社区护理学实践技能教学方法的研究

目的 探讨提高护生社区护理学实践操作技能的教学方法.方法 将380名护生按年级分为对照班200名(2002～2003级)和实验班180名(2004～2005级).对照班按传统的社区护理实践课程进行教学,即授课后由教师按教学大纲要求,联系社区教学点,分组进行社区护理实践.实验班增加实践课学时,建立模拟社区护理实训中心,根据不同教学内容设计实践情景,采用问题探究式及多媒体等多种形式分段教学.结果 78.9%～100%实验班护生认为教学改革增强了社区护理实践技能,提高了护生分析问题和解决问题的能力,有利于综合素质的培养.实验班理论考试成绩、操作技能考核成绩及综合能力评分与对照班比较,差异有显著性意义(均P＜0.05).结论 社区护理实践教学改革可提高护生理论知识、操作技能及综合能力.     

社区护理学实践技能教学方法的研究

目的 探讨提高护生社区护理学实践操作技能的教学方法。方法 将380名护生按年级分为对照班200名（2002～2003级）和实验班180名（2004～2005级）。对照班按传统的社区护理实践课程进行教学．即授课后由教师按教学大纲要求，联系社区教学点，分组进行社区护理实践。实验班增加实践课学时，建立模拟社区护理实训中心。根据不同教学内容设计实践情号，采用问题探究式及多媒体等多种形式分段教学。结果78．9％～100％实验班护生认为教学改革增强了社区护理实践技能，提高了护生分析问题和解决问题的能力，有利于综合素质的培养。实验班理论考试成绩、操作技能考核成绩及综合能力评分与对照班比较，差异有显著性意义（均P〈0．05）。结论 社区护理实践教学改革可提高护生理论知识、操作技能及综合能力。     

高职护理专业养老志愿服务教学模式的实践

目的在高职护理专业开展养老志愿服务教学,以培养养老服务人才。方法将入校新护生根据其养老志愿服务意向分班,愿意养老志愿服务的58名护生分为实验班,剩余61名护生分为对照班。对照班根据高职护理院校人才培养方案进行常规教学,课程内容包括职业素质、专业知识与技能、综合实践三大模块;实验班在对照班基础上增加90学时的养老志愿服务课程内容,其中理论26学时,实践64学时,持续4个学期完成教学任务。教学前后采用老年人态度量表、老化知识问卷I及从事养老护理职业意愿问卷调查护生。结果教学后实验班护生对老年人态度、老化知识掌握及从事养老护理职业意愿得分显著高于对照班(均P 0. 01)。结论开展养老志愿服务教学可使护生掌握老化知识,提高护生对老年人态度及从事养老护理职业意愿,可作为养老护理人才培养的有效实践教学模式。     

病案引导联合以文献为导向的自我学习在传染病护理教学的应用

目的探讨病案引导联合以文献为导向的自我学习(CBS-RISE)传染病护理教学的效果。方法将助产班护生87人按班级划分为实验班43人和对照班44人,分别采取CBS-RISE教学和传统方式教学。比较两组护生的理论成绩、课程开设前后临床评判性思维能力及实验班护生的教学评价。结果课程开设后,实验班案例分析、研究设计成绩显著高于对照班(均P0.01),护生临床评判性思维能力除"自信心"外,其余维度得分显著高于对照班(P0.05,P0.01);实验班护生对该教学法10个方面的认同率达81.40%～97.67%。结论 CBS-RISE有利于提高教学效果和护生评判性思维能力,提高护生教学满意度。     

基于工作过程的外科护理项目化教学研究

目的探讨基于工作过程的教学应用于高职护理专业外科护理课程中的效果。方法将2009级高职护理专业两个班随机分为实验班(60人)和对照班(60人)。实验班采用基于工作过程的外科护理项目化教学,对照班采用传统模式教学。结果两班理论、操作考核成绩比较,差异有统计学意义(均P<0.01);95.00%护生对基于工作过程的项目化教学模式持肯定态度。结论在外科护理课程中采用基于工作过程的项目化教学,能激发学生的学习兴趣,有利于学生理论联系实践,提高护生的综合素质,缩小教学和临床的距离。     

强化医院感染知识对无菌技术教学效果的影响

目的 探讨强化医院感染知识对提高无菌技术教学效果的作用.方法 将2006级两个班的中专护生按班级随机分为实验班(58人)和对照班(52人).对照班采用传统授课法按教材内容讲解;实验班采用强化医院感染知识的教学方法 .结果 实验班考核成绩及对提高教学效果评价显著优于对照班(P＜0.05,P＜0.01).结论 在中职护生无菌技术课程教学中强化医院感染知识利于提高护生学习效果,规范护生的职业行为.     

组长责任制在护理基本理论与技术操作教学中的应用

目的探讨组长责任制在《护理基本理论与技术》操作教学中的应用效果。方法随机选择三年制护理专业10班(对照班,50人)、16班(实验班,49人)护生99人为研究对象,对照班采取传统教学方法(讲解→课后辅导→分组练习),实验班采取组长责任制的教学方法(讲解→课后辅导组长→组长辅导护生→分组练习)。结果教学结束实验班操作考试成绩优良率显著高于对照班,医院带教老师对实验班护生的评价显著高于对照班(均P0.01)。结论将组长责任制应用到《护理基本理论与技术》操作教学中,可有效调动护生的学习积极性,培养护生的团队精神、综合素质等能力,提高总体课程的教学效果。     

循证护理在中专护生基础护理教学中的应用

目的 探讨循证护理在基础护理学(下称基护)教学中的应用效果,提高护生的批判性思维能力.方法 随机抽取1个教学班62人作为实验班,另一教学班63人作为对照班.对照班采用传统授课法按教材内容讲解;实验班在基护课程开课前讲授循证护理基础知识,课堂教学中选择部分内容进行循证护理教学和实践.结果 实验班基护理论成绩、信息载体与场所利用率及对教材知识采取批判性思维的比例显著高于对照班(均P＜0.05),实验班67.74%～100%护生对该教学方法持肯定态度.结论 基护教学中引入循证护理有利于培养护生的批判性思维能力,提高教学效果.     

教学做一体化教学模式在外科护理学教学中的实践

目的探讨"教、学、做"一体化教学模式在外科护理学教学中的应用效果。方法将118名高职护生随机分为实验班(60名)和对照班(58名)。对照班采用传统教学方法授课,即先预习、理论讲解,再进行实践。实验班采用"教、学、做"一体化教学模式教学,即在模拟手术室以及相关的模拟病房授课,边教、边学、边做,师生双方共同完成教学任务。结果实验班85.00%护生认为能够激发学习兴趣,96.67%护生认为能够提高动手能力,93.33%护生认为能够提高学习效率及促进师生之间的交流。实验班的理论及综合技能考核成绩显著高于对照班(均P0.01)。结论运用"教、学、做"一体化教学模式有利于提高护生的理论成绩、操作技能及综合能力。     

强化医院感染知识对无菌技术教学效果的影响

目的探讨强化医院感染知识对提高无菌技术教学效果的作用。方法将2006级两个班的中专护生按班级随机分为实验班（58人）和对照班（52人）。对照班采用传统授课法按教材内容讲解;实验班采用强化医院感染知识的教学方法。结果实验班考核成绩及对提高教学效果评价显著优于对照班（P〈0．05,P〈0．01）。结论在中职护生无菌技术课程教学中强化医院感染知识利于提高护生学习效果．规范护生的职业行为。     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

动静脉穿刺网络课件的开发及其应用

目的:确保护理教学效果，提高教学水平。方法:应用多项信息技术将动静脉穿刺技术制作成教学网络课件，并用于临床教学。结果:该课件在本校园网上运行半年余，2000余人次对其进行访问，受到师生好评。结论:该课件能及时反映动静脉穿刺的最新研究进展及具体操作步骤和使用方法，实现护理教学的直观性和交互性，对护理教学和临床带教指导有一定的借鉴作用。     

Physiology and pharmacology of nausea and vomiting

The physiology of nausea and vomiting is poorly understood. The initiation of vomiting varies and may be due to motion, pregnancy, chemotherapy, gastric irritation or postoperative causes. Once initiated, vomiting occurs in two stages, retching and expulsion. The muscles responsible for this sequence of events are controlled by either a vomiting centre or a central pattern generator, probably in the area postrema and the nearby nucleus tractus solitarius. Drugs which induce vomiting include ipecacuanha, a gastric irritant, and apomorphine, a dopamine-receptor agonist. Opioid drugs also induce vomiting, but opioid antagonists are not useful to treat nausea and vomiting. Anti-emetic drugs consist of a variety of neurotransmitter antagonists and may act in the periphery, the central nervous system or both sites. The most important drugs are antagonists at muscarinic, dopamine D₂, 5-HT₃, histamine H₁ and neurokinin NK₁ receptors. These drugs are discussed with particular attention to post-operative nausea and vomiting (PONV).     

足踝损伤的分类与治疗的要点和难点

足踝部损伤主要有踝关节骨折脱位、距骨骨折脱位、跟骨骨折以及跖骨骨折、趾骨骨折、跖趾关节脱位、踝关节周围软组织损伤等。足踝损伤防治的重点是踝关节骨折脱位、距骨骨折脱位、跟骨骨折以及踝关节周围软组织损伤。本文针对足踝损伤的要点和难点分类进行阐述。1踝关节骨折目前踝关节骨折的分类主要有:Ashhurst分类法[1]、Lauge-Hanson分类法[2]、Danis-Weber分类法[3]。Ashhurst分类法按照外力的性质分类,然后按单踝、双踝、三踝骨折分级,优点是简单易记,对认识外力的性质很有帮助,缺点是没有考虑到外伤时的体位、姿势等复合因素;Laug…     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.