【摘要】护理是一门科学性极强的应用性学科，在临床实习期运用好的带教方法为护理本科生实施带教，以帮助其更快、更好地完成从单纯接受知识到运用知识解决实际问题的转变。文章总结了近年来在护理本科生临床实习过程中所采用的创新带教方法，并对其科学依据和特点进行分析，为本科护理实习临床带教提供理论参考。【Abstract】 Nursing is a discipline of scientific application. In the clinical intern period, with better teaching methods, nursing students can faster and better complete the transformation from simple knowledge acceptance to use of knowledge to solve practical problems. We summarized some innovative teaching methods in the clinical intern period of the nursing undergraduate students in recent years, and analyzed the scientific base and advantages of each method, to provide a theoretical reference for the clinical teaching of undergraduate nursing practice.
Objective To examine the effects of pulmonary rehabilitation training on pulmonary function in patients post-stroke. Methods We searched Cochrane Library, PubMed, ProQuest, Embase, China National Knowledge Infrastructure, Wangfang Database, Chinese Biomedical Database, and VIP Chinese Science and Technology Journal Database for randomized controlled trials of investigating the effects of pulmonary rehabilitation training on pulmonary function in stroke patients published before September 2018. The patients in the training group were treated with pulmonary rehabilitation, including respiratory muscle training, chest breathing, or abdominal breathing training, with or without respiratory training device. The patients in the control group received conventional stroke rehabilitation. The outcome indicators included forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1 percentage predicted (FEV1%pred), peak expiratory flow rate, maximal inspiratory pressure (PImax), maximal expiratory pressure, exercise endurance, and quality of life. Two researchers independently carried out literature retrieval and data extraction, using Physiotherapy Evidence Database scale, and standard data extraction forms adapted from Cochrane Collaboration model to evaluate the studies quality. The Meta-analysis was performed using Review Manager Version 5.3. Results Eleven studies met the study criteria with a total of 500 stroke patients, including 274 patients in the training group and 226 patients in the control group, respectively. The Meta-analysis showed that after pulmonary rehabilitation training, the values of FVC [mean difference (MD)=0.30 L, 95% confidence interval (CI)(0.26, 0.34) L, P<0.000 01], FEV1 [MD=0.28 L, 95%CI (0.25, 0.32) L, P<0.000 01], and 6-minute walking test [MD=43.43 m, 95%CI (7.92, 78.95) m, P=0.02] in the training group were significantly higher than those in the control group, as well as the change of PImax [MD=6.49 cm H2O (1 cm H2O=0.098 kPa), 95%CI (3.67, 9.32) cm H2O, P<0.000 1]. The advantages of pulmonary rehabilitation training had not been found in improving FEV1/FVC and FEV1%pred (P>0.05). Conclusions The implementation of pulmonary rehabilitation training in the way of respiratory muscle training combined with conventional rehabilitation therapy could improve two kinds of indicators of pulmonary function referring to FVC and FEV1, inspiratory muscle strength and 6-minute waking distance. The long-term effect of pulmonary rehabilitation training on stroke patients, the respiratory training mode of different prescriptions, the endurance of exercise and the quality of life need further study.
Speech enhancement methods based on microphone array adopt many microphones to record speech signal simultaneously. As spatial information is increased, these methods can increase speech recognition for cochlear implant in noisy environment. Due to the size limitation, the number of microphones used in the cochlear implant cannot be too large, which limits the design of microphone array beamforming. To balance the size limitation of cochlear implant and the spatial orientation information of the signal acquisition, we propose a speech enhancement and beamforming algorithm based on dual thin uni-directional / omni-directional microphone pairs (TP) in this paper. Each TP microphone contains two sound tubes for signal acquisition, which increase the overall spatial orientation information. In this paper, we discuss the beamforming characteristics with different gain vectors and the influence of the inter-microphone distance on beamforming, which provides valuable theoretical analysis and engineering parameters for the application of dual microphone speech enhancement technology in cochlear implants.
Objective To systematically review the effectiveness and safety of power chain vs. nickel titanium coil springs in closing dental extraction space. Methods Databases including PubMed, EMbase, The Cochrane Library, Chinese Biomedicine Literature Database, Chinese Scientific Journals Full-text Database, and Chinese Journal Full-text Database were searched to collect the randomized controlled trials (RCTs) on comparing power chain with nickel titanium coil springs published before February 2012. Two reviewers independently screened literature, extracted data and assessed the quality of the included studies. Then meta-analysis was conducted using RevMan 5.0 software. Results A total of 4 RCTs involving 122 patients were included. The results of meta-analyses showed that there was a significant difference in the rate of space closure between the two groups (MD=0.30 mm per month, 95%CI 0.17 to 0.44, Plt;0.000 1); The results of subgroup analyses indicated that, both high-quality trials (MD=0.20, 95%CI 0.07 to 0.34, P=0.003) and low quality trials (MD=0.40, 95%CI 0.30 to 0.50, Plt;0.000 01) showed no significant difference in the rate of space closure. Conclusion Current clinical evidence indicates nickel titanium coil spring is superior to power chain in the rate of space closure, but its long-term effect still needs to be proved by more large-scale RCTs.
目前临床研究协调员（CRC）在完成高质量的临床试验中所扮演的角色越来越受到国内药物临床试验机构及药物申办者的广泛关注。作为临床试验过程中重要的一员，CRC承担着协调及管理临床试验项目的任务，具有“项目管理助手、后勤保障支持”的特点。四川大学华西医院国家药物临床试验机构在中医专业新药临床试验过程中，尝试配备CRC并在实际工作中取得了一定成效，同时也积累了实践经验。现就该机构中医专业新药临床试验过程中，CRC的运行机制和具体工作职责进行简要介绍，为各药物临床试验机构的建设和管理、药物临床试验的质量和整体水平的提高提供参考。
目的：探讨宫颈残端肿瘤的外科治疗方法及手术技巧，提高外科治疗水平。方法：回顾性分析我院自2005年5月至2007年11月手术治疗的宫颈残端肿瘤22例。结果：全组病例行不同程度的残余宫颈切除术，16例辅以不同程度的放疗或化疗，全切率100%，无手术相关死亡，3例并发膀胱损伤，术后恢复良好。结论：根治性手术风险高，难度大，只有根据病情采取合理的术式，掌握手术技巧，宫颈残端肿瘤才望获得较好的疗效。
Objective To study the clinical significance of total gastrectomy in treatment for gastric cardia cancer.Methods The clinical data of 118 patients with gastric cardia cancer underwent operation from May 1997 to October 2012 in the Department of General Surgery of Baiyin Hospital， Affiliated to Lanzhou University were analyzed retrospe-ctively. Among these 118 patients， there were 65 patients treated by total gastrectomy （total gastrectomy group） and 53patients treated by proximal gastrectomy （proximal gastrectomy group）. The postoperative complications， survival rate，quality of life， and nutrition indexes were compared after operation between the total gastrectomy group and the prox-imal gastrectomy group. Results ① The incidence of postoperative complications was 7.7% （5/65） and 13.2% （7/53） in the total gastrectomy group and the proximal gastrectomy group， respectively， the difference was not statistically signi-ficant （χ2=0.972， P=0.248）. ② 1-， 3-， and 5-year survival rate after operation were 63.1%， 46.2%， and 30.8% in thetotal gastrectomy group；which were 66.0%， 36.9%， and 18.5% in the proximal gastrectomy group. The difference of 1-year survival rate after operation was not statistically significant in two groups （χ2=0.193， P=0.402）， the 3- and the 5-year survival rates of the total gastrectong group were significantly higher than those of the proximal gastrectony group （χ2=4.508， P=0.022；χ2=30.271， P=0.000）. ③ The Spitzer quality of life score had no difference at the different timeafter operation in two groups （P＞0.05）. Compared with the proximal gastrectomy group， the points of heartburn， swallo-wing problem， appetite， and food intake on 12 months after operation in the total gastrectomy group were higher （P＜0.05）， the points of the other indexes had no significant differences （P＞0.05）. ④ The nutrition indexes after operationhad no differences at the different time after operation in two groups （P＞0.05）. Conclusions Total gastrectomy in treatment for gastric cardia cancer would not increase complications， also can improve 5-year survival for patients withⅠ-Ⅲ stage， and survival condition after operation is also much better than that of proximal gastrectomy.
Objective To explore feasibility and efficacy of laparoscopic microsurgery by transanal glove port for excision of rectal tumor. Methods Seventeen patients with rectal tumor underwent laparoscopic microsurgery by transanal glove port for local excision of rectal tumor were chosen from March 2015 to March 2016. This device was constructed by using a incision protective sleeve and standard surgical glove. The laparoscopy was used as lighting equipment. The ultrasonic scalpel, operation forceps and lens were separately inserted into the fixed sheath card from the 3 finger gloves. Results The operations of 17 cases were completed successfully. The operative time was 35–90 min with an average 54 min. The closed glove access time was 11 to 26 min with an average 18 min. The diameter of tumor was 1.4–3.5 cm with an average 2.4 cm. The results of postoperative pathology included 8 cases of villos adenemas, 3 cases of high-grade intraepithelial neoplasia, 1 case of low-grade intraepithelial neoplasia, 3 cases of carcinoid , and 2 cases of adenocarcinoma. All resection margins were negative. No infection, intestinal fistula, bleeding, and other complications were found. The hospital stay was 4–9 d with an average of 5 d. No recurrence was found during a follow-up of 1–6 months. Conclusions The preliminary results of limited cases in this study show that laparoscopic microsurgery by transanal glove port for excision of rectal tumor is easy, safe, and effective. It also provides a new choice for individualized comprhensive treatment of rectal tumor.
The measurement of network is one of the important researches in resolving neuronal population information processing mechanism using complex network theory. For the quantitative measurement problem of functional neural network, the relation between the measure indexes, i.e. the clustering coefficient, the global efficiency, the characteristic path length and the transitivity, and the network topology was analyzed. Then, the spike-based functional neural network was established and the simulation results showed that the measured network could represent the original neural connections among neurons. On the basis of the former work, the coding of functional neural network in nidopallium caudolaterale (NCL) about pigeon's motion behaviors was studied. We found that the NCL functional neural network effectively encoded the motion behaviors of the pigeon, and there were significant differences in four indexes among the left-turning, the forward and the right-turning. Overall, the establishment method of spike-based functional neural network is available and it is an effective tool to parse the brain information processing mechanism.
Objectives To observe the distribution of enlarged perivascular spaces (EPVSs) in acute ischemic stroke, and determine the factors that influence basal ganglia and centrum semiovale EPVSs. Methods We prospectively registered consecutive patients with acute ischemic stroke at the neurological wards of Jianyang Municipal People’s Hospital and West China Hospital of Sichuan University from February 1st to November 1st, 2014. Patients with ischemic stroke within 14 days of symptom onset, having magnetic resonance image (MRI) scan were included. Basal ganglia and centrum semiovale EPVSs, white matter hyperintensity, cerebral atrophy and lacunar infraction were rated using validated scales by reading MRI. Clinical information was obtained using standardized forms. The distribution of EPVSs was observed and analyzed. The evalution of EPVSs was analyzed in relation to age, vascular risk factor, cerebral atrophy, white matter hyperintensity, lacunar infraction, etc, by using univariate and multivariate logistical regression to evaluate the influencing factors for basal ganglia and centrum semiovale EPVSs. Results A total of 170 patients with acute ischemic stroke within 14 days from onset were included; in whom, 97.6% had EPVSs in basal ganglia and all had EPVSs in centrum semiovale. The most common scores of basal ganglia EPVSs were 1 point and 2 points. The most common scores of centrum semiovale EPVSs were 2 and 3 points. In logistic regression, age [odds ratio (OR)=1.043, 95% confidence interval (CI) (1.015, 1.071), P=0.002], periventricular white matter hyperintensity [OR=4.203, 95%CI (1.525, 11.583), P=0.006] and hypertension [OR=3.965, 95%CI (1.927, 8.157), P<0.001] were independently associated with increased severity of basal ganglia EPVSs. Only periventricular white matter hyperintensity [OR=2.248, 95%CI (1.054, 4.795), P=0.036] was independently associated with increased severity of centrum semiovale EPVSs in logistic regression. Conclusions EPVSs are common in ischemic stroke. There is a lower prevalence of EPVS in the basal ganglia compared with the centrum semiovale. Compared with centrum semiovale EPVSs, basal ganglia EPVSs are more associated with hypertensive cerebral small vessel disease, which may be a marker for hypertensive cerebral small vessel disease.