小儿罗库溴铵量效关系不同测定方法的比较

目的研究单次法与二次、四次累积法对小儿罗库溴铵量效关系测定结果的影响.方法用TOF-Guard加速度肌松监测仪监测罗库溴铵的肌松效应.70例患儿随机分为三组:S组选择小儿40例用单次法、C2组选择患儿20例用二次累积法、C4组选择患儿10例用四次累积法建立量效关系曲线,算出各组ED50,ED90和ED95.结果单次法、二次累积法和四次累积法所测ED50分别为189,310和356μg/kg;ED90分别为199,326和376μg/kg;ED95分别为223,365和420μg/kg.四次累积法所测罗库溴铵的ED50,ED90与ED95大于单次法,而二次法所测结果与单次法无明显差异.结论二次累积法是一种准确而又节省样本的研究小儿罗库溴铵量效关系的好方法.     

从《医疗事故处理条例》的不足看医患关系建设的完善

从现行《医疗事故处理条例》的不足入手,对进一步完善医疗事故处理的法律规范作一分析探讨,并提出有效解决医疗事故,建立和完善良好的医患关系,促进我国医疗事业的发展的建议。     

医患关系的改善与社区卫生服务的发展

医患关系是影响社区卫生服务中心发展的关键因素之一。目前 ,我国社区卫生服务中心的医患关系虽较以往有较大的改善 ,但仍处于人际关系较低的合作水平。从多方面、深层次建立平等互利的新型医患关系 ,不仅是为了满足广大患者日益增长的健康需要 ,同时也是适应新医学模式发展和加快社区卫生服务中心发展的需要。本文认为应从转变传统的经营观念、改善服务态度、建立标准化的服务等六方面去改善当前的医患关系     

大学生异性关系信念与恋爱行为的相关研究

目的 :研究异性关系信念对大学生恋爱关系建立和维持的影响。方法 :采用异性关系信念量表 ,从大学 1～ 4年级本科生中抽取 5 6 8人进行异性关系信念测验 ,并对其恋爱经历进行调查。结果 :对有无恋爱经历的大学生的得分进行t检验时 ,只在“对默契的需求”一个维度上有显著性差异 (P <0 .0 1) ,χ2 检验显示 ,“对默契的需求”(P<0 .0 1)和“对分歧的容忍”(P <0 .0 5 )两个维度存在差异。对有无失恋经历的大学生得分进行t检验时 ,只在“对分歧的容忍”一个维度有显著差异 (P <0 .0 1) ,χ2 检验显示 ,“对分歧的容忍” (P <0 .0 1) ,“对默契的需求” (P <0 .0 5 )和“对两性差异的认同”(P <0 .0 5 )三个维度存在差异。结论 :异性关系信念与大学生恋爱关系的建立和维持关系密切。     

医德在医患关系中的价值实现

在医护活动中,医患关系是永恒的主题.如何使医患关系和谐、融洽,医护人员的道德水平和技能在医患关系中得以实现,十分重要.医德,只有通过医护人员在医护活动的实践中才能体现其崇高价值.     

Relative fees and the utilization of physicians' services in Canada

Study Question: The study objective is to estimate the relationship between changes in the relative fee physicians receive for a procedure and the utilization of the procedure. Data Sources/Study Setting: The study uses claims-based, procedure-specific, quarterly, aggregate utilization data for physicians in three specialties and four provinces in Canada for the period 1977–1989. Study Design: The unit of analysis is an individual procedure. Multi-variate regression methods for cross-sectional/times-series data are applied to estimate the utilization-fee relationship while controlling for supply- and demand-side determinants of utilization. Principal Findings: There is no evidence of a strong, uniform utilization response among the 11 procedures analyzed. The results include a mixture of significant and non-significant fee coefficients, and among the significant coefficients, a mixture of signs is observed. The results are consistent with utility-maximizing behaviour by physicians rather than with profit-maximizing behaviour. Conclusions: The fact that the direction and degree of the utilization effect associated with changing fees is procedure-specific has direct implications for our ability to develop effective policies to modify physician behaviour that are based primarily on financial incentives, particularly those based on manipulating fees. The study also highlights the limitations of analyses based on aggregate data and suggests methodological approaches that have potential to overcome some of these limitations to fill gaps in our current knowledge.     

Na+ channel modulation and force-frequency relationship in human myocardium

The enhancement of force of contraction (FOC) following increasing frequencies of stimulation is an important mechanism of positive inotropy in human myocardium. The present study aimed to investigate the influence of alterations in Na⁺ influx on FFR in human myocardium. Isometric FOC of electrically stimulated right auricular trabeculae (AUT, n=12) from human nonfailing hearts (n=8) was measured at different stimulation rates (0.5-3 Hz) under control conditions, after increasing Na⁺ influx by the addition of (±)BDF 9148 (BDF, 3 μmol l^-1) and after decreasing Na⁺ influx by the addition of lidocaine (LIDO, 10 μmol l^-1). Additionally, the rate dependent changes in diastolic tension (DT) were measured in all experiments. Under control conditions FOC increased with increasing frequencies of stimulation. The rate at which maximal FOC was observed (SFmax) was 2.0±0.2 Hz and maximal increase in FOC (PIEmax) by increasing frequency of stimulation was +1.5±0.5 mN. After increase of Na⁺ influx by BDF (3 μmol l^-1) SFmax was decreased to 0.8±0.1 Hz (p<0.05 versus control) and PIEmax was +0.1±0.3 mN (p<0.05). When Na⁺ influx was diminished by LIDO (10 μmol l^-1) SFmax and PIEmax were increased compared to control (2.4±0.1 Hz and +4.1±0.9 mN, p<0.05 versus control). The diastolic tension (DT) of AUT at 3 Hz was not changed at higher rates in the control group and after application of LIDO (10 μmol l^-1), whereas after enhancement of Na⁺ influx by BDF there was an increase in DT of +0.7±0.2 at 3Hz (p<0.05 versus control and LIDO). An enhanced Na⁺ influx leads to a decrease in the optimal frequency and to a smaller force potentiation by higher stimulation rates which could be at least partly due to incomplete relaxation at higher frequencies, whereas a reduced Na⁺ influx is followed by opposite alterations. It is concluded that besides Ca²⁺ handling also Na⁺ influx and Na⁺ homeostasis might determine the frequency-induced force potentiation in human myocardium. Thus, the negative FFR in diseased human myocardium might result from changes in cellular Ca²⁺ or Na⁺ regulatory sites. Received: 20 November 1996 / Accepted: 21 February 1997     

Can we develop improved derivatives of valproic acid?

Valproic acid is one of the major antiepileptic drugs. In animal models, valproate showed less anticonvulsant potency than the other three established antiepileptic drugs: phenobarbital, phenytoin and carbamazepine. In addition, two major side-effects, teratogenicity and hepatotoxicity, have been associated with valproate Iherapy. Due to the above and the shortage of new antiepileptic drugs there is a substantial need to develop improved derivatives of valproate. This paper analyses three kinds of valproate derivatives: valpromide, the primary amide of valproate, and its analogues; monoester prodrugs of valproate and an active metabolite of valproate, 2-n-propyl-2-pentenoate. The comparative evaluation was carried out by pharmacokinetic and pharmacodynamic analyses in animals. From the data accumulated so far, we can conclude that 2-n-propyl-2-pentenoatc and/or a valpromide isomer, which does not undergo amide acid biotransformation and preferably is not an epoxide hydrolase inhibitor, may prove to be improved derivatives of the parent compound valproic acid.     

芬太尼贴剂用于外科术后镇痛的临床研究

目的　 探讨芬太尼缓释透皮贴剂用于外科术后镇痛的安全性和时效关系。方法　 将 12 3例择期上腹部手术病人随机分成 4组 :T1组 2 9例 ,T2组 31例 ,T3组 33例 ,C组 30例。T1、T2、T3组分别于术前 1h、6h、12h在胸骨上端皮肤贴 5mg芬太尼贴剂 2片 (药物释放速度 10 0 μg h) ,C组贴不含药物的贴片。术毕病人清醒后记录各组病人疼痛分值 (视觉模拟评分法VAS) ,盐酸哌替啶用量和恶心、呕吐、呼吸困难、眩晕、便秘、尿潴留等副反应的发生率。结果　 镇痛效果 :4组VAS在各个时段相比具有显著性差异。T1、T2、T3组VAS与C组比较 ,均有显著性差异 (P <0 .0 1)。T2组 4h、8h时段的VAS评分均优于T1组 ,T2、T3组 ,每个评价时段的VAS无显著性差异。T1组与T2组相比 ,在恶心、呕吐、烦躁等方面具有显著性差异 (P <0 .0 5 ) ,在其他方面无显著性差异。结论　10 0 μg h芬太尼透皮贴剂术前 6h给药用于上腹部手术后镇痛是安全的 ,并可获得最佳镇痛效果     

Gadow's relational narrative: an elaboration

Nurse philosopher Sally Gadow (1999) has proposed the relational narrative between patient and nurse as a ‘postmodern turn’ for nursing ethics. She has conceptualized this moral approach as the construction by patient and nurse of a coauthored narrative describing the good they are seeking, as well as the means to achieve this good. The purpose of this article is to provide an elaboration of Gadow's seminal conceptualization of relational narrative based on her writings and those of other philosophers. The article will further develop relational narrative's foundations in relationship and narrative and will explore engagement as a dimension essential to its creation and growth. The elaboration first builds on the notion of relationship as foundational to this postmodern moral perspective. Narrative then is advanced as being at the heart of the patient–nurse relationship and their relational narrative, based on an exploration of narrative's role in the moral realm as an epistemology for patient and nurse. Finally, the dialogic and embodied engagement expressed by a relational narrative is developed as a critical element of the ethic.