构建《突发事件现场应急救护》课程设置的研究

目的 通过建立〈突发事件现场应急救护〉的课程,培养武警部队护理学员应对突发事件现场应急救护能力.方法 采取整群抽样设2007级234名学员为对照组、2008级224名学员为实验组,两组学员均进行应急救护知识培训,实验组增加现场应急救护技能训练,课程结束后比较两组考核成绩.结果 培训后实验组现场应急救护理论知识合格率91.07%,技能知识合格率95.1% 对照组应急救护理论知识合格率45.73%,技能知识合格率35.90%,两组比较差异均有统计学意义（P＜0.05）.结论 〈突发事件现场应急救护〉的学科设置是培训武警部队护理学员进行现场应急救护知识技能的主要途径,既有理论又有技能的考核是提高学员救护水平的有效方法,在基层部队和军队院校可以建立相应课程,以达到救护知识和技能的普及和推广.     

护理实习生心肺复苏术的认知及需求调查

目的 了解护理实习生心肺复苏术(cardiopulmonary resuscitation,CPR)的理论知识掌握及培训需求情况,为实习护生的CPR知识及技能培训提供依据及建议.方法 采用自行设计的"护理实习生认知及需求调查问卷",对上海市同济大学附属东方医院202名护理实习生进行调查.结果 护生CPR理论知识认知水平不高;及格率不高(49.00%),良好率及优秀率低(6.93%及2.97%);不同学历护生理论知识掌握情况间差异有统计学意义(P＜0.01);护生接受CPR系统培训只占17.82%,从未接受过培训的占8.42%;实习护生对CPR有强烈的培训需求(95.05%).结论 实习护生CPR的认知水平有待提高,应采取相应措施加大培训力度.     

技能评估与再培训在口腔护理教学实践中的应用

目的总结技能评估与再培训制度在口腔护理操作技能教学实践中的应用。方法 2011年9月-2012年1月对2010级66名护理专业学生,依据口腔护理技术操作要求进行口腔护理技能评估与再培训。结果再培训前,口腔护理操作技能评估平均得分为（69.9±11.2）分,无1人合格;再培训后平均成绩得分为（91.7±5.6）分,合格率为88.5%,优秀率为30%;再培训前后成绩比较差异有统计学意义（P〈0.01）。结论技能评估与再培训,对提高护生临床操作技能水平和护理实践教学质量有积极作用。     

产前超声诊断进修医师培训质量控制

本文通过对比分析2年3期38名产前超声进修医师规范化培训前后胎儿超声检查操作、理论及综合成绩,探讨有效提高产前超声诊断进修医师培训质量的方法。结果发现系统规范化的培训和严格的量化评估能有效地保证产前超声诊断进修医师培训质量,获得很好的培训效果。进修医师经过培训后理论和实际操作成绩显著提高,培训前后成绩差异有统计学意义（P〈0．005）。     

农村社区护理人员心肺复苏技能掌握及培训的现状

目的了解基层（农村社区服务站）护理人员心肺复苏（cardiopul monary resuscitation,CPR）技能掌握及培训的现状,为实施CPR技能培训提供依据。方法对45名农村社区服务站护理人员进行CPR技能掌握和培训情况的问卷调查。结果农村社区服务站的护理人员CPR技能掌握不佳,75.56%的护理人员认为会CPR操作,能独立规范完成CPR操作的仅为5.88%;从没有参加过急救技能培训的护理人员占53.33%;表示＂非常需要＂或＂需要＂急救技能培训的有42名,占93.33%。结论基层护理人员CPR技能和相关理论知识薄弱,但护理人员对培训的需求较高,应尽快给予规范的急救技能培训。     

脑卒中高危人群颈动脉斑块超声规范化检查在基层医院的推广应用

目的依托医共体及区质量控制中心的建设完善对脑卒中高危人群颈动脉超声筛查规范化的培训、指导、帮扶、带教工作,预期达到提升成员单位及社区基层单位医疗技术和服务能力。方法应用统一教材《中国脑卒中血管超声检查指导规范》、宁波市《颈动脉超声检查及报告书写规范(2018年第1版)》及《鄞州区超声质控颈动脉超声建议检查流程及存图规范》、《鄞州区超声质控建议颈动脉超声诊断流程》、《鄞州区超声质控颈动脉超声诊断参考模板》,统一培训的方式,对学员进行理论及实际操作培训,通过短期培训、下基层技术带教、质量控制管理多种方式对基层单位超声医师进行指导及培训。结果基层医院共34家,其中民营医院10家,超声医师124例。所有超声医师共完成18场理论培训,12场技能培训,专家下基层技术带教54次;培训的基层医师中主治医师占48.39%,医师占33.06%。基层医院根据有无设立病房分为中心级及非中心级,其中非中心级卫生院占43.33%,中心级卫生院占33.45%,民营医院占23.22%;规范统一了鄞州区颈动脉筛查标准、制订了培训教材、培训方法和颈动脉超声检查质量控制标准,全区基层医师基本能独立规范的进行颈动脉超声筛查。结论颈动脉超声筛查规范化技术推广到基层,提升了基层医师的诊断水平,为社区建立脑卒中慢病的管控提供了依据。     

不同水平学员心脏超声差异性教学效果的评估

目的探讨不同水平学员心脏超声差异性教学的效果。方法以2015～2017年在我院参与教学的300名研究生、规培生及进修学员作为研究对象,对其进行统一的理论知识和实践技能考核,根据考核成绩分为4类,实施不同的教学方法。结果不同分类学员培训后理论知识和实践技能考核成绩均较培训前有明显提高,差异均有统计学意义(均P0.05)。结论培训教师应针对不同水平的学员将心脏超声的理论知识、学习方法、技能训练融会贯通,形成一个完整的因材施教教学体系,更有利于专业医学人才的培养。     

上海市一二级医院临床护士心肺复苏技能现状及影响因素

目的调查上海市一二级医院临床护士心肺复苏技能现状,分析影响因素,为护理人员CPR培训方向提供理论依据。方法分层随机抽取上海浦东新区13所一二级医院240名护士,采用自行设计的CPR-BLS技能考核评分表进行CPR-BLS技能考核,总结得分情况并分析其影响因素。结果护士CPR技能总体及格率为49．58％,良好率为8．33％,优秀率为0．83,其中一级医院及格率为26．67％,良好率为0．83％,优秀率为0．00％;医院级别、职称、CPR培训经历是影响CPR技能的相关因素（t分别为9．774,2．522,-3．194;P〈0．05）。结论一二级医院临床护士CPR技能水平较低,应采用规范化、系统化技能培训与复训。     

初级生命支持培训课程的实践与思考

目的:探讨基础生命支持(BLS)培训课程对提高心跳骤停(CA)急救能力的作用。方法:采用美国心脏协会心肺复苏课程对从事急救的医护人员进行培训,培训分为理论和实践课,注重于提高学员的现场判断能力和急救技能。结果:培训后学员的理论测试成绩较培训前显著提高,合格率、优秀率均显著提高;学员的技能和理论考核均合格,院前组的培训前理论成绩显著高于院内组,培训后院前组仍明显高于院内组,P均0.05。结论:经BLS培训后,学员的理论、实践和综合救治能力明显提高,团队合作得到加强。     

抛锚式教学联合Gibbs反思循环在手术室专科护士培训中的应用

目的 探讨抛锚式教学联合Gibbs反思循环在手术室专科护士培训中的应用效果。方法 采用整群抽样法,以参加2022、2023年郑州大学第一附属医院手术室专科护士培训的78名学员为研究对象,将2022年和2023年的培训学员分别作为对照组（38名）和试验组（40名）。试验组采用抛锚式教学法联合Gibbs反思循环的教学方法,对照组采用常规教学方法。培训结束后,通过理论、实训成绩、自行设计的调查问卷对2种教学方法进行效果评价。结果 试验组理论和实训成绩分别为（88.33±3.53）分、（89.38±2.42）分,对照组为（83.50±3.45）分、（86.76±3.18）分,2组比较差异有统计学意义（P<0.05）;试验组学员对教学效果的评价较好。结论 抛锚式教学法联合Gibbs反思循环,有助于提高学员的理论知识和临床实训水平,培养学员的自主学习能力和分析解决问题能力,培训效果优于传统教学方法。     

Diagnostic peritoneal lavage and ultrasonography for blunt abdominal trauma: attitudes and training of current general surgical trainees.

OBJECTIVE: It has been suggested that diagnostic peritoneal lavage is now obsolete in UK hospitals with access to either skilled ultrasonography or emergency physician or surgeon-performed focused abdominal sonography in trauma. Diagnostic peritoneal lavage continues to be advocated and taught on Advanced Trauma Life Support courses. The aim of this study was to evaluate the experiences and attitudes of general-surgery trainees in one UK training region towards diagnostic peritoneal lavage and focused abdominal sonography in trauma in managing blunt abdominal trauma. METHODS: An anonymous postal piloted questionnaire was sent to all 66 general surgery specialist trainees in one UK training region between January and March 2005. RESULTS: Out of 40 replies to the questionnaire (response rate 61%), 53% and 38% of surgical trainees had either never performed or never observed a diagnostic peritoneal lavage during their training. Thirteen trainees (33%) felt diagnostic peritoneal lavage to be obsolete and would never contemplate using it; 15 trainees (37%) might consider using diagnostic peritoneal lavage if computed tomography or ultrasonography were unavailable. Ten trainees (25%) felt that diagnostic peritoneal lavage had been superseded by computed tomography. Only 12 trainees (30%) had worked in a UK hospital with access to facilities for focused abdominal sonography in trauma and only seven trainees (18%) had received any training or experience in focused abdominal sonography in trauma. CONCLUSIONS: Surgical trainees in one UK training region lack skills in both diagnostic peritoneal lavage and focused abdominal sonography in trauma for managing blunt abdominal trauma and are therefore reliant upon the availability of prompt, skilled radiological assistance or emergency physician-provided focused abdominal sonography in trauma.     

Status of emergency department ultrasound

Objective : To determine present attitudes to and usage of ultrasound in Australasian emergency medicine. Methods : A questionnaire was devised, field tested and sent, with Australasian College for Emergency Medicine permission, for anonymous completion by the director of emergency medicine training of each emergency department in Australia and New Zealand accredited for advanced training. Results : The overall response rate was 84% (66/79). The data were tabulated and cross‐tabulated comparing major trauma centres, base hospitals, urban hospitals and teaching hospitals. In hours, X‐ray department ultrasound was readily available, but bedside ultrasound was much less available both in and out of hours. There were marked variations in opinion as to whether bedside ultrasound was essential in clinical conditions such as trauma, abdominal or kidney pain. Computed tomography was always preferred to ultrasound. While there was little teaching of either the theoretical or practical aspects of ultrasound to emergency medicine trainees, 75% of respondents believed that ultrasound should not be undertaken only by full‐time ultrasonographers. Conclusions : The survey clearly demonstrated that while bedside or urgent ultrasound is not generally readily available, especially out of hours, the modality is considered to be important by the majority of respondents, and does not require full‐time radiographers. It is clear that formal teaching of ultrasound to trainees is infrequent.     

临床专业住院医师规范化培训超声科带教问题与应对策略分析

临床专业规范化培训(以下简称规培)学员与超声专业规培学员的学历背景、知识构架、学习目的、规培计划均有不同,二者的超声科带教模式及方法应有所区别。本文基于本教研室规培带教经验,分析目前临床专业规培学员超声科带教存在的问题,提出"建立针对临床规培学员超声培训的精品课堂"、"建立针对临床规培学员超声培训的微课-翻转课堂"、"将基于PACS系统的临床典型病例图库应用于临床规培学员教学"、"建立临床典型病例图库/超声仿真病人模拟教学系统"四方面建议,以期完善临床专业规培学员培养模式,为学员提供全面、重点、有针对性的超声知识技能培训,提高规培效率和质量。     

Training for Pediatric Cardiac and Pulmonary Point of Care Ultrasound in Eastern Uganda

Caring for children with acute illness is a challenge in limited-resource settings, especially when diagnostic imaging is limited or unavailable. We developed a training program in cardiac and lung point-of-care ultrasound (POCUS) for pediatric patients in eastern Uganda. Fourteen trainees including physicians, resident physicians and midlevels received training in cardiac and lung POCUS. Training included formal lectures, hands-on skills practice and individualized teaching sessions. Assessment included written knowledge assessment, direct observation and longitudinal image review. Blinded review of 237 consecutive ultrasound studies revealed satisfactory image quality (94.2% for lung and 93% for cardiac) and accurate image interpretation. Sensitivity and specificity of image interpretation were 0.93 (0.75–0.99) and 0.94 (0.78–0.99) for lung and 0.86 (0.71–0.95) and 0.94 (0.84–0.99) for cardiac compared with expert review. All trainees passed written knowledge assessments. After training, 100% of trainees reported that they would use POCUS in clinical activity and thought it would improve patient outcomes. Our training program indicated that trainees were able to perform high-quality cardiac and lung POCUS for pediatric patients with accurate interpretation. This builds a foundation for future studies addressing how POCUS can change outcomes for children in limited-resource settings.     

肿瘤专科护士临床培训的实践研究

目的探讨肿瘤专科护士临床培训的内容、方法及重点内容的培训时间,使其能够满足临床对肿瘤专科护士的需求。方法我院作为肿瘤专科护士培训基地,对102名肿瘤专科护士学员进行个体化带教,重点培训其临床实践能力及教学科研能力。结果仅有2名学员综述写作不合格,其余学员各项考核均合格,合格率为99.35%。结论临床实践是培训重点,教学及论文写作是培训难点,应安排较多的课时。     

护理专业实习生对高血压知识掌握情况的调查分析

目的了解护理专业实习生高血压知识的掌握现状，为临床带教教师进行高血压知识方面的指导提供依据。方法采用便利抽样法．对171名护理专业实习生进行高血压知识的问卷调查。结果护理专业实习生对高血压知识认知的总体水平不高，答对率为57．0％。关于健康教育相关内容的答对率仅为38．3％；护理专业实习生对高血压相关知识培训需求较高，希望在实习期间得到有关知识的培训。结论护理专业实习生对高血压知识掌握欠缺，希望得到相关培训。临床带教教师对护理专业实习生应重视高血压知识的指导，加强对其高血压健康教育相关内容及沟通技能的培训。     

大疫下以提升岗位胜任力为核心的在线护士培训模式构建

目的 疫情形式仍然严峻,积极响应国家“战役”号召,以网络化平台为助力,以提升护士岗位胜任力为核心,探索在线护士培训模式,并总结培训实践体会,为当下医疗机构有效组织培训提供借鉴与参考。方法 对全院护士开展针对性培训,从护理基础理论知识、常用临床技能操作、新冠肺炎新冠常识知识及规范防护技能、临床应对能力以及自我心理建设等各方面统筹护士岗位胜任力的提升。结果 全院护士理论知识考核及实践技能通过率达100%；赴武汉一线支援护士以及轮岗我院发热门诊护士实现“零感染”；有效舒缓护士心理压力；护士对培训满意度达95%以上；录制的护理技术操作得到有效推广。 结论 大疫下以提升岗位胜任力为核心的在线护士培训模式,有效提升护士岗位胜任力,培训内容恰适,形式便捷,便于借鉴推广。     

Evaluation of blunt abdominal trauma: current practice in Taiwan

Objective: To gain an overview of the current practice of different major institutions in Taiwan in the evaluation of abdominal injuries. A further comparison was made between general surgeons and emergency physicians in this aspect.

Method: A telephone survey was conducted of all emergency departments of 58 major institutions (14 medical centres, 44 district hospitals) that are capable of providing definitive care for trauma victims in Taiwan in June 2002. Respondents were asked to select the diagnostic modality of choice in the evaluation of a haemodynamically abnormal blunt trauma victim with suspected intra-abdominal injuries. In the same study period, this particular telephone scenario was also used to survey 109 individual doctors (45 emergency physicians, 64 general surgeons).

Results: Most respondents preferred ultrasound (also known as focused assessment with sonography for trauma or "FAST") instead of diagnostic peritoneal lavage (DPL) because DPL is invasive and most doctors in Taiwan have limited experience in performing DPL or interpreting the results.

Conclusions: It seems reasonable to devote greater resources for emergency departments to incorporate a FAST based algorithm into their initial management of trauma victims, and to improve training in its use. It is also suggested that future ATLS teaching in Taiwan should include didactic material on FAST.

     

湖南省2012届全科医生转岗培训学员状况及培训效果调查分析

【目的】调查湖南省全科医生转岗培训学员的基本情况及培训效果,为更好地开展培训提供依据。【方法】对参加湖南省2012届全科医生转岗培训的学员进行培训前后问卷调查,了解学员基本情况、培训意愿,并对培训基地课程设定以及培训效果进行评估。【结果】培训前问卷发放1238份,回收有效问卷1000份,有效回收率为80．78％;培训后问卷发放1238份,有效回收1238份,有效回收率为100％。参加培训的医生年龄差距较大,以中青年医生为主;男女比例差异较大,以男性为主;职称较低,以初级为主;学历不高,以大专为主（均P＜0．05）。学员培训后知识的掌握程度明显高于培训前（P＜0．05）。85．9％的学员对培训表示满意。【结论】2012届全科医生转岗培训效果明显,学员满意度高,需进一步加强师资队伍建设,改进教学方法,以更好地提高培训效果。     

情景模拟医疗纠纷在临床技能教学中的运用

目的探讨将情景模拟医疗纠纷教学法融入临床技能教学中的教学效果。方法于2012年9月-2013年6月将2010级临床医学专业八年制学生93人随机分为传统教学组（46人）和情景模拟医疗纠纷组（47人）,分别对两组学生进行传统教学和情景模拟法教学。采用临床技能操作考核的方法进行教学效果评估。结果情景模拟医疗纠纷组在运用情景模拟医疗纠纷教学后临床处置能力、操作技巧、沟通技能、人文知识和法律知识等维度技能的掌握能力和理论成绩均明显优于传统组,差异有统计学意义（P〈0.05）。结论将情景模拟医疗纠纷有机融入临床技能教学中能够发挥其优势,有助于提高教学质量。