绝经后阴道流血356例原因分析

目的：分析引起绝经后流血的病因及诊断以及恶性肿瘤的关系，方法：对356例生理性绝经1年以上阴道出血的病人进行病理检查。结果：引起阴道出血的良性疾病为80．90％，恶性肿瘤引起的阴道出血为19．10％。结论：对绝经后出血的诊断应重视常规的妇科检查和必要的B超检查及病理检查，以便早期作出正确的诊断。     

多糖的药理作用研究

多糖按照来源可分为植物多糖、动物多糖、菌多糖等。目前证明多糖具有广泛的生物活性，并已引起医学界浓厚的兴趣。至今已报道其具有免疫调节、抗肿瘤、抗病毒、抗辐射、延缓衰老及抗感染等多种作用，有的已在临床用于肝癌、肝炎、心血管疾病的辅助治疗和康复。本文对三类多糖的生物活性和临床应用的研究进展做了综述。     

《韦氏儿童智力量表-第四版》性能分析

《韦氏儿童智力量表-第四版》于2003年在北美公开发行和使用以来,得到众多学校心理学、儿童心理学和临床心理学专家的好评。与以往韦氏儿童智力量表相比,第四版本不再使用单一的言语量表得分和操作量表得分来笼统概括儿童的智力水平,而是提供了言语理解(Verbal Comprehension)、知觉推理(Perceptual Reasoning)、工作记忆(Working Memory)和加工速度(Processing Speed)四大分量表的索引得分以及一个全量表得分。这种更加细化的分类使得这一测验的结果有助于更精确地做临床诊断。心理学工作者和特殊教育工作者可以更直观、更具体地判断出被试是否在某一特定的认知功能方面有障碍或缺陷。韦氏第四套智力量表与以往的韦氏量表相比不仅仅是更新和扩大了常模,其设计理念的改进、记分方法的改变都使得该测验的结果更有助于心理学和特殊教育工作者做出更准确的解释和临床判断。文章详细介绍了韦氏第四套儿童智力量表的结构、相关的理论支持、各个分测验的设计理念和作用、信度和效度等指标、如何解释该量表的测验结果以及其临床应用价值等。笔者希望该简介有抛砖引玉的作用,使同行可以以“他山之石”为用。     

A Full Revolution: Offering 360 Degree Library Services to Clinical Clerkship Students

ABSTRACT

In their third year, medical students transition from the classroom to the hospital. Librarians can ease this transition from assignment-based to patient-based information needs, and at the University of Iowa this takes many forms. Preparation begins in the second year with foundational instruction. Customized electronic resource centers aid in selection of specialized resources; demonstrations at clerkship orientations promote these centers; attending morning reports show a librarian on the clinical team; and exercises assess the ability to find quality answers quickly. This combination has improved the students' searching facility and their comfort with library staff. Data show student resource selection became varied and appropriate, although understanding of study designs is suboptimal. Feedback has been positive from both students and faculty. While these techniques have been successful, they are only the first step in an evolving program.     

The Value Dilemmas of Faculty Advising; Significant Issues in a Code of Ethics for Faculty Advisors

ABSTRACT

Although frequently challenging, faculty advising continues to be a crucial component of social work education. Yet the current diversity of students, educational programs, and field placements present many ethical dilemmas to the faculty advisor. This paper explores the administrative, educational, and supportive roles of the faculty advisor, the inherent conflicts which develop and the effects of these conflicts on the ethical advising of social work students.

Similar to the classroom teacher, the faculty advisor can positively model ethical social work practice to students. Case examples from faculty advisors are used to study ethical dilemmas which arise in promoting social work values of self-determination and confidentiality. Recommendations are made to promote ethical practice among faculty advisors.     

Adenovirus-mediated wild-type p53 gene transfer in combination with bronchial arterial infusion for treatment of advanced non-small-cell lung cancer, one year follow-up

Objective: In the present study, we have examined the safety and efficacy of recombinant adenovirus encoding human p53 tumor suppressor gene (rAd-p53) injection in patients with advanced non-small-cell lung cancer (NSCLC) in the combination with the therapy of bronchial arterial infusion (BAI). Methods: A total of 58 patients with advanced NSCLC were enrolled in a non-randomized, two-armed clinical trial. Of which, 19 received a combination treatment of BAI and rAd-p53 (the combo group), while the remaining 39 were treated with only BAI (the control group). Patients were followed up for 12 months, with safety and local response evaluated by the National Cancer Institute's Common Toxicity Criteria and response evaluation criteria in solid tumor (RECIST), respectively. Time to progression (TTP) and survival rates were also analyzed by Kaplan-Meier method. Results: In the combo group,19 patients received a total of 49 injections of rAd-p53 and 46 times of BAI, respectively, while 39 patients in the control group received a total of 113 times of BAI. The combination treatment was found to have less adverse events such as anorexia, nausea and emesis, pain, and leucopenia (P<0.05) but more arthralgia. fever, influenza-like symptom, and myalgia (P<0.05), compared with the control group. The overall response rates (complete response (CR)+partial response (PR)) were 47.3% and 38.4% for the combo group and the control group, respectively (P>0.05). Patients in the combo group had a longer TTP than those in the control group (a median 7.75 vs 5.5 months, P=0.018). However, the combination treatment did not lead to better survival, with survival rates at 3, 6, and 12 months in the combo group being 94.74%, 89.47%, and 52.63%, respectively, com-pared with 92.31%, 69.23%, and 38.83% in the control group (P=0.224). Conclusion: Our results show that the combination of rAd-p53 and BAI was well tolerated in patients with NSCLC and may have improved the quality of life and delayed the disease progression. A further study to better determine the efficacy of this combination therapy is warranted.     

The fog of innovation: Innovativeness and deviance in developing new clinical testing equipment

Even when innovators know they are working with a potential breakthrough innovation, they face formidable difficulties in assessing the exact ways it will be innovative as well as deviant in regard to extant systems, business and practices. This finding emerges from our case study that spans the 40-year history of an ongoing and by now potentially radical innovation in automated and miniaturized liquid processing. We analyze the changes in the system-to-be and its relationship to its future contexts throughout this period and show how the developers were able to reliably predict technical compatibility, the outcome, the interface points and effects towards the intended environment only some distance ahead. This ‘fog of innovation’ presents a management challenge not duly met by instruments available in innovation literature.     

Acceptability of the Predicting Abusive Head Trauma (PredAHT) clinical prediction tool: A qualitative study with child protection professionals

The validated Predicting Abusive Head Trauma (PredAHT) tool estimates the probability of abusive head trauma (AHT) based on combinations of six clinical features: head/neck bruising; apnea; seizures; rib/long-bone fractures; retinal hemorrhages. We aimed to determine the acceptability of PredAHT to child protection professionals. We conducted qualitative semi-structured interviews with 56 participants: clinicians (25), child protection social workers (10), legal practitioners (9, including 4 judges), police officers (8), and pathologists (4), purposively sampled across southwest United Kingdom. Interviews were recorded, transcribed and imported into NVivo for thematic analysis (38% double-coded). We explored participants’ evaluations of PredAHT, their opinions about the optimal way to present the calculated probabilities, and their interpretation of probabilities in the context of suspected AHT. Clinicians, child protection social workers and police thought PredAHT would be beneficial as an objective adjunct to their professional judgment, to give them greater confidence in their decisions. Lawyers and pathologists appreciated its value for prompting multidisciplinary investigations, but were uncertain of its usefulness in court. Perceived disadvantages included: possible over-reliance and false reassurance from a low score. Interpretations regarding which percentages equate to ‘low’, ‘medium’ or ‘high’ likelihood of AHT varied; participants preferred a precise % probability over these general terms. Participants would use PredAHT with provisos: if they received multi-agency training to define accepted risk thresholds for consistent interpretation; with knowledge of its development; if it was accepted by colleagues. PredAHT may therefore increase professionals’ confidence in their decision-making when investigating suspected AHT, but may be of less value in court.     

以临床为导向的吞咽障碍资源库的开发和建设

将多种新型教学模式应用于专业课程资源库的建设是目前高等院校康复治疗学专业教学改革一个重要的方向。本课题通过以临床为导向进行资源库内容和框架的开发和建设,使康复治疗师能够快速融入临床教学环节。     

高职临床专业“德技并修、校院循环、三级模块”人才培养模式改革与实践

为深入地探究高职临床专业“德技并修、校院循环、三级模块”人才培养模式,文章从高职临床专业人才培养模式存在的主要问题入手,对其进行了全方位、深层次地剖析,并在此基础上全面而深入地探析了高职临床专业“德技并修、校院循环、三级模块”人才培养模式的特点和优势,最后探究了高职临床专业“德技并修、校院循环、三级模块”人才培养模式改革与实践策略,给出了作者具有代表性的个人建议。