论以患者为中心以问题为导向的外科护理学课间见习带教方法收到了良好的教学效果。     

Problem-solving skills and attributional styles of agoraphobics

Recent formulations of agoraphobia have emphasized the potential role of misattributional processes and dysfunctional problem solving in the development and maintenance of phobic anxiety and avoidance. The present study examined problem-solving skills and attributional styles as a function of experimentally induced success and failure experiences. Twenty-three female agoraphobics and 20 normals solved three sets of anagrams that differed in task difficulty. Subjects also completed an assessment battery that included measures of psychiatric symptomatology, interpersonal problem solving, and general attributional style. Analyses revealed that agoraphobics did not differ statistically from normals on cognitive problem-solving measures of anagram performance. Interpersonal problem-solving deficits were, however, exhibited for generating effective alternative solutions and selecting effective behavioral preferred responses. Moreover, agoraphobics differed from normals for globality attributions, perceived significance, anticipated future outcomes, and performance appraisals toward experimentally induced failure experiences. Conceptual, clinical, and research implications of these findings are discussed.This study is based on a master's thesis submitted by the first author in partial fulfillment of the requirements for the M.S. in psychology at the University of Pittsburgh. This research was supported in part by a grant from the National Institute of Mental Health (MH-36299) to the second author. Appreciation is expressed to Rich Ulrich, M.A., for statistical consultations, Karen Marchione, M.A., for clinical-research refinements, Scott Monroe, Ph.D., for methodological input, and Patricia Biller and Gigi Hart for technical assistance.