临床护理路径在手术室实习带教中的应用与效果

目的探讨临床护理教学路径在手术室实习带教中的应用效果。方法将2010年5月-2011年1月在手术室实习的60名护理实习生（护生）分为对照组和试验组,对照组采用传统方法带教,试验组采用临床护理教学路径带教。结果试验组护生的理论、操作技能考试成绩明显优于对照组,其对带教老师的满意度也较对照组高（P〈0．05）。结论采用临床护理教学路径予以带教,不仅提高了整体带教能力,使护理带教质量得以持续改进,而且护生的理论知识和操作技能获得全面提升。     

责任制护理对护理本科实习生临床决策能力的影响

目的：分析责任制护理对护理本科实习生临床决策能力的影响。方法将在我院实习7个月的护理本科生84人随机分成试验组和对照组各42人,试验组采用责任制护理教学法,由护生主管床位,负责患者从入院至出院全过程的护理服务,要求在带教老师指导下独立完成护理查房工作。对照组采用传统的带教模式,护生跟着带教老师做日常护理工作,不具体负责分管床位。评价两组护生的临床决策能力和患者对护生的评价。结果试验组护生临床决策能力和患者对护生的评价优于对照组（ P〈0.05）。结论采用责任制护理教学法能提高护理本科实习生提高临床决策能力,提高了护生的综合素质。     

导师带教模式在肝病科护生带教中的应用

目的探讨导师带教模式在肝病科护生带教中的应用效果。方法将2017年3月—2018年2月临床护理实习生98人按随机数字表法分为两组,49人为试验组,49人为对照组,对照组采用传统带教模式,试验组在传统带教方式上增加导师带教模式,比较两组护生综合能力及护生对医院临床教学评价满意度。结果试验组护生综合能力考核得分(理论考试、操作技能考试、护理查房讲课、护理病历书写)优于对照组。试验组护生对教学满意度高于对照组,差异有统计学意义(P0.05)。结论导师带教模式可以有效提高护生的临床综合能力,提高临床教学质量。     

循证护理在2型糖尿病临床护理带教中的应用

目的探讨循证护理在2型糖尿病临床护理带教中的应用。方法选取2018年1—10月在我院内分泌科学习的50名护生为研究对象,随机将其等分为对照组和试验组,对照组采用传统的一对一教学方法,试验组采用循证护理教学方法。实习结束后,考核两组护生的糖尿病理论知识及专业操作。结果试验组护生的理论知识及专业操作考核成绩均高于对照组,差异有统计学意义(P 0. 05)。结论在对内分泌科护生的带教教学中,采用循证护理路径可以有效提高护生的专业技能和临床护理带教质量。     

实习护生责任制在普外科病房带教中的应用效果观察

目的:探讨实习护生责任制在普外科病房带教中的应用效果。方法:将2011年实习中后期(进入临床实习4个月后)轮转到普外科的护生106名作为试验组,采用一对一带教,即实习护生责任制模式带教;将2010年实习中后期轮转到普外科的护生98名作为对照组,采用传统的护理带教模式。分别对两组护生的护理服务质量、职业认同感、住院患者满意度等相关资料进行收集并分析。结果:试验组护生护理服务质量、职业认同感、住院患者满意度均高于对照组(P<0.05)。结论:在临床护理带教中,实行实习护生责任制,调动了护生学习的积极主动性,增强了职业认同感,提升了患者满意度及护理服务质量。     

换位思考在临床护理带教中的应用

目的 探索换位思考应用于临床护理带教的方法及对带教质量的影响。方法 将2004年7月～2005年6月外科实习护士264名随机分为观察组和对照组各132名。带教教师38名随机分为对照组和试验组。对照组应用传统带教方法进行带教，试验组采用换位思考的方法进行带教。在护生出科时分别由带教教师对护生和护生对带教教师进行考核。结果 试验组带教教师和护生的成绩分别高于对照组带教教师和护生的成绩（P〈0．05）。结论 换位思考能增进带教教师与护生间的相互沟通与理解，调动护生的学习主动性，提高带教质量。     

PBL教学结合临床路径教学法在急诊护理本科实习生带教中的应用

目的:探讨PBL教学结合临床路径教学法在急诊护理本科实习生带教中的应用效果。方法:将2013年度和2014年度来我科实习的2010级和2011级第二军医大学护理本科生分为两组,2010级护理本科实习生25名为对照组,实施传统教学法带教,2011级护理本科实习生27名为试验组,实施PBL教学结合临床路径教学法带教,比较两组护生的理论成绩、专科技能水平及发现问题能力、分析问题能力、解决问题能力、沟通能力、求知欲。结果:两组护生在我科实习结束后的理论成绩、专科技能水平比较,试验组优于对照组,差异有统计学意义(P0.05);且试验组在发现问题、分析问题、解决问题方面的能力及对知识的求知欲等方面均优于对照组,差异有统计学意义(P0.05)。结论:实施PBL教学结合临床路径教学法对急诊护理本科实习生进行临床护理教学管理,可激发护生的求知欲,促使护生主动探索式学习,培养护生评判性思维能力,从而提高临床护理教学质量。     

基于PDP和CNP的个性化教学在临床护理带教中的应用

目的:探讨基于事业优势诊断系统(PDP)和临床护理路径(CNP)的个性化教学在临床护理带教中的应用效果。方法:将60名实习护生随机分为观察组和对照组各30名,对照组采用LBL教学,观察组采用PDP和CNP的个性化教学,比较两组带教效果。结果:观察组出科考试成绩、患者对护生的评价、带教老师对护生的评价和护生实习结束后自我评价得分均优于对照组(P0.05)。结论:基于PDP和CNP的个性化教学有助于临床实践和理论知识相结合,提高护生的学习针对性,提高学习效率,充分调动护生的学习兴趣,还能培养和提高与带教老师之间的互动性,增强护生的自我价值感。     

线上线下双向融合教学模式在骨科实习护生带教中的应用

目的 探讨线上线下双向融合教学模式在骨科实习护生带教中的应用效果。方法 选取2020年9月-2021年8月本院骨科的54例护理实习生作为对照组,2021年9月-2022年8月本院骨科的58例护理实习生作为试验组。对照组采用传统的本院教学方法,试验组采用基于智能手机线上线下双向融合教学,比较两组实习护生出科时的考核成绩和对教学的满意度。结果 试验组实习护生的理论考核成绩、操作考核成绩及满意度得分高于对照组,两组比较,差异具有统计学意义（均P<0.05）。结论 线上线下双向融合教学模式能提高骨科实习护生带教中教学质量,提高护生满意度,值得推广。     

小组合作式教学模式在儿科临床护理带教中的应用

目的探讨小组合作式教学在儿科临床护理带教中的应用效果。方法选取2015年4月～2017年4月于本院学习的140名护理实习生作为研究对象,随机分为对照组和实验组,每组各70名。实验组实行小组合作式带教模式,对照组按照传统方法进行带教。比较2组护生出科时理论考核及操作考核成绩,患者对其的护理满意度情况及护生对带教的满意度情况。结果实验组护生理论考核及操作考核等分均高于对照组,且患儿家长对护生满意度及护生对带教模式的满意度均高于对照组,差异有统计学意义(P 0. 05)。结论实行小组合作式护理带教模式,能提高护生的儿科护理临床综合技能,在儿科临床护理带教中有较好的推广意义。     

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.