仿真模拟教学系统对护理教学有效性的系统评价

目的采用Meta分析评价仿真模拟教学系统对护理教学的效果。方法计算机全面检索国内主要的医学数据库中有关仿真模拟教学的干预性研究。按照纳入及排除标准筛选文献,提取资料并评价纳入研究的方法学质量后,采用Rev Man 5.0分析软件进行Meta分析。结果共纳入12篇文献,合计2465名护理专业学生。Meta分析结果显示:仿真模拟教学系统在提高护理专业学生理论及操作技能方面优于对照组(P<0.01)。结论仿真模拟教学系统应用于护理教学中的效果优于传统护理教学法。但因纳入研究的质量不高,仍需大样本高质量的随机对照试验进一步验证。     

高仿真模拟人在护理教学中应用效果的系统评价

目的系统评价高仿真模拟人在护理教学中的应用效果。方法计算机检索Cochrane图书馆、JBI循证护理中心图书馆、PubMed、EMbase、中国期刊全文数据库、中国生物医学文献数据库,搜集有关模拟人对比传统教学法在护理教学中应用的随机对照试验（randomized controlled trial,RCT）或类随机对照试验（quasi randomized controlled trial,q-RCT）。对纳人研究进行方法学质量评价,而后提取有效数据并采用RevMan5．0软件进行Meta分析。结果最终纳入3个RCT和5个q-RCT,共2732位研究对象。质量评价结果表明,8个研究的总体质量水平不高。由于纳人研究间的同质性较差,本研究仅采用描述性分析。评价结果显示,与传统教学法相比,应用模拟人可提高学生专业知识水平、护理操作技能,培养学生的临床胜任能力、知识的综合运用、团队合作等多项能力。结论应用高仿真模拟人进行护理教学是一种深受学生欢迎的教学模式,但由于有关高仿真模拟人在护理教学中应用的RCT尚少,纳入研究的教学方法和考核标准差异较大,上述结论尚需开展更多高质量的研究予以验证。     

虚拟现实技术在护理教学中应用效果的Meta分析

目的系统评价虚拟现实技术在护理专业学生教学中的应用效果。方法计算机检索PubMed、Embase、Web of Science、CINAHL、Cochrane Library、知网数据库、万方数据库和维普数据库,收集建库至2020年11月的虚拟现实技术用于护理专业学生教学的随机对照试验研究,采用Cochrane评价手册中提供的随机对照试验研究质量评价标准对纳入文献质量进行评价。采用Stata 13.0软件进行Meta分析。结果共纳入9项随机对照试验,包括638名学生。Meta分析结果显示,与其他或传统护理教学方法相比,虚拟现实技术可更好提高护理专业学生的理论知识水平[SMD=0.51,95%CI(0.31,0.70),P0.05],但在改善护理教学实践技能水平[SMD=0.15,95%CI(-0.21,0.51),P=0.42]和满意度[SMD=0.01,95%CI(-0.81,0.82),P=0.99]方面无明显效果。结论与其他或传统护理教学方法相比,虚拟现实技术可更好提高护理专业学生理论知识水平,但虚拟现实技术在提高护理教学实践技能水平和满意度方面无明显优势。     

高仿真模拟教学在护理本科教学中的应用及效果

目的探讨高仿真模拟教学在护理本科教学中的应用及效果。方法采用方便取样法选取武汉市一所护理本科院校23名护理本科生进行高仿真模拟教学,采用问卷调查的方法调查学生对现有高仿真模拟教学的评价以及学生在教学后的满意度和自信心。结果学生对现有高仿真模拟教学的设计和实践评分较高,学生在模拟教学过程中的满意度和自信心处于较高水平,理论知识水平较模拟教学前有所提高(P0.01)。结论高仿真模拟教学在护理本科教学中的应用效果较好,但将其整合入护理本科教育中的方法尚有待明确。     

护理本科生实习前高仿真模拟教学实践

目的:了解护理本科生对实习前高仿真模拟教学过程及教学效果的评价。方法:选取上海市某高校大学三年级189名护理本科生为研究对象,在实习前开展高仿真模拟教学,采用模拟教学设计量表、模拟教学实践量表、学生学习满意度和自信心量表对教学过程和效果进行评价。结果:护理本科生对高仿真模拟教学设计和教学实践评价较高。学生对模拟教学有较高的学习满意度和自信心。结论:高仿真模拟教学可有效地衔接理论学习与临床实践,护理本科生对此教学方法评价较高。     

高仿真模拟教学对护理学生临床能力影响的系统评价

[目的]评价高仿真模拟(HFS)教学对护生临床能力等方面的影响。[方法]采用Cochrane系统评价方法,检索2000年—2014年CNKI、VIP、Cochrane图书馆、CINAHL、PubMed、EMBASE、PROQUEST中关于高仿真模拟教学对护生临床能力影响的随机对照试验以及类实验性研究,对纳入文献进行文献质量评价后,采用RevMan5.1软件进行数据合并与分析。[结果]共纳入12项研究,包括686名护生,其中2篇为随机对照研究,10篇为类实验性研究。Meta分析结果显示,高仿真模拟教学有助于提高护生的知识水平(SMD=0.48,95%CI为0.06~0.90,P0.01)和临床技能(SMD=0.68,95%CI为0.46~0.91,P0.01),但对评判性思维能力的培养无显著影响(SMD=-0.28,95%CI为-0.64~0.08,P0.05)。[结论]高仿真模拟教学在提高护生知识水平和临床技能上显示出优越性,尤其在知识的长期维持方面,显著高于传统教学方法,但其对护生评判性思维无明显改善作用,仍有待更多的高质量证据来证实其在护生临床能力整体水平上的确切效果。     

高仿真情景模拟教学在急救护理教学中的应用

目的:探讨高仿真情景模拟教学在急救护理教学中的应用效果。方法:采用随机数字表法将125名护理本科生随机分为实验组63名和对照组62名。实验组采用高仿真情景模拟教学法,对照组采用传统情景教学法。比较两组护生考核成绩,并采用问卷方式调查实验组对高仿真情景模拟教学设计与实施和教学效果的评价。结果:课程结束后,实验组护理理论和技能操作成绩均高于对照组(P0.01);所有护生均认为高仿真情景模拟教学有必要在急救护理和其他专业课中开展,且绝大部分护生对模拟训练中的教学设计和实施各环节表示认可,并认为通过训练有利于培养临床急救综合能力。结论:高仿真情景模拟教学可有效提高急救护理教学效果。     

临床护理路径在老年糖尿病病人中应用效果的Meta分析

[目的]评价临床护理路径在老年糖尿病病人中的应用效果。[方法]计算机检索CNKI、维普、万方等中文数据库。纳入按临床护理路径模式护理与常规护理比较的随机对照试验,按Jadad量表进行文献质量评价,而后提取有效数据并采用RevMan5.3软件对结果进行Meta分析。[结果]共纳入12个随机对照试验。Meta分析结果显示,临床护理路径组病人健康知识掌握率、满意率及依从性均高于常规护理组,空腹血糖和餐后2h血糖值低于常规护理组,且差异均有统计学意义(P0.01)。[结论]在老年糖尿病中应用临床护理路径模式可提升病人满意率、依从性及健康知识掌握率,改善病人血糖水平,效果优于常规护理。     

PBL教学法对临床护理带教有效性的Meta分析

目的 采用Meta分析评价以问题为基础的教学法(problem-based learning,PBL)对临床护理带教的效果。 方法 计算机检索国内外主要医学数据库中有关PBL教学的干预性研究。由2名研究者对文献的质量进行严格评价后采用RevMan 5.3软件进行数据分析。 结果 共纳入12篇文献。Meta分析结果显示:PBL教学法在提高护理专业实习生的理论、操作技能及评判性思维能力方面好于传统教学法。 结论 PBL教学法应用于临床护理带教的效果好于传统教学法。但因纳入文献的研究质量不高,未来有必要开展大样本高质量的随机对照试验进一步验证。     

CBL教学法在护理成人教育中应用效果的Meta分析

目的:探讨基于案例的教学法(CBL)在护理成人教育中应用效果的Meta分析。方法:采用计算机检索和手工检索,全面搜集国内外关于CBL教学法在护理成人教育中运用的随机对照试验(RCT),按Cochrane系统评价方法,选择试验、评价质量。结果:共纳入10项研究,分别有9项RCT探讨了案例教学法对学习成绩的影响,其中有8项研究结果显示CBL教学法可提高护理成人教育学生的学习成绩,10项研究显示均能提高学生各方面的业务能力。结论:CBL教学法是护理成人教育的有效教学措施,有助于提高学生的理论知识和技能水平、业务能力及学生满意度。     

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."