工科学生学习成果评价的研究进展及启示

我国高等护理教育正在走向成果导向教育发展阶段,学生学习成果评价是其中至关重要的环节。该文通过介绍我国工科构建评价体系、拟定评价内容、设计评价方式的成果导向教育实践经验,以期为我国高等护理院校成果导向教育理念下教学评价改革提供借鉴和启示。     

PBL教学法在我国护理教育中应用的研究进展

以问题为导向的教学法（PBL）教学法自被引入医学教育领域就得到了国内外教育者的广泛关注。护理教育者也在教学中不断进行PBL教学实践,并取得了一定的成果。而关于适合护理教学采用的PBL案例开发、符合中国教育特点的PBL教学模式和评价方法探索还需要广大护理教育者进行更深入的研究。     

以核心胜任力为导向的Sandwich教学法在儿科护理学中的应用

目的 评价以核心胜任力为导向的Sandwich教学法在儿科护理学教学中的应用效果。方法 选择广西中医药大学护理学院2015级护理学专业1、2班的196名护理学生为研究对象，每班各98人，以抽签法分组（班）。试验班（1班）采用以核心胜任力为导向的Sandwich教学法开展儿科护理教学，对照班（2班）采用传统教学法。采用满意度评价问卷、核心能力量表和期末理论考试等评价方式分析教学效果。结果 试验班学生理论考核成绩、评判性思维能力好于对照班（P<0.05），对教学效果及教学方法的总体满意度及评价均明显优于对照班（均P<0.05）。结论 以核心胜任力为导向的Sandwich教学法有利于引导学生解决护理实践中的实际问题，增强学生评判性思维，提高分析与解决儿科护理临床问题的能力。     

高职护理专业学生临床思维训练平台的建设及应用

目的 设计开发高职护理专业学生临床思维训练平台并探讨其应用效果。方法以临床常见症状为主线、以护理程序为框架,设计高职护理专业学生临床思维训练平台。在护理综合实训课程中,对2018级304名学生（试验组）使用该平台辅助教学,对2017级325名学生（对照组）使用传统临床案例分析法进行教学,比较两组课程结束后的临床思维能力客观结构化临床考试成绩和自我导向学习能力。结果 试验组临床思维能力客观结构化临床考试得分、自我导向学习能力得分均高于对照组,差异有统计学意义（P<0.05）。结论 护理临床思维训练平台具有较好的应用价值,有助于提高护理专业学生的临床思维能力和自我导向学习能力。     

以病例为导向以问题为目标的护理教学查房在心内科的应用效果

目的探讨以病例为导向以问题为目标的护理教学查房模式在心内科临床本科护理教学中的应用效果。方法将在心内科实习的本科护生分为实验组（n=29）和对照组（n=28）,实验组采用以病例为导向以问题为目标的护理教学查房模式进行护理教学查房,对照组实施传统教学查房方法。结果实验组护生对教学查房满意度95．9％,高于对照组的88％（P〈0．05）,出科理论及综合技能考试成绩优于对照组（P〈0．05）。结论以病例为导向以问题为目标的护理教学查房在心内科临床护理教学查房中的应用效果显著,能提高护生的综合素质、临床实践技能、激发了护生的自学动机、扩展思维视觉和促进老师的角色转变、提升了老师的整体综合能力。     

以问题为导向的小组教学对护理本科生信息意识的影响

目的探讨以问题为导向的小组教学对护理本科生信息意识的影响。方法将2009级护理本科生88人分为实验组和对照组。对照组进行传统课堂讲授式教学,实验组进行为期6周的以问题为导向的小组教学。以护理专业大学生信息意识量表及护理本科生主观评价问卷评价其效果。结果干预后实验组护生信息意识及各因子得分高于对照组,且差异具有统计学意义（P〈0．05）;实验组干预前后信息意识及各因子得分比较,差异具有统计学意义（P〈0．05）;对照组前后信息意识比较,差异具有统计学意义（P〈0．05）,但信息认知与信息行为倾向前后得分差异无统计学意义（P〉0．05）;92．86％的护理本科生愿意再次参加以问题为导向的小组教学。结论以问题为导向的小组教学有利于提升护理本科生的信息意识。     

以结果为导向的教学模式在心血管内科护理本科生临床教学中的应用

目的 探讨以结果为导向的教学模式在心血管内科护理本科临床教学中的应用效果。方法 将2020年7月—2021年4月在心血管内科实习的36名护理本科生作为对照组,将2021年7月—2022年4月在心血管内科实习的37名护理本科生作为试验组。对照组采用传统教学方法 ,试验组在传统教学方法的基础上,采用以结果 为导向的O-AMAS教学模型为理论框架设计并进行临床教学,即包含教学目标（objective）、兴趣激活（activation）、多元化教学（multi-learning）、有效测评（assessment）、总结评价（summary）5个要素。比较两组出科时的理论成绩、综合技能考核成绩及学生对临床教学效果的评价。结果 试验组理论成绩为（87.03±5.89）分,高于对照组（80.03±5.55）分,差异具有统计学意义（P<0.05）;试验组综合技能考核成绩为（89.03±3.80）分,高于对照组（84.71±2.65）分,差异具有统计学意义（P<0.05）。试验组学生对临床教学效果的评价各条目得分均高于对照组,差异具有统计学意义（P<0.05）。结论 以结果为导向的教学...     

基于成果导向的教学在高职儿童护理课程中的实施效果

目的 探讨基于成果导向的教学在儿童护理课程中的应用效果.方法 采用便利抽样法,选取某高职院校2017级护理专业1个班的学生为对照组(n=41),实施基于任务导向的教学;2018级1个班的学生为试验组(n=48),实施基于成果导向的教学.干预后比较两组学生的自主学习能力,总结试验组预期学习成果达成情况.结果 干预后,试验...     

危重患者抢救护理技术教学中行动导向法的应用

摘要：目的 探讨行动导向法在危重患者抢救护理技术教学中的应用效果。方法 将２００５级高职护理专业６个教学班的学生２５８人，随机分为观察班和对照班，对照班（１２８人）采用传统方式授课，观察班（１３０人）采用行动导向教学法授课，即按课前提出问题进行课堂讨论，拟定预案，模拟训练，汇报表演，点评引导，整理强化。结果 观察班操作成绩和各方面的能力与对照班比较，差异有显著性意义（均Ｐ＜０．０１）。结论 行动导向教学法适用于危重患者抢救护理技术教学，有利于学生掌握专业技能，培养创新精神、增强其团队协作精神及沟通能力。关键词：危重患者；　急救护理；　抢救护理技术；　行动导向法；　教学法中图分类号：Ｒ４７；Ｇ４２４．１　　文献标识码：Ｂ　　文章编号：１００１-４１５２（２００７）１１-００６１-０３     

护理学生自我导向学习现状的调查

目的比较护理专业本科学生和专科学生的自我导向学习状况。方法应用自我导向学习等级评定量表（SRSSDL）对上海和江苏2所高等护理院校全日制在校护理本科和专科学生共1500人进行调查。结果护理本科学生和专科学生自我导向学习总得分分别为（224．33±25．99）和（224．31±29．78）分;本科学生学习策略维度得分为（45．01±5．920）分,高于专科学生的（44．30±6．749）分,学习行为维度得分为（42．53±5．849）分,低于专科学生的（43．35±6．596）分,差异具有统计学意义（t分别为2．076,-2．445;P〈0．05）。结论护理本科和专科学生自我导向学习各有所长,在今后的教学中可针对性采取措旆．促讲护殚本科和专科学生自我导向学习能力的完善。     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.