单指数、双指数、拉伸指数模型DWI在胶质瘤术前分级中的应用

目的探讨单指数、双指数、拉伸指数模型扩散加权成像(diffusion weightedimaging,DWI)对胶质瘤术前分级的诊断性能,评价灌注参数与血流量(cerebral bloodflow,CBF)的相关性。材料与方法收集经手术病理证实为脑胶质瘤的病例34例,包括低级别17例,高级别17例。受试者术前均行常规扫描、3D动脉自旋标记成像(threedemensional arterial spin labeling,3D ASL)及多b值DWI序列扫描,利用FUNCTIONTOOL后处理软件中的单指数模型计算得到表观扩散系数(apparent diffusion coefficient,ADC),利用双指数模型得到D、D*、f值,利用拉伸指数模型得到分布扩散系数(distribute diffusion coefficient,DDC)、水分子各向异性(alpha,α),利用3D ASL后处理软件得到CBF值。所得各参数利用SAS9.4统计软件进行分析。结果高级别胶质瘤ADC、D、f、DDC、ɑ值低于低级别胶质瘤,D*值高于低级别胶质瘤,P值均<0.05;全部胶质瘤D*与CBF呈正相关(r=0.51,P<0.05);受试者工作特性(receiver operatingcharactsteristic,ROC)曲线分析得出:ɑ、D、DDC、ADC值的曲线下面积(area undercurve,AUC)分别为0.969、0.965、0.961、0.957,其诊断阈值分别为0.88×10^-3mm^2/s、0.86×10^-3mm^2/s、1.10×10^-3mm^2/s、1.11×10^-3mm^2/s。结论单指数、双指数、拉伸指数模型DWI为胶质瘤术前提供更多诊断信息,ɑ、D、DDC、ADC值在鉴别高、低级别胶质瘤均有较高价值,且灌注参数D*与CBF呈正相关。     

基于Self-study模式和Kirkpatrick模型构建住院医师规范化培训评估新体系

住院医师规范化培训是培养合格临床医生的一项重要途径,而对住院医师规范化培训进行评价,有助于提高培训质量和完善培训制度。在综述我国住院医师规范化培训评估体系研究现状的基础上,结合Self-study模式和Kirkpatrick模型的特点,从现况调研、缺陷查找、设定目标、持续改进、反应评估、学习评估、行为评估和结果评估8个层面出发,以培训前评估、培训过程评估和培训后评估3个阶段为过程,从反应层、学习层、行为层和结果层四个方面对417名住院医师进行评估。结果显示,在不降低住院医师所提供的医疗服务质量的同时,基于Self-study模式和Kirkpatrick模型的住培评价新体系提高了学员和教员双方对培训的满意程度,利于协调并完善工作、学习和家庭的时间和精力分配,是提高规范化住院医师培训品质的有效方法之一。     

开放式管理模式对首发精神分裂症患者的康复作用

目的探讨开放式管理模式对首发精神分裂症患者的作用。方法50例首发精神分裂症患者分别在开放式管理模式(开放组)和封闭式管理模式的病房内(封闭组)治疗,采用简明精神病量表(BPRS)、护士用住院病人观察量表(NOSIE)、社会功能缺陷筛选量表(SDSS)和服药依从性等量化指标进行效果评价。结果在入院治疗4、8周时开放组与封闭组BPRS和NOSIE总评分比较差异有显著性(P<0.05、0.01);出院时及出院后6及12个月末SDSS评分开放组显著低于封闭组(P<0.01);服药依从性亦优于封闭组(P<0.05)。结论开放式管理模式对于首发精神分裂症患者的康复有良好的作用,且能提高其服药依从性,延缓社会功能衰退。     

Evaluation of 'partnership care model' in the control of hypertension

One of the shared common goals of World Hypertension League (WHL) and World Health Organization (WHO) is the control of hypertension. Despite many local and international interventions, the goal has not been achieved. This study evaluated an intervention based on the partnership care model to control hypertension in a rural population in the north of Iran. The results showed that the intervention was effective in decreasing systolic and diastolic blood pressure and in increasing the rate of controlled hypertensives (based on criteria of WHO/WHL). The intervention also had positive effects on health-related quality of life, body mass index, anxiety, high density lipoprotein level and compliance score. Based on these results, the partnership care model is effective in hypertension control and is recommended as a model to replace previous approaches in hypertension control.     

Preliminary tests of an ecological model of Hispanic farmworker health

ABSTRACT Objective: The purpose of this study was to propose and test an ecological model to structure research and practice concerning farmworker health in the United States. The research question was, “What is the relationship of selected social, cultural, and economic indicators to the health of adult Hispanic migrant farmworkers?” Design: A model of biogenetic, social, cultural, economic, individual response, and access factors affecting health was derived from the literature and nursing practice. Data from the 1998 National Agricultural Workers Survey (NAWS), conducted by the U.S. Department of Labor, were used in a secondary analysis to perform preliminary tests of the relationships proposed in the model. Sample: The NAWS conducts interviews with a nationally representative sample of farmworkers employed in the United States. Because of the importance of theorized cultural factors, the sample for this study was limited to farmworkers who identified themselves as Hispanic, resulting in 1,864 subjects. Measurements: Variables were used directly from the data or constructed from the available data, and proposed relationships were tested statistically. Results: Analysis of the data supported the relationships proposed in the model. Conclusions: The proposed model is a useful tool for organizing variables and giving direction to farmworker health research. Suggestions for future research are made.     

我国康复机构服务及运营管理现状分析

如何发挥自身优势,提高服务质量、改善运营管理效率、提升市场竞争能力是我国所有康复医疗机构所必须面临的一个复杂问题。本文通过对全国67家不同类型的康复医疗机构的调查,了解目前我国康复机构运营管理的现状,就目前我国康复机构的运营管理模式及阻碍康复事业进一步发展的问题进行分析和总结。     

大鼠自体血栓结合线栓阻塞大脑中动脉制备脑缺血模型的建立与评价

目的建立和评价大鼠自体血栓结合线栓阻塞大脑中动脉（MCA）制备的脑缺血动物模型。方法大鼠随机分为假手术组（10只）、线栓组（12只）、血栓结合线栓组（12只）。线栓组大鼠用尼龙栓线阻塞MCA制备大脑中动脉闭塞（MCAO）模型。血栓结合线栓组由颈外动脉插入改良的内置尼龙套线聚乙烯导管，插管成功后栓线退出一定长度，血液在导管内自凝后拔出套线，经导管推入凝血酶，血栓形成后再次插入套线，根据套线标记的长度向前推进血栓，使之阻塞大鼠MCA制备MCAO模型。术后6h，观察大鼠神经症状评分；测定脑组织含水量、脑梗死面积，观察大鼠脑组织病理变化。结果线栓组和血栓结合线栓组均较假手术组大鼠的神经症状评分增高，脑组织含水量增加，脑梗死面积增大（P均〈0．01），脑组织出现明显的病理损伤；与线栓组比较，血栓结合线栓组大鼠的神经症状评分、脑组织含水量、脑梗死面积及脑组织病理损伤差异均无显著性（P均〉0．05）。结论自体血栓结合线栓阻塞大鼠MCA可引起神经功能损害、脑组织水肿，造成脑组织明显的病理损伤，该法制备的MCAO模型可使血栓阻塞在期望血管（MCA）并可进行脑缺血／再灌注研究，防止血栓模型制备过程中及区域动脉溶栓治疗后再出血等，具有阻塞位置确切、梗死范围恒定、模型易于操作及可重复性好等特点。     

Professional Advancement for Advanced Practice Clinicians

Professional advancement has been essential to the nursing workforce for many years. This article examines a model of APRN and PA advancement as a means to develop novice providers as well as to reward productivity and clinical excellence while establishing ways to improve APRN/PA retention and decrease turnover.     

The combination of cobinamide and sulfanegen is highly effective in mouse models of cyanide poisoning

Context. Cyanide is a component of smoke in residential and industrial fires, and accidental exposure to cyanide occurs in a variety of industries. Moreover, cyanide has the potential to be used by terrorists, particularly in a closed space such as an airport or train station. Current therapies for cyanide poisoning must be given by intravenous administration, limiting their use in treating mass casualties. Objective. We are developing two new cyanide antidotes – cobinamide, a vitamin B₁₂ analog, and sulfanegen, a 3-mercaptopyruvate prodrug. Both drugs can be given by intramuscular administration, and therefore could be used to treat a large number of people quickly. We now asked if the two drugs would have an augmented effect when combined. Materials and methods. We used a non-lethal and two different lethal models of cyanide poisoning in mice. The non-lethal model assesses neurologic recovery by quantitatively evaluating the innate righting reflex time of a mouse. The two lethal models are a cyanide injection and a cyanide inhalation model. Results. We found that the two drugs are at least additive when used together in both the non-lethal and lethal models: at doses where all animals died with either drug alone, the combination yielded 80 and 40% survival in the injection and inhalation models, respectively. Similarly, drug doses that yielded 40% survival with either drug alone, yielded 80 and 100% survival in the injection and inhalation models, respectively. As part of the inhalation model, we developed a new paradigm in which animals are exposed to cyanide gas, injected intramuscularly with an antidote, and then re-exposed to cyanide gas. This simulates cyanide exposure of a large number of people in a closed space, because people would remain exposed to cyanide, even after receiving an antidote. Conclusion. The combination of cobinamide and sulfanegen shows great promise as a new approach to treating cyanide poisoning.     

以健康行为HAPA模型为指导提高造口患者自我效能的研究

目的建立一套以健康行为HAPA模型（health action process approach,健康行动过程取向）为指导,有利于增强膀胱癌造口患者自我效能的医院-家庭一体化康复护理模式。方法选取58例膀胱癌行泌尿造口手术的患者,应用医院-家庭一体化康复护理模式进行康复护理。于患者出院后1年应用一般自我效能感量表、造口自我护理调查问卷对患者的自我效能和造口自我护理能力进行评价。结果除5例患者在1年内死亡,不能参与自我效能和造口自我护理能力的评价外,其余53例患者中,自我效能评分：优（31~40分）32例,良（21~30分）15例,一般（10~20分）6例,优良率为88.68%;44例（83.02%）患者能独立完成造口护理,46例（86.79%）患者没有出现造口相关并发症。结论以健康行为HAPA模型为指导增强自我效能的护理干预模式,能显著提高患者的自我效能,提高康复护理效果。     

医院-社区-家庭一体化合作管理模式在造口护理中的发展与应用

通过文献回顾和政策分析,探讨医院-社区-家庭一体化合作管理模式在造口护理中的发展及应用,并从医院-社区-家庭一体化合作管理的角度,总结造口护理实践研究成果,以期为我国造口护理的专业发展提供参考,进一步促进我国造口护理的发展。     

Towards a 'forensic lens' model of multidisciplinary training

This paper reports on research undertaken to identify if common areas of multidisciplinary training exist in the literature. The literature that specifically focused on training issues in forensic practice (mental health) was located and reviewed by coding analysis. Thirteen common areas were identified and approximately 250 content items were acknowledged. A 'forensic lens' model was established to provide a framework in which multidisciplinary training could be located. Further research is promulgated to establish the actual importance of each training area for specific forensic disciplinary groups.     

Time Dependence of Anodal and Cathodal Refractory Periods in Cardiac Tissue

Mehra et al. (PACE 1980; 3:526) observed that immediately after implantation of a pacing electrode in a dog heart, the anodal refractory period (RP) is shorter than the cathodal RP, but after several weeks the anodal RP becomes longer than the cathodal RP. We examine this experiment using numerical simulations based on the bidomain model of cardiac tissue and a Beeler-Reuter membrane. Our hypothesis is that accumulation of inexcitable tissue around the electrode following implantation causes the effective size of the electrode to increase and that this increase is the mechanism underlying the change in RP. We calculate that the anodal RP is shorter than the cathodal RP for both large and small electrodes. However, for large electrodes the threshold for anode "break" stimulation is greater than 8 mA. Mehra et al. defined RP experimentally as the interval at which the threshold stimulus strength becomes greater than 8 mA. If we restrict the stimulus current in our calculations to less than 8 mA, we exclude anode break stimulation from our calculation of the RP. In that case, our results are consistent with Mehra et al. and suggest that their observation resulted from their definition of RP.     

Identifying the time of occurrence of a hamstring strain injury during treadmill running: a case study

BACKGROUND: While hamstring strain injuries are common during sprinting, the mechanisms of injury are not well understood. In this study, we analyzed the running kinematics of an athlete obtained at the time of an acute hamstring strain injury. The purpose was to identify the period of the gait cycle during which the hamstring was likely injured, as well as to characterize the biomechanical conditions associated with the injury. METHODS: A male professional skier injured his right biceps femoris long head while running at 5.36 m/s on a treadmill with a 15% incline. Whole body kinematics were recorded at the time of injury. A linear periodic prediction model was used to determine when individual marker trajectories deviated from a cyclic periodic pattern, indicating the mechanical response to injury. A three-dimensional musculoskeletal model was used to compute joint angles and hamstring musculotendon lengths during the injurious running trial. These data were used with estimates of neuromuscular latencies and electromechanical delays to identify the most likely time period of injury. FINDINGS: Based upon the earliest indications in marker trajectories, a 130 ms period during the late swing phase of the gait cycle was identified as the period of injury. During this period, the biceps femoris reached a peak musculotendon length that was estimated to be 12% beyond the length seen in an upright posture and exceeded the normalized peak length of the medial hamstrings. INTERPRETATION: This case provides quantitative data suggesting that the biceps femoris muscle is susceptible to an lengthening contraction injury during the late swing phase of the running gait cycle.     

塔中4油田组合油藏三维地质建模方法

组合油藏由于其油藏内各单砂体空间展布和空间接触关系各异,“一砂一藏”,综合开发评价难度大,进行地质建模十分必要。国内外针对单个油藏进行随机性或确定性地质建模技术已十分成熟,但针对复杂组合油藏进行地质建模尚无成熟方法。以塔中4油田422井区CI油组为例,常规建模通过N/G(净毛比)控制砂岩尖灭,无法直观体现单砂体向边部变薄、尖灭的地质现象,本次研究通过精细小层对比、岩心分析建立单砂体地层格架模型,真实展现了单砂体尖灭及构造形态;结合断点数据、地震解释数据、油气充注模式对工区内每条断层断开层位进行分析;为每个单砂体油藏建立虚拟相模型,使每个单砂体油藏独立出来,实现灵活操作;根据井控程度高低,分别采用随机建模、确定性建模方法建立单砂体油藏物性模型及流体分布模型,使建模更加合理。通过该方法建立的地质模型已成功应用于塔中4油田开发方案的编制。     

The experience of two practice education models: collaborative learning unit and preceptorship

Twenty-two Bachelor of Science in Nursing (BSN) graduates shared their perceptions one year after graduation on two practice education models they experienced during years three and four of their nursing education. The two models evaluated were collaborative learning units (CLU) and preceptorship. The participants described what was most important about each of these models in preparing them for graduate practice. While the preceptorship model has been researched for decades, the CLU data are previously unexplored information. The CLU data revealed the themes of working with many and making practice their own, while the themes of working with one and consolidation of nursing practice emerged from the preceptorship data. The participants suggest that both models offer different yet complementary paths for learning and enhanced professional development and practice. There is also confirmation that both are relevant and perhaps necessary to accomplish the complexities of preparing students for professional nursing practice.     

导师组制模式培养护理研究生的实践

近年来,随着护理研究生扩招,传统的单一导师制已不能满足研究生的培养需求,严重影响了研究生的培养质量。而导师组制培养模式则能有效解决单一导师制的种种弊端。本研究通过组建导师团队、学生团队,采用督促研究生课题进展、定期开展专题报告、集体修改文章、邀请交叉学科的专家作报告等方式培养学生,有效提高了护理研究生的培养质量,提高了导师的学术水平及指导研究生的能力,形成了良好的师生协作关系。     

"一贯制"责任护理模式对产妇产后恢复的影响

目的 探讨在产科实施"一贯制"责任护理模式对产妇产后恢复和常见问题的影响.方法 比较实施"一贯制"责任护理模式的产妇与实施岗位功能制护理模式的产妇产后尿潴留、奶胀的发生率、出院时和产后6周时的母乳喂养率,及产妇产后母乳喂养知识的知晓情况.结果 观察组产妇出院时及产后6周的母乳喂养率均高于对照组,差异有统计学意义(P＜0.01);观察组母乳喂养知识知晓得分高于对照组,差异有统计学意义(P＜0.01);观察组产后6 h尿潴留发生率明显低于对照组,差异有统计学意义(P＜0.01);产后72 h内观察组未发生奶胀的人数明显多于对照组,发生奶胀的人数少于对照组,差异有统计学意义(P＜0.01).结论 "一贯制"责任护理是一种先进的护理模式,降低了产妇产后尿潴留、奶胀的发生率,提高了母乳喂养率,值得推广.