升降理论在心血管病中的临床应用

本文从升降学说的理论基础来论证升降理论，体现于脏腑的各种机能活动和各种物质代谢运动中，升降功能的失调是心血管疾病发生发展的主要原因，因此，临床心血管病的治疗亦离不开升降理论作指导，遣方用药注重升中有降，降中寓升，升降相宜     

Longitudinal monthly body measurements from 1 to 12 months of age: a study by practitioners for practitioners

A longitudinal growth study with monthly measurements during the 1st year of life was conducted by nine paediatricians working in private practice in Zurich. Of 92 children, none was lost to the study and only 32 of 1104 planned visits were missed; the quality of the measurements was comparable to that of a specialised university clinic. Compared to the Zurich Longitudinal Growth Studies, children of this study were considerably heavier and taller. In 92% of the subjects, growth velocity was at least once outside the reference range (3rd–97th percentile). For weight increments, the corresponding proportion was 87%. Conclusions The data indicate that current standards for the 1st year of life for the Zurich area might no longer be appropriate and need to be updated. The currently used velocity percentiles based on 3-monthly measurements are not suitable to assess individual height and weight increments calculated from monthly measurements. Received: 9 June 1997 / Accepted in revised form: 21 November 1997     

雷公藤多苷的临床应用进展

综述近10年雷公藤多苷的临床应用进展，为深入研究雷公藤多苷提供理论依据。     

Conduct of trials in private clinical practice

PURPOSE: Trials of antiepileptic medications are usually based in tertiary referral centers with teaching hospital resources. Epilepsy Research & Services (ERS) is part of a private outpatient neurological clinic that is involved in research as part of multicenter clinical trials, adhering to Good Clinical Research Practice. ERS is subject to external monitoring and auditing, but does so outside of the teaching hospital environment. METHODS: The clinic is operated by a neurologist supported by a research assistant, administrative and nursing staff and has no formal university attachment. Patients are recruited for trials from routine referrals for clinical care. The center has formal ties with the ethics committee of the local teaching hospital, but none of the team is formally attached to that hospital. RESULTS: The center conducted trials of zonisamide, oxcarbazepine, gabapentin, remacemide, tiagabine, vigabatrin, felbamate, and lamotrigine both as add-on trials in refractory seizure disorders and as monotherapy trials in de novo epilepsy. More than 200 patients have been recruited for trials at ERS (with some patients being involved in more than one trial). External review endorsed ERS as a superior environment for such research and as a model for other centers. CONCLUSIONS: Private practice is a viable alternative for the conduct of clincial trials and should be considered when establishing such protocols. Simplicity of administration and clinical practice, which more closely mirrors standard patient care, may enhance recruitment and management.     

私立学校初一新生焦虑和抑郁状况

目的探讨私立学校初中新生的情绪状况及性别差异,为开展心理健康教育提供依据.方法采用Zung氏焦虑自评量表(SAS)和抑郁自评量表(SDS),对青岛市某私立学校初一新生228人进行整群抽样测查,匹配市区公立学校初一新生239人作同期对照,并做统计分析.结果观察组有15.79%处于焦虑状态(女生检出率较高),高于对照组(9.21%),差异有显著性(χ2=4.65,P＜0.05);观察组SAS均分高于对照组及常模,其中独生子女SAS均分高于对照组(P＜0.05).观察组中23.25%处于抑郁状态(男生检出率高),明显低于对照组(32.22%)(χ2=4.67,P＜0.05),但SDS均分不低于对照组.焦虑和抑郁同时存在率也以观察组较高(12.28%),与对照组差异有显著性(χ2=4.27,P＜0.05).结论私立学校初一新生存在以女生为主的较高焦虑检出率、以独生子女为主的较高焦虑水平以及以男生为主的抑郁检出率和较高抑郁水平,社会、学校和家庭要根据中学生的年龄和性别特点开展心理健康教育工作.     

Impact of medical practice guidelines on the assessment of patients with acute coronary syndrome without persistent ST segment elevation.

OBJECTIVE: To assess the impact of introducing clinical practice guidelines on acute coronary syndrome without persistent ST segment elevation (ACS) on patient initial assessment. DESIGN: Prospective before-after evaluation over a 3-month period. SETTING: The emergency ward of a tertiary teaching hospital. PATIENTS: All consecutive patients with ACS evaluated in the emergency ward over the two 3-month periods. INTERVENTION: Implementation of the practice guidelines, and the addition of a cardiology consultant to the emergency team. MAIN OUTCOME MEASURES: Diagnosis, electrocardiogram interpretation, and risk stratification after the initial evaluation. RESULTS: The clinical characteristics of the 328 and 364 patients evaluated in the emergency ward for suspicion of ACS before and after guideline implementation were similar. Significantly more patients were classified as suffering from atypical chest pain (39.6% versus 47.0%; P = 0.006) after guideline implementation. Guidelines availability was associated with significantly more formal diagnoses (79.9% versus 92.9%; P < 0.0001) and risk stratification (53.7% versus 65.4%, P < 0.0001) at the end of initial assessment. CONCLUSION: Guidelines implementation, along with availability of a cardiology consultant in the emergency room had a positive impact on initial assessment of patients evaluated for suspicion of ACS. It led to increased confidence in diagnosis and stratification by risk, which are the first steps in initiating effective treatment for this common condition.     

差异教学的探讨与实践

有研究者对中小学生的IQ分数与学习成绩分数进行过大量的相关调查，结果发现两者的相关系数大致为0.5，两者只为中等相关程度。也就是说，影响学习的因素应是多方面的。而布卢姆研究认为，学生学习成绩的差异主要由三个方面的因素造成，即是认知前提行为、情感前提特性、教学质量。本文试图以布卢姆的研究结果为依据，结合自己的教学实践，从多个方位探讨应对差异、实现面向全体的教学策略。     

谈中等卫生学校课堂创新教育

探讨中等卫生学校医学人才的培养问题.方法:以现代教学思想为指导,实行启发式教学和研究性学习.结果:在实践中达到了事半功倍的教学效果.结论:教学一定要根据不同的教学对象,充分利用教学资源,以灵活多变的教学方式才能达到预期的教学目的.     

对医学类高职高专院校计算机基础教育的思考

探讨了目前医学类高职高专院校计算机教育问题,通过分析医学高职高专院校计算机教学的目的和现状,对解决目前存在的一些问题做了初步思考.