中韩护理学研究生教育比较

通过与韩国护理学研究生教育基本情况、培养目标、培养类型、课程体系和课程设置的比较分析,指出建构护理硕士学位研究生培养模式和课程体系是我国护理教育亟待解决的问题;培养目标要具体化,并贯穿于课程设置中.建议在强化专业学位护理研究生培养模式和课程体系研究的同时,明确硕士学位护理研究生和临床护理专家的关系.     

护理硕士专业学位建设专题征文

<正>本刊拟于2016年刊出护理硕士专业学位建设专题报道,欢迎投稿。征文内容:(1)护理硕士专业学位的培养目标和培养模式;(2)护理硕士专业学位的课程设置;(3)护理学专业研究生指导教师的遴选标准及培养策略;(4)护理硕士专业学位培养的评价方法和标准;(5)护理专业硕士研究生教材建设;(6)护理专业硕士研究     

中医院校护理专业学位硕士研究生对其就读学位培养模式看法的质性研究

目的：护理专业学位硕士研究生对其目前所学学位培养模式中各个模块的看法。方法采用半结构式访谈,对11名护理学专业学位硕士进行访谈,将获得的资料用Colaizzi为主的现象学分析一般方法进行分析。结果将访谈结果按照培养模式分为招生条件、培养目标、培养方式、发展方向相关的4个主题。主题1：招生条件应该基于对临床的热爱程度;主题2：培养目标需基于专科护理方向更加明确细化;主题3：培养过程应体现专科特色且临床科研并重,主要包括（1）课程需基于中医特色与专科特色合理设置;（2）临床实践需要重视实践效果并标准化考核方式;（3）学位论文不应低于学术型但选题可偏向临床;（4）呼吁培养过程中消除“偏见”保证科研与临床并重;主题4：未来发展前景开阔,同时顾虑重重。结论对于护理学专业学位硕士研究生,招生条件上应该融入临床工作认同感;在培养目标上利用专科护士方向进行目标细化从而促进专科护士的衔接;在培养方式上,基于能力不断个性化课程设置同时标准化、统一化考核方式;未来发展上需要争取学校、医院、国家的全方位支持,以促进岗位设置的清晰化。     

我国护理专业学位硕士研究生培养现状分析

从招生及生源、培养目标、课程设置、研究方向、考核方式等方面对国内护理专业学位硕士研究生教育发展概况及存在的问题进行了阐述。认为应鼓励临床护士继续深造;构建科学合理、规范完整的护理专业化研究体系;加大重点专科建设,重视对临床护理专家的培养;加强国际合作与交流,促进我国护理学发展与国际接轨;高校应加强自身导师队伍建设,制定护理教育质量评价指标体系,完善专业学位硕士研究生的教育质量评估。     

我国护理专业学位硕士研究生培养现状分析

从招生及生源、培养目标、课程设置、研究方向、考核方式等方面对国内护理专业学位硕士研究生教育发展概况及存在的问题进行了阐述。认为应鼓励临床护士继续深造;构建科学合理、规范完整的护理专业化研究体系;加大重点专科建设,重视对临床护理专家的培养;加强国际合作与交流,促进我国护理学发展与国际接轨;高校应加强自身导师队伍建设,制定护理教育质量评价指标体系,完善专业学位硕士研究生的教育质量评估。     

护理硕士研究生专业学位与科学学位培养区别的质性研究

目的 探讨护理硕士研究生专业学位与科学学位培养模式的区别,为完善护理学科高级人才培养方案的制定提供参考依据.方法 应用质性研究的现象学方法,对在读护理硕士研究生、毕业生、护理硕士生导师及护理学院领导共24名进行半结构式访谈,并对访谈资料反复阅读、分析、编码、分类、提炼,最终得出主题.结果 通过访谈资料分析,提炼出专业学位与科学学位护理硕士研究生培养区别的4个主题.主题1:护理硕士研究生专业学位与科学学位的课程设置在理论学习方面是基本相同或近乎相似的.主题2:专业学位与科学学位在科研能力和临床实践能力要求上的不同是两者的主要区别.主题3:科学学位研究生的临床实践时间少于专业学位研究生.主题4:科学学位研究生的论文要求高于专业学位研究生.结论 我国专业学位和科学学位护理硕士研究生人才培养模式还处于初级阶段,需要通过更多的实践和探索,建立权威、统一的培养方案和考核体系,以培养具有高质量的护理人才.     

基于能力的护理硕士专业学位课程设置的初步研究

目的 以护理硕士专业学位研究生的培养能力为基础,探讨适宜的课程设置.方法 采用德尔菲法对30名专家进行函询.结果 经2轮函询后形成专家一致性意见,护理硕士专业学位研究生的培养能力主要有临床护理能力（100％）、护理科研能力（76.7％）、护理管理能力（76.7％）和护理教育能力（73.3％）,以此为基础设立英语、医学统计学、健康促进与疾病预防、护理科学研究等11门必修课和医事法与问题解析、职业风险防范等8门选修课,同时设有专科护理技术操作、分管患者整体护理等临床实践内容;86.7％的专家认为,专业学位课程应包含专科护士培训要求的内容.结论 护理硕士专业学位研究生课程应根据培养能力进行设置,并与专科护士课程相互衔接,临床实践在注重专科技术操作的同时要进行临床医疗实习.     

专科护士培养状况及其对专业学位硕士培养的启示

目的了解学员对专科护理课程的评价及其学习困难度,为制订专业学位硕士培养方案提供依据。方法采用便利抽样法,利用专科护理课程调查表,对参加专科护士培训的80名学员进行调查。结果全部学员认为设置专科护理理论课程是必要的,课程内容能体现专科特色,学员普遍对课程设置、课堂教学、临床教学及课程管理表示满意。课程难易度适中,有专科临床经验的学员学习困难相对较小。结论专科护理课程的设置及教学成效总体是满意的。建议护理硕士专业学位课程中应设置相应的专科护理课程,保证充足的学时数、足够的临床专科训练时间,并在学习专科护理课程前到相应临床专科轮科,采取学院导师与医院副导师(专科护士)集体指导的方式培养护理硕士专业学位研究生。     

某校护理学专业研究生课程改革成效的质性研究

目的了解我校护理学专业研究生对课程改革成效的反应和评价,为完善护理学专业研究生课程设置提供参考。方法对2007级—2010级15名研究生进行半结构访谈。结果学生对课程改革总体评价是好的,对增加中医护理评价好;对导师方向课表示满意;但希望在授课、选修课、师资力量等方面加以改善。结论通过注重专业课和研究方法论课程的设置与授课,增加不同学科的选修课比例,给学生更多的选课权利,提高师资力量,培养学生自主学习能力等,提高护理学专业研究生的教育质量。     

护理专业学位研究生临床能力培养的质性研究

[目的]探讨护理专业学位研究生临床能力培养的改进措施,以建立完善的培养方案和科学的考核指标体系.[方法]采用质性研究中的现象学研究法,对重庆医科大学护理专业学位研究生及在第一附属医院工作的护理毕业研究生、临床带教老师及管理者共20名进行半结构访谈.[结果]护理专业学位研究生的培养需明确方向,制定专科化的目标和临床实践计划;从临床实践能力、临床思维能力等6个方面完善培养内容;从考核的形式、时间和内容等方面制定临床能力考核指标体系.[结论]护理专业学位研究生的培养还处于探索阶段,应不断完善培养方案,构建统一、权威的临床能力考核体系,以保障培养质量,提升临床护理水平.     

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.