河南省304名急诊科护士评判性思维能力调查研究

[目的]调查河南省急诊科护士评判性思维能力现状并分析其影响因素,为急诊科护士能力培训提供参考。[方法]采用评判性思维能力测量量表对河南省急诊科304名护士评判性思维能力进行调查,采用SPSS 21.0软件进行统计分析。[结果]急诊科护士评判性思维能力量表总分为(279.84±25.51)分,47.04%的护士评判性思维能力得分≥280分,急诊科护士评判性思维能力7个特质得分按分数高低排序依次为评判性思维的自信心、认知成熟度、开放思想、寻找真相、系统化能力、分析能力、求知欲。工作医院级别、年龄、最终学历、职称、进修学习次数、参与死亡病例讨论次数及写作习惯是急诊科护士评判性思维能力的影响因素。[结论]急诊科护士评判性思维能力水平处于中等偏上水平,护士在急诊护理工作中具有评判性思维的自信心,但其在分析、处理临床急救问题方面仍需提高,医院可通过为护士提供进修学习机会、加强继续教育、开展死亡病例讨论、培养写作习惯等方式提高其评判性思维能力。     

不同实习阶段专科护理实习生评判性思维能力的测量及比较分析

目的了解专科护理实习生不同实习阶段的评判性思维能力及其变化。方法采用中文版评判性思维能力测量表对某高校2018届180名专科护理实习生进行评判性思维能力测评,比较分析不同实习阶段专科护理实习生的评判性思维能力。结果护理实习生在实习前、实习中和实习结束时评判性思维能力的总分分别为(266.15±18.38)分,(279.92±24.94)分,(279.17±28.48)分;其中实习前7个维度得分在35～41分之间,只有求知欲维度得分大于40分显示正性特质;实习中期,开放思想、分析能力、系统化能力、求知欲和认知成熟度5个维度和总分都比实习前明显进步,但自信心不足;实习结束时护生评判性思维的自信心增强,而认知成熟度相比实习中期反而下降。结论护理实习生评判性思维能力在实习的不同阶段均处于中等水平,随着实习时间的增加,评判性思维的能力在不断增加,但追求真相倾向性不明显,认知成熟度呈现反复。     

护理人员参与医生查房对护士评判性思维能力的影响

目的 探讨护理人员参与妇科医生查房对护士评判性思维能力的影响.方法 江阴医院妇科从2010-01起实行护理人员参与医生查房,比较2009年度和2010年度全科护理人员的评判性思维能力量表(CTDI-CV)评分变化.结果 2010年度护理人员的寻找真相、开放思想、分析能力、系统化能力、评判思维自信心、求知欲、认知成熟度、总分等CTDI-CV 7个特质评分显著高于2009年度,P＜0.05.结论 护理人员参与妇科医生查房明显提高护士的评判性思维能力,值得临床推广应用.     

临床护士评判性思维与临床决策能力的相关性研究

目的 了解临床护理人员评判性思维能力与护理决策能力的现状,探讨临床护理人员评判性思维能力与护理决策能力的关系.方法 采用评判性思维倾向性调查表(中文版)和护理临床决策能力调查表,对汕头市3所三甲医院223名临床护理人员进行问卷调查.结果 临床护士评判性思维总分平均为(292.12±24.67),决策能力总平均分为(140.72±11.34);评判性思维与决策能力呈显著正相关(P＜0.01).结论 临床护士评判性思维与护理决策能力呈正相关,评判性思维能力越强,护理临床决策能力越强.     

护理本科生自主学习能力及评判性思维的相关性分析

目的:探讨护理本科生自主学习能力与评判性思维的相关性,为护理本科生评判性思维能力的培养提供参考依据。方法 :选取我市某医学院校122名护理本科生为研究对象,采用评判性思维能力(中文版)测量表和自主学习能力量表调查护理本科生的评判性思维能力和自主学习能力,并分析其相关性。结果 :护理本科生的评判性思维能力总分为(296.45±30.87)分;自主学习能力总分为(85.34±6.01)分;自主学习能力总分与寻求真理、分析能力、系统化能力、评判性思维的自信心、求知欲、认知成熟度、评判性思维总分呈显著正相关(P0.05)。结论:护理本科生有正向的评判性思维能力,自主学习能力与评判性思维有相互促进的作用,自主学习能力越强,评判性思维能力越强。     

山西省三级甲等综合医院临床护理教师评判性思维现状调查

[目的]通过了解临床护理教师评判性思维水平,引起护理教育者、管理者及临床护理教师自身对评判性思维的高度重视.[方法]采用一般资料调查表、加利福尼亚批判性思维倾向问卷中文版(CTDI-CV)、加利福尼亚批判性思维技能测验(CCTST)问卷中文版测量山西省三级甲等综合医院临床护理教师评判性思维水平.[结果]临床护理教师评判性思维倾向总分为284.35分±24.48分,7个特质得分由高到低分别是求知欲、分析能力、系统化能力、评判性思维自信心、认知成熟度、开放思想及寻找真相;评判性思维技能总分及其分析、评价、推理子技能得分分别为11.06分±3.13分、3.89分±1.43分、4.37分±1.77分、2.81分±1.53分;临床护理教师评判性思维倾向和评判性思维技能总分呈正相关;不同职称临床护理教师评判性思维水平差异有统计学意义.[结论]山西省临床护理教师有正性评判性思维倾向,但寻求真相能力较差,评判性思维推理技能较弱;临床护理教师评判性思维总体水平不高,亟待提高;评判性思维倾向与评判性思维技能发展相辅相成;重视临床护理教师的选拔.     

中职护理专业学生评判性思维能力的调查研究

目的了解不同年级中职护理专业学生评判性思维能力现状,为深化中职护理教学改革提供科学依据。方法采用"评判性思维能力测量表"(CTDI-CV),对在读一、二、三年级中职护理专业学生共813名进行测试分析。结果中职护理专业学生的CTDI-CV总分为(285.09±24.65)分,表明其具有正性评判性思维倾向,但评判性思维能力不强;在寻找真相、系统化能力、评判性思维自信心方面得分为30-40分,处于中等水平,有待于提高。3个年级学生评判性思维能力各亚类测评≥40分所占比例比较,"开放思想""系统化能力""评判性思维自信心"年级间差异有统计学意义。结论中职护理教育应注重对学生评判性思维能力的培养,对不同年级学生应给予针对性评判性思维教育。     

综合性教学医院临床护士评判性思维的现状及其影响因素

目的探讨综合性教学医院临床护士评判性思维的现状及其影响因素,为提高护理人员评判性思维能力提供依据。方法采用分层随机抽样方法对619名临床护理人员评判性思维现状进行调查,并分析其可能的影响因素。结果临床护士评判性思维的平均得分为(275.84±29.06)分,其中认知成熟度、开放思想和寻找真相三个维度的得分为正性评判性思维。不同年龄、护龄、学历及临床科室间护士的得分差异有统计学意义(P<0.01、P<0.05),而不同职称护士的得分差异无统计学意义(P>0.05)。结论临床护士评判性思维的平均得分属于中等偏下水平,护理管理者必须加强临床护士评判性思维能力的培养。建议临床相关教育部门在临床继续教育中强化护士评判性思维的教育活动,并为护理人员创造有利于评判性思维发展的工作环境,以有效提高临床护士的评判性思维能力。     

济南市2所三级医院269名ICU护士评判性思维能力现状调查分析

目的:调查济南市2所三级医院重症监护室(ICU)护士运用评判性思维能力现状,分析其影响因素,为进行护理人员评判性思维研究提供理论参考。方法:采用便利抽样法于2021年12月—2022年3月选取济南市2所三级医院269名ICU护士进行调查研究,问卷包括一般资料问卷和评判性思维能力测量表中文版(CTDI-CV)问卷。结果:269名ICU科室护士评判性思维能力总分为(286.57±26.19)分,其总体评判性思维能力正性。条目均分最高的维度为分析能力[(4.57±0.59)分],最低为开放思想[(3.32±0.56)分]。其中文化程度、职称、是否参与病例讨论、评判性思维了解程度对ICU护士评判性思维能力有影响(P<0.05)。结论:ICU评判性思维能力倾向总分为正性,离强正性标准还有一定差距且各个维度发展不平衡。建议ICU护士可通过案例分析、反思教学等方式对评判性思维进行进一步强化提高。     

临床护理带教老师评判性思维能力与自我效能感的相关分析

目的了解临床护理带教老师评判性思维能力与自我效能感的现状及两者的相关性。方法采用中文版加利福尼亚评判性思维能力测量表、一般自我效能感量表对222名临床护理带教老师进行问卷调查。结果临床护理带教老师的评判性思维能力总分为(299.55±27.62)分;自我效能感总分为(2.48±0.45)分。自我效能感与评判性思维能力总分、寻求真相、分析能力、系统化能力、评判性思维的自信心、求知欲、认知成熟度均呈正相关(P0.01)。结论临床护理带教老师评判性思维能力和自我效能感总体水平不高,护理管理者应意识到两者的重要性及相关性,积极采取相应的措施,从而不断提升临床护理工作水平及教学质量。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."