基于零缺陷管理理论构建肝胆外科加速康复评价指标体系

目的构建适用于肝胆外科的加速康复评价指标体系,为加速康复外科实施效果提供评价工具。方法在零缺陷管理理论基础上,通过文献查阅、德尔菲专家咨询法构建肝胆外科加速康复评价指标体系。结果 2轮问卷回收率均为100%,专家权威系数分别为0.920、0.919。经过2轮专家咨询,最终构建的肝胆外科加速康复评价指标体系包括3个一级指标,8个二级指标,39个三级指标;指标重要性评分均4分,变异系数0～0.166;并确定各级指标权重。结论肝胆外科加速康复评价指标体系构建合理,有较好的可信度,经验证后可作为肝胆外科加速康复质量评价工具。     

中医儿科胎毒理论源流考

胎毒理论是中医儿科学对某些疾病病因的独特认识。运用传统文献整理方法对中医儿科胎毒理论源流进行梳理,认为其在宋之前开始萌芽,此时尚处于胎病理论阶段,认识到小儿尤其是新生儿诸多疾病的病因是在胎儿时期获得的,与患儿母亲胎孕时期养护及饮食不当相关,防治上注重清热解毒;宋金元时期明确提出胎毒为诸多儿科疾病的病因,并出现了胎毒医案的记载;明清时期渐趋成熟,认为胎儿形成前或胎儿期,由于父母嗜食辛辣甘肥,或五志过极化火,或房事过度,或孕母感受寒热之邪,形成胎毒内蕴,导致小儿出生后罹患鹅口疮、重舌、木舌等口腔疾病,虫疖、流丹、湿疹、痈疖等皮肤疾病,胎黄、胎惊等新生儿疾病以及麻、痘等传染性疾病,防治方法上注重辨证祛胎毒。     

从历法角度探讨《黄帝内经》运气学说的形成年代

本文梳理《黄帝内经》运气学说有关历法方面的内容,归纳出四分历、历元、干支纪年、气朔、置闰、三百六十日法、五星、夏时、漏刻9个问题。然后从历法学角度对这些问题的发展历史做了逐一回顾,提取这些发展历史中的重大事件作为断代标尺,以之来衡量运气学说所描述的历法内容,从而推论出运气学说的形成年代。最后的结论是其形成年代的下限在唐代以前,上限则基本否定了其形成于先秦、秦、汉初的可能性,更支持其形成于西汉中后期,或东汉以后,甚至南北朝之后。     

基于冰山理论的精细化护理在颅内动脉瘤围术期的实践研究

目的 探讨基于冰山理论的精细化护理在颅内动脉瘤围术期的作用效果。方法 回顾性分析31例行颅内动脉瘤术患者的临床资料,围术期接受常规护理,设为常规组;另外31例行颅内动脉瘤术患者的临床资料,围术期接受常规护理基础上的基于冰山理论的精细化护理,设为研究组。对比干预前后2组患者抑郁和焦虑状况,并对比干预期间遵医行为及不良事件发生率;对比干预前后生存质量。结果 干预前2组Zung抑郁(SDS)和焦虑(SAS)自评量表评分比较差异均无统计学意义,干预后2组SDS和SAS平均均低于干预前,且研究组低于常规组;2组遵医行为等级分布比较,差异有统计学意义,且研究组完全依从率高于常规组;2组恶心/呕吐、引流管堵塞及感染不良事件发生率比较,差异无统计学意义,而研究组不良事件总发生率低于常规组;干预前2组躯体、精神、社交能力、环境适应能力评分比较差异均无统计学意义,干预后2组上述生存质量评分均高于干预前,且研究组高于常规组。结论 基于冰山理论的精细化护理有助于改善颅内动脉瘤围术期间抑郁和焦虑状况,提高遵医行为,降低不良事件发生率。     

经方中芍药配伍应用规律探析

考察《伤寒杂病论》经方中配伍应用芍药的61首经方（56首原方，5首加减方）及126条相关条文。通过对经方剂量、比例、配伍、病位主症的分析，认为：经方中芍药为白芍；白芍并非补血药，其益阴补血的功效是通过配伍实现；经方中"分"为计量单位；芍药在丸散汤中的常见用量；经方中芍药主治的症状包括四肢挛急、腹痛、烦满、下利、小便不利等。与不同药物配伍，作用部位与症状随之变化，常见配伍有桂枝、附子、甘草、柴胡、黄芩、枳实、当归、茯苓等。     

于阴阳与基因调控关系辨治胃黏膜上皮内瘤变

胃黏膜上皮内瘤变是胃癌前病变,具有发展为胃癌的危险。阳主动,阴主静,文章基于阴阳理论,衷中参西,微观辨证与宏观辨证结合,以阴阳消长失调和基因调控紊乱的关系为出发点,认为胃黏膜上皮内瘤变发生时胃黏膜细胞凋亡周期紊乱和细胞异常增殖分化是阴阳消长失衡在细胞基因调控水平上的体现,进而探讨胃黏膜上皮内瘤变的病因病机以及辨证论治过程,为中医药治疗胃黏膜上皮内瘤变提供更多的理论依据,丰富治疗该病的临床手段。     

Orem自护理论在腹部手术病人护理中的应用

目的探讨Orem自护理论在腹部手术病人护理中的应用效果.方法将368例行腹部手术的病人按随机原则分为自护组和对照组各184例.对照组按常规术前、术后护理;自护组在常规护理的基础上采用Orem自护理论的3个护理系统,让病人参与健康决策及力所能及的自理.结果自护组术后下床活动时间、术后肛门排气时间及平均住院日显著短于对照组(均P＜0.01);术后并发症发生率显著低于对照组(均P＜0.05).结论在腹部手术病人护理中应用自护理论可降低术后并发症,促进术后身体康复及缩短平均住院日.     

A decision-analytic economic evaluation of valaciclovir prophylaxis for the prevention of cytomegalovirus infection and disease in renal transplantation

OBJECTIVE: This analysis evaluates the cost-effectiveness of valaciclovir prophylaxis using clinically and economically important health outcomes including graft failure, life-years, and quality-adjusted life-years (QALYs). METHODS: A Markov model was developed using a randomized, placebo-controlled trial of valaciclovir prophylaxis, together with a published epidemiological study and national renal transplant registry data. The model's population was stratified into two risk groups by donor/recipient cytomegalovirus (CMV) serostatus at transplantation: donor-positive/recipient-negative (D+R-) and recipient-positive (R+) patients. The model estimated costs and health outcomes over a 30-yr period from the perspective of Australian health care providers. RESULTS: The total health care cost was $3619 lower for D+R- patients receiving valaciclovir prophylaxis compared with those not receiving prophylaxis. D+R- patients receiving valaciclovir gained an extra 0.33 yr of life and 0.27 QALYs. R+ patients receiving valaciclovir prophylaxis gained an extra 0.07 yr of life and 0.05 QALYs, with an incremental cost of $914. This equates to $17 127 per QALY gained, which is highly cost-effective compared with other drugs and health interventions. CONCLUSIONS: Valaciclovir for the prophylaxis of CMV disease in renal transplant recipients is a cost-effective intervention, significantly reducing the burden of CMV disease to patients and health care providers.     

New approach to gridding using regularization and estimation theory.

When sampling under time-varying gradients, data is acquired over a non-equally spaced grid in k-space. The most computationally efficient method of reconstruction is first to interpolate the data onto a Cartesian grid, enabling the subsequent use of the inverse fast Fourier transform (IFFT). The most commonly used interpolation technique is called gridding, and is comprised of four steps: precompensation, convolution with a Kaiser-Bessel window, IFFT, and postcompensation. Recently, the author introduced a new gridding method called Block Uniform ReSampling (BURS), which is both optimal and efficient. The interpolation coefficients are computed by solving a set of linear equations using singular value decomposition (SVD). BURS requires neither the pre- nor the postcompensation steps, and resamples onto an n x n grid rather than the 2n x 2n matrix required by conventional gridding. This significantly decreases the computational complexity. Several authors have reported that although the BURS algorithm is very accurate, it is also sensitive to noise. As a consequence, even in the presence of a low level of measurement noise, the resulting image is often highly contaminated with noise. In this work, the origin of the noise sensitivity is traced back to the potentially ill-posed matrix inversion performed by BURS. Two approaches to the solution are presented. The first uses regularization theory to stabilize the inversion process. The second formulates the interpolation as an estimation problem, and employs estimation theory for the solution. The new algorithm, called rBURS, contains a regularization parameter, which is used to trade off the accuracy of the result against the signal-to-noise ratio (SNR). The results of the new method are compared with those obtained using conventional gridding via simulations. For the SNR performance of conventional gridding, it is shown that the rBURS algorithm exhibits equal or better accuracy. This is achieved at a decreased computational cost compared to conventional gridding.     

Cognitive profile of young well-trained athletes with intellectual disabilities

BackgroundPrevious research has shown that cognitive and motor skills are related. The precise impact of cognitive impairment on sport proficiency, however, is unknown.AimsThis study investigated group and individual differences in cognitive profiles in a large cohort of track and field athletes, basketball players, swimmers and table tennis players with (N = 468) and without (N = 162) intellectual disabilities (ID).Methods and proceduresBased on the Cattell-Horn-Carroll Theory of Cognitive abilities, eight subtests were selected for inclusion in a generic cognitive test (GCT) to assess executive functions and cognitive abilities relevant to sport, i.e., fluid reasoning, visual processing, reaction and decision speed, short-term memory and processing speed.Outcomes and resultsReliability coefficients for the subtests ranged between 0.25 and 0.88 respectively. Factor analysis revealed two clusters of subtests, i.e., a speed-based factor (simple and complex reaction time and simple and complex visual search) and a performance-based factor (Corsi Memory, Tower of London, WASI Block Design and Matrix Reasoning).After controlling for psychomotor speed, the group of ID-athletes scored significantly lower than athletes without ID on all the GCT subtests, except the complex visual search test. When cognitive profiles of individual ID- athletes were examined, some obtained higher scores than the average norm values in the reference population.Conclusions and implicationsThe GCT is currently administered as part of the classification process for athletes with ID who compete in the Paralympic Games. The results of this study indicate that the complex visual search and Tower of London test in the GCT should be reconsidered.