老年食管癌手术患者全身麻醉复合硬膜外麻醉与全身麻醉的比较

目的比较老年食管癌手术患者全身麻醉复合硬膜外麻醉与全身麻醉的效果。方法将76例老年食管癌患者随机分为全麻组(n=38):仅用全身麻醉;复合组(n=38):采用全身麻醉复合硬膜外麻醉。记录在围麻醉期两组患者的平均动脉压(MAP)、心率(HR)、全麻药用量、术后苏醒时间、苏醒质量和拔管时间,并进行比较。结果两组患者的麻醉效果满意。复合组患者的MAP、HR、全麻药用量、术后苏醒时间和拔管时间均明显低于全麻组(P<0.05或P<0.01.)。结论全身麻醉复合硬膜外麻醉的效果优于全身麻醉。     

管理学课程教学创新探讨

管理学是研究管理活动的科学知识体系，是一门综合性应用学科，具有科学性和艺术性。针对管理学在新形势下不断呈现出的特点，探讨了管理学课程的教学目标、教学内容及教学方法应该作出的调整和创新。     

Stress,Symptom Proneness,and General Adaptational Distress During Pregnancy

Abstract

Symptom proneness (SP), the 20 psychiatric items of the Cornell Medical Index, here called the Cornell Psychiatric Items (CPI), and a test developed partially from the Schedule of Recent Experiences called the Utah Stress Scales (STRESS) were used to predict general adaptational distress (GAD) symptoms during pregnancy on a sample of 1306 primigravidas. The causal model explored in seven path analyses developed for months 3–9 of pregnancy is that SP and STRESS affect CPI, and that SP, STRESS, and CPI directly affect GAD symptoms. Results suggest that CPI is most predictive of GAD symptoms until the ninth month when SP and STRESS become more predictive. It is suggested that GAD pregnancy symptoms are affected by situational stress, symptom proneness, and level of psychological upset and that this system of relations changes over the course of pregnancy. This information should have important implications for anticipating potential problems and improving the quality of nursing care of pregnant women.     

Two Nonlinear Positivity-Preserving Finite Volume Schemes for Three-Dimensional Heat Conduction Equations on General Polyhedral Meshes

In this article we present two types of nonlinear positivity-preserving finite volume (PPFV) schemes for a class of three-dimensional heat conduction equations on general polyhedral meshes. First, we present a new parameter selection strategy on the one-sided flux and establish a nonlinear PPFV scheme based on a two-point flux with higher efficiency. By comparing with the scheme proposed in [H. Xie, X. Xu, C. Zhai, H. Yong, Commun. Comput. Phys. 24 (2018) 1375–1408], our scheme avoids the assumption that the values of auxiliary unknowns are nonnegative, which makes our interpolation formulae suitable to be constructed by existing approaches with high accuracy and well robustness (e.g., the finite element method), thus enhancing the adaptability to distorted meshes with large deformations. Then we derive a linear multi-point flux involving combination coefficients and, via the Patankar trick, obtain another nonlinear PPFV scheme that is concise and easy to implement. The selection strategy of combination coefficients is also provided to improve the convergence behavior of the Picard procedure. Furthermore, the existence and positivity-preserving properties of these two nonlinear PPFV solutions are proved. Numerical experiments with the discontinuous diffusion scalar as well as discontinuous and anisotropic diffusion tensors are given to confirm our theoretical findings and demonstrate that our schemes both can achieve ideal-order accuracy even on severely distorted meshes.     

Community orientation of general practitioners in 34 countries

General practitioners (GPs) are frontline health workers. They should be sensitive to the health needs of the community in addition to caring for patients that visit their practice. Due to changes in demography, epidemiology, ecology and healthcare policy, a community orientation becomes more important. Our research question is: to what extent does community orientation of GPs vary between countries and GPs and how can this variation be explained? We use cross-sectional survey data from the QUALICOPC study, conducted among over 7000 GPs in 34 countries. Community orientation was measured through a scale constructed from three survey questions on whether GPs would take action when confronted with: repeated accidents in an industrial setting, frequent respiratory problems in patients living near a certain industry, and repeated cases of food poisoning in the local community. Independent variables are at healthcare system level and GP or practice level. Data were analysed using linear multilevel regression analysis. Community orientation varies between GPs and countries. Community orientation is more frequent in healthcare systems with a list system, among self-employed GPs, those using medical records to make overviews, and those more active in prevention and multidisciplinary cooperation. GPs in rural areas and areas with more people from ethnic minorities are more community oriented. Based on the variation between countries and GPs, we would like to raise awareness and underline the importance of multidisciplinary cooperation.     

Surveying general practitioners: a new avenue

SUMMARY

Background: The validity of opinions expressed in questionnaire surveys diminishes with lower response rates. Recent research suggests that general practitioners (GPs) are more likely to respond to questionnaire surveys if they are motivated to do so because the subject of the survey is perceived as relevant to the practitioner at the time of the survey, and there is an opportunity to respond without encroaching on existing obligations or interests.

Aim: To compare the results of a questionnaire survey administered by two routes: a postal survey with reminders and after an educational meeting with no reminders.

Methods: A validated questionnaire with 19 questions using a Likert scale seeking views about the ideal contents of a referral letter to colorectal surgeons was administered to GPs attending a monthly educational meeting in one locality in the UK and by post to a different group in a second locality. The response rate and demographic characteristics of the GPs were compared for respondents, non-respondents, attenders and non-attenders to the educational meeting. The mean responses to the questions on the Likert scale were used to produce a schedule to score the contents of referral letters. The schedules produced by the two methods (postal/educational meeting) were used to score 551 referral letters at one district general hospital. Mean scores calculated using the two schedules derived by the postal and educational routes were compared. Cases diagnosed with 'significant organic pathology' as defined in a previous study were identified. The predictive value of the scores in identifying these cases was compared.

Results: 88% (138/157) of GPs in the locality attended the educational meeting and were invited to participate in the survey. Non-attenders were more likely to be assistants, locums or part-time practitioners. Overall 71% (98) of the GPs responded to the survey. There were no significant demographic differences between the respondents and non-respondents to the survey. Response rates to the survey conducted by the two routes were similar. Referral letter 'quality' scores derived via the two alternative routes were equally valuable in predicting which patients had significant organic pathology.

Conclusions: Responses to questionnaire surveys are equally valid when administered via an educational meeting or by post. The value of the educational meeting approach was the relative ease of administering the questionnaire and the rapid turn around of replies. However this method may exclude the views of part-time practitioners who were more likely to fail to attend. These practitioners may need to be targeted by alternative routes in questionnaire surveys.     

医院工会对职工主观幸福感的现状调查分析

目的 调查北京天坛医院职工的主观幸福感情况,并分析影响因素,为改善医院职工心理健康提供循证参考。方法 采用分层抽样法随机选取北京天坛医院医生500人,护士800人,医技200人和其他岗位职工300人,资料收集时间为2019年11月1—8日,内容包括职工的一般人口学特征及主观幸福感评分,分析不同人口学特征对职工主观幸福感评分的影响。结果 调查共回收有效问卷1785份,问卷的信度和效度良好(克朗巴赫α系数为0.834; KM0值为0.978),被调查职工的主观幸福感评分为(77.00±5.25)分。不同年龄、婚姻状况、学历、岗位、职称和编制的职工主观幸福感评分比较,差异有统计学意义(P0.001),35岁以上年龄组职工的主观幸福感评分均显著低于35岁以下职工,差异有统计学意义(P0.001);相较于医技和护理岗位,医生的主观幸福感评分较低,差异有统计学意义(P0.001)。结论 医院应持续开展体验式心理服务项目,提高职工心理健康保健能力,积极改善工作-生活不平衡,提升职工共情能力,重视医生群体的主观幸福感,搭建跨学科交流平台,从而提升职工的主观幸福感。