Use of a Checklist During Observation of a Simulated Cardiac Arrest Scenario Does Not Improve Time to CPR and Defibrillation Over Observation Alone for Subsequent Scenarios

Theory: Immersive simulation is a common mode of education for medical students. Observation of clinical simulations prior to participation is believed to be beneficial, though this is often a passive process. Active observation may be more beneficial. Hypotheses: The hypothesis tested in this study was that the active use of a simple checklist during observation of an immersive simulation would result in better participant performance in a subsequent scenario compared with passive observation alone. Methods: Medical students were randomized to either passive or active (with checklist) observation of an immersive simulation involving cardiac arrest prior to participating in their own simulation. Performance measures included time to cardiopulmonary resuscitation (CPR) and time to defibrillation and were compared between first and second scenarios as well as between passive and active observers. Results: Seventy-nine simulations involving 232 students were conducted. Mean time to CPR was 18 seconds (SD = 11.6) for those using the checklist and 24 seconds (SD = 15.8) for those who observed passively (M difference = 6 seconds), t(35) = 1.46, p =.153. Time to defibrillation was 94 seconds (SD = 26.4) for those using the checklist and 92 seconds (SD = 23.8) for those who observed passively (M difference = –2 seconds), t(38) =.21, p =.837. Time to CPR was 24 seconds (SD = 15.8) for passive observers and 31 seconds (SD = 21.0; M difference = 7 seconds), t(35) = 1.13, p =.265, for their first scenario counterparts. Time to CPR was 18 seconds (SD = 11.6) for active observers and 36 seconds (SD = 26.2; M difference = 18 seconds), t(24) = 2.81, p =.010, for their first scenario counterparts. Time to defibrillation was 92 seconds (SD = 23.8) for passive observers and 125 seconds (SD = 32.2; M difference = 33 seconds), t(33) = 3.63, p =.001, for their first scenario counterparts. Time to defibrillation was 94 seconds (SD = 26.4) for the active observers and 132 seconds (SD = 52.9; M difference = 38 seconds), t(28) =.46, p =.008, for their first scenario counterparts. Conclusions: Observation alone leads to improved performance in the management of a simulated cardiac arrest. The active use of a simple skills-based checklist during observation did not appear to improve performance over passive observation alone.     

洛索洛芬钠片辅助治疗骨关节炎的疗效及不良反应

目的探讨洛索洛芬钠片辅助治疗骨关节炎的效果及不良反应。方法选择2018年1月至2020年1月郑州市骨科医院收治的150例确诊为骨关节炎的患者作为观察对象,根据治疗方式不同分为观察组和对照组,每组75例。对照组基于玻璃酸钠注射液治疗,每周行关节腔内注射25 mg,5次为1疗程,共治疗2个疗程。观察组在此基础上联合洛索洛芬钠片,每次60 mg,每天3次,持续治疗10周。比较治疗前后两组患者关节滑液肿瘤坏死因子、细胞白介素水平;患者疼痛程度、膝关节功能以及不良反应情况。结果观察组治疗有效率为97.33%(73/75),对照组为84.00%(63/75),差异有统计学意义(P<0.05)。治疗前,两组之间的VAS和WOMAC评分比较差异未见统计学意义(P>0.05)。治疗后观察组膝关节疼痛和疼痛的改善优于对照组(P<0.05)。治疗前两组患者的白细胞介素-1β(IL-1β),白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平比较差异未见统计学意义(P>0.05),治疗后观察组上述炎性因子水平低于对照组(P<0.05)。观察组不良反应发生率为2.67%(2/75),低于对照组(12%,9/75),差异有统计学意义(P<0.05)。结论洛索洛芬钠片能有效患者患者疼痛和膝关节症状,提高患者治疗效果且疗效确切,值得借鉴。     

情景模拟健康教育在晚期肺癌患者癌痛管理中的应用

目的 探讨情景模拟健康教育在晚期肺癌患者癌痛管理中的应用效果，旨在提高晚期肺癌患者提高癌痛应对和管理能力。方法 采用便利抽样法，选取2019年5月-2020年5月在同济大学附属上海市肺科医院肿瘤科住院的晚期肺癌患者60例为研究对象，按其住院时间先后顺序分为对照组（n=30）和观察组（n=30）。对照组患者给予肺癌常规护理及健康教育，观察组在其基础上给予情景模拟健康教育干预，主要围绕正确认识癌痛、癌痛自我评估、癌痛应对、躯体功能应对和负性心理情绪调试等展开。分别于患者入院第1天及第7天评估患者疼痛管理效能及情绪状况。结果 入院第1天，两组患者慢性疼痛自我效能感量表和中文版简式-简明心境问卷得分组间比较，差异无统计学意义（P＞0.05），入院第7天，组间比较有统计学差异（P＜0.05）。结论 情景模拟健康教育可有效提高晚期肺癌患者疼痛管理自我效能，改善患者负性心理情绪，进而提高其生活质量，值得临床进一步应用和推广。     

Using Simulation to Educate Rural NP students About Cultural Congruence

Between 2000 and 2010, the Hispanic population grew by 44% in rural areas. This community faces barriers to health care. Future nurse practitioners must be educated to provide culturally competent care for patients and families in a primary care setting. A simulation-based learning experience was used evaluate learning modules regarding rural health and Spanish language and culture. A “1 group: pretest–posttest” preexperimental design using the Transcultural Self-Efficacy Tool (TSET) was used to obtain quantitative and qualitative data from nurse practitioner students participating in a simulation-based learning experience to measure students’ self-perceptions of cross-cultural competence. All TSET measures achieved Cronbach’s alpha values of 0.98 or higher.     

Obstetric emergencies

For more than 60 years the Confidential Enquiry into Maternal Deaths triennial reports and later reports from Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) have helped build a picture of maternity care within the UK highlighting not only our successes but failures in caring for women within the puerperal period. Despite most obstetric emergencies being well described and having clear management strategies and guidance, there continues to be substandard management with poor outcomes recorded. This article describes some common obstetric emergencies with which the anaesthetist will become involved. It emphasizes management related to some deficiencies identified in the MBRRACE-UK report as well as highlighting a multidisciplinary approach throughout. Good communication between team members is paramount in all aspects of medical care but this approach should be fostered routinely to ensure that rapid and appropriate decisions are made in a safe and timely manner.     

经颅磁刺激的多尺度建模仿真研究

经颅磁刺激是一种无创无痛的电磁刺激手段，被广泛应用于神经调控，在临床上对多种精神疾病和神经类疾病有明显的治疗效果。本文从电磁场建模仿真，细胞跨膜电位建模仿真，以及神经元响应建模仿真3个方面对经颅磁刺激多尺度建模仿真研究进行了详细的综述，并提出现阶段存在的问题以及对未来的展望。经颅磁刺激的多尺度建模仿真对磁刺激仪的设计开发具有指导意义，对磁刺激的导航系统提供重要的理论基础，有助于我们更好的理解电磁刺激的神经调控机制。