视神经孔位在眼外伤X线检查中的应用价值

目的 探讨视神经孔位在眼外伤Ｘ线检查中的应用价值。方法 ２年来因眼外伤摄视神经孔位３２便，均在大型Ｘ线机电视监视下拍摄。结果 ３２例视神经闰平片中发现视神经管骨折１２例占３７．５％；其中９例俣并眼眶骨折，３例为颅底骨折所致。结论 我们认为眼外伤摄取眼眶平片时，不应只摄眼眶的正侧位和切线位，还应摄取眼眶的斜位，即视神经孔位。视神经孔位应为眼外伤的常规投照位     

Occupational therapy students' paradigms: A passage from beholder to practitioner

The present study explores the development of occupational therapist paradigms among occupational therapy students at the Occupational Therapy Educational Program at the University College of Health Sciences, Jönköping, Sweden. The study is an explorative, comparative study of nearly qualified (last year) and newly enrolled (first week) occupational therapy students' world views and field of action views regarding occupational therapy. The students answered essay questions on paradigmatic matters, and their answers were analysed qualitatively. A study structure comprising three themes with appurtenant categories allowed comparisons between the two groups of students. A major finding was that the nearly qualified occupational therapy students' notions (in contrast to those of the newly enrolled students) gave expression to a more holistic health perspective in which there were numerous examples of interrelations between themes belonging to different paradigm components. According to Törnebohm interrelations between different paradigm components are characteristic of paradigms.     

我国医联体协同关系的构建和完善——制度约束和策略选择

"协同性"不足是医联体建设的瓶颈。本文根据协同理论识别影响组织协同关系的两个关键因素——"目标一致性"和"权力均衡性",并基于此对我国实践中医联体的不同协同模式进行剖析,对医联体建设的制度约束进行解构,提出推进医联体建设的协同策略和发展方向。本文认为受限于不同机构权力结构不均衡的制度约束,组织一体型协同模式是我国十四五时期推进医联体建设的主要方向,需要进一步打造组织一体化条件下的利益融合、区域整体治理条件下的跨部门协同和治理现代化条件下的机制协同。     

Professional knowledge creation in the hospital sector: a qualitative study in Taiwan

This paper aims to develop a professional knowledge creation model for the hospital sector. For this purpose, we qualitatively explore the determinants and process of knowledge creation in the hospital sector. Drawing from organization theory, we develop a hospital's professional knowledge creation model and develop three propositions first. We further explore the theoretical model at organization level by case study in Taiwan. The findings suggest that the hospital's professional knowledge creation is influenced by knowledge stock, social ties and isomorphic pressures as propositions argued. However, hospitals' attempts to keep aligned with their highly institutionalized environments may pay more attention to both existing knowledge stock and the process of professional knowledge creation for their survival. Finally, it is hoped that the significances of this study will contribute to the development of hypotheses in the future quantitative study for building a generalized knowledge creation model for the hospital organization. Copyright © 2010 John Wiley & Sons, Ltd.     

拓展护士知识 推进整体护理

随着整形外科学科发展及护理模式的转变，要求护士具有多学科、多领域的知识体系。通过定期进行业务学习，提高理论水平；进行术前宣教，制定切实可行的护理措施；结合具体病例，学习相关知识及宣传竞争意识，激发学习热情等途径，拓展知识，强化了整形外科护士职业心态，促进心理护理的实施，并能正确认识患者的需求，尊重患者的隐私；运用交流技术进行身心整体护理；制定多元化心理护理，从而提高护理质量。     

Prenatal Screening for Major Congenital Heart Disease

Objective. The purpose of this study was to determine the relative importance of the 4‐chamber view (4CV) compared with the outflow tract views (OFTVs) in prenatal screening for major congenital heart disease (CHD). Methods. We prospectively evaluated 200 consecutive infants undergoing cardiac surgery at our institution for major CHD. By reviewing the infants' medical records and conducting bedside interviews with their parents or guardians, we evaluated detection rates both prenatally and postnatally (before and after discharge to home), and we noted any prenatally identifiable risk factors for CHD. For each infant, we determined whether the 4CV or OFTVs would be expected to have been normal or abnormal on routine midgestation screening fetal sonography. Results. A prenatal diagnosis of CHD was made in 65 infants (33%): 30 of 124 low‐risk pregnancies (24%) and 35 of 76 high‐risk pregnancies (46%). An abnormal screening midgestation 4CV would have been expected in up to 63% of the infants, whereas abnormal midgestation OFTVs would have been expected in up to 91% of the infants. Thus, the potential sensitivity for detecting major CHD was higher with the OFTVs than with the 4CV (91% versus 63%; P < .001). Moreover, the OFTVs were more sensitive than the 4CV for detecting ductal‐dependent forms of CHD. Diagnosis after discharge to home occurred in 39 of 135 postnatal diagnoses (29%), including many cases of isolated outflow tract abnormalities requiring early invasive intervention. Conclusions. Cases of major neonatal CHD with OFTV abnormalities predominate over cases with 4CV abnormalities, particularly among those forms of CHD requiring early invasive intervention.     

试论气之原型

将气作为中医的基本概念,是中医界普遍的"常识"。但对其本身的解释与理解已经脱离了它作为掌握人体的媒介的目的,已呈现貌合神离的地步。本文从气功能的角度探讨气的本质与原型。     

The effect of proximity on open‐loop accommodation responses measured with pinholes

Open‐loop accommodation levels were measured in 41 healthy, young subjects using a Shin‐Nippon SRW‐5000 autorefractor in the three viewing conditions: a small physical pinhole pupil (SP), an optically projected pinhole in Maxwellian view (MV) and in the dark (DF). The target viewed through the pinholes was a high‐contrast letter presented at 0 D vergence in a +5 D Badal lens system. Overall, results showed that SP open‐loop accommodation levels were significantly higher than MV and DF levels. Subjects could be divided into two distinct subgroups according to their response behaviour: responders to the proximal effect of the small physical pinhole (SP accommodation > MV accommodation) and non‐responders to the proximal effect of the small physical pinhole (SP accommodation ≈ MV accommodation). Correlation analysis demonstrated that open‐loop accommodation for both pinhole conditions was correlated with DF for the responders, while for the non‐responders SP and MV accommodation were correlated, but were not related to DF accommodation. This suggests that under open‐loop conditions some individuals’ accommodation levels are mainly affected by proximal and cognitive factors (responders) while others are guided primarily by the presence of the more distal target (non‐responders). In conclusion, MV reduces the proximal effect of the physical pinhole and produces open‐loop accommodation responses which are more consistent than SP and DF responses.