护理专业教师批判性思维能力调查研究

[目的]研究高校护理专业教师批判性思维的能力倾向,找出差距,为师资培训课程提供依据。[方法]采用一般情况问卷及香港理工大学中文版加利福尼亚批判性思维倾向量表(CTDI-CV)对某高校护理学院86名教师集中进行问卷调查和CTDI-CV测量。[结果]护理教师CTDI-CV测量结果中总分最低分为248分,最高分为386分;不同年龄、职称和工作压力的护理教师CTDI-CV中文版特质测量结果比较有统计学意义。[结论]高校护理教师具有较强的批判性思维倾向,但是开放思想等特质还需进一步提高;低年资教师及学院教师的系统化特质等还需进一步提高。     

外科护士批判性思维能力与自主学习能力的调查分析

目的 了解外科护士的批判性思维能力与自主学习能力,为护理管理者提高外科护士批判性思维能力与自主学习能力提供理论依据.方法 采用中文版批判性思维意向问卷(CCTDI)和护理人员自主学习能力评价量表,对3所医院的200名外科护士进行问卷调查.结果 外科护士批判性思维得分为(282.41±19.87)分,拥有正性批判性思维;自主学习能力得分为(131.65±10.29)分,总体得分水平较高.结论 护理管理者应重视对外科护士批判性思维能力和自主学习能力的培养,提高护理人员的自身素质.     

外科护士批判性思维能力与自主学习能力的调查分析

目的 了解外科护士的批判性思维能力与自主学习能力,为护理管理者提高外科护士批判性思维能力与自主学习能力提供理论依据.方法 采用中文版批判性思维意向问卷（CCTDI）和护理人员自主学习能力评价量表,对3所医院的200名外科护士进行问卷调查.结果 外科护士批判性思维得分为（282.41±19.87）分,拥有正性批判性思维;自主学习能力得分为（131.65±10.29）分,总体得分水平较高.结论 护理管理者应重视对外科护士批判性思维能力和自主学习能力的培养,提高护理人员的自身素质.     

N2级儿科护士批判性思维特质的相关性研究

[目的]调查分析N2级儿科护士批判性思维的特质现状及影响因素,为提高儿科临床护士批判性思维能力提供参考依据。[方法]采用彭美慈等翻译修订的批判性思维能力(中文版)测量表(CTDI-CV)对196名N2级儿科护士进行问卷调查。[结果]回收有效问卷189份,有效率为96.43%。189名N2级护士的CTDI-CV总分无一人超过350分,且有183名(96.83%)N2级护士低于280分,得分为248.30分±19.22分。在7个特质中,得分从高到低依次为认知成熟度、寻找真相、开放思想、系统化能力、分析能力、求知欲、批判性思维的自信心,其中仅有寻找真相和认知成熟度2个特质平均分达到最低认可分40分,且仅有认知成熟度、寻找真相、开放思想3个特质中有护士得分超过50分,分别占7.41%、3.7%和0.53%。人口学资料中除学历外不同职称、工作年限、年龄的护士的批判性思维总分或部分特质得分比较差异具有统计学意义。[结果]189名N2级护士总体批判性思维能力较低,还须进一步加强培养,尤其是系统化能力、分析能力、求知欲、批判性思维的自信心4个特质。     

儿科护理教学中护生评判性思维能力调查与分析

目的:调查儿科护理教学中护生批判性思维能力现状,分析其影响因素。方法:采用一般情况调查表和中文版批判性思维意向问卷(CCTDI),对我校2009级、2010级护理大专参与儿科教学的在读学生182名进行问卷调查。结果:参与儿科教学的护生批判性思维得分为(267.34±18.41)分,拥有正性批判性思维;学校因素、个人因素、父母文化程度与护生的批判性思维能力呈正相关(P<0.05)。结论:儿科护理教育者应重视对护生批判性思维能力的培养,提高护理人员的自身素质。     

康复专业大专生批判性思维能力调查

目的了解康复专业大专生的批判性思维能力现状,为康复专业教学改革提供依据。方法采用美国加利福尼亚批判性思维态度倾向测试表中文修订版(CCDI-CV),对康复专业大专二年级学生进行问卷调查。结果康复专业大专生的批判性思维能力总平均分为(238.98±19.78)分,其中认知成熟度(28.29±4.78)分,为负性特质表现。结论康复专业大专生的批判性思维能力得分为特质意义不明确,康复专业教育过程中应改革传统医学教育模式。     

中美合作教学班与普通班护生批判性思维能力的比较研究

[目的]比较中美合作教学班与普通班护生批判性思维能力的差异,探讨我校护理课程设置、护理教学和掌握双语程度与批判性思维能力的关系.[方法]普通班护生246名,中美合作教学班护生251名.采用中文版批判性思维能力测量表(CTDI-CV)对497名护生进行问卷调查.[结果]497名护生批判性思维能力CTDI-CV总分284.69分±29.31分,为正性水平;中美合作教学班护生CTDI-CV总分达到正性水平(291.90分±29.69分),普通班护生CTDI-CV总分处于正负临界水平(277.33分±27.06分),两组比较差异有统计学意义(P＜0.05);一年级、二年级中美合作教学班与普通班护生正性批判性思维比较差异有统计学意义(P＜0.05),三年级两班护生比较差异无统计学意义(P＞0.05).[结论]中美合作教学班与普通班护生批判性思维能力存在差异,可能与课程设置、教学方式和掌握双语的程度有关.     

我院护理管理者批判性思维能力的调查分析

[目的]调查护理管理者批判性思维能力的现状及特征,为护理管理者的批判性思维能力的培养提供参考依据。[方法]采用批判性思维能力测量表(CTDI-CV)对97名护理管理者进行测试。[结果]护理管理者的批判性思维能力总分与护士相比差异无统计学意义(P>0.05);护理管理者除寻找真相的得分低于最低认可分40分外,其他特质得分都大于40分,得分较高的为求知欲、分析能力、批判性思维的自信心。[结论]护理管理者总体具有正性批判性思维能力,但离批判性思维能力强的要求还有差距。应通过针对性的培训,提高护理管理者的批判性思维能力。     

批判性思维能力与学习风格的相关性研究

[目的]探讨学习风格与批判性思维能力的相关性.[方法]采用中文版批判性思维能力测量表(CTDI-CV)和学习风格量表(LSI)对497名护理专业大专学生进行批判性思维能力和学习风格评价,并对结果进行相关分析.[结果]497名护理大专生中发散型学习风格229名(46.1%),同化型131名(26.4%),顺应型90名(18.1%),集中型47名(9.5%).CTDI-CV中7个特质与LSI中具体经验、沉思观察、抽象概括具有相关性.4种学习风格学生的CTDI-CV得分差异有统计学意义,同化型(296.08分±29.46分)和集中型(295.72分±30.98分)学习风格者的CTDI-CV得分高于发散型(277.93分±27.21分)和顺应型(279.52分±26.99分).[结论]护理大专生的学习风格以发散型居多,其批判性思维能力的寻求真相、系统化能力、自信心方面较弱,提示教师应将批判性思维能力培养有意识地融入课程教学目标中.     

临床实习对医护本科生批判性思维的影响

[目的]探讨临床实习对医疗护理本科学生批判性思维能力的影响。[方法]应用中文版的批判性思维问卷(CCTDI)对我校150名99级医疗和护理本科学生分别于实习前后进行调查。[结果]医护本科生实习前后CCTDI总分均>280分;实习后CCTDI总分均低于实习前(P<0.001),除寻找真相和自信心外,其他5个分量表的得分低于实习前(P<0.01);寻找真相在实习前后得分均<40分。实习后,医疗本科学生除寻找真相与自信心没有变化外,求知欲、系统化能力、分析能力、开放思想及认知成熟度均下降(P<0.05);而护理本科学生实习后仅认知成熟度较实习前下降(P<0.05)。[结论]实习后医护本科生批判性思维能力下降。医学院校及医院的领导应加强实践教学管理,加强师资队伍建设,提高教学质量,尤其重视医学生和护生批判性思维能力的培养。     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.