Objective:To explore the application of the flipped classroom based on the production-oriented approach (POA) theory in the teaching of standardized training in the Department of Joint and Sports Medicine.Methods:A total of 37 standardized training physicians who rotated in the Department of Joint and Sports Medicine in Zhongnan Hospital of Wuhan University from January 2019 to December 2019 were selected as the control group, and the traditional teaching was adopted. Another 39 standardized training physicians who rotated from April 2020 to March 2021 were selected as the study group, and the flipped classroom based on POA theory was adopted. At the end of the rotation, the scores of theoretical knowledge and practical operation skills, the scores of mini-clinical evaluation exercise (Mini-CEX) and the teaching satisfaction were compared. SPSS 22.0 was used for t-test and Chi-square test. Results:The various scores and total score of theoretical knowledge and practical operation skills in the study group at the end of rotation were significantly higher than those in the control group ( P < 0.05). There was no significant difference in the various scores and total score of Mini-CEX between the two groups at the time of admission ( P > 0.05). The above scores in the two groups at the end of rotation were significantly higher than those at the time of admission ( P < 0.05), and the above scores of the study group were significantly higher than those of the control group ( P < 0.05). The overall teaching satisfaction rate of the study group was higher than that of the control group ( P < 0.05). Conclusion:The application of the flipped classroom based on POA theory in the teaching of standardized training in the Department of Joint and Sports Medicine can significantly improve the teaching effect and quality, and improve the clinical comprehensive ability and teaching satisfaction of the standardized training physicians, which is worthy of popularization and application.

病人,男性,53岁.左下肢疼痛肿胀2个月余于2020年2月18日入院.体格检查:左下肢肿胀、活动受限,小腿及足部发黑,左侧足背动脉搏动消失,足背散在多个张力性水疱.既往体健,否认特殊病史.实验室D-二聚体原液1914 ng/ml,新型冠状病毒核酸检测阳性.B超检查提示左下肢动脉血栓合并静脉血栓.双下肢血管CTA检查发现左侧股动脉远端-胭动脉血栓形成;股深静脉及其属支血栓形成.本院胸部CT检查提示两肺见斑片及毛玻璃密度影.临床诊断为左下肢血栓闭塞性脉管炎,左下肢动脉栓塞,左侧下肢深静脉血栓形成,轻型新型冠状病毒肺炎.联合感染科、呼吸与重症医学科、血管外科、麻醉手术科等多科室进行术前评估,均认为手术指征明确,宜进行左大腿中下段截肢手术治疗,并建议术前先置入腔静脉滤器.经病人及家属同意后,于2月22日晚,行腔静脉滤器植入术.24日上午,在负压手术室进行截肢手术,采用三级防护[1-2].腰硬联合麻醉成功后根据术前计划,选择左大腿中下段闭合性截肢.设计鱼嘴切口,充分显露血管及神经后血管予以缝扎彻底止血,神经予以利多卡因封闭后外膜缝合以避免神经瘤形成.线锯截断股骨,骨端修整光滑后石蜡封闭断端髓腔.确认皮肤软组织活力后内置引流管一根,维持适当的张力予以缝合关闭伤口.

在欧盟法体系中,一般法律原则得到广泛的适用,而作为不成文法,其概念与内容仍然具有模糊性与抽象性.欧盟法一般法律原则的创制主体是欧盟法院,法院通过司法实践从而逐步确定了一般法律原则的适用及其内容.在此基础上,对于欧盟法一般法律原则的概念应该采取狭义解释,只有那些被欧盟法院所确认的具有宪法属性的法律原则才属于欧盟法一般法律原则的范畴.同时欧盟法一般法律原则与欧盟其他法律原则之间、与国际法一般法律原则之间既有区别又有联系,在法律基础、适用范围及其效力范围上都有重大不同.

目的 探讨基于授权理论的自我管理模式在膝关节置换术患者出院准备服务中的应用效果.方法 将2015年10月至2016年3月收治的49例膝关节置换术患者作为对照组,落实常规治疗、护理及健康教育;将2016年4～10月收治的51例膝关节置换术患者作为观察组,实施基于授权理论的自我管理出院准备服务.结果 术后3个月、6个月,观察组膝关节功能、自我管理行为及生活质量得分显著高于对照组(P＜0.05,P＜0.01).结论 基于授权理论的自我管理模式用于出院准备服务,可以有效改善膝关节置换术患者的自我管理能力,提高术后康复效果及生活质量.

Objective To investigate the empathy ability of the orthopaedics nurses and its relation?ship with professional identity, social support and job stressors for the orthopaedics nurses. Methods A total of 228 orthopaedics nurses who worked in Wuhan hospitals were enrolled in this study, and were assessed with Jefferson scale of empathy?health professionals, nursing professional identification scale, social support scale and nurse’s work pressure scale. By using the empathy ability as the dependent variable, and the demograph?ics, professional identity, social support and job stressors as the independent variables, a regression model was set up. Results The score of the empathy ability for the orthopaedics nurses was (5.41 ± 0.81). Professional identity and social support had a positive correlation with the empathy ability for the orthopaedics nurses, and there was a negative correlation between the empathy ability and job stressors. Educational level, marital status, work experience, professional identity, social support and job stressors could affect the orthopaedics nurses ’em?pathy ability. Conclusions Several factors can affect the nurses’empathy ability. The nurse managers should pay more attention to the development of the nurses’empathy ability, improve the nurses’professional identity and social support, alleviate their job stressors and enhance the nurses’empathy ability.

目的 控制关节外科护理隐患,保证病房护理安全.方法 科室建立每周“安全日”,通过互动式晨会讨论发现科内近期存在或潜在的护理安全隐患事件,根据事件的性质、类型梳理归类,采用Vincent临床事件分析法对发生的各类护理安全隐患事件进行系统归因,提出改进措施,鼓励人人参与、建立科内多方位、多视角的护理安全质量监督模式,持续质量改进.结果 应用Vincent临床事件分析法后(2015年3～8月)发生护理不良事件1起,护理隐患事件43起,低于2014年同期水平;应用后医护满意率显著高于应用前(均P＜0.05);科室护理质量综合评分高于2014年同期水平;患者对护理工作满意率逐月升高,每月调查结果均高于95％.结论 应用Vincent临床事件分析法对护理隐患事件进行根因分析,可以预防护理不良事件发生、减少护理纠纷,对护理安全管理有重要意义.

军舰实施的海难救助依其是否属于军舰职责可以分为两大类.通过梳理军靓实施海难救助报酬请求权的相关立法与实践,明确军舰实施职责范围外的海难救助,应依据《中华人民共和国海商法》的规定享有报酬请求权.军舰可以请求报酬的情形主要有路过、应召和非用于军事目的时.

目的:通过视频教学提高急诊护生对针刺伤的认识,减少针刺伤事件的发生,达到有效预防针刺伤的目的.方法:选取2012-10-2013-07在我院急救中心实习的120名护生为研究对象,采用随机数字表法将其随机分为普通教学组和视频教学组,每组各60名.在教学内容完成后,分别进行理论和操作的考核以及护生评价.结果:视频教学组理论考试成绩、技能考试成绩均高于普通教学组,差异有统计学意义(P＜0.05);97％的护生对视频教学方式表示认可,而仅有60％的护生对普通教学方式表示认可,差异有统计学意义(P＜0.05).结论:视频教学可以更为有效地预防护生针刺伤事件的发生,应该在今后的教学中加以推广.

内脂素是一种脂肪细胞因子,在内脏脂肪组织内呈现高度表达,具有促血糖下降及促进脂肪细胞分化的生理作用,具有类胰岛素样作用,在糖脂代谢中发挥着重要的生理作用。本文观察2型糖尿病患者血清内脂素水平改变的意义。现报告如下。1资料和方法1.1一般资料选择我院2010年10月至2011年10月2型糖

目的 探讨救护车急救转运途中患者的护理问题及特点,以提高院前急救护理水平.方法 回顾性分析228例救护车陆路急救转运患者的病种特点,及针对其采取的护理措施.结果 急救转运患者228例,226例被平安转送至目的 地.5例出现心跳呼吸骤停,其中3例经现场抢救复苏成功后转运,2例抢救无效死亡.结论 急救转运病人病情重、病种杂、护理工作难度大、强度大、涉及护理问题多,需加强院前急救护理技能训练及急救车日常管理和维护,建立医患之间的沟通,以提高救治成功率.

As the population grows and the economy develops in flood detention areas,the landform in flood detention areas becomes complicated,which brings difficulties in simulating the flood flow in flood detention areas.Function of the 2-D flow numerical model is extended to simulate flood flow in flood detention areas existing inter-crossing line-type structures,like canals and roads.Exchanges of flow between the land surface and line-type structures are considered.Finally,two cases are given and the numerical results show that the new model can simulate the flows reasonably in the flood detention areas existing inter-crossing line-type structures.

结合洞庭湖区毛角口滩险滩整治工程设计,合理地将船舶物理模型、定床物理模型和平面二维水流数学模型等试验手段用于方案比选,对整治工程方案从改善通航条件、引起河道分流比变化、沿程水位变化、局部流态变化及整治工程对堤防安全的影响等方面作出了综合分析,为优选工程方案提供依据,并总结出了不同模型在此类工程应用上各自的特点.

In order to raise the train speed at Hu-Han-Rong Railway line,the department of railway plans to build the Xin'andu bridge at the Lunhe River on Han-Dan Railway line.Building a bridge at Lunhe River will influence the natural water level and velocity near the project.For analyzing the influence of Xin'andu bridge on flood control,the paper builds a 2-D non-orthogonal curvilinear coordinate flow mathematical model which applied to the Lunhe River.The computational results show that there is no obvious influence on water level and velocity in the Lunhe River after the construction;so the project will not bring disadvantageous influence on flood control basically.

Based on the method of simulating the process of dike burst by using a previous 2-D mathematical model for unsteady flow and non-uniform sediment,the breach's expansion and collapse process was also simulated in this paper.To analyze the breach's stability,a method of cohesive riverbank stability analysis put forward by Darby was adopted in the paper.Finally,a new mixed mathematical model is developed to simulate breach's expansion and scouring process in dike burst.The model is applied to simulate the process of dike burst in a general area,and the application result shows the process of break's expansion,collapse,scouring and evolvement of scouring puddle in dike burst can be simulated preferably.The result can provide the basic technical support for the establishment of closure work after dike burst.

An unsteady two-dimension(2-D) horizontal mathematical model for flow and sediment in generalized curvilinear coordinate is employed to simulate the contaminated zone induced by side-discharged dense slurry in Wuhan reach of the Yangtze River.The exchange between suspended silt and riverbed,sand graduation and riverbed deformation are taken into account in the model.The results can give reliable and scientific base for engineering organization to make a decision.

A new higher accuracy scheme named as ILF(Improved Leap-frog) scheme is developed by (using) the undetermined coefficient method to improve Leap-frog scheme. The new scheme includes both conservative and non-conservative forms.Numerical tests show that the computed results of the ILF scheme agree well with the exact solution of the convection equation.Through the comparison with the result from the original Leap-frog scheme,the accuracy of the ILF scheme is obviously improved.