Seizures and civilian head injuries

Although several studies have reported on the risk of "early seizures" (seizures occurring within 7 days following a head injury), the reported proportions of patients experiencing these seizures vary from 1.4 to 15%. This wide divergence may be due to problems with methodology such as case selection and definitions of head injury and early seizures. In a series of 702 patients admitted with a head injury to Cook County Hospital (CCH), Chicago, Illinois, 29 (4.1%) had early seizures. This proportion is twice as high as one previously reported in a comparable series. This may reflect an actual difference between the two series or a case selection bias serving to elevate the proportion of patients with early seizures at CCH.     

Urodynamics of the lower urinary tract

Summary The principles and techniques of uroflowmetry, cystometry, pressure-flow studies and urethral pressure profilometry are reviewed. The interpretation of urodynamic tests depends on the methodology used and whether the patients usual voiding symptoms during the examination. The more complicated urodynamic tests may require computer assistance both for data storage but also for test interpretation. One of the main challenge in future urodynamic is to transform these tests to clinical usable tools.     

中医疾病名称的特征、存在问题与研究思路

中医疾病名称（中医病名）的标准化研究是中医药现代化的重点和难点。中医病名是指传统医学对身心困苦的合理界定与指称关系所构建的符号系统,具备时空特征、临床特征和文化特征。这些特征既是中医病名的特点也是造成其应用弱化、标准化不足以及方法学缺失等问题的根源。针对上述问题提出对中医病名的研究思路：首先应根据应用需求选择合适的样本,通过模式的构建促成中医病名指称体系在内容与形式上的对齐,以此解决应用弱化的问题;其次应同步进行语义、语用和临床定位等研究,促进语言符号的实证化,强化中医病名的临床特征;最后应加强方法学的研究,对传统的名学方法与西方科学领域的命名法进行充分借鉴,通过理论对复杂系统的观照,明确分类体系与命名方法的内在关系,进而完成中医病名指称体系构建过程的标准化研究。     

临床诊断的思维方法

文章将临床诊断思维归纳为病变部位定位诊断法、病因机理诊断法、模板诊断法、概率诊断法四种方法,结合临床经验阐述了各种诊断方法的特点、步骤、适应性、局限性及相互关系,提出有机运用各种诊断思维,有益于减少误诊误治。     

Emergency skill training--a randomized controlled study on the effectiveness of the 4-stage approach compared to traditional clinical teaching

Introduction

The “4-stage approach” has been widely accepted for practical skill training replacing the traditional 2 stages (“see one, do one”). However, the superior effectiveness of the 4-stage approach was never proved.

Objectives

To evaluate whether skill training with the 4-stage approach results in shorter performance time needed for a successful percutaneous needle-puncture cricothyroidotomy, and consequently in a reduced number of attempts needed to perform the skill in <60 s compared to traditional teaching.

Trial design

Randomized controlled single-blinded parallel group study at the University Hospital Bern.

Methods

With IRB approval and informed consent 128 undergraduate medical students were randomized in four groups: traditional teaching, no stage 2, no stage 3, and 4-stage approach for the training of cricothyroidotomy. Everyone watched a video of the cricothyroidotomy as stage 1 followed by skill training in the respective teaching group. Participants had to perform the cricothyroidotomy 10 times on skin-covered pig larynxes. Performance time was measured from skin palpation to trachea ventilation. Study participants filled out a self-rating on competency during the training.

Results

Performance time for each attempt was comparable in all groups and improved similarly to reach a performance time of <60 s. Self-rating revealed that all groups felt equally competent throughout.

Conclusions

Even if the 4-stage approach is widely accepted and used as a didactic method for skill teaching we could not find evidence that its use or omitting stage 2 or 3 results in superior learning of an emergency skill compared to traditional teaching.     

Air and shock two-way shuttlebox avoidance in C57BL/6J and 129X1/SvJ mice

Despite multiple advantages of the use of electric shock as an aversive stimulus, reasons exist for considering alternative aversive stimuli. In the present study, we examined and compared the acquisition of two-way shuttlebox avoidance with 275.8-kPa (40-psi) pulsed air and continuous 0.4-mA shock in two strains of mice commonly employed in targeted gene mutation research, C57BL/6J and 129X1/SvJ. Each trial consisted of a 5-s warning stimulus (WS, light) during which shuttling to the other side cancelled delivery of the aversive stimulus. Once initiated, the aversive stimulus remained active for 20 s or until an escape response occurred. For C57BL/6J mice, air and shock were equally and highly effective aversive stimuli. In contrast, air was less effective than shock for 129X1/SvJ mice. C57BL/6J mice outperformed 129X1/SvJ mice for both stimulus types. For 129X1/SvJ mice, longer escape latencies were observed initially for air, suggesting that shock is more effective. However, these differences in latency dissipated within the first seven sessions. Nevertheless, by the end of the 17-day study, asymptotic levels of avoidance proficiency were substantially lower for air than for shock in 129X1/SvJ mice. These results indicate that air is a suitable substitute for shock as an aversive stimulus in shuttlebox active avoidance; however, the relative efficacies of these aversive stimuli appear to depend upon the strain chosen for study.     

^13C-呼气试验检测胃排空的原理及其结果分析

随着稳定性核素^13C-呼气试验检测胃排空临床应用的普及,与其相关的问题也日益突出。作为一种间接测定胃排空的定量手段．理解试验原理和解读试验结果对临床工作者尤为重要。本文通过全面阐述^13C-呼气试验的原理、与其他胃排空检测方法的比较、试剂种类以及胃排空呼气试验底物^13C-辛酸和^13C-乙酸在体内的代谢以及^13C-的转运和分布规律,以期能帮助临床工作者理解^13C-呼气试验的原理并分析试验结果。     

Digital video analysis of health professionals’ interactions with an electronic whiteboard: A longitudinal,naturalistic study of changes to user interactions

As hospital departments continue to introduce electronic whiteboards in real clinical settings a range of human factor issues have emerged and it has become clear that there is a need for improved methods for designing and testing these systems. In this study, we employed a longitudinal and naturalistic method in the usability evaluation of an electronic whiteboard system. The goal of the evaluation was to explore the extent to which usability issues experienced by users change as they gain more experience with the system. In addition, the paper explores the use of a new approach to collection and analysis of continuous digital video recordings of naturalistic “live” user interactions. The method developed and employed in the study included recording the users’ interactions with system during actual use using screen-capturing software and analyzing these recordings for usability issues. In this paper we describe and discuss both the method and the results of the evaluation. We found that the electronic whiteboard system contains system-related usability issues that did not change over time as the clinicians collectively gained more experience with the system. Furthermore, we also found user-related issues that seemed to change as the users gained more experience and we discuss the underlying reasons for these changes. We also found that the method used in the study has certain advantages over traditional usability evaluation methods, including the ability to collect analyze live user data over time. However, challenges and drawbacks to using the method (including the time taken for analysis and logistical issues in doing live recordings) should be considered before utilizing a similar approach. In conclusion we summarize our findings and call for an increased focus on longitudinal and naturalistic evaluations of health information systems and encourage others to apply and refine the method utilized in this study.