失效模式和效应分析在髋关节置换术后护理中的应用

目的探讨失效模式和效应分析(FMEA)在髋关节置换术后护理中的应用效果。方法将2009年1～6月收治的28例全髋关节置换术患者设为对照组,围手术期按骨科护理常规护理;2009年7～12月收治的30例髋关节置换术患者设为观察组,在围手术期除执行骨科护理常规外,还运用FMEA对髋关节置换术后可能发生脱位的失效模式进行前瞻性原因和操作流程分析、评估、计算,找出导致术后关节脱位的最高危因素及高危操作步骤,制定防范的优先行动计划和改进措施。结果观察组6个高危因子的危机值显著低于对照组(均P0.01);两组患者对防脱位相关知识掌握程度、住院时间、满意度比较,差异有统计学意义(P0.05,P0.01)。观察组住院期间人工关节未发生脱位,对照组发生脱位1例。结论应用FMEA对髋关节置换手术后患者进行评估、分析和采取相关措施,能有效防范风险,降低术后脱位的发生,提高护理质量,促进患者康复。     

整形外科临床教学模式浅析

随着整形美容外科专业在我国的蓬勃发展,国内不同等级的医疗机构对经过正规培训的整形美容外科医生的需求逐年在增加。为了提高教学效果,针对整形外科不同层次的学生,我们采用了多种形式、有针对性的教学模式,并取得了一定的效果。本文分别从教学查房、手术带教、读书报告、技能培训、学术交流、专题讲座等多个层面浅析了整形外科临床教学模式。     

犬双肺序贯性移植的研究

目的探讨犬双肺序贯性移植时供肺的采取及受体移植手术技巧。方法犬16条,体重差异<5%的随机配对作为供受体进行双肺序贯移植实验共8次,移植右肺钳夹左房时采用了‘v’钳夹技术,并检测左肺及右肺术后0.5、1、2 h各进行血气分析、肺水含量及电镜下超微结构,了解术后肺功能。结果移植右肺时采取的‘v’型钳夹术良好地解决了钳夹左房时因回心血量受阻而引起的心功能不全。术后检测结果表明移植后肺功能良好。结论掌握了犬双肺序贯性移植的全过程,"V"形双阻断钳夹左心房技术提高了犬肺移植的成功率。     

教师标准化病人在护生临床见习中的应用

目的探讨教师标准化病人(TSP)教学模式用于护生临床见习的效果。方法选取2010年进入我院内外科进行护理临床见习的大专及以上学历的护生62人,将其随机分为观察组与对照组各31人。对照组采用常规教学方法,即讲解-示教-练习的教学模式。观察组采用常规教学方法+TSP的教学模式。见习结束后对两组护生操作考核成绩与理论考核成绩进行比较并征求观察组对培训方式的效果评价。结果观察组护生理论考试的病例分析成绩和操作考试的沟通技能成绩显著优于对照组(均P<0.01);除提高临床护理技能、促进知识掌握与理解外,观察组对TSP教学的认可度显著优于对照组(均P<0.01)。结论 TSP教学法应用于护理临床见习教学中,有助于提高教学效果,提高护生病例分析能力和沟通能力。     

护士及护生对优质护理服务的认知比较

目的 了解护士与护生对优质护理服务认识的异同,为护理管理者针对性制定护理人员培养计划并调整护生带教内容,提高临床护理水平提供参考.方法 采用护士优质护理观点问卷对某三级甲等医院108名护士及105名实习护生进行调查.结果 护士及护生均在护士的工作态度维度上得分率最高(86.15％,83.93％);护士及护生在优质护理5...     

高原军事作业人员心理健康的调查研究与分析

为了解西藏高原军事作业人员的心理健康状况,应用SCL—90精神卫生自评量表,对80名高原军事作业人员进行心理健康状况的测试研究。结果显示:高原军事作业人员的心理健康水平低于中国成人常模。分析原因主要是:①高原低氧环境因素的影响。由于环境条件所限,难以充分满足心理需求,容易产生心理困扰;②部队特殊的纪律和紧张的军事训练使心理负荷加重。     

Cognitive control, goal maintenance, and prefrontal function in healthy aging

Cognitive control impairments in healthy older adults may partly reflect disturbances in the ability to actively maintain goal-relevant information, a function that depends on the engagement of lateral prefrontal cortex (PFC). In 2 functional magnetic resonance imaging studies, healthy young and older adults performed versions of a task in which contextual cues provide goal-relevant information used to bias processing of subsequent ambiguous probes. In Study 1, a blocked design and manipulation of the cue-probe delay interval revealed a generalized pattern of enhanced task-related brain activity in older adults but combined with a specific delay-related reduction of activity in lateral PFC regions. In Study 2, a combined blocked/event-related design revealed enhanced sustained (i.e., across-trial) activity but a reduction in transient trial-related activation in lateral PFC among older adults. Further analyses of within-trial activity dynamics indicated that, within these and other lateral PFC regions, older adults showed reduced activation during the cue and delay period but increased activation at the time of the probe, particularly on high-interference trials. These results are consistent with the hypothesis that age-related impairments in goal maintenance abilities cause a compensatory shift in older adults from a proactive (seen in young adults) to a reactive cognitive control strategy.     

Initial fixation strength of a new hybrid technique for femoral ACL graft fixation: the bone wedge technique

Background Aperture fixation with interference screws matching the diameter of the tunnel is associated with the risk of graft laceration and graft rotation. Hypothesis A hybrid fixation technique (extracortical and aperture fixation) with undersized interference screw placed behind a bone wedge provides a higher fixation strength as aperture fixation with a screw alone matching the size of the tunnel. Study design Experimental laboratory study. Methods We evaluated the initial fixation strength (single cycle and cyclic loading tests) of hybrid and interference screw aperture fixation using different sized interference screws in porcine knees. Results Analysis of yield load, maximum load and stiffness in the single cycle loading test showed no statistically significant differences for hybrid fixation with a 1 mm undersized screw and aperture fixation with a screw matching the size of the tunnel. The use of an undersized screw alone resulted in low fixation strength. Conclusion The initial fixation strength of the hybrid technique with undersized screws is comparable to that of interference screw fixation matching the size. Clinical relevance The new “bone wedge fixation” is an alternative for ACL graft fixation without the risk of graft laceration and graft rotation.     

As time goes by: temporal constraints on emotional activation of inferior medial prefrontal cortex

To investigate the influence of stimulus duration on emotional processing, we measured changes of regional cerebral blood flow (rCBF) in 14 healthy subjects who viewed neutral or emotional images presented for 3 or 6 s. Presentation for 3 s reproduced the previous result of higher rCBF in inferior medial prefrontal cortex (IMPC) during neutral than emotional stimulation. Six-second presentation reverted this relationship, with activity in IMPC being higher during emotional stimulation. Prolonged stimulus presentation attenuated the rise of rCBF associated with emotions in left parietal cortex and cerebellar hemisphere. We speculate that the different rCBF during neutral and emotional stimulation for 6 s is a consequence of attention divided between the emotional stimuli and their associations. Thus, prefrontal activity rises when a cognitive task accompanies emotional stimulation because several cognitive processes compete for attention. The IMPC may serve the mechanism of attention underlying the concept of a default mode of brain function, selecting among competitive inputs from multiple brain regions rather than just processing emotions. The results emphasize the importance of implicit cognitive processing during emotional activation, however, unintended.     

结核病临床研究生科研能力的培养现状和教学体会

随着人们生存环境和生活方式的改变,人类的传染性疾病谱也发生了日新月异的变化。交通事业的飞速发展,人员流动的范围不断扩大,出行频度逐年增多,加快了传染性疾病的传播速度和蔓延范围。作为以收治结核病为主的传染病医院,本院不仅要履行常规的传染病的预防和诊治工作,而且要加强临床研究生科研能力的培养来应对传染性疾病谱的改变。但是,在当前医学的教育模式下,结核病临床研究生的科研能力的培养仍然存在着一些弊端和不足,因此,教育模式的转型,优秀教育方法的引进以及不断地完善自身的科研激励措施,依旧是本院教育改革的重要方面。