《护理学基础》多元化考核评价体系改革研究

[目的]探讨《护理学基础》多元化考核评价体系的实施效果及其对护理专业学生批判性思维和自主学习能力的影响。[方法]以潍坊医学院护理学院本科2009级170名学生作为对照组,2010级129名学生作为试验组,对照组采用传统考核评价体系,试验组采用多元化考核评价体系。[结果]试验组考核体系满意度、实施效果、自主学习能力、考核成绩均高于对照组,差异有统计学意义(P0.05),试验组中文版加利福尼亚评判性思维倾向测量表(CTDI-CV)总分高于对照组,但差异无统计学意义(P0.05)。[结论]多元化考核评价体系优于传统考核评价体系,有助于护生学习成绩及学习能力的综合提高。     

“鱼缸”教学法在神经系统疾病物理治疗实践教学中的应用

目的：探讨“鱼缸”教学法在神经系统疾病物理治疗实践教学中的应用效果。方法：选择44名康复治疗专业学生,随机分为2组各22名。其中观察组采用“鱼缸”教学法,对照组采取PBL教学法。结果：2个月后,观察组在理论和实践考核方面的成绩明显优于对照组（P＜0.05）。观察组实习生在调动学习积极性、提高学习能力、培养临床推理思维、培养批判性思维、提高团队协作能力、提高自身整体能力以及教学满意度这七个方面显著优于对照组（P＜0.05）,2组在提高医患沟通能力、提高师生互动沟通能力、加强理论与实践更好结合这3个方面比较差异无统计学意义。结论：“鱼缸”教学法可显著提升神经系统疾病物理治疗实践教学效果,但仍需不断总结完善以更好地在临床教学中推广应用。     

PBL教学法在护理本科生批判性思维能力培养中的应用效果评价

[目的]探讨以问题为导向的教学方法(PBL)对护理本科生批判性思维能力的影响。[方法]将113名护理本科生随机分为实验组57名和对照组56名,实验组采取PBL教学法,对照组采取传统教学法。实验前后采用中文版批判性思维能力测量表(Critical Thinking Disposition Inventory-Chinese version,CTDI-CV)对两组学生的批判性思维能力进行评价。[结果]教学后实验组学生批判性思维的开放思想、分析能力、系统化能力、批判性思维的自信心及批判性思维能力总分均高于对照组,差异有统计学意义(P0.05),且实验组进行自身前后对照总分和各维度均具有统计学差异(P0.05)。[结论]PBL教学法对护理本科生批判性思维能力培养有积极作用。     

“三明治”教学模式在《内科护理学》临床见习中的应用研究

目的观察应用"三明治"教学模式在《内科护理学》临床见习中对护生批判性思维能力、护患沟通能力的影响及教学的效果。方法选取某大学2014级护理本科生为研究对象,采用便利抽样法,1班(33人)为对照组,2班(35人)为观察组。对照组采用传统临床见习教学方法,观察组在临床见习中应用"三明治"教学模式。见习结束时采用批判性思维能力测量表、护患沟通能力量表、教学效果评价表对两组护生进行测评。结果观察组护生的批判性思维能力总分及寻找真相、开放思想、分析能力、系统化能力、批判思维的自信心、求知欲6个维度得分高于对照组,观察组护生的护患沟通能力总分及基本语言沟通能力、基本非语言沟通能力、协调沟通网络能力3个维度得分高于对照组,观察组护生的课堂教学、学习促进、能力提高得分高于对照组,比较差异均有统计学意义(P0.05)。结论 "三明治"教学模式能提高护生批判性思维能力和临床沟通能力,有助于提升《内科护理学》临床见习教学效果。     

ECS模拟技术在急重症护理教学中的应用

[目的]探讨急救护理模拟病人(ECS)情景教学在急重症护理技能教学中的应用效果。[方法]将56名有急救理论基础和基本技能的护生随机分为对照组和观察组各28人,观察组使用ECS情景教学进行急救综合技能的培训,对照组采用传统教学方法进行急救综合技能的培训。比较两组护生急救护理操作和理论考核成绩,采用中文版评判性思维能力测量表(CTDI-CV)测评护生的评判性思维能力。[结果]观察组护士理论成绩及技能考核成绩优于对照组(P0.05);两组护生在寻找真相、开放思想、分析能力、系统化能力、批判性思维的自信心、求知欲、认知成熟度7个维度得分比较,差异有统计学意义(P0.05)。[结论]ECS情景教学可提升护理教学效果,提高护生急重症综合护理能力及评判性思维能力。     

CDIO模式应用于护生内科护理学临床见习教学的效果

目的 :将CDIO教学模式应用于内科护理学临床见习中,分析其对护生批判性思维能力和临床沟通能力的影响。方法 :选取大连市某大学2012级本科护理学专业护生为研究对象,采用方便抽样法选取一个班30名护生为对照组,另一个班30名护生为试验组。对照组采用传统见习方法,试验组在见习中应用CDIO教学模式。临床见习前和见习结束时采用批判性思维能力测量表和临床沟通能力测量表对两组护生进行评价。结果 :试验组护生的批判性思维能力总分及寻找真相、开放思想、系统化能力、批判思维信心、求知欲、认知成熟度6个维度得分高于对照组(P0.05)。试验组护生的临床沟通能力总分及建立和谐关系、确认患者问题、共同参与、传递有效信息4个维度得分高于对照组(P0.05)。结论 :CDIO教学模式能提高护生批判性思维能力和临床沟通能力。     

《护理学基础》多元化考核评价体系改革研究

[目的]探讨《护理学基础》多元化考核评价体系的实施效果及其对护理专业学生批判性思维和自主学习能力的影响。[方法]以潍坊医学院护理学院本科2009级170名学生作为对照组,2010级129名学生作为试验组,对照组采用传统考核评价体系,试验组采用多元化考核评价体系。[结果]试验组考核体系满意度、实施效果、自主学习能力、考核成绩均高于对照组,差异有统计学意义（P〈0.05）,试验组中文版加利福尼亚评判性思维倾向测量表（CTDI CV）总分高于对照组,但差异无统计学意义（P〉0.05）。[结论]多元化考核评价体系优于传统考核评价体系,有助于护生学习成绩及学习能力的综合提高。     

批判性思维在护生实习教学中的应用

目的:探讨批判性思维在护生实习教学中的应用。方法:将98级、99级和2000级护理本科实习学生140人,随机分为对照组70人,观察组70人,观察组采用Jones&Sheridan的病例研究法进行教学,对教学效果应用CTD I-CV进行评价,对照组采用一般实习教学法。结果:观察组与对照组相比,批判性思维能力高,有显著差异(P<0.05)。结论:病例研究教学法对培养护生的批判性思维能力效果好。     

网络环境下基于问题学习教学模式在《基础护理学》课程中的应用

目的:探究网络环境下基于问题学习的教学模式在《基础护理教学》课程中的应用效果。方法:将本校2012级护理专业90名学生随机等分为试验组和对照组,试验组采用网络环境下基于问题学习的教学模式,对照组采用传统以讲授为主的教学模式。课后通过闭卷考试评价两组教学效果,并采用问卷调查两组学生的批判性思维能力及试验组对网络环境下基于问题学习教育模式的评价结果。结果:试验组学生综合知识得分及总分高于对照组(P0.05),但基础知识得分却低于对照组(P0.05)。试验组学生在开放思想、分析能力、自信心、求知欲及批判性思维能力总分高于对照组(P0.05)。试验组有90%以上的学生认为网络环境下基于问题学习的教学模式是一种好的教学模式,有助于提高自学能力和文献检索能力。结论:网络环境下基于问题学习的教学模式有助于提高《基础护理学》课程的教学效果,培养学生的职业核心能力,值得进一步研究推广。     

交互式教学法在高职护生老年护理教学中的应用

目的 :了解交互式教学法在高职护生老年护理教学中的应用效果。方法 :将我校11级高职护理1~3班156人作为对照组,采用以教师讲授为主的传统教学方法 ;11级高职护理4~6班159人作为实验组,采用交互式教学法,两组均进行老年护理教学。采用评判性思维能力测量表(CTDI-CV)和理论考核结果对两组教学效果进行评价。结果 :教学后,实验组学生除评判性思维的自信心以外,寻求真相、开放思想、分析能力、系统化能力、求知欲、认知成熟度维度得分均高于对照组(P0.05)。教学后,实验组理论成绩高于对照组(P0.01)。结论 :交互式教学法有利于提高高职护生的评判性思维能力和学习效果,可行且有效,值得推广。     

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.