BACKGROUND & AIMS: PURPOSE:There has been little radiation oncologist (RO)-specific research in continuing medical education (CME) or quality improvement (QI) program efficacy. Our aim was to evaluate a CME/QI program for changes in RO behavior, performance, and adherence to department protocols/studies over the first 12 months of the program. METHODS AND MATERIALS:The CME/QI program combined chart audit with feedback (C-AWF), simulation review AWF (SR-AWF), reminder checklists, and targeted CME tutorials. Between April 2003 and March 2004, management of 75 patients was evaluated by chart audit with feedback (C-AWF) and 178 patients via simulation review audit (SR-AWF) using a validated instrument. Scores were presented, and case management was discussed with individualized educational feedback. RO behavior and performance was compared over the first year of the program. RESULTS:Comparing the first and second 6 months, there was a significant improvement in mean behavior (12.7-13.6 of 14, p = 0.0005) and RO performance (7.6-7.9 of 8, p = 0.018) scores. Protocol/study adherence significantly improved from 90.3% to 96.6% (p = 0.005). A total of 50 actions were generated, including the identification of learning needs to direct CME tutorials, the systematic change of suboptimal RO practice, and the alteration of deficient management of 3% of patients audited during the program. CONCLUSION:An integrated CME/QI program combining C-AWF, SR-AWF, QI reminders, and targeted CME tutorials effectively improved targeted RO behavior and performance over a 12-month period. There was a corresponding increase in departmental protocol and study adherence.

背景与目标： 目的：在继续医学教育（CME）或质量改善（QI）计划功效方面，几乎没有针对放射肿瘤学家（RO）的研究。我们的目的是评估一个CME / QI计划，以了解该计划的前12个月RO行为，绩效以及对部门规约/研究的遵守情况的变化。
方法和材料：CME / QI程序将图表审核与反馈（C-AWF），模拟审阅AWF（SR-AWF），提醒清单和目标CME教程相结合。在2003年4月至2004年3月之间，使用经过验证的工具，通过带有反馈的图表审计（C-AWF）评估了75名患者的管理，通过模拟审查审计（SR-AWF）评估了178名患者的管理。提出分数，并通过个性化的教育反馈讨论案例管理。在该计划的第一年，对RO的行为和性能进行了比较。
结果：与前六个月和第二个六个月相比，平均行为（14.12.7-13.6，p = 0.0005）和反渗透表现（7.6-7.9，8，p = 0.018）有显着改善。方案/研究依从性从90.3％显着提高到96.6％（p = 0.005）。总共产生了50项行动，包括确定直接进行CME指导的学习需求，对次优RO实践的系统性改变以及在该计划中审核的3％的患者管理不善的变更。
结论：结合了C-AWF，SR-AWF，QI提示和目标CME教程的集成的CME / QI程序可以在12个月内有效改善目标RO的行为和性能。部门规程和研究依从性相应增加。

BACKGROUND & AIMS: Importance:Individuals with attention-deficit/hyperactivity disorder (ADHD) are at greater risk for academic problems. Pharmacologic treatment is effective in reducing the core symptoms of ADHD, but it is unclear whether it helps to improve academic outcomes. Objective:To investigate the association between the use of ADHD medication and performance on higher education entrance tests in individuals with ADHD. Design, Setting, and Participants:This cohort study observed 61 640 individuals with a diagnosis of ADHD from January 1, 2006, to December 31, 2013. Records of their pharmacologic treatment were extracted from Swedish national registers along with data from the Swedish Scholastic Aptitude Test. Using a within-patient design, test scores when patients were taking medication for ADHD were compared with scores when they were not taking such medication. Data analysis was performed from November 24, 2015, to November 4, 2016. Exposures:Periods with and without ADHD medication use. Main Outcomes and Measures:Scores from the higher education entrance examination (score range, 1-200 points). Results:Among 930 individuals (493 males and 437 females; mean [SD] age, 22.2 [3.2] years) who had taken multiple entrance tests (n = 2524) and used ADHD medications intermittently, the test scores were a mean of 4.80 points higher (95% CI, 2.26-7.34; P < .001) during periods they were taking medication vs nonmedicated periods, after adjusting for age and practice effects. Similar associations between ADHD medication use and test scores were detected in sensitivity analyses. Conclusions and Relevance:Individuals with ADHD had higher scores on the higher education entrance tests during periods they were taking ADHD medication vs nonmedicated periods. These findings suggest that ADHD medications may help ameliorate educationally relevant outcomes in individuals with ADHD.

背景与目标： 重要性：患有注意力缺陷/多动症（ADHD）的人更容易出现学术问题。药物治疗可有效减轻多动症的核心症状，但尚不清楚它是否有助于改善学业成果。
目的：探讨多动症患者使用多动症药物与高等教育入学考试成绩之间的关系。
设计，背景和参与者：该队列研究从2006年1月1日到2013年12月31日观察了61640名患有ADHD的患者。他们的药物治疗记录与瑞典的学历能力数据一起被提取。测试。使用患者内设计，将患者服用ADHD药物时的测试得分与未服用ADHD药物时的得分进行比较。数据分析时间为2015年11月24日至2016年11月4日。
暴露：有或没有使用ADHD药物的时期。
主要成果和措施：高等教育入学考试分数（分数范围：1-200分）。
结果：在930名个体（平均SD年龄，22.2 [3.2]岁）中，参加了多次入院测试（n = 2524）并且间歇性地使用了ADHD药物，测试得分平均为4.80分在调整年龄和实践影响后，他们在服药期间与非服药期间相比更高（95％CI，2.26-7.34； P <.001）。在敏感性分析中，ADHD药物使用与测试评分之间存在相似的关联。
结论与相关性：ADHD患者在接受ADHD药物治疗期间与非药物治疗期间在高等教育入学考试中得分较高。这些发现表明，多动症药物可能有助于改善多动症患者的教育相关成果。

BACKGROUND & AIMS: BACKGROUND:A growing body of literature shows that many universities and colleges are making educational portfolios part of their faculty assessment and student's learning plan for both undergraduate and graduate programs. We provide an outline for the development of a medical educator's portfolio, including an electronic version. DESCRIPTION:Guidelines for the development of an educational portfolio focusing on medical education are provided, including design, format, and content. An electronic version of the portfolio, which combines flexibility and ease of revision, is also described, including formats for publication and distribution. Student reflections on the e-portfolio are presented, and potential applications of the e-portfolio in medical education are described. CONCLUSION:We believe that portfolio development is a valuable application that provides rich documentation of participants' educational history, accomplishments, and intellectual property as related to their professional learning and growth.

背景与目标： 背景：越来越多的文献表明，许多大学和学院正在将教育档案袋作为其本科和研究生课程教师评估和学生学习计划的一部分。我们为医学教育者的档案袋的发展提供了一个大纲，包括电子版本。
描述：提供了针对医学教育的教育档案袋的开发指南，包括设计，格式和内容。还介绍了组合的灵活性和易于修改的电子版本，包括发布和分发的格式。介绍了学生对电子档案夹的思考，并描述了电子档案夹在医学教育中的潜在应用。
结论：我们认为，档案袋开发是一种有价值的应用程序，它为参与者的教育历史，成就和与他们的专业学习和成长有关的知识产权提供了丰富的文档。

BACKGROUND & AIMS: :This paper examines factors that have lead to increasing internationalisation in nursing workforce and nursing education and contends that education and support for nurse managers and nurse academics is required in order to better prepare them for the challenges they will face. There are many benefits to be gained from internationalisation of nursing, the most significant being greater cross-cultural understanding and improved practices in workplaces across countries. However, the way in which nursing and nurses contribute to the international agenda is crucial to maintaining standards of education and nursing care in Australia and in countries with whom Australians collaborate. Internationalisation poses numerous challenges that need to be carefully thought through. This paper seeks to unravel and scrutinize some of the issues central to internationalisation in nursing, particularly in the Australian context.

背景与目标： ：本文探讨了导致护理人员队伍和护理教育国际化的因素，并认为需要对护士管理者和护士学者进行教育和支持，以便更好地为他们准备应对挑战。护理国际化将带来许多好处，其中最重要的是在各国之间提高对跨文化的了解和改进工作场所的实践。但是，护理和护士为国际议程做出贡献的方式对于维持澳大利亚以及与澳大利亚人合作的国家的教育和护理标准至关重要。国际化提出了许多挑战，需要仔细考虑。本文旨在探讨和审查护理国际化中的一些重要问题，特别是在澳大利亚的情况下。

BACKGROUND & AIMS: :In 1998 the Society for Academic Emergency Medicine's (SAEM's) Board of Directors asked the SAEM Public Health and Education Task Force to develop recommendations for prevention, screening, and counseling activities to be conducted in emergency departments (EDs). The Task Force's work was divided into two phases: 1) a discussion of the rationale for preventive services in the ED, along with generation of a preliminary list of prevention activities that could be studied for ED implementation; and 2) a formal evidence-based review of topics chosen from the preliminary list, along with recommendations for ED implementation and further study. This paper represents Phase I of the project. Phase II, the formal evidence-based review and recommendations, is published separately in this issue.

背景与目标： ：1998年，美国学术急诊医学协会（SAEM）董事会要求SAEM公共卫生和教育工作组制定有关在急诊科（ED）开展的预防，筛查和咨询活动的建议。专责小组的工作分为两个阶段：1）讨论急诊中预防服务的理由，并生成可以进行急诊研究的预防活动初步清单； 2）对从初步清单中选择的主题进行基于证据的正式审查，以及有关ED实施和进一步研究的建议。本文代表了该项目的第一阶段。第二阶段，即正式的基于证据的审查和建议，在本期中单独出版。

BACKGROUND & AIMS: OBJECTIVE:Nurse educators need an enhanced understanding of factors contributing to nursing student success to decrease attrition and increase retention. Improved understanding of factors related to successful nurse preparation could improve educational processes and facilitate student success, thereby addressing the worldwide nursing shortage as well as increasing the competence and expertise of new graduates. Student-faculty trust and related characteristics have been identified as factors associated with student success (Applebaum, 1995). Research investigating trust in communications and education has been conducted with students in other disciplines but not with nursing students. This research investigated the complex relationships between students' trust in faculty, the students' mood states, and students' educational performance and outcomes. METHOD:The study utilized a quantitative, cross-sectional, descriptive, and correlational design. Student volunteers were recruited from a baccalaureate nursing education program located in the southwest United States. Participants completed three instruments: the Health Sciences Reasoning Test (HSRT), Profile of Mood States (POMS), and Interpersonal Trust Scale (ITS). The resulting scores were compared and contrasted along with selected demographic variables. RESULTS:The study identified a significant relationship between total mood disturbance and interpersonal trust. The trends in the POMS subscales of Anger and Confusion are of particular interest, as the two factors strongly influenced shifts in Total Mood Disturbance. As students progressed through the nursing program, experiences of Anger and Confusion increased with each progressive semester and were accompanied by corresponding decreases in trust. CONCLUSIONS:The results complement established findings relating mood and cognitive function. Alterations in the student's level of trust potentially could share relationships with cognition and critical thinking, although perhaps not in a direct and linear fashion.

背景与目标： 目的：护士教育者需要对有助于护理学生成功的因素有更深入的了解，以减少损耗和增加保留率。更好地理解与成功的护士准备相关的因素，可以改善教育过程并促进学生的成功，从而解决全球范围内的护理短缺问题，并提高新毕业生的能力和专业知识。学生与教师之间的信任和相关特征已被确定为与学生成功相关的因素（Applebaum，1995）。已经与其他学科的学生进行了调查研究，以研究对交流和教育的信任，但没有与护生一起进行。这项研究调查了学生对教师的信任，学生的情绪状态以及学生的教育表现和成果之间的复杂关系。
方法：本研究采用定量，横断面，描述性和相关性设计。学生志愿者是从位于美国西南部的学士学位护理教育计划招募的。参与者完成了三项工具：健康科学推理测验（HSRT），情绪状态简介（POMS）和人际信任量表（ITS）。将所得分数与选定的人口统计学变量进行比较和对比。
结果：该研究确定了总情绪障碍与人际信任之间的显着关系。愤怒和混乱的POMS子量表的趋势特别受关注，因为这两个因素强烈影响了总情绪干扰的变化。随着学生逐步完成护理计划，每学期的学期中，愤怒和困惑的经历就会增加，随之而来的是信任的减少。
结论：该结果补充了有关情绪和认知功能的既定发现。学生信任度的改变可能会与认知和批判性思维共享关系，尽管可能不是直接和线性的方式。

BACKGROUND & AIMS: :Parents and school staff play important roles in promoting children's oral health. Our study goals were to investigate whether an intervention targeting parents and school staff can improve the oral-health behavior and oral-health status of schoolchildren. Three-hundred and ninety-two schoolchildren in six schools in Tehran participated in a group randomized trial from September 2010 to March 2011. Schools were randomly allocated into three groups: comprehensive, student, and control. Intervention in the comprehensive group consisted of strategies to encourage children, their parents, and school staff to increase the frequency of toothbrushing and flossing. In the student group, the intervention targeted only children. The control group received no intervention. The primary outcome was change in oral-health behaviors (brushing and flossing), while the secondary outcomes were changes in oral hygiene and Community Periodontal indices and in Health Belief Model components. Multilevel modeling was employed for data analyses. Students who were in the comprehensive intervention group brushed and flossed significantly more frequently compared with those in the student intervention group. Although students' gingival health improved significantly in the comprehensive intervention group, such significant improvement was not seen in the student group. In conclusion, promising results are seen when the oral-health education targets both school and home settings.

背景与目标： ：父母和学校职员在促进儿童口腔健康中发挥重要作用。我们的研究目标是调查针对父母和学校员工的干预措施是否可以改善小学生的口腔健康行为和口腔健康状况。从2010年9月至2011年3月，德黑兰六所学校的392名学童参加了一项小组随机试验。学校被随机分为三组：综合，学生和对照。对综合人群的干预包括鼓励儿童，他们的父母和学校工作人员增加刷牙和使用牙线的策略。在学生群体中，干预仅针对儿童。对照组未接受干预。主要结果是口腔健康行为的变化（刷牙和使用牙线），而次要结果是口腔卫生和社区牙周指数以及健康信念模型组成部分的变化。采用多级建模进行数据分析。与学生干预组相比，综合干预组的学生刷牙和使用牙线的频率明显更高。尽管在综合干预组中学生的牙龈健康显着改善，但在学生组中却没有看到这种显着改善。总之，当口腔健康教育针对学校和家庭环境时，可以看到令人鼓舞的结果。

BACKGROUND & AIMS: Background:Since 1985, nurse-run asthma clinics have been developing and are now widespread in the United Kingdom, having been greatly stimulated by the New Contract for General Practice (1990). To date, there have been few definitive studies evaluating such clinics. This study, in two adjacent general practices in semi-rural Somerset, evaluates the effect of nurse-run clinics on patients' symptoms, pulmonary function, and healthcare utilisation over a four-month period. Methods:One hundred and twenty-nine subjects, aged 2-79 years, were recruited from the two practices over a one-year period (1991-1992). All patients identified in either practice who had used preventive therapy in the preceding 12 months were eligible and were included if they had a positive exercise or reversibility (20%) test and had not previously received formal asthma education. A pre- and post-experimental study design was used. Subjects' symptoms, pulmonary function, and health care in the preceding eight weeks were assessed at intake and at 16 weeks; the nurse education being delivered at intake, one and four weeks. Results:Both mean number of days off work/school and mean number of nights on which waking occurred fell (p < 0.001). Peak expiratory flow rates and forced expiratory volumes improved during the study period (p < 0.001 and p < 0.01 respectively). Use of antibiotics, oral steroids, and rescue bronchodilator use all improved significantly (p < 0.001). Physician attendances were also reduced. Conclusions:A nurse-run asthma clinic in general practice is an effective way to improve symptoms, pulmonary function, and health care utilisation for asthmatic patients.

背景与目标： 背景：自1985年以来，由护士执照的哮喘诊所一直在发展，并在英国得到广泛应用，这受到《新通用合同》（1990年）的大力推动。迄今为止，很少有明确的研究评估此类诊所。这项研究是在半农村萨默塞特郡的两个相邻常规实践中，评估了四个月内护士经营的诊所对患者症状，肺功能和医疗保健利用率的影响。
方法：在一年的时间里（1991-1992），从这两种实践中招募了129名2-79岁的受试者。两种做法中确定的在过去12个月中均使用过预防性治疗的所有患者均符合资格，并且如果他们的运动或可逆性测试阳性（20％）并且先前未接受过正规的哮喘教育，则将其包括在内。实验之前和之后的研究设计被使用。在进食时和第16周评估受试者在前八周的症状，肺功能和医疗保健；入学时分一，四个星期进行护士教育。
结果：平均下班天数/上学时间和平均醒来晚数均下降（p <0.001）。在研究期间，峰值呼气流速和强制呼气量有所改善（分别为p <0.001和p <0.01）。抗生素，口服类固醇和急救支气管扩张剂的使用均显着改善（p <0.001）。医师出勤率也有所降低。
结论：一般由护士经营的哮喘诊所是改善哮喘患者症状，肺功能和医疗保健利用率的有效方法。

BACKGROUND & AIMS: BACKGROUND:Evidence suggests that behavioral, social, and environmental factors may modify the effects of life stress on health and performance of new nurses as they transition to hospitals. OBJECTIVES:The aim of this study was to describe the methods of a project designed to investigate the role of social, behavioral, and environmental factors in modifying the adverse effects of stress on new nurses and to discuss demographic, health, and life stress characteristics of the cohort at baseline. METHODS:A prospective cohort design was used to conduct a comprehensive assessment of health endpoints, life stress, behaviors, personal traits, social factors, indicators of engagement and performance, and environmental exposures in nursing students. Adjusted odds ratios and analyses of covariance were used to examine associations between these factors at baseline. RESULTS:Health indicators in the cohort were comparable or better than in the broader United States population, and lifetime stress exposure was lower than among students from other majors. Exposure to more lifetime stressors was associated with greater risk for various health conditions, including hypertension, diabetes, and depression. Conversely, better social, environmental, behavioral, and personal profiles were associated with protective effects for the same health conditions. DISCUSSION:These data comprehensively summarize the lives of predominately Hispanic nursing students and highlight risk and resilience factors associated with their health and well-being. The findings are timely, as the nursing field diversifies in preparation to care for a diverse and aging population. Comprehensively assessing stress-health relationships among student nurses ought to inform the policies, practices, and curricula of nursing schools to better prepare nurses to thrive in the often-strenuous healthcare environment.

背景与目标： 背景：证据表明，行为，社会和环境因素可能会改变生活压力对新护士过渡到医院时的健康和绩效的影响。
目的：本研究的目的是描述一个项目的方法，该项目旨在研究社会，行为和环境因素在减轻压力对新护士的不良影响中的作用，并讨论人口统计学，健康状况和生活压力特征。基线时的同类群组。
方法：采用前瞻性队列设计，对护理专业学生的健康终点，生活压力，行为，个人特质，社会因素，参与度和绩效指标以及环境暴露进行了综合评估。调整后的优势比和协方差分析用于检查基线时这些因素之间的关联。
结果：该队列中的健康指标与美国更广泛的人群相当或更好，并且终身压力暴露低于其他专业的学生。暴露于更多终生应激源与各种健康状况（包括高血压，糖尿病和抑郁症）的更大风险相关。相反，在相同的健康状况下，更好的社交，环境，行为和个人形象与保护作用相关。
讨论：这些数据全面总结了主要是西班牙裔护生的生活，并突出了与他们的健康和福祉相关的风险和适应力因素。由于护理领域的多样化，为照顾多样化和老龄化的人群做准备，因此发现是及时的。全面评估学生护士之间的压力与健康的关系，应告知护理学校的政策，做法和课程，以更好地为护士做好准备，使其在经常艰苦的医疗环境中壮成长。

BACKGROUND & AIMS: :America is in the grips of a diabetes epidemic. Underserved communities disproportionately bear the burden of diabetes and associated harms. Diabetes self-management education and training (DSME/T) may help address the epidemic. By empowering patients to manage their diabetes, DSME/T improves health outcomes and reduces medical expenditures. However, participation in DSME/T remains low. Insurance coverage offers 1 approach for increasing participation in DSME/T. The impact of DSME/T insurance coverage on advancing diabetes-related health equity depends on which types of insurers must cover DSME/T and the characteristics of such coverage. We conducted a legal survey of DSME/T coverage requirements for private insurers, Medicaid programs, and Medicare, finding that substantial differences exist. Although 43 states require that private insurers cover DSME/T, only 30 states require such coverage for most or all Medicaid beneficiaries. Public health professionals and decision makers may find this analysis helpful in understanding and evaluating patterns and gaps in DSME/T coverage.

背景与目标： ：美国正处于糖尿病流行的风口浪尖。服务不足的社区过多地承受着糖尿病和相关危害的负担。糖尿病自我管理教育和培训（DSME / T）可能有助于解决这一流行病。通过授权患者管理糖尿病，DSME / T改善了健康状况并减少了医疗费用。但是，对DSME / T的参与仍然很低。保险范围提供了一种增加DSME / T参与度的方法。 DSME / T保险范围对推进与糖尿病相关的健康公平性的影响取决于哪些类型的保险公司必须承保DSME / T，以及这种范围的特征。我们对私人保险公司，Medicaid计划和Medicare的DSME / T承保要求进行了法律调查，发现存在实质性差异。尽管有43个州要求私人保险公司承保DSME / T，但只有30个州要求大多数或所有医疗补助受益人都享有这种保险。公共卫生专业人员和决策者可能会发现此分析有助于理解和评估DSME / T覆盖率的模式和差距。

BACKGROUND & AIMS: BACKGROUND:Coronary artery disease is a major cause of morbidity and mortality among adults worldwide, including China. After a hospital stay, transitional care could help to ensure improved patient care and outcomes, and reduce Medicare costs. Nevertheless, the results of the existing transitional care are not always satisfactory and our knowledge of how to perform effective transitional care for patients with coronary artery disease is limited in mainland China. OBJECTIVES:To examine the effectiveness of a nurse-led transitional care program on clinical outcomes, health-related knowledge, and physical and mental health status among Chinese patients with coronary artery disease. DESIGN:Randomized controlled trial. METHODS:The Omaha system and Pender's health promoting model were employed in planning and implementing this nurse-led transitional care program. The sample was comprised of 199 Chinese patients with coronary artery disease. The experimental group (n=100) received nurse-led transitional care intervention in addition to routine care. The nurse-led transitional care intervention included a structured assessment and health education, followed by 7 months of individual teaching and coaching (home visits, telephone follow-up and group activity). The control group (n=99) received a comparable length routine care and follow-up contacts. Evaluations were conducted at baseline and completion of the interventions using the perceived knowledge scale for coronary heart disease, the medical outcomes study 36-item short-form health survey and clinical measures (blood pressure, blood glucose, lipids, body mass index). Data were collected between March and October 2014. RESULTS:Compared with the control group, participants in the experimental group showed significant better clinical outcomes (systolic blood pressure, t=5.762, P=0.000; diastolic blood pressure, t=4.250, P=0.000; fasting blood glucose, t=2.249, P=0.027; total cholesterol, t=4.362, P=0.000; triglyceride, t=3.147, P=0.002; low density lipoprotein cholesterol, t=2.399, P=0.018; and body mass index, t=3.166, P=0.002), higher knowledge scores for coronary artery disease (total knowledge score, t=-7.099, P=0.000), better physical health status (t=-2.503, P=0.014) and mental health status (t=-2.950, P=0.004). CONCLUSIONS:This study provides evidence for the value of a nurse-led transitional care program using both the Omaha system and Pender's health promoting model as its theoretical framework. The structured interventions in this nurse-led transitional care program facilitate the use of this program in other settings.

背景与目标： 背景：冠状动脉疾病是包括中国在内的世界各地成年人发病和死亡的主要原因。住院后，过渡护理可以帮助确保改善患者护理和结局，并降低医疗保险成本。然而，现有的过渡治疗的结果并不总是令人满意的，在中国大陆，我们对如何为冠心病患者进行有效的过渡治疗的知识是有限的。
目的：探讨由护士主导的过渡护理计划对中国冠心病患者的临床结局，健康相关知识以及身心健康状况的有效性。
设计：随机对照试验。
方法：奥马哈系统和Pender的健康促进模型被用于计划和实施由护士主导的过渡护理计划。样本包括199名中国冠心病患者。除常规护理外，实验组（n = 100）还接受了护士主导的过渡护理干预。由护士主导的过渡护理干预包括结构化评估和健康教育，然后是7个月的个人教学和辅导（上门拜访，电话随访和小组活动）。对照组（n = 99）接受了相当长度的常规护理和随访。在基线和干预措施完成时使用已知的冠心病知识量表，医学成果研究36个项目的简短健康调查和临床指标（血压，血糖，血脂，体重指数）进行评估。数据是在2014年3月至2014年10月之间收集的。
结果：与对照组相比，实验组参与者表现出明显更好的临床结局（收缩压，t = 5.762，P = 0.000；舒张压，t = 4.250，P = 0.000；空腹血糖，t = 2.249 ，P = 0.027；总胆固醇，t = 4.362，P = 0.000；甘油三酸酯，t = 3.147，P = 0.002；低密度脂蛋白胆固醇，t = 2.399，P = 0.018；体重指数，t = 3.166，P = 0.002），对冠心病的知识得分更高（总知识得分，t = -7.099，P = 0.000），更好的身体健康状况（t = -2.503，P = 0.014）和心理健康状况（t = -2.950，P = 0.004）。
结论：本研究提供了以奥马哈体系和彭德健康促进模型为理论框架的护士主导的过渡护理计划的价值的证据。该由护士主导的过渡护理计划中的结构化干预措施有助于在其他环境中使用该计划。

BACKGROUND & AIMS: THE AIM OF THE STUDY:The aim of this study is to examine the effect of critical thinking education on nursing students' problem-solving skills. MATERIALS AND METHOD:This study was conducted with 93 nursing students, 49 in the control group and 44 in the education group. The California Critical Thinking Disposition Inventory and the Problem-solving Inventory were administered to them before and after 12 weeks of critical thinking education. RESULTS:The education group's mean critical thinking score was 253.61 on the pretest and 268.72 on the posttest. This increase was statistically significant (p < .001). The posttest mean score of the control group fell to 258.18 on the posttest after a pretest mean score of 260.79, and this difference was statistically significant (p < .001). According to the posttest results, the problem-solving skills of education group increased significantly (p < .001), while the control group's score fell significantly (p < .001). CONCLUSION:This study determined that critical thinking education improves problem-solving skills.

背景与目标： 研究目的：本研究的目的是检验批判性思维教育对护理学生解决问题能力的影响。
材料与方法：本研究针对93名护理专业学生，对照组49名，教育组44名进行。在进行批判性思维教育12周之前和之后，对他们进行了加利福尼亚批判性思维倾向量表和问题解决量表。
结果：教育组的平均批判性思维得分在测验前为253.61，在测验后为268.72。这种增加具有统计学显着性（p <0.001）。对照组的测试后平均得分在测试前平均得分为260.79后下降至测试后的258.18，这一差异具有统计学意义（p <0.001）。根据测试后的结果，教育组解决问题的技能显着提高（p <0.001），而对照组的得分显着下降（p <0.001）。
结论：这项研究确定批判性思维教育可以提高解决问题的能力。

BACKGROUND & AIMS: PURPOSE:To explore patient satisfaction, intention to adhere to nurse practitioner (NP) plan of care, and the impact of managed care on NPs' patients in multiple settings, the final phase of a three-part study of NPs and managed care. DATA SOURCES:Postvisit questionnaires and narrative comments about patient satisfaction with NP communication, overall satisfaction with visit, recall of plan of care, intention to adhere to NP's recommendations, and impact of managed care on ease of obtaining healthcare resources. CONCLUSIONS:Patients were very satisfied with NP communication and with their healthcare visit. They mostly intended to adhere to the NP-recommended plan of care but less so to recommended lifestyle changes. Patients trusted their NPs, valued their expertise, were confident in the NPs' care, and believed that the NPs considered their best interests. They appreciated that the NPs took time to listen to their concerns and helped them to obtain healthcare resources. Most patients were not greatly impacted by managed care and obtained needed healthcare resources with little difficulty. IMPLICATIONS FOR PRACTICE:Although the first two phases of this study found that many NPs had strong negative attitudes toward managed care, these attitudes were not conveyed toward patients in this sample. NPs, however, will continue to face new challenges as third-party payers attempt to reduce healthcare costs, further testing NP adaptability and resourcefulness.

背景与目标： 目的：探讨患者满意度，遵守护士执业医师（NP）护理计划的意图，以及在多种情况下管理式护理对NPs患者的影响，NPs和管理式护理三部分研究的最后阶段。
数据来源：事后访问有关患者对NP交流满意度，对访视的总体满意度，召回护理计划，遵守NP建议的意愿以及管理式护理对获得医疗资源的难易程度的影响后的问卷调查和叙述性评论。
结论：患者对NP的交流和他们的医疗就诊感到非常满意。他们的主要目的是遵守NP推荐的护理计划，但不建议改变生活方式。患者信任他们的NP，重视他们的专业知识，对NP的护理充满信心，并相信NP认为他们的最大利益。他们赞赏国家警察花费时间倾听他们的担忧，并帮助他们获得医疗资源。大多数患者不受管理治疗的影响很大，并且几乎没有困难地获得所需的医疗资源。
实践的意义：尽管本研究的前两个阶段发现许多NP对管理式护理抱有强烈的消极态度，但这些态度并未在本样本中传达给患者。但是，随着第三方付款人试图降低医疗保健成本，进一步测试NP的适应性和足智多谋，NP将继续面临新的挑战。

BACKGROUND & AIMS: :While the nephrology nursing shortage persists despite the continued growth of the population of individuals with Stage 5 chronic kidney disease, there is a paucity of empirical data regarding nephrology nurses' perceptions of their work environments. Moreover, there are no studies that have examined the relationship of work environment attributes to patient and nurse outcomes in dialysis settings. The purpose of this study was to examine the relationships between staff nurses' perceptions of dialysis work environments, nurses' intentions to leave their current jobs, nurse turnover, patient satisfaction, and patient hospitalization rates. A descriptive, correlational design was used. Nurse level and facility level data were obtained. The sample for nurse-level data consisted of 199 registered nurses in staff nurse roles in 56 dialysis facilities of a national dialysis company. The sample for facility-level analysis consisted of 46 dialysis facilities, and nurse-level data were aggregated for facility-level analysis. The Practice Environment Scale-Nursing Work Index (PES-NWI) was used to measure nurses' perceptions of the dialysis work environment. Nurses' intention to leave their jobs and facility-level turnover rates were the nurse outcomes examined in this study. Facility-level patient satisfaction and hospitalization rates were the patient outcomes examined. Correlation coefficients were computed to measure the relationships between study variables, and independent t-tests were performed to examine subgroup differences in work environment perceptions. Overall, nurses rated the work environment somewhat favorably. Nurses who expressed intention to leave their jobs rated the work environment more negatively compared to nurses who intended to stay. Significant correlations were found between nurses' perceptions of the dialysis work environment, nurses' intention to leave their jobs, nurse turnover rates, and patient hospitalizations. Study findings suggest that nurses' perceptions of the dialysis work environment are important for nurse and patient outcomes in dialysis settings. Further research is needed to explore the predictive ability of the work environment for nurse and patient outcomes in hemodialysis units.

背景与目标： ：尽管尽管患有5期慢性肾脏病的人数持续增长，但肾科护理人员短缺仍然存在，但是关于肾科护士对其工作环境的看法的经验数据很少。此外，尚无研究检查透析环境中工作环境属性与患者和护士结局之间的关系。这项研究的目的是检验护士对透析工作环境的看法，护士离职的意图，护士离职率，患者满意度和患者住院率之间的关系。使用了描述性的相关设计。获得了护士级别和设施级别的数据。护士级数据的样本由199家在一家国家透析公司的透析设施中担任护士职位的注册护士组成。用于设施级分析的样本由46个透析设施组成，并且汇总了护士级数据以进行设施级分析。实践环境量表-护理工作指数（PES-NWI）用于衡量护士对透析工作环境的看法。护士离开工作的意图和机构级别的离职率是本研究中检查的护士结局。设施水平的患者满意度和住院率是检查的患者结局。计算相关系数以衡量研究变量之间的关系，并进行独立的t检验以检验工作环境感知中的亚组差异。总体而言，护士对工作环境的评价较高。与打算留下来的护士相比，打算离开工作的护士对工作环境的评价更为负面。在护士对透析工作环境的看法，护士离开工作的意愿，护士离职率和患者住院之间，发现了显着的相关性。研究结果表明，护士对透析工作环境的理解对于透析环境中的护士和患者结局非常重要。需要进一步的研究来探索工作环境对血液透析部门护士和患者结果的预测能力。

BACKGROUND & AIMS: BACKGROUND:National Cholesterol Education Program (NCEP) guidelines have been used to define treatment goals in patients with hypercholesterolemia. However, epidemiology-based guidelines are unable to identify all subjects with coronary artery disease for aggressive lipid intervention. OBJECTIVE:We sought to evaluate the additive value of multislice computed tomography (MSCT) angiography to the NCEP guideline classification for lipid treatment. METHODS:Multislice computed tomography was performed in 114 consecutive patients (mean age 57+/-14 y; 59% male) without known coronary artery disease. Subjects were classified into 3 categories (low-, intermediate-, and high-risk) according to their Framingham risk scores (FRS). RESULTS:Traditional cardiac risk factors were common: hypertension 59%, diabetes 13%, and smoking 22%. On the basis of the FRS, 11% (n=12/114) of the patients met high-risk criteria requiring aggressive cholesterol reduction. Of those in the low- and intermediate-risk groups, MSCT found coronary plaque in 76% (n=77/102), with moderate or severe plaque in 38% (n=39/102), thus reclassifying them in the high-risk category. Use of statin drugs increased from 32% at baseline to 53% (p=0.002) based on MSCT results; statin dose was increased in 31% of the patients who were already on a statin. The mean low-density lipoprotein cholesterol (LDL-c) decreased from 114 mg/dL to 91 mg/dL after MSCT (p<0.001). CONCLUSION:Multislice computed tomography reclassifies a high percentage of patients considered to be low- to intermediate-risk into the high-risk category based on their coronary artery lesions. Thus, the rise in MSCT use at present may have a large impact on clinician practice patterns in lipid-lowering therapy.

背景与目标： 背景：国家胆固醇教育计划（NCEP）指南已用于定义高胆固醇血症患者的治疗目标。但是，基于流行病学的指南无法识别出患有冠状动脉疾病的所有受试者进行积极的脂质干预。
目的：我们试图评估多层计算机断层扫描（MSCT）血管造影对脂质治疗的NCEP指南分类的附加价值。
方法：对114例无已知冠状动脉疾病的连续患者（平均年龄57 / -14岁；男性59％）进行了多层计算机断层扫描。根据弗雷明汉风险评分（FRS）将受试者分为3类（低，中和高风险）。
结果：传统的心脏危险因素是常见的：高血压59％，糖尿病13％，吸烟22％。根据FRS，11％（n = 12/114）的患者符合需要积极降低胆固醇的高风险标准。在低危和中危组中，MSCT发现冠状动脉斑块占76％（n = 77/102），中度或重度斑块占38％（n = 39/102），因此将其重新分类为高危风险类别。根据MSCT结果，他汀类药物的使用从基线的32％增加到53％（p = 0.002）；在已经接受他汀类药物治疗的患者中，有31％的患者增加了他汀类药物的剂量。 MSCT后，平均低密度脂蛋白胆固醇（LDL-c）从114 mg / dL降至91 mg / dL（p <0.001）。
结论：多层计算机断层扫描根据其冠状动脉病变将高百分比的被认为是低风险至中风险的患者重新分类为高风险类别。因此，目前MSCT使用量的增加可能对降脂治疗中临床医生的实践模式产生重大影响。