多元化培训方式用于新护士人文关怀能力培养的效果观察

目的观察应用多元化培训方式对新护士人文关怀能力培养的效果。方法对107名新护士在岗前培训阶段予人文关怀理论、医院护理人文关怀制度、优质护理服务理论等教育,同时参加患者体验实践活动及年轻护士成长历程分享活动。结果 107名新护士培训后参加理论考核,合格率100%;患者体验实践活动汇报评分75~93分,每年度评选出6名优秀者;采纳新护士意见及建议完善就诊流程和管理制度6项。结论多元化培训方式能提升新护士人文关怀实践能力。     

新护士人文关怀培训方案的设计与实践

目的探讨新护士人文关怀培训的方法及效果。方法在2016年、2017年入职的130名新护士的规范化培训中加入人文关怀培训,主要包括:人文关怀理论讲授、急症患者就医情境模拟、陪同患者进行检查和治疗、人文关怀护理查房。培训前后,应用关怀能力评价量表对参加培训的新护士进行问卷调查。结果人文关怀培训后,护士的人文关怀能力和关怀品质相比于培训前均有了较大的提升(P0.05)。结论人文关怀培训有助于提升新护士的人文关怀能力。     

“情感教育”在新护士人文关怀培训中的实施与探索

目的为了提高新护士的人文关怀能力,探讨在新护士岗前培训中以"情感教育"为基础实施人文关怀培训路径的效果。方法选取2015年83名入职护士开展"情感教育"人文关怀课程,分四个主题,采取四种方式,将课程贯穿于整个培训班中,通过自我关怀、人与人的关怀、住院患者的关怀、临终患者的关怀等主题来开展培训,比较干预前后护士关怀能力及患者护理满意度。结果培训后与培训前比较,护士关怀能力提升,患者的满意度提高,护理服务改善。结论进行"情感教育"有助于新护士尽快适应护理工作,提高新护士的人文关怀能力。     

养老院服务体验对护理人员人文关怀能力影响的质性研究

目的 深入了解养老院服务体验对护理人文关怀能力的影响.方法 采用现象学方法,深入访谈参与养老院服务的15名临床护士,并用Colaizzi的7步分析法分析资料.结果 提炼出3个主题:服务体验;对护理人文关怀的理解;服务体验对护理人文关怀能力的影响.结论 护士参与养老院服务促进了护理人文关怀能力的提升,是培养护理人文关怀能力的积极方式.     

人文关怀教育在整形外科轮转新护士中的应用

目的探索轮转新护士工作培训中注重人文关怀的培养对新护士自身能力及工作的影响。方法对36名整形外科轮转护士,开展多种形式的人文关怀教育,培养其人文关怀能力并比较其培训前后人文关怀能力的变化。结果对轮转新护士进行人文关怀教育后,新护士人文关怀能力较培训前显著提高(P0.05)。结论对轮转新护士采取多种形式的人文关怀能力培养和实践,有利于提高其人文关怀能力及综合素质,帮助新护士更好更快进入工作角色,提升了患者满意度。     

ICU护士人文关怀能力培养的效果观察

目的调查ICU护士人文关怀能力,探讨开展人文关怀培训与患者满意度以及护士职业认同感之间的关系。方法开展多元化人文关怀护理培训,并对培训前后护士人文关怀能力、职业认同感、患者关怀感知进行量表调查,统计分析调查结果。结果开展护士人文关怀护理培训干预后,护士关怀能力、职业认同、患者对护理满意度比干预前明显提高,差异有统计学意义(P0.05)。结论在护理管理中,重视护士人文关怀培训护理干预,不仅提高了护士的综合素质,同时还提高了患者的满意度。     

ICU新入职护士多元化培训方法及效果观察

目的:探讨ICU新入职护士多元化培训的方法及效果。方法:对ICU新入职护士进行多元化计划性培训及导师专人一对一带教,理论结合临床实践。培训内容包括ICU基础知识、专科理论及操作规范、ICU感染预防及消毒隔离、ICU护理管理、ICU护理安全、ICU护患沟通、ICU专科仪器使用及保养。结果:通过多元化培训,逐步提高了新入职护士的专科理论水平、专业实践能力水平及人文关怀能力水平。结论:多元化培训对ICU新入职护士树立高尚的职业认同感尽快适应临床工作、提高自身综合素质和人才培养都具有重要意义。     

PBL结合情景模拟教学在手术室新护士人文关怀能力培训中的应用

目的在手术室新护士培训工作中,采用问题式教学(Problem-Based learing,PBL)结合情景模拟教学,了解对其人文关怀能力的影响效果。方法对2014年5-12月入科的50名新护士采用PBL与情景模拟教学法进行1个月岗前人文关怀能力培训。运用中文版人文关怀能力评价量表(CAI)调查培训前后的新护士的人文关怀能力状况。结果培训后新护士在认知、勇气、耐心人文关怀能力三个维度得分及总分均高于培训前,差异有统计学意义(P0.05)。结论对于手术室护理管理者来说,采用PBL与情景模拟教学结合培训的方法能够显著提高手术室新护士人文关怀能力,帮助新护士更好地适应手术室护理工作,从而为手术患者提供优质护理服务,提高手术室护理质量。     

"学姐妹"带教模式在新入职护士人文关怀能力培训中的应用研究

目的探讨"学姐妹"带教模式在新入职护士人文关怀能力培训中的应用及效果评价。方法选取2015年至2016年93名新入职护士为对照组,2017年至2018年92名新入职护士为观察组,对照组沿用传统导师制模式进行带教培训,观察组采用"学姐妹"带教模式,包括组建培训师资和"学姐妹"带教团队、制订培训体系、实施培训方案。培训结束后,比较两组新入职护士的理论成绩、操作技能成绩、临床护理能力及人文关怀品质。结果观察组新入职护士的理论成绩、操作技能成绩、临床护理能力及人文关怀品质得分均高于对照组,差异具有统计学意义(P0.01)。结论通过"学姐妹"带教模式在新入职护士规范化培训中的实施,不仅提高了新入职护士的临床护理能力和人文关怀品质,而且对稳定护理队伍、提升团队协作有积极的促进作用,为新入职护士的培训模式提供了借鉴,值得护理管理者关注和探索。     

人文关怀课程设置在新护士岗前培训中的应用效果

目的探讨人文关怀课程设置在新护士岗前培训中的应用效果。方法选取2015年9月～2017年8月于本院新入职的护士143名,开展"中日人文交流——关怀技巧分享——体验就医感受"人文关怀系列培训,采取讲授法、小组讨论法、案例研究法、多媒体教学法、角色扮演法、书籍自学法等多种培训形式,比较干预前后护士关爱能力及关怀照护行为改变情况。结果经过一系列融合人文关怀理念的岗前培训,新入职护士关爱能力评价表总分和各维度干预后均分均高于干预前,认知维度t值29. 47,勇气维度t值25. 73,耐心维度t值19. 45,P 0. 05,差异有统计学意义。结论对新护士进行多种形式的人文关怀培训,能有效提升新护士的人文关怀能力,调动其积极性,提高患者满意度。     

Reducing boundary effects in static EIT imaging

Electrical impedance tomography (EIT) is a non-invasive technique used to image the electrical conductivity and permittivity within a body from measurements taken on the body's surface. High-quality static images are required for many medical imaging applications. Forming such images usually requires an accurate way to calculate the expected voltages on the surface resulting from the application of known currents to that surface. This is described as the forward problem. This paper introduces a new method to improve static images by using an improved forward solution which estimates a different conductivity value for each applied current pattern. This method, creating an automatically adjusting forward solution, can improve the sensitivity of static images under many EIT imaging applications. It does so by reducing the boundary effects caused by electrodes and any layered structures near them such as skin. The drawback of this method is that circularly symmetric structures of interest may be suppressed or eliminated from the images. The performance of this method is illustrated in a 2D circular phantom with simulation data from both a FEM model and experimental data.     

Acoustic radiation force on a spherical contrast agent shell near a vessel porous wall--theory

Contrast agent microshells (CAMSs) are under intensive investigation for their wide applications in biomedical imaging and drug delivery. In drug delivery applications, CAMSs are guided to the targeted site before fragmentation by high-intensity ultrasound waves leading to the drug release. Prediction of the acoustic radiation force used to nondestructively guide a CAMS to the suspected site is becoming increasingly important and gaining attention particularly because it increases the system efficiency. The goal of this work is to present a theoretical model for the time-averaged (static) acoustic radiation force experienced by a CAMS near a blood vessel wall. An exact solution for the scattering of normal incident plane acoustic waves on an air-filled elastic spherical shell immersed in a nonviscous fluid near a porous and nonrigid boundary is employed to evaluate the radiation force function (which is the radiation force per unit energy density per unit cross-sectional surface). A particular example is chosen to illustrate the behavior of the time-averaged (static) radiation force on an elastic polyethylene spherical shell near a porous wall, with particular emphasis on the relative thickness of the shell and the distance from its center to the wall. This proposed model allows obtaining a priori information on the static radiation force that may be used to advantage in related as drug delivery and contrast agent imaging. This study should assist in the development of improved models for the evaluation of the time-averaged acoustic radiation force on a cluster of CAMSs in viscous and heat-conducting fluids. (E-mail: mitri@lanl.gov)     

Errors due to the truncation of the computational domain in static three-dimensional electrical impedance tomography

In electrical impedance tomography (EIT), an approximation for the internal resistivity distribution is computed based on the knowledge of the injected currents and measured voltages on the surface of the body. The currents spread out in three dimensions and therefore off-plane structures have a significant effect on the reconstructed images. A question arises: how far from the current carrying electrodes should the discretized model of the object be extended? If the model is truncated too near the electrodes, errors are produced in the reconstructed images. On the other hand if the model is extended very far from the electrodes the computational time may become too long in practice. In this paper the model truncation problem is studied with the extended finite element method. Forward solutions obtained using so-called infinite elements, long finite elements and separable long finite elements are compared to the correct solution. The effects of the truncation of the computational domain on the reconstructed images are also discussed and results from the three-dimensional (3D) sensitivity analysis are given. We show that if the finite element method with ordinary elements is used in static 3D EIT, the dimension of the problem can become fairly large if the errors associated with the domain truncation are to be avoided.     

A review of recent studies relating ligand diffusion, general anesthesia, and sleep

This review article presents 3 theories related to ligand diffusion, general anesthesia and sleep. The first theory describes the diffusion of molecules across a protein surface to a receptor. It is based on the effect of the amino acid side chains on the protein surface on the structure of bulk water nearby. This influence creates pathways, called chreodes, through the water near the protein surface, permitting a rapid diffusion of molecules to the receptors. A second theory involving the role of chreodes presents a mechanism of action of nonspecific anesthetic agents. These agents interrupt the diffusion of neurotransmitter molecules to their receptors, bringing on the anesthetic effects. Finally, building on the similarities of anesthesia and sleep, a theory is presented proposing that an external agent influences sleep in a way similar to that of the nonspecific anesthetic molecules. This external agent is proposed to be elemental nitrogen. Several observations are presented to support this mechanism.     

Biomaterials lubricated for minimum frictional resistance.

To improve the frictional characteristics of a biomaterial, the mechanical performance of a lubricated surface was studied. In vitro friction tests showed that the coefficient of dynamic friction of the lubricated surface was about 0.01 against rabbit bladder and the coefficient of static friction increased with the preload period. The efficacy of a lubricated cystoscope was evaluated by an in vivo test simulating cystoscope operation. The maximal and the total resistance force on the cystoscope model were found to decrease with the surface lubrication. Histological study revealed that urethral damage caused by rubbing with the cystoscope model was reduced by this lubrication technique. Presumably, prolonged retention of water on the lubricated surface region prevented tissue adhesion to the foreign material.     

A 2D/3D correspondence building method for reconstruction of a patient-specific 3D bone surface model using point distribution models and calibrated X-ray images

Constructing a 3D bone surface model from a limited number of calibrated 2D X-ray images (e.g. 2) and a 3D point distribution model is a challenging task, especially, when we would like to construct a patient-specific surface model of a bone with pathology. One of the key steps for such a 2D/3D reconstruction is to establish correspondences between the 2D images and the 3D model. This paper presents a 2D/3D correspondence building method based on a non-rigid 2D point matching process, which iteratively uses a symmetric injective nearest-neighbor mapping operator and 2D thin-plate splines based deformations to find a fraction of best matched 2D point pairs between features extracted from the X-ray images and those extracted from the 3D model. The estimated point pairs are then used to set up a set of 3D point pairs such that we turn a 2D/3D reconstruction problem to a 3D/3D one, whose solutions are well studied. Incorporating this 2D/3D correspondence building method, a 2D/3D reconstruction scheme combining a statistical instantiation with a regularized shape deformation has been developed. Comprehensive experiments on clinical datasets and on images of cadaveric femurs with both non-pathologic and pathologic cases are designed and conducted to evaluate the performance of the 2D/3D correspondence building method as well as that of the 2D/3D reconstruction scheme. Quantitative and qualitative evaluation results are given, which demonstrate the validity of the present method and scheme.     

Detection of static and dynamic components of mechanical allodynia in rat models of neuropathic pain: are they signalled by distinct primary sensory neurones?

In the present study, chronic constrictive injury (CCI model) of the sciatic nerve or tight ligation of L5 and L6 spinal nerves (Chung model) produced both dynamic and static components of mechanical allodynia in rats. The two responses were detected, respectively, by lightly stroking the hind paw with cotton wool or application of pressure using von Frey hairs. Animals with spinal nerve ligation developed both types of responses at a faster rate compared to animals with the CCI. Morphine (1-3 mg/kg, s.c.) dose-dependently blocked static but not dynamic allodynia. In contrast, pregabalin (previously S-isobutylgaba and CI-1008) dose-dependently (3-30 mg/kg, p.o.) blocked both types of allodynia. In CCI animals, two administrations of capsaicin (100 microg/50 microl) into the plantar surface of the ipsilateral paw at 1-h intervals blocked the maintenance of thermal hyperalgesia without affecting either static or dynamic allodynia. The similar administration of a further two doses of capsaicin into the same animals blocked the maintenance of static allodynia without affecting the dynamic response. These data indicate that thermal hyperalgesia, static and dynamic allodynia are respectively signalled by C-, Adelta- and Abeta/capsaicin insensitive Adelta- primary sensory neurones. It is suggested that pregabalin possesses a superior antiallodynic profile than morphine and may represent a novel class of therapeutic agents for the treatment of neuropathic pain.     

Strategy for accurate liver intervention by an optical tracking system

Image-guided navigation for radiofrequency ablation of liver tumors requires the accurate guidance of needle insertion into a tumor target. The main challenge of image-guided navigation for radiofrequency ablation of liver tumors is the occurrence of liver deformations caused by respiratory motion. This study reports a strategy of real-time automatic registration to track custom fiducial markers glued onto the surface of a patient’s abdomen to find the respiratory phase, in which the static preoperative CT is performed. Custom fiducial markers are designed. Real-time automatic registration method consists of the automatic localization of custom fiducial markers in the patient and image spaces. The fiducial registration error is calculated in real time and indicates if the current respiratory phase corresponds to the phase of the static preoperative CT. To demonstrate the feasibility of the proposed strategy, a liver simulator is constructed and two volunteers are involved in the preliminary experiments. An ex-vivo porcine liver model is employed to further verify the strategy for liver intervention. Experimental results demonstrate that real-time automatic registration method is rapid, accurate, and feasible for capturing the respiratory phase from which the static preoperative CT anatomical model is generated by tracking the movement of the skin-adhered custom fiducial markers.OCIS codes: (170.0170) Medical optics and biotechnology, (120.3890) Medical optics instrumentation     

Mesh-based Monte Carlo method using fast ray-tracing in Plücker coordinates

We describe a fast mesh-based Monte Carlo (MC) photon migration algorithm for static and time-resolved imaging in 3D complex media. Compared with previous works using voxel-based media discretization, a mesh-based approach can be more accurate in modeling targets with curved boundaries or locally refined structures. We implement an efficient ray-tracing technique using Plücker Coordinates. The Barycentric coordinates computed from Plücker-formed ray-tracing enables us to use linear Lagrange basis functions to model both media properties and fluence distribution, leading to further improvement in accuracy. The Plücker-coordinate ray-polygon intersection test can be extended to hexahedral or high-order elements. Excellent agreement is found when comparing mesh-based MC with the analytical diffusion model and 3D voxel-based MC code in both homogeneous and heterogeneous cases. Realistic time-resolved imaging results are observed for a complex human brain anatomy using mesh-based MC. We also include multi-threading support in the software and will port it to a graphics processing unit platform in the near future.     

Global Electrophysiological Mapping of the Atrium: Computerized Three-Dimensional Mapping System

The atria are anatomically complex three-dimensional (3-D) structures. Impulse propagation is dynamic and complex during both normal conduction and arrhythmia, Atrial activation has traditionally been represented on two-dimensional surface maps, which have inherent inaccuracies and are difficult to interpret. Interactive computerized 3-D display facilitates interpretation of complex atrial activation sequence data obtained from form-fitting multipoint electrodes. Accordingly, the purpose of this article is to describe the application of 3-D form-fitting electrode molds to the 3-D mapping and display system developed in this laboratory for the study of complex cardiac arrhythmias. Computer generated 3-D surface models are created from a database of serial cross-sectional anatomical images. Points chosen on endocardial and epicardial surfaces in each cross-sectional image are processed to create polygons defining myocardial wall boundaries. The polygons from adjacent serial images are then combined, to create a 3-D surface model. The discrete anatomical locations of unit electrodes on multipoint electrode templates are then assigned in the proper position on the surface model. Computer analysis of simultaneous activation data from each unit electrode is performed based on parameters set by the user. Activation data from each unit electrode site are displayed on the computer surface model in a color spectrum correlating with a user-defined time scale. Activation sequence maps can be visualized as static isochrone maps, interval maps, or as dynamic maps at variable speeds, from any 3-D perspective. Thus, an interactive computerized 3-D display system is described, which allows anatomically superior analysis and interpretation of complex atrial arrhythmias.