【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.
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 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.
ObjectiveTo investigate the risk factors of internal mammary lymph node (IMLN) metastasis in breast cancer patients, and to provide evidence for clarifying the TNM stage of tumors and formulating precise treatment plans. Methods The female patients who were admitted to the First Affiliated Hospital of Chongqing Medical University from February 2019 to January 2020 and diagnosed with breast cancer by tissue biopsy pathology based on the new tracer technology were retrospectively collected. All IMLNs were dissected. The associations of IMLN metastasis with patients’ age, tumor size (long diameter), tumor location, tumor grade, estrogen and progesterone receptor statuses, human epidermal growth factor receptor-2 (HER2) status, number of axillary lymph node (ALN) metastasis, and pathological molecular typing were analyzed. ResultsA total of 28 patients were included in this study. The visualization rates in the ALN and IMLN by the new tracer technique were 96.4% (27/28) and 35.7% (10/28), respectively. The pathological results of IMLN biopsy confirmed that 6 patients (The 6 cases were all displaying) had IMLN metastases, with an IMLN metastasis rate of 21.4%. The IMLN metastasis was related to the tumor location and ALN metastasis number of patients with breast cancer (P<0.05). That is to say, when the tumor located in the medial quadrant and the number of ALN metastasis was 4 or more, the IMLN metastasis rates were higher than those in the lateral quadrant (57.1% vs. 10.0%, P=0.028) and in the patients with ALN metastasis number <4 (50.0% vs. 11.1%, P=0.038). It was not found that IMLN metastasis was related to age, tumor size, tumor grade, estrogen and progesterone receptor statuses, HER2 status, and pathological molecular typing of patients with breast cancer (P>0.05). And the area of the receiver operating characteristic curve of the number of ALN metastasis for assessing IMLN metastasis was 0.697. ConclusionFrom the summarized results of cases in this study, the visualization rate of IMLN is higher based on the new tracer technology. When breast cancer locates in the medial quadrant and the number of ALN metastasis is 4 or more, it is recommended to actively carry out IMLN biopsy to clarify the results of pathological diagnosis, so as to accurately assess the tumor stage and formulate appropriate individualized treatment plan.
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。
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 the diagnostic value of contrast-enhanced ultrasonography (CEUS) in axillary and internal mammary lymph node metastasis of invasive breast cancer. Methods A total of 100 patients with invasive breast cancer treated from September 2020 to September 2022 were selected. Preoperative CEUS examination was completed, and the perfusion sequence, enhancement mode and enhancement sequence of lymph nodes were dynamically observed. The CEUS characteristics of metastatic and benign lymph nodes were compared. Using postoperative pathological results as the gold standard, the diagnostic efficacy of CEUS in evaluating lymph node status was analyzed. Results Among the 100 patients, 28 patients were diagnosed with metastatic axillary lymph nodes (ALN) by pathological biopsy. The sensitivity, specificity, accuracy, positive prediction rate and negative prediction rate of CEUS in evaluating ALN status were 71.4%, 87.5%, 83.0%, 69.0% and 88.7%, respectively. In 9 patients, CEUS showed internal mammary lymph node metastasis, and postoperative pathological examination confirmed that 5 patients had internal mammary lymph node metastasis, so the positive predictive rate of CEUS was 55.6%. Conclusion CEUS can evaluate the metastatic status of axillary and internal mammary lymph nodes.
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.
ObjectivesTo systematically review the influence of nifedipine combined with atorvastatin on hypertension in patients with hypertension.MethodPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of nifedipine combined with atorvastatin on hypertension in patients with hypertension from inception to November 20th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 17 RCTs involving 1 838 patients were included. The results of meta-analysis indicated that nifedipine combined with atorvastatin was superior to nifedipine alone on SBP (MD=−8.937, 95%CI−11.913 to −5.962, P<0.001), DBP (MD=−3.702, 95%CI−6.626 to −0.778, P=0.013) and total effective rate (RR=1.24, 95%CI 1.07 to 1.44, P=0.003). There was no significant difference between two groups in the incidence of adverse reactions (P>0.05).ConclusionsCurrent evidence shows that nifedipine combined with atorvastatin can significantly improve total effective rate, decrease the level of SBP and DBP, and increasing of dose not increase the incidence of adverse reactions. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
In order to standardize the suppliers’ behavior and ensure the healthy development of medical and health services, West China Hospital of Sichuan University deeply analyzed the suppliers’ thought, behavior, and result risk under the idea of Integrity Risk Prevention and Control, and explored the management mode of " dare not rot” " can’t rot” and " don’t want to rot” from the suppliers’ perspective. Several methods were adopted to guide and control suppliers’ behaviors in a standardized way, such as system formulation and publicity, signing the " incorruptible purchasing and saling contract”, supplier filing, " sunshine promotion”, whole-process evaluation, serious accountability, etc. This model can provide a reference for the construction of a new type of cooperation relationship between hospitals and medical enterprises under the new situation.