经验学习法在《康复护理学》教学中的应用

目的探讨经验学习法在《康复护理学》教学中的实践效果。方法通过便利法选取2013级护理专业本科2个班共200名学生为研究对象,随机分为2组,对照组采用传统教学模式,研究组采用经验学习理论教学模式,最后通过期末理论成绩、问卷调查评价教学效果。结果研究组学生期末理论成绩、自我导向学习能力、思维能力和沟通表达能力各维度得分优于对照组,比较差异均有统计学意义(均P0.05)。结论在《康复护理学》中应用经验学习法能提高教学效果,有利于促进学生自我导向学习能力、思维能力和沟通表达能力的发展。     

电影教学在《护理人际沟通》课程中的应用

电影教学作为一种教学方式在我国渐渐兴起.它以新颖、生动的人物形象和逼真的模拟情景吸引了学生的目光,激发了学生的学习兴趣.本文对电影教学法在护理人际沟通课程中的应用情况进行了客观介绍,以期对护理教学提供点滴的经验和体会.     

应用经验学习法培养护生临床高层次认知能力

目的 探讨经验学习法在培养护生临床高层次认知能力过程中的作用.方法 将护理实习生60名随机分为两组.常规带教组30名,采取临床带教制,经验学习组30名,在常规教学的基础上,采取反思小组讨论会、临床护理个案研究等形式开展经验学习法.采取理论考试、模拟考核、床边考核形式评价护生解决问题、评判性思维和临床决策能力.结果 两组学生在理论考试、模拟考核、床边考核成绩比较,经验学习组学生成绩优于常规带教组.结论 经验学习法可以提高学生预见护理问题的能力、评判性思维能力、临床决策能力,同时可以提高教学双方的专业素质.     

OSCE在护理本科生“人际沟通”教学中的应用

OSCE是一种客观评估临床技能的方法.文章总结了应用OSCE方法于护理本科生"人际沟通"教学中的经验和体会,充分发挥了护生学习的积极性和主动性,有效地提高了学生的沟通能力,提高了护理本科生"人际沟通"的教学效果.     

经验教学法应用情况调查

经验学习法(experiental learning methods)已被推荐在护理教育,特别是发展交流技巧方面使用。这种方法能促使学生积极参与学习技巧和思考问题。本文旨在探讨经验学习法在威尔士采用的程度。研究对象是威尔士184名综合性护理和精神护理指导教师。问答式调查表是根据过去搜集的会谈资料设计的,回收表格共135份。其中109份来自综合性护理指导教师,占被调查综合性护理指     

角色实践法在护理教育学教学中实施效果的质性研究

目的分析角色实践法在护理教育学课程教学中的实施效果。方法采用目的抽样,抽取参与护理教育学课程角色实践教学的20名学生进行访谈,运用质性研究的内容分析法对学生参与角色实践教学的感受进行分析。结果学生通过角色实践获得了对角色过程的真切体验,掌握了角色实践的全过程,并在实践中体会了学习的主体性和自主性。结论角色实践法具有良好的教学效果,为护理教育学课程教学的方法改革和创新提供了初步借鉴经验。     

合作学习在本科《护理研究》教学中的应用

目的探讨合作学习在本科《护理研究》教学中的应用效果。方法在2003级护理本科的《护理研究》课教学中实施该方法,在课后进行问卷调查和学生成绩的分析。结果合作学习法有助于培养学生合作的精神和竞争意识,可以弥补一个教师难以面向有差异的众多学生教学的不足,真正实现使每个学生都得到发展的目标;同时这种教学方法激发了学生的主观能动性,培养了创新性思维能力,增强了自主学习、合作、交流、分析与解决问题等能力。结论合作学习是提高《护理研究》课教学质量的有效教学方法。     

PBL在《护理学基础》临床教学中的实践

目的探讨PBL在《护理学基础》临床教学中实施的效果。方法回顾总结PBL法在第二军医大学护理学院护理本科2007级、2008级、2009级和2010级学生《护理学基础》课程临床教学中的实施效果和学生的教学反馈情况。结果各年级学生对教学反馈调查问卷中的各项条目赞同率均在90％以上。结论《护理学基础》临床教学中采用PBL法对于激发护理本科学生专业学习兴趣以及培养其综合学习能力有一定的作用。在实施过程中,教师应重点启发和引导学生寻找和确立PBL学习中的问题,注重教师自身的示范和影响作用,并且能确保学生有充足的学习时间。     

认知结构迁移理论在《护理管理学》教学中的应用

认知结构迁移理论揭示了学生知识学习的本质特征．即学生学习新知识的过程是以已有的知识经验为基础,有助于从深层次理解学习和解决问题的过程,在《护理管理学》教学中通过操纵认知结构变量及实施“为迁移而教”的教学策略,促进学习迁移。     

文献阅读研讨法在本科护理研究课程中的探索性应用

文献阅读研讨法是一种以学生自主学习为主、教师组织引导为辅的教学方法,注重学生自主探究的学习过程,培养学生运用评判性思维和创新性思维提出问题,分析问题和解决问题的科研能力。本文主要阐述了文献阅读研讨法在本科护理研究课程的教学过程中的具体应用以及教学效果。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.