调脉饮治疗气阴两虚兼瘀郁化热型快速型心律失常临床研究

目的：评价自拟凉血清热的调脉饮治疗气阴两虚兼瘀郁化热型快速型心律失常的临床疗效。方法将符合入选标准的60例快速型心律失常患者按随机数字表法分为2组各30例,治疗组服用调脉饮,对照组服用倍他乐克缓释片(琥珀酸美托洛尔缓释片),2组均治疗4周。观察2组治疗前后中医证候疗效、心电图及24 h动态心电图及安全性指标的变化。结果心电图及动态心电图疗效比较,治疗组总有效率为86.67%(26/30)、对照组为56.67%(17/30),2组比较差异有统计学意义(χ2＝6.708,P＜0.05)。中医证候疗效比较,治疗组总有效率为93.33%(28/30)、对照组为63.33%(19/30),2组比较差异有统计学意义(χ2＝7.957,P＜0.05)。治疗组气短[(1.40±2.11)分比(2.10±1.87)分,t＝-3.341]、乏力[(1.30±2.33)分比(2.10±1.84)分,t＝-3.262]、口干喜饮[(0.09±1.34)分比(2.50±2.41)分,t＝-3.194]、舌象[(1.90±1.65)分比(3.90±1.81)分,t＝-3.217])、脉象[(2.60±1.71)分比(5.10±2.55)分,t＝-3.283]5项中医证候积分均明显低于对照组(P＜0.01)。结论调脉饮可减少气阴两虚兼瘀郁化热型快速型心律失常发作及伴随症状,且心律改善情况优于倍他乐克缓释片,对心电图PR间期、QT间期无影响。     

A Mixture of Experts Network Structure for Breast Cancer Diagnosis

Mixture of experts (ME) is a modular neural network architecture for supervised learning. This paper illustrates the use of ME network structure to guide diagnosing of breast cancer. Expectation-maximization (EM) algorithm was used for training the ME so that the learning process is decoupled in a manner that fits well with the modular structure. Diagnosis tasks are among the most interesting activities in which to implement intelligent systems. Specifically, diagnosis is an attempt to accurately forecast the outcome of a specific situation, using as input information obtained from a concrete set of variables that potentially describe the situation. The ME network structure was implemented for breast cancer diagnosis using the attributes of each record in the Wisconsin breast cancer database. To improve diagnostic accuracy, the outputs of expert networks were combined by a gating network simultaneously trained in order to stochastically select the expert that is performing the best at solving the problem. For the Wisconsin breast cancer diagnosis problem, the obtained total classification accuracy by the ME network structure was 98.85%. The ME network structure achieved accuracy rates which were higher than that of the stand-alone neural network models.     

Experts’ views regarding Australian school‐leavers’ knowledge of nutrition and food systems

Objective: To explore Australian experts’ views regarding strengths and gaps in school‐leavers’ knowledge of nutrition and food systems ( N&FS) and factors that influence that knowledge. Method: Semi‐structured interviews were conducted with 21 highly experienced food‐related experts in Australia. Qualitative data were analysed thematically using Attride‐Stirling's thematic network framework. Results: Two global themes and several organising themes were identified. The first global theme, ‘structural curriculum‐based problems’, emerged from three organising themes of: inconsistencies in provided food education programs at schools in Australia; insufficient coverage of food‐related skills and food systems topics in school curricula; and the lack of trained school teachers. The second global theme, ‘insufficient levels of school‐leavers knowledge of N&FS ’, was generated from four organising themes, which together described Australian school‐leavers’ poor knowledge of N&FS more broadly and knowledge translation problem for everyday practices. Conclusion: Study findings identified key problems relating to current school‐based N&FS education programs in Australia and reported knowledge gaps in relation to N&FS among Australian school‐leavers. Implications: These findings provide important guidance for N&FS curriculum development, to clearly articulate broadly‐based N&FS knowledge acquisition in curriculum policy and education documents for Australian schools.     

不同专家对青年教师专业素质结构的观点比较

目的 比较不同身份专家(医学教育专家、医学教育管理干部和青年教师)对青年教师专业素质构成的看法,为青年教师完善自身素质提供参考.方法 通过文献回顾、小型专家会议,初步建立青年教师专业素质结构体系,进行专家函询,比较不同专家的看法.结果 在青年教师专业素质构成的一级指标比较中(Kendall协和系数W＝0.944,P=0...     

Developing expert clinical nurses: grow them, hold them and let them walk away

Spivak M., Smith A. & Logsdon M.C. (2011) Journal of Nursing Management 19, 92–97
Developing expert clinical nurses: grow them, hold them and let them walk away Aim The aim of the present study was to describe three case studies that exemplify decision making by a nursing leader related to retention of expert clinical nurses in the Emergency Department. Background Further understanding of decision-making processes that help nursing leaders to retain (or let go of) expert clinical nurses is needed so that sufficient numbers of expert nurses are available in the workforce to provide high-quality and safe patient care. Evaluation Decision processes related to retention of expert clinical nurses are exemplified in three case studies. Key issues Orienting nurses to specialty areas is costly and retention of nurses is an important international issue. Conclusions Expert clinical nurses across the skill continuum need guidance from nursing leaders related to their work behaviours and best choice for employment. Implications for Nursing Management Nursing leaders who are well acquainted with the skills and motivations of their employees are in the best position to promote the health of individual nurses and of specialty nursing units.     

首席医学专家下社区为居民服务的实践与思考

目的寻找合适的方法,让有限的资源在一、二级医院间共享,使社区居民得到更好、更便捷的医疗服务。为解决＂看病贵、看病难＂的问题探索出路。方法通过上海市奉贤区中心医院近年来向社区派驻首席医学专家,发挥他们的桥梁纽带作用,从传技术、帮管理、带培训等各方面提高基层医疗机构的服务水平,同时缓解二级医院的压力。结果调整社区医疗服务重点,找到一、二级医院的既合理分工又紧密合作的契合点,充分发挥各自作用。结论首席专家下社区活动充分体现医疗服务行业应该贴近社会,贴近患者的整体方针,也更好地为＂看病难,看病贵＂的社会问题提供了可行性的解决方案。对保证社区卫生服务事业健康有序的发展具有重要意义。     

氯雷他定与自血疗法联合复方甘草酸苷治疗慢性特发性荨麻疹的临床研究

目的:探讨氯雷他定与自血疗法联合复方甘草酸苷治疗慢性特发性荨麻疹的临床疗效。方法:选择64例慢性荨麻疹患者,随机分为观察组和对照组各32例,观察组给予氯雷他定与自血疗法联合复方甘草酸苷口服,对照组仅给予氯雷他定治疗,两组患者分别治疗4周后观察临床疗效。分别对用药后第7、14、28天瘙痒、风团最大直径、数量及发作持续时间进行四级评分,观察治疗28d后的疗效及药物不良反应发生情况。结果:用药后各项症状均较治疗前有所改善,用药28d后总观察组总有效率100%,对照组总有效率81.25%,两组比较,差异具有显著性(P<0.05),两组患者在用药期间均没有明显不良反应。结论:氯雷他定与自血疗法联合复方甘草酸苷口服治疗慢性荨麻疹疗效显著,患者依从性好。