护士规范化培训对提升其自主学习能力的效果评价

目的 :评价北京市属医院护士规范化培训对提升护士自主学习能力的效果,以期为规范化培训方案的修订及深入开展提供依据。方法 :选取北京市护士规范化培训试点和非试点医院各3家,采用便利抽样法,抽取2014年新入职护士,通过问卷调查法对护士自主学习能力进行评价。结果 :规范化培训一年后,护士的自主学习能力总分为(130.31±16.87)分,高于培训前的(125.21±17.82)分,也高于非试点医院护士的(125.80±16.04)分,差异有统计学意义(P0.05)。大专及以下学历护士在培训后自主学习能力得分有所提高(P0.05),本科及以上学历护士培训前后自主学习能力得分无统计学差异。结论 :规范化培训对提升护士的自主学习能力有正向作用,需要针对护士具体情况进行培训,保证不同层级的护士能有效提升自主学习能力。     

新入职护士核心能力的现状及影响因素研究

目的:了解新入职护士规范化培训后核心能力现状及影响因素,为完善新入职护士培训方案提供理论支持.方法:采用一般资料调查表、中国注册护士核心能力量表对南昌市属三级甲等医院161名新入职护士进行调查.采用单因素分析、两独立样本t检验、多元线性回归分析分析影响新入职护士核心能力的因素.结果:南昌市属三级甲等医院的161名新入职护士核心能力总分为(126.60±36.66)分,教育与咨询能力得分最高,为(2.41±0.65)分,领导能力得分最低为(2.21±0.71)分.不同婚姻状态护士临床护理维度得分比较差异有统计学意义(P<0.05);不同批次进行规范化培训护士核心能力总分及多个维度得分比较差异有统计学意义(P<0.05).单因素分析显示每月不同夜班数量、所在科室新入职护士核心能力总分及多维度得分比较差异有统计学意义(P<0.05),不同规范化培训时间新入职护士核心能力总分和各维度得分比较差异有统计学意义(P<0.05),进入了核心能力得分的回归方程,解释核心能力得分总变异量达到78.6％.结论:针对影响因素分层设计规范化培训方案和考核指标,进一步提升新入职护士核心能力.     

18家不同级别医院不同层级血液净化专业护士核心能力现状调查

目的了解不同级别医院不同层级血液净化专业护士核心能力状况,为各级医院血液净化专业护士的培训与护士准入、认证提供理论依据。方法采用自行设计的问卷,对18家不同级别医院不同层次84名血液净化专业护士进行知识、技能和临床实践累积核心能力现状调查。结果不同级别医院初级责任护士(N1)、高级责任护士(N2)核心能力总得分比较,差异无统计学意义;护理组长(N3)级核心能力总得分比较,差异具有统计学意义(P﹤0.05),以三级医院得分最高,得分为64.76分;N2级临床实践累积得分在不同级别医院比较,差异具有统计学意义,以三级医院得分最高,得分为38.12分;N3级护士核心知识得分、临床实践累积得分在不同级别医院比较,差异具有统计学意义,以三级医院得分最高,分别为76.35分和51.47分。结论 18家不同级别医院不同层级血液净化专业护士核心能力有待提高,其中级别较高的三级医院血液净化护士整体核心能力较强,但在所有医院中护士在临床实践积累方面还较薄弱。     

基于ADDIE教学模型的新生儿科护士分层培训的应用与效果评价

目的 :基于ADDIE教学模型开展新生儿科护士分层培训,观察其对新生儿科护士核心能力的影响。方法 :成立新生儿科护士分层培训小组,按ADDIE教学模型的5个阶段,采用便利抽样法选取我院新生儿科参加学习的护士开展理论和实践教学。于培训前后对护士进行教学效果评价(理论成绩、核心能力、教学评价)。结果 :基于ADDIE培训模型培训后新生儿科护士考核成绩高于培训前(86.08±6.68 vs 78.92±5.95,P0.05),新生儿科护士核心能力总分高于培训前(173.70±8.36 vs 167.22±8.30,P0.05),新生儿科护士对基于ADDIE教学模型的分层培训的培训安排、培训方法、教学氛围、教师水平4方面的满意度比培训前更好,差异均有统计学意义(P0.05)。结论:基于ADDIE教学模型的新生儿科护士分层培训可提高新生儿科护士核心能力,护士对该培训认可度较高。     

新入职护士核心能力的调查及对护士规范化培训的启示

目的了解新入职护士核心能力现状,为开展护士规范化培训提供依据。方法采用新入职护士核心能力问卷,对北京市8所市属三级甲等综合医院的583名新入职护士进行调查。结果新入职护士的核心能力总分(77.85±11.33)分,其中法律、伦理实践维度得分最高,为(3.63±0.44)分,评判性思维、科研维度得分最低,为(2.75±0.56)分;不同性别、不同学历的新入职护士核心能力得分比较,差异无统计学意义(P>0.05)。结论新入职护士的核心能力处于中等水平,规范化培训除了各方面继续加强外,应更加注重培养护士的评判性思维能力。     

专科护士规范化培训体系对急诊科临床护理教师胜任力的影响

[目的]探讨专科护士规范化培训体系对急诊科临床护理教师胜任力的影响。[方法]采用临床护理教师胜任力量表,对95名参加急诊急救专科护士规范化培训且有临床带教资格的护理人员在培训前后进行调查。[结果]95名专科护士培训前临床护理教师胜任力总分为137.27分±16.70分,3个月培训后其总分为151.71分±16.06分,培训后总分高于培训前,差异有统计学意义(P0.01);其中培训后专业态度、专业能力和教学能力3个维度得分均高于培训前,差异有统计学意义(P0.01)。[结论]医院对临床护理人员进行规范化培训可提高其临床实践操作能力及其临床带教能力,从而保证临床护理教学质量,培养适应当今社会的应用型护理人才。     

精神科低年资护士核心能力现状调查与分析

目的:调查精神科低年资护士核心能力的现状和特点,为专科核心能力培训提供依据。方法:采用中国注册护士核心能力量表(CIRN)通过自我评价和护士长评价对83名低年资护士核心能力进行调查。结果:精神科低年资护士核心能力自我评价总分为(154.19±27.74)分,护士长评价总分为(146.85±44.10)分,在核心能力总体水平分布方面,护士和护士长评分比较差异有统计学意义(P0.05)。CIRN7个维度中,自评和他评最高分均为"伦理和(或)法律实践能力",评分排在最后三位的依次为"临床护理能力""评判性思维和(或)科研能力"和"教育和(或)咨询能力"。结论:精神科低年资护士核心能力处于中等水平。医院护理管理者应重视低年资护士和护士长在核心能力认识上的差异,加强低年资护士培养,尤其是培养临床护理能力、评判性思维和科研能力以及教育咨询能力。     

基于微课的翻转课堂在新护士安全培训中的应用

目的观察基于微课的翻转课堂教学模式在新护士安全培训中的应用效果。方法 2016年新护士为观察组,采用基于微课的翻转课堂教学模式进行规范化安全培训,2015年新护士为对照组,采用传统教学模式进行培训。比较两组新护士的培训效果。结果观察组新护士培训后安全文化认知水平总分为(3.95±0.83)分,自主学习能力总分为(4.22±0.77)分,培训结束理论考核成绩为(90.5±4.5)分,半年试用期理论考核成绩为(89.0±5.5)分,对整个培训过程的满意度得分为(93.1±6.4)分,培训后1年内的护理不良事件发生率为11.76%,对护理不良事件上报制度知晓率100%,与对照组比较,差异均有统计学意义(P0.05)。结论采用基于微课的翻转课堂教学模式对新护士进行规范化安全培训效果良好。     

多元化分层培训模式对神经内科护士专业核心能力的影响

目的：探讨多元化分层培训模式对神经内科护士专业核心能力的影响。方法2014年对神经内科不同层级护士,采取多元化分层培训模式,培训前根据培训内容需求调查设置课程;培训后对109名护士进行培训内容掌握度自评得分比较;从培训前对内容了解程度、此培训内容是否最新最难、是否提高专科知识、实践及专科护理能力5方面调查培训效果;进行专科理论与临床实境考核并将考核结果与2013年比较。结果多元化分层培训内容掌握度方面：基础知识总分由(8.52±2.89)分上升至(12.43±2.67)分,专科知识总分由(31.96±11.19)分上升至(47.18±11.52)分,专科技术总分由(8.34±3.14)分上升至(11.82±3.37)分,急救技术总分由(29.07±10.71)分上升至(40.68±9.91)分,总分(77.9±24.85)分上升至(112.11±22.81)分,差异具有统计学意义( P均<0.01);培训效果反馈总认可度90.89%;专科考核成绩方面：理论成绩由(81.27±0.74)分上升至(86.08±4.54)分;临床实境成绩由(79.76±5.84)分上升至(83.68±5.56)分,差异有统计学意义(P均<0.01);对培训部门满意度：总满意率90.7%。结论对神经内科护士进行多元化分层培训,能提高其专业核心能力,促进专科护理人才的培养,推动护理专科的发展。     

基于能级进阶的护士分层培训模式构建与实践

目的 :总结并评价基于能级进阶的护士分层培训模式的建立与实施成效,为各级医院开展护士分层培训提供参考。方法 :通过设置各层级护士核心能力要求及进阶条件,在此基础上进行分层培训需求评估、确定分层培训内容、开展分层培训的具体实践,比较实施前后护理人员参加培训的情况,护士规范化培训考核合格率及护士临床综合能力的考核情况。结果:护士参加培训人次由2012年的1674人次增加至2014年的3729人次,个人年平均参加培训次数由2012年的2.09次提高至2014年的4.66次;护士市级规范化培训考核通过率由2012年的89.56%提高至2014年的97.50%(P0.05);护士临床综合能力考核得分由2012年的(74.46±7.62)分提高至2014年的(81.13±8.09)分,差异具有统计学意义(P0.05)。结论 :基于能级进阶的护士培训模式能有效调动护士参加培训的积极性,提升护士核心能力,推动护士岗位管理,是一种行之有效的护士在职培训方法。     

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.     

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.     

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.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."