血液流变学的临床意义与存在问题的探讨

1 血液流变学研究的临床意义 血液流变学是一门研究血液流动与变型的新型学科,其范围包括血液流量、流速、流态、血液凝固性,血液中有形成分及血管变形性与弹性、微循环、微血管血液流变性等.血液流变性的异常将会引起机体功能性或器质性障碍.因此血液流变学在临床上具有十分重要的意义,主要有:     

菊藤降压胶囊对高血压患者血液流变学的影响

目的观察纯中药制剂菊藤降压胶囊(JTJYC)对原发性高血压(EssentialHypertension,EH)患者血液流变学的影响。方法口服JTJYC每次5粒 ,3次/d ,1月为1疗程 ,采用NEX -1型锥板黏度仪测定全血黏度 ,JB多功能电脑毛细血管黏度仪测定血浆比黏度 ,观察服药后各项指标的变化。结果临床降压有效率84.0 % ,血液流变学主要指标有明显改善 (P<0.05)。结论JTJYC可用于EH和血液高黏滞综合征等病的治疗。     

227例血液高粘滞综合征流变学分析

本文报道227例血液高粘滞综合征(简称高粘征)患者9个流变学指标(ηb、ηre、Hct、EET、PET、ηp、ESR、Kesr、IR)的检测结果。提示,与正常对照组差异有显著性意义。并将其流变学变化分为血液粘度增高等五型;认为高粘征的血液粘滞因素分别是血液粘度、红细胞变形性和红细胞压积。     

血液流变学研究进展与问题

本文根据大量资料归纳整理，扼要介绍我国临床血液流变学发展现状，基本研究方法，总体成就，红细胞、血浆流变性异常和高粘滞综合症的分子流变学基础及存在问题。     

临床常用血液流变学指标的含义与评价（一）

临床常用血液流变学指标的含义与评价（一）文／翁维良１什么叫血液流变学？血液流变学是专门研究血液流动与变形规律的一门新的医学分学科。它研究的内容包括人体血液循环、微循环，血液的流量、流速及流态，血液的流动性及凝固性，血液的有形成分及心脏、血管变形性和弹...     

血液流变学在临床检测中的应用

流 变学是研究物质流动 (ｆｌｏｗ)与变形 (ｄｅｆｏｒｍａｔｉｏｎ)的学科。生物流变学的概念首先由ＣｏｐｌｅｙＡＬ于 1984年提出 ,即指那些界于生物学与流变学边缘的一系列研究。近五十年来 ,生物流变学主要研究活物质以及某些从机体分离出的有主要生物学意义的物质的流动与变形。血液则是其中最主要的研究对象。因此 ,血液流变学是生物流变学的最主要分支。 195 1年 ,Ｃｏｐｌｅｙ提出的定义为“血液流变学是在宏观、微观、亚微观水平上 ,研究血液的细胞成分和血浆的变形和流动特征 ,以及与血液直接接触的血管结构的流变特性。由此可见…     

高粘滞血症患者血液流变学研究

目的：本文观察150例高粘滞血症患者的血液流变学变化，探讨多种药物的治疗效果。方法：150例患者平均分成三组，分别用丹参，川芎嗪，肝素钙治疗，观察每组治疗前后的血液流变学10项指标的改变。统计学处理用方差分析。结果：每组治疗后的血液流变学10项指标值与治疗前相比明显降低（P＜0．01）。结论：本文表明丹参、川芎嗪、肝素钙能降低血液粘度，提高红细胞变形能力，抗血小板聚集，促进料溶活性，扩张微血管，改善微循环，是治疗高粘滞血症的有效药物。     

闭经妇女血液流变学变化的探讨

本文测定62例闭经妇女血液流变学各项指标及体外血栓形成试验，发现全血低切粘度、血浆粘度，还原粘度、K值、血栓长度、血栓湿重与对照组比较均有非常显著差异（P＜0．01）。说明闭经妇女存在着高粘血症。且血液流变学的改变不随着闭经年限的延长及闭经年龄的增大而相应增高。同时指出血液流变学的检测可对闭经妇女的高粘血症作出早期诊断、并可作为指导治疗及疗效观察的客观依据。     

临床血液流变学指标检测报告单设计不合理应该修正

笔者发现虽然血液流变学广泛用于l临床已经20几年,但其指标检测报告单的指标设置仍然比较混乱。报告单设计不合理的现象普遍存在。笔者为了纠正这种现象而撰写此文。研究指出了哪些是科学合理必须的指标和设置这些指标的两方面依据。论文阐明了全血高剪变率、中剪变率、低剪变率黏度,红细胞变形性、聚集性指标的正确含义,并将若干指标的优劣性进行了分析、比较。笔者为血液流变学首次提出了红细胞变形率、红细胞聚集率这两个新概念。研究揭示报告单指标设置不合理性归纳为三个方面：指标太多,指标重复,指标无意义。产生这些不合理性的缘由是：检测仪器厂商炫耀其仪器功能齐全,利于销售;设计者和检验人员血液流变学知识浅薄,指标良莠不分。但愿此文能引起人们重视,共同促进临床血液流变学指标设置和检测规范化。     

临床血液流变学专业委员会第三次学术会在天津召开

中国生物医学工程学会医学物理分会(CSMP)临床血液流变学专业委员会第三次学术会于2007年9月20日到23日在天津宾馆隆重召开。全国各省(市、自治区)临床医学、医学检验、医学物理等相关各界从事血液     

Development of Standards and Criteria for the Selection, Training, and Evaluation of Athletic Training Approved Clinical Instructors

OBJECTIVE: To develop standards and associated criteria for the selection, training, and evaluation of athletic training approved clinical instructors (ACIs). DESIGN AND SETTING: A previously developed set of 7 physical therapy clinical instructor standards/criteria and 2 additional standards/criteria developed through a review of the literature were systematically adapted, judged, and revised through a Delphi technique. SUBJECTS: Athletic training education experts currently employed as program directors for entry-level Commission on Accreditation of Allied Health Education Programs-accredited athletic training educational programs and who had the following: a doctoral degree, at least 5 years of supervising athletic training students, and familiarity/experience with clinical instruction in various athletic training clinical education settings. MEASUREMENTS: We used panelists' critiques and ratings to make sequential revisions in a series of 3 Delphi rounds. Standards were rated as to whether they were clear, necessary, and appropriate. We rated criteria for the associated standard as to whether they were useful, helpful, clear, specific, and consistent. RESULTS: We developed a final set of 7 standards and 50 associated criteria to measure these standards. The accepted standards include the following: legal and ethical behavior, communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge. CONCLUSIONS: The 7 standards and associated criteria developed in this research project could be used not only for selecting, training, and evaluating an ACI but also for developing an understanding of the requirements of clinical education in general. Further research should include validating these standards/criteria among athletic training ACIs representing different types of clinical settings.     

The Basic Science/Clinical Science Interface and Treatment Development

Psychological constructs often are incorporated into treatments before they are investigated systematically from a basic-science perspective. We discuss the potential costs of such a sequence of events and the potential benefits of closer working ties between basic and clinical scientists, and we consider how applying basic knowledge of cognitive processes could enhance our understanding of psychotherapy outcome and mechanisms of action. We call upon clinical and basic scientists to engage in a more "mindful" enterprise of translational research.     

研究生教育是推动医院科技发展的动力

本文通过统计分析在以论文形式的科研成果产出中,研究生群体在论文数量、质量和影响力方面,对医院科研做出的积极贡献,进一步阐明了研究生教育对医院科技发展的推动作用,并提出研究生创新能力培养中要注意研究生创造性思维的培养和人文社会科学知识教育,正确认识创新与跟踪、创新与失败、创新与效益回报的关系。此外,对研究生科研成果及时鉴定、请奖,是培养研究生科研能力和科研自信心、拓宽医院成果产出渠道的良好途径。     

临床医学八年制科研能力培养现状及改革建议

科研能力的培养是八年制临床医学教育的一个重要环节,科研能力日益成为评价医学院和医院的重要因素之一。本文对各高校试办八年制科研能力的培养特点进行了概述,并提出了临床医学八年制科研能力培养改革的建议,以期为八年制医学教育改革提供参考依据。     

精准医学模式下医学生临床与科研能力并重培养的思考

精准医学作为一种新的医疗模式,是生命医学发展的方向。目前临床医生普遍对其认识不足,需正确认识精准医学,并加强学习及应用。通过分析精准医学对医学生的要求,可以发现一个能胜任岗位的医学生必须具备以下特质:临床与科研能力并重、注重团队及合作精神、积极创新、拥有人文精神。对带教医师的培训、多学科协作联合教学查房、引入导师制和联合导师制等措施,可以让医学生既锻炼了临床能力,又学习和掌握了科研思维与相关的研究方法。     

Experiences of empathy training in healthcare: A systematic review of qualitative studies

ObjectiveTo synthesise qualitative studies reporting student, practitioner, or patient experiences of empathy-training in healthcare.MethodsWe included qualitative studies exploring (i) student or practitioner experiences of empathy training, or (ii) patient experiences of being treated by someone who has undergone empathy training. We used the Critical Appraisal Skills Programme (CASP) tool to assess study quality. Thematic synthesis was used to integrate findings from studies and to generate new insights.ResultsOur search yielded 2768 citations, of which 23 (1487 participants) met inclusion criteria. Two clusters of themes were identified from included studies. Firstly, themes related to practitioner/trainee professionalism and wellbeing, where the main finding was that participants experienced benefit from therapeutic empathy training. Secondly, themes related to the understanding and treatment of patients, where the main finding was practitioners’ deeper recognition of the positive impact of empathic care.ConclusionsThis review found that taking part in empathy-focused training can benefit practitioner/student personal growth and professional development, and benefits patient care. This review is limited by the difficulty in defining empathy and heterogeneity amongst included studies.Practice implicationsThese results support a rationale for empathy training and the development of a framework to ensure training is having the desired effect.     

Clinical anatomy as the basis for clinical examination: development and evaluation of an Introduction to Clinical Examination in a problem-oriented medical curriculum

Clinical anatomy is usually defined as anatomy applied to patient care. The question is asked whether students of a new horizontally and vertically integrated medical curriculum recognize the subject as the basis for clinical examination. A clinical anatomy practicum was developed in the special activity, "Introduction to Clinical Medicine," held in the second year of the Pretoria medical curriculum. The practicum was conducted on a station basis to anatomically prepare the student for the inspection, palpation, percussion, and auscultation of the cardiovascular, respiratory, abdominal, and urogenital systems. A total of 23 stations consisting of eight cardiovascular, seven respiratory, and eight abdominal/urogenital stations were designed. Standardized patients, cadavers, skeletons, prosected specimens, x-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), multimedia programs, and clinical case studies were used as resources. A Likert-type questionnaire was used for student evaluation of the practicum. Most students realized the importance of surface anatomy for a family physician. More than two-thirds thought the practicum improved their understanding of the anatomical basis for clinical examination. The minority of students were stimulated to do further reading on clinical examination. The students' response to their ability to integrate the clinical examination with the radiological anatomy was average. Most students were continuously aware of the appropriateness of the practicum for their future career. We conclude that medical students recognize the importance of anatomy as the basis for clinical examination when exposed to an appropriate integrated presentation format.     

Client Accounts of Corrective Experiences in Psychotherapy: Implications for Clinical Practice

The Patient Perceptions of Corrective Experiences in Individual Therapy (PPCEIT; Constantino, Angus, Friedlander, Messer, & Moertl, 2011) posttreatment interview guide was developed to provide clinical researchers with an effective mode of inquiry to identify and further explore clients’ firsthand accounts of corrective and transformative therapy experiences and their determinants. Not only do findings from the analysis of client corrective experience (CE) accounts help identify what and how CEs happen in or as a result of psychotherapy, but the measure itself may also provide therapists with an effective tool to further enhance clients’ awareness, understanding, and integration of transformative change experiences. Accordingly, we discuss in this afterword to the series the implications for clinical practice arising from (a) the thematic analysis of client CE accounts, drawn from a range of clinical samples and international research programs and (b) the clinical effect of completing the PPCEIT posttreatment interview inquiry. We also identify directions for future clinical training and research.     

Context and Current and Future Activities of the Society of Clinical Psychology

Several themes and activities of the Society of Clinical Psychology (Division 12 of APA) are discussed: a seemingly inexorable trend towards more and more specialization, posing a challenge to the very identity of clinical psychology; the importance of broad and general education in core content areas, especially in the science of psychology; continuing education; a newly established committee on diversity to help promote and support the inclusion of diversity variables in both the scientific and political activities of the Society; and the Evidence-Based Practices in Psychology report, recently adopted by the Council of Representatives as the basis of APA policy.     

Clinical Psychologists in the 2010s: 50 Years of the APA Division of Clinical Psychology

The American Psychological Association's Division of Clinical Psychology constitutes one of the oldest, largest, and most active organizations of clinical psychologists in the world. For 50 years, beginning with E. Lowell Kelly in 1960, researchers have chronicled the evolution of its membership and the transformation of clinical psychology in the United States. In this article, we highlight the continuity and change in clinical psychologists’ demographics, educations, theories, employment, activities, and satisfactions over a 50‐year span. Results from the most recent, 2010 study (N = 588, 46% return rate) are summarized in both contemporary and historical contexts. Among the prominent trends are steady increases in the proportion of female and ethnic minority psychologists, the rise of Psy.D. graduates, the domination of the cognitive orientation, a relative decline in psychological assessment in general and projective testing in particular, the ascendancy of independent practice, and a pattern of high career satisfaction.