肿瘤专科医院低年资护士核心能力调查

目的：了解低年资护士核心能力总体情况及影响因素,为下一步培训提供参考依据。方法对中国医学科学院肿瘤医院已考取护士职业资格证书的95名低年资（护龄≤3年）护士进行中国注册护士核心能力量表问卷调查。结果肿瘤医院低年资护士核心能力总分为（173．05±27．21）分,维度总均分为（2．98±0．47）分,属于中等偏上水平;各维度条目均分显示,法律/伦理实践得分最高,为（3．25±0．52）分;教育/咨询得分最低,为（2．74±0．59）分;不同性别、工作年限、职称、学历、工作科室、聘任方式、是否独生子以及对工作满意度评价不同的低年资护士核心能力总均分比较,差异均无统计学意义（P＞0．05）。结论低年资护士其核心能力水平还有提升空间,特别是在教育/咨询,评判性思维/科研等方面。     

“订单式”培养模式对高职护生自主学习能力的影响

目的探讨“订单式”培养模式对护生自主学习能力的影响。方法在3年制高职护理教育中,抽取280名护生组建2个ICU教学班,从第4学期开始对其进行重症医学专科护士的“订单式”培养：由医院和学校组成专业教学指导委员会,双方共同研讨和制定“订单式”培养计划,紧紧围绕重症医学专科护理的特点和要求设置课程,双方共同参与人才培养过程,实施3+1+2培养方案,以“边理论边实践”为主要教学方式。第6学期结束时,从“订单式”培养的ICU教学班随机抽取140名护生作为观察组,从普通护理班级分层随机抽取140名护生作为对照组,运用林毅等编制的自主学习能力量表对两组护生进行测评,比较其自主学习能力情况,并对其毕业考试成绩进行比较分析。结果观察组的自主学习能力量表总分为（89.21±7.30）分,高于对照组的（84.36±8.14）分,差异有统计学意义（P<0.05）;两组在3个维度的比较中,除信息能力得分差异无统计学意义外,其他2个维度得分差异均具有统计学意义（P<0.01）。观察组毕业考试的理论、实训成绩分别为（77.55±8.52）、（75.40±8.70）分,高于对照组的（75.03±9.07）、（73.38±7.74）分,差异有统计学意义（P<0.05）。结论高职护生自主学习能力总体不高,“订单式”培养模式有利于提高护生的自主学习能力,使高职护生能更好地满足未来学科发展的需要。     

护理硕士研究生实习前后临床实践能力的调查分析

目的：分析临床实习前后护理研究生的临床实践能力水平,筛查实践能力培养中的不足点,为完善研究生临床实践能力培养模式提供参考依据。方法对山西医科大学2008-2011级160名护理学硕士研究生实行“临床实践指导教师制”管理,根据实践要求设计《护理研究生临床实践记录手册》并应用于实践教学管理,应用“护理问题对应行动”（ OPSN）和“护理行为目标达成度”（ NPGA）两个量表进行实习前后临床实践能力的测评。结果临床实习后“OPSN”量表中的“组织、应用信息探索发现问题”“提供个性化护理解决患者问题”“为解决问题给患者心理支持”和“对已解决问题进行自我评价”4个维度得分分别为（20．28±2．78）,（17．23±1．92）,（26．81±2．59）,（20．76±2．59）分,临床实习前得分分别为（17．82±3．47）,（14．53±3．03）,（24．82±3．44）,（18．31±4．40）分,差异有统计学意义（t值分别为3．98,5．40,3．32,3．43;P＜0．05）;维度“为解决问题协调护患行为”临床实习前后得分分别为（16．76±2．72）,（17．51±1．96）分,差异无统计学意义（t＝1．61,P＞0．05）。“NPGA”量表中“自主决策”“个性化护理”“促进患者理解/参与”“开放性交流”“个性尊重”“团队中工作角色”和“个人发展”7个维度得分差异均无统计学意义（P＞0．05）。结论现有临床教学环境下学生习得的临床实践能力与标准要求有差距,具有局限性,应针对临床实践能力薄弱项目开展专项培训。     

亚专业化护理模式对护士核心能力的影响

目的探讨亚专业化护理模式对护士核心能力的影响,分析和评价新模式的临床应用效果。方法采用“注册护士核心能力量表”评估我科31名护士在亚专业护理模式实施前后核心能力的情况,使用SPSS13．0统计学软件进行配对t检验,以分析护士核心能力的差异,评价新模式的临床应用效果。结果亚专业护理模式前后我科护士核心能力总分差异有显著意义（P=0．004）;批判性思维／科研、临床护理、领导能力、人际关系、专业发展及教育／咨询等各个能力得分的差异有显著意义（P〈0．05）,法律／伦理能力得分的差异无显著意义（P=0．173）。结论亚专业化护理模式促进了护士核心能力的培养,改进了科室医疗护理质量。     

临床路径在神经外科新进岗护士培训中的应用

目的：探讨临床路径在神经外科新进岗护士（简称新护士）培训中的应用效果。方法以2012年8月进入神经外Ⅰ科的新护士6人、神经外Ⅱ科的新护士7人,共13人为实施临床路径培训前组;以2013年8月进入神经外Ⅰ科的新护士8人、神经外Ⅱ科的新护士7人,共15人为实施临床路径培训后组。比较实施前后新护士的工作能力、培训质量及新护士对培训方法的满意度。结果实施临床路径培训后新护士的理论成绩、操作成绩、综合能力分别为（90．72±3．47）,（92．34±3．27）,（88．78±4．48）分,高于实施前的（84．15±3．70）,（86．93±2．61）,（83．96±3．21）分,差异有统计学意义（t分别为3．324,6．240,3．530;P＜0．05）;实施后新护士的满意度为100．00％,高于实施前的76．92％,差异无统计学意义（ P＞0．05）。结论实施临床路径培训新护士能提高临床培训质量,调动带教老师及新护士的积极性和主动性,不但提高新护士对培训的满意度,还能为临床一线培养优秀的护理人才,是一种规范化、系统化的培训模式。     

手术室专科护士核心能力现状调查

目的了解手术室专科护士核心能力现状,探讨其影响因素,为护理管理者合理安排工作岗位提供依据。方法采用方便抽样方法抽取83名手术室专科护士。采用护士一般情况调查表、中国注册护士核心能力量表进行调查。结果专科护士核心能力总分（169．77±33．86）分,专科护士的核心能力维度中法律／伦理实践均分最高（3．16±0．57）,评判性思维／科研均分最低（2．76±0．62）;多元线性逐步回归结果显示职称影响专科护士核心能力（t=2．89,P=0．01）。结论专科护士核心能力处于中等水平,护士能够胜任临床工作。护理管理者应有针对性的制定干预措施,以提高护理质量,促进护理队伍的整体发展。     

对护生护理安全影响因素认知情况的调查

目的了解某三级甲等医院入科前的实习护生对护理安全影响因素的认知程度。方法采用“护理安全影响因素的调查问卷”,选取某三所医院入科前的实习护生371人进行问卷调查并分析。结果影响因素的4个维度平均得分由高到低依次为：护士素质与能力（4．584±0．557）分、组织管理（4．464±0．634）分、护理工作环境（4．319±0．693）分、临床工作环境（4．282±0．685）分。护理安全影响因素的重要程度分析,护士素质与能力维度中“基础知识理论及操作技能”平均得分最高（4．80±0．443）分;护理工作环境中“药品的摆放及标识”平均得分最高（4．61±0．561）分;临床工作环境中“病区医疗设备及配套用品性能”得分最高（4．46±0．64）分;组织管理中“各种抢救、意外应急预案”得分最高（4．70±0．540）分。结论护生能意识到护理安全影响因素各条目的重要性。实习医院要强化护生的护理安全意识及各项规章制度,培养其个人综合素质及预防安全隐患的能力,从而避免差错事故的发生。     

特需病房护士核心能力的调查

目的 了解特需病房护士核心能力现状,为特需病房护士的选拔、培养和管理提供借鉴。方法采用便利抽样方法,对某医院特需病房工作的100名护士进行注册护士核心能力量表问卷调查。结果特需病房护士的核心能力总分为（178．9±25．29）分,属于中等偏高水平。不同职称、年龄及工作年限护士的核心能力差异有统计学意义（P〈0．05）。结论特需病房护士尚需进一步提升护理核心能力的水平。护理管理者应制定护士准入、考核标准,在护士任用及制定培训计划时要充分考虑年资、职称等因素与护理核心能力的关系,科学的使用和培养人才,构建合理的护理人才梯队。     

口腔专科医院护士核心能力与一般自我效能感相关性分析

目的：了解口腔专科医院护士核心能力与一般自我效能感的关系。方法采用注册护士核心能力量表、一般自我效能感量表对北京市某三级甲等口腔专科医院的632名护士进行调查,了解护士核心能力和自我效能,分析两者的关系。结果632名护士核心能力总均分为（163．90±36．06）分,各条目均分（2．83±0．62）分,处于中等水平;一般自我效能感总均分（26．13±5．09）分,与核心能力总分呈正相关（r＝0．482,P＜0．01）;多元回归显示护士一般自我效能感对核心能力各维度均具有预测作用。结论口腔专科医院护士自我效能在不同方面影响护士核心能力,提高护士的自我效能感有助于提高其核心能力。     

肿瘤科新入职护士组织支持感与工作满意度的相关性研究

目的探讨肿瘤科新人职护士组织支持感和工作满意度的相关性。方法采用组织支持感问卷和明尼苏达满意度问卷对125名肿瘤科新人职护士进行调查。结果125名护士组织支持感3个维度得分分别为：工作支持（45．32±9．45）分,员工价值认同（27．43±6．86）分,关注员工利益（27．55±8．31）分。工作满意度得分分别为：内在工作满意度（46．28±6．48）分,外在工作满意度（26．38±7．49）分,一般工作满意度（67．38±10．54）分。组织支持感不同的护士工作满意度不同,组织支持感各维度和工作满意度各维度均呈正相关（P〈0．05）。结论肿瘤科新入职护士组织支持感和工作满意度呈正相关,组织支持感对工作满意度有一定的预测作用。     

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.