翻转课堂教学法在消化内科临床带教的应用评价

目的 探讨翻转课堂教学法在消化内科临床带教的教学效果.方法 选取2018年10月—2019年10月在消化内科进行临床见习的护生48人(全部为女生),按照实习先后顺序,前24人作为试验组,给予翻转课堂教学法教学;后24人作为对照组,采用传统的带教模式.讨论两组护生在理论和操作成绩和对带教满意度方面有无差异.两组学生在试验开始之前的成绩相比较,差异无统计学意义(P>0.05).结果 试验组在理论、操作、教学满意度等方面的成绩均高于对照组,P<0.05.结论 翻转课堂教学法在消化内科的临床带教中有较好的教学效果,可以提高学生的学习成绩和教学满意度.     

基于整合医学理念的护理路径应用于脑梗死后鼻饲患者的临床成效

目的 剖析基于整合医学理念的护理路径应用于脑梗死后鼻饲患者的临床成效,以增加医疗实践经验。方法 利用电脑对我院在2015年10月至2017年10月收治的88例脑梗死后鼻饲患者行随机化分组,各自命名为研究组(n=44)和对照组(n=44)。对照组实施传统护理,研究组采取整合式医疗模式护理路径。待干预后第4周末,比较两组患者的吞咽功能、情感状况、生活质量及营养状况。结果 干预后,研究组患者的SAS、SDS评分低于对照组,营养状况优于对照组,生活质量评分高于对照组,洼田试验评分高于对照组,均有统计学差异(P<0.05)。结论 基于整合医学理念的护理路径应用于脑梗死后鼻饲患者,对其吞咽功能的改善以及情感状况的稳定大有助益,且能增进机体对营养物质的吸收及提升生活质量。     

Violence et institution militaire

ObjectivesThis work consists in a study of the links between the concept of violence and military environment where its problematic is particularly acute. Violence is at the heart of the profession of arms, which conveys a transgression, the prohibition of murder, which itself is at the foundation of the organization of our society.MethodsThe soldier occupies a position of exception by this possibility of giving death, which finds its legitimacy in a regulated use of the force, while responding to very precise conditions of use of the weapons. The power granted to the soldier is none the less marked up, presupposing a regulated use of the armed force, which implies its control, but commits jointly the possible overflow of these conditions of employment; sometimes there is an insidious sliding, much more obvious elsewhere, towards a deregulated violence, attesting a loss of control of the force. These specific coordinates of emergence of violence are here detailed, to specify the springs and the repercussions, beyond contextual considerations.ResultsTwo expressions in mirror of violence have been pinpointed in order to be clarified. The one which refers to a controlled and framed violence, then lever and driving force of the war action, and the other consisting of a out of frame violence, in connection with a use against the use of force; we did the hypothesis that this deregulated violence is the expression of a point of impossibility for the subject, a form of impasse both in his own psychic functioning and in his relationship to the group.ConclusionsThe military environment, which is itself violence holder, is structured in such a way that it can frame and control the intrinsic violence to warlike action. But as soon as the violence comes to express itself out of frame, it is outside the precise and regulated context of the use of the armed force, it becomes destructive, hindering the work of symbolization of the psyche, to lead to breaking the links of the subject with himself and with his group.     

Development and validation of a novel scoring system to predict severe intraventricular hemorrhage in very low birth weight infants

ObjectiveWe sought to develop and validate a novel scoring system for the prediction of severe intraventricular hemorrhage (SIVH) in very low birth weight infants (VLBWI).MethodsThis retrospective cohort multicenter study included 615 VLBWI born between 24 and 32 weeks gestational age (GA). Multivariable logistic regression analyses were used to determine which factors evaluated within the first 5 days of life were associated with SIVH and the weights of these variables. The accuracy of the predictive scoring system was prospectively tested in the same units.ResultsThe final SIVH scoring system included the following variables: antenatal steroid therapy, GA, birth weight (BW), 1-min Apgar score, mechanical ventilation and hypotension. The SIVH scores used to divide the subjects into three tiers (low-risk (<5), moderate-risk (5–8) and high-risk (>8)) were developed based on these variables. Of infants with a score below 5, 1.2% (4/339) developed SIVH. Of those with a score above 8, 42.5% (17/40) developed SIVH. The scores were successfully verified in 99 VLBWI.ConclusionsThese findings suggest that among infants with a score >8, the incidence of SIVH is significantly higher. This scoring system can be used to predict the incidence of SIVH during the first 5 days after birth and may contribute to the early intervention in and prevention of SIVH.