在客观结构化临床考试中评价护理本科毕业生沟通能力的探索

[目的]探讨护理本科毕业生在客观结构化临床考试(OSCE)中学生沟通能力的评价方法。[方法]通过采用OSCE多站点考试,设置考察护生沟通能力的考试站点。[结果]考试成绩呈正态分布。[结论]OSCE多站点考试能够科学、客观地评价护生沟通能力,对教学改革和培养学生的沟通能力有重要的促进作用。     

客观结构化临床考试在ICU专科护生临床能力评价中的应用研究

[目的]探讨ICU专科护生的培训及考核方法,推进护理教学改革,培养ICU专业学生临床能力。[方法]在查找文献的基础上自行设计调查问卷和成绩考核评分标准,对90名ICU专业护生进行传统教学方法与客观结构化临床考试（OSCE）教学方法的前后对照研究,对两种教学方法的考试成绩和问卷调查结果进行统计分析。[结果]确定了本次OSCE考试的10个考试站点、考试具体内容、各考站的评分标准;采用OSCE教学前后笔试成绩差异有统计学意义;在OSCE考试成绩中,考生技能操作方面的得分率较高,问诊、体格检查、团队合作（急危重病人救护）等考站的得分率较低;问卷调查结果表明OSCE考试模式得到了学生和教师的一致认可。[结论]OSCE客观评价了ICU专科护生临床能力的真实水平,可以作为评价ICU专科护生临床能力的有效工具;应用OSCE教学模式可提高ICU专业护生临床能力。     

客观结构化临床考试在ICU专科护生临床能力评价中的应用研究

[目的]探讨ICU专科护生的培训及考核方法,推进护理教学改革,培养ICU专业学生临床能力。[方法]在查找文献的基础上自行设计调查问卷和成绩考核评分标准,对90名ICU专业护生进行传统教学方法与客观结构化临床考试(OSCE)教学方法的前后对照研究,对两种教学方法的考试成绩和问卷调查结果进行统计分析。[结果]确定了本次OSCE考试的10个考试站点、考试具体内容、各考站的评分标准;采用OSCE教学前后笔试成绩差异有统计学意义;在OSCE考试成绩中,考生技能操作方面的得分率较高,问诊、体格检查、团队合作(急危重病人救护)等考站的得分率较低;问卷调查结果表明OSCE考试模式得到了学生和教师的一致认可。[结论]OSCE客观评价了ICU专科护生临床能力的真实水平,可以作为评价ICU专科护生临床能力的有效工具;应用OSCE教学模式可提高ICU专业护生临床能力。     

OSCE在护理本科生临床考核中的实施与评价

[目的]了解参加客观结构化临床考试(OSCE)的护生和教师对OSCE的评价。[方法]选取64名护理本科实习生和参加主考的12名教师作为研究对象,将64名护生随机分为两组,对照组按教学大纲进行常规带教,2个月后实施常规出科考核;实验组增加OSCE临床考核规程及教师标准化病人(TSP)培训与应用等内容培训,2个月后应用OSCE考核系统进行出科考核,并对OSCE考试的设计组织、质量和效能进行调查分析。[结果]实验组大部分护生认为OSCE考试形式有利于提高自身综合素质及沟通能力;教师普遍反映新型考试模式全面改革了护生临床能力评价方式,可充分发挥考试的功能。[结论]应用OSCE对护理本科生进行实践考核客观、真实、科学、有效。     

客观结构化临床考试在本科护生临床综合能力评价中的应用

[目的]对本科护生进行客观结构化临床考试（OSCE），探讨OSCE在本科护生临床综合能力评价中的应用。[方法]对我院3年级、4年级护理本科生进行OSCE，分析考试结果。[结果]4年级学生考试成绩明显高于3年级（F=23．153，P〈0．001），护生OSCE考察了学生的真实水平。[结论]护生僦明确了两个年级学生的差异之处，体现了考试的客观性、规范性和可重复性，应进一步推广。     

护生人际沟通学习需求调查

[目的]从护生角度了解自我沟通能力及学习需求。[方法]采用自制的半结构式调查问卷，对已完成4周临床见习的大专护生进行调查。[结果]36．75％护生对自我护理沟通能力评价好，大多数护生认为护理实践中需要强化人文关怀，提高护生专业素质是达到主动和有效护患沟通的关键，护生需要训练有效的沟通能力。[结论]经验性实践活动对强化护生的专业行为和促进沟通能力的提高具有重要作用；护士专业态度可促进关爱行为的形成和沟通能力的发挥。     

考试改革对高职护生学习行为的影响

[目的]评价考试改革对高职护生学习行为的影响。[方法]对参与考试改革的高职护生，应用调查问卷对其考试改革前后的学习行为进行对照研究。[结果]考试改革后，高职护生上课记笔记、课堂注意力集中程度、课前预习和课后复习情况明显好于考试改革前；课后自习时间利用率显著增加；学习中能经常发现和提出一些问题，增强了解决问题的能力。[结论]考试方式和指导思想会把护生引入相应的学习方式，考试改革使护生学习行为发生了积极变化，促进了学习方法和技能的提高；考试改革有利于发展护生的学习能力，教会护生学习方法，有利于提高教学质量。     

实习护生临床能力培养模式的研究

[目的]对实习护生进行职业能力培训和教育,为临床培养合格护理人才。[方法]随机将实习护生120人分为实验组和对照组,每组60人,实习前实验组采用以临床能力培训模式进行培训,对照组采用传统的实习教学法。培训后及实习后10个月,考核两组护生临床能力,进行相关理论、客观结构化临床考试（OSCE）、临床能力评价。[结果]实验组除职业情感项目外,在知识技能应用、沟通、安全意识、思维品质等方面的能力均明显高于对照组。[结论]该能力模式训练能有效提高护生的职业能力,模式化的能力训练应成为临床实习的必备课程。     

护理专业本科毕业生客观结构化临床考试的实施及评价

[目的]探讨客观结构化临床考试（OSCE）在护理专业本科毕业生考试中的应用。[方法]对2007年毕业的259名护理专业本科毕业生进行客观结构化临床考试，分析考试结果。[结果]考试成绩呈正态分布。[结论]护生OSCE考试客观、公平、真实，考查了学生的总体水平以及临床综合能力。     

儿科护理教学中培养护生非语言沟通能力的探讨

[目的]探讨在儿科护理教学中培养护生非语言沟通能力的效果。[方法]选择50名2008级护生为实验组,50名2007级的护生为对照组。对照组采用传统教学方法,实验组在采用传统教学方法的基础上给予非语言沟通能力的培养。比较两组护生实习评价情况。[结果]实验组护生实习评价情况优于对照组。[结论]在儿科护理教学中加强对护生进行非语言沟通能力的培养,可提高护生的护理水平及沟通能力。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.