健康教育题库建设的实践与思考

健康教育题库建设是健康教育指标制订和评价工作规范化的需要。本文详细介绍了确定题库内容、建立基础题库、确定题目难易度、建立出题系统、题库系统测试和完善等健康教育题库建设的实践经过,并就实践过程中的经验教训提出了思考和建议。     

护士岗前职业安全教育的实践

目的通过对护士进行有针对性的岗前教育,达到提高对职业安全重要性的认知和保障护理安全的目的。方法结合典型案例、病案书写问题等对护理工作中存在的安全隐患和护理缺陷进行分析、讨论。结果护士在校期间法制教育缺乏,对相关法律和病案的证据性缺乏了解;因护理差错和病案书写问题导致高额赔偿或败诉的严重性尚未引起护士足够的重视。结论与案例和工作实际结合的岗前教育受到护士欢迎,对于培养法律意识和促进执业安全具有实践意义。     

研究性教学在高等医学教育中的研究与实践

大学研究性教学是通过教学与研究的有机结合引导学生进行研究性学习的教学.它是培养具有研究能力、创新精神和实践能力的人才的必然要求,也是促进大学教学和科研结合、实现教学相长的重要途径.在我国高等医学院校中,虽然研究性教学已经受到关注,但是受诸多因素的限制仍然未能得到广泛应用.本文力求通过对高等医学教育中研究性教学的基本分析、改革实践及实施的对策与建议的研究,寻求更为广泛的共识并促进更为广泛的应用.     

思维导图在本科护生精神科实习带教中的应用

目的　探讨思维导图在本科护生精神科实习带教中的应用效果。方法　选取2018年6月至12月31名本科护生为试验组,采用思维导图进行带教;选取2019年4月至7月32名本科护生作为对照组,采用传统的带教方法进行带教。比较两组前后评判性思维能力、对带教方法的评价,以及两组护生的理论、操作考试成绩。采用SPSS 20.0进行t检验、卡方检验和秩和检验。结果　试验组在评判性思维能力量表各项得分明显提高,由带教前的（248.09±24.45）分提高至（331.03±14.31）分,且高于对照组（P<0.05）。试验组在带教方法肯定性评价各项得分均高于对照组,差异均有统计学意义（P<0.05）。试验组带教后理论成绩为（88.35±7.71）分、操作考试成绩为（86.45±5.03）分,对照组带教后理论成绩为（74.41±10.27）分、操作考试成绩为（81.02±6.64）分,两组比较差异有统计学意义（P<0.05）。结论　运用思维导图对精神科护生进行临床带教,提高了护生学习积极性,学习由被动变主动,同时促进了护生评判性思维能力培养,值得临床推广。     

护理专业教学中概念图的应用实践

旨在探讨概念图在护理专业课教学中的应用,使其作为一种学习工具,促进护理本科生开展有意义学习,并在研究中根据应用结果优化此教学方式;从而为护理教育者提供一个有效的教学策略和评价工具,并进而使之推广到临床护理实践与护理科研中。     

Clinical and laboratory features of seventy-eight UK patients with Good’s syndrome (thymoma and hypogammaglobulinaemia)

Good’s syndrome (thymoma and hypogammaglobulinaemia) is a rare secondary immunodeficiency disease, previously reported in the published literature as mainly individual cases or small case series. We use the national UK-Primary Immune Deficiency (UKPID) registry to identify a large cohort of patients in the UK with this PID to review its clinical course, natural history and prognosis. Clinical information, laboratory data, treatment and outcome were collated and analysed. Seventy-eight patients with a median age of 64 years, 59% of whom were female, were reviewed. Median age of presentation was 54 years. Absolute B cell numbers and serum immunoglobulins were very low in all patients and all received immunoglobulin replacement therapy. All patients had undergone thymectomy and nine (12%) had thymic carcinoma (four locally invasive and five had disseminated disease) requiring adjuvant radiotherapy and/or chemotherapy. CD4 T cells were significantly lower in these patients with malignant thymoma. Seventy-four (95%) presented with infections, 35 (45%) had bronchiectasis, seven (9%) chronic sinusitis, but only eight (10%) had serious invasive fungal or viral infections. Patients with AB-type thymomas were more likely to have bronchiectasis. Twenty (26%) suffered from autoimmune diseases (pure red cell aplasia, hypothyroidism, arthritis, myasthenia gravis, systemic lupus erythematosus, Sjögren’s syndrome). There was no association between thymoma type and autoimmunity. Seven (9%) patients had died. Good’s syndrome is associated with significant morbidity relating to infectious and autoimmune complications. Prospective studies are required to understand why some patients with thymoma develop persistent hypogammaglobulinaemia.     

Factors influencing the participation of adolescents and young adults with a congenital heart disease in a transition education program: A prospective multicentre controlled study

ObjectiveTransition education programs dedicated to adolescents and young adults with congenital heart disease (CHD) aim to facilitate transfer to adult cardiology and bring more autonomy to teenagers. This prospective controlled multicentre study analysed the factors influencing the participation in a transition education program.MethodsCHD patients aged 13–25 y were offered to participate in the transition program. A multiple linear regression identified the explanatory factors for participation in the program.ResultsA total of 123 patients (mean age 19.6 ± 3.4 y) were included in the study, with 57 participants and 66 non-participants. Both groups showed similar socio-demographic and quality of life characteristics, low level of physical activity with muscular deconditioning and high exposure to risk behaviours (71% patients with ≥1 risk factor). Patients with complex CHD (OR = 4.1, P = 0.03), poor disease knowledge (OR = 0.3, P = 0.02), risk behaviours (body piercing, OR = 5.53, P = 0.01; alcohol, OR = 3.12, P = 0.06), and aged <20 y (OR = 0.29, P = 0.03), were more likely to join the program.ConclusionMany risk factors influencing the participation of adolescents and young adults with CHD in transition education programs are controllable.Practice implicationFurther randomized studies are necessary to evaluate the impact of transition education program on quality of life, successful transfer to adult centre and, ultimately, prognosis.     

Effective communication in the era of precision medicine: A pilot intervention with low health literacy patients to improve genetic counseling communication

Effective communication, where all parties share a common understanding, is necessary to realize the promise of Genomic Medicine. It is especially salient given the imperative to increase the participation of diverse populations in genomics research and to expand the reach of clinical genomics. We have previously shown that cancer genetic counseling is suboptimal for patients with limited health literacy. To address this finding, we implemented a pilot study to improve verbal communication between genetic counselors and their patients of limited health literacy that consisted of: i) curriculum development and delivery of a Genetic Counselors (GC) communication workshop; ii) two-month post-workshop interviews with GC participants (n = 9); iii) observations/audio recordings of counseling sessions involving 24 patients and two GC workshop participants; iv) post-counseling interviews with patients (n = 9). The 4.5-h workshop presented evidenced-based principles and strategies for effective communication with limited health literacy patients (e.g. use of plain language and teach-back), and offered specific techniques and exercises to practice adoption of such practices in the genetic counseling context. GCs expressed appreciation for the opportunity to refine their skills; however, they reported that some strategies were challenging given their professional training and communication habits. For example, GCs were concerned that use of plain language could undermine efforts to obtain informed consent and provide scientifically accurate information. Observations and patient interviews after the workshop revealed that GCs were able to employ the communication strategies with positive effects, with patients indicating sufficient understanding of the genetic test and its implications as well as satisfaction with the counselors’ communication. While derived from research on communication with those of limited health literacy, the communication approaches taught in the GC workshop could benefit most patients, given the high rates of low health literacy in many countries, and the many factors beyond health literacy that can contribute to reduced comprehension in health care environments.     

SCMC APL-2010方案治疗44例儿童急性早幼粒细胞白血病的临床总结

目的 评价SCMC APL-2010方案治疗儿童急性早幼粒细胞白血病（APL）的疗效。方法 收集2010年4月至2016年7月采用SCMC APL-2010方案治疗的44例APL患儿的临床资料,采用Kaplan-Meier生存分析评估患儿的无事件生存（EFS）率和总生存（OS）率。结果 44例APL患儿中,42例（95%）经1个疗程达完全缓解（CR）,1例经2个疗程达CR,总CR率为98%,9年EFS率为96%±3%,OS率为97.7%±2.2%。不良事件中,发生感染41例（93%）,粒细胞减少29例（66%）,分化综合征12例（27%,其中死亡1例）,肝功能异常16例（36%）,胃肠道不良反应12例（27%）,QT间期延长7例（16%）,睾丸炎1例（2%）,无第二肿瘤发生。结论 SCMC APL-2010方案治疗儿童APL预后好,可获得长期生存,但治疗相关感染较多。