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1.
目的对部分发达国家社会急救培训实践经验进行梳理总结,为我国社会急救培训体系建设提供参考与建议。方法通过文献检索的方法对美国、德国、日本、新加坡四个国家在法律法规、培训机构或组织、培训种类和方式、培训内容、培训时间、培训标准和认证等方面的内容进行归纳总结。结果发达国家普遍构建了完备严谨的急救培训法律体系,重视对不同职业人群的培训并进行严格考核,采用多样培训方式传授急救知识或技能,并注重学校教育,积极引导社会力量参与其中。结论完善社会急救培训需要完善急救培训立法、注重培训人群的分级分类、规范培训流程与模式、健全考核评估制度、重视心理急救培训、培训方式多样化以及动员全社会参与等。  相似文献   
2.
PurposeRotational intensity-modulated radiation therapy currently has a growing role in breast cancer radiation therapy, since this radiation technique reduces cardiac radiation exposure while homogeneously covering target volumes. This study aims to evaluate radiation exposure of cardiac substructures across a broad spectrum of breast cancer cases differing by cancer laterality, fractionation regimen and addition of deep-inspiration breath hold.Materials and methodsCardiac substructures were delineated following guidelines endorsed by the European Society for Radiotherapy and Oncology (ESTRO) for forty-four breast cancer patients having undergone conserving surgery and adjuvant rotational intensity-modulated radiation therapy. Target volumes consisted of the whole breast with a boost, axillary and internal mammary nodes. Patients were treated using free-breathing technique for left-sided or right-sided, normofractionated or hypofractionated helical tomotherapy or volumetric modulated arc therapy, or using deep-inspiration breath hold for left-sided normofractionated volumetric modulated arc therapy. Mean and maximum doses to cardiac substructures were retrieved. Correlations were performed between mean- and maximum radiation doses to cardiac substructures.ResultsLeft-sided and right-sided irradiations were associated with different cardiac substructure exposure patterns despite comparable mean heart dose: 7.21 Gy for left-sided normofractionated regimen, 6.28 Gy for right-sided normofractionated regimen. Deep-inspiration breath hold reduced mean doses to almost all cardiac substructures for left-sided irradiation, but did not decrease maximum doses to coronary arteries. Correlations between mean- and maximum doses to cardiac substructures were usually moderate, but stronger for right-sided irradiation.ConclusionDespite comparable mean heart dose, cardiac substructure radiation exposure patterns with rotational intensity-modulated radiation therapy strongly depend on the breast side, which could trigger clinically different long-term cardiotoxicity events. Deep-inspiration breath hold improves cardiac substructure dosimetry. Mean- and maximum heart dose could probably not be used as surrogate markers for precise cardiac substructure evaluation. In a near future, clinical practice and cardiotoxicity studies could possibly gain by considering cardiac substructure in a more systematic manner, possibly relying on cardiac autosegmentation algorithms.  相似文献   
3.
Respiration is essential for smell perception. Previously we found that 8–12-Hz cortical rhythms were phase-locked to inspiration onset during the presentation of odor stimuli; this is referred to as inspiration phase-locked alpha band oscillation (I-α). Generators of I-α estimated with a dipole fitting model were found in the piriform, the entorhinal cortex (ENT), the amygdala (AMG), the hippocampus (HI) and the orbitofrontal cortex (OFC). Such olfactory perception is said to occur via the orthonasal olfaction route. Another route is the retronasal olfaction route. In this study, we investigated the link between respiration phase and retronasal olfactory perception. Electroencephalograph (EEG) and respiratory flows (separately measured with mouth and nose) were simultaneously recorded during stimulation of subjects’ tongues with liquids of chocolate, sucrose and water. The percentage of subjects correctly identifying the chocolate taste was higher when subjects were asked to breathe through the nose than when they were breathing through the mouth. In the averaged EEGs triggered by the onset of expiration measured from the flow through the nose, a 8–12-Hz oscillation was observed. Generators of this potential were found in the left ENT, HI, AMG and OFC in the order of milliseconds after expiration onset. Perception of retronasal olfaction is dependent on expiration, and combining retronasal olfactory information with gustatory information and somatosensation enable us to identify flavors when drinking and feeding.  相似文献   
4.
人性化管理在临床护理工作中的应用评价   总被引:4,自引:1,他引:3  
目的:对人性化管理在临床护理工作中的应用进行评价。方法:分别于2008年9月和2009年5月对临床护士人性化管理实施前后的职业倦怠及工作满意度进行两次满意度问卷调查。结果:实施人性化管理后,护士的情感耗竭、去人格化得分均较实施前降低;护士的工作满意度总分显著提高,职业本身、人际关系、管理政策、排班与工作条件等维度的得分亦均显著提高。结论:人性化管理能够有效降低临床护士的职业倦怠水准、提高护士对于职业本身的满意度。  相似文献   
5.
儿童营养问题是困扰发展中国家的重大公共卫生问题。儿童营养政策经历了早期跨部门营养计划、"营养孤立主义"和以战略目标为导向的营养行动三个时期。在总结归纳儿童营养政策发展历程的基础上,我们结合一些发展中国家在基础营养项目等国际项目和本国营养计划中加强政治承诺、整合政策措施等的做法,对我国制定儿童营养政策提出对策,如制定国家营养战略要注意的方面,从干预人群、干预项目的选择和加强营养政策或项目的执行等方面完善营养项目的设计。  相似文献   
6.
目的:观察布地奈德联合硫酸特布他林吸入治疗儿童哮喘急性发作的临床疗效。方法:选取2007年11月~2009年11月符合哮喘诊断标准的哮喘急性发作患儿92例,随机分为两组,对照组46例,予硫酸特布他林2.5mg/次,q8h经空气压缩泵吸入,口服泼尼松龙2mg/(kg·d),最大剂量为40mg,治疗组46例,予布地奈德2mg/次联合硫酸特布他林0.5mg/次,q8h吸入治疗,疗程7d。比较两组临床症状消失的时间及肺功能改善程度。结果:治疗组临床症状及肺部体征消失时间较对照组缩短,肺功能改善明显优于对照组。结论:布地奈德与硫酸特布他林联合治疗哮喘急性发作能迅速缓解临床症状、体征,改善肺功能,具有协同作用,且安全性高,值得临床推广应用。  相似文献   
7.
Brain activation patterns derived from neurofunctional methods are often implicitly regarded as being directly related to subjective perceptual experience in an iso- or at least homomorph manner, neglecting the operational differences between these two dimensions. This paper (a) introduces a method for assessing 'perceptual maps' of stimulation patterns presented to the body surface, providing a means to parametrically relate neural representation and subjective percept, and (b) applies this method to demonstrate the existence of 'somatotopic maps' of hot and painful stimulus patterns independent from mechanoceptive co-activation. Brief (90 ms) CO2 laser pulses were presented in an array of multiple stimulation sites on the dorsal forearms (N. radialis area, C7 dermatome) of healthy subjects. Perceived locations were indicated with a 3D tracker without touching the skin, and (mis-)localizations in distal-proximal direction were analyzed. Stimuli were localized with overall mean errors of 22 mm (SD: 16 mm) toward the wrist and 24 mm (SD: 18 mm) toward the elbow. Somatotopic representation of thermal-nociceptive stimuli could be demonstrated in all subjects, independent from mechanoceptive co-activation. The perceptual maps revealed striking individual (mis-)localization patterns, many subjects exhibiting 'stretched', some 'condensed' somatotopic representations. In estimating the mapping parameters from physical to perceptual space linear regressions generally provided a good fit (adj. R2>0.80 in 10 out of 12 subjects). Nonlinear models were advantageous in some subjects only. Our method can be useful in assessing inter-individual differences or experimentally induced shifts in somatotopic processing.  相似文献   
8.
中美高等医学教育比较及启示   总被引:3,自引:0,他引:3  
美国高等医学教育是特色鲜明和比较成功医学教育模式之一,与之相比,我国高等医学教育存诸多方面存存着较大的差距。借鉴美国医学教育的经验,对我国新的历史时期建设一流高等医学院校将大有裨益。  相似文献   
9.
基于问题学习(problem-based learning,PBL)是一种以学习者为中心,通过合作学习完成解决问题的全新教学模式。本文介绍了加拿大McMaster大学医学院PBL教学模式的具体安排和评估方式,探讨了其对我国推进PBL教学带来的启示:根据医学生教育背景选择切合实际的具体教学方式和教案;选择合适的PBL导师并保证教师角色的顺利转变;强化以学生为中心的理念,积极发挥教学评估的促进作用;引导学生充分使用多媒体、互联网等资源,发挥其对PBL的推动作用。  相似文献   
10.
近年来,医患关系紧张成为困扰中国社会和普通民众的热点问题。毛泽东《关于正确处理人民内部矛盾的问题》一文的“正确处理人民内部矛盾”理念,对当前构建和谐社会有着重要参考价值。医患之间的矛盾是在人民利益根本一致基础上的矛盾,是人民内部矛盾。医患双方应该互相尊重、互相理解、互相信任,本着“团结-批评-团结”的原则来化解医患矛盾。构建和谐医患关系建议:建立健全完善的医疗保障制度和法律法规,医生终身学习、对患者加强人文关怀,加强对群众的教育和正向引导,完善医疗风险分担机制等,逐步构建起良好的医患关系,促进社会和谐健康发展。  相似文献   
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