护理专业教师批判性思维能力调查研究

[目的]研究高校护理专业教师批判性思维的能力倾向,找出差距,为师资培训课程提供依据。[方法]采用一般情况问卷及香港理工大学中文版加利福尼亚批判性思维倾向量表(CTDI-CV)对某高校护理学院86名教师集中进行问卷调查和CTDI-CV测量。[结果]护理教师CTDI-CV测量结果中总分最低分为248分,最高分为386分;不同年龄、职称和工作压力的护理教师CTDI-CV中文版特质测量结果比较有统计学意义。[结论]高校护理教师具有较强的批判性思维倾向,但是开放思想等特质还需进一步提高;低年资教师及学院教师的系统化特质等还需进一步提高。     

外科护士批判性思维能力与自主学习能力的调查分析

目的 了解外科护士的批判性思维能力与自主学习能力,为护理管理者提高外科护士批判性思维能力与自主学习能力提供理论依据.方法 采用中文版批判性思维意向问卷(CCTDI)和护理人员自主学习能力评价量表,对3所医院的200名外科护士进行问卷调查.结果 外科护士批判性思维得分为(282.41±19.87)分,拥有正性批判性思维;自主学习能力得分为(131.65±10.29)分,总体得分水平较高.结论 护理管理者应重视对外科护士批判性思维能力和自主学习能力的培养,提高护理人员的自身素质.     

外科护士批判性思维能力与自主学习能力的调查分析

目的 了解外科护士的批判性思维能力与自主学习能力,为护理管理者提高外科护士批判性思维能力与自主学习能力提供理论依据.方法 采用中文版批判性思维意向问卷（CCTDI）和护理人员自主学习能力评价量表,对3所医院的200名外科护士进行问卷调查.结果 外科护士批判性思维得分为（282.41±19.87）分,拥有正性批判性思维;自主学习能力得分为（131.65±10.29）分,总体得分水平较高.结论 护理管理者应重视对外科护士批判性思维能力和自主学习能力的培养,提高护理人员的自身素质.     

N2级儿科护士批判性思维特质的相关性研究

[目的]调查分析N2级儿科护士批判性思维的特质现状及影响因素,为提高儿科临床护士批判性思维能力提供参考依据。[方法]采用彭美慈等翻译修订的批判性思维能力(中文版)测量表(CTDI-CV)对196名N2级儿科护士进行问卷调查。[结果]回收有效问卷189份,有效率为96.43%。189名N2级护士的CTDI-CV总分无一人超过350分,且有183名(96.83%)N2级护士低于280分,得分为248.30分±19.22分。在7个特质中,得分从高到低依次为认知成熟度、寻找真相、开放思想、系统化能力、分析能力、求知欲、批判性思维的自信心,其中仅有寻找真相和认知成熟度2个特质平均分达到最低认可分40分,且仅有认知成熟度、寻找真相、开放思想3个特质中有护士得分超过50分,分别占7.41%、3.7%和0.53%。人口学资料中除学历外不同职称、工作年限、年龄的护士的批判性思维总分或部分特质得分比较差异具有统计学意义。[结果]189名N2级护士总体批判性思维能力较低,还须进一步加强培养,尤其是系统化能力、分析能力、求知欲、批判性思维的自信心4个特质。     

儿科护理教学中护生评判性思维能力调查与分析

目的:调查儿科护理教学中护生批判性思维能力现状,分析其影响因素。方法:采用一般情况调查表和中文版批判性思维意向问卷(CCTDI),对我校2009级、2010级护理大专参与儿科教学的在读学生182名进行问卷调查。结果:参与儿科教学的护生批判性思维得分为(267.34±18.41)分,拥有正性批判性思维;学校因素、个人因素、父母文化程度与护生的批判性思维能力呈正相关(P<0.05)。结论:儿科护理教育者应重视对护生批判性思维能力的培养,提高护理人员的自身素质。     

康复专业大专生批判性思维能力调查

目的了解康复专业大专生的批判性思维能力现状,为康复专业教学改革提供依据。方法采用美国加利福尼亚批判性思维态度倾向测试表中文修订版(CCDI-CV),对康复专业大专二年级学生进行问卷调查。结果康复专业大专生的批判性思维能力总平均分为(238.98±19.78)分,其中认知成熟度(28.29±4.78)分,为负性特质表现。结论康复专业大专生的批判性思维能力得分为特质意义不明确,康复专业教育过程中应改革传统医学教育模式。     

中美合作教学班与普通班护生批判性思维能力的比较研究

[目的]比较中美合作教学班与普通班护生批判性思维能力的差异,探讨我校护理课程设置、护理教学和掌握双语程度与批判性思维能力的关系.[方法]普通班护生246名,中美合作教学班护生251名.采用中文版批判性思维能力测量表(CTDI-CV)对497名护生进行问卷调查.[结果]497名护生批判性思维能力CTDI-CV总分284.69分±29.31分,为正性水平;中美合作教学班护生CTDI-CV总分达到正性水平(291.90分±29.69分),普通班护生CTDI-CV总分处于正负临界水平(277.33分±27.06分),两组比较差异有统计学意义(P＜0.05);一年级、二年级中美合作教学班与普通班护生正性批判性思维比较差异有统计学意义(P＜0.05),三年级两班护生比较差异无统计学意义(P＞0.05).[结论]中美合作教学班与普通班护生批判性思维能力存在差异,可能与课程设置、教学方式和掌握双语的程度有关.     

我院护理管理者批判性思维能力的调查分析

[目的]调查护理管理者批判性思维能力的现状及特征,为护理管理者的批判性思维能力的培养提供参考依据。[方法]采用批判性思维能力测量表(CTDI-CV)对97名护理管理者进行测试。[结果]护理管理者的批判性思维能力总分与护士相比差异无统计学意义(P>0.05);护理管理者除寻找真相的得分低于最低认可分40分外,其他特质得分都大于40分,得分较高的为求知欲、分析能力、批判性思维的自信心。[结论]护理管理者总体具有正性批判性思维能力,但离批判性思维能力强的要求还有差距。应通过针对性的培训,提高护理管理者的批判性思维能力。     

批判性思维能力与学习风格的相关性研究

[目的]探讨学习风格与批判性思维能力的相关性.[方法]采用中文版批判性思维能力测量表(CTDI-CV)和学习风格量表(LSI)对497名护理专业大专学生进行批判性思维能力和学习风格评价,并对结果进行相关分析.[结果]497名护理大专生中发散型学习风格229名(46.1%),同化型131名(26.4%),顺应型90名(18.1%),集中型47名(9.5%).CTDI-CV中7个特质与LSI中具体经验、沉思观察、抽象概括具有相关性.4种学习风格学生的CTDI-CV得分差异有统计学意义,同化型(296.08分±29.46分)和集中型(295.72分±30.98分)学习风格者的CTDI-CV得分高于发散型(277.93分±27.21分)和顺应型(279.52分±26.99分).[结论]护理大专生的学习风格以发散型居多,其批判性思维能力的寻求真相、系统化能力、自信心方面较弱,提示教师应将批判性思维能力培养有意识地融入课程教学目标中.     

PBL教学法对护理本科生批判性思维能力影响的研究

[目的]探讨以问题为基础教学(PBL)对护理本科生批判性思维能力的影响.[方法]采用类试验性研究,对照组学生在腹部外科护理学中接受传统教学;试验组接受2个月的PBL教学.试验前先进行基线资料比较,然后在教学前后用中文版本批判性思维意向量表(CCTDI)测量两组的批判性思维能力.[结果]教学前两组批判性思维能力没有差异,教学后试验组批判性思维能力表现出明显上升趋势,对照组很多条目出现下降,其中在开放思想和认知成熟度方面两组比较差异有统计学意义.[结论]PBL能有效促进护理本科生批判性思维能力的提高.     

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.