概念图教学法在妇产科护理学教学中的应用

[目的]探讨概念图在妇产科护理学教学中的应用方法及效果。[方法]在2009级40名护理本科英语方向(实验组)妇产科护理学教学中实施概念图教学策略,在2008级40名护理本科英语方向(对照组)中采用传统教学方法,比较两组在理论考试中相关试题的得分,并通过问卷调查了解实验组对概念图教学法的反馈情况。[结果]实验组期末考试中的案例分析题得分为18.31分±2.02分,对照组得分为14.73分±1.86分,两组比较差异有统计学意义(P0.01);实验组期末考试总分得分为77.28分±5.59分,对照组得分为73.69分±5.54分;对实验组的调查结果显示,95%学生认为概念图能促进本课程的学习,85%学生认为作图有困难,65%学生建议改进绘图方式方法。[结论]将概念图用于妇产科护理学教学可有效提高学生的成绩,促进其进行有意义的学习。     

护理学基础课程阶段性学习教学方法应用的效果

目的 探究护理学基础课程阶段性学习教学方法在护理专业本科学生不同学习阶段应用的效果.方法 选择2007级护理专业本科学生57名为试验组,将护理学基础课程学习分为3个阶段,应用阶段性学习教学方法;选择2006级护理专业本科学生59名为对照组,在护理学基础课程教学中,采用常规教学法.比较两组的教学效果.结果 在临床护理课程学习阶段(阶段2),试验组护理学基础知识和技能得分分别为(71.56±6.90)分和(91.35±5.24)分,对照组护理基础知识和基础技能得分分别为(62.05±9.63)分和(86.00±11.89)分,两组比较差异均有统计学意义(P均＜0.01).试验组毕业综合考核成绩(89.03±5.10)分,高于对照组(86.52±5.94)分(P＜0.05),其中在资料收集及病历书写、评判性思维方面得分高于对照组(P＜0.05).结论 护理学基础课程阶段性学习教学方法应用于临床护理课程学习中是行之有效的.     

系列化微课程联合案例教学法在外科护理临床见习教学中的应用

目的:分析《外科护理学》系列化微课程联合案例教学法在外科护理临床见习教学中的应用效果。方法:采用便利抽样方法,选取某临床医学院2016级、2017级护理高职护生为研究对象,分别作为对照组(30人)和干预组(30人)。在外科护理学临床见习期间,对照组采用案例教学方式,干预组采用系列化微课程联合案例教学法的模式,干预后对两组见习护生的自我导向学习能力、见习成绩、期末理论考试成绩以及护生对联合模式的态度进行测评。结果 :干预组护生自我导向学习能力评估总分(206.37±13.59)分及各维度得分(不含人际关系技能)均高于对照组的自我导向学习能力评估总分(194.14±12.34)分及各维度得分(P0.05);干预组的见习成绩(94.97±1.75)分高于对照组(93.93±1.39)分,且前者的期末理论考试成绩为(90.73±4.45)分,高于后者的期末成绩(86.00±4.99)分,差异有统计学意义(P0.05);干预组护生对《外科护理学》系列化微课程联合案例教学法的模式呈现积极认可的态度。结论 :《外科护理学》系列化微课程联合案例教学法有助于促进高职护生外科护理学的临床见习效果,能够提高高职护生的自我导向学习能力及学习兴趣,可进一步推广应用。     

概念图教学法在护理本科生临床教学实习中的应用

目的 探讨在护理本科生临床教学实习中应用概念图教学的方法与效果.方法 选择35名三年级护理本科生,在临床护理学课程“活动/休息”部分的临床教学实习过程中应用概念图教学法.教学结束后,采用自行设计的问卷评价学生对概念图教学法的态度及评价.结果 学生对概念图教学活动实施效果的评价和态度得分最低为(4.77+1.03)分,最高为(5.57-0.61)分.结论 概念图是有效的临床教学方法,学生对概念图教学法持肯定态度.     

概念图在儿科护理学教学中的应用

目的 探讨概念图在儿科护理学教学的应用方法及效果.方法 在2006级45名护理本科生(试验组)儿科护理学教学中实施概念图教学策略,在2005级35名护理本科生(对照组)中采用传统教学方法,比较两组在理论考试中相关试题的得分,并通过问卷调查了解试验组对概念图教学的反馈情况.结果 试验组理论考试中采用概念图教学的相关试题得分为(8.25±0.55)分,对照组得分为(7.68±0.47)分,两组比较差异有统计学意义(P<0.05).对试验组的调查结果显示,92.4%学生对概念图的使用较满意,88.4%学生认为概念图能促进护理专业课学习,82.1%学生认为做图有困难,55.6%学生建议改进绘图方式方法.结论 将概念图用于儿科护理学教学可有效提高学生的成绩,促进其进行有意义的学习.     

概念图在本科基础护理学教学中的应用研究

目的探讨概念图在护理本科基础护理学教学中的应用方法及效果。方法采用抽签法以班为单位将2011级护理本科生分为两组,一个班为试验组(151名),一个班为对照组(157名)。试验组在常规教学基础上应用概念图法,对照组接受常规教学方法。于基础护理学课程前后应用护理专业学生自主学习能力测评量表对所有学生进行测评,用自设概念图教学方法的反馈和评价表对试验组学生进行问卷调查。结果课程结束后,试验组学生自主学习能力总分及自我管理能力、学习合作能力、信息素质维度评分均高于对照组(P<0.01);试验组学生自主学习能力高于课程前(P<0.05)。试验组学生对概念图教学方法评价的各条目得分均>4分。结论在基础护理学教学中应用概念图有助于提高护理学生的自主学习能力,并得到学生认可。     

课前提问法在《外科护理学》教学中的应用

[目的]探讨课前提问法在<外科护理学>教学中的应用效果.[方法]应用方便抽样法选择我校2005级护理5班为实验组,6班为对照组.对照组采用传统授课方式,课前不提问,实验组采用课前提问法授课.[结果]实验组考试成绩明显高于对照组( P＜0.05);对课程的满意度明显高于对照组(P＜0.01).[结论]在<外科护理学>教学中采用课前提问法能提高学生学习兴趣、活跃课堂气氛、提高学生语言表达能力和心理素质.     

翻转课堂教学模式在康复护理学教学中的应用研究

[目的]探讨翻转课堂教学模式在康复护理学教学中的应用方法及效果。[方法]选取黑龙江中医药大学选修课康复护理学课程的学生,2015年学习课程的学生为对照组,采用传统教学法;2016年学习课程的学生为试验组,采用翻转课堂教学法。教学结束后,比较两组学生期末考试成绩总分和自主学习能力评分。[结果]试验组期末成绩(82.66分±5.25分)高于对照组(78.14分±4.24分),差异有统计学意义(P0.05);试验组学习动机、自我管理能力、合作能力维度得分及总分高于对照组(P0.05)。[结论]翻转课堂教学模式应用于康复护理学教学中,能有效提高学生成绩和自主学习能力。     

多形式案例教学法在耳鼻咽喉头颈外科护理教学中的应用

目的探讨多形式案例教学法在耳鼻咽喉头颈外科护理教学中的应用效果。方法选取本院实习护士50名作为研究对象,随机分为对照组和实验组,每组25人,采用双盲法对2组学生教学相同的内容,对照组采用传统的教学模式,即老师授课学生听课,实验组采用多形式案例教学进行教学,然后采用相同试卷对2组进行测试,包括笔试和操作,最后对2组护士进行评分。结果实验组得分为(89.20±6.35)分,对照组平均得分为(69.21±6.56)分,实验组成绩明显高于对照组,差异有统计学意义(P0.05)。结论多形式案例教学法可激发学生的学习兴趣,调动学生的学习积极性,提高教学质量,提高学习效果,值得临床推广。     

案例教学结合临床护理路径在《外科护理学》教学中的运用效果

目的评价案例教学结合临床护理路径在《外科护理学》课堂教学中的应用效果。方法选取护理专业的两个班级学生,干预组101名,对照组103名。干预组采用案例教学结合临床护理路径的教学法,对照组采用传统教学法。比较两组学生理论知识和操作技能考核成绩及自主学习能力情况。结果干预组学生理论知识和操作技能成绩优于对照组(P<0.05);干预组学生在自主学习能力总分及自我管理、学习合作、信息素质维度得分明显高于对照组(P<0.01或P<0.05)。结论通过案例教学结合临床护理路径在《外科护理学》课程中的运用,能够有效地提高学生的实践操作能力,同时提高了学生的自我管理和信息收集能力以及学习合作能力。     

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.