PDCA循环法在自动乳腺全容积成像诊断乳腺疾病中的应用

目的探讨PDCA（Plan计划，Do执行，Check检查，Action行动）循环法在自动乳腺全容积成像（ABVS）诊断乳腺疾病中的应用。 方法收集中南大学湘雅三医院2018年1月至2019年12月期间行ABVS检查并经病理确诊或临床明确诊断的乳腺疾病患者2070例，根据PDCA循环法应用时间分为2组，PDCA循环法应用前（2018年1月至2018年12月）患者840例，PDCA循环法应用后（2019年1月至2019年12月）患者1230例。使用χ²检验分析比较PDCA循环法应用前后的诊断符合率、漏诊率、误诊率以及患者满意度的差异。 结果与PDCA循环法应用前比较，PDCA实施后ABVS诊断符合率提高（87.89% vs 82.74%），误诊率下降（11.47% vs 15.63%），漏诊率下降（14.39% vs 23.20%），患者满意度提升（92.59% vs 87.12%），差异均具有统计学意义（χ²=10.856、4.507、3.936、3.922，P=0.010、0.034、0.047、0.048）。 结论PDCA循环法能提升ABVS诊断乳腺疾病过程中的医疗质量。     

Long-term effects of concussion on relevancy-based modulation of somatosensory-evoked potentials

ObjectiveThe purpose of this investigation was to better understand the effects of concussions on the ability to selectively up or down-regulate incoming somatosensory information based on relevance.MethodsMedian nerve somatosensory-evoked potentials (SEPs) were elicited from electrical stimulation and recorded from scalp electrodes while participants completed tasks that altered the relevance of specific somatosensory information being conveyed along the stimulated nerve.ResultsWithin the control group, SEP amplitudes for task-relevant somatosensory information were significantly greater than for non-relevant somatosensory information at the earliest cortical processing potentials (N20-P27). Alternatively, the concussion history group showed similar SEP amplitudes for all conditions at early processing potentials, however a pattern similar to controls emerged later in the processing stream (P100) where both movement-related gating and facilitation of task-relevant information were present.ConclusionsPreviously concussed participants demonstrated impairments in the ability to up-regulate relevant somatosensory information at early processing stages. These effects appear to be chronic, as this pattern was observed on average several years after participants’ most recent concussion.SignificanceGiven the role of the prefrontal cortex in relevancy-based facilitation during movement-related gating, these findings lend support to the notion that this brain area may be particularly vulnerable to concussive forces.     

依据CLSI EP9-A3评价两种方法学检测糖类抗原242的可比性

目的评价两种方法学检测糖类抗原242(CA242)结果的可比性,以评估磁微粒化学发光法检测CA242是否能够满足临床的需求。方法根据美国临床和实验室标准协会(CLSI)新指南EP9-A3文件要求,收集2018年1-7月首都医科大学附属北京康复医院和北京大学首钢医院肿瘤患者检测剩余的新鲜血清标本100例,以Fujirebio Diagnostics AB的酶联免疫法为参比方法,安图生物的磁微粒化学发光法为评估方法,对2种方法检测CA242的结果进行方法学比对和偏移评估。选择Passing-Baklok回归方法进行线性拟合,采用Wilcoxon符号秩检验及Spearman相关分析。结果在4.31~295.63 U/ml范围内,2种方法学的CA242检测结果具有较好的相关性(r=0.991,截距0.652)。参比方法和评估方法比较,差异无统计学意义[(53.75±6.69)U/ml比(56.11±6.86)U/ml,t=0.246,P=0.806]。将CA242的医学决定水平25.00 U/ml代入选取的最佳回归模型拟合方程,计算得到的相对偏移3.52%,<1/2TEa±12.5%(TEa为国家卫生健康委临床检验中心室间质量评审允许总误差),满足要求。结论安图生物的磁微粒化学发光法和Fujirebio Diagnostics AB酶联免疫法检测CA242结果具有可比性,满足临床需要。     

项目教学法在教学中的应用效果研究

目的探讨项目教学法在康复治疗学专业认知功能评定教学中的应用效果研究。方法将2018年6月—2020年6月在苏州大学附属第三医院康复医学科进行临床实习的60名康复治疗技术专业的实习生随机分为两组,每组各30名。对照组采用常规教学方法,观察组使用项目教学法,对比两组的教学效果、考核成绩、自主学习能力以及自我评价。结果观察组的实习同学对“有利于激发学习兴趣”“有利于提高沟通及协作能力”“有利于提高自主学习能力”“有利于提高综合职业能力”“有利于缩小教学与临床的距离”以及“有利于熟悉规范的认知功能评定流程及主要工作内容”等几个教学方面的肯定率高于对照组(P<0.05);同时,观察组理论考核成绩、操作技能考核成绩、实习态度成绩以及考核总分高于对照组(P<0.05);观察组在自主学习、自我管理、信息能力、合作能力等自主学习能力评分也均高于对照组(P<0.05)。结论项目教学法在康复治疗学专业认知功能评定教学中的应用效果显著,明显提高了教学效果,提升了学生的自主学习能力和学习成绩。     

Influence of unfused cranial bones on magnetoencephalography signals in human infants

ObjectiveTo clarify the effects of unfused cranial bones on magnetoencephalography (MEG) signals during early development.MethodsIn a simulation study, we compared the MEG signals over a spherical head model with a circular hole mimicking the anterior fontanel to those over the same head model without the fontanel for different head and fontanel sizes with varying skull thickness and conductivity.ResultsThe fontanel had small effects according to three indices. The sum of differences in signal over a sensor array due to a fontanel, for example, was < 6% of the sum without the fontanel. However, the fontanel effects were extensive for dipole sources deep in the brain or outside the fontanel for larger fontanels. The effects were comparable in magnitude for tangential and radial sources. Skull thickness significantly increased the effect, while skull conductivity had minor effects.ConclusionMEG signal is weakly affected by a fontanel. However, the effects can be extensive and significant for radial sources, thicker skull and large fontanels. The fontanel effects can be intuitively explained by the concept of secondary sources at the fontanel wall.SignificanceThe minor influence of unfused cranial bones simplifies MEG analysis, but it should be considered for quantitative analysis.     

浅谈应用红外热成像技术早期诊断糖尿病足的策略

糖尿病足早期症状不明显,待明确诊断时病程多已步入中后期阶段,严重威胁民众健康。红外热成像技术作为一种医用功能性检测技术,能在人体组织发生结构性病变之前,敏感地发现其功能性改变导致的体表温度异常。基于中医学视角,借用计算机辅助诊断系统及属性篇序结构图,可以为糖尿病足红外热图的多角度、多维度解读提供全新思路,突破传统西医解剖学视角难以全面解读热图异常规律的瓶颈,也为红外热成像技术的应用拓宽视野。     

形成性评价法在新入职护士规范化培训中的应用研究

目的探讨形成性评价法在新护士规范化培训中应用效果。方法将2016年42名新入职护士作为对照组,将2017年38名新入职护士作为试验组,对照组实施终结性评价法,试验组实施形成性评价和终结性评价相结合的方法,比较两组护士四次出科理论和操作考核成绩和新护士岗位胜任力。结果试验组护士的出科理论、操作考核成绩及岗位胜任力指标均优于对照组(P<0.05)。结论通过对新护士规范化培训全程的观察、记录、反馈,帮助他们端正职业态度、明确职业职责、提高职业技能等岗位胜任力,促进了新入职护士规范化培训目标的完成。