概念图教学法在五官科护理临床带教中的应用

[目的]探讨概念图教学法在五官科护理临床带教中的应用。[方法]将64名护生随机分为两组,观察组32名,对照组32名,对照组采用传统带教方法,观察组护生参与概念图教学法培训。采用"护理专业学生自主学习能力测评量表"评估护生干预前后自主学习能力,比较两组护生出科考核成绩。[结果]观察组护生干预后自主学习能力得分高于对照组;观察组出科考核成绩均优于对照组(P<0.05)。[结论]在五官科护理教学中应用概念图教学法,可激发护生学习兴趣,有效提高护生的实习效果。     

多元化教学法在心血管内科护理本科实习带教中的应用

[目的]探讨多元化教学法在心血管内科护理本科实习带教中的应用效果。[方法]选取2016年—2017年在心血管内科实习的92名护理本科实习生,按实习批次分为试验组和对照组,试验组采用多元化教学法,对照组采用传统带教法,比较两组护生的综合成绩,护生对实习带教的问卷调查以及对教学方法的评价。[结果]试验组理论知识、操作水平、授课能力及整体护理文书成绩均高于对照组,试验组护生对教学方法的评价高(P0.01)。[结论]多元化教学法能明确护理本科生的实习目标,提高护生最基本、最核心的胜任力,提高护生的语言表达能力、自主学习能力、人际沟通能力及临床应用能力。     

单元周教学法对提高护生自主学习能力的效果研究

目的探讨单元周教学法对护生自主学习能力的作用效果。方法采取整群抽样法,选取我院2013年6月—2014年5月期间实习的327名护理实习生作为观察组,选取我院2012年6月—2013年5月期间实习的309名护理实习生作为对照组,观察组实施单元周教学法,对照组按传统方式进行临床教学,比较两组护生学习动机与策略调查问卷得分、综合测评成绩及教学满意度得分。结果观察组护生在学习动机与策略问卷中"自我效能""内在价值""认知策略的使用"3个维度、综合测评成绩及教学满意度得分均高于对照组,差异有统计学意义(P<0.05)。结论单元周教学法能明显提高护生的内在学习驱动力,持续改进自主学习方法,促进护生自主学习能力的良性转变。     

PBL教学结合临床路径教学法在急诊护理本科实习生带教中的应用

目的:探讨PBL教学结合临床路径教学法在急诊护理本科实习生带教中的应用效果。方法:将2013年度和2014年度来我科实习的2010级和2011级第二军医大学护理本科生分为两组,2010级护理本科实习生25名为对照组,实施传统教学法带教,2011级护理本科实习生27名为试验组,实施PBL教学结合临床路径教学法带教,比较两组护生的理论成绩、专科技能水平及发现问题能力、分析问题能力、解决问题能力、沟通能力、求知欲。结果:两组护生在我科实习结束后的理论成绩、专科技能水平比较,试验组优于对照组,差异有统计学意义(P0.05);且试验组在发现问题、分析问题、解决问题方面的能力及对知识的求知欲等方面均优于对照组,差异有统计学意义(P0.05)。结论:实施PBL教学结合临床路径教学法对急诊护理本科实习生进行临床护理教学管理,可激发护生的求知欲,促使护生主动探索式学习,培养护生评判性思维能力,从而提高临床护理教学质量。     

基于疾病定义的概念图联合CBL教学模式在临床护生教学中的应用效果

目的 探讨基于疾病定义的概念图联合CBL(case based learning)教学模式在临床护生教学中的应用效果。 方法 将2016年7月—2017年3月在我院实习的大专护生设为试验组(86例);同期在我省同等级综合医院实习的大专护生设为对照组(86例)。试验组采用基于疾病定义的概念图联合CBL教学模式,对照组采用传统教学模式。比较2组护生实习前和实习结束时,对疾病的临床表现和疾病护理的掌握情况;并比较2组护生临床案例分析能力。 结果 实习结束时,试验组对疾病临床表现、疾病护理的掌握以及临床案例分析能力均明显优于对照组(t=-18.692,P<0.001; t=-20.770,P<0.001; t=-7.956,P<0.001)。 结论 基于疾病定义的概念图联合CBL教学模式能有效提高护生临床护理能力和疾病护理等知识掌握程度,值得在临床护生教学中推广应用。     

Kolb学习模型在护生人文关怀教学中的应用研究

目的 探索Kolb学习模型在护理实习生人文关怀能力培养中的应用效果。方法 以2019年6月和2020年6月进入昆山市中医医院临床实习的护生作为研究对象,其中2019年实习的护生109名为对照组,2020年实习的护生116名为观察组。观察组采取基于Kolb学习模型的人文关怀临床带教,对照组采取传统方法行人文关怀临床带教。实习结束时分别采用护生人文关怀量表和自主学习能力量表来测评两组护生的学习效果。结果 观察组护生人文关怀能力和自主学习能力各维度得分均高于对照组,差异具有统计学意义(P<0.01,P<0.05)。结论 Kolb学习模型应用于护生人文关怀教学中,可以提高护生人文关怀能力及自主学习能力,提升教学质量。     

概念图结合PBL教学法在护理带教中的应用

目的探讨概念图结合以问题为基础的学习方法(PBL)在临床护理带学中应用的效果。方法选取于2016年8月~12月在本科室实习的护生118人作为研究对象,分为实验组与对照组,实验组62人采用概念图结合PBL学习方法,对照组56人采用以问题为基础的学习方法。科室实习结束前,对两组护生进行自主学习能力评价及CM学习策略评价。结果实验组较对照组自主学习能力总分明显提高,差异有统计学意义(P0.05);实验组学生对该方法总体持肯定态度。结论概念图结合PBL教学法有利于提高学生自主学习能力。     

概念图在本科基础护理学教学中的应用研究

目的探讨概念图在护理本科基础护理学教学中的应用方法及效果。方法采用抽签法以班为单位将2011级护理本科生分为两组,一个班为试验组(151名),一个班为对照组(157名)。试验组在常规教学基础上应用概念图法,对照组接受常规教学方法。于基础护理学课程前后应用护理专业学生自主学习能力测评量表对所有学生进行测评,用自设概念图教学方法的反馈和评价表对试验组学生进行问卷调查。结果课程结束后,试验组学生自主学习能力总分及自我管理能力、学习合作能力、信息素质维度评分均高于对照组(P<0.01);试验组学生自主学习能力高于课程前(P<0.05)。试验组学生对概念图教学方法评价的各条目得分均>4分。结论在基础护理学教学中应用概念图有助于提高护理学生的自主学习能力,并得到学生认可。     

情景模拟教学法与案例学习法在护生自主学习能力培养中的效果

[目的]探讨情景模拟教学法在本科护生自主学习能力培养中的效果。[方法]将2012年8月—2013年4月在我院儿科实习的本科护生126名随机分为观察组和对照组。观察组采用情景模拟教学法,对照组采用案例教学法。两组护生实习后接受理论、护理技能考核,实习前后填写《护理专业学生自主学习能力》的问卷调查。[结果]观察组护生理论、护理技能成绩及优秀人数均明显高于对照组,差异有统计学意义(均P0.05),观察组护生在实习后自主学习能力高于对照组(P0.05)。[结论]情景模拟教学法较案例教学法更能提高本科护生的自主学习能力。     

反思性学习对本科实习护生临床沟通能力影响的研究

目的本研究旨在探索反思性学习能否改善本科实习护生的临床沟通能力。方法应用便利取样方法,选取2002级5年制本科实习护生60名作为研究对象,再按随机原则分成试验组和对照组各30名。对照组采用常规带教方法实习,试验组采用常规实习和反思性学习。观察6个月后,用《护生临床沟通能力测评量表》测量两组护生的临床沟通能力。结果两组护生在确认病人问题和验证感受两方面差异有统计学意义(P<0.001);在敏锐倾听和共同参与两方面差异有统计学意义(P<0.05);在建立和谐关系与传递有效信息两方面差异无统计学意义(P>0.05)。结论反思性学习能有效地改善本科实习护生高层次的临床沟通能力。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.