护理本科生双导师制带教模式的实践

目的 探索适合护理本科生的临床带教模式.方法 将2001级和2000级护理本科生分为实验组(n=24)和对照组(n=38),对照组给予传统带教模式带教,实验组采用双导师制带教模式,即每名学生在临床实习期间,由1名临床专科导师负责其本科室专科知识方面的指导,1名全程导师负责其实习全过程的督导及检查工作,护理部在学生实习结束前进行带教满意率测评及实习效果评价,并与对照组进行比较.结果 两组对医院带教很满意率、学生护理理论、操作技能考核成绩、论文书写优良率比较,差异有显著性意义(均P＜0.01).结论 双导师制可提高带教质量,是受学生好评和欢迎的带教模式.     

耐热锻炼对人体热暴露时血浆丙二醛和中分子物质含量的影响

本文报告热习服对血浆丙二醛和中分子物质含量的影响。15名健康男子,平均年龄21.8±0.7岁,于平均气温27.3±1.2℃负重行军90min,2周内共锻炼11次(天)。标准热暴露试验对比表明获得了热习服,肛温和心率增值大大降低(P<0.01和P<0.05)。锻炼期前、后标准试验时血浆丙二醛含量降幅分别为29.4%(P<0.01)和30.1%(P<0.01),而中分子物质含量增幅分别为6.3%(P<0.05)和9.2%(P<0.01)。热前、后血浆丙二醛含量较锻炼期前仅分别降低5.5和6.5%(P>0.05),而中分子物质含量分别降低18.3和16.1%(P<0.01),可见,热习服后血浆丙二醛和中分子物质含量没有同步降低。     

Hypertrophy without increased isometric strength after weight training

Summary Eight men (20–23 years) weight trained 3 days week^–1 for 19 weeks. Training sessions consisted of six sets of a leg press exercise (simultaneous hip and knee extension and ankle plantar flexion) on a weight machine, the last three sets with the heaviest weight that could be used for 7–20 repetitions. In comparison to a control group (n = 6) only the trained group increased (P<0.01) weight lifting performance (heaviest weight lifted for one repetition, 29%), and left and right knee extensor cross-sectional area (CAT scanning and computerized planimetry, 11%, P<0.05). In contrast, training caused no increase in maximal voluntary isometric knee extension strength, electrically evoked knee extensor peak twitch torque, and knee extensor motor unit activation (interpolated twitch method). These data indicate that a moderate but significant amount of hypertrophy induced by weight training does not necessarily increase performance in an isometric strength task different from the training task but involving the same muscle group. The failure of evoked twitch torque to increase despite hypertrophy may further indicate that moderate hypertrophy in the early stage of strength training may not necessarily cause an increase in intrinsic muscle force generating capacity.     

The effects of training, immobilization and remobilization on musculoskeletal tissue

Compared with the knowledge on immobilization, the effects of remobilization on musculoskeletal tissues have not been well established. What is sure is that remobilization and rehabilitation of any component of the musculoskeletal tissues require much more time than the time needed to cause the immobilization atrophy. With intensive rehabilitation, the functional properties of skeletal muscles can be improved significantly even years after the injury and following immobilization, but no study has shown whether full recovery is possible and whether these rehabilitated muscles are able to respond normally to further training. Experimental studies have given evidence that slow-twitch muscle fibres have better capacity for recovery than fast-twitch fibres, most likely due to better circulation and higher protein turnover. Also evidence has been given that fibre regeneration is possible through satellite cell activation and myotube formation. Very little is known, however, about the effects of age, gender or the level of preimmobilization muscle performance on the restoration capacity. Also the fate of the marked structural changes (for example, connective tissue accumulation) induced by immobilization is unknown. Tendon and ligament tissues are likely to respond appropriately to remobilization, resulting in acceleration of collagen synthesis and fibril neoformation. However, there is a strong suspicion that remobilized tendons and ligaments will not achieve all the biochemical and biomechanical properties of their healthy counterparts. Specifically, the amount of weak type III collagen has been shown to be overrepresented in these tissues instead of mature, strong type I collagen. It is not known whether this is an important risk factor for ruptures during later activity. The effects of remobilization on muscle-tendon junction and proprioceptive organs are not known. It would not be surprising if the serious structural changes induced by immobilization were unrestorable. In the literature dealing with immobilization and remobilization, cartilage degeneration is always a major concern, because not only too strenuous training or immobilization, but also unskilful remobilization may activate this process leading finally to osteoarthrosis. Bone may be one of the best components of musculoskeletal tissues to respond to remobilization, probably because the immobilization atrophy of bone is largely quantitative (osteoporosis) only. The prerequisites for bony recovery are that the follow-up time is long enough (months) and that immobilization has not exceeded about 6 months, the time limit between active and inactive (irreversible) osteoporosis. Prevention of the atrophying effects of immobilization can be very successful if performed properly. According to present knowledge, there are many methods for the purpose, including preimmobilization training early, controlled mobilization; optimal positioning of the immobilized joint; muscular training during immobilization; early weightbearing; exercise with the nonimmobilized extremity; and electrical stimulation. Lots of education and information will be needed, however, before these methods are deeply rooted in the daily routines of the attending physicians, physical therapists, athletic trainers and other persons involved in the treatment of musculoskeletal problems.     

Exercise tolerance after anaemia correction with recombinant human erythropoietin in end-stage renal disease

The aim of this study was to evaluate the effect of correction of chronic anaemia on the physical performance and the cardiovascular response to effort in children with end-stage renal disease (ESRD) maintained by haemodialysis. Seven patients (mean age 13.9 years) underwent triangular-type treadmill exercise testing before [haemoglobin (Hb) 6.3±0.9 g/dl] and after (Hb 11.2±1.2 g/dl) anaemia correction with recombinant human erythropoietin (rHuEPO). After treatment, the work-load reached, the peak oxygen uptake and average ventilatory anaerobic threshold (VAT) values were significantly increased (P<0.01,P<0.001,P<0.05 respectively). VAT values, expressed as a percentage of normal values, increased from 55.7±16.6% to 82.4±21%. This improvement correlated well with the increase in Hb (r=0.79). Oxygen pulse also increased significantly, when tested after anacmia correction. In conclusion, these data demonstrate that when the anaemia of children with ESRD is corrected with rHuEPO, there is a clear improvement in acrobic work capacity and effort tolerance.     

心绞痛PTCA术后患者以步行为主的康复训练

１４例不稳定性心绞痛患者，男性１２例，女性２例，平均年龄５５岁，均因药物治疗无效而进行ＰＴＣＡ治疗。总计１６个血管段、前降支９段，回旋支４段，右冠状动脉３段。术后执行以步行为主要内容的一周康复训练程度，全部病例均顺利完成，表明以步为主的非监护康复训练对不稳定性心绞痛ＰＴＣＡ术后和是安全可行的。     

提高护士病情观察能力的培训方法与效果

目的提高护士对病人病情观察的能力。方法针对护士观察病情方面存在的问题,制定对策,进行专业知识培训,制订考核标准,加强考核力度。结果培训后护士病情观察能力、病区护理质量有明显提高(P<0 05或 P<0.01)。结论加强培训可以提高护士病情观察能力,提高护理质量。     

我国社区护士培养现状及对策

对社区护士应具备的素质及其培养方法、培养内容及培养方式等进行综述,并对目前我国社区护士培养方面存在的问题进行分析,提出应重视、加强社区护士的培养和教育,建立健全多层次培养途径,优化课程体系,完善培养模式,加大培养力度,大力发展社区护理事业。