低年资护士参与科内小讲课的实践

目的提高低年资护士学习效率。方法按时间段将2015年参加低年资护士培训的16人分为常规组,将2016年参加培训的28人分为观察组。常规组按常规方法由高年资护士及医生授课与示范操作;观察组将40%的基础护理内容交给低年资护士讲授与示范。结果观察组理论、操作技能考核成绩及护理质量评分显著高于常规组(P0.05,P0.01);观察组对低年资护士参与小讲课培训方式认可度为60.7%~100%。结论低年资护士参与临床小讲课可有效提高学习效率,从而提高其综合能力。     

角色模拟培训对儿科低年资护士人文素养的影响

目的 探索角色模拟培训提升儿科低年资护士人文素养的效果。 方法 将儿科工作时间≤3年的低年资护士59人随机分为对照组（n=29）和观察组（n=30）。对照组按年度常规培训计划进行人文关怀及沟通培训,观察组在对照组基础上,进行为期2个月共8次的角色模拟培训。培训前后采用人文关怀能力量表、临床护士沟通能力量表测评培训效果。 结果 培训后观察组人文关怀能力、沟通能力总分显著高于对照组（均P＜0.05）。 结论 对儿科低年资护士进行角色模拟培训,可以有效提升护士的人文关怀能力及临床沟通能力。     

手术室低年资护士应急协调能力的培训

目的提高手术室低年资护士应急协调能力。方法以深圳市手术室专业委员会制定的《深圳市手术室护士层级培训》内容为培训课程指南，应用多媒体专题讲座、情景模拟、实物操作演示、护理查房提问等培训方法，对手术室工作0～5年的护士进行常见急诊手术准备与接诊，急救技术，与医生、麻醉师、手术科室、供应室、后勤部门的沟通等内容的培训。结果培训3个月后低年资护士理论、模拟应急能力、实际应急能力测评成绩显著高于培训前（均P〈0．01）。结论系统、规范的应急能力培训课程及效果评价有助于低年资护士应急能力的提高。     

手术室低年资护士层级式核心能力培训的实施

目的探讨对手术室低年资护士实施层级式核心能力培训的效果,提高低年资护士的工作能力,提高手术工作质量,确保护理安全。方法参照广东省卫生厅《专业护士核心能力建设指南》,对28名低年资护士经自评及他评后定级为N1级,由N2级护士作为导师一对一负责带教,通过专科小讲课、护理查房、每季度专科轮转、每周自学的形式对低层级护士进行核心能力培训。结果培训后低年资护士专科理论、操作技能、消毒隔离、应急抢救、安全管理5项考核成绩显著高于培训前(P0.05,P0.01)。结论对手术室低年资护士实施层级式核心能力培训,可提高其核心能力,提高手术室护理质量。     

手术室低年资护士层级式核心能力培训的实施

目的探讨对手术室低年资护士实施层级式核心能力培训的效果,提高低年资护士的工作能力,提高手术工作质量,确保护理安全。方法参照广东省卫生厅《专业护士核心能力建设指南》,对28名低年资护士经自评及他评后定级为N1级,由N2级护士作为导师一对一负责带教,通过专科小讲课、护理查房、每季度专科轮转、每周自学的形式对低层级护士进行核心能力培训。结果培训后低年资护士专科理论、操作技能、消毒隔离、应急抢救、安全管理5项考核成绩显著高于培训前（P〈0.05,P〈0.01）。结论对手术室低年资护士实施层级式核心能力培训,可提高其核心能力,提高手术室护理质量。     

能级评估结合实训教学用于低年资护士静脉穿刺技能培训

目的 探讨能级评估结合实训教学法在低年资护士静脉穿刺技能培训中的应用效果.方法 将医院某科室16个病区低年资护士随机分为观察组(8个病区,76人),对照组(8个病区,84人).对照组采用常规临床培训方法;观察组先进行静脉穿刺能级评估,针对不同能级实施实验室和临床培训.结果 培训6个月后,观察组静脉穿刺技术水平和患者满意情况显著优于对照组(均P＜0.01).结论 能级评估结合实训教学能在较短时间内提高低年资护士的静脉穿刺技术水平,增强其临床工作信心,提高患者满意度.     

经验学习圈理论在低年资护士过敏性休克急救培训的应用

目的探讨经验学习圈理论在儿科低年资护士过敏性休克急救培训的应用效果。方法以病区为单位将儿科低年资护士111人分为对照组(50人)和实验组(61人)。对照组采用案例教学法组织培训,实验组采用经验学习圈理论指导下的培训模式,包括具体体验、反思观察、抽象概括、积极实践4个阶段。培训结束,组织理论与急救技能考核,并以问卷形式评价培训方法。结果实验组理论与急救技能成绩显著高于对照组(均P0.01);实验组对培训方法的评价总分显著高于对照组(均P0.01)。结论在儿科低年资护士过敏性休克急救培训中应用经验学习圈理论,可提高培训效果,且此培训方法受到低年资护士的肯定。     

案例题库培训法对低年资护士核心能力的影响

目的探讨以案例题库为基础的教学方法在低年资护士核心能力培训中的运用效果。方法在临床收集真实案例经过三轮审核组建护理案例题库,对35名工作3年内的低年资护士实施以案例题库为基础的多形式培训,培训前后评价其学习效果。结果培训后低年资护士核心能力自评及他评得分显著优于培训前(P0.05,P0.01)。结论以案例题库为基础的教学方法有助于提高低年资护士的核心能力。     

手术室低年资护士应急协调能力的培训

目的 提高手术室低年资护士应急协调能力.方法 以深圳市手术室专业委员会制定的<深圳市手术室护士层级培训>内容为培训课程指南,应用多媒体专题讲座、情景模拟、实物操作演示、护理查房提问等培训方法,对手术室工作0～5年的护士进行常见急诊手术准备与接诊,急救技术,与医生、麻醉师、手术科室、供应室、后勤部门的沟通等内容的培训.结果 培训3个月后低年资护士理论、模拟应急能力、实际应急能力测评成绩显著高于培训前(均P＜0.01).结论 系统、规范的应急能力培训课程及效果评价有助于低年资护士应急能力的提高.     

护理应急预案情景模拟教学病例编制与实践

目的提高低年资护士培训效果。方法收集近3年发生的护理应急事件目标病例,编制教学案例,对入院2年的58名低年资护士进行1个月情景教学后考核(晋级N1级)。结果考核均分107.2±8.2,其中专业实践能力得分率82.0%、专业知识得分率63.0%、分工合作得分率71.0%、沟通与交流得分率52.0%、病情观察及评估得分率62.0%、临床决策52.0%、评判性思维得分率45.0%。结论情景模拟教学有利于调动低年资护士学习积极性,提高专业培训效果。但评判性思维等还有待于在临床中更多地实践。     

网络化健康教育在口腔癌患者中的应用效果

目的 分析网络化健康教育在口腔癌患者中的应用效果。方法 选择2020年1月-2021年9月泰州市 人民医院收治的60例口腔癌患者为研究对象，采用随机数字表法分为对照组和观察组，每组30例。对照 组实施常规护理，观察组在对照组护理的基础上实施网络化健康教育，比较两组希望水平（HHI）、 自尊水平（SSES）及生活质量水平（UW-QOL）。结果 观察组HHI评分、SSES评分均高于对照组 （P＜0.05）；观察组术后1个月UW-QOL评分高于对照组（P＜0.05）。结论 网络化健康教育在口腔癌患 者中的应用效果确切，可提升患者的希望水平及自尊水平，有利于提高其术后生活质量，促进康复。     

原癌基因N33在增生性瘢痕中表达的研究

目的 探讨原癌基因N33在增生性瘢痕的形成与发展中基因分布特点与变化趋势。以及在增生性瘢痕中所起的作用及意义。方法 收集增生性瘢痕患者24例、非增生性瘢痕患者24例不同时期的标本，按伤后3、6、9、12个月分组编号。另设12例患者的正常皮肤作为对照组。利用原癌基因N33的基因特异片段制成寡核苷酸探针，与瘢痕组织切片和成纤维细胞爬片原位杂交。经统计学处理后，分析其变化规律。结果 早期增生性瘢痕中，N33基因的探针在组织细胞中有较强的阳性反应．而非增生瘢痕则阳性反应较低，正常皮肤组的阳性反应更少。经对所有标本的观察，增生性瘢痕3～6个月的N33表达，阳性细胞的数量、反应的着色程度，均明显强于9～12个月增生性瘢痕、非增生性瘢痕与正常皮肤组。将增生性瘢痕组与非增生性瘢痕组比较，两者差异有极显著意义。成纤维细胞爬片杂交结果与组织切片存在相同的结果。结论 瘢痕增生与细胞原癌基因及抑癌相关基因之间存在密切关系，而原癌基因N33起到十分重要的作用。同时，调节该基因的表达，有望减轻瘢痕的增生。     

Posttraumatic Reconstruction of the Ankle Using the Ilizarov Method

Reconstruction of the ankle after trauma requires a variety of treatment strategies. Once the personality of the problem is appreciated, a tailored approach may be implemented. The Ilizarov method provides a versatile, powerful, and safe approach. It is particularly useful in the setting of infection, bone loss, poor soft tissue envelope, leg length discrepancy, bony deformity, and joint contracture. In this article, a variety of posttraumatic ankle pathologies are discussed. Treatment methods including osteotomy, arthrodesis, distraction, correction of contracture, nonunion repair, and tibia and fibula lengthening are reviewed. The use of the Ilizarov method for acute and/or gradual correction as well as the application of simultaneous treatments at multiple levels is discussed in this article.     

The location of the inferior angle of the scapula in relation to the spinal level of prone patients

Background:

In two previous studies we established the mean location of the upright inferior angle of the scapula (IAS) to be near the spinous process of T8. The current study investigates the common belief that the prone IAS lines up with the T6 SP.

Methods:

The location of the IAS in relation to the spine of 20 mostly asymptomatic subjects was assessed on a Hi-Lo table in 7 different postures, 2 upright and 5 prone.

Results:

The scapula moved cephalad in two of the test positions: prone, arms at side and prone, chicken-wing. It moved caudad in the other 4 test positions, including prone, using armrest (18.4 mm).

Conclusions:

With the prone patient’s arms on the arm pieces, the most likely patient posture, the average caudad IAS movement is about one vertebral level, notwithstanding the common belief that the IAS is one level cephalad to the upright level.     

124. Gibt es Fortschritte in der Facialischirurgie?

Zusammenfassung Es wird über die Fortschritte bei der Chirurgie des N. facialis während der letzten 10 Jahre berichtet, unter kritischer Würdigung der verbesserten Ausrüstung, der Eingriffe am N. facialis im intrakraniellen, intratemporalen, facialen Verlauf, den neuromusculären Ersatzplastiken und den ergänzenden Maßnahmen.     

A Meta‐Analysis of the Prevalence of Influenza A H5N1 and H7N9 Infection in Birds

Despite a much higher rate of human influenza A (H7N9) infection compared to influenza A (H5N1), and the assumption that birds are the source of human infection, detection rates of H7N9 in birds are lower than those of H5N1. This raises a question about the role of birds in the spread and transmission of H7N9 to humans. We conducted a meta‐analysis of overall prevalence of H5N1 and H7N9 in different bird populations (domestic poultry, wild birds) and different environments (live bird markets, commercial poultry farms, wild habitats). The electronic database, Scopus, was searched for published papers, and Google was searched for country surveillance reports. A random effect meta‐analysis model was used to produce pooled estimates of the prevalence of H5N1 and H7N9 for various subcategories. A random effects logistic regression model was used to compare prevalence rates between H5N1 and H7N9. Both viruses have low prevalence across all bird populations. Significant differences in prevalence rates were observed in domestic birds, farm settings, for pathogen and antibody testing, and during routine surveillance. Random effects logistic regression analyses show that among domestic birds, the prevalence of H5N1 is 47.48 (95% CI: 17.15–133.13, P < 0.001) times higher than H7N9. In routine surveillance (where surveillance was not conducted in response to human infections or bird outbreaks), the prevalence of H5N1 is still higher than H7N9 with an OR of 43.02 (95% CI: 16.60–111.53, P < 0.001). H7N9 in humans has occurred at a rate approximately four times higher than H5N1, and for both infections, birds are postulated to be the source. Much lower rates of H7N9 in birds compared to H5N1 raise doubts about birds as the sole source of high rates of human H7N9 infection. Other sources of transmission of H7N9 need to be considered and explored.     

广义Green关系N、A与广义理想N(a)

定义了广义关系N和A以及主N理想N(a) ,并证明了N J A ,进而加细了Green关系 ,且给出了关系结构 :　　　　　　　　　　　　 　N　 　　　　B　　　　　　J A　　　　　　　 L　　　　 H　　 D 　　　　　　　 R     

The possibility of nervus ilioinguinalis and nervus iliohypogastricus injury in lower abdominal incisions and effects on hernia formation

AIM: The aim of this study was to determine the distances of nervus ilioinguinalis and nervus iliohypogastricus to McBurney's and paramedian incisions. MATERIALS AND METHODS: This study was performed on 12 adult cadavers. Right and left inguinal regions of the cadavers were dissected by inguinal incision. The points where the nerves perforated the internal obliquus muscles were determined, and the distances of these points to the spina iliaca anterior superior (SIAS) and to the umbilicus were measured. These distances were marked over a diagram, and distances of the nerves to McBurney's and paramedian incisions were measured by illustrating these incisions on the same diagram. FINDINGS: While the distance of the iliohypogastric nerve from the SIAS was 1.5-8 cm on the right and 2.3-3.6 cm on the left, the distance of the ilioinguinal nerve from the SIAS was 3-6.4 cm on the right and 2-5 cm on the left. The distance of the ilioinguinal nerve from McBurney's incision was 0.2-6.1 cm on the right and 1.8-7.5 cm on the left, and that of the iliohypogastric nerve was 2.2-6.9 cm on the right and 2.9-6.2 cm on the left. The distances of the nerves from paramedian incision were found to be 4.6-10 cm on the right and 6.4-11.2 cm on the left for the ilioinguinal nerve and 5-11.2 cm on the right and 7.4-11.6 cm on the left for the iliohypogastric nerve. CONCLUSION: Both nerves perforate the musculus obliquus internus, scattered in a wide area. Considering the distances, the paramedian incision seems to be more reliable with respect to the risk of nerve injury. Incisions performed in the lower abdomen carry the risk of injury to the ilioinguinal and iliohypogastric nerves.     

吸入氧化亚氮对大鼠耳蜗总RNA产量的影响

目的 通过检测氧化亚氮对大鼠耳蜗总RNA产量的影响，探讨氧化亚氮（N2O）对大鼠内耳损伤的机制。方法 将30只健康Wistar大鼠随机等分为3组：A组（对照组，n=10）持续吸入50％O2 3h；B组（实验组，n=10）持续吸入50％N2O＋50％O23h；C组（实验组，n=10）持续吸入50％N2O＋50％O26h。联用TRIzol和RNeasy法分别抽取3组大鼠耳蜗的总RNA，用分光光度法测总RNA的产量及电泳检测其质量。结果 A组大鼠耳蜗得到总RNA7．69μg；B组大鼠耳蜗得到总RNA6．51μg，与A组比较减少15％；C组大鼠耳蜗得到总RNA5．32μg，与A组比较减少31％。A260／A280值分别为2．07、2．04和2．05，提示RNA纯度高，电泳结果提示总RNA元降解。结论长时间吸入N2O的大鼠耳蜗总RNA较正常大鼠耳蜗总RNA产量降低，提示N2O干扰耳蜗RNA产量可能是造成耳损害的原因之一。     

重组血管内皮细胞生长因子在大肠杆菌的高效表达

目的:使重组血管内皮细胞生长因子(VEGF)在大肠杆菌中得到高效表达.方法:通过构建表达重组VEGF的质粒PRL621/VEGF,并在大肠杆菌中高效表达.结果:表达量约占菌体总蛋白的40%.对形成包含体的表达产物进行变性,初步复性处理,得到重组人VEGF粗提液,鸡胚绒毛尿囊膜试验表明有促血管生长活性,N-端15个氨基酸序列分析结果,与天然VEGF蛋白质相应序列一致.