有声思维在护理本科生临床见习中的应用

[目的]探讨有声思维在本科护生见习教学中的应用效果。[方法]随机将116名护生分为观察组与对照组,各58人。对照组见习采用传统教学方法,观察组实施有声思维法教学。[结果]观察组考试成绩总分、简答题及病例分析题得分高于对照组(P0.01)。[结论]有声思维法是一种有效的教学方法,有利于提高护生的学习效果和综合能力。     

CDIO模式应用于护生内科护理学临床见习教学的效果

目的 :将CDIO教学模式应用于内科护理学临床见习中,分析其对护生批判性思维能力和临床沟通能力的影响。方法 :选取大连市某大学2012级本科护理学专业护生为研究对象,采用方便抽样法选取一个班30名护生为对照组,另一个班30名护生为试验组。对照组采用传统见习方法,试验组在见习中应用CDIO教学模式。临床见习前和见习结束时采用批判性思维能力测量表和临床沟通能力测量表对两组护生进行评价。结果 :试验组护生的批判性思维能力总分及寻找真相、开放思想、系统化能力、批判思维信心、求知欲、认知成熟度6个维度得分高于对照组(P0.05)。试验组护生的临床沟通能力总分及建立和谐关系、确认患者问题、共同参与、传递有效信息4个维度得分高于对照组(P0.05)。结论 :CDIO教学模式能提高护生批判性思维能力和临床沟通能力。     

“三明治”教学模式在《内科护理学》临床见习中的应用研究

目的观察应用"三明治"教学模式在《内科护理学》临床见习中对护生批判性思维能力、护患沟通能力的影响及教学的效果。方法选取某大学2014级护理本科生为研究对象,采用便利抽样法,1班(33人)为对照组,2班(35人)为观察组。对照组采用传统临床见习教学方法,观察组在临床见习中应用"三明治"教学模式。见习结束时采用批判性思维能力测量表、护患沟通能力量表、教学效果评价表对两组护生进行测评。结果观察组护生的批判性思维能力总分及寻找真相、开放思想、分析能力、系统化能力、批判思维的自信心、求知欲6个维度得分高于对照组,观察组护生的护患沟通能力总分及基本语言沟通能力、基本非语言沟通能力、协调沟通网络能力3个维度得分高于对照组,观察组护生的课堂教学、学习促进、能力提高得分高于对照组,比较差异均有统计学意义(P0.05)。结论 "三明治"教学模式能提高护生批判性思维能力和临床沟通能力,有助于提升《内科护理学》临床见习教学效果。     

基于规范化课间见习的翻转教学在《内科护理学》中的应用效果研究

[目的]探讨基于规范化课间见习的翻转教学在《内科护理学》中的应用效果。[方法]将133名本科护生按所在教学班级随机分为对照组66人和观察组67人,对照组护生接受规范化课间见习和传统授课模式,观察组护生进行基于规范化课间见习的翻转教学,比较干预后两组护生评判性思维倾向的变化。[结果]干预后观察组护生较对照组在寻求真相、分析能力、系统化能力、评判性思维自信心、求知欲、认知成熟度方面分值增加,差异均有统计学意义(P0.05),在开放思想方面分值增加的差异无统计学意义(P0.05)。[结论]基于规范化课间见习的翻转教学可提高本科护生的评判性思维能力。     

以团队为基础教学模式在本科护生临床见习中的应用效果

目的：探讨以团队为基础教学模式在本科护生临床见习中的应用效果。方法选择某医科大学65名本科护生为研究对象,以班级为单位,将1班33名本科护生作为对照组,将2班32名本科护生作为观察组。对照组给予传统临床见习教学模式,观察组给予以团队为基础见习教学模式。评价观察组本科护生对以团队为基础见习教学模式效果,并观察比较2组本科护生临床见习理论成绩及教学满意度。结果评价以团队为基础见习教学模式,观察组认同率较高的是能够提高团队意识（97%）、能够促进知识理解和掌握（97%）;观察组临床见习理论成绩高于对照组（P<0.05）;观察组在教学方法、教师表现、教学环境方面的满意度高于对照组,差异具有统计学意义（P<0.05）。结论本科护生临床见习采用以团队为基础教学模式,应用效果良好,提高本科护生临床见习理论成绩,教学满意度也较高,值得在临床教学中推广使用。     

儿科护理见习应用模拟教学法对培养本科护生人际沟通能力的影响

[目的]探讨儿科护理见习中应用模拟教学法对培养本科护生人际沟通能力的影响.[方法]抽取2008级本科护理学生180人,随机分为试验组和对照组.对照组采用传统见习法,对典型病例,老师带学生到患儿床边见习,对临床缺乏病例,则观看教学录像;试验组见习课中部分教学内容采用模拟教学法,对典型病例,老师带学生到床边见习,对临床缺乏病例及不典型病例则采用模拟教学法.见习前、后应用护生临床沟通能力量表进行评价,并在见习结束后对两组本科护生见习授课满意度进行评价.[结果]两组本科护生见习前、后人际沟通能力得分差异有统计学意义（P＜0.05）;见习结束后试验组本科护生对见习授课满意度评分高于对照组（P＜0.01）.[结论]儿科护理见习中应用模拟教学法可提高本科护生的人际沟通能力及对见习授课的满意度.     

Seminar教学法结合案例情境见习模式对护生护理胜任力的影响

[目的]探讨Seminar教学法结合案例情境见习模式在护生临床见习中的应用,了解其对护生护理胜任力的影响。[方法]选取2013年进入我院外科进行护理学临床见习的本科护生122人,将其分为试验组(59人)与对照组(63人)。对照组采用常规教学方法;试验组采用Seminar教学法结合案例情境见习模式完成见习计划。见习结束后采用见习质量评价表了解两组护生对不同见习方式的评价,同时采用护理标准化病例对两组护生进行护理综合能力考核。[结果]试验组护生对见习教学形式、促进临床思维、培养应用能力、提高沟通能力、增强团队合作、促进知识理解与掌握6个条目的评价显著优于对照组(P0.01),且试验组护理综合能力考核成绩也显著优于对照组(P0.05)。[结论]Seminar教学法结合案例情境教学法有助于提高护理临床见习教学效果,提高学生的护理职业胜任力。     

综合干预对儿科家属配合见习意愿及护生实习满意度的影响

目的:探讨综合干预对儿科家属配合见习意愿及护生实习满意度的影响。方法:将80名配合见习教学的患儿家属随机分为实验组1和对照组1各40名,5名本科护生见习1例患儿,实验组2和对照组2参与见习的本科护生各200名,对照组1按常规配合见习教学,干预组1在对照组1基础上进行综合干预,比较干预效果。结果:两组家属干预后配合意愿评分及护生见习效果满意度评分比较差异有统计学意义(P0.05)。结论:综合干预能提高儿科家属配合见习意愿及护生实习满意度。     

同理心地图联合情景教学在本科护生“护士人文修养”护患沟通教学中的应用

目的 探讨同理心地图联合情景教学在本科护生护患沟通教学中的应用效果。方法 选取2021年9-12月，某高校大二本科护生190名，采用便利抽样法，将护理本科一班（92名）设为对照组，采取常规教学法；护理本科二班（98名）设为观察组，采取同理心地图联合情景教学。护患沟通教学前及结束后，采取共情量表和临床沟通能力测评量表进行调查，比较2组护生的共情能力和临床沟通能力。结果 观察组护生应用同理心地图联合情景教学后，护患沟通的共情能力和临床沟通能力上，均明显优于对照组（P<0.01)。结论 将同理心地图联合情景教学融入护理本科生护患沟通教学中，有利于提升护生临床沟通能力，也有助于护生共情能力的培养。     

Seminar教学法结合案例情境见习模式对护生护理胜任力的影响

[目的]探讨 Seminar教学法结合案例情境见习模式在护生临床见习中的应用,了解其对护生护理胜任力的影响。[方法]选取2013年进入我院外科进行护理学临床见习的本科护生122人,将其分为试验组（59人）与对照组（63人）。对照组采用常规教学方法;试验组采用 Seminar教学法结合案例情境见习模式完成见习计划。见习结束后采用见习质量评价表了解两组护生对不同见习方式的评价,同时采用护理标准化病例对两组护生进行护理综合能力考核。[结果]试验组护生对见习教学形式、促进临床思维、培养应用能力、提高沟通能力、增强团队合作、促进知识理解与掌握6个条目的评价显著优于对照组（P〈0.01）,且试验组护理综合能力考核成绩也显著优于对照组（P〈0.05）。[结论]Seminar教学法结合案例情境教学法有助于提高护理临床见习教学效果,提高学生的护理职业胜任力。     

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.     

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.     

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.     

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.