支架式教学对实习护生临床沟通能力的影响

目的 探讨支架式教学对专科实习护生临床沟通能力的影响.方法 将90名护生随机分成两组各45名.对照组采用常规带教方法实习,观察组在常规带教方法上开展支架式教学.分别在实习1周和6个月时评价护生的临床沟通能力.结果 观察组在敏锐倾听、确认患者问题、验证感受、共同参与和建立和谐关系方面评分显著高于对照组（均P＜0.01）;但两组护生在传递有效信息方面无统计学差异（P＞0.05）.结论 支架式教学能较好地提高实习护生的临床沟通能力.     

临床实习护生人际沟通能力培养与实习效果的相关性

目的 探讨临床实习护生人际沟通能力与实习效果的关系,寻求提高护生沟通能力、提高实习效果的新方法 .方法 将60名护生随机分为试验组和对照组各30名,对照组采用传统临床教学方法 带教;试验组在传统临床教学基础上,于实习12周开始对护生进行人际沟通能力培训.采用自行设计的护生沟通能力与实习效果问卷进行调查.结果 实习后36周两组人际沟通能力与实习效果均显著提高,试验组效果更显著(均P＜0.01);试验组护生沟通能力与实习效果呈显著正相关(r=0.461).结论 沟通能力培训能提高护生的综合素质,提高实习效果.     

手术室两种带教方法效果比较

目的提高大专护生手术室临床实习效果。方法将80名三年制大专实习护生随机分为两组各40人。在4周的实习中,对照组按常规带教,即护生跟班学习,并参与晨交班;改进组相对固定带教老师,由总带教老师带领护生单独晨交班。实习结束前进行效果评价。结果改进组护生理论、操作考试成绩显著优于对照组（均P〈0．01）;改进组对8项教学方法认可率达87．5％～100％。结论护生单独晨交班及相对固定带教老师有利于提高手术室护生的实习效果。     

运用自我效能感理论对实习护生护患沟通能力的干预

目的 探讨运用自我效能感理论对实习护生护患沟通能力的干预效果.方法 将2005级<护理专业学生护患沟通能力评价量表>评分<154分的本科实习护生60名,随机分为实验组和对照组各30名.对照组采用常规带教方法实习,实验组针对护生的自我效能感状况,运用自我效能感理论进行护患沟通能力培养.结果 干预6个月后实验组护患沟通能力评分显著高于对照组(P<0.05,P<0.01).结论 运用自我效能感理论对实习护生护惠沟通能力进行干预,可有效提高其护患沟通能力.     

以护生为主体的小讲课在临床护理教学中的应用

目的探索提高本科护生临床实习效果的教学方法。方法将72名护生随机分为两组，在4周实习期间，实验组（35人）以护生为临床护理课程教学授课主体，带教老师进行启发和督导；对照组（37人）由带教老师授课，护生自由提问。比较两组出科考核成绩及学习满意率。结果实验组出科理论、技能考核成绩及综合素质评分显著优于对照组（均P〈0．01），实验组护生临床小讲课达标率91．4％．护生对学生形式、学习效果及自我评价的满意率显著高于对照组（均P〈0．05）。结论在临床护理教学中，采取以护生为主体的小讲课教学模式不仅可以提高护理教学效果和质量，而且可增强护生学习的主观能动性。     

同理心地图联合情景教学在护患沟通技巧教学的应用

目的 探讨同理心地图联合情景教学在护患沟通技巧教学中的应用效果。方法 采用便利抽样法选取某高校本科护生114人,将本科一班（56人）设为对照组,在护患沟通技巧实训教学中实施常规教学法;本科二班（58人）设为研究组,实施同理心地图联合情景教学。采用共情量表和临床沟通能力测评量表对两组护生进行效果评价。结果 教学后研究组护生共情能力和临床沟通能力得分显著高于对照组（均P<0.05)。结论 将同理心地图联合情景教学融入本科护生护患沟通技巧课程中,能有效提高护生的临床沟通能力,有助于护生共情能力提升。     

反思性学习对本科护生临床实践行为的影响

目的 探讨反思性学习对本科护生临床实践行为的影响。方法 将5年制本科护生60名随机分成实验组和对照组各30名。对照组采用常规带教方法实习；实验组在此基础上进行反思性学习，并于实习前及实习6个月后，采用护理本科生实践过程行为评价表测评两组护生的临床实践行为。结果 实习6个月后，两组护生临床实践行为总分及应用护理程序、与患者的沟通交流、应用相关学科知识、明确自己的学习需求、明确患者的权利与义务、证实自己的专业能力、分析影响患者的因素方面比较，差异有显著性意义（P〈0．05，P〈0．01）。结论 反思性学习能有效地改善本科护生的临床实践行为。     

护生基于Gibbs反思循环圈撰写实习反思日志的效果

目的 探讨护生基于Gibbs反思循环圈撰写实习反思日志的效果.方法 按照进入临床实习的时间将本科护生分为对照组62名和观察组63名.两组均采用传统临床带教,对照组每周撰写心得体会,观察组基于Gibbs反思循环圈按描述、感受、评价、分析、总结和行动计划6步每周书写实习反思日志.结果 实习10个月后,观察组评判性思维能力总分、各维度评分及床边护理综合能力评分显著高于对照组;且观察组对实习带教总体评价及建立临床思维,提升理论知识、人际交往和沟通能力、循证能力方面的评价显著优于对照组(P＜0.05,P＜0.01).结论 临床实习中,护生基于Gibbs反思循环圈撰写反思日志,有利于培养其评判性思维能力,提升其临床实践综合能力,并赢得护生对实习带教的好评.     

创客教育在本科护生手术室无菌技术教学中的应用

目的 探索创客教育在本科护生手术室无菌技术教学中的应用效果。方法 将手术室实习的本科护生83人随机分为对照组41人与试验组42人。对照组采用手术室常规教学;试验组采用创客教学。结果 试验组出科操作考核成绩及创造性思维测验得分显著高于对照组(均P<0.05),试验组对创客教育的评分为(4.31±1.16)～(4.74±0.49)分。结论 创客教育有利于护生对无菌操作的掌握,激发及提高护生的创新思维及创作能力,且受到护生好评。     

提高护生临床药物知识教学初探

对在外科进行毕业实习的82名中专护生（实验组）制定学习药物知识目标及质控标准，采用多种形式授予或指导其药物知识的学习，并与采取常规带教的97名中专护生（对照组）进行比较。结果药物理论知识考试成绩、药物知识认知情况及病人满意度实验组均显著高于对照组（P＜0．05或P＜0．01）。提示在实习带教中增加认知药物的带教内容与措施，可提高护生药物知识，加强用药护理，提高实习质量。     

An analysis of the survival outcomes of simultaneous pancreas and kidney transplantation compared to live donor kidney transplantation in patients with type 1 diabetes: a UK Transplant Registry study

Transplant options for patients with type 1 diabetes and end‐stage renal disease (ESRD) include deceased donor kidney, live donor kidney (LDK) and simultaneous pancreas‐kidney (SPK) transplantation. The aim of this study was to compare outcomes between LDK and SPK for patients with type 1 diabetes and ESRD in the UK. Data on all SPK (n = 1739) and LDK (n = 385) transplants performed between January 2001 and December 2014 were obtained from the UK Transplant Registry. Unadjusted patient and kidney graft survival were calculated using the Kaplan–Meier method. Multivariate analysis of kidney graft and patient survival was performed using Cox proportional hazards regression. There was no significant difference in patient (P = 0.435) or kidney graft survival (P = 0.204) on univariate analysis. On multivariate analysis there was no association between LDK/SPK and patient survival [HR 0.71 (0.47–1.06), P = 0.095]. However, LDK was associated with an overall lower risk for kidney graft failure [HR 0.60 (0.38–0.94), P = 0.025]. SPK recipients with a functioning pancreas graft had significantly better kidney graft and patient survival than LDK recipients or those with a failed pancreas graft. SPK transplantation does not confer an overall survival advantage compared to LDK. However, those SPK recipients with a functioning pancreas have significantly better outcomes.     

Defining outcomes for β‐cell replacement therapy in the treatment of diabetes: a consensus report on the Igls criteria from the IPITA/EPITA opinion leaders workshop

β‐cell replacement therapy, available currently as pancreas or islet transplantation, has developed without a clear definition of graft functional and clinical outcomes. The International Pancreas & Islet Transplant Association (IPITA) and European Pancreas & Islet Transplantation Association (EPITA) held a workshop to develop consensus for an IPITA/EPITA Statement on the definition of function and failure of current and future forms of β‐cell replacement therapy. There was consensus that β‐cell replacement therapy could be considered as a treatment for β‐cell failure, regardless of etiology and without requiring undetectable C‐peptide, accompanied by glycemic instability with either problematic hypoglycemia or hyperglycemia. Glycemic control should be assessed at a minimum by glycated hemoglobin (HbA_1c) and the occurrence of severe hypoglycemia. Optimal β‐cell graft function is defined by near‐normal glycemic control [HbA_1c ≤ 6.5% (48 mmol/mol)] without severe hypoglycemia or requirement for insulin or other antihyperglycemic therapy, and with an increase over pretransplant measurement of C‐peptide. Good β‐cell graft function requires HbA_1c < 7.0% (53 mmol/mol) without severe hypoglycemia and with a significant (>50%) reduction in insulin requirements and restoration of clinically significant C‐peptide production. Marginal β‐cell graft function is defined by failure to achieve HbA_1c < 7.0% (53 mmol/mol), the occurrence of any severe hypoglycemia, or less than 50% reduction in insulin requirements when there is restoration of clinically significant C‐peptide production documented by improvement in hypoglycemia awareness/severity, or glycemic variability/lability. A failed β‐cell graft is defined by the absence of any evidence for clinically significant C‐peptide production. Optimal and good functional outcomes are considered successful clinical outcomes.     

临床学习环境对护理本科生临床实习表现的影响

目的探讨临床学习环境(CLE)对护理本科生(护生)临床实习表现(CPs)的影响。方法按比例分层从全国142所医药高校中抽取22所的毕业实习护生923名,采用护理临床学习环境评价量表、护理本科生毕业实习临床实践行为表现自评量表进行问卷调查。结果护生CLE总评分为3.39±0.62,CPs总评分为3.68±0.47;护生对CLE评价与其CPs相关系数是0.520(P<0.01);个性化、学生参与性、任务定位是影响护生CPs的主要因素(均P<0.01)。结论 CLE可影响护生的CPs。在临床实习中,护理管理者和临床带教老师应给护生一定的自主性,并进行因人而异的个性化施教,为护生创造更多的动手机会,对护生的实习活动指示明确,让护生清楚自己的实习角色和实习任务,以提高临床实习质量。     

Reliability and usefulness of clinical encounter cards for a third-year surgical clerkship

BACKGROUND: Third-year medical students (MS3) were given clinical encounter cards (CECs) to stimulate feedback during their surgery clerkship. This study analyzes the feedback given on their clinical performance using CECs. METHODS: Two hundred one students enrolled in the 12-week surgery clerkship were given CECs. Each card contained the chief focus of the encounter, which was rated on a six-point Likert scale. The CECs were analyzed to determine if they provided reliable formative information, identified marginal performances, and identified differences between raters, settings, rotations, and aspects of clinical performance evaluated. RESULTS: Seven thousand three hundred eight CECs were submitted from 201 students. The CECs were completed most often (65%) in the inpatient setting. Technical skills were evaluated on 49% of CECs, history/physical examinations on 40%, and case presentations on 30%. There were comments written on half of the CECs and 89% of these were strictly positive. Women (52.8%) and faculty (63.3%) were more likely to provide written comments. The students were most likely to seek feedback from the interns and faculty who gave significantly higher ratings. The Cronbach-alpha reliability coefficient was 0.69, based on 12 raters per student. There was a significant positive correlation (P < 0.05) between the CEC composite rating and the clinical performance rating (r = 0.356), NBME score (r = 0.258), and the final grade (r = 0.250). CONCLUSIONS: The implementation of CECs in a surgery clerkship provided a large quantity of positive feedback. The quality was limited because there were minimal recommendations for improvement and they were a poor predictor of overall clinical performance.     

Clinical research and good clinical practice

Clinical research is one of the important missions of an academic Albert Einstein medical centre and forms the cornerstone for improvement of healthcare. Funding for clinical research has increased steadily over the past few decades, both from the US government and the pharmaceutical industry. In this chapter we will explore how clinical research contributes to improvements in patient care and medical education and describe the process of clinical research. Whereas there can be deficiencies in the process of conducting research, as evidenced by recent media reports, research involving human subjects is a necessary and crucial step in the mechanism of translating scientific discovery and technological advancement into procedures and products that offer the prospect of better lives for all of us. Guidelines on good clinical practice should be followed and, above all, trust between research subjects and investigators should always be upheld and respected.     

Review of the Australian incident monitoring system

BACKGROUND: A survey was conducted to assess the benefits and limitations of the Australian Incident Monitoring System (AIMS) as a programme to improve patient safety. METHODS: A 12-point questionnaire was sent to 12 current users of AIMS in November 2002. RESULTS: The AIMS provides a consistent system of coding, trending and monitoring of incident data. It promotes a patient safety culture and an awareness of system error. Other benefits include the building of teamwork and the implementation of strategies to reduce the prevalence and severity of incidents. The majority of respondents (83%) reported that AIMS investigations resulted in significant changes to equipment usage, medication prescribing or administration, clinical protocols, training programmes and falls risk assessment tools. Although 75% of users reported improvements in patient outcomes, these were difficult to measure. A major limitation of AIMS was the low rate of incident reporting by medical staff. Voluntary reporting systems did not capture all incident data and the information was often too generic for root cause analysis. There were difficulties benchmarking data and concerns were raised regarding the ownership of information. The programme requires ongoing resources to implement change strategies and to maintain incident reporting levels. On a scale of 1 (poor rating) to 10 (excellent rating) the mean benefit rating was 7.6. CONCLUSION: The Australian Incident Monitoring System is beneficial as a component of a clinical risk management strategy. Usefulness could be improved by increased participation by medical staff. The level of resources required should not be underestimated if the programme is to demonstrate improvements to patient outcomes. More recent versions of AIMS promise improved capabilities and will require similar evaluation.