基于 SPOC+FCM 混合式教学模式在妇产科护理课程教学中的应用

目的 探讨 SPOC+FCM 混合式教学模式在妇产科护理学课程教学中的应用效果。方法 选取本院 2020 级本科护理学专业 的 102 名学生作为研究对象。按照班级为单位进行分组,分为对照组（54 人）和试验组（48 人）。对照组采用传统教学方式; 试验组采用 SPOC+FCM 教学方式。分析比较两组的考核成绩、学习效果以及教学满意度。结果 试验组考核成绩显著高于对照 组（P<0.05）。试验组的教学效果显著优于对照组（P<0.05）。试验组的教学满意度显著高于对照组（P<0.05）。结论 基于 SPOC+FCM 的混合式教学模式能提高学生考核成绩,提高教学效果以及教学满意度,指导推广。     

线上线下混合式教学在灾害护理学选修课程中的应用

目的 探讨线上+线下混合式教学在灾害护理学选修课程中的教学效果。方法 以南昌大学2019—2020年度第二学期选修灾害护理学通识课程的本科生作为试验组（n=41）,实施线上+线下混合式教学;第一学期选修灾害护理学通识课程的本科生作为对照组（n=40）,实施传统线下教学。比较两组课后学习成绩、灾害救护能力、自主学习能力,调查试验组对课程的评价。结果 试验组综合成绩（85.27±4.04）高于对照组（83.10±4.14）(t=2.385,P=0.019)。课程结束后,试验组灾害救护能力自评得分和自主学习能力得分均高于对照组,差异具有统计学意义（P<0.05）。34名（82.9%）学生对课程总体效果满意。结论 灾害护理学选修课程中采用线上+线下混合式教学方法能够充分调动学生的积极性和学习自主性,提高了教学效果和满意度,有助于学生掌握灾害救护技能。     

心理情景剧教学法在《精神科护理学》教学中的应用

[目的]探讨将心理情景剧教学法用于《精神科护理学》中的教学效果。[方法]将2009级护理本科专业学生134人分为对照组（66人）和观察组（68人）,对照组采用常规教学方法授课,观察组采用常规教学与心理情景剧教学相结合的方法授课。课程结束后,采用统一试题测试和相同问卷调查两组学生对教学效果的评价。[结果]观察组学生考核成绩为（86.3±4.2）分,对照组为（82.5±5.4）分,两组比较差异有统计学意义（t=4.816,P〈0.01）。问卷调查结果显示,观察组学生在激发学习兴趣、促进对精神疾病的认识和理解、促进师生交流与互动、增强团队协作意识、拓展创新性思维等方面均优于对照组（P〈0.05或P〈0.01）。[结论]心理情景剧教学法不仅可以激发学生学习积极性,还能促进学生创新性思维和护理沟通技能的提高,适用于精神科护理学教学。     

雨课堂在护理学实训课混合式翻转课堂教学中的应用实践

[目的]探讨雨课堂在护理学实训课混合式翻转课堂教学中的应用效果。[方法]抽取2016级专科护理1班58名学生为观察组,使用雨课堂进行课前实训预习,包括视频、操作流程和注意事项等;抽取2016级专科护理2班60名学生为对照组,采用实训课常规教学。课程结束后,比较两组的成绩、学生满意度、学习能力及教师评价情况。[结果]观察组实训考核成绩为(88.45±5.28)分,对照组实训考核成绩为(82.33±8.79)分,两组比较差异有统计学意义(P0.05);观察组在认知能力、综合能力、学习能力及学生学习满意度高均都优于对照组(P0.05);教师对基于雨课堂的护理学实训课翻转混合式教学有较高的满意度,认为基于雨课堂的护理学实训课翻转混合式教学可有效提高实训操作能力,实现护理学实训课的翻转混合式教学。[结论]基于雨课堂的护理学实训课翻转混合式教学能够实现较好的教学管理,能够对学生学习能力及实训成绩有明显的促进作用,实现护理学实训课的翻转混合式教学,实现护理学实训课的信息化、网络化、数据化管理。     

促进护理本科生深度学习的基础护理学教学设计与实践

目的 探讨O-AMAS有效教学模型在基础护理学课程混合式教学中的应用效果。方法 便利选取我校2019级护理专业2个班为对照组（n=86）,在基础护理学课程中采用传统翻转课堂教学模式;2020级护理专业2个班为试验组（n=87）,实施基于O-AMAS有效教学模型的混合式教学,课堂教学包括教学目标设计（Objective）、迅速激活（Activation）、多元学习（Multi-learning）、有效测评（Assessment）、简要总结（Summary）5个环节。课程结束后比较两组学生课程学习成绩、深度学习能力及学习投入度。结果 试验组课程学习成绩、深度学习能力各维度及总量表均分,以及学习投入度中行为投入维度、情感投入维度、总量表均分高于对照组（均P<0.05）。结论 基于O-AMAS有效教学模型的基础护理学混合式教学,有助于提高课程教学效果和学生学习投入度,促进学生深度学习。     

混合式教学在高职内科护理学课程中的实践研究

目的 探索混合式教学在《内科护理学》课程中的实践及效果。方法 2019年2月至7月将渭南职业技术学院五年制高职护理专业2015级4个班级的学生，随机分为2组，针对本学期开设的《内科护理学》课程，对照组（n=82）采用传统授课，试验组（n=78）部分课程内容采用混合式教学法，其余课程内容仍用传统授课。对比两组学生成绩，并采用《中文版自我导向学习能力量表》以及自制满意度问卷调查试验组学生。结果 试验组成绩优于对照组（P＜0.05）；试验组学生自我导向学习能力较之前显著提高（P＜0.05）；89.61%的试验组学生满意此教学法。结论 混合式教学用于《内科护理学》课程的教学效果良好，提高了学生的学习成绩，提升了学生对课程的满意度，有利于学生自我导向学习能力的逐步提高，为过程性评价提供了依据，同时，教师能及时了解学生的学习动态，有助于教学相长，值得推广。     

基于BOPPPS模型的混合式教学在基础护理学中的应用效果

目的 探讨基于BOPPPS模型的混合式教学在基础护理学教学中的应用效果。方法 选择我校护理学2019级本科班中的1个班为对照组（n=60）,1个班为观察组（n=57）。对照组理论课采取传统教学法;观察组以超星学习通平台为基础的BOPPPS教学模型开展混合式教学。在课程结束后比较两组学生的学习投入、自主学习能力和期末理论考核成绩。结果 采用BOPPPS教学模型后,观察组学生的学习投入、自主学习能力各维度得分（除人际沟通维度）及总分、期末理论考核成绩均高于对照组,组间比较差异均有统计学意义（P<0.05）。结论 基于BOPPPS模型的混合式教学可提高学生的学习投入程度、自主学习能力、学习成绩和满意度。     

基于混合式教学的基础护理学理实一体化翻转课堂教学改革

目的 探讨基于混合式教学的理实一体化翻转课堂在基础护理学教学中的应用效果。方法 采用便利抽样的方法,选取2019级护理本科生为对照组,理论课采用基于混合式教学的翻转课堂,实验课采用传统教学;选取2020级护理本科生为试验组,采用基于混合式教学的理实一体化翻转课堂。通过过程性评价成绩、终结性评价成绩、教师观察和学生反馈来评价教学效果。结果 试验组过程性评价成绩（除线上学习外）、期末实训考核成绩、课程结业成绩均优于对照组（P<0.05）;教师和学生对基于混合式教学的理实一体化翻转课堂教学模式整体评价均良好。结论 基于混合式教学的理实翻转可促进学生更系统地掌握知识,提升学生学习的积极性和主动性,提高了学生的实训技能和综合能力,对学生职业素养和职业道德的培养也有较好的效果,可以在护理专业课程教学中借鉴和推广。     

混合式教学在精神科护理学课程中的应用

目的探讨混合式教学在精神科护理学课程中的应用效果。方法选择精神科护理学课程中的部分内容开展基于翻转课堂的混合式教学,共56名学生进行课程学习。围绕选定的教学内容写了7个脚本并录制成微课视频,设计了6个典型教学分析案例,建设了网上精神科护理学题库。课前将微课视频、案例和课件放在e-Learning教学平台上,布置学习任务,指导学生自学;在翻转课堂环节,组织学生以小组形式进行案例分析讨论和汇报;利用平台的网上题库,组织学生做每课练习与定期测验。教学评价指标包括学生参与该课程学习的状况、综合考核成绩,及其对课程教学的评价。结果学生学习的参与度和积极性很高,课程总体成绩为81.13±7.14;学生对本课程的课程组织与教学方式总体满意程度较高(98.1%)。结论混合式教学有利于培养护理本科生的综合能力,提高其对于精神科护理学课程的学习参与度和学习兴趣。     

心理情景剧教学法在《精神科护理学》教学中的应用

[目的]探讨将心理情景剧教学法用于《精神科护理学》中的教学效果。[方法]将2009级护理本科专业学生134人分为对照组(66人)和观察组(68人),对照组采用常规教学方法授课,观察组采用常规教学与心理情景剧教学相结合的方法授课。课程结束后,采用统一试题测试和相同问卷调查两组学生对教学效果的评价。[结果]观察组学生考核成绩为(86.3±4.2)分,对照组为(82.5±5.4)分,两组比较差异有统计学意义(t=4.816,P0.01)。问卷调查结果显示,观察组学生在激发学习兴趣、促进对精神疾病的认识和理解、促进师生交流与互动、增强团队协作意识、拓展创新性思维等方面均优于对照组(P0.05或P0.01)。[结论]心理情景剧教学法不仅可以激发学生学习积极性,还能促进学生创新性思维和护理沟通技能的提高,适用于精神科护理学教学。     

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.