实习护生人文关怀能力培养方案的实施

目的提高实习护生人文关怀能力。方法遴选人文关怀教师并进行培训,对60名实习护生开展人文关怀临床带教,包括人文关怀理论学习、人文关怀教学查房、人文关怀护理,写关怀日记及人文关怀护理个案,评选关怀之星。评价该方案实施前后护生人文关怀能力以及患者对护生人文关怀表现的满意度。结果出科时护生的人文关怀能力及患者对护生人文关怀满意度评分显著提高(均P0.01)。结论对实习护生进行人文关怀能力培养,可加深护生对人文关怀护理的理解,激发护生内在的关爱、同情等情感体验,提升护生人文关怀能力。     

泌尿外科实习护生人文关怀临床教学的设计与实施

目的 提高泌尿外科临床实习护生人文关怀能力.方法 将本科护生106人按进入泌尿外科实习时间分为对照组52人和观察组54人.对照组按实习计划进行常规专科护理与人文关怀临床带教,观察组对人文关怀教学内容进行专项设计,包括激发兴趣、角色扮演、角色体验、深入交流、反馈讨论、调整优化6种形式,并融入4周专科临床教学中.结果 实习结束时观察组护生专科理论及操作考核成绩、人文关怀能力得分显著高于对照组,对教学模式认可度显著高于对照组(P＜0.05,P＜0.01).结论 将人文关怀内容融入专科临床教学中,可有效提高护生实习成绩和人文关怀能力,教学模式获得护生认可.     

人文关怀在临床护理教学中的实践及效果

目的 探讨临床护理带教中的人文关怀教学方法.方法 选取120名实习护生为对象,从带教老师的人文培训、带教老师对护生的关怀及人文关怀教学实践方面进行为期3周的护理人文关怀教学.结果 教学后,护生的人文关怀能力及住院患者对护生的人文关怀护理满意度显著高于教学前(均P＜0.01).结论 人文关怀教学有利于提高护生人文关怀能力及患者对护生的人文关怀满意度.     

实习护生人文关怀品质与人文关怀能力的相关性研究

目的调查临床实习护生人文关怀品质和人文关怀能力的现状以及两者之间的相关性。方法采用人文关怀品质和人文关怀能力问卷对90名临床实习护生进行调查。结果临床实习护生人文关怀能力得分62.95±8.27,人文关怀品质得分163.11±14.54,两者之间呈正相关(r=0.338,P0.01)。人文关怀理念、知识、能力和感知与人道利他价值观、促进情感交流、灌输信念与希望呈正相关(P0.05,P0.01),人文关怀知识与提供良好环境呈负相关(r=-0.223,P0.05)。结论临床实习护生的人文关怀品质呈中等偏上水平,能力呈较低水平,两者之间相互影响。临床教师应根据临床环境,引导护生体验关爱,使其认同和内化人文关怀价值取向,形成良好的人文关怀品质。     

本科护生人文关怀能力与利他行为的关系研究

目的了解本科护生人文关怀能力现状,探讨其与利他行为的相关性,为提升本科护生人文关怀意识和能力提供依据。方法采用一般资料调查问卷、人文关怀能力评价量表、大学生利他行为问卷对安徽省2所护理院校已完成临床实习的437名全日制本科护生进行问卷调查。结果本科护生人文关怀能力得分(186.78±15.58)分,处于低水平;利他行为得分(113.66±11.09)分。本科护生人文关怀能力与利他行为及其各因子呈显著正相关(均P0.01);与老师、同学的关系及利他行为各因子对本科护生人文关怀能力有正向预测作用(P0.05,P0.01)。结论本科护生人文关怀能力有待提高,利他行为可显著影响本科护生的人文关怀能力。护理管理者和教育者可通过培养本科护生利他行为意识促进其人文关怀能力的提升。     

实习护生参与患者关怀需求调查体验的质性研究

目的了解实习护生在参与患者关怀需求调查中的真实体验,为护生教学管理工作提供参考。方法采用质性研究中的现象学研究方法 ,分析12名护生在实习初期参与患者关怀需求调查过程的真实体验。结果通过运用对照、归纳等方法 ,提炼出"提高了沟通能力","理解、同情患者,提高了人文关怀能力","提高了心理承受能力和应对能力","提高职业认同感"4个主题。结论护生在实习初期面临诸多压力和挑战,通过组织实习护生参与患者关怀需求调查,培养了护生的沟通能力和人文关怀意识,提高了心理承受能力和职业认同感,促使护生尽快适应临床护理工作。     

从临床教师视角分析本科护生人文关怀能力及影响因素

目的了解临床护理教师对本科护生人文关怀能力现状及其影响因素的主观感受,旨在为提升护生人文关怀能力提供参考。方法对12名临床护理教师进行深度访谈,应用诠释现象研究方法对资料进行整理分析并提炼主题。结果本科护生的人文关怀能力不足,与生活环境、自身素质、临床实习环境、受教育环境等有关。结论教育者应从营造良好人文环境、加大人文课程的设置比例、注重对护生综合素质的培养、丰富临床实践教学形式等方面加大对护生人文关怀能力的培养,为建立优秀的护理人才储备奠定基础。     

运用知信行模式对护生进行护理人文关怀教学的研究

目的研究运用知信行模式对护生进行护理人文关怀教学的效果。方法从知识、信念与行为三方面对136名护生进行为期4周的护理人文关怀教学,比较培训前后护生人文关怀能力及患者对护士人文关怀满意度。结果培训后护生人文关怀能力评分及住院患者对护生人文关怀护理满意度显著高于培训前(均P0.01)。结论知信行模式对护生进行人文关怀护理教学可提高护生人文关怀护理能力和患者对护生的人文关怀护理满意度,增加护生的工作成就感和自信心。     

本科男护生人文关怀能力的培养

目的提高本科男护生人文关怀能力。方法将男女护生各80名分为男护生组和女护生组,女护生组按常规授课,男护生组在此基础上开设护理人文选修课、相关课程增加专项学时等进行人文关怀能力培养。采用人文关怀能力量表评价效果。结果培训后男护生人文关怀能力显著提升(均P0.01);培训前显著低于女护生组(均P0.01),培训后与女护生组比较,差异无统计学意义(均P0.05)。结论对男护生实施人文关怀能力培养可有效提高其人文关怀能力。     

护生人文关怀品质影响因素调查分析

目的分析影响在校护生人文关怀品质形成的因素,为培养护生人文关怀品质提供参考。方法采用方便抽样,运用护生人文关怀品质量表对1 218名在校护生进行问卷调查。以护生人文关怀品质总分作为应变量,以护生的一般情况及相关因素作为自变量,采用多元线性回归进行统计分析。结果护生人文关怀品质总得分为116.86±17.02,与护生学历、年级、是否为独生子女、是否接受人文关怀教育、来自母亲和同学的关怀6个因素有相关性(P<0.05,P<0.01)。结论护生人文关怀品质为中等水平。加强人文关怀教育、营造关爱的环境、注重对独生子女的关怀教育是提高护生人文关怀品质的有效途径。     

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.     

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.