我国儿科临床护理专家课程设置的调查研究

[目的]了解儿科临床护理专家、护理管理专家和儿科临床医学专家对我国儿科临床护理课程设置的意见。为设置符合我国国情的课程提供依据。为培养我国护理专家奠定基础。[方法]采用自行设计的问卷对广州、沈阳、武汉地区10名临床护理专家、10名护理管理专家和10名儿科临床医学专家进行调查。[结果]3组人群对18门儿科专科护理课程的重要性评价基本相同（P〉0．05），认为与临床结合密切的儿科专科护理课程最重要；而与临床实践联系较少的课程则不重要。[结论]儿科，临床护理专家、儿科护理管理专家和儿科临床医学专家都希望我国儿科临床护理专家具有丰富的护理知识和高超的临床技能。     

我国儿科临床护理专家课程设置的调查研究

[目的]了解儿科临床护理专家、护理管理专家和儿科临床医学专家对我国儿科临床护理课程设置的意见,为设置符合我国国情的课程提供依据,为培养我国护理专家奠定基础。[方法]采用自行设计的问卷对广州、沈阳、武汉地区10名临床护理专家、10名护理管理专家和10名儿科临床医学专家进行调查。[结果]3组人群对18门儿科专科护理课程的重要性评价基本相同(P>0.05),认为与临床结合密切的儿科专科护理课程最重要;而与临床实践联系较少的课程则不重要。[结论]儿科临床护理专家、儿科护理管理专家和儿科临床医学专家都希望我国儿科临床护理专家具有丰富的护理知识和高超的临床技能。     

肾病临床护理专家的培养

目的:探讨有影响力的具备较高护理实践、教育、科研和管理能力的肾病护理专家的培养方法.方法:根据培养目标,结合国外已有报道以及专家的最后论证对课程设置进行了设计.包括理论课程、临床实习、教学实习3部分.其中理论课程包括基础核心课程、高级临床护理实践核心课程、专业领域课程3部分;临床实习包括两个阶段;教学实习包括本、专科学生的教育、临床带教和病人的健康教育3部分.按本课程设置对2002年入学的13名肾病护理专家学生实施教学.结果: 13名学生均修满33学分,如期结业.完成肾病专科系统综述、护理计划、健康教育计划、临床带教简案、理论授课教案各1份,达标及格率100%,试讲量化考评结果及格率100%,优秀率38%.结论:本课程设置体系注重学生实践、科研、教育和管理能力的培养,但目前仍属于探讨和试验期,其内容将在今后的培养工作中不断更新和完善.     

本科护理课程的重要性评价及设置现状

目的 调查不同群体对本科护理课程的重要性评价,并与实际设置情况对比.方法 采用自行编制的问卷,调查287名临床带教教师、95名护理本科实习生及27名护理院校专职教师,对51门本科护理课程重要性的评价;结合《中国高等医药教育课程指南》,分析国内44所护理本科院校课程设置的实际情况.结果 调查对象对所有课程的重要性评价均在一般及以上;评价为重要课程的前10位中,护理职业防护和人际沟通课程的开设率低,分别为0及11.6％;重要性评价在后10位的课程中,护理信息学和护理经济学等5门课程开设率为0,而政治类课程开设率为100％.结论 调查对象对本科护理课程重要性评价结果与44所院校本科护理课程的实际设置情况相符合;建议增设护理职业防护、人际沟通等课程,尝试拓展护理信息学、护理经济学等新兴课程.     

儿科临床护理专家角色作用评价指标体系的初步研究

[目的]了解儿科临床护理人员、护理管理人员和儿科临床医学专家对我国儿科临床护理专家评价指标体系的意见,建立具有儿科特色的评价指标体系。[方法]采用自行设计的问卷,对广州、沈阳、武汉地区10名临床护理人员、9名护理管理人员和8名儿科临床医学专家进行调查。[结果]儿科临床护理人员、儿科护理管理人员和儿科临床医学专家都认为专业素质是儿科临床护理专家最基本、最重要的评价指标;初步形成了儿科临床护理专家角色作用评价指标体系。[结论]我国儿科临床护理专家应该具有高超的专业素质、较高的科学文化素质和思想道德素质。     

儿科临床护理专家角色作用评价指标体系的初步研究

[目的]了解儿科临床护理人员、护理管理人员和儿科临床医学专家对我国儿科临床护理专家评价指标体系的意见，建立具有儿科特色的评价指标体系。[方法]采用自行设计的问卷，对广州、沈阳、武汉地区10名临床护理人员、9名护理管理人员和8名儿科临床医学专家进行调查。[结果]儿科临床护理人员、儿科护理管理人员和儿科临床医学专家都认为专业素质是儿科临床护理专家最基本、最重要的评价指标；初步形成了儿科临床护理专家角色作用评价指标体系。[结论]我国儿科临床护理专家应该具有高超的专业素质、较高的科学文化素质和思想道德素质。     

护理单元设置专职护理文员的方法及效果

为合理使用护理人员,提高护理工作质量,在各护理单元均设置1名专职护理文员,以替代办公室护士工作,将资深护师充实到临床一线直接护理病人。结果:护士站设置专职护理文员后,对医疗、护理工作起到了良好的辅助作用;一线护理人员力量增强,既缓解了临床护理人员紧缺的现状,又提高了护理质量。     

我国临床护理专家培养现状及对策

社会对护理人员的要求在不断提高，护理工作的范围也在不断拓宽。因此，随着专科医疗水平的提高，势必要求专科护理水平与之相适应，临床护理专家（CNS）必然在今后的护理发展中发挥着重要的作用。而我国目前尚未建立完整的临床护理专家培养体系，国内对CNS的概念、入选条件、培训机构及课程设置各不相同，因此，规范CNS的培养体系则显得尤为重要。现将我国临床护理专家培养现状及对策综述如下。     

我国临床护理专家培养对象的选拔条件和方法的调查研究

目的 :了解护理人员对我国临床护理专家培养对象的选拔条件和方式的意见 ,为建立我国临床护理专家的选拔标准提供依据。方法 :对广州地区 413名护理人员进行问卷调查。结果 :85 %以上的护理人员认为选拔临床护理专家培养对象应具备7个条件 ,其中 42 .40 %护理人员认为我国临床护理专家培养对象应具有护理本科以上学历 ;62 .67%认为应达到中级以上技术职称 ;临床专科工作经验、临床教学经验、护士职业证书的注册时间均应在 5a以上的分别为76.5 3 %、49.60 %、64 .5 3 % ,并应通过英语 4级考试(63 .47% ) ;选拔方法应采取统一考试 (3 4.14 % )或个人申请 单位推荐 统一考试(3 1.72 % )。结论 :我国临床护理专家培养对象的选拔条件和方法应突出其职业特点 ,符合我国国情     

在本科护理教育中设置循证护理课程的研究

目的探讨在本科护理教育中设置循证护理课程,为循证护理教育和临床护理人员循证实践的相关培训提供依据和参考。方法采用德尔菲专家咨询法对17名护理管理、临床护理、护理教育专家进行3轮问卷调查,听取专家的意见和建议,筛选循证护理课程设置指标条目。结果 70.59%的专家认为在护理专业本科教育中开设循证护理课程"非常必要",29.41%的认为"必要";70.59%的专家建议将循证护理课程列入护理专业本科的选修课程,学时数为17-24学时;76.47%的专家建议将循证护理课程安排在整个护理学学习的中后期,即基础课程学习后期,临床实习前期;76.47%的专家建议从事临床工作的教师担任本科循证护理课程教学任务。结论本科循证护理课程开课形式为选修课;开课时机为基础课程学习后期,临床实习前期;学时数为17-24学时;师资来源为从事临床工作的临床教师。     

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.