心血管内科临床实习教学中引入微课的应用研究

目的 为了满足学生的个性化学习需求、推动教育信息化，探究“微课”教学模式在心血管内科临床实习教学中的应用情况。方法 纳入2016 年1-9月西安交通大学第二附属医院在心血管内科实习的学生98例，随机地将其分为对照组和观察组，对照组实习生进行传统实习教学，观察组实习生在传统实习教学中引入“微课”教学模式，对比两组在心血管内科实习的理论和技能考核成绩，并且进行对心内科实习教学满意度情况的调查。结果 观察组实习生的临床技能考核成绩显著高于对照组，差异有显著性(P<0.05)。并且，观察组对心血管内科教学方法满意度明显高于对照组，差异有显著性(P<0.05)。结论 将“微课”模式引入心血管内科临床实习教学中可显著增强实习生对临床操作技能的掌握，并且可增强实习生对心血管内科实习教学的满意度     

Instrucciones de Alta por Video: Effectiveness of Video Discharge Instructions for Spanish-Speaking Caregivers in the Pediatric Emergency Department

IntroductionAlthough evidence supports the addition of video discharge instructions to improve caregiver knowledge among English-speaking caregivers of children in the pediatric emergency department, there is no evidence about the effectiveness of videos for Spanish-speaking caregivers. The purpose of this study was to test whether Spanish video discharge instructions added to standard written and oral discharge instructions would result in improved knowledge and satisfaction among caregivers compared with written and oral instructions alone.MethodsSpanish videos were created for fever, gastroenteritis, and bronchiolitis. A quasi-experimental, consecutive-sample, pre–post-test design was used with an audio computer-assisted survey platform to provide surveys in Spanish. The intervention group received written and oral instructions + video, whereas the comparison group received written and oral instructions alone.ResultsData were collected from 150 caregivers. Caregivers who were given written and oral instructions + video showed significant knowledge improvement regarding their child’s diagnosis and treatment (+19.3% and +23.6%, respectively, among standard participants; P < 0.001). Moreover, videos did not significantly improve caregivers’ knowledge regarding illness duration and when to seek further care. Regardless of the discharge instruction format, no significant difference was observed in the helpfulness of the instructions (-1%; pre vs post, 84% vs 80%; χ² = 0.35; P = 0.58).DiscussionStudy results demonstrate that when tailored to reflect diagnosis-specific education, video discharge instructions can improve Spanish-speaking caregiver knowledge about discharge education compared with written and oral instructions alone. Videos can be integrated to standardize the ED discharge process as an adjunct to nurse-provided written and oral instructions with an interpreter for Spanish-speaking families.     

基于流程化沟通模式的健康教育对老年患者视频脑电图监测成功率及配合率的影响

目的对老年患者基于流程化沟通模式的健康教育下进行视频脑电图(VEEG)监测,探讨此模式对此类患者监测成功率及主动配合率的影响。方法选择2017年9月-2019年9月因疑似癫痫、脑炎等疾病需在遂宁市中心医院接受VEEG监测的患者118例进行研究(患者年龄61~73岁;男54例,女64例)。采用随机数字表法将患者分为2组,每组各59例。A组行常规护理,B组在此基础上加以基于流程化沟通模式的健康教育。对比两组患者监测成功率、负性情绪、主动配合率及护理满意度。结果B组脑电监测总成功效率为86.44%,显著高于A组的76.27%(P<0.05)。护理干预后两组患者焦虑、抑郁维度得分均显著下降,但B组下降幅度更大(P<0.05)。B组患者主动配合率、护理满意度均显著高于A组(P<0.05)。结论基于流程化沟通模式的健康教育较常规护理能显著提高老年患者VEEG监测成功率,缓解其负性情绪,提高主动配合率及护理满意度。     

颞叶癫痫发作间期PET-CT与VEEG检查对致癫灶的诊断价值比较

目的 比较分析颞叶癫痫发作间期正电子发射计算机断层显像（PET-CT）和视频脑电图（VEEG）检查对致癫灶的诊断价值。方法 回顾性分析2016年3月至2018年3月手术治疗的80例单侧颞叶癫痫的临床资料。另选取同期健康体检者30例作为对照。术前进行PET-CT和VEEG监测定位致痫灶，以术中监测结果为定位致痫灶的金标准。利用受试者工作特征（ROC）曲线评价PET-CT放射性分布不对称指数（AI）对颞叶癫痫致癫灶的诊断价值。结果 PET-CT、VEEG确定致癫灶的灵敏度分别为88.73%、47.89%，特异度分别为88.89%、66.67%。颞叶癫痫发作间期病灶侧AI显著高于非病灶侧（P<0.05），同时也显著高于健康体检者颞叶内侧AI（P<0.05）及颞叶外侧AI（P<0.05）。ROC曲线分析结果显示，AI=0.153诊断颞叶癫痫致癫灶的曲线下面积为0.730，95%置信区间在0.544~0.916。结论 颞叶癫痫发作间期PET-CT脑显像定位准确率优于VEEG，对手术治疗准确定位有很高的应用价值，且AI为0.153时诊断癫痫灶的效果最好。     

前庭性偏头痛的眼震视图表现及诊断价值

目的比较前庭性偏头痛(VM)和健康受试者的眼震视图(VNG)表现,明确VNG检查在VM中的诊断价值.方法前瞻性连续纳入2018年8月至2019年8月在新乡医学院附属人民医院神经内科就诊的VM患者55例和体检中心健康受试者45例,所有患者及健康受试者在条件允许下行VNG检查,包括视动性试验(扫视试验、平稳跟踪试验、视动性试验)、前庭功能试验(温度试验、摇头眼震)、自发性眼震、诱发性眼震检查(静态位置性试验).采用χ^2检验比较两组之间VNG结果的差异.结果VM组与健康受试者组之间人口统计学差异无统计学意义(均P>0.05).扫视试验:VM组有17例(30.9%)异常,健康受试者组异常例数3例(6.7%;χ^2=9.091,P<0.05);平稳跟踪实验:VM组异常20例(36.4%),健康受试者组异常5例(11.1%;χ^2=8.418,P<0.05);视动性眼震检查:VM组异常例数24例(43.6%),健康受试者组异常例数6例(13.3%;χ^2=10.823,P<0.05);温度试验:VM组有13例(23.6%)异常,健康受试者组中异常2例(3.6%;χ^2=7.150,P<0.05);摇头眼震:VM组有11例(20.0%)异常,健康受试者组异常2例(3.6%;χ^2=5.295,P<0.05);自发性眼震检查:VM组中异常10例(18.2%),健康受试者组异常4例(8.9%;χ^2=1.775,P>0.05);静态位置性眼震检查:VM组共有22例(40.0%)异常,健康受试者组中共有7例异常(16.5%;χ^2=7.183,P<0.05).结论VM组的总VNG检查异常率高于健康受试者组,说明VNG检查有助于VM的诊断,且其表现提示VM患者中枢及外周均有损害的迹象.     

Neonatal nurses’ perceptions of using live streaming video cameras to view infants in a regional NICU

Tertiary hospital services have introduced live streaming video cameras into Neonatal units with the aim of reducing distress and enhancing bonding and attachment between infants and parents during hospitalisation. However, there is a paucity of research exploring the impact of using live streaming video cameras in the neonatal unit. The aim of this study was to describe staff perceptions of using a live streaming video camera in a neonatal context. Quantitative and qualitative data were collected via an online questionnaire. While staff reported benefits for parents, concerns regarding increased workload and difficulties in using the technology were also reported. For this technology to be implemented as standard care, and to ensure nurses confidence in using it, it will be important to address these concerns. Working in collaboration with nurses who have daily and ongoing experience with the cameras in clinical practice is key to finding effective solutions for implementing live web streaming cameras into standard care.     

Créativité numérique et innovation thérapeutique : recréer un lieu de soin sur Minecraft

ObjectivesToday, video games are recognized as an excellent tool for therapeutic mediation with young children with Autism Spectrum Disorder (ASD), playing the role of a malleable medium facilitating the evolution of group dynamics and creating a play area between the child and the adult, a space of creativity and shared pleasure allowing them to “be together,” to communicate, and to enter into a secure and holding-type intersubjective relationship. This is why we wanted to maintain this type of treatment during the general lockdown imposed in France in March 2020.MethodWe set up a virtual activity based on the use of the video game Minecraft, after having reconstituted our outpatient clinic for children and adolescents on a private server. Following the end of the lockdown, we were able to experiment with two workshops: one face-to-face; and the other in video therapy.ResultsWe were able to observe similarities and differences in the use of this medium by our young ASD patients, but also in the way in which this treatment allowed us to “put a little institution” back into the daily lives of youth during lockdown. Thus, we were able to see that the content of the Minecraft game, and more specifically the reconstructed clinic, functioned as a space of holding for the adolescents. The comparison between the digital institution and the real institution was present throughout the session in the adolescents’ exploratory actions. However, they were never “tricked” by this virtual reality, each one considering this digital clinic as a simple simulation of the institution where they go for treatment.DiscussionIt should be noted, however, that this type of mediation is not the easiest to set up for a team of professionals. Indeed, we were confronted with certain difficulties, notably the amount of time required to recreate the clinic in the game, problems with the private servers, the quality of the hardware, and the extraordinary public health situation.ConclusionThis therapeutic workshop with digital mediation allowed the very early establishment of a group dynamic and of a group psychic envelope. Therapy sessions conducted in Minecraft allowed us to work on group dynamics, on the real and digital representations of a place of care, on the children's identity references (therapeutic groups, home, etc.), and on their capacity to play in a group. The adolescents enrolled were able to individually search for their own identity markers, according to their place in the institution. Finally, the Minecraft project allowed for the emergence of many interactions and shared emotions between the members of the therapeutic group (children and adults).