案例学习结合情景模拟在护理实习生岗前技能培训中的应用

目的:探讨案例学习结合情景模拟在护理实习生岗前技能培训中的应用效果。方法:本次研究选取的对象为在我院实习的护理专业学生100名,按照培训方式的不同等分为观察组和对照组,对照组学生采用培训和考核各项护理技能操作的方法,观察组学生采用案例学习结合情景模拟的方式进行培训。对比两组护理实习生的各临床科室实习理论考核成绩和操作技能考核成绩以及带教老师对学生的综合评价。结果:观察组学生各临床科室实习理论考核成绩和操作技能考核成绩均高于对照组(P0.05),带教老师对观察组护理实习生的满意度高于对照组(P0.05)。结论:在护理实习生岗前技能培训中应用案例学习结合情景模拟教学法的效果较为理想,学生的综合能力得到了提高。     

综合性情景模拟演练在护生实习前护理培训中的应用研究

目的探讨综合性情景模拟训练对护理专业本科生在实习前护理培训中的应用效果。方法选取110名护理本科生为研究对象,分为对照组和观察组,各55名。观察组行综合性情景模拟训练,对照组行常规护理培训。培训结束后,比较2组学生的护理知识理论、护理技能掌握程度,并比较2组学生对于本次护理培训的满意度和认可度。结果观察组护理理论、护理技能考核均显著高于对照组(P0.05);观察组对于护理培训的满意度和认可度显著高于对照组(P0.05)。结论护理本科生实习前,接受综合性情景模拟培训,可有效提高其对于护理知识及技能的掌握程度,值得推广应用。     

高仿真模拟教学对护理本科生临床能力影响的研究

目的探讨高仿真模拟教学对护理本科生临床能力的影响。方法将实习前的60名护理本科生随机分为试验组和对照组,各30名,试验组采用高仿真模拟教学,对照组采用普通教学(案例讨论与护理技能操作训练),各培训20学时,并利用客观结构化临床考试(objective structured clinical examination,OSCE)分别在培训前后对学生进行考核。结果培训后,试验组的11项成绩比培训前均有提高(P<0.05);培训后,试验组在小组综合能力、护理问诊、护理体检、健康教育口试、职业态度考核成绩上高于对照组(P<0.05)。结论高仿真模拟教学可显著提高学生的临床能力,比普通教学具有优势。     

儿科护理应急预案演练在学生实习前培训中的应用

目的 探讨应急预案演练在培养学生儿科护理综合能力中的效果.方法 选择即将进入临床实习的高职护理专业2个班的学生,按照班级分为试验组和对照组.试验组62名,实习前培训采用儿科护理应急预案演练法;对照组60名,采用传统的教学方法.培训结束后,对两组学生进行儿科应急理论知识与技能考核,并调查临床带教教师对两组学生临床工作的综合评价,试验组学生接受应急预案演练培训后的自我评价.结果 试验组学生的儿科护理应急理论知识与技能考核成绩均优于对照组(P＜0.01),临床带教教师对其评价明显高于对照组,试验组学生自我评价较好.结论儿科护理应急预案演练能提高学生实习前培训的效果,亦可增强学生的团队合作能力,缓解学生的心理压力.     

以案例为导向的情景模拟教学法在急诊护理实习中的应用

[目的]探讨以案例为导向的情景模拟教学法在急诊护理实习中的应用效果。[方法]将在护理部进行培训的实习护生122人按照学号单双号分为观察组、对照组,每组61人。观察组实施以案例为导向的情景模拟教学法,对照组给予传统教学方式,比较两组实习护生理论知识和实践操作成绩、综合能力考核成绩,比较两组实习护生自主学习能力。[结果]护理实习结束后两组实习护生理论知识和实践操作技能考核成绩均较培训前显著提高(P0.01),且观察组明显高于对照组(P0.05)。实习结束后两组实习护生品德修行、工作态度、劳动纪律、医德学风、业务能力等得分均较培训前显著升高(P0.05或P0.01),且观察组各项评分均明显高于对照组(P0.05);实习护理结束后两组学习合作能力、学习动机、自我管理能力以及信息素质等得分均较培训前显著升高(P0.05),且观察组各项评分均明显高于对照组(P0.05)。[结论]对急诊护理实习生实施以案例为导向的情景模拟教学法可明显提高其自主学习能力,提高了其理论知识和实践操作成绩及急诊护理效果。     

视频结合情景模拟演练在危重症患者抢救培训中的效果评价危娟,王敏芳,欧淑仪,麦志晖,王昭丽

目的 探讨视频结合情景模拟演练在危重症患者抢救培训中的效果。方法 采用整群便利抽样方法,2015年接受危重症患者抢救培训的73名护士设为对照组;2016年接受此培训项目的68名护士为试验组。对照组采用传统培训模式,试验组采用视频结合情景模拟演练培训模式;比较培训后两组护士理论知识、技能操作成绩、综合能力和护士对培训的满意度。结果 试验组护士培训后理论知识、技能操作考核成绩,综合能力和护士对培训的满意度均高于对照组(p＜0.05)。结论 视频结合情景模拟演练培训模式得到护士普遍认可,对护士危重患症者抢救能力的提高效果明显。     

情景模拟教学法在护理专科学生外科营养护理实习中的应用

目的 探讨情景模拟在专科学生外科营养护理实习带教中的应用效果.方法 将菏泽市立医院实习的138名大专学生分为试验组和对照组,试验组采用情景模拟方法带教,对照组采用传统教学模式带教,比较两种方法的教学效果.结果 试验组学生理论知识、营养护理技能及综合操作能力考核成绩均高于对照组(P＜0.01);91.67％的学生愿意参与情景模拟演练;应用该教学方法能帮助学生更好地掌握营养护理操作(83.33％)、处理好护患关系(73.62％),对将来就业更有信心(80.55％).结论 情景模拟教学法能增强外科营养护理带教的教学效果,具有实用性,深受学生欢迎.     

PBL教学模式在护理本科生急诊实习中的应用效果

目的:探讨"以问题为基础的学习(PBL)"教学模式在护理本科生急诊实习中的应用效果。方法:以在急诊科实习的72名护理本科生为研究对象,随机分成对照组(n=36)和实验组(n=36),对照组采用"以授课为基础的学习(LBL)"教学法,实验组采用PBL教学法。比较两组学生理论考试、综合技能考核成绩,并调查学生对PBL教学法的认可程度及满意度。结果:实验组学生的理论考试、综合能力考核成绩明显好于对照组(P0.05),同时主观认可并乐于参与PBL教学。结论:PBL教学模式应用到护理本科生急诊实习中可以提高学生的临床综合能力,培养学生的学习兴趣,提高学生自主学习能力。     

学生标准化病人的培训及在社区护理实习教学中的应用

目的探索学生标准化病人的培训及在社区护理实习教学中的应用效果。方法把学生培训为标准化病人应用于社区护理实习进行情景模拟教学并与传统教学法进行比较,观察两种方法的教学效果的差异。结果试验组学生病人评价、专业实务综合笔试及实践能力考核成绩均高于对照组(P<0.001)。结论运用学生标准化病人进行情景模拟教学可提高学生社区护理的理论水平及临床操作能力。     

情景模拟演练在肝脏棘球蚴病临床护理带教中的应用

[目的]探讨情景模拟演练在肝脏棘球蚴病临床护理带教中的应用效果。[方法]将130名本科实习护生随机分为两组,对照组护生实施一对一传统临床带教,观察组护生实施一对一传统临床带教加情景模拟演练,出科时分别进行理论考试、临床技术操作考核和护理查房病例分析。[结果]观察组实习护生的理论考核成绩总分、临床技能考核成绩、护理查房病例分析成绩均优于对照组(P0.05)。[结论]情景模拟演练有利于提高实习护生的理论知识、操作技能、综合分析能力和应急水平。     

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.