浅谈妇外科医生手术操作的四个层次

手术是处理妇科疾病的主要手段之一。本文从作者的经历和感触出发,就妇外科医师的成长过程中的共性规律进行总结。对于住院医师,熟悉解剖结构、练习基本操作是主要目标;对于主治医师,归纳手术套路、学会独立操作是主要任务;对于主任医师,承担常规工作的同时,条件和能力许可应有所创新。只有将手术从工作变为创作,将技术升华为艺术时,才能完成从“手术匠”到“大师”的飞跃。     

Interdisciplinary research and interprofessional collaborative care in a memory clinic for rural and northern residents of western Canada: Unique training ground for clinical psychology graduate students

Abstract: In Canada, interprofessional education (IPE) and interdisciplinary health research initiatives are beginning to transform the academic health sciences, including graduate training programs for clinical psychologists. In response to mandates and directives from national health policy and research funding bodies, academic training programs are re‐structuring course offerings, practicum training experiences, and research activities to better prepare students for their future roles within interdisciplinary research groups and collaborative patient‐centred clinical teams. As an example of this transformative movement in IPE, described herein are the recent training initiatives in the Graduate Program in Clinical Psychology at the University of Saskatchewan, and the role of clinical neuropsychology in an innovative interprofessional rural and remote memory clinic.     

Opinions of Australian Psychological Society College Chairs about process and content in supervision training: Preliminary investigation in Queensland

Few psychologists in Australia have been trained to provide supervision to probationary psychologists. The current preliminary study investigated whether a supervision training workshop could, in the view of representative psychologists, provide effective training across a range of psychological specialties, or whether separate training was needed for different specialties. The nine Queensland Chairs of the Australian Psychological Society specialisation colleges were given a semi‐structured interview to investigate the goals, content and processes of supervision within their specialty, and perceived relationships with other specialties. Results indicated considerable agreement regarding the content and process of supervision across specialties, suggesting that supervision has much in common regardless of specialty.     

Toward science‐informed supervision of clinical case formulation: A training model and supervision method

Case formulation is a core competency in the practice of clinical psychology and although many component skills can be taught in lectures, supervised clinical practice is a key step in moving from knowledge about case formulation to knowledge of formulation. The present paper outlines a model of science‐informed clinical practice and the ways in which clinical supervision may play a role. In addition, a methodology for assessing and benchmarking skills in case formulation is described to assist clinical psychology training programs to provide supervisees with normative feedback about their skills in case formulation. In so doing, the supervision of case formulation can become more informed by science and responsive to evaluation.     

Toward the science‐informed practice of clinical supervision: The Australian context

Although supervision of clinical practice is mandatory for trainee psychologists, surprisingly little is known about the key ingredients of effective supervision and the relationship between supervision and patient outcomes. The purpose of this paper was to review current regulations that shape supervision in Australia and explore the links between these regulations and the components of effective supervision. Although recent developments including supervisor training and other quality control programs are an indication of progress, there are several empirical and conceptual issues in the supervision literature that require resolution. The second part of this paper identifies the gaps in the supervision literature and suggests steps to advance the development of a mature science of clinical supervision. The main areas requiring attention include the identification of the mechanisms by which supervision produces change in supervisees and their patients, the refinement of measurement methods and instrumentation, and the need to pursue collaborative research that maximises the generalisability of research findings.     

An evaluation of intraverbal training and listener training for teaching categorization skills

The effects of vocal intraverbal training and listener training on the emergence of untrained categorization skills were evaluated. Five typically developing preschool children initially learned to name a number of previously unfamiliar visual stimuli. Each child then received one of two types of training. Intraverbal training involved reinforcing vocally emitted category names by the child in the presence of a spoken exemplar name. Listener training involved reinforcing the selection of visual stimuli by the child in the presence of a spoken category name. A multiple baseline design was used to evaluate the effects of training on each child's intraverbal category naming and stimulus selection. Pre- and posttests were used to assess additional emergent relations. Four of 5 participants did not demonstrate the emergence of any untrained relations. The current findings suggest that additional research is needed to determine the optimal sequencing of conditions in programs designed to teach categorization skills.     

Saints and Sinners: Training Papua New Guinean (PNG) Christian Clergy to Respond to HIV and AIDS Using a Model of Care

Papua New Guinea has experienced a growing HIV/AIDS epidemic. The Christian Churches have played a vital role in responding to HIV, through community support, encouragement and social change. Strong, effective Church leadership can help create safe environments of care and support for those infected and for prevention of HIV. Method A series of trainings in capacity development for clergy were undertaken by the National AIDS Council Secretariat (NACS)/National HIV/AIDS Support Project (NHASP). Results A model “Church’s Response to HIV and AIDS in a Care Continuum” was developed to assist the training. This paper discusses the model and the lessons learned.

认知灵活性和顿悟表征转换：练习类型的影响

以停车场问题为实验材料,以42名大学生为被试,探讨认知灵活性高和低的被试在不同练习类型下顿悟问题表征转换的差异。结果表明：1）不同的练习类型对顿悟表征转换有影响,被试在难度逐渐增加的练习类型下比在简单的练习类型下顿悟产生得更快;2）顿悟表征转换的速度因认知灵活性的不同有差异,在简单的练习类型下,认知灵活性高的被试比认知灵活性低的被试顿悟产生得更早,在难度逐渐增加的练习类型下两者无差异;3）认知灵活性高的被试比认知灵活性低的被试顿悟问题解决更快。     

Psychoendocrine and physical performance responses in male Tunisian rugby players during an international competitive season

The aim was to investigate a follow-up study based on hormonal, physical, and psychological parameters among rugby players who trained during a whole season interspersed with competitions on an international level. Fitness or reciprocally tiredness as well as competitive anxiety were evaluated, respectively, using the French Society for Sports Medicine (SFMS) and the sport competition anxiety test (SCAT) questionnaires. In this study, SFMS and SCAT scores increased respectively over the competitive season. The SFMS score revealed a state of relative tiredness at the end of the season, highlighted by a slight decrement in physical performances. The SCAT score changes are related to the competition context and therefore increased accordingly to the importance of the competition stake. We analyzed the corticotrope and the gonadotrope axis before (T(1)), and at the end of the national and international rugby season (T(2)). Training did not affect the resting salivary cortisol (Csal) levels, but induced a decrease in resting testosterone (Tsal) values, resulting in a dropped T/C ratio. Competition, in both periods (T(1)-T(2)), provoked a significant increase in Csal levels, but the Tsal responses depended on the match stake. Their concentrations increased when the competition generated an important stress and decreased when the psychological conditions remained relatively stable. SFMS is preferentially correlated with resting Csal levels and T/C values measured at 08:00 hr but not with Tsal. SCAT is highly correlated with competitive Csal and Tsal concentrations measured before and after the matches.     

Muscular contribution to low-back loading and stiffness during standard and suspended push-ups

Push-up exercises are normally performed to challenge muscles that span upper extremity joints. However, it is also recognized that push-ups provide an effective abdominal muscle challenge, especially when the hands are in contact with a labile support surface. The purpose of this study was to compare trunk muscle activation levels and resultant intervertebral joint (IVJ) loading when standard and suspended push-ups were performed, and to quantify and compare the contribution of trunk muscles to IVJ rotational stiffness in both exercises. Eleven recreationally trained male volunteers performed sets of standard and suspended push-ups. Upper body kinematic, kinetic, and EMG data were collected and input into a 3D biomechanical model of the lumbar torso to quantify lumbar IVJ loading and the contributions of trunk muscles to IVJ rotational stiffness. When performing suspended push-ups, muscles of the abdominal wall and the latissimus dorsi were activated to levels that were significantly greater than those elicited when performing standard push-ups (p<.05). As a direct result of these increased activation levels, model-predicted muscle forces increased and consequently led to significantly greater mean (p=.0008) and peak (p=.0012) lumbar IVJ compressive forces when performing suspended push-ups. Also directly resulting from the increased activation levels of the abdominal muscles and the latissimus dorsi during suspended push-ups was increased muscular contribution to lumbar IVJ rotational stiffness (p<.05). In comparison to the standard version of the exercise, suspended push-ups appear to provide a superior abdominal muscle challenge. However, for individuals unable to tolerate high lumbar IVJ compressive loads, potential benefits gained by incorporating suspended push-ups into their resistance training regimen may be outweighed by the risk of overloading low-back tissues.