应用和推广烧伤皮肤再生医疗技术的体会(二)

目的：通过临床实践总结、分析、认识干细胞与再生医学理论在烧伤创疡中的作用与效果；方法：应用MEBT／MEBO观察烧伤创疡创面的再生修复变化。结果：MEBT／MEBO治疗77种创疡疾病冶愈率达92％以上，有效率达100％。结论：MEBT／MEN)治疗慢性体表性溃疡及皮肤病性皮肤损伤、感染性溃疡效果满意。     

Drawing the Boundaries: Exploring gender issues in young children's classifications of work using visual representations

This study examines young children's perceptions of work through a specific example. Reception class children at an inner city school were shown pictures of the same figure washing in four different contexts, ranging from housework to paid employment, in order to examine early classifications and conceptual systems relating to the concept of work and to ascertain whether these were gender related. Individual children varied in the complexity of their ideas, but the majority had not yet began to form hierarchical classifications of work which favour paid employment. There was evidence however that some children were beginning to devalue traditional women's work, suggesting that gender stereotypes are still prevalent amongst this age group, despite efforts by the educational system to counter this.     

The introduction of a new assessment system in restorative dentistry: the undergraduate and patient experience

In 2000, the University of Bristol Dental School Division of Restorative Dentistry carried out a review of the assessment methods used within the undergraduate programme. Following this review, a number of key recommendations were made and the system of formative assessment within the division was changed. Audits were conducted immediately prior to the introduction of the new system and 2 years after it had been introduced, the results of these audits are presented. There was no change in the number of failed appointments between the initial audit and the second audit. There was a reduction in the number of patients treated by more than one student from 25% to 14% (approximating to 3% if student withdrawal from the course is taken into account). The length of time taken to complete treatment reduced between the two audits with more than half of all patients having their treatment completed within 3 months of their initial examination in the second audit. Ninety-five percent of treatment plans were completed in the second audit compared with only 62% in the first audit. In the second audit, the outstanding 5% of cases were signed off as incomplete for satisfactory reasons by the member of supervisory staff (e.g. patients who had moved away or were discharged due to poor attendance). Student comments were mostly positive, the small number of negative comments related to some students being confused by the paperwork in the new system. The overall process has been an extremely positive experience which has resulted in an assessment system with increased clarity which appears to have reduced the stress levels reported by the undergraduate students on the programme and improved the quality of patient care within restorative dentistry.     

Assessment of postoperative pain: impact of clinical experience and professional role

Background: Unrelieved postoperative pain is still reported to be a rather common clinical problem which may be related to inadequate routines for pain assessment. Therefore, the aim of the study was to describe strategies used by experienced and less experienced nurses and physicians in their assessment of postoperative pain and to relate different approaches, clinical experience, and professional role to the accuracy of the pain ratings.
Methods: Data collection was based on repeated interviews with nurses (n=30) and physicians (n=30) in connection with clinical pain assessments (n=180) including VASscoring
Results: Commonly used strategies in the pain assessment were: - how the patient looks, - what the patient says, - the manner of talking, and - past experience of similar circumstances. The mean VAS-score given by the patients (6.1±21.1) was significantly (P<0.001) higher than that rated by the staff members (4.9±21.2). Nurses as well as physicians overestimated low and underestimated high levels of pain indicated by the patients. The accuracy of the ratings by nurses, especially by more experienced ones (≤10 years in nursing), was found to be less precise than that of physicians. The pain assessment of these very experienced nurses was characterized by a systematic underestimation.
Conclusions: The present study emphasizes a need for definition of more precise strategies for clinical postoperative pain assessment which better take into consideration the pain experiences and needs of individual patients     

开展卫勤指挥员任职培训的教学实践和体会

近几年来,第二军医大学卫生勤务学系承担了大量卫勤指挥员的任职培训任务.通过几年的理论研究和实践摸索,在教学的组织、管理、实施、保障等方面积累了一些经验,获得了一些具体的体会.我们认为要做好卫勤指挥员的任职培训教学必须明确培训目标,科学制定教学方案,精心安排教学内容,做好施训教员的培训,并在教学中注重合理运用教学方法,特别是要做好下部队调研,切实提高教学实效.     

王国三治疗脱疽（血栓闭塞性静脉炎）用药特点

介绍国医大师王国三治疗脱疽热毒血瘀型用药特点。依据脱疽的病因病机，从其整体辨证论治，通过用药及药量的加减变化达到治疗目的。     

汪明德主任医师治疗崩漏经验

汪明德主任医师治疗崩漏有其独特的理论和用药。主张崩、漏分治:暴崩者止血截流为急务;漏下者虚实分治。     

何首乌"补肝肾、益精血、强筋骨"功效相关的药理研究

目的:从现代药理学角度阐述何首乌"补肝肾、益精血、强筋骨"功效.方法:通过查阅中国期刊全文数据库(CNKI)、维普全文数据库(VIP)等,分析1989～2007年期间与何首乌功效与药理相关文献,归纳汇总何首乌的中药功效及现代药理学研究,探讨两者间的相关性.结果:[1]何首乌药理作用与其性味归经功效有相合之处.何首乌性温味苦涩,温能补肝,苦能补肾,收敛精气.与功效相关的药理作用主要有:"久服延年不老"与延缓衰老;"入血分,消痰毒"与调节血脂;"止心痛,益血气"与抗心肌缺血;"调气血,泻肝风"与抗动脉粥样硬化;"专入肾,益精髓"与提高学习记忆;"补肝肾,入肝肾脾经"与增强免疫等.[2]与何乌"乌须发"功效相关的药理研究有待于进一步深入.[3]生何首乌、制何首乌功效不同,药理研究应根据其功能主治加以辨别.结论:何首乌现代药理研究与其性味归经功效有一定的相吻之处,这为合理阐述何首乌的中药药性理论提供依据,并为何首乌进一步的药理研究与临床应用提供参考.     

硝酸甘油加多巴酚丁胺治疗难治性心力衰竭体会

目的 :探讨用硝酸甘油加多巴酚丁胺治疗难治性心力衰竭。方法 :以阳泉钢铁集团有限公司医院 30例顽固性心力衰竭患者为研究对象 ,其中男性 18例 ,女性 12例 ,年龄 37岁～ 81岁 ,平均 5 6岁 ,心功能均为 级～ 级 ,在综合治疗同时 ,加用小剂量硝酸甘油加多巴酚丁胺开始 ,以后据病情逐渐增加剂量 ,把血压维持在正常水平 ,结果 :30例患者中 ,显效 2 0例 ,有效 9例 ,无效 1例 ,总有效率 96 .6 %。结论 :在强心、利尿等基础治疗的前提下 ,用硝酸甘油加多巴酚丁胺治疗难治性心力衰竭 ,既能通过多巴胺直接增强心肌收缩力作用 ,增加心排血量 ,提高血压 ,抵消硝酸甘油不良反应 ,可能发挥硝酸甘油扩张动、静脉 ,减轻心脏前后负荷 ,改善全身及肾血流灌注 ,在临床上值得进一步研究探讨