脂联素减轻心脏骤停后综合征小鼠脑损伤的机制研究

目的 在建立心脏骤停后综合征(PCAS)小鼠模型的基础上,探究脑组织神经细胞凋亡与炎症介质TNFα、IL-6的关系,以及经尾静脉注射脂联素(Adiponectin,APN)后,能否减少炎症介质释放,从而减轻神经细胞凋亡损伤。方法 将60只小鼠随机分为3组:心脏骤停后综合征组(PCAS组)、脂联素干预组(APN组)及对照组(C组)。使用经食道交流电诱发室颤导致心脏骤停,再经心肺复苏恢复自主循环的方式建立PCAS小鼠模型。APN组和PCAS组在自主循环恢复(ROSC)后,通过尾静脉分别注射10μg APN溶液0.25ml和等体积无菌生理盐水,分别在ROSC后第0.5、3、6、12h采集标本,采用TUNEL染色检测脑组织神经细胞凋亡情况; 免疫组化法半定量检测脑组织中TNFα、IL-6表达情况。结果 1PCAS组小鼠的脑组织出现噬神经、神经元细胞凋亡,脑组织内TNFα、IL-6表达增加。2PCAS后神经细胞凋亡数与TNF-α、IL-6之间具有正相关性(P<0.05)。3APN减少ROSC后脑组织的细胞凋亡,减轻脑组织内TNFα、IL-6的表达。结论 PCAS后小鼠脑组织中炎症因子TNFα、IL-6的释放导致脑组织神经细胞凋亡。APN可通过降低ROSC后小鼠脑组织中TNFα及IL-6的表达而减轻神经细胞凋亡。     

Relate better and judge less: Poverty simulation promoting culturally competent care in community health nursing

The study aim was to evaluate the effectiveness of a poverty simulation in increasing understanding of and attitudes toward poverty and resulting in changes in clinical practice among nursing seniors. A poverty simulation was conducted using a diverse group of nursing professors and staff from local community agencies assuming the role of community resource providers. Students were assigned roles as members of low-income families and were required to complete tasks during a simulated month. A debriefing was held after the simulation to explore students' experiences in a simulated poverty environment. Students' understanding of and attitude toward poverty pre- and post-simulation were examined. Changes in the students' clinical experiences following the simulation were summarized into identified categories and themes. The poverty simulation led to a greater empathy for the possible experiences of low income individuals and families, understanding of barriers to health care, change in attitudes towards poverty and to those living in poverty, and changes in the students' nursing practice. Use of poverty simulation is an effective means to teach nursing students about the experience of living in poverty. The simulation experience changed nursing students' clinical practice, with students providing community referrals and initiating inter-professional collaborations.     

Cost Savings of Frequent,Concise Skills Competency Training in the Emergency Department

Nurse educators are confronted with ensuring skills competency and staff compliance to support the provision of safe and quality care. The ED setting presents additional challenges when conducting skills competency training. One military hospital’s emergency department implemented a method of frequent, concise skills training sessions to overcome barriers unique to the ED setting; the same method was then implemented at a second military organization owing to the effectiveness of the training approach to increase staff compliance. This article outlines the methods for the implementation of frequent, concise skills training sessions, and it displays the cost savings and increased compliance experienced by the 2 health care organizations after the implementation of this frequent, concise skills training method.