全程导师联合目标反馈法提高手术室新入职护士胜任力效果观察

目的:探讨全程导师制联合目标反馈法提高手术室新入职护士胜任力的效果。方法:选取2013年1月~2014年12月33名手术室新入职护士为对照组,采用传统带教模式进行培训;选取2015年1月~2016年12月36名手术室新入职护士作为观察组,采用全程导师制联合目标反馈法的培训方法。结果:两组手术室新入职护士在安全管理、专科理论与操作、围术期管理、消毒隔离管理、仪器设备管理及护理文书等方面比较差异有统计学意义(P0.01);手术医生、麻醉医生及手术室患者对两组满意度比较差异有统计学意义(P0.05)。结论:全程导师联合目标反馈法可提高手术室新入职护士胜任力及医生和患者的满意度,是培训手术室新入职护士的重要方法。     

症状护理课程在新入职护士规范化培训中的应用效果评价

目的探讨症状护理课程在新入职护士规范化培训中的应用效果。方法选取2013年7月至2014年6月护士规范化培训基地78名新入职护士为对照组,采用传统课程培训。选取2014年7月至2015年6月规范化培训基地79名新入职护士为观察组,采用症状护理课程培训。培训结束后,采用理论考试及客观结构化临床考试成绩评价教学效果;采用教学质量调查问卷评价教学质量。结果观察组客观结构化临床考试成绩和教学质量满意度评价得分均高于对照组,差异有统计学意义(P0.01或P0.05)。结论症状护理课程使护理培训临床化,同时提高教学质量,提升新入职护士综合素质。     

新入职护士实施医学慕课教学效果观察

目的：探讨对新入职护士实施医学慕课教学的效果。方法：选取2018年新入职护士76名作为观察组,实施医学慕课规范化培训;2017年新入职护士79名作为对照组,实施传统的规范化培训,比较两组规范化培训参与率、规范化培训时长、规范化培训考核情况、规范化培训与考核方式的满意率以及规范化培训模式教学效果的评价。结果：新入职护士规范化培训参与率两组均为100.00%,观察组新入职护士规范化培训时长短于对照组,差异有统计学意义（P＜0.01）;观察组理论、操作考核成绩优秀率、良好率均优于对照组,差异有统计学意义（P＜0.01）;观察组新入职护士规范化培训与考核方式的满意度及总满意率及对规范化培训模式教学评价各项指标满意率均优于对照组,差异有统计学意义（P＜0.05）。结论：新入职护士实施医学慕课教学,有效提高新入职护士规范化培训效果,提高临床教师的教学水平和教学质量。     

规范化培训提高新入职护士核心能力的效果评价

目的探讨规范化培训对提高低年资护士核心能力的效果,为完善规范化培训方案提供依据。方法选取2011年至2012年168名新入职护士为对照组,采用传统低年资护士培训方案;选取2013年至2014年185名新入职护士为观察组,采用规范化培训方案,包括组建专项培训队伍,制订新护士分层培训计划及考核要求,实施岗前培训和临床轮转培训模式,应用现场培训与在线学习相结合的培训方法。培训结束后,比较两组新入职护士核心能力得分情况及满意度。结果观察组新入职护士在临床核心能力得分及对培训内容、定科方案、培训形式、考核方案的满意度均高于对照组,两组比较差异有统计学意义(P0.05)。结论规范化培训对提升护士核心能力具有显著作用,护理人员对规范化培训的满意度较高。护理管理者需要进一步科学设计培训内容和方案,重视低年资护士培训需求,保障规范化培训效果。     

新入职护士规范化培训实践与评价

目的：探讨新入职护士规范化培训的方法和内容,以提高培训效果、护理技能、满足临床护理工作需求。方法：采用目的抽样法,选取武汉协和医院224名新入职护士为研究对象。将2016年111名新入职护士设为对照组,采用传统新护士培训方案;2017年113名新入职护士设为观察组,根据《大纲》要求,重新制定新入职护士培训方案,培训后采用临床实境考核进行综合测评。结果：根据《大纲》重新制定的培训方案,观察组临床实境考核效果优于对照组（P＜0.05）。结论：重新制定的规范化培训方案提高了新护士的业务能力和水平,提高新护士岗位胜任力。     

"学姐妹"带教模式在新入职护士人文关怀能力培训中的应用研究

目的探讨"学姐妹"带教模式在新入职护士人文关怀能力培训中的应用及效果评价。方法选取2015年至2016年93名新入职护士为对照组,2017年至2018年92名新入职护士为观察组,对照组沿用传统导师制模式进行带教培训,观察组采用"学姐妹"带教模式,包括组建培训师资和"学姐妹"带教团队、制订培训体系、实施培训方案。培训结束后,比较两组新入职护士的理论成绩、操作技能成绩、临床护理能力及人文关怀品质。结果观察组新入职护士的理论成绩、操作技能成绩、临床护理能力及人文关怀品质得分均高于对照组,差异具有统计学意义(P0.01)。结论通过"学姐妹"带教模式在新入职护士规范化培训中的实施,不仅提高了新入职护士的临床护理能力和人文关怀品质,而且对稳定护理队伍、提升团队协作有积极的促进作用,为新入职护士的培训模式提供了借鉴,值得护理管理者关注和探索。     

新入职护士岗前规范化培训需求调查

目的:了解新入职护士岗前规范化培训需求,为制定科学可行的新入职护士规范化岗前培训方案提供参考依据。方法:采用自制新入职护士岗前规范化培训需求问卷,调查分析87名新入职护士对岗前规范化培训的需求。结果：87名新入职护士总的希望接受岗前规范化培训需求程度平均得分是(4.57±0.28)分;新入职护士的不同年龄、性别、学历、实习单位、实习单位等级、入职时间岗前规范化培训需求存在差异（P＜0.05或P＜0.01）;新入职护士总的培训时长需求最高4~5周,得分(4.77±0.34)分;基本理论知识需求最高是沟通技巧,得分(4.73±0.39)分;常见的护理技术操作需求最高是心肺复苏,得分(4.79±0.35)分,培训方式需求最高是线上学习,得分(4.78±0.37)分;考核方式理论考核需求最高是线上答题,得分(4.75±0.33)分、护理技术操作考核需求最高是情景模拟,得分(4.74±0.32)分。结论：新入职护士希望接受岗前规范化培训需求程度较高,希望接受岗前规范化培训总时长、培训内容、培训及考核方式上偏重于短期、信息化、多元化的培训需求,护理管理者应针对不同新入职护士的需求进行针对性培训,完善新入职护士规范化培训内容,提高护理质量。     

青海省新入职护士培训方案的设计与实施

目的设计并实施青海省新入职护士培训方案,评价其对新入职护士基本能力及核心能力的影响。方法便利选取青海省人民医院、西宁市第一人民医院、西宁市第二人民医院2016年8月130名新入职护士作为研究对象。组建专家团队、制订培训方案、遴选师资,对新入职护士进行为期2年的培训。结果新入职护士基本能力、核心能力总分及各单项能力得分在培训前及培训后4个阶段比较,差异均具有统计学意义(P<0.05);理论与操作成绩较培训前有提高(P<0.05)。结论青海省新入职护士培训方案的实施可以提高新入职护士基本能力及核心能力。     

微信教学模式联合思维导图对手术室新入职护士综合素养的影响

目的探讨微信教学模式联合思维导图对手术室新入职护士综合素养的影响。方法选取2018年1月至2019年10月40名医院手术室新入职护士作为观察对象,随机等分为观察组和对照组。对照组采取常规培训模式,观察组予以微信教学模式联合思维导图培训。比较两组手术室新入职护士在培训结束时的综合能力、自我导向能力评分。结果培训后,观察组新入职护士工作主动性、应急反应能力、协作沟通能力、学习能力明显高于对照组,差异有统计学意义(P 0.05),学习意识、学习行为、学习策略、学习评价、人际关系技能等自我导向能力各维度及总评分明显高于对照组,差异有统计学意义(P 0.05)。结论微信教学模式联合思维导图可操作度高、灵活性好,不仅能确保新入职护士的学习能力,还可提高手术室新入职护士的综合能力,值得临床推广应用。     

新入职护士中应用情景化职业防护培训的效果观察

目的观察在新入职护士中应用情景化职业防护培训的效果。方法选取2016年1月至2017年5月本院80名新入职护士作为研究对象,将2016年1月至2016年8月40名新入职护士作为参照组,给予常规防护培训。将2016年9月至2017年5月40名新入职护士作为研究组,给予情景化职业防护培训。比较两组新入职护士的防护培训效果。结果入职1年后,研究组护士理论知识考试得分和实践操作考试得分均显著高于参照组,差异均有统计学意义(P0.05);入职1年期间,研究组护士伤口处理正确率以及后续处理正确率均显著高于参照组,而锐器伤发生率显著低于参照组,差异均有统计学意义(P0.05)。结论新入职护士实施科学有效的情景化职业防护培训方案,能够良好地增强防护技能,降低职业伤害风险,值得临床重视。     

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.     

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.     

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.     

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.