继续医学教育管理工作的几点思考

继续医学教育作为医护人员从业后获取新知识、新理论、新技术和新方法的终身性医学教育，发展至今已有十几年了。期间通过继续医学教育管理工作者的不懈努力，不仅充分调动了广大卫生专业技术人员的学习热情，使其不断提高专业技能和业务水平，同时继续医学教育管理工作也得到了飞速发展，已经形成了良好的运行机制，但在具体实践中也存在不少问题。     

人钠/二羧基转运蛋白1在肾组织的表达变化及其与肾结石发病的关系

目的研究肾组织钠/二羧基转运蛋白1(hNaDC1)表达变化与肾结石发病的的关系.方法85例肾结石患者分为、尿枸橼酸正常结石组和低枸橼酸尿结石组.并设50例对照为非结石患者.采用RT-PCR及Northem印迹法检测其中部分肾结石患者肾组织的hNaDC1mRNA水平;免疫组化检测hNaDCl蛋白表达的变化;常规生化方法测定血、尿枸橼酸、草酸等生化指标.结果低枸橼酸尿结石组结石复发率(36.1%),显著高于尿枸橼酸正常结石组(16.3%,P＜0.01).hNaDC1mRNA在正常肾组织中有表达,分布于近端肾小管刷状缘;低枸橼酸尿结石患者hNaDC1mRNA/18sRNA比值(0.65±0.21)显著高于对照组(0.36±0.11,P＜0.01);而尿枸橼酸正常结石患者(0.4±0.13)与对照组比较差异无显著意义(P＞0.05);低枸橼酸尿结石组hNaDC1蛋白表达也显著高于对照组及尿枸橼酸正常结石组(P＜0.01),而后两组间差异无显著意义(P＞0.05).低枸橼酸尿结石组尿pH值、尿钠水平显著低于尿枸橼酸正常结石组和对照组;尿钙、尿草酸水平均显著高于对照组,与尿枸橼酸正常结石组无显著差异.结论肾组织hNaDC1表达上调可能是低枸橼酸尿的重要原因,与肾结石的形成和复发存在某种内在联系.     

直肌联结术治疗高度近视伴固定性内斜视的护理

高度近视性斜视属于少见的特殊类型的斜视,多见于中老年人,病情发展呈渐进性,斜视为恒定性,固定于内转位或内下转位,严重者瞳孔可被完全遮挡,眼球向各个方向转动受限,以致不能视物,严重影响病人正常生活[1]。我科自2011年1月为高度近视致固定性内下斜视的病人施行内直肌后徙加外直肌上     

库车坳陷东部迪北侏罗系致密砂岩气藏特征

岗位评价又称职位评价,是指在岗位分析的基础上,按照一定的标准,对各个岗位的工作性质、责任要素、复杂因素、任职要素、工作环境等方面进行综合性的评价,确定岗位相对价值的过程[1].岗位评价方案通过对一系列报酬要素的排序或评分,衡量工作的相对价值,明确各个岗位的分类、级别的高低,保证对每个岗位的工作人员进行考核、晋升、奖罚等管理时,具有统一的标准,是现代人力资源管理理论中的重要内容.本文对国内外岗位评价方法及应用现状综述如下.     

The association between stereotyping and interprofessional collaborative practice

Objective

This study aimed to identify the association between stereotyping and professional intercollaborative practice.

Thinking critically about client-centred practice and occupational possibilities across the life-span

Abstract

Background: Client-centred occupational therapy practice is tacitly guided by prevailing social values and beliefs about what are “normal” occupational possibilities. These values and beliefs privilege some occupations and negate others. Aim: This study aims to identify and problematize assumptions regarding the value of approximating normal occupational possibilities, showing how these assumptions influence and may diminish client-centred practice. Methods: Using empirical research examples it demonstrates how occupational therapists and clients are immersed in contexts that shape values and beliefs about what are considered “normal” occupations and how these taken-for-granted values structure occupational therapy practice. Conclusion: Critique of client-centred practice requires conscious reflexivity, interrogating our own and our clients’ predispositions to value some occupations over others. Engaging in critical reflexivity can help therapists develop new perspectives of how client-centred practice can be applied that includes enabling possibilities for occupations that would be missed altogether in the pursuit of “normal’.     

Effect of abdominal massage on feeding intolerance among premature baby with mechanical ventilation in neonatal intensive care unit in indonesia

BackgroundFeeding intolerance in premature infants is due to the immaturity of the gastrointestinal system which is aggravated by the installation of mechanical ventilation. The impact of premature babies is delaying enteral nutrition, NEC, the risk due to parenteral nutrition and the high cost of care. Abdominal massage is one of the recommended actions to prevent it.ObjectiveThe study aimed to determine the effect of abdominal massage on feeding intolerance in premature infants with mechanical ventilation in the NICU.MethodsThis study was conducted using quasi-experimental with nonequivalent control group pretest and posttest design in the neonatal intensive care unit (NICU). The study was conducted on 34 premature infants, 17 groups who did abdominal massage and 17 as a control group. Feeding intolerance is determined by the presence of one or more symptoms such as increased gastric residue, abdominal distension and frequency of vomiting observed on the first (pre) and fifth (post) days. Abdominal massage is carried out twice a day for 15 min in a 5 day period. Data can be seen the difference on the first day and the last day.ResultsThe results showed a decrease in average gastric residue difference of 0.65 cc and abdominal distension of 0.59 cm in the intervention group (p < 0.05). Whereas in the control group gastric residue increased 3.59 cc and abdominal distension 1.88 cm (p < 0.05). The mean difference in vomiting frequency decreased in both groups, a decrease of 0.118 in the intervention group and 0.18 in the control group (p = 0.63). There was a significant difference in the occurrence of feeding intolerance between groups after the intervention (p = 0.05), where the incidence of feeding intolerance did not increase (0%) in the intervention group, while the control group increased by 9 (52.9%) respondents. There was a significant contribution to the confounding factor of the type of mechanical ventilation in the amount of gastric residue after the intervention (p = 0.02).ConclusionThere is an effect of abdominal massage on the incidence of feeding inolerance in premature infants with mechanical ventilation, so researchers recommend SPO abdominal massage to be considered as a treatment for intolerance feeding in premature infants with mechanical ventilation in the NICU.