免疫学教学中应用创新教学模式的实践探索

目的为提高免疫学课程的教学质量,加深学生对课程的理解,研究创新教学模式在免疫学教学中的应用效果。方法2019年2—6月,选取该校2017级临床专业学生227名,分别为1班115名,2班112名开展该次创新教学模式研究。1班学生进行创新教学模式上课,包括以问题为导向的(PBL)翻转教学模式、渗透愉悦教学模式以及科研促进教学模式等,2班学生进行以授课为导向(LBL)的传统教学模式。对比不同教学模式后两组学生的期末成绩、对课程的满意度、学习动力评分、记忆学习态度评分。结果1班学生期末成绩(83.78±5.36)分,2班学生期末成绩(78.69±5.23)分,1班学生期末成绩得分显著高于2班学生,差异有统计学意义(P<0.05);1班学生课程满意度、学习动力评分显著高于2班学生,差异有统计学意义(P<0.05);学习态度评分中,1班学生在课堂表现、作业完成度、课外自学三项评分均显著高于2班学生,差异有统计学意义(P<0.05)。结论在免疫学教学中,使用创新教学法可提高学生学习成绩,增加学生的学习动力,提高学习态度评分,使学生掌握免疫学基本理论及发展规律,创新教学模式在免疫学教学中应用效果较佳。     

A comparison of cognitive performance in binge versus regular chronic alcohol misusers.

One hundred cases of individuals assessed for alcohol-related cognitive performance were examined. The assessment included demographic and alcohol consumption data, as well as performance on tests of auditory verbal learning, memory, motor skills, general intellectual functioning, and visuospatial functioning. All participants regularly drank in excess of 10 standard drinks/session. Fifty cases were binge drinkers who consumed alcohol on 2 days/week or less and 50 cases were individuals who consumed alcohol daily. The two groups of drinkers were statistically matched on a number of demographic and misuse factors. The results indicated similar performance for both the binge drinkers and the regular drinkers in visuo-motor speed, visuo-spatial organization and planning, learning, proactive interference, retroactive interference, and retrieval efficiency. However, performance differences were observed on tasks that required semantic organizational ability, with binge drinkers performing better than regular drinkers on these tasks. Due to the differences in the cognitive performance of the two groups, it was concluded that drinking pattern is an important factor in investigating cognitive performance in alcoholics.     

What kind of motivation drives medical students' learning quests?

AIMS: To describe the patterns of medical students' motivation early in the undergraduate programme and to examine their relationships with learning features and motivational outcomes. METHODS: The Academic Motivation Scale (AMS) was administered after the first medical year to 297 students of both sexes from consecutive classes within a 4-year timeframe. Measures of learner orientation and reflection in learning were also obtained. Academic achievement and peer tutoring experience were recorded during a 2-year follow-up. Quantitative approaches included analysis of variance, correlational and classificatory analyses of the data. RESULTS: The profile of the students' responses revealed higher levels of autonomous motivation than of controlled motivation although such measures were positively related. Correlation analysis showed significant association of autonomous motivation with higher levels of meaning orientation, reflection in learning, academic achievement, cross-year peer-tutoring experience, and intention to continue with studies. Classificatory analysis identified 4 student groups with distinct patterns of motivation. Analysis of variance revealed significant and consistent differences in learning features and outcomes among such groups. CONCLUSIONS: The findings indicate that medical students portray distinct patterns of autonomous and controlled motivation that seem to relate to the learners' frame of mind towards learning as well as the educational environment. Autonomous motivation had closer relationships than controlled motivation with measures of self-regulation of learning and academic success in the context of a demanding medical programme.     

Studer Unplugged: Identifying Underlying Managerial Concepts

There is evidence that the application of Quint Studer's Hardwiring Excellence approach to organizational change is associated with significant accomplishments in hospitals. The authors’ review finds the Studer approach to be closely aligned with management-related concepts of motivation and feedback, social networks, human capital, social capital, management by objectives, evidence based management, and organizational learning. The article is intended to familiarize more managers and management researchers with the content of the Studer approach, demonstrate its grounding in management concepts and principles, and stimulate additional discussion around the utility of such human resources-focused interventions in significant organizational change.     

Effectiveness of training on the community skills of children with intellectual disabilities

Background: Children with intellectual disabilities often have difficulties in daily tasks, requiring training to increase functional independence. This study measured the effectiveness of community skills training in a telephone task and a shopping task, and examined if community-based training was more effective than classroom-based training. Material and methods: A randomized control trial with 40 children aged 9–11years was completed. Intervention groups attended an eight-week training programme; the control group received no treatment. One intervention group practised skills in local shops. All participants were assessed before and after treatment in a shopping task and telephone task, using task analysis methodology. Results: Data showed a highly statistically significant difference between intervention and control groups in the shopping task (p=0.007); however, there was no significant difference between classroom and classroom supplemented by community-based learning in the shopping task. There was no significant difference between the intervention and control groups in the telephone task. Conclusion: Results suggested that skills training was effective in one of the skill areas with this client group. Further research is required to determine if community-based training is more effective than classroom-based learning.     

Efficacy of an assessment instrument to measure affective and cognitive learning domains of students enrolled in food or nutrition courses

The purpose of the project was to evaluate the feasibility of using a public domain instrument, the Motivated Strategies for Learning Questionnaire (MSLQ), to assess affective and cognitive learning domains among volunteer students ( n =44) enrolled in food and nutrition courses. Using SAS and alpha 0.01, significant Pearson's Product Moment Correlation Coefficients were calculated between the MSLQ scale, intrinsic motivation, and the following MSLQ scales: task value ( r =0.55), metacognition ( r =0.5) and time management ( r =0.54). Correlations between task value and metacognition, students' effort, rehearsal or elaboration learning strategies were r =0.48, 0.51, 0.55 and 0.58, respectively. Correlations between students' effort and time management, metacognition and sense of self-efficacy were r =0.71, 0.73 and 0.48, respectively. Significant inverse correlations were identified between students' fear of tests and their sense of self-efficacy ( r =−0.50) or the effort expended to master learning ( r =−0.40). Multiple regression analysis revealed that a three predictor variable model including metacognition, peer help and seeking help from the instructor explained 51.6% of the variance in scores of the first course exam ( F =14.22, P =0.0001). Educators need to consider how cognitive and affective differences in learning processes influence curricular and instructional decisions in human nutrition and dietetics.     

护士长在神经内科绩效考核中的管理职能分析

在医院管理系统中,最主要的管理岗位中包括护士长职务,护士长面临的任务和承担的责任在临床管理中发挥着及其重要的作用,其作用有利于建立良好与和谐的科室,护士长在绩效考核中发挥着管理职能,保证科室能够正常运转。绩效考核可以提升护理工作质量和水平,提高患者满意度,从多方面满足患者的需求,激发护理人员的创新性、工作潜能、自主学习能力、提高护理人员的上进心。通过绩效考核鼓励护理人员工作的积极性,提高工作效率,使其保持良好的工作状态。同时,为护理人员创造了公平、公正、公开的竞争平台,并且还能调动每个护理人员的工作积极性和主动性,从而提高患者及患者家属的满意度,护理人员的综合素质得到提高。在该次研究中,研究护士长在神经内科绩效考核中的管理职能,为医院同行提供更多的参考意见。     

The Motivated Strategies for Learning Questionnaire: score validity among medicine residents

Medical Education 2011: 45 : 1230–1240 Context The Motivated Strategies for Learning Questionnaire (MSLQ) purports to measure motivation using the expectancy‐value model. Although it is widely used in other fields, this instrument has received little study in health professions education. Objectives The purpose of this study was to evaluate the validity of MSLQ scores. Methods We conducted a validity study evaluating the relationships of MSLQ scores to other variables and their internal structure (reliability and factor analysis). Participants included 210 internal medicine and family medicine residents participating in a web‐based course on ambulatory medicine at an academic medical centre. Measurements included pre‐course MSLQ scores, pre‐ and post‐module motivation surveys, post‐module knowledge test and post‐module Instructional Materials Motivation Survey (IMMS) scores. Results Internal consistency was universally high for all MSLQ items together (Cronbach’s α = 0.93) and for each domain (α ≥ 0.67). Total MSLQ scores showed statistically significant positive associations with post‐test knowledge scores. For example, a 1‐point rise in total MSLQ score was associated with a 4.4% increase in post‐test scores (β = 4.4; p < 0.0001). Total MSLQ scores showed moderately strong, statistically significant associations with several other measures of effort, motivation and satisfaction. Scores on MSLQ domains demonstrated associations that generally aligned with our hypotheses. Self‐efficacy and control of learning belief scores demonstrated the strongest domain‐specific relationships with knowledge scores (β = 2.9 for both). Confirmatory factor analysis showed a borderline model fit. Follow‐up exploratory factor analysis revealed the scores of five factors (self‐efficacy, intrinsic interest, test anxiety, extrinsic goals, attribution) demonstrated psychometric and predictive properties similar to those of the original scales. Conclusions Scores on the MSLQ are reliable and predict meaningful outcomes. However, the factor structure suggests a simplified model might better fit the empiric data. Future research might consider how assessing and responding to motivation could enhance learning.     

PDCA循环管理在手术室护理带教中的应用价值

目的探讨PDCA循环管理在手术室护理带教中的应用效果。方法选取2017年9月-2018年10月在该院手术室实习带教护生86名,按照随机数表法分成两组,各43名,对照组采取常规带教方式,观察组应用PDCA循环管理,对比两组护生学习效果。结果观察组护生理论成绩和实践操作成绩明显高于对照组,差异有统计学意义(P<0.05),观察组患者对护生的满意度为95.34%、老师对护生以及患者对护生的满意度为97.67%高于对照组的76.74%、81.39%,差异有统计学意义(P<0.05)。结论 PDCA循环管理在手术室护理带教中的应用效果显著,使可提高护生的理论成绩和实践操作成绩,值得推广。     

PBL和LBI双轨教学模式在妇产科护理教学中的应用研究

目的探讨PBL和LBI双轨教学模式在妇产科护理教学中的应用效果。方法从2017—2019年该院护理专业在读学生中选择170名,以随机原则分成两组,即观察组(组内包含85名学生)和对照组(组内包含85名学生)。观察组学生在常规教学模式下实施妇产科护理教学,观察组学生则采取PBL和LBI双轨教学模式实施妇产科护理教学。结果观察组学生的理论成绩、护理操作成绩、护理病案书写考核成绩、理论实践综合能力考核成绩,都明显比对照组学生更高,组间比较差异有统计学意义(P<0.05)。观察组学生的学习积极性(96.47%),明显比对照组学生(80.00%)更高,组间比较差异有统计学意义(P<0.05)。观察组学生在课堂师生互动、激发学习兴趣、提高自学能力、提高解决问题能力、增强团队协作能力、增强个人成就感等方面的认可度,都明显比对照组学生更高,组间比较差异有统计学意义(P<0.05)。结论应用PBL和LBI双轨教学模式开展妇产科护理教学,能够显著提高教学质量,最大程度上激发学生的学习积极性,不仅能够有效提高学生的理论知识水平和护理操作水平,同时还能够提高学生的护理病案书写水平,在此基础上提高学生对妇产科临床护理教学的认可度。     

健康指导员及健康责任员对社区慢性病健康管理研究

目的探讨一种适合社区慢性病持续、有效健康管理模式。方法实施健康指导员及健康责任员对社区慢性病健康管理一年,将慢性病规范化管理率及高血压、糖尿病控制率前后一年进行对比分析、评价其效果。结果经一年实施健康指导员及健康责任员对社区慢性病健康管理后,慢性病规范管理率、高血压及糖尿病控制率显著上升(p<0.01)。有统计学意义。结论以健康指导员及健康责任员对社区慢性病进行健康管理,慢性病规范管理率、高血压及糖尿病控制率显著上升。证明健康指导员及健康责任员对社区慢性病进行健康管理的模式是可行、持续及有效。     

大一学生学习动机自主学习能力与学业成绩满意度的关系研究

目的 探讨大一学生学习动机、自主学习能力与学业成绩满意度之间的关系。方法 采用大学生学习动机量表、自主学习能力量表和学业成绩满意度自我评定量表对随机抽取的284名大一学生进行调查。结果 284名大一学生学习动机均分(12.6±10.2)、自主学习能力均分(255.9±37.0)、学业成绩满意度(3.1±0.9),大一学生学习动机、自主学习能力与学业满意度均无性别、学科差异(P＞0.05)。大一学生学习动机总分与自主学习能力总分呈正相关(r=0.396,P＜0.01)、与学业成绩满意度总分呈正相关(r=0.299,P＜0.01);自主学习能力总分与学业成绩满意度呈正相关(r=0.547,P＜0.01)。大一学生学习动机中的认识因子能有效预测学业成绩满意度(t=3.232,P＜0.01),自主学习能力中学习动机因素(t=2.054,P＜0.05)、学习过程因子(t=2.731,P＜0.01)能有效预测学业成绩满意度。结论 认识、学习动机和学习过程能有效预测大一学生的学业成绩满意度。     

神经内科护理人员对脑卒中康复护理认知状况及对策分析

目的分析神经内科护理人员对脑卒中康复护理认知状况,探讨管理对策。方法研究选择该院神经外科共有护理人员28名,对2017年度护理人员对脑卒中康复护理认知状进行分析,对相关因素进行多因素分析。结果通过对2017年度调查表的分析,护理人员康复护理相关知识掌握评分,康复护理态度评分,发现工作年限、职称、婚姻状况是影响护理人员对脑卒中康复护理认知、态度的因素,统计比较差异有统计学意义(P<0.05)。结论重视神经内科护理人员对脑卒中康复护理认知状况,落实高效管理对策,能够增加护理人员康复护理认知程度,强化护理技能,是对患者良好预后的重要保障。     

Abstinence Education for Urban Youth

Teen sexual problems in the U.S. are reaching enormous proportions. Attempts to prevent common problems, pregnancy and sexually transmitted diseases, are underway through the persistent efforts of community, health, academic and government organizations. Abstinence education is one of the current attempts. However, the lack of well defined theoretical frameworks and analyses of outcomes have limited progress in the study of abstinence education. This article describes a pilot program in abstinence-only education provided to six groups of young teens within an urban middle school. The framework for the program, cognitive social learning theory, is described and operationalized. Student pretest-posttest attitudes, open-ended written comments about the program and the researchers' anecdotes about behavioral changes in the students are the outcome measures. Positive attitudes about premarital abstinence increased for all six groups; for four of the six groups the increase was statistically significant.     

The effects of knowledge management on surgeon behavior

Knowledge management is an important process for health care researchers and administrators. The way we manage and transfer knowledge in an organization can have a substantial impact on behavior and performance. In this article, we examine the behavioral effects of transferring performance-efficiency knowledge to a group of hospital-based surgeons. We observe the way the knowledge transfer impacts their sense of professional accountability and practice patterns for a limited set of diagnoses. We defined performance efficiency for a surgeon as the deviation from expected average length of inpatient hospital stay, and from expected average hospital charges (adjusted for risk and outcomes) for three of the most frequently performed and most costly surgical procedures in our subject hospital. We communicated knowledge of their performance efficiency to the group of hospital-based surgeons, along with benchmarked professional best practices, and included an identification of dimensions where performance could be improved. We then measured and compared their performance efficiency one year later. We did observe differences in performance efficiency, but not in consistent directions, and not in statistically significant magnitudes. Also, surgeons who initially had low levels of efficiency continued to have low levels of efficiency one year later. Within a professional accountability system, transfer of performance-efficiency knowledge alone did not provide sufficient motivation to induce consistent, significant change in practice behaviors among the group of surgeons. We conclude that medical opinion leaders and individualized strategies for surgeon motivation may have greater promise for improving performance efficiency if linked to the knowledge transfer system.     

精细化管理在感染科护理安全管理中的应用

目的分析探讨感染科护理安全管理工作中精细化管理的应用效果。方法采取随机数字表法将该院在2018年1月-2019年1月收治的128例感染科患者分成两个不同的组别,每组64例;对照组给予常规护理安全管理方法 ,观察组则在护理安全管理工作中渗透精细化管理理念方法,比较两组护理管理效果。结果观察组术后进食时间、下床活动时间、住院时间,均明显短于对照组,两组数据差异有统计学意义(t=12.358、11.287、5.263,P<0.05)。在护理管理风险事件总发生率方面,观察组的3.13%,和对照组的26.56%比较明显更低,两组数据差异有统计学意义(χ^2=11.256,P<0.05)。在护理管理服务总满意程度方面,观察组的96.88%,和对照组的62.50%比较明显更高,两组数据差异有统计学意义(χ^2=11.468,P<0.05)。结论感染科护理安全管理工作中,精细化管理理念方法的应用,可提高护理管理质量,降低护理管理风险事件发生率,提高患者对护理管理服务的满意程度;因此,值得采纳及应用。     

A psychological approach to learning causal networks

We examine the role of a common cognitive heuristic in unsupervised learning of Bayesian probability networks from data. Human beings perceive a larger association between causal than diagnostic relationships. This psychological principal can be used to orient the arcs within Bayesian networks by prohibiting the direction that is less predictive. The heuristic increased predictive accuracy by an average of 0.51 % percent, a small amount. It also increased total agreement between different network learning algorithms (Max Spanning Tree, Taboo, EQ, SopLeq, and Taboo Order) by 25 %. Prior to use of the heuristic, the multiple raters Kappa between the algorithms was 0.60 (95 % confidence interval, CI, from 0.53 to 0.67) indicating moderate agreement among the networks learned through different algorithms. After the use of the heuristic, the multiple raters Kappa was 0.85 (95 % CI from 0.78 to 0.92). There was a statistically significant increase in agreement between the five algorithms (alpha <?0.05). These data suggest that the heuristic increased agreement between networks learned through use of different algorithms, without loss of predictive accuracy. Additional research is needed to see if findings persist in other data sets and to explain why a heuristic used by humans could improve construct validity of mathematical algorithms.     

Diagnostic ability of medical students in relation to their learning characteristics and preclinical background

Is the diagnostic ability of medical students — as appraised by the Diagnostic Thinking Inventory (DTI) — influenced by the learners’ characteristics, or the way they acquired basic knowledge? This question was explored in a 4-year consecutive sampling of clinical clerkship students. DTI inventory scores (flexibility in thinking and structure in memory), learners’ characteristics (learning style, self-confidence as a learner, and motivation to learn), together with knowledge scores (grade-point average and problem-solving test) were measured and analysed for their relationships and the differences between groups. Results revealed that higher scores of the DTI measures were associated with students’ high self-confidence, high motivation to learn, and abstract learning types. Correlation coefficients showed significant relationships between the DTI scores and both knowledge measures. In addition, t-tests showed that students with an integrated teaching background and problem-based learning (PBL) experience obtained significantly higher scores for structure in memory. The findings suggest that the inventory scores are sensitive to both cognitive and non-cognitive factors. The inventory may be useful in detecting subtle influences on diagnostic ability differentiation in medical students.     

抗菌药物综合干预管理的研究

目的运用综合干预措施对临床使用抗菌药物进行管理,为合理应用和管理抗菌药物提供科学依据。方法从2004年起采取强化医院感染知识的宣传,制定抗菌药物的使用率及费用比的量化标准,制定抗菌药物合理使用制度等干预措施,并对干预前后的使用率、费用进行调查。结果干预前后抗菌药物使用率、手术患者抗菌药物使用率差异有统计学意义。结论运用综合干预措施对临床抗菌药物的使用进行管理,降低了抗菌药物使用率,提高了临床医生合理使用抗菌药物的自觉性。     

医院保洁人员医疗废物管理认知水平的调查与分析

目的通过对培训前后保洁员医疗废物管理认知水平的调查,了解培训所产生的效果,为加强医疗废物管理提拱依据。方珐对6家医院402名保洁人员进行培训前后2次问卷调查。结果（1）培训后保洁人员对医疗废物管理认知水平有了明显的提高,培训起到明显的效果,差异有统计学意义。（2）培训后保洁人员发生利器刺伤事件明显下降,由培训前的98．51％降至76．87％,差异有统计学意义（x2=87．19,P〈0．05）：能正确处理皮肤伤口人员由培训前23．38％增加到70．40％,差异有统计学意义（X2=225．59,P〈O．05）。（3）培训后对医疗废物管理现状评价为“好”的增加到39．30%,“差”的降至10．70％,差异有统计学意义（X2=69．05,P〈0．05）。结论经培训后保洁人员对医疗废物管理认知水平明显提高。