PBL教学法结合情景教学法在急救护理教学中的应用

目的研究以问题为基础的教学(PBL)和情景教学相结合的方法在院前急救护理教学中的应用。方法将南华大学2011级护理学本科生110名,按班级随机分为观察组和对照组。观察组为1班和2班,共计56人,对照组为3班和4班,共计54人。观察组采用PBL教学法与情景教学法相结合的模式,对照组采用传统教学法,两组的教学内容均为急诊常见的心肺复苏、电除颤、创伤急救与中毒护理。比较两组的理论考试与技能考核成绩,调查学生对情景教学法和PBL教学法相结合的认可程度。结果观察组对PBL教学法结合情景教学法的各项教学效果评价均较好,期末考试成绩与对照组相比较,总分有统计学意义(P0.05),且实践技能考核成绩明显高于对照组。结论 PBL教学法结合情景教学法能够提高学生的学习兴趣,增强学生的自主学习能力和综合分析问题的能力,并对培养护生团队合作精神及锻炼学生的实践能力有很大帮助。     

PBL教学法联合CP教学模式在老年科护理临床教学中的应用

[目的]探讨以问题为基础的学习(PBL)教学法联合临床路径(CP)教学模式在老年科护理临床教学中的应用效果。[方法]将2015年12月—2016年10月在老年科实习的护理专业学生54人随机分为对照组30人和观察组24人,对照组采取CP教学法带教,观察组采取PBL教学法联合CP教学模式。比较两组护生出科理论、操作考试成绩和学生个案书写情况。[结果]观察组护生出科理论、操作考试和学生个案书写考核成绩优于对照组(P0.05)。[结论]在老年科护理临床教学中应用PBL联合CP教学模式有利于提高护生的学习能力、临床综合能力、学习效率以及实习效果,效果优于CP教学模式。     

PBL教学方法在急诊护理临床教学中的应用

目的:研究PBL教学法与传统教学法对急诊实习护生的教学效果.方法:将2007年1月至2008年10月在急诊实习的护生107例中奇数批次的学生作为对照组(n=50),偶数批次的学生作为实验组(n=57),分别使用传统教学法和PBL教学法,比较其教学效果.结果:实验组护生出科理论、专科操作、实习综合成绩均高于对照组(P<0.05).结论:PBL教学方法能有效提高护生在急诊的实习效果.     

以问题为基础的教学法在护理本科生风湿科实习中的应用

目的 探讨以问题为基础的教学法（PBL）在护理本科生风湿科实习中应用的效果.方法 将90名护理本科实习生按时间顺序分为试验组和对照组,试验组58名采用PBL教学,对照组32名采用传统的带教模式,学生实习结束时,进行出科考核和临床综合能力评价.结果 试验组考核成绩明显优于对照组（P＜0.01）,临床综合能力明显提高.结论 PBL教学法能促进护理本科实习生学习积极性和提高临床分析、解决问题的能力.     

PBL在护理本科生社区实习课中的应用效果研究

目的探讨改进护理本科生社区临床实习的最佳方法.方法将到社区实习的护理本科生64人随机分为实验组和对照组.对照组32人,按照传统的临床实习方法带教;实验组32人,将"以问题为基础"的教学模式(PBL)应用于社区临床实习教学工作中,以临床问题作为激发学生学习的动力、引导学生把握学习内容,培养学生有效运用知识解决问题的能力.结果改进后的临床实习带教方法,学生对教学的满意度93%(P＜0.01)、学生综合能力优良率98%(P＜0.05)、<护理研究>理论考试优良率93%(P＜0.01).结论PBL优于传统临床带教模式,而且有利于提高临床教师综合素质.     

以问题为基础教学法在神经内科护理临床教学中的应用

目的探讨以问题为基础的教学法(problem-based learning,PBL)在神经内科护理临床教学中的应用效果。方法将2013年3~6月在神经内科实习的46名学生设为对照组,采用传统的教学方法进行教学。2013年9~12月实习的48名护理专业学生设为试验组,采用PBL教学法进行教学;比较两组出科考核成绩,分析学生的实习体会。结果试验组学生出科考试中口试、笔试成绩及总分高于对照组(P<0.05)。两组学生都对神经内科临床教学表示认可。结论PBL教学法能够提高护理实习生的学习积极性,加深学生对护理知识与技能的理解和掌握。     

微格与PBL混合式教学法在呼吸科护理操作教学中的应用研究

目的 观察微格与PBL混合式教学法在呼吸科护理本科生护理操作教学中的应用效果.方法 将来自昆明医科大学2016级护理本科生82人以随机数字法分为实验组42人和对照组40人,实验组采用微格与PBL混合式教学法,对照组采用传统教学,比较两组教学效果.结果 实验组护理操作考核成绩优于对照组,自主学习能力量表评分高于对照组,组间差异均有统计学意义(P＜0.05).结论 微格教学与PBL混合式教学方法在呼吸科实习学生护理操作课程中的应用,可提高学生学习的积极性和自主性、提高护理操作课程的教学效果,教师也可主动调节自己的教学行为.     

以问题为基础的教学法在康复科临床护理带教中的应用

目的:探讨以问题为基础的教学法(PBL)在康复科临床护理带教中的应用效果。方法:选取2012年6~12月在我科实习的30名护理大专生设为对照组,用传统方法教学;将2013年1~6月在我科实习的护理大专生30名设为实验组,用PBL教学法教学。出科前进行护理理论和护理病历的书写考试,并发放问卷调查,用两组的成绩和问卷调查的结果来评价PBL教学的效果。结果:PBL教学法能调动学生的学习积极性,提高团队精神,提高解决问题的综合能力。结论:PBL教学法的教学效果优于传统教学法,值得推广。     

PBL教学法在内科临床实习教学中的应用

[目的]探讨PBL教学法在内科临床实习教学中的应用效果。[方法]将66名护理本科生随机分成实验组和对照组,实验组采用PBL教学法,对照组采用传统教学法,实习结束前进行出科考试及学习效果问卷调查。[结果]实验组护理技能操作、病历书写和口试成绩优于对照组(P<0.01);实验组学生对教学效果的评价优于对照组(P<0.001)。[结论]PBL教学法应用于内科临床教学中可以提高学生分析和解决问题的能力,增强学生间的交流和合作。     

PBL教学法在消化内科临床实习教学中的应用

目的 探讨PBL教学法在消化内科临床实习教学中的应用效果.方法 2009年至2010年,选择在我科实习的医学本科实习生92人,随机分为实验组和对照组各46人,实验组采用PBL教学法,对照组采用传统实习教学法,于出科前评价2组学生的临床工作能力,并通过问卷形式了解学生对PBL教学法的评价.结果 2组学生通过客观考试,理论成绩比较无显著差异,实验组综合能力明显优于对照组.通过问卷调查,多数学生认为PBL教学法有助于自我学习能力、临床实践能力及团队合作技巧的提高.结论 PBL教学法能提高学生的病史采集、体格检查及医疗操作等临床综合能力,并得到了广大实习学生的认可,其教学效果优于传统教学方法.     

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.