Thyroid-stimulating hormone receptor and its role in Graves' disease

The thyroid-stimulating hormone (TSH, or thyrotropin) receptor (TSHR) mediates the activating action of TSH to the thyroid gland, resulting in the growth and proliferation of thyrocytes and thyroid hormone production. In Graves' disease, thyroid-stimulating autoantibodies can mimic TSH action and stimulate thyroid cells. This leads to hyperthyroidism and abnormal overproduction of thyroid hormone. TSHR-antibodies-binding epitopes on the receptor molecule are well studied. Mechanism of TSHR-autoantibodies production is more or less clear but a susceptibility gene, which is linked to their production, is still unknown. Genetic studies show no linkage between the TSHR gene and Graves' disease. Among three common polymorphisms in the TSHR gene, only the D727E germline polymorphism in the cytoplasmic tail of the receptor showed an association with the disease, and this association is weak. The absence of a strong genetic effect of the TSHR polymorphisms in such a common and complex disorder as Graves' disease may be explained by a high degree of evolutionary conservation in TSHR. This can be shown by naturally existing germline and somatic mutations in the TSHR gene that cause various types of nonautoimmune and hereditary thyroid disease.     

螺旋CT在肝、脾损伤诊断中的作用

目的 评价螺旋CT在肝、脾损伤诊断中的作用.方法 采用日立Pronto螺旋CT扫描仪,它克服了普通CT扫描速度慢、需要控制呼吸、图像移动性伪影多、分辩力差等缺点,50例肝、脾损伤患者检查前均不服用造影剂,为避免移动伪影,可选择性地注射一定量镇静剂,必要时再作增强扫描,均取得良好的诊断效果.结果 螺旋CT是一种相对无损伤的检查,其评价肝、脾及其他脏器损伤的效果已得到广泛承认,因为它具有很高的敏感性和特异性;肝、脾损伤的分级,为外科医师决定手术还是保守治疗提供了重要依据.结论 肝、脾损伤的诊断及评价患者进行非手术治疗的可能性,螺旋CT检查是重要步骤之一,外科和放射科的密切合作可减少不必要的剖腹探查.     

辅导员在大学生学习目标建构中的角色与功能

针对当前部分大学生在校学习过程中存在的学习行为消极、懈怠现象,从学习需求动机与行为目标角度揭示大学生学习目标建构的现状,提出辅导员加强学生学习目标重构的必要性、紧迫性;揭示辅导员在大学生学习目标建构中的主体地位和主导作用,强化辅导员的角色认同,注重对学生内在学习动机的激励,强化学生主体性的培养和提高,通过学习目标的建...     

The value of role modelling: Perceptions of undergraduate and diploma nursing (adult) students

Using a grounded theory methodology, this paper demonstrates the value of role modelling in teaching and learning within the clinical area. Views of undergraduate (n = 20) and diploma (n = 22) nursing (adult) students were sought using individual and focus group interviews. Although the importance of role modelling is acknowledged within the literature, there appears to be little written about the value of providing role modelling within the clinical learning environment to facilitate learning for student nurses. Both groups of students stated the importance of having access to a good role model in order that they could observe and practice skills and/or behaviour. ‘Good’ role models were seen to have a tremendous influence on the clinical learning environment and on the development of students’ competence and confidence. Recommendations were made to include discussions on the value of role modelling on enhancing the clinical learning environment within mentor preparation courses. These discussions should emphasise the value of observational learning, the necessity of providing constructive feedback and the need for role models to enable the student to convert observed behaviour/skills into their own behaviour and skills set.     

The palliative care clinical nurse consultant: An essential link

This study describes the role of acute hospital palliative care nurse consultants and makes recommendations about future directions for the role development of this role. While the palliative care nurse consultant role is accepted in the acute setting there is little evidence or literature about what contributes to the success of this role. A three-phase study was undertaken to describe the role of palliative care nurse consultants in acute hospitals in Melbourne, Australia. The first phase of the three-phase study, involving in-depth qualitative interviews with the palliative care nurse consultants, is reported in this article. Using open-ended semi-structured questions, 10 palliative care nurse consultants were interviewed using open-ended questions about aspects of their role and the interviews were thematically analysed. Four main themes were identified that clarified the role; being the internal link; being the lynch pin; being responsive and being challenged. The palliative care nurse consultants were the first point of introduction to palliative care and thus they saw a significant role in introducing the concept of palliative care to those requiring palliative care, their families and others. They are an important link between the settings of care required by people accessing palliative care—acute, in-patient palliative care and community care. The palliative care nurse consultants saw themselves in leadership positions that in some ways defy boundaries, because of the inherent complexity and diversity of the role. The palliative care nurse consultants’ role appears to be pivotal in providing expert advice to staff and people requiring palliative care, and connecting palliative care services both within the hospital and to external services.     

精神科教学培训中“角色扮演”及“巴林特小组”的应用

精神科医师与患者的沟通内容多涉及患者隐秘的心理活动,应有较强的医学伦理学意识,而患者对于谈论自身心理活动又可能有所避讳,因此建立良好的医患关系极为重要,而对于精神科医师的培训更应注重提高建立良好医患关系的能力。“角色扮演”及“巴林特小组”是两种有效的教学方式。     

大学生综合素质培养——医学院校推行大学生班主任助理制度的探索与思考

大学生素质培养是一个重要的理论和实践问题,本文通过医学院校推行大学生班主任助理制度对大学生综合素质培养的作用和效果提出了思考,对大学生班主任助理制度的方法进行了探讨。     

我院就诊患者对医院药学服务和国家基本药物认知情况的调研

目的:为提高医院药学服务水平和国家基本药物制度工作的深入开展提供参考。方法:采用问卷调查法,向我院就诊的患者发放问卷共400份,进行现场填写,并如实回答相关内容,调查目前大众对医院药学服务工作的认知情况和对国家基本药物的认知情况,并与2003年同样的调研结果作一比较。结果:患者对用药知识需求较大,对医师的信任度仍然高于药师,但对药师的药学服务满意度则有较大的提高,对国家基本药物了解甚少。结论:我院药学服务水平有所提高,药师的工作正逐步得到大众的欢迎和认可。还应对医护人员和患者进一步宣传国家基本药物制度。