Auditory Analgesia: Somatosensory Evoked Response and Subjective Pain Rating

Subjective rating responses and averaged evoked responses (AERs) to shock stimuli of varying intensity were recorded in 20 subjects to examine the possible analgesic effects of sound stimulation (music) and suggested analgesia. Subjects (10 men, 10 women, ages 19–31) were divided into two groups of 10, each receiving the sound-suggestion condition and the no-sound, no-suggestion condition in different order. Sound and suggestion produced the following significant (p<.05) effects: 1) increased electrical stimulus levels required to elicit discomfort ratings; 2) decreased slope of somatosensory AER amplitudes plotted against stimulus intensity; and 3) decreased mean AER amplitudes. These AER effects were greatest in time bands centered on the P100 component. Prior exposure to the electrical stimuli also reduced AER slopes and mean amplitudes, but mostly in time bands centered on the P200 component.     

住院医师规范化培训现状分析与建议

我国实行的住院医师规范化培训以及近来在北京试点的住院医师/专科医师基地培训项目与“全球医学教育最低基本要求”在培训要求上是基本一致的,有些方面还结合我国的国情进行了拓展。但在实施过程中,规范的培训体系中依然存在着很多“不规范”的情况。本文分析了现有住院医师规范化培训体系中存在的问题,指出培训要规范还需要依靠规范的管理,并就如何加强规范管理提出了建议。     

Le concept d’automatisme à l’épreuve de la filiation. De Charles Richet à Pierre Janet

In 1885, the philosopher Théodule Ribot and the physiologist Charles Richet founded the Society of physiological psychology with the objective of studying the psychic phenomena. The two men had numerous contacts in France and abroad hoping to interest French scientists in a subject that was still widely neglected. Favourably welcomed, Pierre Janet, a young professor of philosophy working in Le Havre made his first communication about the experiments of hypnosis with “Léonie” in collaboration with Dr Joseph Gibert. Janet mentioned cases of mental suggestion. The scientific community is highly impressed and Charles Richet in particular. Remaining dubious about the nature of these phenomena, Janet holds his judgment and continues to accumulate his observations of general psychology during the following four years. In 1889, he finally gathered all his research in a philosophy thesis, now notoriously knowned as: L’Automatisme psychologique. Throughout this work, Pierre Janet was widely inspired by the thoughts of Théodule Ribot, which quickly became one of his close acquaintances. Above all, he abundantly quotes the original work of Charles Richet, using books extracts from L’Intelligence de l’homme as well as articles from Revue Philosophique, which deals with the concept of automatism. In this respect, Pierre Janet can be historically regarded as the renowned successor of Charles Richet. Despite their initial and common understanding, they undeniably moved away from each other due to subtle differences regarding the interpretation of the psychic phenomena.     

骨科医疗纠纷相关因素的分析与对策

随着人们生活水平的提高和法制观念的增强，患者对健康恢复的要求也越来越高，医生一旦侵犯了患者权益，不管行为是故意或是过失，都可能引发医疗纠纷。尤其骨科医疗纠纷发生率比较高，位居医院各专业科室之首，占医疗事故鉴定总例数的30％左右。所以了解骨科医疗纠纷发生的规律，掌握其特点，找出重点防范环节，才能进一步提高医疗质量，预防或减少医疗纠纷的发生。     

Enhancement of suggestibility and imaginative ability with nitrous oxide

Rationale  Imaginative suggestibility, a trait closely related to hypnotic suggestibility, is modifiable under some circumstances. Nitrous oxide (laughing gas) is commonly used for sedation in dentistry and is reported to be more effective when combined with appropriate suggestions. Objective  The aim of this study was to determine whether nitrous oxide inhalation alters imaginative suggestibility and imagery vividness. Methods  Thirty participants were tested twice in a within-subjects design, once during inhalation of 25% nitrous oxide and once during inhalation of air plus oxygen. Before the study, participants’ expectancies regarding the effects of nitrous oxide were assessed. Participants were blinded to drug administration. During each session, participants were verbally administered detailed measures of imagination and suggestibility: the Sheehan–Betts Quality of Mental Imagery scale and the Stanford Hypnotic Susceptibility Scale Form C, minus the hypnotic induction. Results  Imaginative suggestibility and imaginative ability (imagery vividness) were both elevated in the nitrous oxide condition. This effect was unrelated to participants’ expectations regarding the effects of the drug. Conclusions  Nitrous oxide increased imaginative suggestibility and imaginative ability. Possible explanations of these findings are discussed with respect to the effects of N-methyl-d-aspartate antagonists and to other pharmacological effects upon suggestibility and imagination.     

核电厂通风系统中压差测量问题分析及解决建议

目的 分析核电厂通风系统中压差测量装置的有效性,解决发现的压差测量问题。方法 通过总结测压系统常见问题,运用流体力学原理分析系统不同部位的压力变化及对压差测量的影响。结果 核电厂某些测压系统存在取压口布置不合理或部件损坏等问题,影响了碘吸附器等净化设备阻力测量的代表性和准确性,建议对其进行检查和分析。结论 根据压差问题的分析,通过对压差测量装置的排查可有效提高阻力测量的准确性,为净化设备的更换提供更好依据,确保通风系统的安全运行。     

基于执行力视角的我国疫苗监管体系探析

目的:为提高我国疫苗监管活动中的执行力提供切实有效的建议和帮助。方法:通过搜集疫苗行业相关的数据和政策,从执行力视角出发,分解执行力5个要素:执行主体、执行客体、执行制度、执行资源、执行环境,剖析我国疫苗监管体系的现状。结果与结论:在执行力视角下,我国疫苗监管体系主体构成合理,但客体被动性较大,执行制度严谨,执行资源丰富,执行环境良好。可通过建立完整的执行力培训体系、合理的绩效奖惩机制,完善执行监控机制,建立高效的资源配置机制以及树立正确的执行力观念等措施来进一步提高我国疫苗监管活动中的执行力。     

WHO 2005年版GDP对我国GSP修订的启示

目的:为我国《药品经营质量管理规范》(GSP)的修订提供参考。方法:分析比较世界卫生组织(WHO)推荐的《药品配送管理规范》(GDP)与我国新版GSP(征求意见稿)的差异,进而提出修订建议。结果与结论:GSP(征求意见稿)与GDP相比还存在一些差距,GSP(征求意见稿)应加强药品使用环节管理,扩大GSP的适用范围;完善质量管理体系,强化对假劣药品的防范;增加药品进口的管理规定;进一步完善仓储与运输管理规定;加强药品的运输、投诉、召回和退货管理等。应建立覆盖整个药品供应链的完善的质量管理体系,以保证药品质量的稳定性和可追溯性。     

四省(市)基本药物制度实施进展、问题及建议

目的:为巩固和完善我国基本药物制度提供参考。方法:对重庆、四川、湖南、河南四省(市)基本药物制度的实施情况进行实地调研,收集四省(市)实施基本药物制度的文件,同时与四省(市)卫生厅(局)相关行政人员、基层医疗卫生机构管理者、基层医疗卫生机构医务人员及患者进行座谈,了解四省(市)基本药物制度实施过程中的问题及建议。结果与结论:调查的四省(市)都实现了基本药物制度在基层医疗卫生机构的全覆盖,并且依据地方需求制定了省(市)增补目录、建立起了基本药物制度配送机制,基本药物制度初步建立。基本药物制度实施后,基层医疗卫生机构收入结构发生变化,总收入增加,但仍存在药品不能满足需求、配送不能完全到位等问题。     

全科医生转岗培训临床实训现状调查分析

目的进一步促进全科医生转岗培训工作的有效实施,加强临床实训阶段的质量监控。方法重庆市全科医学教育中心针对重庆市2010～2011年全科医生转岗培训临床实训基地进行实地调研,通过问卷调查法和访谈法分别从学员学习体会、出勤率、在培期间工资福利、临床培训基地管理及带教师资方面了解全科医生转岗培训临床实训的现状。结果普遍反映通过全科医生转岗培训、临床实训阶段能很大程度提高学员的医疗卫生服务实践能力;学员临床操作技能和常见症状的诊断与鉴别诊断、主要疾病的防治与转诊能力均能得到提高;学员普遍很珍惜培训机会;同时也存在学员工学矛盾、经济压力大等问题。结论全科医生转岗培训是解决当前基层急需全科医生的重要途径之一,为了确保培训质量,需落实相关政策。