PBL护理查房在临床护理教学中的应用及效果评价

目的探讨PBL护理查房在临床护理教学中的效果。方法以我院外科全体护士为对象,以病区为单位,⒚抽签的方式,随机分为试验组(86人)和对照组(85人)。试验组采用PBL护理查房模式,持续8个月;对照组采用传统护理查房模式。采用评判性思维能力测量表(CTDI-CV)观察PBL护理查房对护士评判性思维能力的影响。结果 PBL护理查房实施后试验组护士的评判性思维能力均有不同程度的提高,差异有统计学意义(P0.01)。结论运用PBL护理查房模式,对外科护士评判性思维能力的提高有明显的效果。     

晨间床边护理查房模式在神经内科的应用

目的探讨晨间床边护理查房在神经内科的应用效果。方法每天早交班后,由护士长主持,围绕病区患者的情况进行30～40 min的床边查房。结果神经内科实施晨间床边护理查房后,患者满意率由87.50%上升至98.04%,护士专科知识掌握率由实施前的76.00%上升至96.00%;护士病情知晓率由84.00%上升至100%。实施后护理质量提升;护士寻求真相、分析能力、求知欲评分及评判性思维总分较实施前显著提高(P<0.05,P<0.01)。结论神经内科护士长晨间护理查房对提高临床护理质量、护士业务水平、评判性思维能力以及患者的满意度起到积极的促进作用。     

“1+1+1”教学模式对高职护生评判性思维的影响

目的调查不同教学模式对高职护生评判性思维能力的影响,为护理教学改革提供参考。方法将136名高职护生分为对照组(n=50)与观察组(n=86)。对照组实施传统"2+1"教学模式,观察组采用"1+1+1"教学模式,实施前后采用中文版评判性思维能力测量表进行调查。结果实施后观察组护生评判性思维能力总分(282.85±25.48)显著高于对照组(271.56±28.10),两组在分析能力、求知欲及总分项目差异有统计学意义(P0.05,P0.01)。结论高职"1+1+1"教学模式能提高护生的评判性思维能力,但尚存在薄弱环节。在护理教学中要注重采取合适的教学策略,不断促进护生评判性思维能力的提高。     

改良护理查房培养实习护生评判性思维能力

为培养实习护生的评判性思维能力,对74名护生分别进行两种方法护理查房各1次.第1次(传统护理查房)由带教老师指导,主持护士1人准备护理计划,包括资料收集、病例评价、护理等,其它护生仅参与讨论.第2次(改良护理查房)由带教老师指导,每个护生均准备1份护理计划,包括病例选择(同1名典型病例)、资料收集、患者评估等,由主持护士报告,其他护士针对护理问题对照自身护理计划,阐述其各自见解.提出传统护理查房方法,因内容过度集中而限制了护生思维的发展;改良护理查房方法,选择典型病例,人人参与式查房,从而增强了护生学习自觉性,活跃了讨论气氛,培养了护生的评判意识和评判性思维能力,以适应现代护理发展的需要.     

改良护理查房培养实习护生评判性思维能力

为培养实习护生的评判性思维能力,对74名护生分别进行两种方法护理查房各1次。第1次(传统护理查 房)由带教老师指导,主持护士1人准备护理计划,包括资料收集、病例评价、护理等,其它护生仅参与讨论。第2 次(改良护理查房)由带教老师指导,每个护生均准备1份护理计划,包括病例选择(同1名典型病例)、资料收集、 患者评估等,由主持护士报告,其他护士针对护理问题对照自身护理计划,阐述其各自见解。提出传统护理查房方 法,因内容过度集中而限制了护生思维的发展;改良护理查房方法,选择典型病例,人人参与式查房,从而增强了护 生学习自觉性,活跃了讨论气氛,培养了护生的评判意识和评判性思维能力,以适应现代护理发展的需要。     

危险预知训练在手术室新护士培训中的应用

目的 探讨危险预知训练在手术室新护士培训中的应用效果.方法 根据新护士入科时间,将2018年8月入手术室的新护士23名作为对照组,使用常规培训方法进行带教;将2019年8月入手术室的24名新护士作为观察组,在常规培训基础上,实施危险预知训练.培训6个月后比较两组新护士评判性思维能力、安全态度及护理不良事件发生率.结果 培训后观察组评判性思维能力各维度得分及总分、安全态度评分显著高于对照组(均P＜0.01),工作1年内不良事件发生率低于对照组.结论 对手术室新护士开展危险预知训练,能提高其评判性思维能力及安全态度,减少护理不良事件的发生,保障手术室护理安全.     

外科护士评判性思维能力的测量及分析

目的了解外科护士评判性思维的现状，为临床护理教学改革提供依据。方法使用评判性思维能力测量表（CTDI-CV）对184名外科护士进行评判性思维能力的测评，并对结果进行分析。结果外科护士整体上具备正向性的评判性思维能力；除寻找真相得分〈40分外，其余的评判性思维他特质的得分均〉40分；不同级别护士的评判性思维能力有所差异。结论外科护士有正向性的评判性思维倾向，但是寻找真相等特质得分偏低，评判性思维能力强的护士仍占少数，还需进一步提高。     

思维导图结合情景模拟用于急诊护士创伤急救规范化培训

目的探讨思维导图结合情景模拟在急诊护士创伤急救规范化培训中的应用效果。方法根据培训时间将急诊科规培护士分为两组,将2017年1～12月的30名护士设为对照组,按传统培训方式进行创伤急救规范化培训;2018年1～12月的32名护士为观察组,采用思维导图结合情景模拟方法进行创伤急救规范化培训。结果培训后观察组理论成绩、操作成绩显著高于对照组,评判性思维能力总分和7个维度得分显著高于对照组(P0.05,P0.01)。结论思维导图结合情景模拟的培训方式有助于提高急诊科规培护士的评判性思维能力,增强培训效果,从而使护士能更好地配合创伤急救,提高创伤急救护理工作质量。     

医护团队情景教学法在急诊临床教学中的应用

目的探讨医护团队情景教学法在急诊临床教学中的应用及效果。方法将急诊科实习的67名本科医学生、89名护生随机分为观察组和对照组,每组78名。对照组采用传统教学法教学,观察组采用医护团队情景教学法教学。培训4周后,比较两组综合考核评分。采用中文版评判性思维能力量表(CTDI-CV)对学生培训前、后进行评定并对两组的教学满意度进行评价。结果培训后,观察组综合考核评分、评判性思维总分及5个因子分显著高于对照组(均P<0.05)。观察组对教学模式满意度的评分显著高于对照组(P<0.01)。结论医护团队情景教学法能够有效提升学生的临床操作和思维能力,提高临床教学质量。     

以团队为基础的教学模式在急重症护理教学中的应用

目的探讨以团队为基础的教学模式在急重症护理教学中的应用效果。方法选取102名高职护生,随机分为观察组(52名)和对照组(50名)。观察组采用以团队为基础的教学模式教学,对照组采用传统教学模式,教学结束后进行综合理论及实践技能考核,并对两组护生的评判性思维能力及自主学习能力进行问卷调查。结果观察组理论考核成绩、实践技能考核成绩、自主学习能力、评判性思维能力显著优于对照组(P<0.05,P<0.01)。结论以团队为基础的教学模式可提高护生的自主学习能力及评判性思维能力。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.