高职护生评判性思维能力与自我效能感的相关性研究

目的 分析高职护生评判性思维能力和自我效能感之间的相关性.方法 利用评判性思维态度倾向性调查表-中文版和一般自我效能感量表调查128名正在实习的高职护生.结果 高职护生评判性思维能力总平均分为(274.30±36.30)分;自我效能感总分为(22.23±4.75)分.护生自我效能感与评判性思维总分、分析能力、系统化能力...     

高职护生学业自我效能现状及影响因素

[目的]探讨护理高职护生学业自我效能现状及影响因素,为护理教育者更好地开展教学,提高护生自我效能和学习成绩提供依据。[方法]采用学业自我效能感量表对1 282名高职护生进行学业自我效能及其影响因素调查。[结果]高职护生学业自我效能感总分为74.712分±8.795分,学习能力自我效能、学习行为自我效能得分分别为38.243分±5.405分、36.470分±4.388分;经济状况、性别、年龄、专业是高职护生学业自我效能的影响因素(P0.05)。[结论]高职护生的学业自我效能有待进一步提高,可采取多种针对性措施提高高职护生学业自我效能水平,从而提高其学业成就。     

1482名专科护生专业态度与学业自我效能感的相关性分析

目的了解专科护生专业态度与学业自我效能感的现状,探讨两者的相关性。方法采用整群抽样法,于2018年5—6月抽取某医学高等专科学校1 482名专科护生,采用一般情况调查表、护理专业学生专业态度量表和学业自我效能感量表对其进行问卷调查。结果 1 482名专科护生专业态度总分为(108.05±11.50)分,各维度得分分别为:专业发展(22.26±3.84)分、对科学知识的贡献(21.48±4.32)分、合作性(18.24±2.43)分、伦理准则和理论(12.82±1.73)分、护理自主性(12.73±1.77)分、继续教育(13.55±1.67)分、社区服务(6.98±1.43)分;学业自我效能感总分为(77.61±9.94)分,各维度得分分别为:学习能力自我效能(39.42±6.05)分、学习行为自我效能(38.18±4.98)分。专科护生专业态度与学业自我效能感总分呈密切正相关(r=0.414,P0.01)。结论专科护生专业态度和学业自我效能感得分均处于中等偏上水平;专科护生专业态度与学业自我效能感呈密切正相关。建议高职院校护理教育者采用叙事教育、实体课与网络课相结合的教学模式、增加见习课时,并且在见习带教中实施双导师制带教,培养护生积极的专业态度,提高学业自我效能感。     

应对方式在护生一般自我效能感与评判性思维间的中介效应

目的:探讨大专护生应对方式在一般自我效能感和评判性思维间的中介效应,尝试以新视角为提高护生评判性思维能力提供理论依据。方法:采用一般自我效能感量表、评判性思维量表和简易应对方式量表对435名大专护生进行调查。结果:大专护生评判性思维总分(283.01±34.54)分,其中47.36%的护生评判性思维未达到正性水平,强评判性思维者仅占0.46%;大专护生一般自我效能感和应对方式均可直接正向预测其评判性思维;一般自我效能感还以应对方式为中介变量间接正向预测评判性思维。结论:自我效能感和应对方式对大专护生的评判性思维具有良好的预测效果,培养良好的自我效能感和积极的应对方式是提高评判性思维能力的有效途径。     

临床护理带教老师评判性思维能力与自我效能感的相关分析

目的了解临床护理带教老师评判性思维能力与自我效能感的现状及两者的相关性。方法采用中文版加利福尼亚评判性思维能力测量表、一般自我效能感量表对222名临床护理带教老师进行问卷调查。结果临床护理带教老师的评判性思维能力总分为(299.55±27.62)分;自我效能感总分为(2.48±0.45)分。自我效能感与评判性思维能力总分、寻求真相、分析能力、系统化能力、评判性思维的自信心、求知欲、认知成熟度均呈正相关(P0.01)。结论临床护理带教老师评判性思维能力和自我效能感总体水平不高,护理管理者应意识到两者的重要性及相关性,积极采取相应的措施,从而不断提升临床护理工作水平及教学质量。     

专科护生人格倾向和自我效能对评判性思维的预测作用

[目的]探讨专科护生人格倾向和自我效能对评判性思维的预测作用.[方法]采用评判性思维量表、艾森克人格问卷和一般自我效能量表对368名专科护生进行调查.[结果]专科护生评判性思维总分为(277.99±28.23)分,51.90％的护生评判性思维未达到正性水平,强评判性思维者仅占0.27％;评判性思维总分与内外倾呈正相关(P＜0.01),与神经质和精神质呈负相关(P＜0.01);评判性思维总分与一般自我效能呈正相关(P＜0.01).回归分析显示,内外倾、神经质和自我效能是评判性思维良好的预测因子(P＜0.01).[结论]人格倾向和自我效能对专科护生的评判性思维具有良好的预测作用,护理教育者应根据护生人格特征和自我效能培养评判性思维能力.     

大专护生学习适应与心理健康状况、学业自我效能感的关系

[目的]探讨高职大专护生学习适应与心理健康状况、学业自我效能感的关系。[方法]采用分层整群抽样法,抽取高职大专护理专业学生432名,采用学习适应量表、症状自评量表(SCL-90)和学业自我效能感量表进行调查,分析学习适应性与心理健康状况、学业自我效能感的关系。[结果]不同年级、不同专业兴趣、父母不同关心程度的高职大专护生学习适应性存在显著差异(P0.01);学习适应量表各维度得分和总分与SCL-90的10个因子得分及总分呈负相关(P0.01);学习适应量表各维度得分和总分与学业自我效能感总分和2个维度得分呈正相关(P0.01)。[结论]心理健康状况、学业自我效能感是影响高职大专护生学习适应的重要因素。     

民办院校护理专业教育环境、护生专业自我概念及评判性思维能力的相关性研究

[目的]调查民办院校本科护生所处的护理专业教育环境、护生专业自我概念及评判性思维能力的现状并分析三者间的相关性。[方法]选取湖南省长沙市某民办医学院校大学一年级到四年级527名本科护生,采用医学教育环境测量量表、护理专业自我概念量表、评判性思维能力测量表进行调查。[结果]护理专业教育环境量表总分为(2.55±0.67)分,护生专业自我概念量表总分为(2.78±0.28)分,评判性思维能力测量表总分为(3.85±0.42)分,三者均处于中等水平,三者的相关系数介于0.266~0.433(P0.01)。[结论]民办院校护理专业教育环境与护生专业自我概念及评判性思维能力的形成与发展密切相关,应注意加强护理专业教育环境的建设,从而提升护生的专业自我概念及其评判性思维能力。     

在校护生学业自我效能感与职业决策自我效能的相关性研究

[目的]调查在校护生学业自我效能感和职业决策效能的现状,并分析其相关性。[方法]选取湖南省某医学院校护生712名,采用学业自我效能感量表和护生职业决策自我效能量表进行调查。[结果]学业自我效能感得分为(72.79±13.95)分,处于中等水平;护生职业决策自我效能得分为(129.43±29.01)分,处于较低水平;护生的学业自我效能感与职业决策效能呈正相关(P0.01)。[结论]在校护生学业自我效能感与职业决策自我效能密切相关,二者相互促进,医学院校可开展学业自我效能感训练来提升护生的职业决策自我效能。     

一般自我效能感和心理健康对护生评判性思维的预测作用

目的探讨大专护生一般自我效能感和心理健康对评判性思维的预测作用。方法采用评判性思维量表、SCL-90症状自评量表和一般自我效能感量表对524名大专护生进行调查分析。结果大专护生评判性思维总分为(283.93±34.26)分,其中47.33%的护生评判性思维未达到正性水平,强评判性思维者仅占0.38%;除躯体化和敌对两个因子外,大专护生SCL-90各因子得分均高于国内成人常模(P<0.01)。评判性思维总分与一般自我效能感呈正相关(P<0.01),与SCL-90总均分呈负相关(P<0.01)。回归分析显示:一般自我效能感可正向预测评判性思维,而焦虑和阳性症状可负向预测评判性思维,三者共解释总变量的32.4%。结论一般自我效能感和心理健康对大专护生的评判性思维具有良好的预测效果,培养良好的自我效能感和心理状况,是提高评判性思维的有效途径。     

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.     

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.