“三番式”临床技能教学模式的建立及其在临床医学教学中的应用与思考

传统的临床技能教学存在诸多弊端,从而影响了医学生临床技能的培养及合格医学人才的培养。我们在多年的临床教学实践基础上,构建了临床技能学实践教学平台,创建了“三番式”临床技能教学模式,并将其应用于临床实践教学中,对所取得的显著教学效果进行深入剖析。     

父母教养方式对应对方式影响:自尊的中介作用

目的研究初二学生父母教养方式、自尊对应对方式的影响。方法使用父母教养方式问卷、自尊量表、中学生应对方式量表对广州及深圳162名初中二年级学生进行施测。结果 (1)各量表不同因子存在不同的性别效应,父亲惩罚(t=2.737,P<0.01)、父亲拒绝否认(t=2.444,P<0.05)、问题指向应对(t=2.196,P<0.05)。(2)父母情感温暖与自尊、问题指向应对有显著的正相关(r=0.350,r=0.490,P<0.01),父亲偏爱对问题指向应对有显著的正相关(r=0.170,P<0.05);而母亲的拒绝否认和严惩与自尊存在显著的负相关(r=-0.198,r=-0.209,P<0.01),但与情绪指向应对有显著的正相关(r=0.235,r=0.258,P<0.01)。(3)父亲情感温暖(β=0.413,P<0.05)和自尊(β=0.230P<0.05)是问题指向应对方式的预测因子,且自尊是中介因素;母亲严惩(β=0.299,P<0.001)、父亲温暖(β=0.158,P<0.05)对情绪指向应对方式存在显著的预测作用。结论不同教养方式、自尊对不同应对方式存在影响。     

大学生自尊与父母教养方式的相关研究

目的:通过问卷调查了解当代大学生的自尊水平及其父母教养方式,并分析两者之间的关系,为父母教育子女提供有效建议。方法:采用分层随机抽样的方法,运用自尊量表(SES)和父母教养方式评价量表(EMBU)对长江大学320名大学生进行调查。结果:1.大学生自尊与情感温暖方式呈显著正相关,与惩罚严厉、过分干涉保护、拒绝否认呈显著负相关,与偏爱被试无显著相关;2.高自尊大学生与低自尊大学生在父亲和母亲的情感温暖、惩罚严厉、拒绝否认上存在显著差异,在父亲的过度保护方面存在显著差异;3.父母教养方式受城乡环境等因素影响。结论:父母应当采取积极的教养方式教育孩子,塑造孩子的自尊。     

Interlimb coordination following stroke

Studies investigating whether simultaneous bilateral movements can facilitate performance of the impaired limb(s) of stroke patients have returned mixed results. In the present study we compared unilateral limb performance (amplitude, cycle duration) with performance during an interlimb coordination task involving both homologous (both arms, both legs) and non-homologous (one arm, one leg) limbs in stroke participants (n=7) and healthy age-matched controls (n=7). In addition, the effect of on-line augmented visual feedback on interlimb coordination was investigated. Participants performed cyclical flexion-extension movements of the arms and legs in the sagittal plane paced by an auditory metronome (1 Hz). Movement amplitudes were larger and cycle durations shorter during homologous limb coordination than non-homologous coordination. Compared with unilateral movements both groups had reduced movement amplitudes and the stroke group increased cycle duration when interlimb coordination tasks were performed. These effects were most evident during non-homologous (arm and leg) coordination. No evidence of facilitation of the impaired limb(s) was found in any of the interlimb coordination conditions. Augmented visual feedback had minimal effect on the movements of control participants but lead to an increase of cycle duration for stroke participants.     

The scaling of postural adjustments during bimanual load-lifting in traumatic brain-injured adults

Previous postural studies of traumatic brain injury (TBI) patients have been limited to identifying deficits in static and quasi-dynamic postural control tasks such as weight shifting. In this study, we examined whether or not patients with TBI are able to scale adequately their postural adjustments during the performance of the dynamic task of bimanual load-lifting. An age matched group of healthy adults served as controls. We used the Tetrax posturography system that calculates a stability score (ST) based on fluctuations in vertical ground reaction forces, normalized for body weight. During quiet standing, the ST scores of the TBI group were significantly higher than the control group. Forward weight shift and percentage change in the vertical ground reaction forces (lift postural adjustment (LPA) and post-lift postural adjustment (PLPA) scores) linearly increased with increasing load weight in both healthy and TBI subjects. Group differences were found in the magnitude of forward weight shift but not in the relative increase of the LPA and PLPA scores during the lifting and post-lifting phases respectively. The forward weight shift of the TBI group was lower-than-normal and asymmetrical--there was significantly less forward weight shift on the more affected than on the less affected limb. In addition, a significant amplitude coupling was found between the scaling of the weight shift of the heel and forefoot of each limb. However, no coupling was found between the weight shift amplitudes of homologous parts of both limbs in the TBI group. The results showed that scaling based on prior experience was preserved in the TBI group, though some TBI subjects demonstrated absent scaling in either the more affected or less affected heel or forefoot. The differences between the normal and TBI groups in postural adjustments are not necessarily a sign of pathology; rather they may represent a deliberate choice of the central nervous system to counteract predictable disturbances.     

Not just standing there: the use of postural coordination to aid visual tasks

Postural control is an integral part of all physical behavior. Recent research has indicated that postural control functions in a manner that facilitates other higher order (suprapostural) tasks. These studies, while showing that postural sway is modulated in a task specific manner, have not examined the form of postural coordination that allows for the achievement of these higher behavioral goals. The current study examined the relation between visual task constraints (viewing distance), environmental constraints (changes in the surface of support), and the postural coordination employed to complete the task. Thirty-one participants were asked to perform a reading task while standing on various surfaces. Postural motion was recorded from the head, cervico-thoracic spine, sacrum (hip), and ankle. It was found that body segment coordination changed as a function of surface characteristics and task constraints. Additionally, the overall pattern of postural sway (head motion) replicated that which was found by Stoffregen et al. [J. Exp. Psychol. Human Percep. Perform. 25 (6) (1999) 1641]. These findings suggest that postural adaptation involves more than basic reduction or increase of motion; it involves the functional coordination of body segments to achieve a particular goal. The data further suggest that there is a need to examine postural control in the absence of external perturbations.     

旋转汉字识别的眼动特性

该文以客观眼动测量方法考察了单个旋转汉字的识别和由旋转汉字组成的短文的阅读过程。对心理旋转操作在汉字辨认过程中的作用及其操作对象进行了探讨。     

Learning a pointing task with a kinematically redundant limb: Emerging synergies and patterns of final position variability

The study tested a hypothesis that practice of arm pointing movement can lead to a reorganization of the joint coordination reflected in the emergence of several synergies based on the same set of joints. In particular, involvement of the wrist may represent a choice by the central nervous system and not be driven by the typical “freezing-to-freeing” sequence. The effects of practice on the kinematic patterns and variability of a “fast and accurate” pointing movement using a pointer were studied. An obstacle was placed between the initial position and the target to encourage a curvilinear trajectory and larger wrist involvement. Practice led to a decrease in variability indices accompanied by an increase in movement speed of the endpoint and of the elbow and the shoulder, but not of the wrist joint. Five out of six subjects decreased the peak-to-peak amplitude of wrist motion. Before practice, the variability along the line connecting the endpoint to the shoulder (extent) was similar to that in the direction orthogonal to this line. After practice, variability was reduced along the extent, but not along the orthogonal direction perpendicular to this line. Prior to practice, indices of variability of the endpoint were lower than those of the marker placed over the wrist; after practice, the endpoint showed higher variability indices than the wrist. We interpret the data as consequences of the emergence of two synergies: (a) Pointing with a non-redundant set of the elbow and shoulder joints; and (b) keeping wrist position constant. The former synergy is based on a structural unit involving the elbow and the shoulder, while the latter is based on a structural unit that includes all the major arm joints.     

安乐死论纲

就发展中国式安乐死提出了１８条纲领性意见。指出安乐死是一种社会文明,需要进行学科的、理论的、法制的、伦理的建设,超越传统上升到新的时代高度。就安乐死的定义、本质、目的、性质、权利、分型、对象等基本问题提出了不同于国外的独立见解。对于安乐死的立法、法制管理的体制和程序,以及医学伦理、生命伦理要服从社会伦理,树立新的安乐死伦理观提出了具体建议。     

Effects of instructional constraints on human fixed-interval performance

Several groups of human subjects were exposed to a variety of experimental conditions involving a fixed-interval 27-second schedule of reinforcement in compound with instructions to constrain in the number of responses within the interreinforcement interval and/or the duration of the experimental session. One group was further exposed to a contingency involving the placement of responses within the IRI. A diversity of patterns of performance was observed, including those typically associated with animal subjects exposed to FI schedules. Generally, the imposition of instructions to minimize session duration reduced post-reinforcement pausing and increased overall reinforcement density from those levels obtained with only instructions to expend a given number of responses per reinforcer. The results are seen to underscore the sensitivity of human fixed-interval performance and the contribution of extra-experimental contingencies.