A summary of the exploration of the teaching mode of the general practice teaching clinic, a summary of the deficiencies of the teaching clinic and a summary of the significance of the establishment of the general pra...A summary of the exploration of the teaching mode of the general practice teaching clinic, a summary of the deficiencies of the teaching clinic and a summary of the significance of the establishment of the general practice teaching clinic are presented with a view to promoting the development of general practice and cultivating more excellent successors in general practice.展开更多
BACKGROUND Bleeding is one of the major complications after endoscopic submucosal dissection(ESD)in early gastric cancer(EGC)patients.There are limited studies on estimating the bleeding risk after ESD using an artifi...BACKGROUND Bleeding is one of the major complications after endoscopic submucosal dissection(ESD)in early gastric cancer(EGC)patients.There are limited studies on estimating the bleeding risk after ESD using an artificial intelligence system.AIM To derivate and verify the performance of the deep learning model and the clinical model for predicting bleeding risk after ESD in EGC patients.METHODS Patients with EGC who underwent ESD between January 2010 and June 2020 at the Samsung Medical Center were enrolled,and post-ESD bleeding(PEB)was investigated retrospectively.We split the entire cohort into a development set(80%)and a validation set(20%).The deep learning and clinical model were built on the development set and tested in the validation set.The performance of the deep learning model and the clinical model were compared using the area under the curve and the stratification of bleeding risk after ESD.RESULTS A total of 5629 patients were included,and PEB occurred in 325 patients.The area under the curve for predicting PEB was 0.71(95%confidence interval:0.63-0.78)in the deep learning model and 0.70(95%confidence interval:0.62-0.77)in the clinical model,without significant difference(P=0.730).The patients expected to the low-(<5%),intermediate-(≥5%,<9%),and high-risk(≥9%)categories were observed with actual bleeding rate of 2.2%,3.9%,and 11.6%,respectively,in the deep learning model;4.0%,8.8%,and 18.2%,respectively,in the clinical model.CONCLUSION A deep learning model can predict and stratify the bleeding risk after ESD in patients with EGC.展开更多
Objective: To establish breastfeeding clinical holistic nursing model used in clinical nursing and teaching, it is possible to improve nurses and nursing students to master knowledge of breastfeeding, analysis, judgme...Objective: To establish breastfeeding clinical holistic nursing model used in clinical nursing and teaching, it is possible to improve nurses and nursing students to master knowledge of breastfeeding, analysis, judgment, decision-making and the ability to care-related issues, promoting pure improve breastfeeding rates. Method: 1) The North American Nursing Diagnosis Nursing Association (NANDA), Nursing Outcomes Classification (NOC) and Nursing Classification (NIC) link (NNN link) clinical clues reasoning to determine the contents of the questionnaire were used. Then, the Delphi method to care was used. 2) The survey questionnaire was designed. The content included the clinical holistic nursing care model in breastfeeding and the model’s use situation. 3) Questionnaire survey: in the national midwifery care industries, volunteers were collected who were willing to use the breastfeeding clinical holistic nursing care model in the nursing work. We issued 98 questionnaires and took back 76 valid questionnaires. Results: The construction of the breastfeeding clinical holistic nursing model includes 9 nursing diagnoses which contain the breastfeeding effective, the lack of knowledge, the decision conflicts, the risk of breast tenderness, the risk of cracked nipple, the invalid hazard occurring in breastfeeding, the risk of caregiver role strain, the risk of breast feeding jaundice and the ineffective community coping, 18 nursing outcomes and 64 nursing measures. In the composition of breastfeeding after clinical holistic nursing model in clinical practice, 100% of obstetric nurses think that the breastfeeding nursing model can promote the nursing staff to care patients according to the nursing process, can help nurses to analyze, evaluate, make decision, and care about breastfeeding related problems, as well as can promote the mother’s milk feeding rate. Conclusion: The establishment of the breastfeeding nursing model provides a learning material for obstetric breast-feeding. Moreover, nursing diagnosis, nursing outcomes and nursing measures correspond according to the form of chart, which are easy to use and find. The breastfeeding clinical holistic nursing model is practicing in clinical nursing, which can help nursing staff to improve the ability of nursing personnel according to evidence-based nursing patients, to improve the ability of nursing personnel analysis, evaluation, decision-making and nursing in breastfeeding problems and to promote the rate of breastfeeding.展开更多
Objective To explore a corresponding model that would bridge the gap between the practice of clinical teaching of nursing students in clinical settings in China and the clinical instructors' standard teaching of n...Objective To explore a corresponding model that would bridge the gap between the practice of clinical teaching of nursing students in clinical settings in China and the clinical instructors' standard teaching of nursing students in clinical settings in the Philippines. Methods A phenomenological-qualitative,non-experimental type of research was utilized to recruit 27 staff nurses/clinical teachers in China. Data was collected by using audio-tapes and taking notes in the interviews. Results A content analysis was conducted and the sorted into four themes:(1) The things that they were able to teach their students;(2) The things that they were not able to teach their students;(3) The difficulties encountered in doing Clinical Teaching for their students;(4) Suggestions to improve Clinical Teaching. Conclusion According to the findings,the "CP's Proposed Nursing Clinical Teaching Model"should be introduced into the clinical set-up for staff nurses/clinical teachers handling nursing students in China.展开更多
Background: An Advanced Practice Nurse is a generalist or specialized nurse who has acquired thorough graduate education a minimum of a master’s degree. The need for Advanced Practice Nurses is increasingly recognize...Background: An Advanced Practice Nurse is a generalist or specialized nurse who has acquired thorough graduate education a minimum of a master’s degree. The need for Advanced Practice Nurses is increasingly recognized globally. This paper describes the process, which was undertaken by School of Nursing Sciences, University of Zambia in reviewing and developing advanced practice nursing and midwifery curricula which will be implemented using the Early and Enhanced Clinical Exposure model (EECE). Materials and Methods: The curricula development/review process utilized a modified Taba’s Model which followed a step-by-step approach including: 1) desk review, 2) diagnosis of needs (needs assessment), 3) stakeholder consultations, 4) content development, 5) validations and approval from which several lessons were learnt and recommendations made. Findings and recommendations from different stages were used as a basis for reviewing and developing advanced practice nursing and midwifery curricula. Results: Desk review needs assessment and stakeholder consultations identified both strengths and weaknesses in the existing curricula. Major strengths were duration and core courses which met the minimum requirement for postgraduate nursing and midwifery training. Major weaknesses/gaps included some content that was too basic for the master’s level and the delayed exposure to practicum sites which limited the development of advanced practice skills. Others were inadequate competence for advanced practice, inadequate research methodology course, lack of content to foster development of personal soft skills and predominant use of traditional teaching methods. Stakeholders recommended implementing advanced, clinical and hands-on Masters of Nursing and Midwifery programmes which resulted in the review of four existing and development of five demand-driven curricula. Conclusion: The reviewed and developed curricula were strengthened to close the identified gaps. Both the reviewed and developed curricula have been implemented using the Early and Enhanced Clinical Exposure Model with a view to producing Advanced Practice Nurses and Midwives who are competent to meet diverse health care needs and contribute to improving patient outcomes.展开更多
<strong>Objective: </strong>To explore those differences and relationships of the initial diagnostic clinical data between confirmed cases of 2019-nCoV and suspected cases of COVID-19, and then to establis...<strong>Objective: </strong>To explore those differences and relationships of the initial diagnostic clinical data between confirmed cases of 2019-nCoV and suspected cases of COVID-19, and then to establish prediction models for predicting the probability of the first diagnosis of 2019-nCoV. <strong>Methods:</strong> A total of 81 suspected cases and 87 confirmed cases of moderate 2019-nCoV diagnosed initially in the isolation wards of the First People’s Hospital of Wuhu and the People’s Hospital of Wuwei and Wuhan Caidian Module Hospital with the help of our hospital doctors were gathered, and retrospectively analyzed. <strong>Results:</strong> The most common symptoms were fever (76.79%) and cough (64.29%) in the total of 168 cases. The median age was 45 (35 - 56) years old in the 87 confirmed cases of moderate 2019-nCoV, older than the median age 36 (29 - 50) in the 81 suspected cases. There were significant more in the former than in the latter in the incidence of myalgia, ground-glass opacity (GGO), invasions of lesion in the peripheral lobes, vascular thickening and bronchial wall thickening, interlobular septal thicking, and small pulmonary nodules. On the contrary, there were less in the former than in the latter in the total number of leukocytes and neutrophils in blood routine examination and the levels of procalcitonin (PCT). Two groups were statistically significantly different (<em>P</em> < 0.05). Multivariate logistic regression analysis showed that age, fever, myalgia, GGO, vascular thickening and bronchial wall thickening, invasions of lesion in the peripheral lobes were independent factors for identification of 2019-nCoV, and the total number of leukocytes, cough, pharyngalgia and headache were negatively related. The established mathematical equation for predicting model for predicting the probability of the first diagnosis of 2019-nCoV is: <em>P</em> = e<sup><em>x</em></sup>/(1 + e<sup><em>x</em></sup>), <em>x</em> = <span style="white-space:nowrap;">−</span>6.226 + (0.071 × ages) + (1.720 × fever) + (2.858 × myalgia) + (2.131 × GGO) + (3.000 × vascular thickening and bron-chial wall thickening) + (3.438 × invasions of lesion in the peripheral lobes) + (<span style="white-space:nowrap;">−</span>0.304 × the number of leukocytes) + (<span style="white-space:nowrap;">−</span>1.478 × cough) + (<span style="white-space:nowrap;">−</span>1.830 × pharyngalgia) + (<span style="white-space:nowrap;">−</span>2.413 × headache), where e is a natural logarithm. The area under the ROC curve (AUC) of this model was calculated to be 0.945 (0.915 - 0.976). The sensitivity is 0.920 and the specificity is 0.827 when the appropriate critical point is 0.360.<strong> Conclusions: </strong>A mathematical equation prediction model for predicting the probability of the first diagnosis of 2019-nCoV can be established based on the initial diagnostic clinical data of moderate 2019-nCoV. The prediction model is a good assistant diagnostic method for its high accurateness.展开更多
In this study, we have observed the conditions of clinical application of Model CLRHA Auricular Point Detector from the aspects of accessory diagnosis and effective comparison of acupuncture at positive point and non-...In this study, we have observed the conditions of clinical application of Model CLRHA Auricular Point Detector from the aspects of accessory diagnosis and effective comparison of acupuncture at positive point and non-positive point. The preliminary results show that using this device to seek reaction point is quick and reliable, the coincidence rate of diagnosis is higher (76. 77 % ); the indix is objective. It can effectively direct doctors to select acupoints correctly for treatment, resulting in improving the therapeutic effect. The results of contrastive observation show that the therapeutic effect of positive point group is much better than that of non-positive point group (P < 0. 001 ). This instrument has following characteristics, i. e. it is simple, safe, small and exquisite to be portable, and economic. It is more suitable to the clinical needs, possessing a higher practical value.展开更多
文摘A summary of the exploration of the teaching mode of the general practice teaching clinic, a summary of the deficiencies of the teaching clinic and a summary of the significance of the establishment of the general practice teaching clinic are presented with a view to promoting the development of general practice and cultivating more excellent successors in general practice.
文摘BACKGROUND Bleeding is one of the major complications after endoscopic submucosal dissection(ESD)in early gastric cancer(EGC)patients.There are limited studies on estimating the bleeding risk after ESD using an artificial intelligence system.AIM To derivate and verify the performance of the deep learning model and the clinical model for predicting bleeding risk after ESD in EGC patients.METHODS Patients with EGC who underwent ESD between January 2010 and June 2020 at the Samsung Medical Center were enrolled,and post-ESD bleeding(PEB)was investigated retrospectively.We split the entire cohort into a development set(80%)and a validation set(20%).The deep learning and clinical model were built on the development set and tested in the validation set.The performance of the deep learning model and the clinical model were compared using the area under the curve and the stratification of bleeding risk after ESD.RESULTS A total of 5629 patients were included,and PEB occurred in 325 patients.The area under the curve for predicting PEB was 0.71(95%confidence interval:0.63-0.78)in the deep learning model and 0.70(95%confidence interval:0.62-0.77)in the clinical model,without significant difference(P=0.730).The patients expected to the low-(<5%),intermediate-(≥5%,<9%),and high-risk(≥9%)categories were observed with actual bleeding rate of 2.2%,3.9%,and 11.6%,respectively,in the deep learning model;4.0%,8.8%,and 18.2%,respectively,in the clinical model.CONCLUSION A deep learning model can predict and stratify the bleeding risk after ESD in patients with EGC.
文摘Objective: To establish breastfeeding clinical holistic nursing model used in clinical nursing and teaching, it is possible to improve nurses and nursing students to master knowledge of breastfeeding, analysis, judgment, decision-making and the ability to care-related issues, promoting pure improve breastfeeding rates. Method: 1) The North American Nursing Diagnosis Nursing Association (NANDA), Nursing Outcomes Classification (NOC) and Nursing Classification (NIC) link (NNN link) clinical clues reasoning to determine the contents of the questionnaire were used. Then, the Delphi method to care was used. 2) The survey questionnaire was designed. The content included the clinical holistic nursing care model in breastfeeding and the model’s use situation. 3) Questionnaire survey: in the national midwifery care industries, volunteers were collected who were willing to use the breastfeeding clinical holistic nursing care model in the nursing work. We issued 98 questionnaires and took back 76 valid questionnaires. Results: The construction of the breastfeeding clinical holistic nursing model includes 9 nursing diagnoses which contain the breastfeeding effective, the lack of knowledge, the decision conflicts, the risk of breast tenderness, the risk of cracked nipple, the invalid hazard occurring in breastfeeding, the risk of caregiver role strain, the risk of breast feeding jaundice and the ineffective community coping, 18 nursing outcomes and 64 nursing measures. In the composition of breastfeeding after clinical holistic nursing model in clinical practice, 100% of obstetric nurses think that the breastfeeding nursing model can promote the nursing staff to care patients according to the nursing process, can help nurses to analyze, evaluate, make decision, and care about breastfeeding related problems, as well as can promote the mother’s milk feeding rate. Conclusion: The establishment of the breastfeeding nursing model provides a learning material for obstetric breast-feeding. Moreover, nursing diagnosis, nursing outcomes and nursing measures correspond according to the form of chart, which are easy to use and find. The breastfeeding clinical holistic nursing model is practicing in clinical nursing, which can help nursing staff to improve the ability of nursing personnel according to evidence-based nursing patients, to improve the ability of nursing personnel analysis, evaluation, decision-making and nursing in breastfeeding problems and to promote the rate of breastfeeding.
文摘Objective To explore a corresponding model that would bridge the gap between the practice of clinical teaching of nursing students in clinical settings in China and the clinical instructors' standard teaching of nursing students in clinical settings in the Philippines. Methods A phenomenological-qualitative,non-experimental type of research was utilized to recruit 27 staff nurses/clinical teachers in China. Data was collected by using audio-tapes and taking notes in the interviews. Results A content analysis was conducted and the sorted into four themes:(1) The things that they were able to teach their students;(2) The things that they were not able to teach their students;(3) The difficulties encountered in doing Clinical Teaching for their students;(4) Suggestions to improve Clinical Teaching. Conclusion According to the findings,the "CP's Proposed Nursing Clinical Teaching Model"should be introduced into the clinical set-up for staff nurses/clinical teachers handling nursing students in China.
文摘Background: An Advanced Practice Nurse is a generalist or specialized nurse who has acquired thorough graduate education a minimum of a master’s degree. The need for Advanced Practice Nurses is increasingly recognized globally. This paper describes the process, which was undertaken by School of Nursing Sciences, University of Zambia in reviewing and developing advanced practice nursing and midwifery curricula which will be implemented using the Early and Enhanced Clinical Exposure model (EECE). Materials and Methods: The curricula development/review process utilized a modified Taba’s Model which followed a step-by-step approach including: 1) desk review, 2) diagnosis of needs (needs assessment), 3) stakeholder consultations, 4) content development, 5) validations and approval from which several lessons were learnt and recommendations made. Findings and recommendations from different stages were used as a basis for reviewing and developing advanced practice nursing and midwifery curricula. Results: Desk review needs assessment and stakeholder consultations identified both strengths and weaknesses in the existing curricula. Major strengths were duration and core courses which met the minimum requirement for postgraduate nursing and midwifery training. Major weaknesses/gaps included some content that was too basic for the master’s level and the delayed exposure to practicum sites which limited the development of advanced practice skills. Others were inadequate competence for advanced practice, inadequate research methodology course, lack of content to foster development of personal soft skills and predominant use of traditional teaching methods. Stakeholders recommended implementing advanced, clinical and hands-on Masters of Nursing and Midwifery programmes which resulted in the review of four existing and development of five demand-driven curricula. Conclusion: The reviewed and developed curricula were strengthened to close the identified gaps. Both the reviewed and developed curricula have been implemented using the Early and Enhanced Clinical Exposure Model with a view to producing Advanced Practice Nurses and Midwives who are competent to meet diverse health care needs and contribute to improving patient outcomes.
文摘<strong>Objective: </strong>To explore those differences and relationships of the initial diagnostic clinical data between confirmed cases of 2019-nCoV and suspected cases of COVID-19, and then to establish prediction models for predicting the probability of the first diagnosis of 2019-nCoV. <strong>Methods:</strong> A total of 81 suspected cases and 87 confirmed cases of moderate 2019-nCoV diagnosed initially in the isolation wards of the First People’s Hospital of Wuhu and the People’s Hospital of Wuwei and Wuhan Caidian Module Hospital with the help of our hospital doctors were gathered, and retrospectively analyzed. <strong>Results:</strong> The most common symptoms were fever (76.79%) and cough (64.29%) in the total of 168 cases. The median age was 45 (35 - 56) years old in the 87 confirmed cases of moderate 2019-nCoV, older than the median age 36 (29 - 50) in the 81 suspected cases. There were significant more in the former than in the latter in the incidence of myalgia, ground-glass opacity (GGO), invasions of lesion in the peripheral lobes, vascular thickening and bronchial wall thickening, interlobular septal thicking, and small pulmonary nodules. On the contrary, there were less in the former than in the latter in the total number of leukocytes and neutrophils in blood routine examination and the levels of procalcitonin (PCT). Two groups were statistically significantly different (<em>P</em> < 0.05). Multivariate logistic regression analysis showed that age, fever, myalgia, GGO, vascular thickening and bronchial wall thickening, invasions of lesion in the peripheral lobes were independent factors for identification of 2019-nCoV, and the total number of leukocytes, cough, pharyngalgia and headache were negatively related. The established mathematical equation for predicting model for predicting the probability of the first diagnosis of 2019-nCoV is: <em>P</em> = e<sup><em>x</em></sup>/(1 + e<sup><em>x</em></sup>), <em>x</em> = <span style="white-space:nowrap;">−</span>6.226 + (0.071 × ages) + (1.720 × fever) + (2.858 × myalgia) + (2.131 × GGO) + (3.000 × vascular thickening and bron-chial wall thickening) + (3.438 × invasions of lesion in the peripheral lobes) + (<span style="white-space:nowrap;">−</span>0.304 × the number of leukocytes) + (<span style="white-space:nowrap;">−</span>1.478 × cough) + (<span style="white-space:nowrap;">−</span>1.830 × pharyngalgia) + (<span style="white-space:nowrap;">−</span>2.413 × headache), where e is a natural logarithm. The area under the ROC curve (AUC) of this model was calculated to be 0.945 (0.915 - 0.976). The sensitivity is 0.920 and the specificity is 0.827 when the appropriate critical point is 0.360.<strong> Conclusions: </strong>A mathematical equation prediction model for predicting the probability of the first diagnosis of 2019-nCoV can be established based on the initial diagnostic clinical data of moderate 2019-nCoV. The prediction model is a good assistant diagnostic method for its high accurateness.
文摘In this study, we have observed the conditions of clinical application of Model CLRHA Auricular Point Detector from the aspects of accessory diagnosis and effective comparison of acupuncture at positive point and non-positive point. The preliminary results show that using this device to seek reaction point is quick and reliable, the coincidence rate of diagnosis is higher (76. 77 % ); the indix is objective. It can effectively direct doctors to select acupoints correctly for treatment, resulting in improving the therapeutic effect. The results of contrastive observation show that the therapeutic effect of positive point group is much better than that of non-positive point group (P < 0. 001 ). This instrument has following characteristics, i. e. it is simple, safe, small and exquisite to be portable, and economic. It is more suitable to the clinical needs, possessing a higher practical value.
