ECMO专科护士培训方案的构建

目的 构建体外膜肺氧合(ECMO)专科护士培训方案,为ECMO专科护士培养提供参考。方法 基于文献回顾、半结构式访谈,初步拟定ECMO专科护士培训方案初稿,采用德尔菲法对17名专家进行2轮函询。结果 2轮专家函询问卷回收率均为100%;专家权威系数为0.921;第2轮专家协调系数为0.235～0.400(均P<0.01)。最终形成ECMO专科护士培训目标11个,培训方案包括培训内容、培训方法、准入条件和考核评价4个一级指标、17个二级指标和86个三级指标。结论 ECMO专科护士培训方案可作为ECMO专科护士培养的参考。     

我国专科护士的相关问题分析

目的探讨我国专科护士的相关问题,以期为统一相关认识、促进行业发展提供参考。方法采用改良Delphi法,针对我国专科护士的概念、命名、角色定位和核心能力对31名专家进行2轮咨询。结果 2轮问卷回收率分别为96.9%和100%。专家熟悉系数0.82,判断系数0.87,权威系数0.85。所有问题形成一致性意见:命名宜为"专科护士",且其含义与"临床护理专家"不同(54.8%);概念是指在某专科领域具有一定的工作经历,经过该专科领域系统化的理论和实践培训,并通过考核获得医疗卫生行政部门认可的相应资格证书,能熟练运用专科护理知识和技术为服务对象提供专业化护理服务的注册护士(93.5%);角色定位包括专科护理提供者(100.0%)、教育/咨询者(100.0%)、沟通/协调者(96.8%)、研究者(83.9%);核心能力包括专业实践能力(100.0%)、教育/咨询能力(100.0%)、临床决策能力(96.8%)、沟通/协调能力(93.5%)、专业发展能力(90.3%)。结论我国专科护士的发展应遵循初级到高级的渐进过程,目前的专科护士尚不属于高级层次,但仍需承担部分研究者的角色。     

整复外科病房专科护士核心能力评价指标体系的构建

目的初步构建整复外科病房专科护士核心能力评价指标体系。方法通过查阅文献及讨论,构建出整复外科病房专科护士核心能力评价指标体系基本框架及调查问卷,运用德尔菲(Delphi)专家咨询法对22位整复外科医疗与护理专家进行二轮问卷咨询,应用层次分析法确立各级指标的权重。结果专家的判断系数(Cr)为0.923,熟悉程度系数(Cs)为0.800,权威系数(Ca)为0.861。确立整复外科病房专科护士核心能力评价指标包括5个一级指标、13个二级指标、60个三级指标。各级指标的协调系数分别为0.312、0.148和0.091,具有统计学意义(P0.05)。结论整复外科病房专科护士核心能力评价指标体系专家权威程度高,意见集中,研究结果科学可靠,为整复外科病房专科护士的培训、考核、能力评价提供了客观、科学、合理的依据和标准。     

医院感染控制专科护士培养模式的构建

目的构建适合感染控制专科护士的培养模式。方法采用德尔菲法对北京、广东、四川等5省市的25名感染控制及护理管理专家进行2轮专家咨询。结果 2轮专家咨询的问卷有效回收率分别为92.59%、100%,专家权威系数为0.91、0.93。第2轮咨询一、二、三级指标专家意见协调系数分别为0.120、0.301、0.445(均P0.05)。初步形成感染控制专科护士的培养模式指标体系,包括4个一级指标,19个二级指标和82个三级指标。结论专家积极性和权威程度高,研究结果可靠,可为我国感染控制专科护士的任用、培养、考核评价和资格认证提供理论基础。     

基于核心胜任力的疼痛治疗专科护士培训

目的 设计并评价基于核心胜任力的疼痛治疗专科护士培训课程。方法 参考疼痛管理核心胜任力跨专业专家共识,采用德尔菲法设置疼痛治疗专科护士培训课程。来自7个省40家医院的50名护士接受了3个月的理论和实践培训。比较培训前后疼痛知识和态度调查及临床疼痛知识测验得分,组织结业考核并调查学员的满意度。结果 49名学员完成结业考核和培训前后调查。学员的疼痛知识和态度调查平均答对率由57.54%提高至70.98%,临床疼痛知识测验平均答对率由52.53%提高至66.19%,结业考核成绩（82.75±2.93）分,学员对培训满意。理论课程需求满足程度、授课满意程度及临床实践满意度评分均>4分。结论 基于核心胜任力的疼痛治疗专科护士培训课程可以提高学员的疼痛知识水平和能力。     

运用Delphi法构建中医专科护士培训方案指标体系

目的 建立中医专科护士培训方案的指标体系,为中医专科护士规范化培训提供参考.方法 在文献回顾、专家访谈并结合临床实践经验的基础上形成指标体系草案,运用Delphi法对来自10个省市的19名护理专家进行2轮问卷咨询.结果 两轮问卷有效回收率分别为84.00％、90.48％,专家权威系数0.867.最终确立的方案包括4个一级指标、12个二级指标、36个三级指标,其重要性评分为3.68～4.89,变异系数为0.057～0.204.结论 研究结果具有可靠性、现实性和针对性,形成的指标体系对中医专科护士规范化培训的开展有指导作用.     

泌尿外科专科护士培训核心知识体系构建与应用效果

目的 构建泌尿外科专科护士培训核心知识体系,为泌尿外科专科护士培训提供参考。方法 以提高泌尿外科专科护士核心能力为导向,通过查阅文献、小组讨论,结合专科发展、专科护士培训经验,拟订泌尿外科专科护士培训核心知识体系初稿,采用德尔菲法对25名专家进行2轮函询。结果 两轮函询中问卷收回率分别为100%、96%;各项指标评价结果算术均数为4.17～5.00,满分频率为32%～100%,等级和为100～125;权威系数为0.938、0.946;专家意见和谐系数分别为0.182、0.209(P<0.001)。最终形成的泌尿外科专科护士培训核心知识体系包含7个一级指标、48个二级指标。并应用于第三届泌尿外科专科护士培训,培训后护士核心能力总分为（95.6±13.4）分,较培训前有显著提升（P<0.05）。结论 运用德尔菲法构建的泌尿外科专科护士培训核心知识体系具有科学性、权威性、实用性、有效性及重要性,可为泌尿外科专科护士规范化、同质化培训提供理论及实践依据。     

硕士学历护士规范化培训方案的构建

目的构建适用于硕士学历护士的规范化培训方案,为高学历护士规范化培训打下基础。方法基于胜任力理论,运用半结构访谈法及文献回顾法设计硕士学历护士规范化培训方案问卷,通过Delphi法对25名专家进行2轮专家函询,确立硕士学历护士规范化培训方案。结果硕士学历护士的规范化培训方案包括培训项目、培训内容、培训方式、考核方式4方面共70个条目。2轮函询专家积极系数分别为83%、100%,专家权威系数分别为0.783、0.869;肯德尔协调系数分别为0.276、0.302。结论本研究构建的硕士学历护士规范化培训方案有较高的专家认同度和可靠性,适用于硕士学历护士的培训;尚有待实践检验和进一步完善。     

心血管病专科护士胜任特征模型的构建

目的构建心血管病专科护士胜任特征模型,为心血管病专科护士的选拔、培训、考核提供依据。方法采用Delphi法对35名心血管病护理专家和医学专家进行2轮问卷函询,建立心血管病专科护士胜任特征模型。结果专家函询的权威系数为0.87,2轮函询问卷回收率分别为94.29%、96.97%,胜任特征族和胜任特征的协调系数分别为0.33、0.28。确定出知识族、技能族、角色能力族、个人特质族、动机族和价值观族6项胜任特征族和29项胜任特征的胜任特征模型。结论构建的心血管病专科护士胜任特征模型,专家意见集中,研究结果可信度高。     

盆底康复专科护士临床实践教学体系的构建

目的 为盆底康复专科护士临床教学基地制订同质化教学方案,以规范临床实践培训.方法 以专科护士核心能力为理论依据,通过查阅文献、半结构式访谈初步形成盆底康复专科护士临床实践教学体系条目池,采用德尔菲法对30名盆底康复护理、医疗、教育专家进行2轮专家函询,最终确定盆底康复专科护士临床实践教学体系的框架和内容.结果 2轮专家函询问卷有效回收率均为100％,专家权威程度为0.87,专家协调系数分别为0.347、0.442.根据专家咨询意见修订而成的临床实践教学体系包括一级指标4项、二级指标14项、三级指标51项.结论 盆底康复专科护士临床实践教学体系具有可靠性、合理性和实用性,可为盆底康复专科护士培训基地制订同质化教学方案提供参考,为临床实践阶段的教学评价提供依据.     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.