耳鼻咽喉头颈外科亚专科临床护理教学实践

目的 探讨亚专科教学模式用于耳鼻咽喉头颈外科的临床护理教学效果。方法 将38名实习护生按时间段分为对照组和观察组各19名。对照组采用常规临床护理教学；观察组采用亚专科模式教学，即实习护生于耳科、鼻科、咽喉科依次实习2周，完成6周实习出科时评价教学效果。结果 观察组专科理论操作成绩、综合素质评分、教学体验(教学素质和教学方法)显著优于对照组(均P<0.05)。结论 亚专科教学模式可有效提高耳鼻咽喉头颈外科实习护生临床教学效果，同时改善护生实习体验。     

选择式目标计划表的制定及在急诊抢救室教学中的应用

目的提高急诊抢救室临床教学质量。方法将308名护生按实习时间先后分为对照组152人和观察组156人,对照组采取常规教学法,观察组采用自制的选择式目标计划表（下称计划表）,针对不同实习时间、不同实习阶段选取合适的内容和方式进行教学。结果观察组护生出科理论及操作成绩均优于对照组（均P〈0．01）;观察组护生对本科室的教学满意度显著高于对照组（P〈0．05）。结论急诊抢救室临床带教采用自制计划表可显著提高教学效果和护生满意度。     

选择式目标计划表的制定及在急诊抢救室教学中的应用

目的提高急诊抢救室临床教学质量。方法将308名护生按实习时间先后分为对照组152人和观察组156人,对照组采取常规教学法,观察组采用自制的选择式目标计划表(下称计划表),针对不同实习时间、不同实习阶段选取合适的内容和方式进行教学。结果观察组护生出科理论及操作成绩均优于对照组(均P0.01);观察组护生对本科室的教学满意度显著高于对照组(P0.05)。结论急诊抢救室临床带教采用自制计划表可显著提高教学效果和护生满意度。     

泌尿外科实习护生人文关怀临床教学的设计与实施

目的 提高泌尿外科临床实习护生人文关怀能力.方法 将本科护生106人按进入泌尿外科实习时间分为对照组52人和观察组54人.对照组按实习计划进行常规专科护理与人文关怀临床带教,观察组对人文关怀教学内容进行专项设计,包括激发兴趣、角色扮演、角色体验、深入交流、反馈讨论、调整优化6种形式,并融入4周专科临床教学中.结果 实习结束时观察组护生专科理论及操作考核成绩、人文关怀能力得分显著高于对照组,对教学模式认可度显著高于对照组(P＜0.05,P＜0.01).结论 将人文关怀内容融入专科临床教学中,可有效提高护生实习成绩和人文关怀能力,教学模式获得护生认可.     

骨科护理实习教学表的设计与应用

目的提高骨科临床护理教学质量。方法将2010年实习护生50人作为对照组,2011年实习护生50人作为实验组。对照组使用传统的教学方法,即以实习教学大纲进行带教。实验组使用自制骨科护理教学表进行带教。出科前对实习护生进行考核,比较两组护生出科成绩。结果实验组出科成绩、操作成绩及专科知识成绩显著高于对照组(均P<0.01)。结论使用骨科护理教学表进行临床带教,护生可以在掌握基础知识的情况下,更好地了解骨科的专科知识,提高骨科临床护理教学质量。     

导学式情境模拟教学法在实习护生职业风险培训中的应用

目的提高实习护生护理职业风险意识。方法根据实习时间将2018年6月至2019年4月的实习护生98人作为对照组,2019年6月至2020年4月的实习护生72人作为观察组。对照组按传统方法开展以PPT讲授为主导的不良事件分析会进行职业风险培训。观察组运用导学式情境模拟教学法,将护理不良事件案例结合情境模拟进行职业风险培训。采用中文版护士安全态度问卷、护士对不良事件报告认知问卷及自行设计的临床职业风险教学模式反馈问卷进行评估。结果培训后,观察组护理安全态度总分及对不良事件的认知得分显著高于对照组(均P<0.01);观察组实习护生对临床教学模式的评价显著优于对照组(P<0.05,P<0.01)。结论对实习护生实施导学式情境模拟教学,可有效提升实习护生的安全态度及对不良事件的认知,为今后的护理实践中更好地保障患者安全奠定基石。     

Design and application of an orthopedics nursing teaching arrangement form

目的 提高骨科临床护理教学质量.方法 将2010年实习护生50人作为对照组.2011年实习护生50人作为实验组.对照组使用传统的教学方法,即以实习教学大纲进行带教.实验组使用自制骨科护理教学表进行带教.出科前对实习护生进行考核,比较两组护生出科成绩.结果 实验组出科成绩、操作成绩及专科知识成绩显著高于对照组(均P＜0.01).结论 使用骨科护理教学表进行临床带教,护生可以在掌握基础知识的情况下,更好地了解骨科的专科知识,提高骨科临床护理教学质量.     

本科护生临床护理科研能力培养方法的探讨

目的探讨本科护生护理科研临床教学的有效方法,以提高临床教学质量.方法将2003～2004年在三级甲等医院实习的157名本科护生按所实习的医院不同分为实验组(47名)和对照组(110名),对照组按常规进行临床护理实习,实验组在进行临床护理实习的同时,进行临床护理科研能力培训,即组成护理科研指导导师组,制订专项教学计划,由教学督导负责落实.结果两组论文成绩比较,实验组显著优于对照组(P＜0.01).结论通过对本科生临床护理科研能力的培养,取得良好的教学效果,达到了临床教学中的科研教学目标.     

本科护生临床护理科研能力培养方法的探讨

目的 探讨本科护生护理科研临床教学的有效方法。以提高临床教学质量。方法 将2003～2004年在三级甲等医院实习的157名本科护生按所实习的医院不同分为实验组（47名）和对照组（110名），对照组按常规进行临床护理实习，实验组在进行临床护理实习的同时，进行临床护理科研能力培训。即组成护理科研指导导师组。制订专项教学计划。由教学督导负责落实。结果 两组论文成绩比较。实验组显著优于对照组（P〈0．01）。结论 通过对本科生临床护理科研能力的培养。取得良好的教学效果，达到了临床教学中的科研教学目标。     

本科护生临床教学中服务剧本的应用研究

目的探讨服务剧本教学方式在本科护生临床教学中的应用效果。方法将117名(20轮)护理本科护生按入科轮次随机分成观察组60名、对照组57名,对照组采用传统教学方法带教,观察组在传统教学方法的基础上每周安排服务剧本教学,通过让护生提前熟悉剧本内容、参与剧本演出、总结演示效果及护士长点评的方式来带教。实习1个月结束后,比较两组理论、操作、情景模拟考核成绩及对临床教学效果评价。结果两组理论、情景模拟考核成绩比较,观察组显著优于对照组(均P0.01);观察组护生对教学效果的评价显著优于对照组(均P0.01)。结论服务剧本教学方式有效地提高了本科护生的专业知识水平、服务及危机意识、沟通能力、分析及解决问题的能力。     

An analysis of the survival outcomes of simultaneous pancreas and kidney transplantation compared to live donor kidney transplantation in patients with type 1 diabetes: a UK Transplant Registry study

Transplant options for patients with type 1 diabetes and end‐stage renal disease (ESRD) include deceased donor kidney, live donor kidney (LDK) and simultaneous pancreas‐kidney (SPK) transplantation. The aim of this study was to compare outcomes between LDK and SPK for patients with type 1 diabetes and ESRD in the UK. Data on all SPK (n = 1739) and LDK (n = 385) transplants performed between January 2001 and December 2014 were obtained from the UK Transplant Registry. Unadjusted patient and kidney graft survival were calculated using the Kaplan–Meier method. Multivariate analysis of kidney graft and patient survival was performed using Cox proportional hazards regression. There was no significant difference in patient (P = 0.435) or kidney graft survival (P = 0.204) on univariate analysis. On multivariate analysis there was no association between LDK/SPK and patient survival [HR 0.71 (0.47–1.06), P = 0.095]. However, LDK was associated with an overall lower risk for kidney graft failure [HR 0.60 (0.38–0.94), P = 0.025]. SPK recipients with a functioning pancreas graft had significantly better kidney graft and patient survival than LDK recipients or those with a failed pancreas graft. SPK transplantation does not confer an overall survival advantage compared to LDK. However, those SPK recipients with a functioning pancreas have significantly better outcomes.     

Defining outcomes for β‐cell replacement therapy in the treatment of diabetes: a consensus report on the Igls criteria from the IPITA/EPITA opinion leaders workshop

β‐cell replacement therapy, available currently as pancreas or islet transplantation, has developed without a clear definition of graft functional and clinical outcomes. The International Pancreas & Islet Transplant Association (IPITA) and European Pancreas & Islet Transplantation Association (EPITA) held a workshop to develop consensus for an IPITA/EPITA Statement on the definition of function and failure of current and future forms of β‐cell replacement therapy. There was consensus that β‐cell replacement therapy could be considered as a treatment for β‐cell failure, regardless of etiology and without requiring undetectable C‐peptide, accompanied by glycemic instability with either problematic hypoglycemia or hyperglycemia. Glycemic control should be assessed at a minimum by glycated hemoglobin (HbA_1c) and the occurrence of severe hypoglycemia. Optimal β‐cell graft function is defined by near‐normal glycemic control [HbA_1c ≤ 6.5% (48 mmol/mol)] without severe hypoglycemia or requirement for insulin or other antihyperglycemic therapy, and with an increase over pretransplant measurement of C‐peptide. Good β‐cell graft function requires HbA_1c < 7.0% (53 mmol/mol) without severe hypoglycemia and with a significant (>50%) reduction in insulin requirements and restoration of clinically significant C‐peptide production. Marginal β‐cell graft function is defined by failure to achieve HbA_1c < 7.0% (53 mmol/mol), the occurrence of any severe hypoglycemia, or less than 50% reduction in insulin requirements when there is restoration of clinically significant C‐peptide production documented by improvement in hypoglycemia awareness/severity, or glycemic variability/lability. A failed β‐cell graft is defined by the absence of any evidence for clinically significant C‐peptide production. Optimal and good functional outcomes are considered successful clinical outcomes.     

临床学习环境对护理本科生临床实习表现的影响

目的探讨临床学习环境(CLE)对护理本科生(护生)临床实习表现(CPs)的影响。方法按比例分层从全国142所医药高校中抽取22所的毕业实习护生923名,采用护理临床学习环境评价量表、护理本科生毕业实习临床实践行为表现自评量表进行问卷调查。结果护生CLE总评分为3.39±0.62,CPs总评分为3.68±0.47;护生对CLE评价与其CPs相关系数是0.520(P<0.01);个性化、学生参与性、任务定位是影响护生CPs的主要因素(均P<0.01)。结论 CLE可影响护生的CPs。在临床实习中,护理管理者和临床带教老师应给护生一定的自主性,并进行因人而异的个性化施教,为护生创造更多的动手机会,对护生的实习活动指示明确,让护生清楚自己的实习角色和实习任务,以提高临床实习质量。     

Reliability and usefulness of clinical encounter cards for a third-year surgical clerkship

BACKGROUND: Third-year medical students (MS3) were given clinical encounter cards (CECs) to stimulate feedback during their surgery clerkship. This study analyzes the feedback given on their clinical performance using CECs. METHODS: Two hundred one students enrolled in the 12-week surgery clerkship were given CECs. Each card contained the chief focus of the encounter, which was rated on a six-point Likert scale. The CECs were analyzed to determine if they provided reliable formative information, identified marginal performances, and identified differences between raters, settings, rotations, and aspects of clinical performance evaluated. RESULTS: Seven thousand three hundred eight CECs were submitted from 201 students. The CECs were completed most often (65%) in the inpatient setting. Technical skills were evaluated on 49% of CECs, history/physical examinations on 40%, and case presentations on 30%. There were comments written on half of the CECs and 89% of these were strictly positive. Women (52.8%) and faculty (63.3%) were more likely to provide written comments. The students were most likely to seek feedback from the interns and faculty who gave significantly higher ratings. The Cronbach-alpha reliability coefficient was 0.69, based on 12 raters per student. There was a significant positive correlation (P < 0.05) between the CEC composite rating and the clinical performance rating (r = 0.356), NBME score (r = 0.258), and the final grade (r = 0.250). CONCLUSIONS: The implementation of CECs in a surgery clerkship provided a large quantity of positive feedback. The quality was limited because there were minimal recommendations for improvement and they were a poor predictor of overall clinical performance.     

Clinical research and good clinical practice

Clinical research is one of the important missions of an academic Albert Einstein medical centre and forms the cornerstone for improvement of healthcare. Funding for clinical research has increased steadily over the past few decades, both from the US government and the pharmaceutical industry. In this chapter we will explore how clinical research contributes to improvements in patient care and medical education and describe the process of clinical research. Whereas there can be deficiencies in the process of conducting research, as evidenced by recent media reports, research involving human subjects is a necessary and crucial step in the mechanism of translating scientific discovery and technological advancement into procedures and products that offer the prospect of better lives for all of us. Guidelines on good clinical practice should be followed and, above all, trust between research subjects and investigators should always be upheld and respected.     

Review of the Australian incident monitoring system

BACKGROUND: A survey was conducted to assess the benefits and limitations of the Australian Incident Monitoring System (AIMS) as a programme to improve patient safety. METHODS: A 12-point questionnaire was sent to 12 current users of AIMS in November 2002. RESULTS: The AIMS provides a consistent system of coding, trending and monitoring of incident data. It promotes a patient safety culture and an awareness of system error. Other benefits include the building of teamwork and the implementation of strategies to reduce the prevalence and severity of incidents. The majority of respondents (83%) reported that AIMS investigations resulted in significant changes to equipment usage, medication prescribing or administration, clinical protocols, training programmes and falls risk assessment tools. Although 75% of users reported improvements in patient outcomes, these were difficult to measure. A major limitation of AIMS was the low rate of incident reporting by medical staff. Voluntary reporting systems did not capture all incident data and the information was often too generic for root cause analysis. There were difficulties benchmarking data and concerns were raised regarding the ownership of information. The programme requires ongoing resources to implement change strategies and to maintain incident reporting levels. On a scale of 1 (poor rating) to 10 (excellent rating) the mean benefit rating was 7.6. CONCLUSION: The Australian Incident Monitoring System is beneficial as a component of a clinical risk management strategy. Usefulness could be improved by increased participation by medical staff. The level of resources required should not be underestimated if the programme is to demonstrate improvements to patient outcomes. More recent versions of AIMS promise improved capabilities and will require similar evaluation.     

How to design a randomized controlled trial

Randomized controlled trials are the ideal study design to evaluate the effectiveness of health-care interventions. The conduct of a clinical trial is a collaborative effort between participants, investigators and a range of health-care professionals involved both centrally and locally in the coordination and execution of the trial. In this article, the key steps that are required to design a randomized controlled trial are summarized.