《循证护理学》混合模式教学与课堂教学效果的研究

[目的]比较基于线上教学与翻转课堂相结合的混合模式教学与课堂教学在护理研究生中开展《循证护理学》的教学效果。[方法]选取2014年9月—2015年1月在复旦大学参加《循证护理学》课堂教学的全日制研究生和研究生课堂班80名学生作为对照组,以同期参加混合模式教学且来自CMB资助的8所高校的全日制护理研究生24名作为观察组。教材、授课内容、教学团队及考核方式均一致。[结果]在课程后对照组和观察组学生对循证护理知识的掌握评分均显著增加;对照组学生对循证护理价值的态度更为积极,但对学习循证护理的期望评分显著下降;观察组学生的态度得分和期望得分无显著变化。协方差分析表明,在排除基线不均衡的影响下,混合模式教学比课堂教学能够提高学生对循证护理的知识、态度、期望达成及能力自评评分。[结论]混合模式教学能够有效促进教育资源的共享,提高教学质量和促进学生自主学习。     

第二期护理学博士研究生核心课程混合模式教学圆满完成

<正>2016年7月22日,第二期护理学博士研究生核心课程——高级质性研究、护理哲学与理论构建和高级循证护理3门核心课程的混合模式教学圆满完成。在完成为期4个月的在线学习后,7月6日—7月22日,来自复旦大学、北京大学、北京协和医学院、西安交通大学、四川大学、中南大学、中国医科大学及中山大学的8所护理院校共28名护理学博士研究生,在复旦大学护理学院完成了为期3周的翻转课堂的学习。     

我国护理学博士核心课程的设置及混合式教学模式的构建

[目的]探索我国护理学博士核心课程的设置及课程混合式教学模式的构建与设计。[方法]邀请美国中华医学基金会(CMB)院校资深护理领域专家参与两次主题项目讨论会,根据讨论提纲,共同探讨适合我国现阶段护理发展状况的护理学博士核心课程,以及在校际间对核心课程进行混合式教学模式的构建方案。[结果]共确立了3门护理学博士研究生核心课程:护理哲理和理论构建、高级质性研究和高级循证护理。校际间开展护理学博士核心课程的混合式教学模式主要由两个教学环节构成:在线教学和翻转课堂,并构建与设计了3门课程线上教学内容、教学形式、教学评价、在线平台以及翻转课堂的教学内容、教学形式和教学评价。[结论]构建了我国护理学博士核心课程及混合式教学模式,以提高我国护理学博士研究生教育的综合水平。     

我国护理学博士核心课程的设置及混合式教学模式的构建

[目的]探索我国护理学博士核心课程的设置及课程混合式教学模式的构建与设计。[方法]邀请美国中华医学基金会(CMB)院校资深护理领域专家参与两次主题项目讨论会,根据讨论提纲,共同探讨适合我国现阶段护理发展状况的护理学博士核心课程,以及在校际间对核心课程进行混合式教学模式的构建方案。[结果]共确立了3门护理学博士研究生核心课程:护理哲理和理论构建、高级质性研究和高级循证护理。校际间开展护理学博士核心课程的混合式教学模式主要由两个教学环节构成:在线教学和翻转课堂,并构建与设计了3门课程线上教学内容、教学形式、教学评价、在线平台以及翻转课堂的教学内容、教学形式和教学评价。[结论]构建了我国护理学博士核心课程及混合式教学模式,以提高我国护理学博士研究生教育的综合水平。     

护理哲学与理论构建博士课程的设置与实施效果

目的构建护理学博士护理哲学与理论构建课程内容与混合式教学模式,评价该课程的实施效果。方法由2所护理学院教师组成核心课程团队,通过研讨形成课程内容及混合式教学模式方案并在8所院校实施,采用自制问卷了解学生对课程的评价和学习效果。结果自2015年3月—2018年1月共实施4期课程教学,102名学生参与线上及翻转课堂的课程学习并填写问卷。82.4%(84/102)的学生认为开设护理哲学课程非常有必要,88.2%(90/102)的学生认为开设护理理论构建课程非常有必要。4期学员对课程学习内容大部分掌握或完全掌握的比例为44.1%～89.2%。结论该课程促进了研究生对护理以及护理哲学与护理实践的理解,采用混合式教学模式可以达到教学资源的共享,并促进我国护理院校博士研究生教育的合作。     

护理博士核心课程混合式教学模式的实践效果研究

目的评价3门护理博士核心课程混合式教学模式在中华医学基金会中国护理网8所院校的实施效果。方法采用自制问卷描述记录3门护理博士核心课程混合式教学模式的2轮实施情况和8所院校护理研究生的参与情况,以及参与学习的研究生对每门护理博士核心课程线上课程、翻转课堂以及混合式教育模式的评价与反馈。结果共有35名研究生(26名博士研究生,9名硕士研究生)参加了第1轮的课程学习,28名博士研究生参加了第2轮的课程学习。研究生一致认为3门护理博士核心课程的内容科学、资源丰富,组织形式合理,评价方式综合全面,在线平台易操作,翻转课堂的内容具有整合性,提高了对课程的深入理解,时间和生活安排较为合理,师生间和学生间的互动和交流非常深入。总体上认为3门课程的混合式教学模式提高了护理研究生的综合学术能力。此外,研究生对3门课程的进一步开展也提出了建议。结论护理博士核心课程混合式教学模式的2轮教学实践促进了校际护理博士核心课程体系的共建,培养了护理研究生的综合学术能力。     

本科护生在内科护理学翻转课堂中的学习体验

目的 了解护理本科生对内科护理学翻转课堂的教学体验,探讨该教学模式对本科护理教学的意义.方法 采用质性研究的诠释现象学方法,对21名参与了内科护理学翻转课堂学习的本科护生进行一对一访谈,以Colaizzi 7步分析法对资料进行分析,提炼出主题.结果 受访学生的体验可归纳为促进学习和负面的学习体验两个主题.促进学习的体验主要有激发学习兴趣、促进自学、提高学习效果和锻炼护理思维能力4个方面,负面学习体验主要有不太适应翻转课堂学习模式、课外学习压力较大、课堂时间不足和课堂评价不公平4个方面.结论 内科护理学翻转课堂是有益的教学尝试,但教师应根据课程特点合理设计,扬长避短,使更多学生在翻转课堂学习中获益.     

构建循证护理教学体系的探索

[目的]把循证护理引入护理教学中,构建以培养护生循证能力和循证思维的循证护理教学体系。[方法]根据课程开发理论和技术对护理专业课程进行整合,构建循证护理教学体系,将我校2010级100名专科护生从入校开始随机分为实验组和对照组各50人,实验组按照循证护理教学体系进行教学,对照组按照传统教学体系进行教学。两年教学期结束时,通过客观成绩比较和问卷调查,了解循证护理教学体系的效果。[结果]实验组成绩明显高于对照组,在循证能力和评判性思维能力方面也明显优于对照组。[结论]循证护理教学能够提高护生学习成绩及评判性思维能力。     

基于小规模限制性在线课程的混合学习模式在护理研究课程中的应用与效果评价

[目的]探讨基于小规模限制性在线课程(SPOC)的混合学习模式在护理研究课程中可行性及应用效果,为混合学习模式在其他护理课程中的应用提供实践依据。[方法]选择某医学院2016级127名全日制护理本科生作为试验组,在护理研究课程中采用以"SPOC"为基础的混合学习模式,主要形式为SPOC+翻转课堂学习。对照组为2015级127名全日制护理本科生,在护理研究课程中使用多媒体授课+合作学习模式,以小组为单位进行综述、开题报告等汇报讨论。在课程结束后采用批判性思维能力测量表(CTDI-CV)、大学生课程体验调查问卷(CEQ)中的"优质教学"与"课程整体满意度"2个维度评价两组学生评判性思维能力、优质教学及课程满意度的差异。[结果]试验组评判性思维能力、优质教学评分高于对照组(P<0.05)。[结论]在护理研究课程运用基于"SPOC"的混合学习模式可提高护理本科生的评判性思维能力,促进优质教学。     

护理博士高级质性研究课程的建设

目的建设护理博士高级质性研究课程并评价教学效果。方法构建护理学博士核心课程高级质性研究,以8所院校护理学博士研究生作为教学对象,以混合式教学作为主要教学方式,从学生线上参与情况、课程成绩、学生对课程的评价、总结与反思4个方面对课程进行教学评价。结果 3期学生课程访问次数分别为2 274次、2 679次、1 776次;参与讨论发文402次、428次、524次。学生课程平均成绩为78分、74分、79分。大部分学生对本课程给予较高评价,认为高级质性研究课程对学生质性研究学习及实践训练有极强的帮助,提高了学生对质性研究的评判能力以及实际应用能力。结论高级质性研究课程在国内率先启动和实施了护理质性研究课程教学及实践训练,弥补了国内各院校护理博士研究生课程设置自主性较大、缺乏统一标准的不足。不仅激发了学生学习的主动性,提高了学习的兴趣,还能引发学生深入思考,加深对质性研究的理解,提升教学质量。     

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.     

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.     

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.     

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.