客观结构化临床考试中评判性思维能力测评的探索与实践

[目的]探讨护理专业本科毕业生客观结构化临床考试(OSCE)中评判性思维能力的测评方法。[方法]利用自设的测评问卷对我校259名护理专业本科应届毕业生进行测评,并对结果进行分析。[结果]护生评判性思维能力测评的平均得分在中等水平,总体成绩分布呈现正态分布。[结论]对护生评判性思维能力的测评,增强了护生的自身意识,有利于强化教师对护生评判性思维能力的培养,创造良好的学习环境。     

本科护生客观结构化临床考试中评判性思维能力测评结果分析

[目的]评价本科护生评判性思维能力状况。[方法]在客观结构化临床考试（嗍）中，通过采用自行设计的测评问卷对我校护理学院统招本科、专升本科临床实习前后各两个年级的护生进行测评，并分析结果。[结果]护生各年级测评成绩总体呈正态分布，统招本科护生成绩略高于专升本科护生，不同类别两个年级本科护生之间比较，高年级（实习后）护生总成绩及情境分析题成绩均高于低年级（实习前）护生（P〈0．05）。[结论]通过OSCE测评，实习前后本科护生评判性思维能力成绩存在统计学差异。     

中医护理“订单式”培养模式对护生评判性思维能力的影响

[目的]探讨中医护理“订单式”培养模式对护生评判性思维能力的影响。[方法]于分班前和实习前采用中文版评判性思维态度倾向性量表(CTDI-CV)对2013级参与我院中医护理“订单式”培养的护生(38人)与自愿在我院实习的普通护理专业护生(40人)进行测评。[结果]实习前两组在寻求真相、开放思想、分析能力、系统化能力、自信心、求知欲6个维度和总分比较差异具有统计学意义(P0.05),订单班护生评判性思维能力高于普通护理班护生。[结论]中医护理“订单式”培养模式有利于提高护生评判性思维能力。     

不同学历实习护生评判性思维能力的比较性研究与分析

[目的]比较不同学历护生实习前后的评判性思维能力,为提高实习前后护生评判性思维能力培养提供依据。[方法]利用评判性思维量表对我院护理专业高职生及大专生进行调查。[结果]高职及大专护生实习前的评判性思维能力无明显差异,实习后大专护生评判性思维能力强于高职护生。[结论]不同学历护生的评判性思维能力受护理教育过程的影响,护理院校应多开展教育教学的改革,进一步提高护生的评判性思维能力。     

不同年级本科护生评判性思维能力的比较研究

[目的]比较不同年级本科护生的评判性思维能力，为进一步深化改革本科护理教育教学方式提供依据。[方法]采用中文版本的评判性思维测量袁（CTDICV），对南通大学护理学院217名在校本科护生进行问卷调查。[结果]本科护生评判性思维能力总分平均为293．91分。本科护生具有正性评判性思维倾向；各年级的评判性思维能力总分及各项目的得分情况比较，差异有统计学意义。[结论]护理院校应深化改革，进一步培养和强化护生评判性思维能力。     

本科护生客观结构化临床考试中评判性思维能力测评结果分析

[目的]评价本科护生评判性思维能力状况.[方法]在客观结构化临床考试(OSCE)中.通过采用自行设计的测评问卷时我校护理学院统招本科、专升本科临床实习前后各两个年级的护生进行测评,并分析结果.[结果]护生各年级测评成绩总体呈正态分布,统招本科护生成绩略高于专升本科护生,不同类别两个年级本科护生之间比较,高年级(实习后)护生总成绩及情境分析题成绩均高于低年级(实习前)护生(P＜0.05).[结论]通过OSCE测评,实习前后本科护生评判性思维能力成绩存在统计学差异.     

循证护理融合PBL教学模式在外科临床护理教学中的应用

[目的]探讨循证护理融合以问题为基础学习(PBL)模式在外科临床护理教学中的应用效果。[方法]将五年制高职护生100人随机分为两组各50人,对照组采用传统教学模式,观察组采用循证护理融合PBL教学模式,比较两组教学效果。[结果]两组护生理论成绩、评判性思维能力测评总分比较,差异均有统计学意义(P0.05)。[结论]循证护理融合PBL的教学模式有利于调动护生学习的积极性、主动性,有助于护生评判性思维能力、循证思维能力的培养。     

不同年级本科护生评判性思维能力的比较研究

[目的]比较不同年级本科护生的评判性思维能力,为进一步深化改革本科护理教育教学方式提供依据。[方法]采用中文版本的评判性思维测量表(CTDI-CV),对南通大学护理学院217名在校本科护生进行问卷调查。[结果]本科护生评判性思维能力总分平均为293.91分,本科护生具有正性评判性思维倾向;各年级的评判性思维能力总分及各项目的得分情况比较,差异有统计学意义。[结论]护理院校应深化改革,进一步培养和强化护生评判性思维能力。     

本科护生评判性思维能力及其影响因素的研究

[目的]了解本科护生评判性思维能力水平及其影响因素,为本科护生的培养提供参考依据.[方法]采用评判性思维能力测量表对某校229 名护生的评判性思维能力进行调查.[结果]本科护生评判性思维能力得分为（287.60±16.76）分;年级和有无参加过护理综合能力比赛是影响护生评判性思维能力的因素.[结论]各护理院校应在掌握学生评判性思维特征的基础上创造有利于护生评判性思维发展的学习环境,采取个性化培养方式加强护生评判性思维能力的培养.     

护理专业本科学生评判性思维能力及影响因素的研究

[目的]调查护理专业本科学生评判性思维能力现状,并分析其影响因素。[方法]采用一般资料问卷和评判性思维测量量表(CTDI-CV)中文版,对齐齐哈尔医学院482名本科护生进行问卷调查。[结果]本科护生评判性思维总分为243.03分±13.72分,评判性思维水平中等,各维度得分由高到低分别是寻求真相、认知成熟度、求知欲、开放思想、分析能力、系统化能力、自信心;不同学生类别中,专升本学生评判性思维总得分高于本科四年制学生,但差异无统计学意义(P0.05);不同学习动机的护生评判性思维能力差异有统计学意义(P0.05)。[结论]本科护理专业学生评判性思维中等,教育者要优化课程设置、改进教学方法,进一步培养和提高学生的评判性思维能力。     

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.