护理本科实习生临床能力水平的调查研究

目的 了解临床带教老师对护理本科实习生临床能力的评价,为高等护理教育改革提供理论依据.方法 便利抽取6所护理本科院校中的314名护理本科实习生为研究对象,采用护理本科生临床能力评价量表对其进行调查.结果 护理本科实习生评判性思维能力、沟通交流与合作能力、整体护理能力、技能操作能力、护理教育能力得分相对较高;自主学习能力、护理科研能力和护理管理能力得分相对较低.结论 高等护理教育应不断优化课程设置、改革教学方法,以全面培养护理本科生的临床能力,尤其是自主学习能力、护理科研和护理管理能力.     

护理本科毕业生临床综合能力调查研究

[目的]调查本校护理本科毕业生的临床综合能力,为深化教育教学改革提供依据。[方法]使用护理本科毕业生临床综合能力调查表,对本校2005届—2013届108名护理本科毕业生及所在用人单位的60名护理管理者进行问卷调查。[结果]问卷总分为3.32分±0.46分,76.85%的毕业生完全达标,22.22%的毕业生基本达标,仅1名不达标,得分最高的是临床处置能力,然后依次是临床沟通能力、健康教育能力、职业心理素质、临床教学能力、临床管理能力,得分最低的是护理科研能力。[结论]本校护理本科毕业生的临床综合能力达到了培养目标,得到了用人单位的认可,在今后的教育教学改革中应不断加强学生护理科研能力、临床教学能力及临床管理能力的培养,以满足临床对本科护理人才的需求。     

护理本科毕业生临床综合能力调查研究1）

[目的]调查本校护理本科毕业生的临床综合能力,为深化教育教学改革提供依据。[方法]使用护理本科毕业生临床综合能力调查表,对本校2005届—2013届108名护理本科毕业生及所在用人单位的60名护理管理者进行问卷调查。[结果]问卷总分为3.32分±0.46分,76.85%的毕业生完全达标,22.22%的毕业生基本达标,仅1名不达标,得分最高的是临床处置能力,然后依次是临床沟通能力、健康教育能力、职业心理素质、临床教学能力、临床管理能力,得分最低的是护理科研能力。[结论]本校护理本科毕业生的临床综合能力达到了培养目标,得到了用人单位的认可,在今后的教育教学改革中应不断加强学生护理科研能力、临床教学能力及临床管理能力的培养,以满足临床对本科护理人才的需求。     

对护理本科毕业生工作能力的调查及评价

目的:了解护理本科毕业生的工作能力,以指导护理本科人才培养目标的确立和教学改革.方法:对76 名护理本科毕业生的用人单位进行毕业生工作能力总体评价问卷调查.调查内容涉及毕业生在临床护理、护理管理、护理教育等方面的能力.结果:被调查者认为本科毕业生中的61.9%已较好地具备了临床护理能力,90.5%具备了护理教育能力,仅有47.5%具备了护理管理和科研能力.结论:应进一步调整和完善护理本科生培养目标,在课程设置、教学内容、教学方法和手段方面还需加大改革力度,尤其需要提高学生科研和管理能力.     

上海交通大学护理本科毕业生临床能力的追踪调查

目的追踪调查上海交通大学四年制护理本科毕业生临床能力的现状,分析管理者他评与毕业生自评之间的差异,为提高毕业生临床能力、深化和完善教学改革指明方向。方法对2006～2010届97名护理本科四年制毕业生及其相应的85名主管领导进行问卷调查,包括毕业生一般资料问卷、毕业生临床能力的自评问卷及他评问卷。结果护理本科毕业生临床沟通能力、临床教学能力、职业心理素质各维度评分及其总分的他评得分高于自评(P<0.05);参与科研的毕业生临床能力的他评总分及各维度得分(除临床管理能力)高于未参与科研者(P<0.05);无离职意向的毕业生护理科研能力自评得分高于有意向者(P<0.05)。结论护理本科毕业生临床能力达到了学院的培养目标,并得到了用人单位认可;毕业生参与护理科研有助于临床能力提升,应不断加强学生科研和教学能力的培养,以满足临床对本科护理人才的期望。     

468名护理本科毕业生临床工作能力评价与分析

目的评价与分析护理专业本科毕业生的临床工作能力,为高等护理教育改革提供依据。方法采用方便抽样的方法,采用自制护理本科毕业生工作能力评价问卷,对468名本科毕业生所在的35所单位及护理管理者调查,评价护理本科生临床工作能力。结果35所用人单位的医院及护理管理者对护理专业本科毕业生的临床护理能力、护理教育能力及获取知识能力评价较高,对护理科研、创新能力、对外交流能力及促进专业发展能力等方面评价仍较薄弱。结论学校及用人单位应注重对本科生护理科研、创新能力、对外交流能力的培养。     

护理系本科毕业生工作能力与在校学习成绩的相关分析

对山东医科大学护理系85～91级117名本科毕业生进行问卷调查,以研究本科毕业生的工作能力与在校学习成绩的关系。工作能力分临床护理能力、护理管理能力、护理教育能力和护理科研能力四部分来衡量,学习成绩以毕业生在校总成绩的平均成绩为标准。结果表明毕业生整体工作能力与在校学习成绩明显相关,具体到各部分工作能力来说,除护理科研能力外,其余三部分工作能力也都与在校学习成绩有明显的相关性。根据研究结果得出,今后高等护理教育不仅要继续强化本科生基础知识与专业理论知识的教育,更要加强其科研能力的培养。     

护理本科毕业生质量追踪调查分析

[目的]追踪调查护理本科毕业生的质量。[方法]应用自制护理本科毕业生质量追踪调查问卷对护士及用人单位主管领导各130名进行调查。[结果]用人单位对毕业生专业能力、自主学习能力、人文素质评价较高;对教学能力、科研能力、管理能力评价较低;各方面他评得分高于自评(P0.05)。[结论]用人单位对护理本科毕业生的质量总体评价较高,但教学、科研及管理能力仍有待加强;毕业生对自身发展期望较高。     

云南地区本科护理人才质量评价及分析

[目的]了解云南地区本科护理人才质量培养现状,分析护理人才培养过程中存在的问题,为完善和优化本科护理人才培养方案提供依据。[方法]采用自行设计的问卷,调查昆明医科大学4家附属医院的146名护理工作者和昆明医科大学2015级、2016级的153名在读护理本科生。通过自评和他评的方式对云南地区护理本科生的综合能力进行评价,以了解护理本科生的人才质量培养情况。[结果]本科护理毕业生和专科护理毕业生综合能力总得分和各维度得分比较差异有统计学意义(P<0.05);在读护理本科生对自己综合能力的自评得分和附属医院护理人员对本科护理毕业生综合能力的他评得分在总分和7个维度得分都有统计学意义(P<0.05)。[结论]云南地区本科护理毕业生综合能力远优于专科护理毕业生,但本科护理毕业生的综合能力仍需进一步提高。建议鼓励护理人员参加继续教育学习,提升学历层次;建议高校注重护理本科生的科研素质培养,提高科研水平;建议规范临床实习带教管理,严格监管实习过程。     

用人单位对护理本科毕业生综合素质评价的调查研究

[目的]了解用人单位对我院护理本科毕业生综合素质的评价,为提出新的高等护理教育改革方案提供依据。[方法]自制调查问卷,对我院护理本科毕业生所在的用人单位进行问卷调查。[结果]用人单位认为我院护理本科毕业生具有良好的职业价值观、扎实的医学和护理学专业知识及技能,具有较好的职业沟通能力和人文素质;护理本科毕业生普遍存在的问题为科研能力有所欠缺、护理教学和管理能力尚显不足、创新意识薄弱。[结论]在教育观念、教学内容、教学方法等方面还需加大改革力度,尤其需要提高护理本科生的科研、教学、管理和创新能力。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.