以能力为核心的临床护理教学模式的构建与实践

目的探讨以能力为核心的临床护理教学模式。方法编写《临床护理教学手册》,制订分阶段目标教学计划,将实习分为基础护理阶段、专科护理阶段和整体护理阶段．由带教老师对274名实习学生实施以能力为核心的临床护理教学模式的带教。结果学生临床护理能力得到提高,学生和带教老师对教学模式的满意度均较好（P〈0．01）。结论以能力为核心的临床护理教学模式能提高学生临床护理能力,有利于提高临床教学质量。     

护生实习转科综合技能考试形式探讨

护理教育的发展 ,是护理事业发展的前提 ,改进护生实习转科综合技能考试的形式 ,是护理教育发展的要求 ,也是培养实用型人才的途径。在实施整体护理实践能力考试形式以前 ,我院护生实习转科综合技能考试形式的发展经历了 2个阶段 :一是闭卷理论考试和基础护理技术操作考核分开形式 ;二是基础护理技术操作与专科护理技术操作相结合的考试形式。经过对比观察 ,我们对 2 0 0 1届大专护生采取了整体护理实践能力考核形式 ,得到了带教老师及护生一致的认可 ,现介绍如下。1　整体护理实践能力考核形式护生于本区实习的最后 1周 ,为避免考试成绩受…     

“名片案例签”在基础护理技能操作考核中的应用

目的 探讨“名片案例签”在基础护理技能操作中的应用与效果.方法 在2008级三年制护理专业328名学生中,采用“名片案例签”考核护理技能操作,通过学生和实习医院的反馈对“名片案例签”的应用效果进行评价.结果 95.3％和90.3％的学生认为能提高学习兴趣和加深理论知识学习;88.2％和88.9％的学生和实习医院带教教师认为提高了学生的应变能力;88.5％和90.1％的学生和实习医院带教教师认为提高了学生的分析问题能力;89.8％和89.7％的学生和实习医院带教教师认为提高了学生的解决问题能力;85.6％和90.6％的学生和实习医院带教教师认为培养了学生的临床思维能力.结论 “名片案例签”考核护理技能操作能提高学生的综合能力.     

多方努力提高护理本科生临床实习质量

论述了影响护理本科生临床实习效果的几个环节。对带教教师素质的提高提出如下建议加强学科专业知识学习,加强教育理论学习,提高科研能力,培养高尚的职业道德品质;同时总结了影响实习学生临床角色转变的内外因素,并提出对策加强学生实习前培训,调动学生实习积极性,建立和谐的师生关系,增强全员带教意识,并且论述了建立健全的管理体制的方法实行带教教师聘任制度,做好带教质量反馈工作。     

浅谈临床分期护理带教体会

在护理教学中，临床实习是护生学习的一个重要环节，既是护生将理论知识与临床实践相结合的初步体验，也是护生今后步入临床护理工作的起始阶段，良好的、扎实的临床带教工作是培养、优秀护士的重要基础。因此，在带教工作中必须重视带教质量，因人施教，随时查找带教工作中存在的问题，不断提高带教质量。我科2007年1月～2008年7月承担带教护生72人，对其实行分期带教，在本科室实习结束时对护生进行综合考核及双向征求意见，取得良好效果。现报道如下。     

中专护生骨科病房的实习目标与带教程序

为了适应护理教育改革的需要，更好地培养“实用型”中级护理人才，作者积极探索了适合骨科的新的临床带教方法：即首先根据实习目标的总体要求。确定专科实习目标体系，包括知识、技能、态度三个方面，然后根据实习目标，设计带教程序及安排带教内容；且在出科时采用综合考核方式对学生的专业理论、护理技能、护士素质进行综合评定。实践表明：明确专科实习目标，对临床带教和护生实习均起到良好的导向作用，提高了临床教学质量。同时要求护生按照护理程序对病人进行身心整体护理，不仅强化了学生整体护理的意识，而且培养与提高了护生的综合能力。     

骨科实习护生阶段式带教计划手册的设计与应用

目的设计制作骨科实习护生阶段式带教计划手册,提高临床带教质量。方法将2015年3月～2016年2月期间接收的实习护生作为对照组,实施常规带教;将2016年3月～2017年3月期间接收的实习护生作为观察组,采用骨科实习护生阶段式带教计划手册作为带教指引。该手册按照时间顺序分为入科当周、入科到出科前1周及出科当周3个时间段;教学内容由入科教育、专科知识与操作、基础护理操作、出科准备与考核4大板块组成;带教方式根据带教内容可以采取讲授、示范、床边教学。对比两组护生的临床带教效果。结果观察组的带教质量、理论考核、操作考核评分均高于对照组,差异有统计学意义(P 0.05)。结论骨科护理实习生带教计划以表格的形式,按实习的进程将专科理论与基础护理操作以周为单位进行分解,给带教老师和护生指引,避免护生在骨科实习的学习盲目感;方便督促检查带教进度及质量,促使带教老师与护生都能高质量完成教学任务。     

多方努力提高护理本科生临床实习质量

论述了影响护理本科生临床实习效果的几个环节.对带教教师素质的提高提出如下建议:加强学科专业知识学习,加强教育理论学习,提高科研能力,培养高尚的职业道德品质;同时总结了影响实习学生临床角色转变的内外因素,并提出对策:加强学生实习前培训,调动学生实习积极性,建立和谐的师生关系,增强全员带教意识,并且论述了建立健全的管理体制的方法:实行带教教师聘任制度,做好带教质量反馈工作.     

谈我院对中医实习护生的带教方法

护生毕业前均须经过32周的临床实习期。这个阶段是培养学生临床工作能力的关键时期,中医护生实习除与西医护生相同之外,还强调中医特色,即运用四诊八纲对疾病进行辨证施护。我院通过对7届110名中医实习护生的临床带教,着重抓了实习心得、临床讲课、现场教学、双向测评、考核评估等几方面,体会到制定严格的实习计划,选择优秀的带教老师能激发护生的学习热情,加深对中医护理事业的热爱,认清中医护生是中医护理事业的未来,使护生从思想作风、理论技术上打好基础,才能培养出品学兼优的中医护理人才。     

实习护生入科前集中培训基础护理操作技能的效果研究

目的 探讨实习护生入科前集中培训基础护理操作技能的效果.方法 将2007年实习护生176名列为对照组,将2008年实习护生320名列为实验组.对照组护生在接受常规的入科前教育后即安排进入临床实习,实验组护生除常规入科前教育外,再进行为期1周的集中基础护理操作技能培训并考核,合格者进入临床实习,未合格者继续培训至考核合格,再进入临床实习.比较2组护生在第一阶段掌握操作技能时间、出科操作考核成绩和带教老师对护生实习质量的效果评价.结果 与对照组护生比较,实验组护生在第一阶段掌握操作技能的时间缩短,出科操作考核成绩明显上升,带教老师对实验组护生实习质量效果评价优良率较对照组明显提高.结论 通过集中培训考核,可缩短护生掌握基础护理操作技能时间,提高护生操作能力,促进临床护理带教质量的提高.     

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.