低年资护士职业性腰背痛预防行为及影响因素研究

目的 调查低年资护士职业性腰背痛预防行为现状，分析其影响因素，为针对性干预提供参考。方法 对446名低年资护士采用一般资料调查问卷、护士预防职业性腰背痛量表、离职意愿量表及职业疲劳耗竭恢复量表进行调查。结果 低年资护士职业性腰背痛预防行为总分(92.31±17.11)分。多元线性回归分析显示，离职意愿、职业疲劳耗竭恢复(急性疲劳、慢性疲劳、班次间恢复)、学历为低年资护士职业性腰背痛预防行为的影响因素(均P<0.05)。结论 低年资护士职业性腰背痛预防行为处于中等水平，护理管理者应针对影响因素采取有效干预措施，提高低年资护士职业性腰背痛防护水平。     

精神科护士道德勇气及影响因素分析

目的 了解精神科护士道德勇气现状,分析其影响因素,为针对性干预提供参考。方法采用护士道德勇气量表、道德困境量表对305名精神科护士进行调查。结果精神科护士道德勇气总分为（79.00±13.09）分。多元线性回归分析显示,职务、职称、每月夜班数、是否为独生子女和护士道德困境是精神科护士道德勇气的影响因素（均P<0.05）。结论精神科护士的道德勇气水平处于中等偏上水平,护理管理者需关注低年资、夜班数较多及独生子女护士的道德勇气状况,并通过合理排班、及时识别道德困境等措施,提供心理支持等措施提高护士的道德勇气。     

低年资护士职业延迟满足状况及影响因素调查

目的调查低年资护士的职业延迟满足状况及其影响因素,为制定合理的管理措施提供参考。方法对200名低年资护士应用一般情况调查表、职业延迟满足量表、职业生涯自我管理量表、成就动机量表进行调查。结果低年资护士的职业延迟满足得分(13.58±4.03)分,处于较低水平;职业生涯自我管理得分为(40.38±11.40)分,处于中等水平;成就动机得分为(17.44±9.34)分;平均月收入、职业生涯自我管理、学历、成就动机是低年资护士职业延迟满足的影响因素(P0.05,P0.01)。结论低年资护士职业延迟满足整体水平较低,且受多种因素影响。护理管理者应针对性制定措施以提高低年资护士职业延迟满足水平。     

低年资护士工作积极性现状及影响因素研究

目的 了解低年资护士工作积极性现状及影响因素,为提高低年资护士工作积极性和工作质量提供参考.方法 采用中文修订版护士心理资本问卷、护士心理契约量表(医院责任)、工作积极性问卷对211名低年资护士进行问卷调查.结果 低年资护士工作积极性得分为74.68±14.56;多元线性回归分析显示,学历,护士心理契约中的团队责任维度,心理资本的自我效能、韧性、乐观维度是其工作积极性的影响因素(P＜0.05,P＜0.01).结论 低年资护士工作积极性处于中等水平,影响因素较多,护理管理者可据此制订针对性干预方案,从多方面着手提高低年资护士工作积极性.     

护士工作偏差行为及影响因素调查

目的 了解护士的工作偏差行为现状,分析其影响因素,为针对性干预提供参考.方法 采用护理人员工作偏差行为量表、工作倦怠量表、护理工作环境量表对598名在职护士进行调查.结果 护士工作偏差行为得分为1.29±0.42,护士工作偏差行为与护理工作环境呈负相关,与工作倦怠呈正相关(均P＜0.01);多元线性回归结果显示,性别、与同事间的关系、职务和去人格化是护士工作偏差行为的独立影响因素(P＜0.05,P＜0.01).结论 护士工作偏差行为处于较低水平.应改善护理工作环境,减少工作倦怠,以减少工作偏差行为的发生,提高护理质量.     

护士职业偏差行为与组织公平感和工作压力的关系研究

目的了解护士职业偏差行为现状并探讨其影响因素,为进一步探讨有效的干预策略提供参考。方法对632名在职护士采用护理人员职业偏差行为量表、组织公平感量表、工作压力量表进行调查。结果护理人员职业偏差行为得分为1.21±0.37;护士职业偏差行为与组织公平感、工作压力显著相关(均P0.01);性别、工作年限、信息公平和组织氛围压力是护士职业偏差行为的独立影响因素(P0.05,P0.01)。结论护理人员职业偏差行为总体良好,护士性别、工作年限、信息公平和组织氛围压力对职业偏差行为有预测作用。护理管理者需对护理人员进行干预,以提高护士对自身职业行为的感知,进而提高其职业行为,促进护理服务质量的提高。     

护理人员道德勇气与道德困境的相关性研究

目的 探讨护理人员道德勇气与道德困境的现状及其相关性,为采取针对性措施降低护理人员道德困境水平提供参考。 方法 采用护士道德勇气量表与护士道德困境量表,方便抽取390名护理人员进行调查。 结果 护理人员的道德勇气评分为（79.95±13.71）分,道德困境评分为24.00（7.00,52.00）分。道德勇气与道德困境呈负相关（P＜0.05）。回归分析结果显示,学历、科室、道德勇气是道德困境的影响因素（均P＜0.05）。 结论 道德勇气是护理人员道德困境的重要影响因素,道德勇气高的护理人员能正向面对道德困境。应创造良好的伦理环境并进行相关培训,以提高护理人员的道德勇气,正确应对道德困境。     

ICU护士道德勇气现状及影响因素分析

目的 了解ICU护士道德勇气现状并分析影响因素。 方法 方便抽样法抽取四川省422名ICU护士,采用一般资料问卷、护士道德勇气量表、心理授权量表、医院伦理氛围量表进行调查。 结果 ICU护士道德勇气总分（83.96±13.91）;多元线性 回归分析显示,参与临床教学、心理授权的自我效能及工作影响维度、医院伦理氛围的与患者关系维度显著正向预测ICU护士道德勇气（均P＜0.05）,共解释总变异的55.7%。 结论 ICU护士道德勇气处于中上水平,受个人及医院环境的影响。护理管理者应采取措施提高ICU护士心理授权,营造良好伦理氛围,以提升护士道德勇气水平,减轻道德困境与伦理冲突。     

差错反感文化在护士内部人身份认知与道德勇气间的中介作用

目的 探讨差错反感文化对护士内部人身份认知与道德勇气的影响及机制,为提高其道德勇气提供依据.方法 抽取湖南省湘西自治州7所二级医院的693名护士,采用一般资料调查表、差错反感文化量表、内部人身份认知量表及道德勇气量表进行调查.结果 护士的差错反感文化、内部人身份认知、道德勇气总分分别为(26.05±4.92)分、(27.99±3.15)分、(84.28±9.48)分.差错反感文化与道德勇气呈负相关,内部人身份认知与道德勇气呈正相关(均P＜0.01),差错反感文化在内部人身份认知与道德勇气间发挥部分中介作用,间接效应占总效应的15.74％.结论 护士的道德勇气总体水平较高,可以通过合理管理差错反感文化、增强内部人身份认知来提高护士道德勇气.     

格林模式培训促进低年资护士胰岛素规范化注射行为

目的 提高低年资护士胰岛素注射知识,规范其胰岛素注射行为.方法 采用格林模式对93名低年资护士进行胰岛素规范化系统培训.采用问卷、现场观察、深入访谈方式调查低年资护士对胰岛素认知和注射行为状况,分析影响低年资护士胰岛素规范化注射行为形成的倾向、促成和强化因素;相应给予规范化的胰岛素知识和技能培训;完善流程和制度、提供学习资源和技术的支持;采用自评、持续督导和及时反馈等一系措施.结果 培训后低年资护士胰岛素认知总分及胰岛素保存、胰岛素基本知识、注射知识和低血糖防治知识等各维度得分均提高（均P＜0.01）;胰岛素保存、胰岛素注射步骤、注射部位规范检查、低血糖防治等胰岛素注射相关行为正确率显著提高（均P＜0.01）.结论 格林模式指导下的培训能提高低年资护士胰岛素注射知识,规范其胰岛素注射行为,提高胰岛素治疗的有效性和安全性.     

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 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.     

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.     

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.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.