Clinical application of case teaching method combined with clinical pathway in pediatrics teaching

Objective To explore the clinical pathway teaching method application effection end-stage renal disease(ESRD)teaching practice. Methods From May 2013 to July 2014, a total of 80 nursing intern students in Nephrology Department, the Fifth Hospital of Wuhan, were divided into observation group (40 cases) and control group (40 cases) according to a random number table method. Conventional teaching method was applied in the control group whereas the observation group used clinical pathway teaching method. Four weeks after the internship, the quality of clinical teaching programs scores, nursing students theoretical knowledge, skills assessment excellent rates and patient satisfaction levels of both groups were compared. Results Statistical analysis of the quality of clinical teaching programs filled by nursing intern students showed that the observation group nursing students in the teachers′ teaching management, teaching attitude, knowledge level and teaching skill level four aspects were higher than those in the control group (P<0.05). The average total score of the observation group was (91.3±4.1) while the control group was (79.6±3.2), and the difference was statistically significant (P<0.01). Nursing students theoretical knowledge and skills excellent rates of the observation group were 55.0% and 57.5%, significantly higher than those ofthe control group(22.5%, 17.5%). Patients in the observation group of nursing students satisfaction rate was 76.58%, significantly higher than these of the control group which was 51.89% (P<0.05). Patients′ nursing students satisfaction rate in the observation group was 76.58%, higher than that of the control group (51.90%), and the difference was statistically significant (P<0.01). Conclusions Clinical pathway teaching method which can promote effective communication between teachers and students, strengthen teacher-student communication, and improve the learning efficiency of nursing intern students is also conducive to nursing intern students′ practice, improve their theoretical knowledge, operation skills, and comprehensive ability. Satisfaction of patients with end-stage renal disease can be improved as well. Key words: End stage renal disease; Nursing intern; Clinical pathway; Teaching methods

Objective To explore the impact of participatory anti-discrimination ethics education on professional ethics and professional quality of trainee nurses in the department of infectious diseases. Methods From January 2015 to October 2016, 160 undergraduate trainee nurses were selected and divided into the observation group (from January to October 2016) and the control group (from January to October 2015) according to the internship time. There were 80 nurses in each group. The nurses in the control group were taught with the routine teaching method in the department of infectious diseases. The nurses in the observation group were taught with the method of participatory anti-discrimination ethics education teaching. Using the 360-degree evaluation method, professional ethics and professional quality of nurses in the two groups were compared with the self-made student nurses' professional ethics formation evaluation form and student nurses' professional quality questionnaire. Results The scores of professional ethics in the observation group were (33.53±6.42) according to the teachers' evaluation, (31.60±5.47) according to the nurses' evaluation, (28.81±6.59) according to the patients' evaluation and (88.16±10.37) according to the total evaluation, which were significantly higher than those in the control group (t=3.74, 4.51, 4.65, 9.58; P<0.05) . After 4 weeks internship, the scores of professional quality of nurses in the observation group was (96.42±15.07) , which was significantly higher compared to the control group (78.24±13.86) (t=12.35, P<0.05) . Conclusions The participation anti-discrimination ethics education method can effectively enhance professional ethics and professional quality of trainee nurses in the department of infectious diseases Key words: Department of infectious diseases; Ethics education; Professional ethics; Professional quality; Trainee nurses

To improve the teaching effect of Chinese medicine preparation analysis,the undergraduate students of Taishan Medical University enrolled in 2007 and 2008,majoring in Chinese materia medica,were taken as the research object.They were taught by traditional teaching method and case teaching method,respectively.The effect of the two teaching methods was evaluated by the final exam scores and the questionnaire survey results.The final exam scores showed that under the case teaching mode,the students' scores of subjective questions were significantly higher than that of the traditional teaching mode,and the total results as well.The survey results showed that the case teaching method can effectively mobilize the students' learning initiative and enthusiasm,improve their comprehensive abilities of analyzing and solving problems,enhance their learning effect and promote the quality of teaching. Key words: Case teaching; Analysis of Chinese medicine preparation; Teaching effect

Objective To explore the application effects of Flipped Classroom based on micro-lecture in the teaching practice of health assessment for nursing undergraduates. Methods Nursing undergraduates in the natural class of grade 2016 in Xi'an Creation College of Yan'an Universitywas randomly selected as the control group. A total of 55 students, with an average age of (20.22±1.13) years, were enrolled in the study. Another nat-ural class was chosen as the observation group, with a total of 54 students, with an average age of (20.37±1.21) years. Results At the end of the course, the students of the two groups received the course examination. The training scores of the control group were (80.13±1.73) and the observation group (90.67±1.53), while total score was (76.36±2.05) and (84.21±1.66) respectively. There were significant differences in the training results and the total score between the two groups (P<0.01). Comparing the results of teacher-student satisfaction test, 89.09% of the teachers were satisfied, 98.15% of the observation group while 94.55% of the students were satisfied, and 98.15% of the observation group. There was significant difference between the two groups (P<0.05, P<0.01). The satisfaction of teachers and students in the observation group was significantly higher than that in the control group, and the questionnaire survey showed that more than 90% of the students in the observation group were satisfied with the teaching effect. Conclusion The Flipped Classroom teaching based on micro-lecture could promote the students' mastery of the theoretical knowledge and practical skills of the health assessment course. Key words: Micro-lecture; Flipped Classroom; Health assessment; Practical teaching

Objective To explore the clinical teaching effects of virtual scenario simulation combined with PBL teaching method in pediatric nursing teaching. Methods A total of 60 intership nurses in pediatric department from May to December 2015 were analyzed and they were randomly divided into control group and experimental group. Nurses in the control group were taught by conventional pediatric nursing method, while the experimental group nurses by the method of virtual scenario simulation combined with PBL teaching method. After the teaching, evaluation and self-evaluation of the theory and health education abilities between the two groups were compared. Results The scores of theoretical achievement, psychological experience and social experience in experimental group were significantly higher than the control group (P<0.05); the scores of learning motivation, abilities of autonomous learning, negative pressure, communication and the ability of winning patients′ trust in the experimental group were significantly higher than the control group (P<0.05). Conclusions Using the virtual scenario simulation combined with PBL teaching method in pediatric nursing teaching can improve the intership nurses′ learning motivation and autonomous learning ability, which is worthy of clinical promotion. Key words: Pediatric nursing; Virtual scenario simulation; PBL; Conventional teaching; Teaching effect

Objective To explore the application effect of clinical nursing pathway in minimally invasive transforaminal lumbar interbody fusion for lumbar disc herniation. Methods 120 patients with lumbar intervertebral disc herniation treated by minimally invasive transforaminal lumbar fusion in our hospital from April 2015 to March 2017 were divided into the observation group (n=62) and the control group (n=58) by the random number table method. The control group was given routine nursing, while the observation group was given clinical nursing pathway intervention. Compared the nursing effect, the average hospitalization time, postoperative ambulation time, hospitalization expenses, and incidence of complications were recorded, and the mastery rate of functional exercise was compared. Results After nursing, the total effective rate of the observation group was 96.78%, significantly higher than that of the control group (77.58%) (P<0.05); the average time of hospitalization and the postoperative ambulation time in the observation group were shorter than those in the control group, the hospitalization cost was lower than that in the control group (P<0.05); the incidence of complications in the observation group was 3.22%, lower than that in the control group (18.96%) (P<0.05); the mastery rate of functional exercise in the observation group was 93.55%, which was significantly higher than that in the control group (79.31%) (P<0.05). Conclusion The intervention of clinical nursing path for patients with lumbar intervertebral disc herniation can promote the rapid recovery of the patients, reduce the postoperative complications, and improve the quality of nursing, with remarkable effect. Key words: Clinical nursing pathway; Lumbar disc herniation; Transforaminal lumbar interbody fusion

Objective To explore the application effect of clinical nursing pathway on maintenance hemodialysis patients.Methods Totally 120 patients with maintenance hemodialysis between January 1 and December 31 2009 were randomly assigned to the control group and the observation group with 60 patients in each group.The clinical pathway was established and applied to the observation group.The treatment effect was compared between two groups.Results The incidence of complications and nursing errors declined with the application of clinical nursing pathway,and the doctor's orders compliance and the satisfaction and quality of care were improved significantly.Conelusions The application of clinical nursing pathway in maintenance hemodialysis patients is an effective method for improving overall care quality and the satisfaction degree of the patients with nursing,so as to improve their survival rate. Key words: Maintenance hemodialysis; Clinical nursing pathway; Satisfaction scores of care; Quality of care

Objective To investigate the influence of alprostadil on renal function, oxidative stress, and immune function in early diabetic nephropathy patients. Methods Eighty-six cases of early diabetic nephropathy patients in our hospital during April 2013 to January 2016 were chosen as research subjects, all patients were divided into observation (n=43) and control (n=43) groups according to random data form. Patients in observation group received alprostadil combined with pioglitazone treatment and those in control group received pioglitazone treatment only, both lasted for one month. Before treatment, one month after treatment, renal function indices were detected; serum oxidative stress indices were detected by automatic biochemical analyzer; T lymphocyte subsets in peripheral blood were measured by flow cytometry. Results Before treatment, there were no significant differences in renal function, oxidative stress, immune function between two groups (P>0.05). One month after treatment, peripheral blood renal function indices such as blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), and cystatin C (CysC) levels were lower in observation group than in control group, the level of serum albumin (Alb) was higher in observation group than in control group, the difference was statistically significant (P<0.05); serum oxidation indices malondialdehyde (MDA), and advanced oxidation protein products (AOPP) were lo-wer in observation group than in control group, human antioxidant indices such as superoxide dismutase (SOD), and total antioxidant capacity (T-AOC) were higher in observation group than in control group, the difference was statistically significant (P<0.05); peripheral blood CD3+ , CD4+ T lymphocytes and the ratio of CD4+ /CD8+ were higher in observation group than in control group, CD8+ T lymphocyte level was lower in observation group than in control group, the difference was statistically significant (P<0.05). Conclusions Alprostadil can optimize the renal function and immune function in early diabetic nephropathy patients, reduce the degree of oxidative stress. Key words: Alprostadil; Diabetic nephropathies; Kidney; Oxidative stress; Immunity

Objective To compare the differences between conventional Mammotome biopsy of benign breast tumor and Mammotome biopsy under the electronic clinical pathway,in order to provide basis for Mammotome biopsy of benign breast tumor under clinical pathway.Methods 160 patients with benign breast tumor in affiliated Hospital of Binzhou Medical College from January 2010 to December 2011 were divided into the control group (80 patients treated with conventional Mammotome biopsy) and the observational group (80 patients treated with Mammotome biopsy under clinical pathway).Patients' waiting days before surgery,days in hospital,total cost,obedience,health knowledge,postoperative complications and satisfaction between two groups were compared.Results Days before surgery in the observational group were (1.25 ± 0.33),and days in hospital were (4.28 ± 1.52),both of which were shorter than those in the control group (2.44 ± 0.65),(6.02 ± 4.12).The differences were statistically significant (t =7.48,9.86,respectively ; P ＜ 0.05).Total cost in the observational group was (4 758.48 ± 686.34) yuan,fewer than that in the control group which was (4 998.76 ± 778.32) yuan,and the differences were statistically significant (t =3.46,P ＜ 0.05).Compared with the control group,the observational group had better obedience rate (97.5％ vs 85％),better mastering of health knowledge (97.5％ vs 82.5％),and higher satisfaction (97.5％ vs 85％).The differences were statistically significant (x2 =7.83,10.0,7.83,respectively ; P ＜ 0.05).Conclusions Mammotome biopsy under clinical pathway can further improve patients' obedience and satisfaction,reduce days in hospital,total cost and postoperative complications,thus should be promoted actively. Key words: Clinical pathway; Mammotome; Biopsy

BackgroundThe bone holes in the skull during surgical drainage were accurately located at the site of the MMA. The MMA was severed, and the hematoma was removed intraoperatively; furthermore, surgical drainage removed the pathogenic factors of CSDH. This study aimed to describe and compare the results of the new treatment with those of traditional surgical drainage, and to investigate the relevance of this approach.MethodsFrom December 2021 to June 2023, 72 patients were randomly assigned to the observation group and the control group. The control group was treated with traditional surgical drainage, while the observation group was treated with DSA imaging to accurately locate the bone holes drilled in the skull on the MMA trunk before traditional surgical drainage. The MMA trunk was severed during the surgical drainage of the hematoma. The recurrence rate, time of indwelling drainage tube, complications, mRS, and other indicators of the two groups were compared, and the changes of cytokine components and imaging characteristics of the patients were collected and analyzed.ResultsOverall, 27 patients with 29-side hematoma in the observation group and 45 patients with 48-side hematoma in the control group were included in the study. The recurrence rate was 0/29 in the observation group and 4/48 in the control group, indicating that the recurrence rate in the observation group was lower than in the control group (P = .048). The mean indwelling time of the drainage tube in the observation group was 2.04 ± 0.61 days, and that in the control group was 2.48 ± 0.61 days. The indwelling time of the drainage tube in the observation group was shorter than in the control group (P = .003). No surgical complications were observed in the observation group or the control group. The differences in mRS scores before and after operation between the observation group and the control group were statistically significant (P < .001). The concentrations of cytokine IL6/IL8/IL10/VEGF in the hematoma fluid of the observation and control groups were significantly higher than those in venous blood (P < .001). After intraoperative irrigation and drainage, the concentrations of cytokines (IL6/IL8/IL10/VEGF) in the subdural hematoma fluid were significantly lower than they were preoperatively. In the observation group, the number of MMA on the hematoma side (11/29) before STA development was higher than that on the non-hematoma side (1/25), and the difference was statistically significant (P = .003).ConclusionIn patients with CSDH, accurately locating the MMA during surgical trepanation and drainage, severing the MMA during drainage, and properly draining the hematoma, can reduce the recurrence rate and retention time of drainage tubes, thereby significantly improving the postoperative mRS Score without increasing surgical complications.

Objective: To compare the effects of the China Children's Asthma Action Plan (CCAAP)-based remote joint management model with traditional management model on the control of childhood asthma. Methods: A retrospective cohort study was conducted to analyze the general data and asthma control assessment data of 219 children with asthma who attended the respiratory department of Guangzhou Women's and Children's Medical Center from April 2021 to October 2021 and were followed up for 1 year or more. According to the follow-up management model, the CCAAP-based remote joint management model was used in the observation group and the traditional management model was used in the control group, and the propensity score matching method was applied to match the data of children in the two management models for comparison. Paired-samples t-test, Wilcoxon signed-rank test, McNemar χ2-test or χ2-test or nonparametric tests were used to compare the general data and asthma control assessment data between the two matched groups of children. Results: Among 219 children with asthma, 145 were male and 74 were female, aged at consultation (7.2±2.4) years. There were 147 cases in the observation group and 72 cases in the control group, and 27 cases in each of the observation and control groups were successfully matched. The number of asthma exacerbation aura, acute exacerbations, and emergency room visits or hospitalizations for asthma exacerbations were lower in the observation group than in the control group after pairing (1 (0, 2) vs. 3 (1, 5) times, 0 (0,0) vs. 0 (0, 1) times, 0 (0,0) vs. 1 (0, 1) times, Z=-3.42, -2.58, -3.17, all P<0.05). The use of peak flowmeters was higher in children aged 5 years and older in the observation group than in the control group after pairing (100% (22/22) vs. 13% (3/23), χ2=54.00,P<0.001). The ratio of actual to predicted 1st second expiratory volume of force after follow-up in the observation group after pairing was higher than that before follow-up in the observation group and after follow-up in the control group ((95±11)% vs. (85±10)%, (95±11)% vs. (88±11)%, t=-3.40, 2.25, all P<0.05). The rate of complete asthma control after follow-up was higher in both the observation and control groups after pairing than before follow-up for 12 months in both groups (93% (25/27) vs. 41% (11/27), 52% (14/27) vs. 41% (11/27), H=56.19, 45.37, both P<0.001), and the rate of complete control of asthma in children in the observation group was higher than that in the control group at 3 and 12 months of follow-up management (56% (15/27) vs. 25% (5/20), 93% (25/27) vs. 52% (14/27), χ2=47.00, 54.00, both P<0.001). The number of offline follow-up visits, inhaled hormone medication adherence scores, and caregiver's asthma perception questionnaire scores were higher in the observation group than in the control group after pairing (6 (4, 8) vs. 4 (2,5), (4.8±0.3) vs. (4.0±0.6) score, (19.3±2.6) vs. (15.2±2.7) score, Z=6.58, t=6.57, 5.61, all P<0.05), and the children in the observation group had lower school absences, caregiver absences, asthma attack visit costs, and caregiver PTSD scores than the control group (0 (0,0) vs.3 (0, 15) d, 0 (0,0) vs. 3 (0, 10) d, 1 100 (0, 3 700) vs. 5 000 (1 000, 10 000) yuan, 1.3 (1.1, 1.9) vs. 2.0 (1.2, 2.7) score, Z=-2.89, -2.30, 2.74, 2.73, all P<0.05). Conclusion: The CCAAP-based joint management model of asthma control is superior to the traditional management model in the following aspects: it can effectively improve asthma control, self-monitoring, and lung function in children; it can improve treatment adherence and caregivers' asthma awareness; and it can reduce the duration of absenteeism from school, the cost of asthma exacerbation visits, and caregiver's negative psychology.

Objective To investigate application effect of micro-courses in the clinical teaching of operating room nursing, and to improve practice quality. Methods A total of 81 nursing interns of Grade 2012, majored in Nursing of Cangzhou Medical College, had internship from July 2014 to November 2014 were treated as the control group; another 82 nursing interns, who had internship from December 2014 to April 2015 were treated as the observation group. The control group applied traditional one-one teaching style, while observation group used an extra operating room nursing micro curriculum on this basis. At the end of the operating room practice, theory, skills assessment, self-satisfaction and satisfaction of teaching methods were compared. Results Observation group theory and skills assessment scores were better than the control group[(83.72±3.53) vs (71.21±4.36), (89.72±3.53) vs (81.21±4.36); t=14.58, 11.15; P<0.01)]. nursing interns self-learning satisfaction of the control group and the observation group were 88.9% and 98.8% respectively(Z=12.73, P<0.01). Nursing interns teaching methods satisfaction for operating room teaching of the control group and the observation group were 90.1% and 100.0% respectively (Z=17.12, P<0.01). Conclusions During clinical teaching of operating room nursing, micro courses could improve the quality of practice, improve nursing interns′ self-study and clinical teaching satisfaction. Key words: Nursing education; Operating room; Nursing intern; Micro courses; Clinical teaching

Objective To evaluate the role of evidence-based nursing in clinical ophthalmology teaching. Methods Fifty nursing interns in department of ophthalmology in Southwest Hospital were randomized into control group and observation group in accordance with the principle of equal number of junior college students and undergraduates. Traditional teaching was applied in control group while clinical ophthalmology teaching combined with traditional teaching was used in observation group. Teaching effect was evaluated at the end of internship by questionnaire and examination. Data were analyzed by SPSS 13.0 using χ2 test and independent sample t test（taking students with score ≥60 as effective indicator）. P〈0.05 indicated significant difference. Results Scores of questionnaire and examination were higher in observation group than in control group, with statistically significant differ-ence（ χ2=6.818, P=0.018）. Theoretical exam score was 67.12±11.53 in control group and 84.96± 9.27 in observation group; practical score was 65.68±8.0 in control group and 80.28±10.65 in observation group with significant differences between two groups （P=0.000）. Conclusions Adoption of evidence-based nursing intervention in ophthalmic clinical teaching help students learn to think, consult literature and use critical thinking to raise questions during the internship. It also makes stu-dents regard the results of scientific research and personal experience as the basis for mastering pro-fessional and scientific expertise, thereby enhancing the ability of nursing practice. Key words: Department of ophthalmology; Evidence-based nursing; Clinical teaching

Objective To discuss the clinical effects of early enteral nutrition on elderly patient with gastric cancer after total gastrectomy. Methods A total of 138 elderly patients with gastric cancer after total gastrectomy in Renji Hospital Shanghai Jiaotong University School of Medicine from September 2014 to September 2016 were selected using purposive sampling. They were divided into the observation (n=73) and control (n=65) groups using random number table. Patients in the control group were given parenteral nutritional support. The energy was 125 KJ/ (kg.d) ; nitrogen content was 0.15 g/ (kg.d) ; total fluid amount was 50 ml/ (kg.d) . They were prepared to bags of 3 L and given by intravenous dripping through internal jugular vein. After the anal exhaust and removing gastric tube, patients were routinely given from water to clear fluid diet, fluid diet, semi-fluid diet until normal diet. Patients in the observation group received indwelling three-lumen gastrojejunal tube. At 12 h after the operation, heating 100 ml 5% glucose were given through three-lumen gastrojejunal tube. At 24 h after the operation, Ruidai (enteral nutritional suspension-TPF) were given at the total 500 ml and increased by 500 ml/d until 1 500 ml at 4 d after the operation. The drop speed increased from 20 ml/h to 100 ml/h. The incidence of postoperative complications, the anal exhaust time, the leaving bed time, hospital days and nutritive indexes were compared between the two groups. Results The hospital days, anal exhaust time and the leaving bed time in the observation group were (12.9±5.9) d, (70.3±16.7) h and (15.24±13.28) h, which were significantly lower than those in the control group [ (18.6±6.9) d, (97.5±22.3) h and (29.95±15.23) h] (P<0.05) . There was 1 case of diarrhea in the observation group, while 2 cases of anastomotic leakage, 2 case of infection, 1 case of obstruction and 2 cases of diarrhea were observed in the control group. The incidence of postoperative complications in the observation group was significantly lower than that in the control group (P<0.05) . The nutritive indexes at 7 d and 14 d after the operation in the observation group were statistically significantly better than those in the control group (P<0.05) . Conclusions Early enteral nutrition on elderly patient with gastric cancer after total gastrectomy can reduce the incidence of postoperative complications, improve the postoperative nutrition status, shorten the time of anal exhaust and leaving bed, and reduce the hospital days. Key words: Aged; Gastric neoplasms; Total gastrectomy; Early enteral nutrition

Objective To study the effect of external diaphragmatic pacing on lung function and exercise endurance in patients with chronic respiratory failure. Methods There were 120 patients with chronic obstructive pulmonary disease admitted to Daxing Teaching Hospital, Capital Medical University from May 2017 to May 2018 selected as study subjects, and divided into observation group and control group by random number table method, with 60 cases in each group.Patients in the control group were given conventional treatment, and patients in the observation group were treated with extracorporeal diaphragmatic pacing on the basis of the control group.The indexes of forced expiratory volume in the first second, forced expiratory volume in the first second/forced vital capacity, forcad vital capacity, partical pressure of oxygen in artery, arterial oxygen saturation, partical pressure of carbon dioxide in artery, myoglobin, creatine kinase and lactate dehydrogenase before and after treatment in the two groups were compared.Chronic obstructive pulmonary disease assessment test and modified British medical research council (mMRC) scores before and after treatment were compared between the two groups. Results After treatment, the levels of forced expiratory volume in the first second, forced expiratory volume in the first second/forced vital capacity and maximum ventilation per minute in the observation group were significantly higher than those before treatment and after treatment in the control group (all P<0.05). The levels of partical pressure of oxygen in artery and arterial oxygen saturation in the observation group after treatment were significantly higher than those before treatment and after treatment in the control group (all P<0.05). Partical pressure of carbon dioxide in artery in the observation group was significantly lower than that before treatment and after treatment in the control group (all P<0.05). After treatment, the levels of myoglobin, creatine kinase and lactate dehydrogenase in the observation group were significantly lower than those before treatment and after treatment in the control group (all P<0.05). After treatment, the scores of cough, sputum, chest tightness, climbing, housework, confidence in outdoor activities, sleep and spirit in the observation group were significantly lower than those before treatment and after treatment in the control group (all P<0.05). There was no significant difference in mMRC grade between the two groups before treatment (Z=0.283, P=0.963). After treatment, the mMRC grade of the observation group was significantly lower than that of the control group (Z=9.318, P=0.025). Conclusions Extracorporeal diaphragmatic pacing for the treatment of chronic obstructive pulmonary disease can improve the patient′s lung function, relieve the patient′s clinical symptoms, improve exercise endurance, worthy of clinical application. Key words: Pulmonary disease, chronic obstructive; Respiratory function tests; External diaphragmatic pacing; Exercise endurance