护理专业学生一般自我效能与评判性思维能力的相关分析

目的 通过一般自我效能与评判性思维能力的相关分析,探讨提高学生评判性思维能力的途径.方法 使用一般自我效能量表和评判性思维能力调查表对护理专业58名本科学生进行调查,并对结果进行分析.结果 护理专业学生的一般自我效能得分为(27.14±4.48)分,评判性思维能力得分为(52.34±7.87)分,两者相关系数r=0.363(P＜0.01),存在正相关.结论 可以通过提高学生自我效能来提高学生评判性思维能力.     

护理学硕士研究生择业效能感地区差异研究

[目的]探讨148名护理研究生择业效能感在不同地区的差异性，为高校护理研究生的就业指导提供依据。[方法]运用《择业效能感问卷》并结合深度访谈法对2006年北京、太原的148名在读女护理研究生的择业效能感进行调查。[结果]护理研究生择业效能感中自我评价得分为3．345分±0．584分，自我概念得分3．625分±0．606分，社会支持得分3．218分±0．502分，学绩得分3．750分±0．628分，职业信息收集得分3．340分±0．541分，目标设定得分3．460分±0．500分；太原护理研究生的择业效能感得分高于北京护理研究生，差异有统计学意义（P〈0．01）；北京护理研究生的择业效能感随年级的增高呈先平缓后降低的变化趋势，各年级间差异有统计学意义（P〈0．01）；太原护理研究生的择业效能感随年级的增高呈低-高-低的发展趋势，各年级间差异无统计学意义（P〉0．05）。[结论]不同地区护理研究生的择业效能感水平不同；不同年级、不同地区护理研究生的择业效能感发展趋势不同。     

不同民族本科护生评判性思维能力的对比研究

目的比较不同民族护理本科生的评判性思维能力,为建立针对不同民族护理本科生的培养教育方式提供依据。方法采用彭美慈等修订的评判性思维量表,对新疆医科大学护理学院1—4年级本科护生（2005级-2008级）进行普查。评判性思维得分采用（平均数±标准差）表示,不同民族本科护生之间评判性思维能力的两两比较采用LSD法。结果汉族、回族、维吾尔族、哈萨克族、其他少数民族本科护生评判性思维能力得分分别是（283．65±26．75）、（279．92±30．71）、（266．94±27．99）、（266．40±30．82）、（270．70±18．80）分。汉族与维吾尔族本科护生评判性思维能力在总分和各维度得分方面的差异均有统计学意义（P〈0．01或P〈0．05）;汉族与哈萨克族本科护生评判性思维能力总分、分析能力和认知成熟度方面的差异均有统计学意义（P〈0．01或P〈0．05）;回族与维吾尔族、回族与哈萨克族除在认知成熟度方面的得分差异有统计学意义（P〈0．01）外,其他各项差异均无统计学意义;维吾尔族和哈萨克族本科护生在评判性思维自信心方面的差异有统计学意义（P〈0．05）。结论汉族本科护生评判性思维能力得分较高,不同民族本科护生评判性思维能力不同。护生评判性思维的养成与宗教信仰、民族个性、语言文化、风俗习惯以及整个护理教育过程息息相关,护理院校针对不同民族护生的特点采用不同的教学方法,进一步培养和提高各民族护生的评判性思维能力,对促进我国少数民族地区护理教育及临床护理工作的进步具有非常重要的意义。     

护理高职生评判性思维倾向性及影响因素研究

目的 调查高职护理专业学生评判性思维倾向性的现状，并分析其影响因素。方法 2017年4月至7月，采用一般资料调查表、中文版评判性思维测量表（CTDI-CV）、护理专业学生自主学习能力量表和一般自我效能感量表(GSES)，调查1 198名黄山职业技术学院护理专业学生的评判性思维倾向性现状。结果 1 198名护理高职生评判性思维能力的得分为（270.43±23.69）分，33.4%的学生处于正性评判性思维水平；超过50%的学生求知欲、分析能力和开放思想3个维度为正性评判性思维。担任过学生干部、自主学习能力强和自我效能感高是正性评判性思维的预测因子（P＜0.05）。结论 高职护理专业学生的评判性思维能力处于中等水平，学校应积极进行教学改革，注重评判性思维能力的培养。     

外科住院病人与健康教育项目相关的自我效能研究

[目的]了解外科住院病人对健康教育项目的自我效能水平,为自我效能测评效标研究提供基线（或量化）依据。[方法]选择外科住院病人105例,分别测评一般自我效能及对临床实施的健康教育项目的自我效能,分析自我效能在不同变量间的分布,了解一般自我效能和健康教育项目自我效能的关系。[结果]病人一般自我效能总分为26．82分±5．67分,对健康教育项目的自我效能总分为0．82分±0．17分,相关分析显示两者相关不密切;不同文化程度病人一般自我效能得分差异有统计学意义;手术与非手术治疗病人自我效能得分差异有统计学意义;健康教育项目自我效能各项目得分差异有统计学意义。[结论]外科住院病人的自我效能水平处于中等水平。病人健康行为的自我效能测量量表应考虑护理健康教育目标、内容与病人健康需求多方因素。病人自我效能的测量对护理健康教育计划的制订和资源合理分配具有指导性意义。     

社区护士自我效能感现状及影响因素研究

[目的]了解社区护士一般自我效能感状况。[方法]采用问卷调查法,对参加陕西省社区护士培训的560名社区护士进行调查。[结果]社区护士一般自我效能感得分为2．60分±0．47分,低于常模（P〈0．01）;多重线性回归分析显示：从事护理工作年限和自评健康状况对自我效能感的影响有统计学意义（P〈0．01）。[结论]在社区护理工作过程中管理者应重视对社区护士一般自我效能感的提高。     

中专护生评判性思维的调查分析

目的：了解和衡量中专护生的评判性思维能力，为今后护理教育提供一定的实证依据。方法：采用评判性思维能力（中文版）测量表为研究工具，应用方便抽样法共抽取70名中专护理学生为研究对象。结果：中专护生评判性思维能力的总得分为224．96±25．79，与本科护生的同类研究结果（290．72±30．36）相比，中专护生的评判性思维能力显著低于本科护生。结论：中专护理教育有待进一步完善，以便培养出更优秀的护理人才。     

循证护理在《外科护理学》教学中的应用

目的比较循证护理教学法与传统教学法的授课效果及对学生的影响。方法随机抽取2006级护理专业两个本科班共200名学生,分为实验组和对照组,实验组采用循证护理教学法,对照组采用传统教学法。结果实验组学生循证护理教学前后对教学正性评价比较有统计学意义（p〈0．05）,循证护理教学法学生期末考试平均成绩为（86．15±6．54）分,传统教学法学生期末考试平均成绩为（78．56±7．32）分。两组学生平均成绩差异有统计学意义（p〈0．001）。结论在《外科护理学》教学中应用循证护理教学法,能激发学生学习兴趣,培养学生评判性思维能力、科研协作能力等,提高教学质量。     

护理学硕士研究生择业效能感年级差异研究

[目的]探讨不同年级护理研究生择业效能感存在的差异,为高校护理研究生的就业指导提供依据。[方法]运用《择业效能感问卷》结合深度访谈法对2006年北京、太原148名在读女护理研究生的择业效能感进行调查。[结果]择业效能感各维度得分：学绩3.750分±0.628分,自我评价3.345分±0.584分,自我概念3.625分±0.606分,社会支持3.218分±0.502分,职业信息收集3.340分±0.541分,目标设定3.460分±0.500分;二年级护理研究生择业效能感得分高于一年级护理研究生,一年级护理研究生择业效能感得分高于三年级护理研究生,差异有统计学意义（P〈0.001）。[结论]不同年级护理研究生的择业效能感水平不同;随着年级的升高,护理研究生的择业效能感呈现出低—高—低的发展趋势。     

批判性思维能力与学习风格的相关性研究

[目的]探讨学习风格与批判性思维能力的相关性。[方法]采用中文版批判性思维能力测量表（CTDI-CV）和学习风格量表（LSI）对497名护理专业大专学生进行批判性思维能力和学习风格评价,并对结果进行相关分析。[结果]497名护理大专生中发散型学习风格229名（46.1%）,同化型131名（26.4%）,顺应型90名（18.1%）,集中型47名（9.5%）。CTDI-CV中7个特质与LSI中具体经验、沉思观察、抽象概括具有相关性。4种学习风格学生的CTDI-CV得分差异有统计学意义,同化型（296.08分±29.46分）和集中型（295.72分±30.98分）学习风格者的CTDI-CV得分高于发散型（277.93分±27.21分）和顺应型（279.52分±26.99分）。[结论]护理大专生的学习风格以发散型居多,其批判性思维能力的寻求真相、系统化能力、自信心方面较弱,提示教师应将批判性思维能力培养有意识地融入课程教学目标中。     

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.