基于岗位胜任力的手术室低年资护士规范化培训指标的构建

目的 构建基于岗位胜任力的手术室低年资护士规范化培训指标，为手术室低年资护士培训和评价提供参考。方法 以岗位胜任力模型和国家《新入职护士培训大纲(试行)》为理论框架，结合手术室护理专科特点，通过文献回顾法、德尔菲专家函询法以及层次分析法，确定手术室低年资护士岗位胜任力培训各级指标及权重。结果 手术室低年资护士岗位胜任力评价指标体系包含专业知识、专业技能、专业能力和个人特质4项一级指标、11个二级指标和103个三级指标。2轮函询专家积极系数均为100%,意见提出率分别为45.83%和20.83%。专家权威系数分别为0.891和0.912,肯德尔协调系数为0.314～0.377(P<0.05)。结论 构建的基于岗位胜任力的手术室低年资护士规范化培训指标体系具有较高的科学性和可靠性，可为手术室低年资护士规范化培训和考核提供客观参考。     

基于岗位胜任力的低年资护士规范化培训大纲的构建

目的构建基于岗位胜任力的低年资护士规范化培训大纲。方法采用文献回顾、理论研究和小组讨论的研究方法,以岗位胜任力理论框架为指导,以低年资护士工作内容为导向初步构建培训大纲,再运用德尔菲法专家咨询最终确定大纲内容。结果两轮专家咨询的专家权威系数为0.85,培训项目与培训内容专家协调程度(变异系数)分别为0.032~0.188及0.043~0.236,构建的培训大纲包括10个培训项目及40项培训内容。结论构建的低年资护士规范化培训大纲,专家积极系数和权威程度较高,意见集中,咨询结果可靠,具有良好的科学性、实用性和可操作性,为临床低年资护士规范化培训提供理论依据。     

社区护士岗位胜任力评价指标体系的构建

[目的]构建一套科学、规范、可行的社区护士岗位胜任力评价指标体系。[方法]通过文献回顾和半结构式访谈初步构建社区护士岗位胜任力评价指标体系基础框架并制定专家咨询问卷,采用德尔菲法对22名专家进行2轮咨询。[结果]2轮咨询有效问卷回收率均为100%,专家权威系数为0.86,2轮咨询结果 Kendall和谐系数分别为0.287和0.632。构建的社区护士岗位胜任力评价指标体系涵盖一级指标4个、二级指标14个、三级指标35个;4个一级指标分别是知识、技能、能力、特征与品质。[结论]咨询专家参与的积极性和权威程度均高,函询意见的协调程度和可信度高。基于岗位胜任特征所构建的社区护士岗位胜任力评价指标体系可为社区护士的聘任、培训、评价及绩效考核提供参考依据。     

运用德尔菲法制定手术室低年资护士培训需求调查问卷

[目的]制定适合手术室护理工作特点的科学、实用、可行的"手术室低年资护士培训需求调查问卷".[方法]运用德尔菲法确定15名涉及手术室护理、护理教育、护理管理、流行病学调查、统计学等领域的专家权威性和培训需求问卷的内容与编排形式.[结果]专家权威程度系数为0.88;确定了28项手术室低年资护士培训需求问卷的条目,其专家认可度均>70%.[结论]经过3轮德尔菲法评价,修订并完善了手术室低年资护士培训需求调查问卷的内容,其指标具有较高的专家认可程度和一致性.     

基于岗位胜任力的达芬奇机器人手术室护士培训方案的构建

目的 构建科学、实用的机器人手术室护士培训方案。方法 以岗位胜任力为基础，通过文献回顾、小组讨论拟订达芬奇机器人手术室护士培训方案，采用德尔菲法对25名专家进行2轮专家咨询。结果 2轮专家咨询问卷有效回收率均为100%,2轮专家权威系数分别为0.932、0.942。最终确立的达芬奇机器人手术室护士培训方案包括准入条件、培训内容、培训方法、考核方法 4个部分，其中包含了17个二级条目，65个三级条目。结论 基于岗位胜任力的达芬奇机器人手术室护士培训方案构建过程科学、可靠，可为机器人手术室护士的培训提供借鉴。     

四川省三级医院手术室本科与大专学历低年资护士基于胜任力的临床培训需求调查

目的 了解手术室低年资护士基于胜任力的培训需求,为构建手术室低年资护士的临床教育模式提供依据.方法 采用通过德尔菲法制定的问卷对四川省综合性三级医院的178名手术室低年资护士进行培训需求调查,内容包括:专业发展与胜任力、专业知识与技能、相关专业知识的培训方式需求.结果 不同学历层次手术室护士在专业发展与胜任力维度中,对团队建设与管理、自我管理、论文写作等能力需求差异有统计学意义(P<0.05);在专业相关知识需求上,对手术配合技术与护理操作技术、医院感染预防与控制、手术室职业安全与防护、患者安全管理等需求差异有统计学意义;在培训方式需求上对聘请外院专家讲授、参加学习、交流座谈会、案例分析等需求差异有统计学意义.结论 手术室低年资护士对专科培训需求较高,且不同学历护士的需求间存在差异.对手术室低年资护士的专科知识和操作技能培训,应更多关注低年资护士的需求,在培训内容与形式上实行分层次按需培训,以取得良好的专业培训效果.     

手术室低年资护士在职培训模式的建立与实施

[目的]探讨医院手术室低年资护士在职培训的模式和方法.[方法]对低年资护士在岗前基础培训、临床专科培训、多样化的培训方式、严格考核评价四方面采取规范化培训.[结果]通过对低年资护士进行规范化培训,使其最终达到全面掌握并胜任手术室护理工作.[结论]通过对低年资护士进行在职培训,取得了满意的效果.     

新护士岗位核心胜任力评价指标体系的构建

[目的]构建一套新护士岗位核心胜任力评价指标体系。[方法]采用文献分析法、理论分析法和头脑风暴法初步构建新护士岗位核心胜任力评价指标体系,运用德尔菲(Delphi)法通过2轮专家咨询和论证确定评价指标体系;运用层次分析法和专家重要性赋值平均分配法确定各指标权重。[结果]2轮专家咨询的应答率均95%,专家权威程度系数(Cr)=0.89,一级、二级、三级指标的协调系数分别为0.21,0.19,0.21(均P0.01)。最终形成的新护士岗位核心胜任力指标体系包括职业态度、职业职责、职业知识、职业技能、职业规范、职业适应、职业教育7个一级指标,权重分别为0.098,0.126,0.177,0.216,0.145,0.119,0.119,17个二级指标权重为0.123~0.666。[结论]在岗位胜任力的理论框架指导下,构建新护士岗位核心胜任力评价指标体系,为新护士的培训与考核提供科学依据。本研究结果表明专家咨询代表性和可信度高。     

手术室专科护士胜任力指标的初步构建

目的构建手术室专科护士胜任力的指标。方法通过查阅文献、设计咨询问卷,选取三级甲等医院手术室护理、管理专家、临床外科医疗专家,以及赴港培训1年并取得中国香港医管局颁发的手术专科护士证书的广东省手术室专科护士等20名医护专家,进行Delphi法专家咨询,调查结果应用SPSS13．0进行统计学分析。结果2轮专家咨询后,其积极系数为100％、权威系数为0．79、协调系数为0．31（x。=37．09,P=0．000）,手术室专科护士的胜任力指标包括职业素质、专业态度、手术护理专业能力、手术室临床教学与培训能力、沟通协调能力、手术团队合作能力、个性特征7个一级指标以及责任心、主动性等26个二级指标。结论参与构建手术室专科护士胜任力指标的专家积极性高、代表性强、权威系数和协调系数好：Delphi专家咨询法等构建的7个一级指标和26个二级指标,可作为手术室专科护士的人员选拔、培训体系设置、考核标准制定及资格认证的参考依据。     

手术室低年资护士危急症护理核心能力评价体系的构建研究

目的构建手术室低年资护士危急症护理核心能力评价体系。方法采用自行设计的咨询表及德尔菲(Delphi)专家咨询法,选取广东医学院附属医院、湛江市中心医院、湛江市农垦医院、湛江市第二人民医院等临床护理专家、广东医学院护理学教授、统计学专家共32名进行调查。结果专家咨询的权威系数为0.771,熟悉系数为0.826,判断系数为0.764,经过2轮咨询后确定的手术室低年资护士危急症护理核心能力评价体系中,一级指标5条,二级指标16条,三级指标40条;专家咨询内部协调系数为0.716,Cronbach’sα系数为0.783。结论经过专家咨询及修改、删除、添加条目,手术室低年资护士危急症护理核心能力评价体系各级指标共有条目61条,经检验,结果可靠、信度较高,对手术室低年资护士危急症护理核心能力的考核、评价、培训提供量化的可参考依据。     

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.     

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.