低温等离子体灭菌器灭菌效果观察

为观察低温等离子体灭菌器灭菌效果及其使用的可行性,采用化学指示卡和生物指示剂方法,进行了实际灭菌效果监测。结果,采用过氧化氢气体低温等离子体,灭菌处理周期为52~72 m in,经过265锅次化学指示卡监测全部合格;经213锅次生物指示剂监测均为无菌生长;对64件灭菌后物品进行细菌培养均无菌生长。结论,该低温等离子体灭菌器全部灭菌过程监测均达到合格要求,操作简便,使用安全。     

全国42家医院过氧化氢低温等离子体灭菌器现状调查及生物监测抽检比较

摘要 目的 了解过氧化氢低温等离子体灭菌器在使用过程中存在的问题,以便加强灭菌质量管理。 方法 采用生物监测方法,抽取国内部分省市42家医院使用中的过氧化氢低温等离子体灭菌器进行现场抽样监测,并以问卷形式进行灭菌效果影响因素调查。 结果 从42家医院抽检用于内镜灭菌的过氧化氢低温等离子体灭菌器217台次,出现14次生物监测失败(管腔PCD监测失败12次和普通生物监测失败2次)。生物监测失败的过氧化氢低温等离子体灭菌器主要分布在二级医院,且灭菌器使用时间较久。调查发现过氧化氢低温等离子体灭菌器使用中的问题主要有部分灭菌器陈旧(使用约10年),多数灭菌器内物品摆放不正确,还存在装载过量的问题。 结论 对于管腔器械的灭菌监测,管腔生物PCD相对于普通生物指示物更容易发现灭菌失败。目前国内医院使用中的低温等离子体灭菌器生物监测失败率仍较高,使用中仍存在较多的问题,应加强督查和培训。     

过氧化氢低温等离子体灭菌效果不同评价方法的比较

摘要 目的 用不同方法评价过氧化氢气体等离子体低温灭菌效果及其影响因素。方法 采用生物指示剂和化学指示剂方法，对某过氧化氢低温等离子体灭菌器的灭菌效果进行评价，分析影响因素。结果 某医院分别采用一类卡、四类卡、灭菌过程挑战装置(PCD)和生物指示剂4种方法监测某过氧化氢低温等离子体灭菌器长循环灭菌379批次物品，结果显示PCD检测出18批不合格、四类卡检测出2批不合格，其余2种监测全部合格。短循环灭菌365批，结果显示化学PCD有146批不合格、四类卡有16批不合格，生物指示剂检测出1次不合格，一类卡全部合格。结论 采用4种方法监测某过氧化氢低温等离子体灭菌器的灭菌效果，以PCD法检出不合格率最高，其次是四类卡，灭菌效果与灭菌程序、装载量和干燥方法有关。     

过氧化氢低温等离子体灭菌器灭菌效果监测方法的探讨

目的探讨过氧化氢低温等离子体灭菌器灭菌效果监测方法。方法采用非管腔生物监测法和管腔生物PCD监测法,用不同生物指示剂对过氧化氢低温等离子体灭菌过程进行效果监测,比较使用模拟管腔载体染菌和一种管腔生物PCD进行试验的灭菌效果。结果管腔生物PCD监测法比非管腔生物监测法灭菌难度大,管腔生物PCD的抗力差异大。结论使用与待灭菌物品相近的模拟载体生物指示物进行过氧化氢低温等离子体灭菌器灭菌效果监测,结果更为客观可靠。     

过氧化氢低温等离子体灭菌生物监测方法探讨

摘要 目的 探讨过氧化氢低温等离子体灭菌的最佳生物监测方法,以便及时、准确地判断灭菌效果,保证无菌物品的质量。方法 2013年4-12月,每天第一锅次同时使用过氧化氢低温等离子体灭菌自含式生物指示剂（嗜热脂肪杆菌芽孢）和环氧乙烷（EO）灭菌快速生物培养指示剂（枯草杆菌黑色变种芽孢）对2台低温等离子体灭菌器进行生物监测。结果 2台灭菌器共进行两种生物监测各520次,其中合格515次,不合格5次,合格率均为99.04%,两种生物监测结果一致,快速生物监测结果合格后可及时放行灭菌物品,满足了手术和诊疗需要;监测不合格时及时处理。结论 自含式生物指示剂（嗜热脂肪杆菌芽孢）和EO灭菌快速生物培养指示剂（枯草杆菌黑色变种芽孢）配合使用是目前过氧化氢低温等离子体灭菌理想的生物监测方法。     

过氧化氢低温等离子体灭菌器应用灭菌效果观察

为了解STERRAD 100S过氧化氢低温等离子体灭菌器性能,采用化学指示剂和生物指示剂方法,对其灭菌效果进行了监测。结果,经过该灭菌器常规灭菌程序445次灭菌处理,所有灭菌包装袋指示条及化学指示胶带和化学指示卡全部由桔红色变为淡黄色,均达到合格要求;灭菌后的生物指示剂经培养全部呈紫色,阳性对照组全部变成呈黄色,即生物监测结果全部合格。灭菌器自动工艺监测发生12次灭菌程序自动中断,经检查发现为灭菌物品过湿所致;经重新干燥,更换包装,继续灭菌程序,灭菌合格。结论STERRAD 100S过氧化氢低温等离子灭菌器灭菌效果可靠,灭菌过程故障可自动检出。     

灭菌器使用的影响因素研究及风险防范

目的了解医院手术室不同类型灭菌器使用情况及存在问题,以便防范灭菌失败的风险。方法通过现场检查和资料调查方法,对某医院手术室使用中的不同类型灭菌器使用情况进行调查与分析。结果该医院手术室共有3种4台灭菌器,分别为卡式压力蒸汽灭菌器、B型台式脉动真空式压力蒸汽灭菌器和过氧化氢低温等离子体灭菌器。2013年4台灭菌器共运行灭菌1 135次,其中过氧化氢低温等离子体灭菌器使用率为71.81%,脉动真空式压力蒸汽灭菌器使用率为16.12%,卡式压力蒸汽灭菌器使用率为12.07%。两种压力蒸汽灭菌器生物监测全部合格,过氧化氢低温等离子体灭菌器生物监测合格率为98.25%。结论该医院手术室灭菌器应用环节存在问题,过度依赖低温灭菌器,应科学调配应用结构和规范操作。     

快速生物监测在过氧过氢低温等离子体灭菌监测实践中存在的问题与对策

摘要 目的 了解快速生物监测在过氧过氢低温等离子体灭菌监测实践中存在的问题,以便更准确地对等离子体灭菌质量的控制。方法 通过收集低温等离子灭菌器快速生物指示剂监测结果数据,分析并找出使用中存在的问题,提出整改对策。结果 整改前3个月内,使用快速培养生物指示剂监测82次,出现问题16次,问题发生率为19.5%。经整改后3个月内,使用快速生物指示剂监测92次,生物监测结果全部符合要求。结论 过氧化氢低温等离子灭菌器快速生物指示剂使用中,应规范操作,严格检查产品质量,提高操作准确度。     

过氧化氢等离子体低温灭菌器灭菌效果评价

目的观察过氧化氢等离子体低温灭菌器灭菌效果,评价其在中心供应室实际使用价值。方法采用灭菌器自检系统和生物指示剂与化学指示剂评价方法进行了检测。结果连续进行800次灭菌运行,成功完成运行736次,有64次灭菌程序中断。在成功完成灭菌循环中,化学检测全部合格,生物检测培养均为阴性。结论该过氧化氢等离子体低温灭菌器灭菌效果可靠,灭菌周期短、自检系统严密、能满足供应室临床灭菌需要。     

过氧化氢低温等离子体灭菌生物监测方法的比较

目的选择结果准确、价廉、操作简便的过氧化氢低温等离子体灭菌生物监测方法。方法将嗜热脂肪杆菌芽孢菌片装入10mL刻度螺旋瓶盖试管,与凯斯普过氧化氢低温等离子体灭菌生物指示剂同时进行灭菌效果生物监测。结果螺旋瓶盖试管装菌片15次75管均为阴性;凯斯普过氧化氢低温等离子体灭菌生物指示剂15次15管均为阴性。结论螺旋瓶盖试管装嗜热脂肪杆菌芽孢菌片可用于过氧化氢低温等离子体灭菌生物监测。     

Incomplete holism in pre-registration nurse education: the position of the biological sciences

There is an ongoing debate in nurse education concerning the role and delivery of the biological sciences in the nursing curriculum. One of the fundamental questions raised by this debate asks how best can teachers impart biological knowledge in a manner that can be readily applied by students and qualified nurses to inform their clinical practice. This paper will include a discussion of some of the features of pre-registration education that may have influenced the manner in which biological sciences are perceived, taught and used by nurses. It will be argued that nursing may have developed a form of incomplete holism and that this may be in part responsible for the challenges that remain to be met within this area of the nursing curriculum. As a response to incomplete holism an innovative approach within pre-registration education will be introduced. This development involves the use of linked teaching sessions which aim to develop the analytical skills necessary to apply physiological knowledge to nursing practice.     

Tandem measurement of D-dimer and myeloperoxidase or C-reactive protein to effectively screen for pulmonary embolism in the emergency department

OBJECTIVES: The hypothesis was that the tandem measurement of D-dimer and myeloperoxidase (MPO) or C-reactive protein (CRP) could significantly decrease unnecessary pulmonary vascular imaging in emergency department (ED) patients evaluated for pulmonary embolism (PE) compared to D-dimer alone. METHODS: The authors measured the sequential combinations of D-dimer and MPO and D-dimer and CRP in a prospective sample of ED patients evaluated for PE at two centers. Patients were followed for 90 days for venous thromboembolism (VTE, either PE or deep venous thrombosis [DVT]), which required the consensus of two of three blinded physician reviewers. RESULTS: The authors enrolled 304 patients, 22 with VTE (7%; 95% confidence interval [CI] = 5% to 10%). The sensitivity and specificity of a D-dimer alone (cutoff > or = 500 ng/mL) were 100% (95% CI = 85% to 100%) and 59% (95% CI = 53% to 65%), respectively, and was followed by pulmonary vascular imaging negative for PE in 38% (115/304; 95% CI = 32% to 44%). The combination of either a negative D-dimer, or MPO < 22 mg/dL, had a sensitivity of 100% and specificity of 73% (95% CI = 67% to 78%). Thus, tandem measurement of D-dimer and MPO would have decreased the frequency of subsequent negative pulmonary vascular imaging from 38% to 25% (95% CI of the difference of -13% = -5% to -20%). The combination of CRP and D-dimer would not have significantly improved the rate of negative imaging. CONCLUSIONS: The tandem measurement of D-dimer and MPO would have significantly decreased negative pulmonary vascular imaging compared with D-dimer alone and should be validated prospectively.     

A personal reflection on the nature of somatic treatments and the implications for mental health nursing

Somatic treatments in psychiatry, ECT (electro-convulsive therapy) and pharmacotherapy, are based on a particular conception of our nature as human beings, and on a particular conception of clinically constructed reality. Acceptance of the basis for such treatments constitutes a tacit admission of our nature as being essentially materialist and deterministic biological machines, and undermines the connectedness which ensures that we each acknowledge the humanity and humanness of the other. By objectifying the other as different (by reason of disordered biology), these connections are severed and allow the imposition of physical forms of treatment in the name of cure. In this personal reflection, I draw upon my own experience of ECT from a nursing perspective, and attempt to explain the basis of my antipathy for this treatment. In the course of this exploration I also raise some of the issues which I feel nursing must deal with if it is to continue uncritically to adopt the biological paradigm as the basis of its praxis.     

Biological therapies for the treatment of cutaneous wounds: Phase III and launched therapies

Introduction: Normal wound healing mechanisms can be overwhelmed in the setting of complex acute and chronic tissue injury. Biological therapies are designed to augment and/or restore the body's natural wound healing abilities. There are a variety of available and emerging technologies utilizing this approach that have demonstrated the ability to augment wound healing.

Areas covered: In this review, the clinical data on launched and emerging biological therapies for wound healing applications are summarized. The methodologies discussed include biological skin equivalents, growth factors/small molecules and stem cell-based therapies.

Expert opinion: While many products possess convincing clinical data demonstrating their efficacy in comparison to standard treatment options, more robust, controlled studies are needed to determine the relative value among established and emerging biological therapies. Future bioengineering and stem cell-based approaches are of particular interest due to the simultaneous correction of multiple deficiencies present in the nonhealing wound.     

超声对猪子宫急慢性影响的研究

在研究小鼠的基础上进一步研究超声对猪子宫的近远期影响、转归以及剂量与效应的关系。实验结果显示，超声强度为１２Ｗ／ｃｍ２×９０ｓ时，光镜下香猪子宫组织学急性表现是子宫内膜机能层水肿。超声强度为２０Ｗ／ｃｍ２×９０ｓ时，机能层水肿更明显，但无明显出血灶。肌层仅见淋巴管扩张。电镜示子宫内膜上皮细胞和肌层平滑肌细胞均有线粒体肿胀，最大剂量组可见上皮细胞内有灶性坏死和大、小不等的空泡。超声辐照３月后，子宫内膜、肌层用光镜、电镜观察均未见异常改变。该结果证实，在本研究所用的超声剂量范围内，对猪子宫的影响是一过性的，不会导致疤痕的形成。     

压力蒸汽灭菌两种生物监测方法效果的研究

压力蒸汽灭菌适用于耐湿、耐热的器械、器具和物品的灭菌,是医疗器械、器具、物品的首选灭菌方法[1],但因影响因素较多,使用时要监测其效果.生物监测是最可靠、最有效的监测方法,目前有两种生物监测法,即快速生物监测和传统生物监测,我院供应中心从2010年11月开始根据WS310.3-290《清洗消毒及灭菌效果监测标准》的规定,每周做一次传统的生物监测,植入性器械每锅快速生物监测[2],为了验证快速生物监测的准确性,设计同步两种监测52次.现将结果报告如下.     

诊断超声对中孕宫内胎儿脑垂体超微结构影响的研究

将２８名中孕妇女随机分为四组，Ⅰ组（对照组），Ⅱ组（超声照射５ｍｉｎ组），Ⅲ组（超声照射１０ｍｉｎ组），Ⅳ组（超声照射３０ｍｉｎ组）。采用诊断超声辐射人体宫内胎儿蝶鞍内的脑垂体，４８小时后取出胎儿脑垂体组织进行超微结构研究，结果发现：Ⅳ组有垂体细胞核染色质稀疏，线粒体嵴模糊，细胞间隙增宽，血管傍组织水肿；Ⅱ组与Ⅲ组无改变。结果提示：诊断用超声定点持续辐射５ｍｉｎ及１０ｍｉｎ均无损伤；辐射３０ｍｉｎ有脑垂体超微结构改变。     

时间护理在护理工作中的应用现状

时间生物医学是近年来崛起的一门新兴学科,时间护理学是其中的一个重要分支.通过对时间护理在给药、病情观察、心理护理、护理管理、健康教育等各项护理工作中的实际应用及研究进展的阐述,为广大护理人员更好地了解和应用时间护理提供了指导.     

Comorbidity Between Autistic Syndrome and Biological Pathologies: Which Implications for the Understanding of the Etiology?

It is estimated that at least 24% of cases of autism are potentially associated with other syndromes, to infective, metabolic or genetic pathologies, and to anatomical or functional alterations. Problems connected with interpretation of the association between biological damage and autistic behavioral phenotype in causal terms are briefly exposed. Three critical periods for the beginning of an anomalous behavioral development in the child with autism are identified: prenatal, prior to 9 months from birth, after 1 year of age. Psychopathological consequences potentially deriving from biological damages on every critical period are described, and their compatibility with the characteristic behavioral features observed in individuals affected by autism is discussed. On this basis, a theoretical model that represents infantile autism as a specie-specific human psychopathology of early emotional communication during the primary intersubjectivity stage is proposed.