护理本科生共情及与人格的相关性研究

目的探讨护理本科生(下称护生)共情的特点及其与人格的相关性,为针对性培养护生的共情能力提供依据。方法采用一般资料问卷、人际反应指针量表(IRI-C)和大五人格量表(BFI)对184名护生进行问卷调查。结果护生IRI-C得分57.05±7.84,女护生身心忧急得分高于男护生,学生干部观点取替得分高于非学生干部,非独生子女同情关怀得分高于独生子女(P0.05,P0.01);BFI神经性、宜人性、开放性、外倾性及谨慎性5个维度评分为(12.68±4.27)～(24.55±3.91)分;IRI-C总分与BFI神经性、宜人性及开放性维度呈正相关(P0.05,P0.01)。结论护生共情水平较高,不同人口特征,人格的神经性、宜人性、开放性可影响护生共情。要加强护生的感情培训和人格健康教育,进一步提高护生共情能力。     

内蒙古地区本科护生专业认同的调查分析

目的了解内蒙古地区护理本科生专业观认同情况。方法采用问卷对内蒙古地区4所高校232名本科护生进行调查。结果本科护生总体专业观得分66.27±11.55,处于一般水平。不同年级、性别专业认同感比较,差异有统计学意义(均P0.01)。结论护生总体专业认同状况一般,高年级、男护生的专业认同感较低。卫生行政管理部门、医院、学校及护生应共同努力,积极改善和提高护理本科生专业认同感。     

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。     

我国护理本科生临床实习表现的调查

目的了解我国护理本科生临床实习表现,为提高临床实习质量提供依据。方法按比例分层从全国142所护理本科高校中抽取22所毕业实习的护理本科生(实习初期1074名,实习中期935名),采用护理本科生毕业实习临床实践行为表现自评量表进行调查。结果我国护理本科生实习初期和中期临床实习表现总分分别为(3.70±0.43)和(3.68±0.47),两者比较,差异无统计学意义(P0.05);实习初期和中期各维度得分顺序一致,得分最高的维度是专业和自我发展(4.07±0.48,3.95±0.50),得分较低的是教学指导(3.63±0.51,3.62±0.53)、临床护理(3.58±0.55,3.59±0.58)和科研(3.19±0.74,3.25±0.72);仅专业和自我发展维度得分实习初期显著高于中期(P0.01)。结论我国护理本科生在实习初期和中期临床实习表现一般;护生在遵守医院规章制度、法律法规及保护患者隐私方面表现较好,但在教学指导、整体化护理和科研方面表现相对较差,临床护理教育者要加强护理本科生这三方面的培养。     

不同层次护理本科生评判性思维能力比较

目的 比较不同层次护理本科生(下称护生)的评判性思维能力,为建立不同层次护理本科生的培养教育方式提供依据.方法 采用中文版评判性思维情感倾向问卷,对本科第二批次(本二)和本科第三批次(本三)在读2004、2005级共307名护生进行问卷调查.结果 本二和本三护生评判性思维能力总分分别为294.89±25.55和286.10±23.65,本二护生的评判性思维能力总分及各项目得分(除系统化能力及求知欲外)高于本三护生(P＜0.01,P＜0.05);各班级护生的评判性思维能力各项目得分及总分比较,差异有显著性意义(均P＜0.01).结论 护生均具有正性评判性思维倾向,不同层次护生评判性思维能力不同.护生评判性思维的养成与整个护理教育过程息息相关,护理院校应针对不同层次的护生开展教育教学方法的探讨和改革,进一步培养和提高各层次护生的评判性思维能力.     

贯穿循证理念的护理研究课程设计及教学效果评价

目的构建贯穿循证理念的《护理研究》课程并评价教学效果。方法在本科护理教育课程《护理研究》中融入循证知识和理念,采用"序贯式科研方案构建"的教学策略对232名本科护生开展教学。结果护生课程成绩为(83.23±7.33)分;教学后护生循证知识得分显著高于教学前(均P0.01);除"教学内容难度适中"外(得分3.85分),护生对教学效果的反馈得分均4分。结论贯穿循证理念的《护理研究》课程及序贯式科研方案构建的教学模式能够同步培养护生的科研能力和循证理念。     

护生对护理美学学习兴趣的调查分析

目的 探讨护生对护理美学各部分教学内容的兴趣差异,为今后护理美学的教学提供参考.方法 采用自制问卷,调查68名护理本科生和78名护理高职生对护理美学的学习兴趣.结果 146名护生对护理美学中护士职业形象美最感兴趣,得分最高(2.77±0.35),而美学基本理论得分最低(2.18±0.43).护理本科生对科学美和护理美学在护理管理中的应用2个条目的 兴趣显著高于护理高职生(均P＜0.01).结论 授课者应把握护生的心理特点,丰富护士职业形象美的授课内容,进而增强护生的专业情感;积极汲取美学专业知识,以更完美的讲解提高护生对美学基本理论等人文知识的学习兴趣.     

Research on the relationship between empathy and emotional intelligence in nursing undergraduates

目的 了解护理本科生共情状况及其与情绪智力的关系.方法 采用一般资料问卷、大学生共情量表和中文版情绪智力问卷(ESCQ)对351名护理本科生进行调查.结果 护理本科生的共情总分为99.94±12.06,不同特征(除家庭月收入外)护生共情各维度得分存在差异(P＜0.05,P＜0.01).情绪智力总分为109.26±13.60;ESCQ的情绪认知、情绪表现和情绪调节维度与共情各维度及总分呈不同程度的显著相关(P＜0.05,P＜0.01).结论 护生共情能力总体水平较高,在情绪智力上的总体表现尚好,其共情能力与情绪智力之间具有一定相关性,护理教育者应针对两者的共同点,寻找合理恰当的教育对策,在已有基础上继续培养,以提升护理本科生综合素质.     

不同层次护生资讯素养能力的比较

目的了解不同层次护生资讯素养能力的现状和差异,为高等护理院校进一步规划课程设置提供参考。方法采用护生资讯素养能力评估问卷对474名护生(本科组221名,大专组253名)进行问卷调查。结果护生资讯素养能力总体得分为(2.65±0.41)分,其中本科组得分(2.76±0.36)显著高于大专组得分(2.55±0.42)。除媒体素养外,本科组传统素养、计算机素养、网络素养3个维度得分显著高于大专组(均P0.01)。结论护生资讯素养能力总体得分处中等水平,且本科护生资讯素养能力高于大专护生。高等护理院校应重视护生资讯素养意识的培养,逐步将资讯素养融入专业课程的教与学中,发挥图书馆在培养护生资讯素养能力中的作用,从而提高其资讯素养能力。     

本科护生应变能力及与评判性思维能力的相关性分析

目的了解本科护生应变能力现状及评判性思维能力与应变能力的相关性。方法采用加利福尼亚评判性思维倾向问卷(CTDI-CV)和应变能力测试问卷,对409名本科护生进行问卷调查。结果本科护生评判性思维能力总分为290.18±24.86,应变能力得分为82.92±16.43,其中70.90%的本科护生应变能力较强。不同性别、年级本科护生的应变能力评分比较,差异有统计学意义(P0.05,P0.01),本科护生的应变能力与评判性思维能力呈正相关(P0.01)。结论本科护生的评判性思维能力和应变能力整体较强,年级、性别和评判性思维能力可影响本科护生的应变能力。     

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.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

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.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery: A randomised, double-blind, cross-over study with and without adrenaline

Background: Basic pharmacological research indicates that there are synergistic antinociceptive effects at the spinal cord level between adrenaline, fentanyl and bupivacaine. Our clinical experience with such a mixture in a thoracic epidural infusion after major surgery confirms this. The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief and side effects when removing adrenaline from this triple epidural mixture. Methods: A prospective, randomised, double-blind, cross-over study was carried out in 24 patients after major thoracic or abdominal surgery. Patients with only mild pain when coughing during a titrated thoracic epidural infusion of about 10 ml · h^?1 of bupivacaine 1 mg · ml^?1, fentanyl 2 μg · ml^?1, and adrenaline 2 μg · ml^?1 were included. On the 1^st and 2^nd postoperative days each patient was given a double-blind epidural infusion, at the same rate, with or without adrenaline. The effect was observed for 4 h or until pain when coughing became unacceptable in spite of a rescue analgesic procedure. Rescue analgesia consisted of up to two epidural bolus injections per hour and i.v. morphine if necessary. All patients received rectal paracetamol 1 g, every 8 h. Fentanyl serum concentrations were measured with a radioimmunoassay technique at the start and end of each study period. Main outcome measures were extent of sensory blockade and pain intensity at rest and when coughing, evaluated by a visual analogue scale, a verbal categorical rating scale, the Prince Henry Hospital pain score, and an overall quality of pain relief score. Results: The number of hypaesthetic dermatomal segments decreased (P <0.001) and pain intensity at rest and when coughing increased (P <0.001) when adrenaline was omitted from the triple epidural mixture. This change started within the first hour after removing adrenaline. After 3 h pain intensity when coughing had increased to unacceptable levels in spite of rescue analgesia (epidural bolus injections and i.v. morphine). Within 15–20 min after restarting the triple epidural mixture with adrenaline, pain intensity was again reduced to mild pain when coughing. Serum concentration of fentanyl doubled from 0.22 to 0.45 ng · ml^?1 (P <0.01), and there was more sedation during the period without adrenaline. Conclusions: Adrenaline increases sensory block and improves the pain-relieving effect of a mixture of bupivacaine and fentanyl infused epidurally at a thoracic level after major thoracic or abdominal surgery. Serum fentanyl concentrations doubled and sedation increased when adrenaline was removed from the epidural infusion, indicating more rapid vascular absorption and systemic effects of fentanyl.     

Utilisation des médicaments prokinétiques en réanimation : indications et limites ?

Enteral feeding is often limited by gastric and intestinal motility disturbances in critically ill patients, particularly in patients with shock. So, promotility agents are frequently used to improve tolerance to enteral nutrition. This review summaries the pathophysiology, presents the available pharmacological strategies, the clinical data, the counter-indications and the principal limits. The clinical data are poor. No study demonstrates a positive effect on clinical outcomes. Metoclopramide and erythromycin seems to be the more effective. Considering the risk of antibiotic resistance, the first line use of erythromycin should be avoided in favor of metoclopramide.