急诊科护理带教中存在的问题与对策

目的:分析急诊科带教存在的问题及相应对策,以提高急诊带教质量,使实习生能更好地服务于患者。方法:通过从轮转过急诊科的实习护生中随机发放自行设计问卷调查表100份,收回有效问卷100份进行统计分析。结果:从中发现急诊科带教存在的问题,并采取针对性强、有效的对策,使急诊带教质量得到了明显提高。结论:急诊科带教工作取得了满意的效果,受到教育学院和护生的一致好评,为今后的带教打下了良好的基础。     

基于循证思维的临床能力培养方案在急诊实习护生中的应用

目的:探讨基于循证思维的临床能力培养方案在急诊实习护生中的应用效果.方法:将急诊科实习的90名护理实习生采用随机数字表法分为对照组和观察组,每组45名.对照组进行常规临床带教,观察组基于循证思维对护生进行临床带教,共干预2个月.比较急诊科实习结束时两组护生的急诊临床能力水平、评判性思维、学习态度、学习主动性和临床带教满...     

临床路径教学法在急诊科护理带教中的应用

目的：探讨临床路径带教在急诊科护理实习生教学中的应用效果。方法选取2014年7~12月在我急诊科实习的护理实习生48名为对照组,实施传统方法带教;选取2015年1~6月来本院急诊科实习的护理实习生50名为实验组,按照临床路径对实习生进行带教。结果实验组护生的理论、操作水平、综合能力以及对带教教师的综合满意度均明显高于对照组( P<0.05)。结论临床路径带教可明确规范教学流程、教学目标,对提高急诊科护生的临床教学质量及教学满意度有重要意义。     

以问题为基础的教学法联合启发式护理教学在急诊科临床护理带教中的应用

目的：探讨以问题为基础的教学法(PBL)联合启发式护理教学在急诊科临床护理带教中的应用效果。方法：选取2017年1月1日～2021年6月1日在急诊科实习的82名高职护生,按照实习时间先后顺序分为对照组和观察组各41名,对照组实施启发式护理教学,观察组在对照组基础上实施PBL教学;比较两组带教前后自主学习能力、理论与实践考核成绩及对护理带教工作满意度评价。结果：带教后,两组自主学习能力、理论与实践考核成绩及对护理带教工作满意度均高于带教前(P<0.01),且观察组高于对照组(P<0.01)。结论：PBL是一种以学生为主题的带教模式,引导护生学习和思考,提高护生自主学习能力;启发式护理教学注重理论和实践的结合,借助现代化设备向护生展示急诊病房相关知识,循序渐进引导护生自主学习。两者联合教学有助于提高护生自主学习能力,促使护生提高临床实践能力及对理论知识的掌握,从而改善对护理带教工作的满意度。     

深化本科护理专业实习生临床教育的实践

目的探索改进本科护理专业实习生实习带教工作的方法，深化临床教育内涵。方法针对本科护理实习生的培养目标，从设置实习计划、营造良性实习环境、培养临床工作综合能力等方面人手，提高实习生的临床实践能力。结果本科护理实习生普遍认为带教计划安排全面，在实践过程中得到了充分的锻炼，动手能力和综合素质通过临床实习得到很大提高。结论通过改进临床带教工作，使本科护理专业实习生在医院实习过程中得到良好的锻炼，从而保证了护理本科人才培养目标的实现。     

小组带教模式在急诊护理带教中的应用

目的探讨小组式层级带教方法在急诊护理带教中的应用。方法2004年以后在急诊护理带教中逐步改进和完善小组带教模式。结果小组带教保证了急诊带教计划的落实,增强了科室对护士学生的实习管理,提高了护士学生的急救综合能力和临床工作能力。结论通过小组带教,灵活实施带教计划,使护士学生在急诊实习过程中,既有负责老师又有实习管理者带教,在有限的实习时间内适当地分配学习机会,使带教老师在提高综合工作能力的同时,也提高了急诊整体带教意识与能力。     

自动化流水线大规模应用下门诊检验实习生带教工作探讨

由于大规模自动化流水线的应用,五年制的医学检验学变成四年制的医学检验技术的改革,更加强调检验复合型人才的培养,但也暴露出许多问题。对仪器的依赖,实习生学习主动性不强、生物安全意识淡薄、操作技能生疏、缺乏质量控制意识和沟通意识等。为顺应教学改革的需要在临床带教中改进了一些方法,首先在实习生进入实习前进行岗前培训,让实习生熟悉环境,消除对全自动流水线的恐惧。引入以问题为基础的学习教学法(PBL),让实习生带着问题去学习,提高自主学习能动性。带教老师进行一对一的实习带教,制订个性化的学习培训计划和考核,提高实习生理论和实践水平。在带教老师示教下让实习生全程参与临床工作,增加实习生检验质量控制意识。经过这样的实习周期,可为实习生将来进入工作岗位打下扎实的基础。     

急诊科不同阶段实习生的带教体会

目的根据不同阶段进急诊科实习的学生特点,选择合理的带教方式进行临床教学,使学生在有限的实习期间获得最大临床实践知识。方法以完成教学大纲要求为前提,分3阶段进行,第1阶段(实习的第1至第3个月)以强化护理“基本功”和急诊专科技术的理论指导为主;第2阶段(实习的第4至第7个月)以护理“基本功”和专科技术实践并重;第3阶段(实习的第8至第10个月)以培养学生的综合分析能力和解决问题能力为主。结果合理的带教模式,能使不同阶段的实习生都有收获,临床教学满意度有较大的提高。     

推行实习生意见本 提高带教水平

我院承担着省内外十多所高校护理专业学生实习工作。为了更好地开展院内带教工作,充分调动带教老师的积极性,提高医院整体带教水平,我院护理部自2002年开始实施了“实习生意见本”监督机制。向进入医院相关科室实习的学生提供一个与实习单位沟通的平台,实习学生在实习过程中遇见的问题,通过“实习生意见本”及时与带教老师或科室护士长沟通,以获取解决对策。     

GCSPC 模式在临床检验基础实习带教中的应用研究

临床检验基础是医学检验专业一门重要的主干学科，涵盖体液、血液等常规检验及其形态学的基础检验，包含手工与自动化操作技能。遵义医学院附属医院医学检验科是“系科合一”统一管理的模式，培养学生能学以致用、掌握扎实的理论知识、初步具备临床工作能力是教学宗旨，每年接收来自全省各医学院校实习生，多年的实习带教积累了相当丰富的经验。但随着检验医学的迅速发展，仪器自动化程度提高，实验室认可工作的推行，新的理念的涌入，实习带教中存在如若干问题，鉴于存在的这些问题笔者提出了新的实习带教管理模式，     

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.