计算机模拟技术在漏斗胸治疗中的应用

NUSS手术是矫治儿童漏斗胸畸形的首选方法,但目前对制定个体化手术和评估术后矫形效果尚缺乏科学的手段.以有限元分析法为基础的计算机三维成像技术能模拟NUSS手术术后矫形效果,测算钢板的数量、塑形和置入部位及胸廓应力状态,预计手术并发症的发生.计算机模拟技术可为减少手术风险,制定科学的个体化NUSS手术提供有效的指导.     

乳腺肿瘤微创美容手术策略分析

乳腺肿瘤的发病率呈逐年上升趋势,随着乳腺学科的发展进步、现代医学模式的改变、患者结构和希求的根本变化,大多数患者除了疾病治疗本身外,对术后外观美容提出更高的要求。乳腺专科医生必须适应新的生物心理社会环境医学模式,构建良好的医患协作关系,制定科学的治疗方案、合理选择微创美容手术方法,提高专业技能和转变观念,利用新技术、新材料、新仪器,按照个体化治疗原则,制定乳腺肿瘤微创美容手术策略。     

中医理念在拇趾外翻临床中的运用

探讨运用中医治病求本、阴阳学说、筋束骨、小夹板纸压垫原理、辨证施治等中医理论,构筑的中西医结合微创技术治疗拇外翻畸形的诊疗体系。从拇外翻畸形的病因、病理、矫形手术、手法复位、生物固定、术后康复等几方面,阐述对拇外翻畸形的新的矫形理念。     

中医理念在拇趾外翻临床中的运用

探讨运用中医治病求本、阴阳学说、筋束骨、小夹板纸压垫原理、辨证施治等中医理论,构筑的中西医结合微创技术治疗拇外翻畸形的诊疗体系.从拇外翻畸形的病因、病理、矫形手术、手法复位、生物固定、术后康复等几方面,阐述对拇外翻畸形的新的矫形理念.     

导言:努力提高胃癌外科治疗水平

正胃癌的外科治疗在经历了原创期、根治期、合理治疗期后进入个体化治疗时期,长期生存率也由10%~20%,上升到50%~60%。近年,手术技术的进步和新的医疗器械、设备的开发,早期胃癌的治疗方法的选择呈现出多样化,进展期胃癌D2廓清的标准手术在世界范围已成为主流,化学疗法的进步正在改变高度进展期胃癌的治疗模式。实践证明,与时俱进,基于科学证据的医疗,精细化管理,手术质量控制,有助于提高治疗水平和效果。     

乳腺癌康复治疗理念与策略

在乳腺癌诊疗方案制定和具体实施过程中存在康复理念指导下的评估及融入不足,影响了手术方式的抉择与治疗方案的优选,也影响治疗效果和患者的生命质量。因此,乳腺癌治疗在科学、个体化、全程管理的同时,必须从一开始就将康复理念融入到每一个治疗方案准备及设计之中,只有这样才能实现患者尽早健康回归家庭、回归社会,有幸福感的终极目标。     

科学研究的DNA共享与协作精神

股骨头坏死、髋关节脱位是骨科常见病,随着人们生活模式的改变发病率有所上升。对该病的成因、流行病学、病理转归、临床治疗策略与髋关节严重病损后功能重建等问题,学术界存在很大争议。作者提出从生物进化的角度、用自然重建理念做指导,应用髋关节分离牵拉术治疗股骨头坏死、骨盆补充截骨术重建青少年严重病损的髋关节功能人、组合性矫形手术治疗年长儿先天性髋关节脱位,获得了优良效果。因此呼吁:用自然重建理念治疗青少年股骨头坏死、髋关节脱位,降低人工假体置换对此类疾病的手术指证。     

Ⅲ级、Ⅳ级患者开展日间手术的策略探讨

为切实落实国家卫生健康委员会分级诊疗的政策,真正解决老百姓"看病难、住院难、手术迟"之医疗供需矛盾,探讨三级以上医院让经美国麻醉医师协会分级的Ⅲ级、Ⅳ级的患者(以下简称"Ⅲ级、Ⅳ级患者")得以开展日间手术的策略。结合工作经验,查阅文献发现,加强围术期评估和术后随访,以对患者进行闭环管理,可最大限度降低患者安全隐患;术后快速康复理念下多学科协作是使Ⅲ级、Ⅳ级患者得以顺利开展日间手术的基石;麻醉医生通过制定个体化麻醉方案为Ⅲ级、Ⅳ级患者开展日间手术提供安全保障。从而进一步说明Ⅲ级、Ⅳ级患者得以开展日间手术是个系统工程,需要医院众多科室协作努力,以满足人们对美好生活的向往。     

整形外科技术在早期乳腺癌保乳手术中的临床应用

探讨整形外科技术在早期乳腺癌保乳手术中的临床应用。选取2011年6月~2013年6月应用整形外科技术施行早期乳腺癌保乳手术的29例患者,其临床资料通过回顾性分析得出,针对术后患者的乳房整形效果进行剖析,同时对肿瘤复发率进行随访。29例患者均成功应用整形外科技术完成早期乳腺癌保乳手术,术后乳房整形效果优良满意度为75.9%(22/29)。术后乳房整形效果满意度与年龄、肿瘤大小、肿瘤位置与乳头距离有相关性,其差异有统计学意义(P0.05)。跟踪随访结果无一例复发或再次手术。早期乳腺癌患者可联合应用整形外科技术实施保乳手术治疗,其术后乳房整形效果满意度较高,此术式安全有效,在限定条件下值得临床推广应用。     

自然重建理念治疗股骨头坏死、髋关节脱位

股骨头坏死、髋关节脱位是骨科常见病,随着人们生活模式的改变发病率有所上升.对该病的成因、流行病学、病理转归、临床治疗策略与髋关节严重病损后功能重建等问题,学术界存在很大争议.作者提出从生物进化的角度、用自然重建理念做指导,应用髋关节分离牵拉术治疗股骨头坏死、骨盆补充截骨术重建青少年严重病损的髋关节功能人、组合性矫形手术治疗年长儿先天性髋关节脱位,获得了优良效果.因此呼吁:用自然重建理念治疗青少年股骨头坏死、髋关节脱位,降低人工假体置换对此类疾病的手术指证.     

外科疾病的发热

发热是临床上的一种常见症状,引起发热的原因很多,只有找到发热的原因才能做出正确的处理。启动临床思维必须掌握充分的临床资料,然后进行周密的鉴别诊断思维程序,首先排除引起发热的其他科疾病,再考虑外科原因。感染是外科发热最主要的原因,如果是手术病人,特别应该想到和手术有关的各种感染问题。思维惯性、思维顺性和思维惰性的误导是误诊的思维原因。     

老年人术后认知功能障碍的影响因素和预防

人口老龄化问题日趋严重,老龄社会已悄然到来,老年人手术,术前、术中、术后都有其独特性,如何避免或者减少手术后并发症的发生,尤其是预防严重并发症的发生意义重大。笔者从老年人生理改变,老年人术后认知功能障碍（postoperative cognitive disorder,POCD）的影响因素以及手术前、手术中（麻醉期）、...     

Storytelling: An enjoyable and effective therapeutic tool

Storytelling has great potential for stimulating insight and behavior change, particularly when client and clinician seem to have reached an impasse, as is frequently the case with adolescent clients. The storytelling process provides a viable alternative to the traditional therapeutic communication style in which the client is the only storyteller. It provides a means to circumvent client resistance and present new concepts and paradigms for healthy behavior. This paper provides a practical guide for the use of therapeutic metaphors and storytelling as an intervention technique, provides examples of successful interventions made through the storytelling process with both adolescent and adult clients, and outlines suggestions for the effective use of storytelling as a therapeutic tool.Joyce Divinyi, MS, a licensed professional counselor, is a consultant with The Wellness Connection, Peachtree City, Georgia, providing wellness education and mental health training programs and individual and family counseling services. She was formerly the executive director of a residential treatment program for adolescent girls. Reprint requests should be sent to the author at The Wellness Connection, 125 Highgreen Ridge, Peachtree City, GA 30269.     

The Collaborative Drawing Technique

In recent years more and more attention has been focused on the family as the unit of treatment. With this expanded focus, innovations in projective testing are desired to provide information that is meaningful for the treatment process. The Collaborative Drawing Technique represents an effort to meet this need through a projective device which yields information about the functioning of the individual within the context of his family. The CDT was designed to be easily and quickly administered with a minimum of required materials and still give information which can guide the treatment process. To date, the technique has been used primarily as a part of an initial diagnostic interview with families presenting for therapeutic treatment. Research and development are obviously needed in the instrument and several efforts are underway at present.     

The Optimal Team Functioning Model: A Grounded Theory Framework to Guide Teamwork in Curling

A constructivist grounded theory approach was used to investigate teamwork and team effectiveness in the sport of curling. Focus group and individual interviews were conducted with 78 athletes and 10 coaches from 19 high-performance curling teams. Data analysis led to the creation of the Optimal Team Functioning (OTF) model, which comprises 8?key components for optimal team functioning: (a) individual attributes, (b) team attributes, (c) foundational process of communication, (d) structural team processes, (e) individual regulation processes, (f) team regulation processes, (g) context, and (h) desired outcomes. Components and relationships within the model, along with practical implications, are discussed.

Lay Summary: Developing effective sport teams is a challenging and complex process. Unfortunately, few resources are available to guide coaches and athletes in their efforts to optimally function and perform as a unit on a daily basis. This novel team dynamics research was carried out with high-performance coaches and athletes to uncover a comprehensive and ecologically valid model mapping out effective teamwork within the sport of curling. The Optimal Team Functioning Model focuses on concrete actions that can be applied to successfully set up and manage a team and its individual members throughout a season.     

Triggering Individual Emergence: Inspiration of Banathy,the Visionary

This paper examines how metaphors can play a key role in triggering individual emergence. Metaphor is referenced in two main ways: the enthalpy metaphor is used to provide understanding of, and guide, the process of effective conversation. Metaphor is also interpreted very broadly to define those images, analogies, concepts, models, and theories that define our understanding of the world and our perception. It is our perception that must change if we are to improve the future. The paper examines how sharing of appropriate metaphor through conversation can lead to collective emergence; and similarly, how integral conversation-with-self triggered by metaphors in (1) conversation with others, (2) other external stimuli, and (3) internal thought processes, can trigger individual emergence. The paper examines which of the three sources of trigger may be singly/jointly or sequentially the most powerful in their effect of triggering individual emergence, and under what context. The model presented is evaluated for the process of emergence of the paper. The reader is invited to participate in furthering the evaluation process. The author's own individual emergence is recognized as stemming from ongoing association with, and inspiration of, Bela Banathy, to whom the work is dedicated.     

Making Group Brainstorming More Effective: Recommendations From an Associative Memory Perspective

Much literature on group brainstorming has found it to be less effective than individual brainstorming. However, a cognitive perspective suggests that group brainstorming could be an effective technique for generating creative ideas. Computer simulations of an associative memory model of idea generation in groups suggest that groups have the potential to generate ideas that individuals brainstorming alone are less likely to generate. Exchanging ideas by means of writing or computers, alternating solitary and group brainstorming, and using heterogeneous groups appear to be useful approaches for enhancing group brainstorming.     

Discrete versus continuous stage models of human information processing: in search of partial output

This article introduces a new technique designed to study the flow of information through processing stages in choice reaction time tasks. The technique was designed to determine whether response preparation can begin before stimulus identification is complete ("continuous" models), or if a stimulus must be fully identified prior to any response activation ("discrete" models). To control the information available at various times during stimulus identification, some relevant stimulus characteristics were made easy to discriminate and some were made hard to discriminate. The experimental strategy was to look for effects of partial output based on information conveyed by characteristics that were easy to discriminate. The technique capitalized on the fact, demonstrated in Experiment 1, that preparation of two response fingers on the same hand is more effective than preparation of two response fingers on different hands. The usefulness of partial output was varied by manipulating the assignments of stimuli to responses. For some mappings partial information could contribute to effective response preparation because the responses consistent with partial information were assigned to fingers on the same hand. For other mappings partial information could not contribute to effective response preparation because the responses consistent with partial information were assigned to fingers of different hands. Performance differences between these mappings were considered evidence that partial information about a stimulus was transmitted to response activation processes before the stimulus was uniquely identified, and thus were considered evidence against discrete transmission of information about the stimulus as a whole. A variety of stimulus sets were studied; the results suggest that information is transmitted discretely with respect to stimulus codes, although distinct codes activated by a single stimulus may be transmitted at different times.     

Effects of Solution Elicitation Aids and Need for Cognition on the Generation of Solutions to Ill-Structured Problems

Numerous techniques have been proposed to assist problem solvers in the solution generation process. We empirically examined the effectiveness of a solution elicitation technique based on the presentation of problem objectives and also examined whether the technique was effective across individual differences in need for cognition (NC). We found that when two conflicting objectives were presented successively, more solutions, more categories of solutions, and more effective solutions were generated than when the same two objectives were presented simultaneously or not at all. However, the results indicated that effective solutions may be more efficiently generated by considering objectives simultaneously. Need for cognition was positively related to measures of divergent thinking, and the presentation of objectives was particularly effective as a solution elicitation aid for individuals with low NC. Implications for creative problem-solving research and practice are discussed.     

Mothers,Fathers, and Parental Systems: A Conceptual Model of Parental Engagement in Programmes for Child Mental Health—Connect,Attend, Participate,Enact (CAPE)

Parenting programmes are one of the best researched and most effective interventions for reducing child mental health problems. The success of such programmes, however, is largely dependent on their reach and parental engagement. Rates of parental enrolment and attendance are highly variable, and in many cases very low; this is especially true of father involvement in parenting programmes. This paper proposes a conceptual model of parental engagement in parenting programmes—the CAPE model (Connect, Attend, Participate, Enact) that builds on recent models by elaborating on the interdependent stages of engagement, and its interparental or systemic context. That is, we argue that a comprehensive model of parental engagement will best entail a process from connection to enactment of learned strategies in the child’s environment, and involve consideration of individual parents (both mothers and fathers) as well as the dynamics of the parenting team. The model provides a framework for considering parent engagement as well as associated facilitators and mechanisms of parenting change such as parenting skills, self-efficacy, attributions, and the implementation context. Empirical investigation of the CAPE model could be used to further our understanding of parental engagement, its importance for programme outcomes, and mechanisms of change. This will guide future intervention refinement and developments as well as change in clinical practice.