老年护理专业本科生自主学习准备度、学习过程及学习风格的研究

[目的]了解老年护理专业本科生自主学习准备度、学习过程、学习风格的现状,并探讨其特点。[方法]采用自主学习准备度量表、学习过程问卷、学习风格量表对天津中医药大学老年护理专业自愿参与本研究的77名学生进行调查。[结果]一年级和二年级学生自我管理维度得分最低;学习动机各维度差异有统计学意义(P<0.05);学习风格以集中型为主,具体经验和感知信息维度差异有统计学意义(P<0.05)。[结论]老年护理专业学生有自主学习的需求,对自主学习的主观态度较好,但自我管理能力较差;学习动机与学习策略倾向于深层型;学习能力偏好抽象概括和主动实践;可以通过对学习动机与学习策略以及学习风格的调整来增强学生自主学习能力。     

护理本科学生体验式学习风格调查研究

目的 调查不同年级护理本科生的体验式学习风格特点,为教学方式的选择提供一定的参考依据.方法 采用Kolb体验式学习风格量表,对遵义医学院护理专业1 230名护理本科学生进行调查,分析学生的学习风格.结果 4种学习风格的学生人数由高到低排序为辐合式、发散式、同化式及顺应式.在体验式学习风格能力圈上,学生发展较为突出的方面是发散式学习方式,其中创建新思维及行动方式方面得分较低.结论 护理本科4个年级学生具有不同的学习风格倾向,根据不同年级学生的学习风格特点,采取相应的教学策略及手段,对有效提高教学质量和水平有重要作用.     

不同专业高职医学生学习风格现状的调查研究

目的调查不同专业高职医学生学习风格现状,为高职医学教育者根据学生的学习风格开展教学和教学改革提供依据。方法采用Kolb学习风格量表,对清远职业技术学院护理学院助产、康复、护理、医学美容4个专业一、二年级共1624名学生进行调查。结果高职医学生学习风格依次为发散型565名(34.8%),同化型412名(25.4%),聚合型345名(21.2%),顺应型302名(18.6%);学生更倾向于反思观察型和主动实践型的学习方式。结论高职医学生学习风格倾向于反思观察型和主动实践型,护理教育者可根据学生不同学习风格特点,采取相应的学习方法指导,改善教学方法,培养学生不同情境下运用不同学习风格的能力。     

大学生认知风格发展：4省4460份问卷

目的:认知风格影响着个体面临同一压力情境时的应对方式。采用问卷方式调查4省6406名大学生,分析返回问卷中认知风格发展的特点。方法:于2006-01/11对新疆、江西、河北、辽宁等省的6406名大一到大四的文科、理科和体艺专业大学生进行问卷调查,所有被试对调查方案均知情同意。采用青少年认知风格问卷系统考察大学生的认知风格在专业发展、家庭来源和年级上的特点。该问卷有15个项目,为4点量表,有较好的信效度。结果:收回内容详实问卷4460份,回收率为69.62%。将认知风格分为认知决策、认知方法、认知加工、认知行为和认知倾向5个维度,在不同家庭来源、不同专业和不同年级上,大学生的认知风格呈现出不同的发展特点:①大学生认知风格总体的发展在专业、年级上差异有显著性意义(P<0.01),但是不同家庭来源的大学生认知风格总体上差异无显著性意义(P>0.05)。②在专业方面,除认知决策以外,无论是文科、理科还是体艺专业在认知方法、认知加工、认知行为和认知倾向上差异均具有显著性意义(P<0.01),这种差异主要体现在体艺专业学生和文理科学生之间。③在年级方面,认知方法、认知行为和认知倾向3个维度差异具有显著性意义(P<0.05￣0.01),并且主要体现在大二和大四这两个年级上。④在家庭来源方面,认知方法、认知加工和认知行为3个维度差异具有显著性意义(P<0.01)。结论:不同家庭来源、不同专业和不同年级大学生的认知风格呈现出不同的发展特点;认知风格总体发展受专业、年级的影响。     

不同年级护理本科生职业态度的调查

目的了解不同年级护理本科生职业态度,分析她们对护理学专业态度的差异,探讨相应的职业态度教育方法。方法采用调查研究的方法,调查我校护理本科2003~2006级4个年级共160名学生。调查问卷的内容为个人资料和职业态度。结果从学生职业选择看职业态度,临床护理是就业的主流,社区护理就业尚未被认识,部分学生倾向改行。各年级职业态度比较中,不同年级的护理本科生的职业态度不同,职业态度在一年级与二、三年级有差异,三年级与四年级有差异(P<0.01)。结论一年级学生对护理专业的认知程度较差;多数同学愿意学习并喜欢护理专业;四年级临床实习学生没有明显愿意参加护理活动的意愿。本科护理教育应注重学生早期接触护理,创造良好的生产实习环境及合理使用护理人才;教师在授课中应客观地向同学介绍现实的临床工作,使同学有充分的心理准备,迎接挑战。     

不同年级护理本科生职业态度的调查

目的 了解不同年级护理本科生职业态度,分析她们对护理学专业态度的差异,探讨相应的职业态度教育方法.方法 采用调查研究的方法,调查我校护理本科2003～2006级4个年级共160名学生.调查问卷的内容为个人资料和职业态度.结果 从学生职业选择看职业态度,临床护理是就业的主流,社区护理就业尚未被认识,部分学生倾向改行.各年级职业态度比较中,不同年级的护理本科生的职业态度不同,职业态度在一年级与二、三年级有差异,三年级与四年级有差异(P＜0.01).结论 一年级学生对护理专业的认知程度较差;多数同学愿意学习并喜欢护理专业;四年级临床实习学生没有明显愿意参加护理活动的意愿.本科护理教育应注重学生早期接触护理,创造良好的生产实习环境及合理使用护理人才;教师在授课中应客观地向同学介绍现实的临床工作,使同学有充分的心理准备,迎接挑战.     

护理中专生与护理本科生学习风格的比较和分析

[目的]基于科尔布（Kolb）学习风格的研究,对500名护理中专生和400名护理本科生的学习风格进行调查,了解中专护生和本科护生学习风格的分布情况,为护理教学提供依据。[方法]采用Kolb学习风格量表对运城市卫生学校3个年级中专护生和山西医科大学护理系一年级和三年级护生进行抽样问卷调查。[结果]中专护生中分散型人数最多（25.4%）,同化型人数最少（19.0%）;本科护生中以同化型人数最多（33.3%）,而适应型人数最少（16.5%）;3个年级中专护生的学习风格类型差异无统计学意义,两个年级本科护生学习风格类型差异也无统计学意义;在信息领悟方面,中专护生抽象概括平均分低于具体经验的平均分,而本科护生则相反;在信息加工方面,二者的主动实践平均分均低于反思观察平均分。[结论]中专护生相对于本科护生来说,理论基础较差,对抽象概念的感知力较弱,倾向于具体经验的支持;中专护生和本科护生的主动实践能力均有待加强。     

护理中专生与护理本科生学习风格的比较和分析

[目的]基于科尔布(Kolb)学习风格的研究,对500名护理中专生和400名护理本科生的学习风格进行调查,了解中专护生和本科护生学习风格的分布情况,为护理教学提供依据.[方法]采用Kolb学习风格量表对运城市卫生学校3个年级中专护生和山西医科大学护理系一年级和三年级护生进行抽样问卷调查.[结果]中专护生中分散型人数最多(25.4%),同化型人数最少(19.0%);本科护生中以同化型人数最多(33.3%),而适应型人数最少(16.5%);3个年级中专护生的学习风格类型差异无统计学意义,两个年级本科护生学习风格类型差异也无统计学意义;在信息领悟方面,中专护生抽象概括平均分低于具体经验的平均分,而本科护生则相反;在信息加工方面,二者的主动实践平均分均低于反思观察平均分.[结论]中专护生相对于本科护生来说,理论基础较差,对抽象概念的感知力较弱,倾向于具体经验的支持;中专护生和本科护生的主动实践能力均有待加强.     

护理本科生创造力倾向与学习风格的相关性研究

[目的]通过对本科生进行现状调查,分析大学生的创造力倾向和学习风格的特点,探讨创造力倾向和学习风格的相关性,并初步探索提高创造力水平的最佳学习风格.[方法]抽取山西省有代表性的两所医学院校,采用分层和整群抽样方法抽取护理本科生和临床医学本科生共569人(国家统招本科生),再随机抽取2006年7月-2007年7月在<护理研究>上旬版上发表文章的临床护士(学历为本科)99人进行调查.采用SPSS 13.0软件进行t检验、多项式Logistic回归分析、多变量方差分析和典型相关性分析.[结果]①临床医学本科生创造力倾向总分明显高于护理本科生(P<0.05),两所医学院学生创造力倾向总分存在差异(P<0.05).在创造力倾向维度上,不同学院之间不同,临床医学本科生冒险性、挑战性和好奇心得分均比护理本科生高,临床护士的挑战性和好奇心高于护理本科生,而护理学生的想象力比临床护士丰富.②在学习风格类型上,同化型人数最多,顺应型人数最少,但在学校、专业、年级、性别之间无差异;在感知信息方面护理本科生比临床护士更倾向于具体经验,在信息加工方面护理本科生比临床护士更倾向于主动实践.③学习风格与创造力倾向存在相关性(r=0.235),具体经验与想象力的相关性最大(r=0.168 3);学生抽象概念与好奇心相关性最大(r=0.160 5);临床护士具体经验与冒险性相关性最大(r=0.291 3).[结论]护理本科生的创造力倾向低于临床医学生;护理本科生的学习风格与临床护士有一定的差异,在学习过程中应该促进培养护理本科生抽象概念和反思观察的风格;学习风格感知信息的两个维度和创造力倾向相关,即具体经验对创造力倾向的冒险性以及想象力有一定的积极作用,抽象概念对创造力倾向的好奇心有一定的积极作用.     

不同年级护理本科生学习风格的现状研究

目的调查护理本科生学习风格现状,为护理教育者提高教学质量提供依据。方法采用Kolb编制的学习风格量表,对421名护理本科生进行问卷调查。结果护理本科生顺应型学习风格所占比例最高(160名,占41.7%),不同年级本科生在4种学习风格的构成上差异有统计学意义(χ2=13.311,P=0.038),且在反思观察这种学习过程的得分上差异有统计学意义(F=6.484,P=0.002),四年级高于其他年级(P<0.001)。随年级增长,具有从趋于实践操作的顺应型向趋于理论概念的发散型转变的趋势。总体上,护理本科生倾向于用具体经验感知信息,通过主动实践加工信息。结论护理本科生动手操作能力较强,但抽象思维能力不足。应加强对本科生抽象思维的训练,开展有针对性的学习指导,因材施教,从而培养综合素质人才。     

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.     

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.     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.