护理管理

9,1.114国外远程护理教育对我们的启迪/王建荣…才中华护理杂志一1998.33(11)一681~682.封三 远程教育是利用信息传播技术对异地的人员进行教育的一种方式。利用此系统可使教师在一个教室授课的同时可与数个其它教室,包括其它城市.其它国家或其它洲教室的学生进行交流.效果与在同一教室一样。发达国家已将远程教育方式用于护理教学.并收到较好效果。在已经具备r远程护理教育基本条件的我国.信息产业的发展已成规模;个人电脑拥有量在不断增加;各种平台的远程会诊已在国内许多医院展开.其技术与方式与远程教育相似。再加上国内上百万护士需要…     

远程网络教育在我国护理学继续教育中的应用现状及策略

随着远程教育和信息技术的快速发展,传统的继续教育形式已不能适应时代发展的要求。我国护士的学历水平普遍偏低,构建终身学习体系是非常必要的。本文旨在比较国内外继续教育的现状,发现我国护理继续教育存在的问题,分析远程网络教育的优势及护士对远程网络教育的需求,学习国外先进的经验,将远程网络教育与继续护理学教育更好的结合并提出改进策略。     

远程护理教育中教师的职能转变与素质培养

远程教师是远程教育的实施者、组织者和推动者.随着远程护理教育中教师角色、护生学习地位、媒体作用和教学过程的转变,远程护理教师必须转变教育思想,更新教育观念.了解和研究信息时代教育的模式与方法,提高自身素质,重点培养导学、教学设计、教学控制、创新教学和信息运用能力.     

基于典型工作任务的远程护理教育改革研究

传统的以学科为中心的护理学专业课程体系和教育模式,难以适应远程教育环境下护士在职学习和能力提升的需要。北京大学医学网络教育学院遵循成人学习特点和护士职业成长规律,借鉴典型工作任务课程开发方法开展远程护理教育改革,建立了一套完整的护理学专业课程体系和课程标准,并进行了网络教学实验,取得了预期效果。基于典型工作任务的远程护理教育改革,实现了课程内容与岗位任务的有效对接,充分发挥了远程教育的优势,探索形成了进阶式、工学结合的人才培养模式,对我国远程护理教育模式的建立和完善具有重要的理论和实践意义。     

中国与加拿大合作的远程护理教育网络简介

远程教育已在世界许多国家被采用 ,并广泛应用到护理学的学历教育和继续教育中。天津医科大学护理系与加拿大渥太华大学护理学院合作 ,在我国率先建立了服务于护理教育的中加远程教育网络 ,在中国高等护理教育和继续教育方面进行了有益的探索。我们从 2 0 0 1年 4月至 6月对通过远程网络进行继续教育的学员进行调查 ,考察远程教育网络在继续教育中的应用情况。1　中加远程教育网中加远程教育网是中国与加拿大巩固大学合作特别项目 ( SULCP)的主要任务 ,远程教育设备由加拿大国际发展总署 ( CIDA)无偿援助。网络采用音频、图形电话会议网…     

远程教育在继续护理学教育中的应用

护理质量的提高,关键在于护士的素质,根本在于教育.随着疾病谱的变化和科学技术的不断应用,护理人员越来越需要不断更新知识,提高技能.为了适应未来社会和医学日益发展的今天,广大护理人员迫切需要用新知识充实自已,继续教育已是护理界最关注的问题之一.Barriball指出,护士的继续职业教育的重要性已日益明显[1].目前我国继续护理教育学(CNE)的现状及存在的问题,尚不能满足所有护理人员学习的需求.探索适合护理特点,寻求继续教育的有效途径很有必要.国际互联网(Internet)的兴起和远程教育(RE)的发展,使参加继续教育的困难迎刃而解.天津医科大学护理系和加拿大渥太华大学护理学院合作,在我国率先建立了护理远程教育网络,其实施与评估结果显示,适合在职护理人员的继续教育.远程教育将成为CNE的重要手段之一.发展远程教育,开拓了CNE的有效新途径,展现出CNE的美好前景.笔者认为应大力发展远程护理教育,以推动我国的CNE.     

面向21世纪发展现代远程护理教育

随着2l世纪高新技术的发展，现代信息技术在教育中广泛应用，现代远程教育以其特有的优越性在护理教育领域发挥着越来越重要的作用。作者从现代远程教育的特征及其在护理领域的应用人手，讨论了我国远程护理教育的现状、存在的问题，并提出相应的对策。     

卫星远程护理教育的组织与实施

卫星远程教育是构筑知识经济时代人们终身学习体系的一种新型教育途经，笔者介绍了卫星远程教育系统、卫星远程护理教育应用、组织与实施，提出要转变教育思想，创新教育观念，了解和研究信息时代教育教学的模式、方法、体系；进一步完善远程教育的质量保证体系，不断改革教学方法，提高课件制作水平，切实做好技术保障。     

护理专业远程学习者自我效能感情况调查分析

目的了解护理专业远程学习者网络学习自我效能感现状,为提升网络学习效果并提高远程教育质量提供一定依据。方法采取方便抽样方法,选取长沙市某一护理远程教育教学点自愿参与本次调查研究的网络教育护理本科学生189名,采用自制的一般情况调查表和网络学习自我效能感问卷进行调查。结果护理专业远程学习者网络自我效能感得分为(2.40±0.51)分,其中网络学习特殊效能感得分和网络学习一般效能感得分为(2.36±0.52)分和(2.56±0.53)分。多元线性回归分析结果表明工作年限、上网技能水平和自学能力水平是护理专业远程学习者网络学习自我效能感的主要影响因素。结论护理专业远程学习者网络学习自我效能感处于较低水平,较多护理专业远程学习者存在不同方面的上网操作技能困难,独立完成网络学习情况也不乐观。需探索积极有效的措施切实提高广大在职护理人员在远程教育学习过程中的自我效能感。     

远程护理教育的实施与评估

对在国内首次服务于护理教育的远程教育网络作全面考察并评估，用自行设计的调查表，对与远程教学课程传输有关的各类人员（包括管理者，授课教师，技术人员，学历教育和继续教育学员）进行询问调查，结果：学历教育学员对远程教育大部分指标的评价均达到中等或满意以上，对教师的评定和各门课程的满意度均达到满意以上，但远程组满意程度低于医科大学组，86．0％以上的继续教育学员认为：远程教育增强了继续教育的机会，远程教学内容新，容易理解，对护理知识的积累和护理技能的提高帮助。93．4％教师认为远程教学与课堂教学质量无差别，89．9％的被调查者对远程教育表示支持。而在师生互动交流，声音图像传输，板书效果等方面遇到一些挑战，有待进一步改进，结论：远程护理教育在国内的首次实施效果颇佳，提示应加强各部门之间的协调与合作，尽快提高各类人员运用远程设备的能力，使远程护理教育网络在护理人员的学历和继续教育中发挥更大的作用。     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。