Development of an interactive computer program for advance care planning

Objective  To describe the development of an innovative, multi-media decision aid for advance care planning.
Background  Advance care planning is an important way for people to articulate their wishes for medical care when they are not able to speak for themselves. Living wills and other types of advance directives are the most commonly used tools for advance care planning, but have been criticized for being vague, difficult to interpret, and inconsistent with individuals' core beliefs and values.
Results  We developed a multimedia, computer-based decision aid for advance care planning ( 'Making Your Wishes Known: Planning Your Medical Future' ) to overcome many of the limitations of standard advance directive forms. This computer program guides individuals through the process of advance care planning, and unlike standard advance directives, provides tailored education, values clarification exercises, and a decision-making tool that translates an individual's values and preferences into a specific medical plan that can be implemented by a health-care team. Pilot testing with 50 adult volunteers recruited from an outpatient primary care clinic showed high levels of satisfaction with the program. Further pilot testing with 34 cancer patients indicated that the program was perceived to be highly accurate at representing patients' wishes.
Conclusions  This paper describes the development of an innovative decision aid for advance care planning that was designed to overcome common problems with standard advance directives. Preliminary testing suggests that it is acceptable to users and is accurate.     

组织学与胚胎学教学中备课和授课环节的有效模式探讨

组织学与胚胎学是一门重要的医学基础形态课程,如何提高其教学质量是教学活动的中心问题。针对该课程存在信息量大、概念繁多、微观结构抽象、相对枯燥乏味等特点,从教学过程的两个核心环节———备课与授课入手,总结和提出了个人备课和集体备课相结合的备课模式、基于"四个结合"的授课模式以及基于系统回路反馈的备课/授课整合模式,对于提高组织学与胚胎学的教学质量具有积极意义。     

Systematic cognitive behavioral approach for oral hygiene instruction: a short-term study

OBJECTIVE: Determine whether a six-step behavioral cognitive method is more effective than traditional oral hygiene instruction. METHODS: Thirty-eight patients with chronic periodontitis were randomly assigned to two groups. The control group was given traditional oral hygiene instruction for 20 min. The intervention group received counseling by Farquhar's six-step method for 10 min after traditional oral hygiene instruction. In both groups, oral hygiene instruction was given once a week, and performed three times in total for 3 weeks. Clinical characteristics, deposition of dental plaque, frequency and duration of brushing, frequency of interdental cleaning and scores based on scale of "self-efficacy for brushing of the teeth" were compared in both groups. RESULTS: There were no differences between the two groups in clinical, demographic, behavioral and self-efficacy characteristics at the baseline examination. However after the third visit, the intervention group had a significantly higher self-efficacy, lower plaque index, longer brushing duration and higher frequency of inter-dental cleaning than those of the control group. Multiple regression analysis showed significant association of toothbrushing duration with self-efficacy for brushing of the teeth (p<0.001). CONCLUSION: The six-step method might be more effective for enhancing self-efficacy and behavioral change of oral hygiene than traditional oral hygiene instruction alone. PRACTICE IMPLICATIONS: Dentists and dental hygienists can use the six-step method for effective oral hygiene instruction.     

Effects of a school-based nutrition program diffused throughout a large urban community on attitudes, beliefs, and behaviors related to fruit and vegetable consumption

BACKGROUND: Obesity among US children has increased in recent years. Although increased fruit and vegetable consumption has not been directly linked to obesity prevalence, it has been posited that more fruits and vegetables (FV) could reduce the consumption of high‐fat, energy‐dense foods and may protect against childhood illnesses including asthma and other respiratory diseases. The purpose of this current research was to assess the impact of a large public school district's hybrid approach to nutrition education programming on attitudes, beliefs, and behaviors related to fruit and vegetable consumption. METHODS: A total of 12 elementary schools from the Los Angeles Unified School District (9 intervention schools, 3 control schools) were randomly selected to participate in a “hybrid” school‐based nutrition education program. Data were collected at baseline (beginning of school year) and postintervention data (end of school year 9 months later). Linear mixed models were developed to assess the impact of the intervention. RESULTS: The intervention resulted in a significant change in teacher influence on students' attitudes toward FV (p < .05) and students' attitudes toward vegetables (p < .01), even after adjusting for gender, grade, and race/ethnicity. Although not statistically significant, there was a slight increase in fruit and vegetable consumption from pretest to posttest for both the intervention and control schools. CONCLUSION: The hybrid model reflects a more accurate representation of school‐based interventions. More research is needed to identify the specific components of this model that are most successful in impacting fruit and vegetable consumption among US children.     

个体化健康教育配合足部穴位按摩对0级糖尿病足的护理干预

目的探讨个体化健康教育配合足部穴位按摩对0级糖尿病足的干预效果。方法将100例0级糖尿病足患者按入院日期单双日分为研究组和对照组各50例,对照组采用常规糖尿病治疗及护理＋早期糖尿病足预防护理指导（健康教育大讲堂）,研究组采用常规糖尿病治疗及护理＋个体化糖尿病足部预防护理指导＋足部穴位按摩。结果研究组与对照组的总有效率分别为82%和64%,研究组疗效优于对照组,差异有统计学意义（P〈0.05）。结论个体化糖尿病足足部预防护理指导＋足部穴位按摩在常规糖尿病治疗、护理的基础上可以明显改善0级糖尿病足的病变,在一定程度上减缓了糖尿病足的病变速度。     

口腔卫生宣教对孕妇牙周健康状况的影响

目的 评价口腔卫生宣教在维护中晚期妊娠孕妇牙周健康中的作用.方法 抽取212例妊娠中期孕妇进行问卷调查和牙周健康状况检查,随机分为两组,宣教组106例进行口腔卫生宣教,对照组106例,4～8周后复检,分别记录初、复检时的简化软垢指数(debris index-simplified,DI-S)和简化牙石指数(calcul...     

饮食护理干预对糖尿病肾病患者饮食治疗依从性的影响

目的探讨饮食护理干预对糖尿病肾病患者饮食治疗依从性的效果。方法选择在本院住院治疗的171例糖尿病肾病患者,在常规治疗和护理的同时,实施饮食护理干预,内容包括评估患者情况、对患者和家属进行饮食指导、举办病友交流会。比较实施饮食护理干预前后患者饮食治疗依从性的差异。结果实施饮食护理干预后患者饮食治疗依从性优于干预前,干预前后比较,均P〈0.05,差异具有统计学意义。结论饮食护理干预在提高糖尿病肾病患者对饮食治疗相关知识理解和掌握的同时,提高了患者饮食治疗的依从性,进而延缓疾病的进展和提高治疗效果。     

Cooperative learning as applied to resident instruction in radiology reporting

RATIONALE AND OBJECTIVES: The study is designed to evaluate the effectiveness of an active form of resident instruction, cooperative learning, and the residents' response to that form of instruction. MATERIALS AND METHODS: The residents dictated three sets of reports both before and after instruction in radiology reporting using the cooperative learning method. The reports were evaluated for word count, Flesch-Kincaid grade level, advancement on clinical spectrum, clarity, and comparison to prior reports. The reports were evaluated for changes in performance characteristics between the pre- and postinstruction dictations. The residents' response to this form of instruction was evaluated by means of a questionnaire. RESULTS: The instruction was effective in changing the resident dictations. The results became shorter (P<.035), more complex (P<.0126), and demonstrated increased advancement on clinical spectrum (P<.0204). The resident response to this form of instruction was positive. One hundred percent or respondents indicated enjoyment working with their groups. Seventy-five percent stated they would like to participate in more cooperative learning activities. The least positive responses related to the amount of time devoted to the project. Sixty-three percent of respondents stated that the time devoted to the project was appropriate. CONCLUSION: Cooperative learning can be an effective tool in the setting of the radiology residency. Instructional time requirements must be strongly considered in designing a cooperative learning program.     

网络版胸部影像多媒体教学系统

目的 设计制作 适合在网络环境使用的胸部影像多媒体教学系统。方法 （１）搜集胸部病理证实的各种病例,图像以数码相机,扫描仪等方式数字化处理;（２）使用的制作 软件 Ｆｒｏｎｔｐａｇｅ ９８,Ｈｏｍｅｓｉｔｅ ２．５等。结果 （１）资料内容丰富,信息量大,超过１５００幅图像;（２）以多级目录式结构交互显示每种项目的内容,使用非常方便。（３）在局域网,Ｉｎｔｅｒｅｔ等环境下运行良好。     

护理本科专业课教学质量影响因素的质性研究

目的 探讨影响护理本科专业课教学质量的因素,为护理本科专业的教学改革提供依据.方法 采用质性研究方法,即深入课堂教学进行现场观察,同时对护理专业教师及学生进行深入访谈.运用类属分析法归纳影响护理专业教学质量的因素.结果 影响护理本科专业课教学质量的三大主题为教师教学特点(教师自身影响力、能否尊重学生、巧用幽默、整合内容及进行教学方法改革)、学生方面因素(学生的学习态度、能力及方法)和教学环境(教学物化环境及人文环境).结论 进行护理本科专业教学改革时,应在教师教学特点、学生的学习能力和教学环境这一框架指导下进行,以培养出社会所需要的高层次护理专业人才.