护理专业教师批判性思维能力调查研究

[目的]研究高校护理专业教师批判性思维的能力倾向,找出差距,为师资培训课程提供依据。[方法]采用一般情况问卷及香港理工大学中文版加利福尼亚批判性思维倾向量表(CTDI-CV)对某高校护理学院86名教师集中进行问卷调查和CTDI-CV测量。[结果]护理教师CTDI-CV测量结果中总分最低分为248分,最高分为386分;不同年龄、职称和工作压力的护理教师CTDI-CV中文版特质测量结果比较有统计学意义。[结论]高校护理教师具有较强的批判性思维倾向,但是开放思想等特质还需进一步提高;低年资教师及学院教师的系统化特质等还需进一步提高。     

中美合作教学班与普通班护生批判性思维能力的比较研究

[目的]比较中美合作教学班与普通班护生批判性思维能力的差异。探讨我校护理课程设置、护理教学和掌握双语程度与批判性思维能力的关系。[方法]普通班护生246名,中关合作教学班护生251名。采用中文版批判性思维能力测量表（CTDI—CV）对497名护生进行问卷调查。[结果]497名护生批判性思维能力cTDI—cV总分284．69分±29．31分,为正性水平;中美合作教学班护生CTDI—CV总分达到正性水平（291．90分±29．69分）,普通班护生CTDI—CV总分处于正负临界水平（277．33分±27．06分）,两组比较差异有统计学意义（PdO．05）;一年级、二年级中美合作教学班与普通班护生正性批判性思维比较差异有统计学意义（P〈0．05）,三年级两班护生比较差异无统计学意义（P〉O．05）。[结论]中美合作教学班与普通班护生批判性思维能力存在差异,可能与课程设置、教学方式和掌握双语的程度有关。     

护理生物化学中评判性思维的教学实践

[目的]探讨评判性思维在生物化学教学中的教改实践及其效果。[方法]采用多种评判性思维的教学方法进行教学活动,应用评判性思维能力（中文版）测量表（CTDI—CV）对教学效果进行评价。[结果]教学前后CTDI—CV测量总分、分析能力、评判性思维的自信心、求知欲方面的得分比较,差异有统计学意义（P〈0．05）。[结论]在基础医学课中对护生进行评判性思维训练可为后期临床课学习及今后的护理实践工作中运用评判性思维能力打好基础。     

山西省三级甲等综合医院临床护理教师评判性思维现状调查

[目的]通过了解临床护理教师评判性思维水平,引起护理教育者、管理者及临床护理教师自身对评判性思维的高度重视.[方法]采用一般资料调查表、加利福尼亚批判性思维倾向问卷中文版(CTDI-CV)、加利福尼亚批判性思维技能测验(CCTST)问卷中文版测量山西省三级甲等综合医院临床护理教师评判性思维水平.[结果]临床护理教师评判性思维倾向总分为284.35分±24.48分,7个特质得分由高到低分别是求知欲、分析能力、系统化能力、评判性思维自信心、认知成熟度、开放思想及寻找真相;评判性思维技能总分及其分析、评价、推理子技能得分分别为11.06分±3.13分、3.89分±1.43分、4.37分±1.77分、2.81分±1.53分;临床护理教师评判性思维倾向和评判性思维技能总分呈正相关;不同职称临床护理教师评判性思维水平差异有统计学意义.[结论]山西省临床护理教师有正性评判性思维倾向,但寻求真相能力较差,评判性思维推理技能较弱;临床护理教师评判性思维总体水平不高,亟待提高;评判性思维倾向与评判性思维技能发展相辅相成;重视临床护理教师的选拔.     

我校涉外护理本科生批判性思维倾向性的调查研究

[目的]调查我校涉外护理本科生批判性思维倾向性现状。[方法]整体抽取我校1年级～4年级涉外护理本科生231名，应用中文版批判性思维能力测量表（CTDI-CV）进行调查。[结果]我校涉外护理本科生批判性思维倾向性总分平均196．72分，为负性批判性思维；各特质平均分除寻找真相属意义不明确外，其余均为负性特质表现；二年级、三年级、四年级护生总分差异无统计学意义，但与一年级存在差异。[结论]我校涉外护生批判性思维倾向性为负性批判性思维。提示应从课程设置、教学理念、课程构建、教学目标、教学方法以及评价方法等各方面，有意识地对护理本科生批判性思维倾向性加以培养。     

《护理学基础》多元化考核评价体系改革研究

[目的]探讨《护理学基础》多元化考核评价体系的实施效果及其对护理专业学生批判性思维和自主学习能力的影响。[方法]以潍坊医学院护理学院本科2009级170名学生作为对照组,2010级129名学生作为试验组,对照组采用传统考核评价体系,试验组采用多元化考核评价体系。[结果]试验组考核体系满意度、实施效果、自主学习能力、考核成绩均高于对照组,差异有统计学意义（P〈0.05）,试验组中文版加利福尼亚评判性思维倾向测量表（CTDI CV）总分高于对照组,但差异无统计学意义（P〉0.05）。[结论]多元化考核评价体系优于传统考核评价体系,有助于护生学习成绩及学习能力的综合提高。     

高校护理教师评判性思维情感倾向的现状调查

目的：了解高校护理教师评判性思维情感倾向的现状情况。方法采用中文版评判性思维情感倾向性调查表（CTDI-CV）对6所医学高校97名护理教师进行问卷的调查。结果护理教师评判性思维情感倾向总分数为（303.59±26.03）分，其中开放思想、分析能力、系统化能力、评判思维自信心、求知欲、认知成熟度等6项特质的分数均＞40分。结论在护理教学工作中应重视并培养护理教师的评判性思维能力。     

我校涉外护理本科生批判性思维倾向性的调查研究

[目的]调查我校涉外护理本科生批判性思维倾向性现状。[方法]整体抽取我校1年级~4年级涉外护理本科生231名,应用中文版批判性思维能力测量表(CTDI-CV)进行调查。[结果]我校涉外护理本科生批判性思维倾向性总分平均196.72分,为负性批判性思维;各特质平均分除寻找真相属意义不明确外,其余均为负性特质表现;二年级、三年级、四年级护生总分差异无统计学意义,但与一年级存在差异。[结论]我校涉外护生批判性思维倾向性为负性批判性思维。提示应从课程设置、教学理念、课程构建、教学目标、教学方法以及评价方法等各方面,有意识地对护理本科生批判性思维倾向性加以培养。     

1113名护士批判性思维能力及特征调查

[目的]调查护士批判性思维能力的现状及特征,为护士的批判性思维能力的培养提供参考依据。[方法]采用彭美慈等修订的批判性思维量表中文版,调查1113名护士的批判性思维总分及7个特质得分,所收集的数据采用SPSS12.0统计软件进行统计分析。[结果]1113名护士的批判性思维总均分为293.01分;除寻找真相的得分低于最低认可分40分外,其他特质得分都大于40分,得分从高到低依次为求知欲、分析能力、批判性思维的自信心、系统化能力、认知成熟度和开放思想。[结论]1113名护士总体有正性批判性思维能力,但离批判性思维能力强的要求还有差距;护士的求知欲和分析能力较强,但寻求真相能力较差。     

对分课堂对护生批判性思维的影响

[目的]探讨对分课堂教学模式对护生批判性思维的影响。[方法]采用便利抽样法抽取某高校护理专业二年级116名专科护生为研究对象,应用中文版批判性思维能力测量表评估护生的批判性思维状况,了解对分课堂模式对护生批判性思维的影响情况。[结果]专科护生批判性思维总分为(267.78±25.41)分,其批判性思维态度不明;参加过对分课堂学习护生的批判性思维总得分及寻找真相和分析能力维度得分高于未参加过对分课堂学习的护生(P0.05)。[结论]对分课堂有助于提高护生的寻找真相和分析能力,从而一定程度上提高了护生批判性思维能力。     

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.