运用SimMom模拟人实施PBL教学的体会

"基于问题式学习"模式(problem based-learning, PBL)是学生在思考中进行学习,在理解的基础上形成记忆,在主动的交流过程中获取知识。运用SimMom模拟人实施PBL教学有助于激发学生的学习兴趣,提高学习效率,提高学生分析问题与解决问题的能力、临床实践能力和交流合作能力,在临床教学中可取得很好的教学效果。     

模拟人在产科护理教学中的运用

产科护理的特点及目前医疗环境的现状使传统护理临床技能规范化培训受到了很大的限制。模拟人主导的模拟教学因安全、有效、可重复操作等诸多优点而迅速发展。正确使用模拟人,科学构建模拟教学方法,清楚了解模拟人教学的优缺点,能让模拟人在护理教学中发挥更大作用。     

Interruptive communication patterns in the intensive care unit ward round

OBJECTIVE: An exploratory study to examine interruptive communication patterns of healthcare staff within an intensive care unit (ICU) during ward rounds. METHODS: The study was conducted in a tertiary hospital in Sydney, Australia. Nine participants were observed individually, for a total of 24 h, using the communication observation method (COM). The amount of time spent in conversation, the number of conversation initiating and number of turn-taking interruptions were recorded. RESULTS: Participants averaged 75% [95% confidence interval 72.8-77.2] of their time in communication events during ward rounds. There were 345 conversation-initiating interruptions (C.I.I.) and 492 turn-taking interruptions (T.T.I.). C.I.I. accounted for 37% [95% CI 33.9-40.1] of total communication event time (5 h: 53 min). T.T.I. accounted for 5.3% of total communication event time (56 min). CONCLUSION: This is the first study to specifically examine turn-taking interruptions in a clinical setting. Staff in this intensive care unit spent the majority of their time in communication. Turn taking interruptions within conversations occurred at about the same frequency as conversation initiating interruptions, which have been the subject of earlier studies. These results suggest that the overall burden of interruptions in some settings may be significantly higher than previously suspected.     

骨圈对椎弓根钉系统负载影响的三维有限元分析

目的：探讨单枚人体皮质骨圈(allograft fusion cage，AFC)斜植融合术中椎弓根钉系统受力分布，并对临床常见断钉原理进行分析，为临床应用提供理论依据。方法：采用二三维有限元方法(finite element method，FEM)，对放置及不放置AFC的脊柱Steffee钢板固定效果进行评估。结果：未放置AFC时Steffee钢板所受最大应力约为放置AFC状态下的4．8倍；椎弓根钉与螺帽交界处所受应力为最大，尤其上位螺钉与靠近椎体侧螺帽交界处是应力值最大点，未放置AFC时椎弓根钉最大应力点约为放置AFC状态下的5．0倍。结论：螺钉与钢板交界区是容易发生断钉的区域，尤其上位螺钉与靠近椎体侧螺帽交界处是最易断钉的部位；椎弓根钉系统放置AFC会明显增强融合节段稳定性，减少断钉等并发症。     

心脏灌注磁共振成像的图像配准

医学时序图像的配准是医学图像分析诊断的基础，也是图像融合等图像处理需要先行解决的问题。本研究提出了一种新的基于图像分割和相关法的算法，用于准确、快速实现心脏灌注核磁共振成像(MRI)图像的配准。该方法以图像相关系数为目标函数，利用迭代运算确定心脏图像的水平位移、垂直位移和旋转角度等参数。该算法优点在于充分考虑了心肌灌注图像的特殊性以及被测对象的身体物理运动、生理运动。结果表明，此方法能有效地对心脏灌注磁共振图像进行配准处理。     

Modeling of Diffusion with Partitioning in Stratum Corneum Using a Finite Element Model

Partitioning and diffusion of chemicals in skin is of interest to researchers in areas such as transdermal penetration and drug disposition, either for risk assessment or transdermal delivery. In this study a finite element method is used to model diffusion in the skin’s outermost layer, the stratum corneum (SC). The SC is considered to be a finite two-dimensional composite having different diffusivity values in each medium as well as a partition coefficient at the interfaces between media. A commercial finite element package with thermal analysis capabilities is selected due to the flexibility of this software to handle irregular geometries. Partitioning is accommodated through a change of variables technique. This technique is validated by comparison of model results with analytical solutions of steady-state flux, transient concentration profiles, and time lag for diffusion in laminates. Two applications are presented. Diffusion is solved in a two-dimensional “brick and mortar” geometry that is a simplification of human stratum corneum, with a partition coefficient between corneocyte and lipid. Results are compared to the diffusion in multiple laminates to examine effects of the partition coefficient. The second application is the modeling of diffusion with partitioning through an irregular geometry which is obtained from a micrograph of hairless mouse stratum corneum.     

Fractal characterisation of boundary irregularity in skin pigmented lesions

A growing literature shows researcher's interest in fractal analysis, arising from its ability to describe and characterise quantitatively the complexity of several tumour profiles. The aim of the work was to investigate the fractal properties of skin pigmented lesion boundaries. Although melanoma is one of the most aggressive tumours, early detection and a high rate of diagnostic accuracy, followed by timely excision, can allow complete recovery in melanoma patients. A modified approach to fractal dimension estimation was performed that was able to consider, in a data fit procedure, the range in which lesions show fractal properties. Identification of this zone is the most important step towards a correct fractal analysis procedure. The method was checked against a known fractal dimension object (Koch's curve) with an error of 0.007. The fractal dimension was estimated in 110 skin pigmented lesions and showed a significantly increasing linear regression (p<0.05), from common naevi to naevi with dysplasia to melanomas. This result is important for screening, as it can inform the decision to excise precociously malignant lesions or to avoid unnecessary removal of benign ones. The limitations of the method are discussed.     

人脑颞叶组织中类固醇5a－还原酶同功酶活性分布研究

本文采用酶放射分析法对新鲜人脑颞叶组织中５ａ－还原酶同功酶的活性分布进行研究。结果显示：（１）在颞叶脑组织中，５ａ－还原酶１和５ａ－还原酶２主要分布在灰质，其酶活性（５ａ－还原酶１，３３．６±４．５ｐｍｏｌ·ｈ_（－１）／ｍｇ蛋白，ｎ＝１２；５ａ－还原酶２，１３．８±２．９ｐｍｏｌ·ｈ_（－１）／ｍｇ蛋白，ｎ＝１１）明显高于分布在白质中的酶活性（５ａ－还原酶１，１４．７±２．０ｐｍｏｌ·ｈ_（－１）／ｍｇ蛋白，ｎ＝１２，Ｐ＜０．００１；５ａ－还原酶２，５．２±０．９ｐｍｏｌ·ｈ_（－１）／ｍｇ蛋白，ｎ＝１１，Ｐ＜０，０１）；（２）在灰质中，５ａ－还原酶活性主要来自于５ａ－还原酶１，其酶活性（３４．９±２．５ｐｍｏｌ·ｈ_（－１）／ｍｇ蛋白，ｎ＝３２）明显高于５ａ－还原酶２（１５．０±２．３ｐｍｏｌ·ｒ_（－１）／ｍｇ蛋白，ｎ＝１８，（Ｐ＜０．００１）；（３）５ａ－还原酶１和５ａ－还原酶２的活性在男女性之间差异不显著，且与年龄无相关关系。     

复频聚焦超声激活血卟啉杀伤离体肿瘤细胞的实验研究

在优选的超声辐照参数下 ,利用复频聚焦超声激活血卟啉 (Hp)杀伤肿瘤细胞K5 6 2 ,SW - 4 80并用MTT法检测分析了杀伤细胞的效率其初步结果为 :单频超声杀伤结果时低频优于高频 ;复频和单频比较 ,复频优于单频。而且杀伤效率不是单频的代数和 ,而是二者和的 2 - 3倍 ;由超声辐照后的孵育时间可以看出 :孵育 16h超声 Hp的杀伤效率高于 4h。     

8～16岁苗族学生体型分析

目的：探讨广西苗族中小学生体型特点与规律。方法：应用Heath-Carter人体测量法,对广西8～16岁苗族学生体型进行研究。结果：(1)苗族平均体型男生为均衡的中胚层体型(1．9-4．1-2．3),女生为偏内胚层的中胚层体型(2．8-3．8-2．0);(2)苗族男生8～16岁间随着年龄增加,中、外因子值明显增加,内因子值略有减少;(3)苗族女生自10～岁起,随着年龄增加外因子值减少,内、中因子值明显增加,15～16岁有所回落;(4)苗族学生男、女之间体型除8、9～岁组外,其余年龄组差异显著;苗族男生体型分布较集中。女生体型分布较分散。结论：与其他民族比较,苗族学生身材矮小,皮下脂肪少。