护理本科生对临床学习环境认知与其实习表现相关分析

目的:探讨我国护理本科生对临床学习环境的认知与其临床实习自评情况之间的相关性.方法:研究对象为我国5所部属医科大学在校实习的115名护理本科生.采用临床学习环境量表(CLES)测量学生对临床学习环境的认知情况,护理本科生临床实践行为量表(CET)调查学生实习表现自评情况.2份问卷的信度系数分别为0.95(CLES)和0.86(CET).结果:本科生临床学习环境认知和实习表现自评得分分别为3.31±0.58和2.57±0.52.经Pearson相关分析,学生对临床学习环境的认知与学生对自己实习表现的相关系数为0.53,P＜0.01.结论:学生对自己所在医院的临床学习环境中度满意,学生实习表现自评情况比较令人满意.学生对临床学习环境的认知与其实习表现的自我评价呈中度正相关,对临床学习环境的认知越好,他们对自我实习表现的评价越高.     

综合性情景模拟演练在护理本科生实习前护理培训中的应用

目的:探讨综合性情景模拟演练在护理本科生实习前护理培训中的应用效果。方法:将120名2011级护理本科生随机等分为试验组和对照组,实习前对照组接受常规的护理培训,试验组接受综合性情景模拟演练。培训结束后,比较两组学生的护理理论与护理技能的考核成绩,应用自主学习能力测评量表比较两组学生的自主学习能力;问卷调查试验组学生对综合性情景模拟演练的认可程度。结果:试验组学生的护理理论和护理技能考核成绩高于对照组(P0.05),自主学习能力总分以及自我管理能力、信息能力、合作能力得分均高于对照组(P0.05)。分别有98.33%,96.67%和93.33%的试验组学生认为综合性情景模拟演练有利于提高临床护理决策能力、促进对护理理论的理解与应用以及激发学习兴趣。结论:综合性情景模拟演练能提高护理本科生在实习前护理培训中的教学效果,为学生进入临床实习奠定了坚实的基础。     

PBL在护理本科生社区实习课中的应用效果研究

目的探讨改进护理本科生社区临床实习的最佳方法.方法将到社区实习的护理本科生64人随机分为实验组和对照组.对照组32人,按照传统的临床实习方法带教;实验组32人,将"以问题为基础"的教学模式(PBL)应用于社区临床实习教学工作中,以临床问题作为激发学生学习的动力、引导学生把握学习内容,培养学生有效运用知识解决问题的能力.结果改进后的临床实习带教方法,学生对教学的满意度93%(P＜0.01)、学生综合能力优良率98%(P＜0.05)、<护理研究>理论考试优良率93%(P＜0.01).结论PBL优于传统临床带教模式,而且有利于提高临床教师综合素质.     

护理本科生情绪智力水平与临床实习行为的调查研究

临床实习是护生在实践环境中不断增长知识,提升技能,形成良好专业行为的重要阶段,是认知、情感、动作技能三个领域均处于高水平的学习。临床实习行为则是在临床实习环境中,护生受环境的影响,并与环境互动而形成的专业行为。根据Goleman“情绪智力”理论的观点,护生临床实习行为应该受其情绪智力水平的影响,国外研究也证明,情绪智力是决定个人成功的最重要因素,而我国护理教育领域对情绪智力的研究是空白。     

护理本科生角色认知与临床实践行为的关系研究

目的了解护理本科生角色认知与临床实践行为现状及其相关性,为护理教学提供依据。方法采用角色认知量表及护理本科生临床实践行为评价量表,对某医科大学142名护理本科生进行问卷调查。结果本组本科护生角色认知总均分为(2.77±0.38)分(理论中位数为3分),为中等略偏下水平;临床实践行为总均分为(3.48±0.70)分。认知领域与角色模糊呈正相关(P0.05),认知领域、情感领域、操作技能领域与角色冲突呈正相关(P0.01)。多因素分析显示,角色模糊与角色冲突对护理本科生临床实践行为有预测作用和影响。结论护理本科生角色认知与临床实践行为有密切关系。在临床护理教学中,带教老师应增强学生角色意识,帮助学生端正职业态度,提高学习动机,更好地培养其临床实践能力。     

发展性教学评价在护理本科学生实习前技能培训中的应用

目的 探讨发展性教学评价在护理本科生实习前技能操作培训中的应用效果.方法 将2008级103名护理本科生作为试验组,2007级105名护理本科生作为对照组.对照组采用常规的教学评价,试验组采用发展性教学评价.比较两组学生的操作考试成绩,并对试验组学生进行问卷调查.结果 试验组、对照组学生操作考试成绩分别为(86.39±5.91)分和(83.08±6.43)分,差异有统计学意义(P＜0.05).结论 发展性教学评价有助于调动护理本科生的学习积极性,提高综合能力.     

临床实习对医护本科生批判性思维的影响

[目的]探讨临床实习对医疗护理本科学生批判性思维能力的影响。[方法]应用中文版的批判性思维问卷(CCTDI)对我校150名99级医疗和护理本科学生分别于实习前后进行调查。[结果]医护本科生实习前后CCTDI总分均>280分;实习后CCTDI总分均低于实习前(P<0.001),除寻找真相和自信心外,其他5个分量表的得分低于实习前(P<0.01);寻找真相在实习前后得分均<40分。实习后,医疗本科学生除寻找真相与自信心没有变化外,求知欲、系统化能力、分析能力、开放思想及认知成熟度均下降(P<0.05);而护理本科学生实习后仅认知成熟度较实习前下降(P<0.05)。[结论]实习后医护本科生批判性思维能力下降。医学院校及医院的领导应加强实践教学管理,加强师资队伍建设,提高教学质量,尤其重视医学生和护生批判性思维能力的培养。     

在本科实习护生中开展护理情感教育的实践

目的探讨本科实习护生护理情感教育的实践方法。方法在2003级本科护生进临床实习前,对临床带教老师进行培训,采用护士职业态度量表对临床实习结束后2002级和2003级护生进行问卷调查。结果临床实习结束后,试验组（2003级）的职业态度比对照组（2002级）趋于积极,差异具有统计学意义（t=-2．077,P〈0．05）。结论实习护生对护理工作的情感是可以培养的。临床实习阶段是培养护理本科生职业态度的重要阶段,充分发挥临床带教老师对护生护理情感培养的作用,能促进护生对护理工作的积极情感。     

临床实习对医护本科生批判性思维的影响

[目的] 探讨临床实习对医疗护理本科学生批判性思维能力的影响。[方法] 应用中文版的批判性思维问卷（CCTDI）对我校150名99级医疗和护理本科学生分别于实习前后进行调查。[结果] 医护本科生实习前后CCTDI总分均〉280分；实习后0CmI总分均低于实习前（P〈0．001），除寻找真相和自信心外，其他5个分量表的得分低于实习前（P〈0．01）；寻找真相在实习前后得分均〈40分。实习后，医疗本科学生除寻找真相与自信心没有变化外，求知欲、系统化能力、分析能力、开放思想及认知成熟度均下降（P〈0．05）；而护理本科学生实习后仅认知成熟度较实习前下降（P〈0．05）。[结论] 实习后医护本科生批判性思维能力下降。医学院校及医院的领导应加强实践教学管理，加强师资队伍建设，提高教学质量，尤其重视医学生和护生批判性思维能力的培养。     

护理本科生不同实习阶段临床能力需求调查

目的:了解护理本科生不同实习阶段对临床能力的需求情况,为不同实习阶段临床科室对护理本科生临床能力培养提出建设性意见。方法:采取方便抽样的方法,选取哈尔滨医科大学护理系2005级本科生100名在其临床实习初期、中期和末期进行临床能力需求的问卷调查。结果:在不同实习阶段,护理本科生对各临床能力需求的百分比在81.43%～100.00%之间。不同实习阶段临床能力需求比较,护理本科生对临床处置能力、护理沟通能力、临床科研能力和职业心理素质的需求存在差异(P0.05)。结论:各科室应适当地参照不同实习阶段护理本科生的心理状态和学习需求状况进行相关能力的锻炼和培养,对护理本科生的临床教学做好系统地规划与定位。     

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.     

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.     

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.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.