不同人群对护理硕士专业学位能力培养和课程设置认知的比较研究

目的:了解护理专家及硕士研究生主要生源对专业学位研究生能力培养、课程设置和教学方法的认知及差异。方法:采用问卷调查结合访谈法,对40位副高级及其以上职称的从事和熟悉护理工作的专家、147名具有本科学历的临床护士以及177名应届护理本科毕业生进行调查。结果:专家和生源对评估观察能力、护理操作能力、健康宣教能力的认知比较,差异有统计学意义(P<0.01);本科护士对科研能力的需求高于应届毕业生(P=0.006);生源对基础课程和专业课程的学习重视不足(P<0.001);应届毕业生对跨学科交叉课程有较高需求(维度排序第2位);专家和生源对PBL教学法、小组讨论和课堂讲授的认知存在差异(P<0.01)。结论:教育管理者应重视生源的心理需求和思想误区,满足甚至强化其正向需求,纠正、消除其思想误区。     

伤口造口专科护士岗位管理指标体系的构建

目的构建具有较强科学性的伤口造口专科护士岗位管理指标体系,为伤口造口专科护士的选拔、培养、任用及考核提供依据。方法通过文献分析法和半结构式访谈,拟定伤口造口专科护士岗位管理指标体系初稿,采用德尔菲法对20名护理管理、伤口造口护理、护理教育等领域的专家进行2轮咨询。结果 2轮咨询专家积极系数均为100%,专家权威系数为0.93,各级指标变异系数为0～0.176。伤口造口专科护士岗位管理指标体系包括6个一级指标(岗位描述、岗位设置、岗位培养、岗位使用、岗位考核、岗位待遇)、20个二级指标、59个三级指标。结论本研究构建的伤口造口专科护士岗位管理指标体系科学、合理,可为医院开展专科护士岗位管理提供参考依据。     

护理本科应届毕业生专业认知与就业意向的调查研究

目的调查护理本科应届毕业生专业认知和就业意向,以探求稳定护理本科生专业思想的有效教育引导方法。方法通过方便抽样,对杭州市4所高校190名护理本科应届毕业生进行问卷调查。结果护理本科生选择护理专业多为长辈意愿(50.5%);认为护理专业主要优势在就业方面(92.6%);最不能接受的护理职业的缺点前5位为"工作压力大,身心疲惫"(82.1%)、"三班制工作"(56.8%)、"职业风险高"(44.2%)、"报酬低"(32.6%)和"社会地位低"(31.6%);最可能影响护理专业学习积极性的因素为经济收入(32.6%)和就业形势(25.3%);接触过的护士(58.9%)和本校教师(32.6%)对学生的专业思想影响最大;就业意向集中在中小城市(44.2%)、省会等大城市(40.0%)和三级甲等医院(83.2%);最希望的工作岗位集中在行政(30.5%)、教学(25.3%)和医院临床(20.0%);实际可能的就业选择集中在医院临床(87.4%)。结论护理院校、医院等是影响护理本科生专业认知和就业意愿的重要场所。只有尽量创造良好的实习环境、提供持续可靠的职业规划指导才能有助于吸引并稳定年轻的护理队伍。     

不同入学形式的护理本科生专业承诺的比较研究

目的 了解不同入学形式的护理本科生的专业承诺水平.方法 采用大学生专业承诺量表对济宁医学院819名护理本科生(夏季招考生587名,春季招考生232名)进行问卷调查.结果 春季招考生专业承诺得分(98.13±11.86)高于夏季招考生(93.54±13.25),差异有统计学意义(P<0.001);不同报考原因和毕业意向的...     

应届护理本科毕业生非对口就业原因的质性研究

[目的]探讨应届护理本科毕业生非对口就业的原因.[方法]以某校2012届护理本科毕业生非对口就业者15人为研究对象,运用质性研究方法,对其中9名学生进行了深度访谈,现场录音与笔录,运用Claizzi分析程序分析.[结果]应届护理本科毕业生非对口就业的原因概括为自我价值观的影响、护理专业认知的影响和社会影响三大主题,其中护理专业认知的影响包括工作内容认知、工作模式认知、管理氛围认知和心理多重冲击,社会影响包括非自愿就读护理专业、护士社会地位偏低、带教老师自身的职业倦怠和行业间人才竞争.[结论]应届护理本科毕业生非对口就业是基于自我价值观基础上的选择,这种选择应该得到尊重.应届护理本科毕业生的专业认知失于偏颇,应该进一步修正.各种社会影响在应届护理本科毕业生非口就业的作用应得到护理管理者的重视.     

护理门诊护士工作角色的质性研究

目的探索和理解糖尿病和造口／伤口护理门诊护士的工作角色和功能。方法采用案例研究法。用意图抽样方法,通过“滚雪球”的抽样方法选取和访谈从事糖尿病和造口／伤口护理门诊工作的护士12名。用内容分析法分析访谈资料。结果糖尿病和造口／伤口门诊护士的主要工作角色包括护理者、教育者、指导者、咨询者、协作者和研究者。结论糖尿病和造口／伤口门诊护士的工作角色具有特异性和不可替代性,护士的工作实践具有高级护理实践特征。     

北京市三甲医院对护理学专业本科毕业生需求的质性研究

目的 了解医院对护理学专业本科生的需求与招聘情况,为高校护理学专业的招生及培养提供依据.方法 对北京市9所三甲医院的护理部主任进行半结构式访谈.结果 北京市三甲医院对护理本科生数量需求逐年增加,质量要求越来越高；北京市三甲医院对本科勇护士的需求持续不断；医院招聘应届护理本科生数量受多因素影响；目前本科毕业生不能完全满足临床护理需求,需要进行一定的教学改革.结论 临床对护理学专业本科生需求较大,本科生的招聘受毕业生质量、户籍制度、医院人事制度等因素影响,高等护理教育的招生和培养计划应根据社会实际需求和招聘政策适当进行调整.     

美国伤口造口失禁专科护理特色与启示

美国伤口造口失禁护理经过一个多世纪的发展,已形成系统的培训及实践标准,2010年被美国护士协会认证为"提供伤口造口和失禁护理及实践标准的护理实践专科",标志着伤口造口失禁护理由专业护理升级为专科护理,分析其发展特点与特色,可为我国专科护士的培养和使用提供借鉴和参考。     

伤口造口失禁专科护士培训体系的构建

目的构建具有较强科学性和实用性的伤口造口失禁专科护士培训体系,为伤口造口失禁专科护士的准入、培养、考核和认证提供理论基础。方法通过查阅文献和半结构式访谈,拟定伤口造口失禁专科护士培训体系的咨询问卷。采用德尔菲法,对20名护理管理、伤口造口失禁护理、护理教育领域的专家进行2轮咨询。结果专家的权威系数为0.93,培训体系的协调系数为0.479。构建的伤口造口失禁专科护士培训体系内容包括培训目标、培训过程、考核评价、资格认证4个部分。其中,培训目标部分包含一级指标6项,二级指标32项;培训过程部分包含一级指标5项,二级指标15项,三级指标70项;考核评价部分包含一级指标4项,二级指标7项;资格认证包含一级指标2项,二级指标2项。结论伤口造口失禁专科护士培训体系构建过程科学,内容设置合理,对开展专科护士培训具有较好的指导意义。     

新入职本科护士临床专业实践行为现状及影响因素研究

目的了解新入职本科护士临床专业实践行为现状并分析其影响因素。方法采用护理本科生临床专业实践行为评价问卷,对48所医院169名应届全日制护理本科毕业生进行调查。结果新入职本科护士临床专业实践行为质量总均分为(4.11±0.50)分;行为意愿、自我效能共同解释行为质量总变异的69.7%。结论新入职本科护士临床专业实践行为整体水平较高,行为意愿及自我效能是新入职本科护士临床专业实践行为的重要影响因素。     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.     

Recalcitrant giant orf recurrence after amputation: A case report and review of the literature

Orf is caused by a parapoxvirus. We present a recurrent, giant digital orf case in a female patient with a history of hairy cell leukemia. In spite of shave excision, the lesion progressed and recurred after digital amputation. Treatment with topical imiquimod cream and systemic subcutaneous interferon alfa‐2a was successful.