OSCE在急诊专科护士培训中的应用研究

目的探讨客观结构化临床考试(OSCE)在急诊专科护士培训中的应用效果。方法以2016-06—2018-06间于郑州大学第二附属医院急诊科培训的122名专科护士为研究对象。随机分为2组,各61名。观察组采用OSCE模拟情景教学,对照组采用传统教学方式。通过理论考核、临床技能考核以及对OSCE教学满意度调查等方式评估教学效果。结果 2组护理评估、护理效果考核差异无统计学意义(P0.05)。观察组的急救能力、临床思维、人文关怀、应变能力考核明显优于对照组,差异有统计学意义(P0.05)。超过半数专科护士对OSCE情景模拟教学较为满意。结论 OSCE模拟情景教学可以明显提高专科护士的临床实践技能,有利于提升专科护士对OSCE教学的满意度。     

客观结构化临床考试在新上岗护士临床综合能力评价中的应用

目的 探讨客观结构化临床考试(OSCE)在新上岗护士临床综合能力评价中的应用.方法 参考经典OSCE模式,设计出以一个病例贯穿始终的OSCE模式,并应用于新上岗护士考试中.采用自行设计的问卷调查新上岗护士对该模式的评价.结果 新上岗护士在"列出护理诊断"、"执行医嘱"上的得分率分别为20.00%、25.00%,在"技术操作"上得分率达94.00%.73.53%新上岗护士认为考试项目设置合理;76.47%护士适应这种考试形式;100%新上岗护士认为该考核模式可客观评价临床综合能力,同时认为通过该考核找出了自己的薄弱环节,明确了努力方向.结论 该OSEC模式能够客观评价新上岗护士的临床综合能力,真实地反映新上岗护士中现存问题,为今后的工作提供有益的参考.     

OSCE在全科护士培训考核体系中的应用

目的探讨OSCE考核运用于全科护士综合能力测评的可行性。方法在全科护士培训考核体系中引入OSCE考核,结合培训内容设置情境、编写考核病历,培训SP和设置OSCE考核站点考核80名培训学员并进行成绩分析和问卷调查。结果各站点考核合格率为100%;80.00%以上的学员认为此次OSCE的考核总时间和难度适中,各考核站点的设置合理;78.75%的学员表示OSCE能反映综合能力,73.75%的学员表示能促进职业能力的形成;82.50%的学员认为该考核模式公平。结论应用OSCE考核模拟社区复杂的就医环境,能使学员身临其境地运用培训所学知识解决问题,检验其是否具有全科护士的综合能力;但该考核成绩受各考站主考老师和SP的主观影响较大,尚有待改进。     

现场追踪与mini-CEX考核在新护士独立上岗前考核中的应用

目的探索现场追踪与迷你临床演练评估(mini-cex)考核法在新护士独立上岗前临床综合实践能力考核中的效果。方法将2013年的230名新护士作为对照组,2014年的201名新护士作为观察组。对照组按传统床边实践能力考核法进行考核,观察组则采取现场追踪与mini-cex相结合的方法,评价新护士护理面谈技能、护理评估检查能力、专业态度、临床判断与解决问题、沟通技能、组织效能、整体临床胜任能力。计算两组考核所需时间及患者拒绝或不满的次数。并于考试结束后对新护士及教师进行考核方法的满意度调查。结果观察组新护士护理面谈技能等7项能力平均分都达到合格要求,但单项能力未达合格比例为5.0%~15.9%,观察组考核所需时间及患者拒绝或不满频次显著少于对照组(均P0.01);新护士及教师对追踪与mini-CEX考核方法的满意率为88.6%~100.0%。结论现场追踪与mini-CEX考核法是一种客观、有效、贴近临床且被考核双方接受及认可的临床综合能力考核方法。     

轮科护理教学查房在本科学历新护士培训中的作用

目的开展本科学历新护士(下称新护士)轮科护理教学查房,提高其临床综合实践能力。方法对16名轮转新护士进行护理查房相关知识培训,每月组织护理教学查房1次,由所在科室的轮转新护士轮流主持并授课,参与查房的新护士均接受提问并考核。结果实施轮科护理教学查房后,16名新护士专业理论知识水平、综合技能、授课能力显著提高(均P<0.01)。结论在新护士轮岗期间,开展轮科护理教学查房,可有效提高新护士的临床综合能力。     

护理本科生参与客观结构化临床考试的质性研究

目的了解护理本科生对客观结构化临床考试(OSCE)的真实评价,为我国护理教育进一步完善OSCE提供参考。方法深入访问12名参加OSCE的护理本科生,使用Colaizzi的分析程序进行分析,提炼主题。结果护理本科生参加OSCE的真实体验主要包括3个主题:考试方式新颖客观、综合能力得到考查、标准化病人(SP)对护生有积极和消极两方面的影响。结论护理本科生认可并接受OSCE,认为OSCE可检测被考者的真实综合能力,但SP存在一定局限性。建议统一规范的OSCE培训和考核体系,用于招募SP和实施OSCE,以确保OSCE质量。     

应聘护士综合技能考核分析及对临床护理教学的指导

目的 探讨应聘护士综合技能考核的可行性,并为临床护理教学提供依据.方法 对50名应聘护士接待平诊新患者流程的综合考核结果进行回顾性分析.结果 入院接待及测量生命体征合格率为64.0%,入院介绍与健康教育、体温单的绘制、入院评估与病历书写合格率分别为28.0%、32.0%、32.0%,整个流程操作合格率仅36.0%.应聘护士考试中常见的问题为入院告知内容及填写不全面(98.0%),体温单眉栏填写不完整、错误(82.0%),专科情况填写不全(72.0%)等.结论 应聘护士综合技能偏低,提出护生实习期间应加强告知的重要性、内容及方法的培训,加强护理文书书写、护理流程的带教,培养护生综合分析问题、独立解决问题的能力.     

客观结构化临床考试在新上岗护士临床综合能力评价中的应用

目的探讨客观结构化临床考试（0SCE）在新上岗护士临床综合能力评价中的应用。方法参考经典OSCE模式,设计出以一个病例贯穿始终的OSCE模式,并应用于新上岗护士考试中。采用自行设计的问卷调查新上岗护士对该模式的评价。结果新上岗护士在“列出护理诊断”、“执行医嘱”上的得分率分别为20．00％、25．00％,在“技术操作”上得分率达94．00％。73．53％新上岗护士认为考试项目设置合理;76．47％护士适应这种考试形式;100％新上岗护士认为该考核模式可客观评价临床综合能力,同时认为通过该考核找出了自己的薄弱环节。明确了努力方向。结论该OSEC模式能够客观评价新上岗护士的临床综合能力,真实地反映新上岗护士中现存问题,为今后的工作提供有益的参考。     

OSCE在本科护生临床实习评价中的应用研究

目的探讨客观临床能力结构考试(OSCE)在本科护生临床实习评价中应用的可行性。方法选取毕业实习的本科护生141名为研究对象,在完成内科和外科实习后分别组织OSCE测试,对各项考试成绩、考试难度、信度和效度进行评价,并通过问卷调查护生对OSCE的评价及对自身能力的影响。结果 OSCE平均成绩为(86.98±4.74)分,呈正态分布。难度系数0.81,显示OSCE难度适中。护生问卷调查结果显示,87.7%认为OSCE能客观评价自身的临床综合能力,比传统考试全面和客观。结论 OSCE能较真实地反映本科护生能力,得到大多数本科护生的认同,可为护生临床综合能力评价提供参考。     

德州市综合医院院前急救护士综合能力调查

目的 了解德州市13所二级以上综合医院院前急救护士综合能力现状,探讨提高院前急救护理质量的对策.方法 采用问卷调查和技能考核的方法 ,对德州市13所二级以上综合医院192名院前急救护士进行调查和考核.结果 院前急救护士急救知识及技能考核合格率分别为86.98%及81.77%;不同护龄、学历护士急救知识及技能掌握情况比较,差异有统计学意义(均P＜0.05);护士主要通过自身工作经验(80.21%)和院内培训(50.52%)获得急救相关知识;73.44%喜欢院前急救工作,20.83%服从领导安排,5.73%不喜欢院前急救工作.结论 德州市综合医院院前急救护士的综合能力尚可,在进行岗位人力调配上要充分考虑护士学历和年资的影响;帮助护士树立正确的职业态度,重视知识和技能的培训,有助于进一步提高院前急救护理队伍的综合素质.     

杭州健康女性定量骨超声测定原发性骨质疏松

目的 评价杭州健康女性骨超声速度(SOS)值随增龄减少和骨质疏松患病率，建立杭州地区女性骨超声速度值参考数据库。方法 定量超声法测定1208例杭州地区健康女性桡骨远端(RAD)，第3指骨近节(PLX)，第V跖骨(MTR)和胫骨中段(TIB)的超声速度值。结果 RAD、PLX、MTR和TIBSOS峰值(Peak of SOS)均出现在40-45岁，TJB的SOS峰值出现在35—40岁，此后随年龄增长而下降。绝经后妇女在绝经后早期和晚期各有1个SOS快速减少期，前见于桡骨近端，平均年减少率为2．4％，后见于胫骨中段，平均年减少率为1．8％。各部位骨SOS累积减少率随年龄增长而增加，到85岁4部位累积减少为13％-18％。60岁以后骨质疏松性症(OP)检出率为45％-70％，OP检出率以桡骨远端最高，60-70岁平均为67％，第3指骨近端次之约50％，胫骨中段最低为36％；75岁以后分别为70％，65％和45％。结论 全身各部位骨超声速度值到达峰值的年龄不同，峰值也各有差异。绝经后妇女骨超声速度值随年龄增加减少较快，应予激素和补钙治疗，桡骨远端为本地区SOS检测和OP检出的敏感部位。     

Importance of echocardiography in prognosis of surgical outcomes in cholecystitis in elderly patients

The authors propose to use more often echocardiography (EchoCG) in examination of elderly (over 60 years) of age patients with cholecystitis that permits to increase surgical activity to 92.4%. Left ventricular ejection fraction is the most informative. When this fraction is lower than 45% surgery must be recommended on vital indications only. EchoCG was used in 155 patients with cholecystitis, 131 of them were operated. 2 (1.52%) patients died due to acute cardio-vascular insufficiency and pulmonary artery thromboembolism.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

目的 评价脊髓胶质细胞在小鼠骨癌痛形成中的作用.方法 健康雄性C3H/He小鼠40只,周龄8～10周,体重18～22 g,随机分为4组(n=10):假手术组(S组)、骨癌痛组(B组)、PBS组(P组)和米诺环素组(M组).S组跟骨骨髓腔内注射PBS 10 μl;余3组跟骨骨髓腔内注射含2×105个骨纤维肉瘤细胞的PBS 10 μl制备骨癌痛模型,于造模前即刻开始PBS组鞘内注射PBS 5μl,M组鞘内注射米诺环素(用PBS溶解为0.2 mmol/L)5μl,1次/d,连续11 d.于造模前1 d、造模后即刻、3、5、7、9、11 d时测定机械痛阈;于造模后3、7、9、11 d机械痛阈测定结束后测定冷痛阈.痛阈测定结束后处死小鼠,取脊髓组织,测定神经胶质纤维酸性蛋白(GFAP)和CD11b的表达水平.结果 与S组比较,B组和P组造模后3-11 d时、M组造模后3、5 d时机械痛阈升高,B组、P组和M组造模后7～11 d时冷痛阈升高,脊髓CD11b和GFAP表达上调(P<0.05).与B组比较,M组造模后3-11 d时机械痛阈降低,造模后7-11 d时冷痛阈降低,脊髓CD11b和GFAP表达下调(P<0.05).结论 脊髓胶质细胞(星形胶质细胞和小胶质细胞)的激活参与了小鼠骨癌痛的形成.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.