平肝定眩汤治疗肝阳上亢型后循环缺血性眩晕60例临床观察

目的:观察平肝定眩汤对肝阳上亢型后循环缺血性眩晕的疗效。方法:选取2017年6月-2018年10月烟台业达医院收治的后循环缺血性眩晕的患者120例,按随机数字表法分为治疗组和对照组。治疗组和对照组各60例,两组一般的资料经统计学方法,差异无统计学意义(P>0.05),具有可比性。两组均给予改善循环,控制血压、血糖,调节血脂,抗血小板聚集等基础治疗。治疗组给予平肝定眩汤,对照组给予平眩胶囊。两组疗程均为4周,观察两组患者治疗前后总体症状,脑血流速度、血脂、血糖等指标改善情况。采用SPSS 11.0统计学软件进行计算。结果:治疗组总有效率91.7%(55/60),对照组总有效率61.6%(37/60),两组疗效比较有统计学意义(P<0.05)。治疗组三酰甘油(Triglyceride,TG)、血清总胆固醇(Serum Total Cholesterol,TC)、HDL-C、LDL-C治疗后显著改善,与治疗前比较,差异有统计学意义(P<0.05);对照组TG及TC治疗前后差异有统计学意义(P<0.05),高密度脂蛋白胆固醇(High Density Liptein Cholesterol,HDL-C)及低密度脂蛋白胆固醇(Low Density Liptein Cholesterol,LDL-C)治疗前后比较,差异无统计学意义(P>0.05)。两组治疗后TC比较,差异有统计学意义(P<0.05)。两组治疗后空腹血糖(Fasting Plasma Glucose,GLU)明显降低(P<0.05),两组间的治疗后比较,差异无统计学意义(P>0.05)。治疗组治疗后椎动脉(Vertebral Artery,VA)、基底动脉(Basilarartery,BA)平均血流速度(Mean Blood Flow Velocity,VM)明显提高,与对照组治疗后相比较,差异具有统计学意义(P<0.05)。结论:平肝定眩汤治疗后循环缺血性眩晕在改善患者症状、降低血液黏稠度,改善脑血流状况方面疗效显著。     

以临床胜任力为导向的CBL在急危重症护理本科教学中的实践

目的　探讨临床胜任力为导向的病例教学（case-based learning，CBL）在急危重症护理学本科教学中的可行性和有效性。方法　将急危重症护理本科生120人随机分为CBL教学组和传统教学组。根据每次实习学生人数，CBL教学组分为数个小组，每小组固定一个带教教师，并以小组为单位进行临床教学实践；传统教学组采用既往的临床实习教学方式，即一个学生固定跟随一个带教教师。采用理论考试、技能考试以及问卷调查等多种考核方式评价两组的教学效果，采用SPSS 21.0软件行t检验和卡方检验。结果　与传统教学组相比，CBL教学组在理论考试[（92.5±3.0） vs. （85.3±3.3）]和技能考试[（93.1±4.5） vs. （88.1±3.4）]方面均更好，且差异有统计学意义（P<0.05）；在对教学满意度调查方面，CBL教学组优于传统教学组。结论　以临床胜任力为导向的CBL教学应用于急危重症护理本科教学是可行的，能有效培养学生的临床思维和提高实际的临床胜任力。     

The ‘space’ of friendship: young children's understandings and expressions of friendship in a reception class

The purpose of this study has been to explore young children's understandings and experiences of friendship as these manifested in children's behaviours, in a reception class setting. Drawing on an evolutionary, ecological framework, friendship is seen as not only the expression and further development of social understandings and cognitive advances; more than that, making and maintaining friends is seen as an evolutionary trait and a ‘drive’ to relate to similarly minded others. Through ‘niche picking’, children select the environments and opportunities that suit them in order to develop their dispositions and individual traits. The research employed a participatory design in order to capture the children's views and experiences. It took place in a reception class setting, where children's everyday experiences were observed and discussed with them. The study identified six themes of analysis and offered some suggestions about creating enabling educational environments that allow the ‘space’ for niche construction.     

Pharmacy in transition: A work sampling study of community pharmacists using smartphone technology

Introduction

The nature of community pharmacy is changing, shifting from the preparation and distribution of medicines to the provision of cognitive pharmaceutical services (CPS); however, often the provision of traditional services leaves little time for innovative services. This study investigated the time community pharmacists spend on the tasks and activities of daily practice and to what extent they are able to implement CPS-related services in daily practice.

评教评学模式在肿瘤外科护理带教中的应用评价

目的探讨评教评学模式在肿瘤外科护理带教中的应用效果。方法选择2017年6月—2019年2月于该院肿瘤外科实习的88名护生作为该次研究对象,随机将护生分为对照组与观察组,两组分别有护生44名,对照组给予传统带教方法,观察组给予评教评学模式带教,比较两组护生的护理带教结果。结果观察组护生对带教老师综合能力评价优良率是92.0%,对照组评价优良率是76.0%,组间对比差异有统计学意义(χ^2=4.192,P=0.041<0.05)。观察组带教老师对护生综合能力评价优良率是90.9%,对照组评价优良率是72.7%,组间对比差异有统计学意义(χ^2=4.889,P=0.027<0.05)。观察组护生的理论知识与实操技能考核成绩均要显著比对照组高,差异有统计学意义(P<0.05)。结论评教评学模式在肿瘤外科护理带教中具有显著应用价值,可充分激发师生的教学积极性,改善护理教学质量。     

目标教学运用在神经内科临床护理带教中的效果及方法

目的探究目标教学运用在神经内科临床护理带教中的效果及方法。方法选取2018年6月-2019年6月期间到该院神经内科实习的48名女护生作为研究对象,采取随机双盲方法,将其均分为两组,各24例,对照组护生行常规护理带教模式,观察组护生行目标教学护理带教,对比两组护生出科综合成绩和带教满意度。结果观察组出科综合成绩显著高于对照组(t=3.732、6.862、6.715,P<0.05),且带教满意度优于对照组(χ~2=5.400,P<0.05)。结论在神经内科临床护理带教工作中运用目标教学法可调动护生学习积极性,提升护士对护理知识的掌握程度,提高带教满意度。     

持续质量改进在体检科护理质量管理中的应用效果探讨

目的探究持续质量改进在体检科护理质量管理中的应用效果。方法该次将该院在2018年7-12月的体检者200名作为研究的对象,视为对照阶段,采取常规护理管理方法;将该院2019年1-6月的体检者200名作为观察阶段对象,在护理管理工作中采取持续质量改进管理模式,进一步对比两个阶段患者对于体检科工作质量的评分。结果在体检工作质量、服务态度、体检满意度这3个模块,观察阶段评分对照阶段比较均明显更高,差异有统计学意义(P<0.05)。结论持续质量改进应用于体检科护理质量管理中,可有效提升体检服务品质,值得推广应用。     

Manipulation and free will in shared decision making

In recent years, there has been an increased focus on patient involvement in treatment planning in the health care system. To reduce the risk of the clinician moving towards paternalism, various methods have been introduced—shared decision making, among others. The goal of shared decision making is for the clinician and patient to share available evidence on the best treatment and to raise awareness on the needs and preferences of the patient as to make a genuinely informed choice. However, in the present article, we discuss to which degree paternalism can be avoided in light of the clinician's role as an authority with certain knowledge and expertise. Through the philosophical theory of reasons‐responsiveness, we discuss to which extend free will and control applies to the patient. Through theoretical analysis, we come to suggest that the clinician has a role as an ally rather than manipulator.     

Preceptors’ perceptions of supporting nursing students in prison health services: A qualitative study

BackgroundOur university commenced clinical placements for third-year nursing students in Prison Health Services (PHS) in 2014. Registered nurse preceptors employed in these services facilitated students’ experiential workplace learning, assessed their competence and assisted them to meet course objectives in this challenging environment. To date, no studies have examined preceptors’ experiences of supporting students in the prison health setting.AimThe study aim was to investigate preceptors’ perceptions of supporting nursing students undertaking clinical placements in PHS, in order to inform development of resources and processes.MethodsQualitative data were collected via a focus group and interviews with preceptors (n = 6) working in metropolitan PHS. Data underwent thematic analysis.FindingsParticipants valued the opportunity to support student learning, finding students contributed to the workplace by bringing in new ideas, and conducting beneficial projects. However, preceptors requested better rostering and workload management by their employer. They also wished for more detailed information from the university regarding student orientation and preparation to support student learning. They felt that the employer-provided preceptorship training did not fulfil their needs.DiscussionPreceptors in PHS settings shared many of the support needs of those in other settings, although some challenges were more specific to the setting.ConclusionThis paper makes recommendations on how preceptors in PHS can be better supported to fulfil the role.