Managed Migration: The Caribbean Approach to Addressing Nursing Services Capacity

Objective. To (1) provide a contextual analysis of the Caribbean region with respect to forces shaping the current and emerging nursing workforce picture in the region; (2) discuss country-specific case(s) within the Caribbean; and (3) describe the Managed Migration Program as a potential framework for addressing regional and global nurse migration issues.
Principal Findings. The Caribbean is in the midst of a crisis of shortages of nurses with an average vacancy rate of 42 percent. Low pay, poor career prospects, and lack of education opportunities are among the reasons nurses resign. Many of these nurses look outside the region for job opportunities in the United Kingdom, Canada, the United States, and other countries. Compounding the situation is the lack of resources to train nurses to fill the vacancies. The Managed Migration Program of the Caribbean is a multilateral, cross-sector, multi-interventional, long-term strategy for developing and maintaining an adequate supply of nurses for the region.
Conclusions. The Managed Migration Program of the Caribbean has made progress in establishing regional support for addressing the nursing shortage crisis and developing a number of interesting initiatives such as training for export and temporary migration. Recommendations to move the Managed Migration Program of the Caribbean forward focus on advocacy, integration of the program into regional policy decisions, and integration of the program with regional health programming.     

Nurse Migration: A Canadian Case Study

Objective. To synthesize information about nurse migration in and out of Canada and analyze its role as a policy lever to address the Canadian nursing shortage.
Principal Findings. Canada is both a source and a destination country for international nurse migration with an estimated net loss of nurses. The United States is the major beneficiary of Canadian nurse emigration resulting from the reduction of full-time jobs for nurses in Canada due to health system reforms. Canada faces a significant projected shortage of nurses that is too large to be ameliorated by ethical international nurse recruitment and immigration.
Conclusions. The current and projected shortage of nurses in Canada is a product of health care cost containment policies that failed to take into account long-term consequences for nurse workforce adequacy. An aging nurse workforce, exacerbated by layoffs of younger nurses with less seniority, and increasing demand for nurses contribute to a projection of nurse shortage that is too great to be solved ethically through international nurse recruitment. National policies to increase domestic nurse production and retention are recommended in addition to international collaboration among developed countries to move toward greater national nurse workforce self sufficiency.     

醒脑静注射液治疗肺性脑病31例疗效分析

目的 :探讨醒脑静注射液治疗肺性脑病的临床疗效。方法 :采用随机分组对照法 ,将 6 1例肺性脑病患者分为加用醒脑静组 (治疗组 ) 31例和单纯西药治疗组 (对照组 ) 30例 ,进行疗效对比分析。结果 :治疗组治愈12例 ,有效 15例 ,总有效率 87.10 % ;对照组治愈 5例 ,有效 16例 ,总有效率 70 .0 % ,2组疗效差异有显著性(P<0 .0 5 )。从时效关系看 :治疗组对意识障碍的起效时间〔(72 .0 0± 33.94 )小时〕明显快于对照组〔(117.71± 34.70 )小时 ,P<0 .0 1〕,表现为促醒时间短 ,意识恢复正常快 ,并能达到镇静安神的作用 ;从改善原发病症状、体征及血气指标看 :治疗组在改善头痛、失眠、多语、幻觉、谵妄、狂躁及喘憋等症状方面明显优于对照组 (P<0 .0 5 ) ,对降低 Pa CO2 效果亦明显优于对照组 (P<0 .0 1)。结论 :醒脑静注射液具有开窍醒脑、行痰通瘀、镇静止痉和清热解毒等功效 ,是防治肺性脑病的安全、有效药物。     

益肾化浊注射液对慢性肾功能衰竭大鼠残余肾中细胞因子含量的影响

通过观察益肾化浊注射液对5／6肾切除大鼠残余肾中细胞因子含量的影响，益肾化浊注射液延缓慢性肾功能衰竭（CRF）模型大鼠肾功能减退的作用机理。结果显示：益肾化浊注射液可以降低5／6肾切在鼠血清肌,尿素氮（P＜0．01），下调肾组织中白细胞介素－1（IL－1）（P＜0．05），白细胞介素－8（IL－8）（P＜0．05）及肿瘤坏死因子（TNF）（P＜0．05）的总体水平，说明益肾化浊注射液可以通过下调5／6肾切除大鼠残余肾中相关细胞因子含量，抑制促炎细胞因子对肾脏的损害，从而延缓CRF的进展。     

假腔内注射凝血酶治疗股动脉假性动脉瘤(附6例临床分析)

目的：探讨超声引导下假腔内注射凝血酶对股动脉假性动脉瘤的治疗效果。方法：对本科1999年9月－2002年8月行心脏介入诊疗后并发的6例右侧股动脉假性动脉瘤进行假腔内凝血酶注射治疗，并对其结果进行了分析。结果：6例患者均即刻治疗成功，未见明显并发症，随访30d无复，结论：假腔内注射血酶是一种安全，简便，快速，耐受性佳，经济和有效的治疗股动脉假性动脉瘤的方法。     

Local analgesic and vascular effects of intradermal ropivacaine and bupivacaine in various concentrations with and without addition of adrenaline in man

Ropivacaine, a new long–acting amino–amide local anaesthetic agent, and bupivacaine, in various concentrations with or without addition of adrenaline, were tested in a randomized, double–blind study using intradermal wheals. Ten non–smoking, healthy, young male volunteers participated. In series I plain solutions of ropivacaine (0.25%, 0.5%, 0.75% and 1%) and bupivacaine (0.25%, 0.5% and 0.75%) were injected intradermally and in series II the same concentrations, with the addition of adrenaline 5 ug ml^-1 ( 1 :200 000), were used. The same volunteers took part in both series, with an interval of at least three weeks between the experiments. Saline was included as control in both series. Pin–pricking was used to assess the dermal analgesia. Plain solutions of ropivacaine produced significantly longer durations of dermal analgesia than did plain solutions of bupivacaine, in all tested concentrations. A significant increase in duration was seen for both local anaesthetics when adding adrenaline. Local vascular effects at the injected areas were determined by visual inspection (nil, pink, pale). Local blanching (pale) was significantly more frequent for plain solutions of ropivacaine, in all tested concentrations. Local redness (pink) was significantly more frequent with plain bupivacaine, in a dose–dependent relation. An initial redness was frequently observed for both local anaesthetics containing adrenaline, followed by blanching at most sites.     

四季鹅下丘脑单位放电的研究

实验利用慢性微电极技术观察了清醒活动四季鹅(产蛋期鹅和休产期鹅)下丘脑细胞自发放电及第Ⅱ脑室注入去甲肾上腺素(NE)对单位放电的影响.结果表明无论是产蛋期鹅还是休产期鹅.其下丘脑放电均以中频为主,但产蛋期鹅高频放电高于休产期鹅.放电有单个连续、束状、组群式等3种形式,无论是产蛋期鹅还是休产期鹅,其下丘脑均以单个连续放电为主,但产蛋期鹅组群式放电高于休产期鹅.第Ⅱ脑室注入NE后,75%的单位放电数增加,25%的单位放电数减少.     

提高抗肝癌药物的肝脏浓度并降低心脏,血液浓度的实验研究

实验研究结果表明：阿霉素（ＡＤＭ）在采用推进法注射时，经肝血管或外周静脉途径二者的肝、心与血液浓度均无显著差别．如采用控速缓慢输注法，则经肝血管较经外周静脉在提高肝脏浓度方面具有显著效果，心脏内浓度也有一定程度降低。如在肝血管内输注时与血液净化联合应用，则更能提高上述要求。以上结果将为临床抗癌药介入治疗应用方法的开展提供依据和参考价值。     

黄芪注射液治疗心力衰竭46例临床观察

目的　探讨黄芪注射液对心力衰竭 (HF)的治疗效果。方法　选择 92例住院HF患者随机分为治疗组和对照组 ,对照组给予常规治疗 ,治疗组在常规治疗的基础上给予黄芪注射液 30ml加 5 %葡萄糖液 2 5 0ml,静滴 ,每日一次 ,共 2周。疗程结束后 ,观察心功能改善情况。结果　治疗组有效率 93.4 8% ,对照组有效率 71.74 % ,两组对比 ,差异显著 (P <0 .0 1)。结论　黄芪注射液对HF的治疗效果佳 ,副作用少 ,值得推广。     

灯盏花素合力源精纯溶栓酶治疗不稳定型心绞痛30例

目的 :观察灯盏花素、力源精纯溶栓酶治疗不稳定型心绞痛 (UAP)的临床疗效。方法 :将 6 0例 UAP患者随机分为治疗组和对照组各 30例。治疗组给予灯盏花素、力源精纯溶酶加常规抗心绞痛治疗 ;对照组仅给予常规抗心绞痛治疗。分别观察 2组治疗前后的心绞痛发作及硝酸甘油用量的变化 ,检测静息心电图和血液流变学指标。结果 :治疗组在缓解心绞痛总有效率 (93.33% )、改善异常心电图及血液流变学指标、降低硝酸甘油用量〔(0 .4 5± 0 .15 ) m g/ d〕等方面均显著优于对照组。结论 :灯盏花素联合力源精纯溶栓酶治疗 U AP疗效优于常规西药治疗。