基于“导生制”的基础护理实训教学实践与思考

为培养护生自主学习能力,提高护生实践操作技能和教学质量,在基础护理实训教学中引入“导生制”。从构建导生选拔培养机制、导生带教方式、导生质量保障体系、激励机制、科学评价机制等方面,科学地实施新的实训教学模式。实践证明,“导生制”实训教学是一种积极有效的策略,以后可在实践性强的职业教育中推广应用。     

案例教学法在护理本科生临床教学中的应用及效果评价

[摘要]　目的　探讨案例教学法在护理本科生临床教学中的应用及效果。　方法　选取在大连医科大学附属第一医院循环内科实习的护理本科生80名为研究对象,随机分为试验组及对照组,每组40人。试验组采用案例教学模式进行临床带教,对照组采用传统教学法实施临床教学。实习期为10周,实习结束时对两组护生的理论及操作技能进行测试,并采用问卷调查法评价护生对教学方法的满意度。　结果　试验组护生理论成绩明显高于对照组（P＜0.01）,操作技能和对带教方法的满意度也明显优于对照组（P＜0.05）。　结论　案例教学法可以提高护生理论成绩和操作水平,并能提高其临床实践能力及综合素养,值得在临床护理教学中推广应用。     

“导生制”在护理学基础实训教学中的应用效果观察

目的探讨"导生制"在护理学基础实训教学中的应用效果。方法从2015级护理专业选择64名护生作为"导生",建立培训和监督机制,先由讲师团共同培训"导生",再由"导生"辅导2016级护理专业1班到8班的护生,教学结束后,对接受辅导的8个班护生、未接受辅导的8个班护生和"导生"分别进行理论和技能操作考核。结果 "导生"的理论和技能操作成绩优于接受辅导的护生(P<0.01),接受辅导的护生理论和技能操作成绩优于未接受辅导的护生(P<0.05)。结论"导生制"可提高护理学基础实训教学质量,还可提高护生自我学习和团结互助能力,"导生制"是一种积极有效的教学策略,值得推广。     

分层管理模式在临床护理带教中的运用效果观察

目的:分析分层管理模式在临床护理带教中的运用效果,旨在提高护理教学质量.方法:选取2011年1月-2011年6月在我院实习的84名护生,随机分为传统带教组和分层带教组,每组各42名,实习结束后对所有护生进行理论知识和操作技能考核及教学质量满意度问卷调查,比较两组的带教效果.结果:分层带教组护生的专科理论知识和专科操作技能的分数明显高于传统带教组,差异具有统计学意义(P＜0.05);分层带教组护生的对教学质量满意度明显高于传统带教组,差异具有统计学意义(P＜0.05).结论:分层管理模式在临床护理带教中,能明显提高教学质量,提高护生的满意度,值得推广和应用.     

循证护理在实习护生临床带教中的实践

目的探讨循证护理在实习护生临床带教中的应用效果。方法将100名实习护生随机分为两组,每组各50名,对照组采用传统的临床带教方法,实验组则采用循证护理教学方法。实习结束后比较两组的出科成绩。结果循证组出科考评成绩明显优于对照组,差异有统计学意义（P〈0.05）。结论循证护理教育激发实习护生的学习积极性和主动性,有助于护生综合素质的培养和整体护理水平的提高。     

精细化阶段式带教在急诊护理实习教学中的应用

目的 探讨精细化阶段式带教在急诊护理实习教学中的应用效果。方法 选取2015年6月至2015年7月在急诊轮转的实习护生65例作为对照组，采用传统临床带教模式；选取2015年8月至2015年9月在急诊轮转的实习护生68例作为实验组，按照精细化阶段式带教制定带教要求对护生进行临床实习带教。将两组护生行不同护理实习带教后的理论成绩、操作考核成绩进行对比分析，同时调查记录护生的带教满意分数。结果 实验组护生的理论知识成绩、操作考核成绩、带教满意分数均显著优于对照组，差异有统计学意义（P＜0.05）。结论 精细化阶段式带教有助于提高护生对急诊科护理知识掌握度和临床操作能力，并能够提升护生带教满意度，具有一定的推广价值。     

循证护理在内科护理本科生临床教学中的应用

目的:探讨循证护理的应用,对提高护理本科生临床护理能力及护理科研能力的作用. 方法:将02级50名进入内科临床实习的护理本科生随机分为对照组22人和实验组28人,对照组按原教学模式(即按护理常规实施护理带教),实验组按循证护理模式实施带教,实习结束时对两组护生进行综合技能考核和实习护理论文质量评分. 结果:实验组综合技能成绩及护理论文质量显著优于对照组(P＜0.05). 结论:应用循证护理模式带教有利于提高护理本科生临床护理能力和护理科研能力.     

目标教学在神经内科临床护理带教中的应用

目的:对神经内科临床护理带教中实施目标教学模式的价值进行研究.方法:研究以2016年度至2016年度进入该院神经内科实习的带教护生作对象,从中抽选10名随机分组:观察组5名护生带教中实施目标教学模式,而常规组5名护生则实施传统带教模式,于实习期正式结束后,对2组护生实操成绩以及理论成绩等进行评估与比较.结果:观察组5名护生实操成绩(94.22±5.17)分,常规组5名护生为(75.55±8.26)分,(P＜0.05);观察组理论成绩(98.00±2.00)分,常规组(80.25±5.28)分,(P＜0.05).结论:对于接受护理带教的神经内科护生,带教时选择实施目标教学模式,除了能提升其理论成绩外,还可以对其实操成绩有效提高,从而实现对带教水平的提升,便于获得更高的教学效果,可推广.     

情景式PBL教学在心血管内科带教的实践

目的：探讨情景式PBL教学在心血管内科带教的实践效果.方法：观察组和对照组分别采用情景式PBL教学和传统教学法.结果：观察组理论成绩、操作成绩和总分评价均显著高于对照组（P＜0.05）.观察组护生提高学习兴趣、主动学习、临床思维和沟通能力的效果优于对照组（P＜0.05）.结论：情景式PBL教学在心血管内科带教应用有效提高护生对护理理论和操作的掌握程度,并能调动护生学习积极性和主动性,提高临床教学质量.     

护理专业实习中核心能力教学模式的应用研究

目的在高职护理专业临床实习教学中进行核心能力教学模式的应用研究,以提高临床教学质量。方法将进入实习阶段的200名高职护理专业学生随机分为试验组和对照组,每组各100名。对照组采用传统的带教模式,试验组采用核心能力教学模式。结果两组护生的理论考试、技能考核成绩比较具有显著性差异（均P〈0．01）;自评问卷调查显示,两组护生在临床核心能力、临床护理能力等方面的提高有显著性差异（均P〈0．01）。结论在护理专业实习中应用核心能力教学模式教学效果优于传统教学模式。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.