生存质量及其相关观念

本文介绍了生存质量的含义和主要内容,并对其相关概念作了详细的阐述,它们包括健康、健康状态、健康相关生存质量、功能状态、情绪、症状等.了解这些概念有助于加深我们对生存质量的理解,并更好地在临床工作中加以运用.     

生存质量测评中量表、特殊量表及其使用问题

生存质量在疾病的防治中起着越来越重要的作用,生存质量的测量用了各种工具和评分,组成-系列符合测量目的的量表.量表可分为总量表和特殊量表,在投人使用之前均应检测信度、效度和反应度.而测量结果需用合适的方法进行分析,最终得到科学的依据.本文就生存质量测量中量表、特殊量表及其使用问题作一简介.     

Care transitions: integrating transition theory and complexity science concepts

Care transitions, defined as hospital discharge or movement from one health care setting to another, are currently a major concern of health care providers and policy makers. Extensive empirical research has been conducted on care transitions, but the theoretical foundations are rarely made explicit. We propose that integrating concepts on complex adaptive systems from complexity science with classic theory on transitions in nursing provides a powerful new lens through which to study care transitions and improve transition outcomes. We summarize concepts from both theoretical approaches, propose an expanded model of transitions, and apply the model to the transition from hospital to home.     

Health fairs bring wellness concepts to life.

Incorporated into the nursing curriculum, the health fair is a stimulating, unique, nontraditional educational project that examines effective health education tools, leadership skills, and interaction with the community. Students test theories and collaborate with other school disciplines while planning, implementing, and evaluating health education and health fair promotion. Health fairs help students to identify positive lifestyles and create opportunities to test the skills needed to improve the population's wellness level.     

Importance of mitral subvalvular apparatus in terms of cardiac energetics and systolic mechanics in the ejecting canine heart.

To assess the importance of the intact mitral subvalvular apparatus for left ventricular (LV) energetics, data from nine open-chest ejecting canine hearts were analyzed using piezoelectric crystals to measure LV volume. After mitral valve replacement with preservation of all chordae tendineae, baseline LV function was assessed during transient caval occlusion: A quadratic fit of the LV end-systolic pressure-volume data was used to determine the curvilinear end-systolic pressure-volume relationship (ESPVR). All chordae were then divided with exteriorized snares. Reassessment revealed deterioration of global LV pump function: (a) the coefficient of nonlinearity, decreased (less negative) by 90% (P = 0.06); (b) slope of the curvilinear ESPVR at the volume axis intercept, decreased by 75% (P = 0.01); and V100, end-systolic volume at 100 mmHg end-systolic pressure, increased by 42% (P less than 0.02). Similarly, preload recruitable stroke work fell significantly (-14%) and Vw1,000 (end-diastolic volume [EDV] at stroke work [SW] of 1,000 mmHg.ml) rose by 17% (P less than 0.04). With respect to LV energetics, the total mechanical energy generated by the ventricle decreased, as indicated by a decline in the slope of the pressure volume area (PVA)-EDV relationship (120 +/- 13 [mean +/- SD] vs. 105 +/- 13 mmHg, P less than 0.001). Additionally, comparison of LV SW and PVA from single beats with matched EDV showed that the efficiency of converting mechanical energy to external work (SW/PVA) declined by 14% (0.65 +/- 0.13 vs. 0.56 +/- 0.08, P less than 0.03) after chordal division. While effective systemic arterial elastance, Ea, also fell significantly (P = 0.03) after the chordae were severed, the Ea/Ees ratio (Ees = slope of the linear ESPVR) increased by 124% (0.91 +/- 0.53 vs. 2.04 +/- 0.87, P = 0.001) due to a proportionally greater decline in Ees. This indicates a mismatch in ventriculo-arterial interaction, deviating from that required for maximal external output (viz., Ea/Ees = 1). These adverse effects of chordal division may be related to the observed changes in LV geometry (i.e., eccentricity). We conclude that the intact mitral subvalvular apparatus is important in optimizing LV energetics and ventriculo-vascular coupling in addition to the enhancement of LV systolic performance.     

Use of videos to teach basic science concepts in a doctor of chiropractic training program

ObjectiveThis study examined the effectiveness of teaching biochemical concepts by video in a doctor of chiropractic training program.MethodsStudents in a biochemistry class were taught the Krebs cycle through a video exercise and glycolysis in a traditional lecture format. They received a review of both concepts and were tested. Test performance was examined. Students answered a questionnaire following the exercise.ResultsThere were no significant differences in test performance on the topic learned by the video exercise. However, students felt that both lecture and review were more effective learning tools than video.ConclusionDespite the results of other authors, our students preferred traditional didactic lecture with review rather than video. With no difference in test scores observed, the role of videos in our basic science course remains unclear, perhaps only used as an occasional supplement. These results were not expected, given the often-preferred use of technology by current learners.     

中医时间医学的独特性:节气时令物候观念与临床康复

目的:总结分析中医时间医学中独特的节气时令物侯观念及与临床治疗康复的关系。方法:查阅上世纪70年代至今的国内中医多学科、物候学,以及节气时令方面的重要专著,并查阅先秦时期至金元时期的部分相关历史文献,以及维普期刊数据库近10年有关中医物候思想的有关论文,归纳总结了中医药学中时间医学思想与时令物侯观念的特殊关系与发展过程,说明古今节气时令的差异,说明其在医疗康复中的意义。结果:①古代医学家通过实践,认为人和自然是一个动态的整体,人体受到自然环境的密切影响,所以人体的生理、病理演变规律,也有着与自然四时演变同样的规律。时令-物候-脏腑有密切关系。人体与时间,以及与自然物候因素处于一个动态的生态整体中,在这个整体中,人与植物、动物、水、空气、土壤……以及抽象的时间、温度、湿度、色、味各种因素都组成了一个动态的体系。②从《黄帝内经》始,通过实践总结,古代医家在中医药理论中融进大量时令物候知识,中医时间医学思想中的时间标准往往运用的是与自然相关的节气时令,人与自然协调程度应用的是物候现象标准,这种思想一直指导着临床诊疗、中药药理,以及保健康复中。③古今节气时令的时值有所改变,说明了中医药学中时间医学的物侯观念是来源于古代文化背景及医学实践的总结,反过来掌握这种思想观念又可指导医学实践。结论:中国古代医学讲求“天人合一”,十分注重“天时”与人体生理病理规律的关系,这同现代医学里的时间医学思想是一致的。了解与研究中医时间医学中的节气时令观念,有助于中医药临床治疗与康复。