临床实习护生自主学习能力现状调查及影响因素分析

目的:了解临床实习护生的自主学习能力,探讨其自主学习能力的影响因素,为改进临床教学方法、提高临床实习护生的自主学习能力提供依据。方法:采用护理人员自主学习能力评价量表对175名护生进行调查,调查其自主学习能力现状及影响因素。结果:本组护生自主学习能力总分为(78.68±18.37)分;影响其自主学习能力的因素有学历层次、专业兴趣、临床教学满意度、集体授课兴趣度。结论:临床实习护生的自主学习能力处于中等水平,且受多种因素的影响,学校可根据学历层次、专业及集体授课兴趣程度、改进临床教学满意度的方法,进一步加强对临床实习护生自主学习能力的培养。     

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。     

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。     

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.     

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。     

新疆不同民族实习护生自主学习能力及其影响因素研究

目的了解新疆不同民族实习护生自主学习能力及其影响因素。方法采用护生自主学习能力调查表对新疆3所高等护理院校的466名实习护生进行问卷调查。结果新疆各民族实习护生自主学习能力总分为(91.39±11.24)分,得分率从高到低的维度分别是学习合作能力、自我管理能力和信息能力;影响汉族实习护生自主学习能力的因素为学历、喜欢本专业程度、对临床带教方式的满意程度及实习过程中有无自主学习和评判性思维培训经历;影响回族实习护生自主学习能力的因素为学历、工作是否有成就感、有无自主学习和评判性思维培训经历;影响维吾尔族和哈萨克族实习护生自主学习能力的因素是有无自主学习培训经历。结论新疆护理教育部门应针对不同民族实习护生的自主学习能力特点制订灵活的指导方法,才能有效提高新疆各民族护生的整体水平。     

护理本科实习生自主学习准备度与临床实践能力的相关性研究

目的调查护理本科实习生自主学习准备度与临床实践能力现状并研究两者之间的相关性。方法采用中文版自主学习准备度量表对85名本科护生进行调查,用自制临床实践能力评价指标体系由相应16个科室的护理教学组长对护生进行临床实践能力评价。结果护生的自主学习准备度得分为(134.40±19.52)分,临床实践能力得分(90.20±3.90)分,护生临床实践能力评分与其自主学习准备度评分呈正相关。结论自主学习准备度正向影响临床实践能力,临床带教老师有针对性地采取措施,提高护生的临床实习效果。     

新疆不同民族实习护生评判性思维能力及影响因素比较研究

[目的]了解新疆不同民族实习护生评判性思维能力及影响因素。[方法]采取便利抽样方法对新疆3所高等护理院校的466名实习护生进行问卷调查。[结果]新疆各民族实习护生评判性思维能力得分不高,汉族和回族实习护生得分>280分,其他民族得分均<280分;7个维度中分析能力和求知欲得分最高,寻求真相得分最低。除评判性思维能力自信心维吾尔族实习护生高于其他民族外,其余维度汉族和回族得分高于其他民族;影响汉语言系实习护生评判性思维能力的因素为学历、对专业的喜欢程度、对临床带教方式的满意程度及实习过程中有无自主学习、评判性思维能力培训经历和小组学习经历,影响非汉语言系实习护生评判性思维能力的因素为学历、对专业的喜欢程度及实习过程中有无自主学习和评判性思维能力的培训经历。[结论]新疆护理教育部门和医院护理临床教学部门应针对不同民族实习护生的自身特点制定灵活的教育方法,从而行之有效地提高新疆各民族护生的整体评判性思维能力。     

影响护生临床实习效果的因素及对策

目的探讨影响临床护生实习效果的因素,并提出相应对策,以提高临床教学质量。方法采用自行设计的问卷,调查2005年护理专业护生的临床实习情况。结果反映出在临床实习中影响护生实习的因素有医院和护生两方面。结论护理专业是实践性较强的专业,护理临床实习是重要的教学环节,必须针对问题提出对策,积极进行改进,才能保证护生顺利完成实习任务,成为高素质、实用型护理人才。     

影响护生临床实习效果的因素及对策

目的 探讨影响临床护生实习效果的因素，并提出相应对策，以提高临床教学质量。方法 采用自行设计的问卷，调查2005年护理专业护生的临床实习情况。结果 反映出在临床实习中影响护生实习的因素有医院和护生两方面。结论 护理专业是实践性较强的专业，护理临床实习是重要的教学环节，必须针对问题提出对策，积极进行改进，才能保证护生顺利完成实习任务，成为高素质、实用型护理人才。     

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.     

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.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。