本科护理实习生自主学习准备度现状及影响因素研究

[目的]了解本科护理实习生自主学习准备度现状及影响因素。[方法]采用护理本科实习自主学习准备度量表(SDLRS)和一般情况问卷测量对2013届、2014届、2015届390名本科护理实习生进行自主学习准备度及其影响因素调查。[结果]回收有效问卷347份,3届本科护理实习生自主学习准备度总分149.32分±19.39分;最优尺度回归分析结果显示是否喜欢本专业、自我感知有无学习困难是影响本科护理实习生自我管理、热爱学习、自我控制和自主学习准备度总分的重要因素(P0.05)。[结论]3届本科护理实习生自主学习准备度处于中上水平。是否喜欢本专业、自我感知有无学习困难是影响本科护理实习生自主学习准备度的重要因素。     

实习护生自主学习准备度现状及影响因素分析

目的 通过调查分析实习护生自主学习准备度现状及影响因素,为制订更有针对性的临床教学方法和课程体系提供依据.方法 采用问卷调查法对郑州大学、北京协和医学院护理专业本专科生共240名进行横断面调查;采用定量分析法,进一步精确实习护生自主学习准备度得分;通过文献研究法,分析对影响实习护生自主学习准备度因素问题的研究现状及方向.结果 实习护生自主学习准备度总分为(116.59±21.79)分,影响实习护生自主学习准备度的因素主要包括:是否喜欢护理专业、有无自我感知“学习困难”、有无“小组学习”经历、对临床教师的满意度,课程体系优化度.结论 当前实习护生自主学习准备度相对较低,有多方面的影响因素,院校应采取多种措施提高护生的自主学习准备度,并结合实习护生的特点采用适合、有效的临床教学方法,优化课程体系.     

护理实习生自主学习准备度及影响因素分析

目的 描述护理实习生自主学习准备度现状,并探讨临床教学因素对自主学习准备度的影响. 方法对上海5所医学院校631名护理实习生进行问卷调查,采用中文翻译版<护理自主学习准备度量表>和<临床教学情况调查问卷>分别测量护理实习生的自主学习准备度和临床教学状况. 结果护理实习生自主学习准备度总分(144.19±22.27)分,影响因素按照作用强度依次为是否喜欢护理专业、有无自我感知"学习困难"、有无"小组学习"、"问题解决培训"教学培训经历、对临床教师的满意度.复相关系数R=0.378,R~2=0.143. 结论护理实习生自主学习准备度相对较低,应重视护理学生的自主学习准备度的培养,进一步探讨适合的教学方法.     

实习护生自主学习准备度及自我效能的调查研究

目的:描述北京市实习护生自主学习准备度现状,分析其影响因素,为临床护理教学提供合理化建议。方法:对北京市某"三甲"医院141名实习护生进行问卷调查,采用一般资料问卷、一般自我效能感量表及中文版护理自主学习准备度量表测量实习护生的一般资料、自我效能及自主学习准备度情况。结果:实习护生自主学习准备度总均分为(152.31±19.13)分,影响因素依次为自我效能、是否对自己的职业生涯进行过规划、是否喜欢护理专业、生源地及认为学习时间是否充足,调整系数R2=0.368。结论:实习护生自我学习准备度较低,应重视对其进行自我效能、职业生涯规划、对护理专业认同感等方面的培养,适当引导实习护生合理、高效地利用时间。     

本科实习护生自主学习准备度与成就动机的相关性及影响因素分析

目的：探讨本科实习护生自主学习准备度与成就动机的相关性及影响因素。方法：采用便利抽样法,选取2019年7月至11月于成都市某2所三级甲等医院实习的515名全日制本科实习护生为研究对象。采用一般资料调查表、护理自主学习准备度量表（SDLRS）和成就动机量表对其进行调查,采用SPSS 17.0软件进行统计分析。结果： 515名本科实习护生SDLRS总分为（134.78±13.67）分,成就动机总分为（3.55±0.83）分。多元线性回归分析显示,追求成功动机、是否喜欢本专业、学习困难情况、对前途是否有信心、对自我形象是否满意是本科实习护生自主学习准备度的影响因素,可解释自主学习准备度变异量的40.30%。结论： 本科实习护生自主学习准备度处于中等水平,通过端正实习护生的学习态度,改善实习护生的学习心态,采用适当的教学模式可提高本科实习护生自主学习准备度。     

新医科背景下高职医学检验技术专业学生自主学习能力现状分析

目的 了解新医科背景下高职医学检验技术专业学生自主学习能力现状及其影响因素,为改善线上和线下混合式教学改革提供参考。方法 采用整群抽样方法,选取广州卫生职业技术学院2020级医学检验技术专业学生作为研究对象,利用自主学习能力量表对其进行调查。结果 高职医学检验技术专业学生的自主学习能力总分为(89.14±14.18)分,其中学习动机平均分为(3.28±0.68)分,自我管理能力平均分为(3.49±0.72)分,合作能力平均分为(3.11±0.35)分,信息素养平均分为(3.32±0.57)分。结论 高职医学检验技术专业学生自主学习能力稍高于中等水平,是否期望获得奖学金和是否愿意与同学交流是影响医学检验技术专业学生自主学习能力的主要因素。     

本科护生学业延迟满足现状及其影响因素研究

[目的]了解本科护生学业延迟满足现状并分析其影响因素。[方法]选取某医学院校在校本科护生847人,采用学业延迟满足量表与自主学习准备度量表进行调查。[结果]本科护生学业延迟满足得分为(2.87±0.52)分,属于中等偏上水平。本科护生学业延迟满足总分与自主学习准备度总分呈正相关(r=0.358,P0.01),年级、是否独生子女、护理专业兴趣度、自主学习准备度对学业延迟满足有影响(R~2=0.219,F=59.955,P0.001)。[结论]护生应增强自我调节学习能力,护理教育者须针对不同特征、不同层次本科护生的需求实施分层教学,使护生能够发挥最大潜能,提高自主学习准备度,推迟即时满足,追求更高水平的学业满足。     

助产专业护理学基础教学分析与对策

目的通过调查分析,找出影响高职大专助产专业学生学习护基的因素,以进一步提升教学效果。方法采用问卷调查法,对我院2001～2002级三年级助产、护理两个专业208名学生进行入学动机,专业认识度,护基与专业的相关性认识以及护基学习的态度与行为等方面进行对照性调查与分析。结果两专业学生专业思想较稳定,对学习不构成影响;助产专业护基成绩落差的主要原因是学生对所学专业的认知度欠缺,自我定位不够明确,对护基学习的重要性认识不足,学习态度不端正所造成的。结论要提高助产专业学生护基成绩首先应加强专业理念的形成教育,使学生明确学习的方向,形成良好的学习态度。     

护理高职生自主学习能力及影响因素的调查研究

目的了解护理高职生的自主学习能力现状并分析其影响因素。方法采用一般资料问卷、自主学习能力量表、一般自我效能感量表和中文版评判性思维能力测量表对某高职院校护理专业的1 198名学生进行调查。结果学生自主学习能力得分为(68.02±8.72)分,自我效能感、评判性思维能力、对护理专业的态度、对就业前景认识、年级和学制进入回归方程,能解释自主学习能力总变异的40.3%。结论护理高职生自主学习能力有待提高。学校应积极进行教学改革,注重学生自我效能感和评判性思维能力的培养并营造激发学习兴趣与动机的课堂环境,提高学生的自主学习能力。     

大专护理专业学生专业承诺和自主学习能力关系的研究

目的：调查大专护理专业学生专业承诺和自主学习能力的现状,探索其相互关系。方法：采用“护理自主学习准备度量表”和“护理专业承诺量表”对某医学高等专科学校537名在校护理专业学生进行调查。结果：学生的专业承诺和自主学习能力各因子得分率均未超过85%;专业努力意愿和专业价值认同对自主学习能力有正向预测作用（P〈0.05）。结论：大专护理专业学生专业承诺和自主学习能力均呈中等水平,提高其专业承诺对增加其自主学习能力有重要作用。     

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.