门诊患者医疗服务感受度影响因素研究

??????? 目的 了解门诊患者对就医服务感受度影响因素,以期提高患者满意度。 方法 现场问卷调查法、专家访谈法。 结果 患者在门诊过程中最为关注的就诊流程、等候时间、就医环境、医德医风四个因素,非常看重医护人员服务规范,服务流程便捷流畅。病情不同患者对等候时间要求不同,对医院熟悉程度与就诊环境感受度不同。结论 在门诊服务中为患者提供便捷流畅、规范化的服务,同时应注重患者的不同服务需求。     

Climatic effects in Central Europe on the frequency of medical treatments of dairy cows

In the present study, the relationship between the temperature–humidity index (THI) and the incidence of medical treatments in lactating dairy cows in Lower Saxony, Germany, was investigated. Records of all veterinary-treated cases over 2 years (2003 and 2005) from eight Holstein–Friesian dairy herds raised in loose-housing systems (55 to 170 cows per herd) were evaluated. After exclusion of management-dependent and climate-independent cases, a total of 5547 treatments were analyzed. Treatments were clustered into the following groups: metabolism, fertility, udder and foot/leg. Meteorological data were compiled from the nearest weather station (average distance ± s.d. 39 ± 13 km). Hourly temperatures and relative humidity values were used to calculate the THI, which was divided into classes. Out of the total number of treatments, 37.4%, 32.9%, 21.6% and 8.1% belonged to metabolism, udder, fertility and foot/leg, respectively. Data were analyzed with a mixed model that included THI class, season and year as fixed effects and farm as random effect. In general, incidences were neither affected by the year (P > 0.05) and season (P > 0.05) nor by THI classes (P > 0.05). In tendency, incidences of metabolic treatments increased with increasing THI and incidences of udder treatments increased with decreasing THI. In conclusion, indications of moderate heat stress during summer months in Central Europe were found in the present study, although THI and season did not affect the different disease complexes significantly.     

Bioreactors in tissue engineering—principles,applications and commercial constraints

Bioreactor technology is vital for tissue engineering. Usually, bioreactors are used to provide a tissue-specific physiological in vitro environment during tissue maturation. In addition to this most obvious application, bioreactors have the potential to improve the efficiency of the overall tissue-engineering concept. To date, a variety of bioreactor systems for tissue-specific applications have been developed. Of these, some systems are already commercially available. With bioreactor technology, various functional tissues of different types were generated and cultured in vitro. Nevertheless, these efforts and achievements alone have not yet led to many clinically successful tissue-engineered implants. We review possible applications for bioreactor systems within a tissue-engineering process and present basic principles and requirements for bioreactor development. Moreover, the use of bioreactor systems for the expansion of clinically relevant cell types is addressed. In contrast to cell expansion, for the generation of functional three-dimensional tissue equivalents, additional physical cues must be provided. Therefore, bioreactors for musculoskeletal tissue engineering are discussed. Finally, bioreactor technology is reviewed in the context of commercial constraints.     

Theoretical study of electron transfer process between fullerenes and neurotransmitters; acetylcholine,dopamine, serotonin and epinephrine in nanostructures [neurotransmitters].C<Subscript><Emphasis Type="Italic">n</Emphasis></Subscript> complexes

Neurotransmitters are the compounds which allow the transmission of signals from one neuron to the next across synapses. They are the brain chemicals that communicate information throughout brain and body. Fullerenes are a family of carbonallotropes, molecules composed entirely of carbon, that take the forms of spheres, ellipsoids, and cylinders. Various empty carbon fullerenes (C_n) with different carbon atoms have been obtained and investigated. Topological indices have been successfully used to construct effective and useful mathematical methods to establish clear relationships between structural data and the physical properties of these materials. In this study, the number of carbon atoms in the fullerenes was used as an index to establish a relationship between the structures of neurotransmitters (NTs) acetylcholine (AC) 1, dopamine (DP) 2, serotonin (SE) 3, and epinephrine (EP) 4 as the well-known redox systems and fullerenes C_n (n = 60, 70, 76, 82, and 86) which create [NT].C_n; A-1 to A-5 up to D-1 to D-5. The relationship between the number of carbon atoms and the free energy of electron transfer (ΔG_et(n); n = 1–4) is assessed using the Rehm-Weller equation for A-1 to A-5 up to D-1 to D-5 supramolecular [NT].C_n complexes. The calculations are presented for the four reduction potentials (^Red.E₁ to ^Red.E₄) of fullerenes C_n. The results were used to calculate the four free energy values of electron transfer (ΔG_et(1) to ΔG_et(4)) of the supramolecular complexes A-1 to A-8 up to D-1 to D-8 for fullerenes C₆₀ to C₁₂₀. The first to fourth free activation energy values of electron transfer and the maximum wavelength of the electron transfers, ΔG^#_et(n) and λ_et (n = 1–4), respectively, were also calculated in this study for A-1 to A-8 up to D-1 to D-8 in accordance with the Marcus theory.     

关节镜治疗髋关节疾病的临床研究

目的:研究髋关节镜治疗髋关节疾病的方法、疗效及适应证,探讨髋关节镜在髋关节疾病中的临床价值。方法:研究对象为86例有明显髋关节疼痛的患者,包括股骨头坏死(osteonecrosis,ON)(43%)、盂唇损伤(20%)、退行性关节病变(degenerative joint disease,DJD)(10%)、股骨头骨骺缺血性坏死(Legg-Calve'-Perthes,LCP)(10%)、髋关节游离体(10%)、髋关节疼痛(100%)、机械性损伤(78%)、运动损伤(56%)。对患者采用仰卧位进行髋关节镜检查,使用牵引床,300或700,前外侧入口。观察不同疾病在治疗后的预后结果。结果:所有患者均无并发症,平均随访时间30个月,有60%的患者疼痛症状得到缓解。盂唇(91%,P0.003)或LCP(89%,P0.05)患者疗效较好,而ON和DJD患者疼痛症状缓解较差,改善率仅为40%和44%。在吻合血管游离腓骨移植(free-vascularized fibular graft,FVEG)的患者中有34%在随访期间得到改善(P=0.003)。其中18名患者(21%)进行了全髋关节置换术。结论:髋关节镜手术对于游离体、盂唇损伤、局灶性软骨病变、晚期LCP后遗症患者有良好的治疗效果;对股骨头坏死的治疗效果不佳。     

Focus: The Aging Brain: Palliative Care and the Humanities: Centralizing the Patient at the End of Life

Palliative care is a quickly growing facet of modern medicine. While scientific advancements have broken new ground for the possibilities of end-of-life care, sensitive treatment of the patient as an individual has lagged behind and has frequently led to an unsatisfactory experience for patients, families, and the medical community at large. This essay argues that centralizing patients during the terminal phases of treatment by using humanistic perspectives has the potential to bring new meaning and improved effectiveness to patients and physicians alike.     

双师带教模式在胸外科研究生临床见习教学中的应用效果

目的:探讨双师带教模式在胸外科研究生临床见习教学中的应用效果。方法:选择新疆医科大学附属肿瘤医院2011级~2015级胸外科轮转硕士研究生56人为研究对象,依据随机数字表法将学生分为观察组和对照组,各28人,分别采用双师带教和普通带教进行临床教学,实习8周后统一安排出科考试和满意度评价。结果:两组出科成绩比较,理论考试成绩差异没有统计学意义(P0.05),临床操作得分观察组高于对照组,差异具有统计学意义(P0.05);学生对课程的满意度评价,观察组为85.71%,显著高于对照组的60.71%,差异有统计学意义(P0.05)。结论:在胸外科临床实践教学中运用双师带教制,能充分发挥不同医师的特长,引导学生学习热情,提升临床实习效果,值得在临床实践中推广。     

广东阳春重阳传统药市药用民族植物学研究

该研究自2013年开始对阳春开展了全面的中药资源普查工作,在全面了解阳春地区药用植物资源的基础上,于2013年和2014年两次对阳春重阳传统药市进行全面跟踪调查。结果表明：阳春重阳传统药市出售的药物种类丰富,共收集鉴定得出134种药用植物,隶属于60科117属,并对收集到的药用植物进行编目,包括俗名、学名、药用部位、用途和用法等。从药用植物的科、属分布上来看,其中种类较多的科有大戟科(11种)、蝶形花科(10种)、菊科(10种)、茜草科(9种)、马鞭草科(6种)、姜科(5种)、防己科(5种)。药用植物的种类广泛分布于各科和属中,而非集中于少数科、属内。此外,还对阳春重阳传统药市所形成的文化基础、植物应用特色和药材地域特色进行了分析,在药市中调查到一批具有当地特色的滋补养生类的药材,得出阳春当地具有将药用植物融入日常饮食的习惯。药市中售卖的药材功效与当地的自然环境密切联系,其中尤以治疗与岭南地区湿热的气候和瘴疠虫蛇等特点所引起的常见疾病为主。同时,对阳春药市的可持续发展提出了意见和建议。