左甲状腺素钠早期治疗对妊娠合并亚临床甲状腺功能减退症妊娠结局和胎儿的影响

目的观察左甲状腺素钠早期治疗对妊娠合并亚临床甲状腺功能减退症(甲减)妊娠结局和胎儿的影响。方法回顾性选取 2020年 1月至 2021年 7月安徽医科大学第三附属医院孕期进行产前检查门诊随访治疗的妊娠合并亚临床甲减(即妊娠前或妊娠期甲状腺功能诊断为亚临床甲减) 64例作为观察组,同时收集同期分娩且甲状腺功能正常的 40例孕产妇为作为对照组。比较两组之间分娩方式、产后出血发生率、妊娠结局及新生儿结局的差异。结果观察组替代治疗前促甲状腺激素(TSH)、游离三碘甲状腺原氨酸( FT3)、血清游离甲状腺激素( FT4)、抗甲状腺球蛋白抗体( TGAb)、抗甲状腺过氧化物酶抗体(TPOAb)水平分别为( 6.62±0.66)mU/L、(2.63±0.15)pmol/L、(8.46±0.94)pmol/L、(126.25±10.16)IU/mL、(85.46±6.33)IU/mL,与对照组( 2.15±0.25)mU/L、(3.38±0.25)pmol/L、(14.55±1.25)pmol/L、(86.50±6.54)IU/mL、(10.35±2.59)IU/mL相比均差异有统计学意义( P<0.05),与对照组相比,观察组替代治疗前 TSH、FT3、FT4、TGAb、TPOAb(均 P<0.05);治疗后观察组 TGAb及 TPOAb阳性率均明显降低,与替代治疗前相比( P<0.05);观察组剖宫产率及产后出血发生率与对照组相比差异无统计学意义( P> 0.05);两组妊娠高血压综合征、低出生体质量儿、早产、羊水过少等发生率比较差异无统计学意义( P>0.05);两组新生儿窒息率及住院率比较差异无统计学意义( P>0.05)。结论左甲替代早期治疗后可改善妊娠合并亚临床甲减病人的妊娠结局,改善胎儿情况。     

ICP-MS法测定注射用头孢美唑钠中31种元素杂质的含量

摘 要 目的：建立电感耦合等离子体质谱（ICP-MS）法,测定注射用头孢美唑钠中的31种具有潜在风险的元素杂质：砷（As）、镉（Cd）、汞（Hg）、铅（Pb）、钴（Co）、镍（Ni）、钒（V）、金（Au）、铱（Ir）、锇（Os）、钯（Pd）、铂（Pt）、铑（Rh）、钌（Ru）、银（Ag）、硒（Se）、铊（Tl）、钡（Ba）、钼（Mo）、铬（Cr）、铜（Cu）、锂（Li）、锑（Sb）、锡（Sn）、硼（B）、铝（Al）、硅（Si）、钛（Ti）、锰（Mn）、铁（Fe）,锌（Zn）的含量。方法：采用Agilent 8900 ICP-MS Triple Quad电感耦合等离子体质谱仪,运用碰撞模式消除双电荷干扰,以高基体样品进样系统模式进样,通过在线内标方式消除基质效应,样品稀释直接进样测定。结果：该方法能同时测定31种元素杂质含量,其线性关系良好（r ＞ 0.99）、重复性试验的RSD小于20%（n = 6）、回收率在70%～140%（n = 9）,均满足USP 43 < 233 > 方法学验证碰撞模式的要求。应用该方法测定了20批来自不同生产企业的国产制剂及1批原研制剂中上述元素的含量。结论：国产及原研制剂中元素杂质含量均低于限度的30%,风险可控;所建立的方法操作简便,准确灵敏,专属性强,重复性好,可为化学药品中元素杂质控制方法提供参考。本试验对国评样品的元素杂质迁移情况开展筛查,不仅能够掌握注射用头孢美唑钠质量整体水平,并且可以为监管部门对上市后药品再评价提供技术储备和数据支持。     

以家庭为中心的护理模式对风湿性疾病患儿心理及家长照顾能力的影响

目的探讨以家庭为中心的护理模式对风湿性疾病患儿心理及家长照顾能力影响。方法选择2019年2—8月就诊的50例风湿性疾病患儿作为对照组,2019年9月—2020年2月就诊患儿50例作为观察组。对照组采用常规护理,观察组在对照组基础上给予以家庭为中心的护理模式干预,干预时间为3个月,比较干预前后两组患儿及其家长心理状态;采用主观生活质量问卷(ISLQ)评价两组患儿干预前后生活质量;采用照顾者照顾能力测量表(FCTI)评价两组患儿家长干预前后对患儿的照顾能力。结果干预后,观察组患儿及其家长SDS、SAS得分明显低于对照组,差异有统计学意义(P<0.05);患儿干预结束时、干预后3月ISLQ得分明显高于对照组,差异有统计学意义(P<0.05);患儿家长干预结束时、干预后3月FCTI得分明显低于对照组,差异有统计学意义(P<0.05)。结论以家庭为中心的护理模式能明显调节风湿性疾病患儿及其家长的心理状态,可改善患儿生活质量,提高患儿家长照顾能力。     

北京协和医院内科学系复合型精英医学人才培养探索

临床医学博士后项目是国家人力资源和社会保障部推行的复合型医学精英人才毕业后教育项目。2016年北京协和医院设立了临床医学博士后培养项目,内科学系在既往住院医师培养模式的基础上,创新设立了分层培养模式、阶梯式培养评估反馈体系、360°评价体系及危重症模拟培训课程等,并在实施过程中对项目进行持续改进和优化。本文对北京协和医院内科学系临床医学博士后培养项目运行实践进行总结,为培养具有国际视野的复合型医学精英人才提供借鉴和参考。     

中山大学附属第一医院拔尖创新医学人才培养模式的探索与实践

层出不穷的全球健康挑战对医学人才培养提出了新的要求,大健康视域下的医学教育肩负着培养面向未来的拔尖创新医学人才之重任。中山大学附属第一医院传承创新医学精英人才的培养模式,自2018年起探索实施临床医学博士后项目。该项目依托我院首创的且已相对成熟的"专科学院制"进阶式医学人才培养平台,在现有国家住院医师规范化培训方案基础上,整合高素质多学科交叉融合师资队伍、优化基于目标导向的进阶式培训、考核、评价体系,全面强化临床医学博士后的临床岗位胜任能力、科研创新能力和教育教学能力,为国家高层次复合型医学精英人才培养提供了参考。     

基于FMEA模式的康复护理对支气管哮喘急性发作患者的疗效

目的:探讨支气管哮喘急性发作患者应用基于失效模式和效果分析(failure mode and effect analysis,FMEA)模式的康复护理的效果。方法:选取2015年10月至2020年10月于青岛市市立医院西院区诊治的126例支气管哮喘急性发作患者为研究对象,按照随机单双数法将其分成对照组与研究组,每组各63例。对照组患者予以常规护理,研究组患者予以基于FME A模式的康复护理。护理1周后,对比两组患者的临床症状改善时间、护理前后肺功能指标[包括第1秒用力呼吸容积(forced breathing volume,FEV₁)、用力肺活量(forced vital capacity,FVC)及呼气流速峰值(peak expiratory flow rate,PEFR)]及生活质量综合评定问卷(Generic Quality of Life Inventory-74,GQOLI-74)评分,并分析两组患者并发症状况及对护理的满意度。结果:研究组患者咳嗽、喘息、肺部啰音及哮鸣音的改善时间分别为(5.14±0.51)d、(2.99±0.29)d、(4.70±0.46)d、(4.80±0.47)d,均明显短于对照组[(6.81±0.67)d、(4.36±0.43)d、(5.78±0.57)d、(5.97±0.60)d;P<0.05];护理1周后,两组患者的FEV₁、FVC及PEFR均明显升高(P<0.05),且研究组患者的FEV₁、FVC及PEFR分别为(2.24±0.20)L、(2.40±0.23)L、(3.58±0.35)L/s,均明显高于对照组[(1.60±0.15)L、(1.82±0.17)L、(2.70±0.26)L/s;P<0.05];护理1周后,两组患者的GQOLI-74评分均明显提高(P<0.05),且研究组患者的GQOLI-74评分为(95.43±9.44)分,明显高于对照组的(79.24±7.85)分(P<0.05);研究组患者的并发症发生率为1.59%,明显低于对照组(11.11%,P<0.05);研究组患者对护理的满意度为96.83%,明显高于对照组(73.02%,P<0.05)。结论:基于FMEA模式的康复护理可以明显缩短支气管哮喘急性发作患者临床症状的改善时间,促进肺功能的快速恢复,且有效减少并发症的发生,进一步提高其生活质量及对护理的满意度。     

The precuneus/posterior cingulate cortex plays a pivotal role in the default mode network: Evidence from a partial correlation network analysis

Recent research has shown that intrinsic brain activity as observed by functional magnetic resonance imaging (fMRI) manifest itself as coherent signal changes in networks encompassing brain regions that span long-range neuronal pathways. One of these networks, the so called default mode network, has become the primary target in recent investigations to link intrinsic activity to cognition and how intrinsic signal changes may be altered in disease. In this study we assessed functional connectivity within the default mode network during both rest and a continuous working memory task on a region-by-region basis using partial correlation analysis, a data-driven method that provides insight into effective connectivity within neuronal networks. Prominent features of functional connectivity within the default mode network included an overall strong level of interaction between the precuneus/posterior cingulate region and the rest of the default mode network, as well as a high degree of interaction between the left and right medial temporal lobes combined with weak interactions between the medial temporal lobes and the rest of the default mode network. Additionally, we found support for strong interactions between the precuneus/posterior cingulate cortex and the left inferior parietal lobe as well as between the dorsal and ventral sections of the medial prefrontal cortex. The suggested pivotal role of the precuneus/posterior cingulate cortex in the default mode network is discussed.     

Changes in the effects of process-oriented group supervision as reported by female and male nursing students: a prospective longitudinal study

The aim of this prospective longitudinal study was to perform a large-scale investigation over a longer period of time, to evaluate changes in the effects of process-oriented group supervision (PGS) as reported by female and male nursing students undergoing a 3-year nursing education. The study included nursing students (n = 183) who were followed during their 3-year study period in relation to their participation in PGS.
Methods:  A questionnaire consisting of three subscales: supportive (six items), educational (six items) and developmental (six items) as well as three items of a socio-demographic character (age, gender and previous experience of healthcare work) was used. Student's t -test was conducted to compare the educational, supportive and developmental subscales between the first and third year.
Results:  Females had a significant increase in the educational subscale (p = 0.018) over the 3-year study period, while no such difference was found for the males (p = 0.733). The female students also exhibited an increase in the supportive subscale (p = 0.031) over the 3-year period, while there was no difference for the male students (p = 0.426). There was also an increase in the developmental subscale for the female students over the 3-year period (p = 0.047) but no significant difference for their male counterparts (p = 0.912). For the study group as a whole, an increased positive effect of supervision was observed in the educational subscale (p = 0.020).
Conclusions:  The findings have strengthened the argument for the use of PGS in nursing education. To achieve the goal of PGS, which is supportive, educational and developmental in nature, it is important to bear in mind that the supervision needs of women and men can differ. Further research should therefore map out the supervisees' experiences and expectations of participating in a single sex group.     

Implementing clinical supervision: Part 1: laying the ground work

Australia, like other countries, is experiencing a crisis in the recruitment and retention of nurses. Clinical supervision has been suggested as a potential strategy to enhance retention. However, there is a paucity of literature regarding the successful implementation of clinical supervision. The aim of this study is to explore and evaluate ways of implementing clinical supervision as undertaken in a rural health-care organization in Victoria. Qualitative methodology was used including a documentation audit and individual interviews with the staff responsible for implementation. The findings demonstrate that the successful implementation had occurred in five interrelated stages. This paper, one in a series of three, focuses on the preimplementation phase leading up to initial implementation. The main themes identified during these stages were: organizational culture, exploring the possibilities, leadership and education and training which will be examined. These issues were essential in laying the foundation for the systematic introduction of clinical supervision.