临床护理路径在手术室实习带教中的应用与效果

目的探讨临床护理教学路径在手术室实习带教中的应用效果。方法将2010年5月-2011年1月在手术室实习的60名护理实习生（护生）分为对照组和试验组,对照组采用传统方法带教,试验组采用临床护理教学路径带教。结果试验组护生的理论、操作技能考试成绩明显优于对照组,其对带教老师的满意度也较对照组高（P〈0．05）。结论采用临床护理教学路径予以带教,不仅提高了整体带教能力,使护理带教质量得以持续改进,而且护生的理论知识和操作技能获得全面提升。     

责任制护理对护理本科实习生临床决策能力的影响

目的：分析责任制护理对护理本科实习生临床决策能力的影响。方法将在我院实习7个月的护理本科生84人随机分成试验组和对照组各42人,试验组采用责任制护理教学法,由护生主管床位,负责患者从入院至出院全过程的护理服务,要求在带教老师指导下独立完成护理查房工作。对照组采用传统的带教模式,护生跟着带教老师做日常护理工作,不具体负责分管床位。评价两组护生的临床决策能力和患者对护生的评价。结果试验组护生临床决策能力和患者对护生的评价优于对照组（ P〈0.05）。结论采用责任制护理教学法能提高护理本科实习生提高临床决策能力,提高了护生的综合素质。     

导师带教模式在肝病科护生带教中的应用

目的探讨导师带教模式在肝病科护生带教中的应用效果。方法将2017年3月—2018年2月临床护理实习生98人按随机数字表法分为两组,49人为试验组,49人为对照组,对照组采用传统带教模式,试验组在传统带教方式上增加导师带教模式,比较两组护生综合能力及护生对医院临床教学评价满意度。结果试验组护生综合能力考核得分(理论考试、操作技能考试、护理查房讲课、护理病历书写)优于对照组。试验组护生对教学满意度高于对照组,差异有统计学意义(P0.05)。结论导师带教模式可以有效提高护生的临床综合能力,提高临床教学质量。     

循证护理在2型糖尿病临床护理带教中的应用

目的探讨循证护理在2型糖尿病临床护理带教中的应用。方法选取2018年1—10月在我院内分泌科学习的50名护生为研究对象,随机将其等分为对照组和试验组,对照组采用传统的一对一教学方法,试验组采用循证护理教学方法。实习结束后,考核两组护生的糖尿病理论知识及专业操作。结果试验组护生的理论知识及专业操作考核成绩均高于对照组,差异有统计学意义(P 0. 05)。结论在对内分泌科护生的带教教学中,采用循证护理路径可以有效提高护生的专业技能和临床护理带教质量。     

实习护生责任制在普外科病房带教中的应用效果观察

目的:探讨实习护生责任制在普外科病房带教中的应用效果。方法:将2011年实习中后期(进入临床实习4个月后)轮转到普外科的护生106名作为试验组,采用一对一带教,即实习护生责任制模式带教;将2010年实习中后期轮转到普外科的护生98名作为对照组,采用传统的护理带教模式。分别对两组护生的护理服务质量、职业认同感、住院患者满意度等相关资料进行收集并分析。结果:试验组护生护理服务质量、职业认同感、住院患者满意度均高于对照组(P<0.05)。结论:在临床护理带教中,实行实习护生责任制,调动了护生学习的积极主动性,增强了职业认同感,提升了患者满意度及护理服务质量。     

换位思考在临床护理带教中的应用

目的 探索换位思考应用于临床护理带教的方法及对带教质量的影响。方法 将2004年7月～2005年6月外科实习护士264名随机分为观察组和对照组各132名。带教教师38名随机分为对照组和试验组。对照组应用传统带教方法进行带教，试验组采用换位思考的方法进行带教。在护生出科时分别由带教教师对护生和护生对带教教师进行考核。结果 试验组带教教师和护生的成绩分别高于对照组带教教师和护生的成绩（P〈0．05）。结论 换位思考能增进带教教师与护生间的相互沟通与理解，调动护生的学习主动性，提高带教质量。     

PBL教学结合临床路径教学法在急诊护理本科实习生带教中的应用

目的:探讨PBL教学结合临床路径教学法在急诊护理本科实习生带教中的应用效果。方法:将2013年度和2014年度来我科实习的2010级和2011级第二军医大学护理本科生分为两组,2010级护理本科实习生25名为对照组,实施传统教学法带教,2011级护理本科实习生27名为试验组,实施PBL教学结合临床路径教学法带教,比较两组护生的理论成绩、专科技能水平及发现问题能力、分析问题能力、解决问题能力、沟通能力、求知欲。结果:两组护生在我科实习结束后的理论成绩、专科技能水平比较,试验组优于对照组,差异有统计学意义(P0.05);且试验组在发现问题、分析问题、解决问题方面的能力及对知识的求知欲等方面均优于对照组,差异有统计学意义(P0.05)。结论:实施PBL教学结合临床路径教学法对急诊护理本科实习生进行临床护理教学管理,可激发护生的求知欲,促使护生主动探索式学习,培养护生评判性思维能力,从而提高临床护理教学质量。     

基于PDP和CNP的个性化教学在临床护理带教中的应用

目的:探讨基于事业优势诊断系统(PDP)和临床护理路径(CNP)的个性化教学在临床护理带教中的应用效果。方法:将60名实习护生随机分为观察组和对照组各30名,对照组采用LBL教学,观察组采用PDP和CNP的个性化教学,比较两组带教效果。结果:观察组出科考试成绩、患者对护生的评价、带教老师对护生的评价和护生实习结束后自我评价得分均优于对照组(P0.05)。结论:基于PDP和CNP的个性化教学有助于临床实践和理论知识相结合,提高护生的学习针对性,提高学习效率,充分调动护生的学习兴趣,还能培养和提高与带教老师之间的互动性,增强护生的自我价值感。     

小组合作式教学模式在儿科临床护理带教中的应用

目的探讨小组合作式教学在儿科临床护理带教中的应用效果。方法选取2015年4月～2017年4月于本院学习的140名护理实习生作为研究对象,随机分为对照组和实验组,每组各70名。实验组实行小组合作式带教模式,对照组按照传统方法进行带教。比较2组护生出科时理论考核及操作考核成绩,患者对其的护理满意度情况及护生对带教的满意度情况。结果实验组护生理论考核及操作考核等分均高于对照组,且患儿家长对护生满意度及护生对带教模式的满意度均高于对照组,差异有统计学意义(P 0. 05)。结论实行小组合作式护理带教模式,能提高护生的儿科护理临床综合技能,在儿科临床护理带教中有较好的推广意义。     

线上线下双向融合教学模式在骨科实习护生带教中的应用

目的 探讨线上线下双向融合教学模式在骨科实习护生带教中的应用效果。方法 选取2020年9月-2021年8月本院骨科的54例护理实习生作为对照组,2021年9月-2022年8月本院骨科的58例护理实习生作为试验组。对照组采用传统的本院教学方法,试验组采用基于智能手机线上线下双向融合教学,比较两组实习护生出科时的考核成绩和对教学的满意度。结果 试验组实习护生的理论考核成绩、操作考核成绩及满意度得分高于对照组,两组比较,差异具有统计学意义（均P<0.05）。结论 线上线下双向融合教学模式能提高骨科实习护生带教中教学质量,提高护生满意度,值得推广。     

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.