护理本科生在临床实习中实施"双导师制"的实践与效果

[目的]对本科护生应用"双导师制"临床带教模式,旨在提高护生临床实习质量与综合素质.[方法]对2005年-2007年来院实习的68名护理本科生实施双导师制临床带教模式,并在实习结束时对其进行了临床综合能力考核评价和问卷调查.[结果]"双导师制"带教模式的护生在护理综合知识、护理技能操作、程序应用、护理管理等方面的综合素质明显提高.[结论]"双导师制"临床带教方法对稳定护生的专业思想、实习质量、培养护生的综合素质起着十分重要的作用.     

护理本科生在临床实习中实施"双导师制"的实践与效果

[目的]对本科护生应用"双导师制"临床带教模式,旨在提高护生临床实习质量与综合素质。[方法]对2005年—2007年来院实习的68名护理本科生实施双导师制临床带教模式,并在实习结束时对其进行了临床综合能力考核评价和问卷调查。[结果]"双导师制"带教模式的护生在护理综合知识、护理技能操作、程序应用、护理管理等方面的综合素质明显提高。[结论]"双导师制"临床带教方法对稳定护生的专业思想、实习质量、培养护生的综合素质起着十分重要的作用。     

多元化带教模式在内镜中心临床教学中的探讨

目的探讨腔镜中心实习护生带教方法及多元化带教模式在实习带教中的应用。方法采取整群抽样法,2012届120名实行传统带教方法的实习护士作为对照组,2013届120名实行多元化带教方法的实习护士作为对照组,实习最后一周由总带教老师考核护生的学习效果,并发放"实习护生满意度调查表"。结果多元化的带教模式得到了实习护生的大力认可,护生的操作技能考试成绩和理论测试成绩,以及对教学的满意度均显著高于传统教学法(P0.05)。结论多元化带教模式使临床带教更加规范化、科学化,能更好的提高临床教学质量,为日后培养内镜护理专科人才奠定了基础。     

改良临床路径教学模式在精神科护理带教中的应用效果

目的：评价将改良临床路径教学模式运用于精神科护理实习带教的效果。方法将在我院参加精神科实习的护生按入科时间分为对照组102名,干预组94名。对照组实施传统带教模式;干预组在此基础上引入改良临床路径带教模式,即参照临床路径模式,让护生参与制定教学路径,明确教学内容及目标。比较出科时两组护生的出科考成绩,老师及护生对彼此实习或教学表现的评价,以及教学双方对实习整体满意度的评价。结果干预组护生的出科考核成绩、护生或带教老师对实习或教学表现以及满意度评价均高于对照组,差异有统计学意义（ P＜0．01）。探索性因子分析得出两个因子,因子1：带教技能水平、师德师风、带教知识水平、理论得分、工作态度、操作得分;因子2：教学管理能力、护理查房得分、行为规范、学生对老师评价;总解释度为65．5％。结论临床路径模式可以规范精神科实习教学流程,明确教学内容及目标,提高带教效果,是一种值得推广的临床教学模式。     

WORLD模式在手术室护理实习带教中的应用及体会

目的 探讨WORLD模式在手术室护理实习带教中的应用效果及可行性,提高手术室护理实习带教质量.方法 将120名实习生随机分为常规带教组和WORLD模式带教组各60名,前者采用传统的"师徒式"带教模式,后者则包括与带教老师一起开展临床工作、观摩、研究相关课题、课外学习、走访其他辅助科室等5个部分.比较两组实习护生的考核成绩和对带教老师的评价.结果 WORLD模式带教组护生的考核成绩(包括技术操作、理论知识、科研能力)及对教师的评价均优于常规带教组,差异有统计学意义(P<0.05).结论 WORLD模式提高了手术室护理实习生的临床带教质量,护生综合素质得到了全面的培养,同时有利于带教师资临床、教学、科研水平的整体提升.     

PBL教学法在呼吸科临床护理教学查房中的应用

[目的]转变以"教师为中心"的带教模式,探讨呼吸科护生更有效的临床带教方法.[方法]2006年在我科实习的护生52人为实验组,实习期间采用以问题为基础的学习(PBL)带教法带教.2005年在我科实习的护生41人为对照组,实习期间采用传统模式带教方法带教.出科前对两组进行理论考试和整体护理考核.[结果]实验组在理论考试、整体护理考核等方面成绩明显高于对照组(P＜0.05).[结论]PBL带教法有利于护生各方面能力的培养,使学生更全面掌握呼吸科知识,有利于提高带教质量.     

医护结合模式在骨科护理临床带教中的应用

目的 评价骨科护理临床带教中医护结合带教模式应用的效果.方法 将2009年1月至2010年12月来骨科实习的护生80人按实习时间的先后分为传统护理带教组与医护结合带教组各40人分别进行临床带教.2组护生实习结束安排护理查房进行护理质量评估,对2组进行骨科理论和护理论文考核.结果 医护结合带教组护生骨科理论、护理评估、护理诊断、护理计划、护理目标、人文关怀、沟通协调、操作技能和护理论文等方面得分均显著高于传统护理带教组.结论 医护相结合的带教模式突破了传统护理带教方式,提高了护生的实习质量和综合素质,值得进一步研究和推广.     

临床护理带教程序化管理模式的建立与实施

目的 探讨程序化管理模式在临床护理带教工作中的应用效果.方法 设置对照组和观察组,对传统带教管理模式和程序化带教管理模式的效果进行比较.结果 经统计学处理和分析,实习护生对带教老师的综合满意度及带教科室对实习护生的综合评价结果观察组均高于对照组.结论 程序化临床护理带教模式,强化了带教及管理人员的责任,避免了因各种原因疏于对护生的带教和管理;实习护生在程序的引导下掌握学习的流程,避免了实习过程中的茫然和无序;充分调动了带教老师和实习护生的积极性,有利于教、学水平的同时提高.     

系统化整体护理带教模式在儿科病房中的应用

目的:探讨系统化整体护理带教模式在儿科病房中的应用效果。方法:将2010年1~6月在我科实习的30名护生作为对照组,采用传统带教模式;将2010年7~12月在我科实习的30名护生作为实验组,采用系统化整体护理带教模式,以"护理程序"为具体带教步骤进行带教。出科前由带教老师、患方对护生的实习效果进行10分制评价。结果:实验组护生的责任感、临床观察、沟通交流、护理动态文书书写、创新性思维、患方满意度得分均高于对照组(P<0.01)。结论:系统化整体护理带教模式提高了临床护理教学的质量,适应了新的护理模式,受到了护生和患方的认可。     

根据性格进行一对一护理配对带教模式的应用与探讨

目的 为了进一步提高临床护理教学质量，探索性格因素在一对一带教模式中的影响。方法 将2002年6月～2003年12月来妇产科实习的护生87人，根据性格进行配对带教，分4组型带教。护生实习结束前对配对带教模式进行择优选择，同时护生与带教老师之间进行相互测评，比较4种带教模式的差异性。结果 内向老师→内向护生一型与其他3型配对带教模式之间有统计学差异（P ＜ 0.05）。结论 临床带教中应尽量避免内向老师→内向护生配对模式，在带教过程中充分利用性格因素的互补作用，尽可能发挥带教老师和护生教与学的最大潜能，培养护生优秀的品格，提高护理实习质量。     

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.