Pharmacokinetic modeling and simulation of etodolac following single oral administration in dogs

1. Etodolac is a nonsteroidal anti-inflammatory drug with selective cyclooxygenase-2 inhibition to treat pain and inflammation associated with osteoarthritis in humans and dogs. The aim of the study was to investigate the pharmacokinetics of etodolac following single oral administration of 200?mg to 10 healthy beagle dogs.

2. The plasma concentrations of etodolac were detected using liquid chromatography-tandem mass spectrometry. Pharmacokinetic analysis was conducted using the noncompartmental method and modeling approaches.

3. Etodolac was rapidly absorbed (T_max?=?0.85?h, K_a?=?1.49?h^?1) and slowly eliminated (T_1/2?=?39.55?h) following oral administration to the dogs. A two-compartment pharmacokinetic model with first-order absorption and elimination rate constants was successfully explained for the pharmacokinetic aspects of etodolac in dogs. From a Monte Carlo simulation (1000 repetitions), the accumulation index and AUC_τ at steady state were predicted as 1.60 [90% confidence intervals (CI), 1.24–2.81] and 408.18?ng·hr/mL [90% CI, 271.26–590.58?ng·hr/mL], respectively.

4. This study will help to enact a more accurate optimal dosing regimen of etodolac in dogs with osteoarthritis, and may be useful in developing a novel formulation of etodolac for human in the future.

     

情境模拟案例教学法在护士规范化培训中的应用效果

目的研究情境模拟案例教学法在护士规范化培训中的应用效果。方法选择2017年8月-2018年7月在医院外科系统进行规范化培训的护士60名作为对照组,接受常规模式的规范化培训;而选择2018年8月-2019年7月进行规范化培训的护士60名作为研究组,在规培期间引入情境模拟案例教学法。规培结束后,考核并比较两组规培护士的理论知识和临床护理操作,测评规培护士的评判性思维能力,调查规培护士对规培模式的满意度。结果对照组的理论知识和临床护理操作的得分分别是(86.7±7.5)分、(82.8±8.7)分,而研究组的得分则分别是(91.3±8.4)分、(87.5±8.1)分;与对照组相比,研究组护士对理论知识的掌握和临床护理操作技能更强(P<0.05)。与对照组相比,研究组规培护士具有更强的批判性思维能力(P<0.05)。而且,研究组护士对情境模拟案例教学模式的满意度要优于对照组(P<0.05)。结论情境模拟案例教学法在护士规范化培训中效果较好,可显著提高规培护士的理论及实践操作的综合能力以及评判性思维能力。     

虚拟仿真实验教学项目在临床医学等专业学生培养中的应用

合理设置课程对于人才培养质量起到关键性作用。在临床医学人才培养的课程体系中融入虚拟仿真实验教学项目，是人才培养以及信息化与高等教育实践教学深度融合的内在要求。基于我校虚拟仿真实验教学的开展情况，对虚拟仿真实验教学项目如何在医学生培养中发挥作用进行归纳和总结，包括如何选择虚拟项目，如何融入课程体系等，并以问卷等方式对其教学效果进行调查。结果显示：大部分学生认为虚拟仿真实验教学项目的应用有助于知识的拓展，有助于提升学习效果，有助于培养临床医学人才的临床思维和科研素质，有助于培养自主学习和终身学习能力，有助于掌握信息技术等相关技能。但如何更好地实现虚实融合等问题值得我们进一步的探索和研究。     

Local Leaders' Perspectives on Women Veterans’ Health Care: What Would Ideal Look Like?

Background

The Veterans Health Administration (VHA) faces challenges in providing comprehensive, gender-sensitive care for women. National policies have led to important advancements, but local leadership also plays a vital role in implementing changes and operationalizing national priorities. In this article, we explore the notions of ideal women veterans' health care articulated by women's health leaders at local VHA facilities and regional networks, with the goal of identifying elements that could inform practice and policy.

Monte Carlo based analysis and evaluation of energy spectrum for low-kV IORT spherical applicators

Low-kV IORT is an increasing modality for breast cancer treatment. Soft X-rays from INTRABEAM (Carl Zeiss Meditec AG, Oberkochen, Germany), a dedicated IORT device along with special spherical applicators are employed for this purpose. A Monte Carlo model of INTRAMBEAM and spherical applicators are introduced in the current study to evaluate the dosimetric and physical characteristics of emitted X-rays from the bare probe and different applicator diameters.X-ray probe and different applicator diameters of 1.5 cm to 5 cm were simulated by GEANT4 Monte Carlo Toolkit. Then, the validity of the simulated model was evaluated by comparing the Monte Carlo based PDD (percentage depth dose) and anisotropy data with those reported by the manufacturer. Finally, the physical characteristics of X-rays such as the mean and most probable energy as well as the LET of secondary electrons were obtained and analyzed.There was a good agreement between the simulated and reported PDDs for bare probe and different applicator diameters. The anisotropy values were also within an exemplary range reported by the manufacturer. The X-ray mean energy shifts from 25.6keV to 28.6keV with variations of applicator diameter. The maximum variation of the secondary electron LET was 9% with changing the applicator diameter.The usefulness of GEANT4 Toolkit for Monte Carlo based commissioning of INTRABEAM machine was confirmed in the current study. The variations of the applicator diameter slightly changed the physical characteristics of low-kV X-rays and LET of secondary electrons which cannot considerably affect the relative biologic effectiveness (RBE) for different applicator diameters.     

数字虚拟仿真系统在普通外科教学中的应用

目的探讨数字化虚拟仿真系统(DVSS)在普外科临床教学及技能培训中的应用效果。方法选取锦州医科大学基础学院2015级五年制本科四个班级共140人,按自然班级分组,两班一组,实验组70人实行数字化虚拟仿真系统与传统外科学教学结合教学,对照组70人只进行传统外科学教学。比较两组学生掌握理论知识及对外科手术的认知情况,并通过问卷调查了解学生对两种教学方式的评价。结果实验组与对照组学生考核成绩比较,实验组显著高于对照组,两组统计学数据有明显差异(P<0.05);实验组学生教学评价满意率明显高于对照组,差异有统计学意义(P<0.05)。结论数字化虚拟仿真系统能提高学生的知识储备和综合能力,达到更好的学习效果,在普外科临床教学及技能培训中的作用显著。     

基于团队定位分工模式的情景模拟培训在心肺复苏中的应用

目的探讨基于团队定位分工模式的情景模拟教学在心肺复苏实践中的应用。方法将57名护士按能级及专科技能分A,B,C 3个级别,不同级别的3名护士与1名医生组成的4人抢救小组,进行团队式情景模拟心肺复苏培训,比较实施前后抢救小组开始心肺复苏到建立静脉通路、连接心电监护建立人工气道、首次给入复苏药物的时间以及危重患者抢救质量评分;医生对护士抢救的综合满意度,护士对工作的满意度情况。结果培训后建立静脉通路、连接心电监护、建立人工气道以及首次给入复苏药物的时间较培训前均明显缩短,危重患者抢救质量检查评分明显提高,差异有统计学意义(P<0.05);医生对护士抢救的综合满意度提高,护士对工作满意度由85.97%提高到95.26%。结论基于团队定位分工模式情景模拟教学的实施有利于提高护士的团队配合能力,缩短各项抢救措施的落实时间,提高医生对护士抢救的综合满意度,以及护士对工作的满意度。     

Evaluación de la efectividad de la versión en español de un curso de comunicación de malas noticias

IntroductionGood communication by health professionals is associated with better patient outcomes. The Program to Enhance Relational and Communication Skills (PERCS) has been adapted to other cultures. The objective of this study is to describe the effectiveness of the Spanish version of the PERCS program, from the perspective of the participants, at the end of the course and 6 months after the course.MethodsA process of cultural and epidemiological adaptation of the PERCS program to the reality of Peru was carried out. A qualitative and quantitative approach was used to evaluate the educational impact of the program.ResultsThirty-nine professionals participated voluntarily. Participants found it more difficult to communicate ominous diagnoses (48.15%). Anxiety is the most frequent emotion when faced with difficult communications (77.78%). Almost all (92%) stated that the course improved their preparation, and 88.9% that it reduced their anxiety. At 6 months, participants recognised the importance of honesty and empathy, as well as some steps in conducting the patient-centred interview.DiscussionAn intensive training program in difficult communication can be adapted to Spanish, and positively impact the skills, self-confidence, and self-perception of learning in Peruvian professionals, in relation to promoting communication focused on the needs of the patient and family.     

High-resolution simulation of B0 field conditions in the human heart from segmented computed tomography images

B₀ inhomogeneity leads to imaging artifacts in cardiac magnetic resonance imaging (MRI), in particular dark band artifacts with steady-state free precession pulse sequences. The limited spatial resolution of MR-derived in vivo B₀ maps and the lack of population data prevent systematic analysis of the problem at hand and the development of optimized B₀ shim strategies. We used readily available clinical computed tomography (CT) images to simulate the B₀ conditions in the human heart at high spatial resolution. Calculated B₀ fields showed consistency with MRI-based B₀ measurements. The B₀ maps for both the simulations and in vivo measurements showed local field inhomogeneities in the vicinity of lung tips with dominant Z3 spherical harmonic terms in the field distribution. The presented simulation approach allows for the derivation of B₀ field conditions at high spatial resolution from CT images and enables the development of subject- and population-specific B₀ shim strategies for the human heart.