Who is failing who? A survey exploration of the barriers & enablers to accurate decision making when nursing students’ competence is below required standards

Healthcare practice supports the achievement of programme learning outcomes for nursing students internationally. Within this context the issue of reluctance to fail nursing students, when warranted, is extensively examined within the literature with few definitive solutions emerging. Little is known about the perceived barriers that exacerbate this reluctance, or about factors that might enable and support nurses to fail students. To address this issue our study employed a non-experimental cohort study of nurses (n = 365) from two large teaching hospitals in the Republic of Ireland (ROI). Preceptors in this study clearly enjoyed their role with students, and received positive feedback from students. However, findings suggest that preceptors require more support from colleagues in providing comprehensive evidence in assessment. They also require additional training for providing negative feedback to students. A collaborative approach to competence assessment is recommended, whereby the professional burden can be borne by the team, and where students can engage in a holistic, reflective, learning experience that will ultimately improve their competence.     

川芎-天麻配伍对川芎中2种成分在大鼠脑内药动学的影响

目的探讨川芎⁃天麻配伍对川芎中川芎嗪、阿魏酸在大鼠脑内药动学的影响。方法18只大鼠随机分成川芎组、川芎⁃天麻(1∶0.25)组、川芎⁃天麻(1∶1)组,每组6只,建立血瘀型偏头痛模型。灌胃给药后,于大鼠脑内插入微透析探针,收集不同时间点脑透析液,UPLC⁃MS/MS法检测川芎嗪、阿魏酸含有量,绘制血药浓度⁃时间曲线,计算药动学参数。结果与单味药组比较,配伍组2种成分T1/2[川芎⁃天麻(1∶1)组阿魏酸除外]、MRT0~∞、Cmax、AUC0~∞升高(P<0.05,P<0.01);川芎⁃天麻(1∶0.25)组两者T1/2、MRT0~∞、AUC0~∞高于川芎⁃天麻(1∶1)组(P<0.05,P<0.01),川芎嗪Cmax降低(P<0.05)。结论天麻可提高川芎中川芎嗪、阿魏酸脑组织吸收程度,延长作用时间,减缓消除速率,增加蓄积,其作用强度与天麻剂量有关。     

Excitability of motor and sensory axons in multifocal motor neuropathy

ObjectiveTo assess excitability differences between motor and sensory axons of affected nerves in patients with multifocal motor neuropathy (MMN).MethodsWe performed motor and sensory excitability tests in affected median nerves of 20 MMN patients and in 20 age-matched normal subjects. CMAPs were recorded from the thenar and SNAPs from the 3rd digit. Clinical tests included assessment of muscle strength, two-point discrimination and joint position.ResultsAll MMN patients had weakness of the thenar muscle and normal sensory tests. Motor excitability testing in MMN showed an increased threshold for a 50% CMAP, increased rheobase, decreased stimulus-response slope, fanning-out of threshold electrotonus, decreased resting I/V slope, shortened refractory period, and more pronounced superexcitability. Sensory excitability testing in MMN revealed decreased accommodation half-time and S2-accommodation and less pronounced subexcitability. Mathematical modeling indicated increased Barrett-Barrett conductance for motor fibers and increase in internodal fast potassium conductance for sensory fibers.ConclusionsExcitability findings in MMN suggest myelin sheath or paranodal seal involvement in motor fibers and, possibly, paranodal detachment in sensory fibers.SignificanceExcitability properties of affected nerves in MMN differ between motor and sensory nerve fibers.     

朱生樑辨治难治性胃食管反流病经验撷英

介绍朱生樑教授辨治难治性胃食管反流病的经验。认为难治性胃食管反流病的辨证难点在于涉及多个脏腑,病程中又易形成内生之邪,相似证候、性质不同的病机常复合存在。提出立足主要矛盾、明辨脏腑自身及相似脏腑病机变化的特点、厘清虚实权重的辨证思路,在脏腑辨证结合气血津液辨证的基础上立法处方。并附验案2则。     

残疾预防计划对肢残者重返岗位效果的研究

目的:探讨在残疾预防计划对广东地区工伤肢残者出院后结局的影响。方法:选取2018年2~7月在我院进行工伤康复的肢残患者160例,按照入院先后顺序分为观察组和对照组各80例,对照组采取传统医疗康复措施,观察组采取传统医疗康复措施+残疾预防计划措施,观察两组干预前后就业意愿评估,在出院后进行为其三个月的随访,以出院时的就业意愿、出院后三个月内成功复工率、复工后的工作满意度作为职业康复疗效测量指标研究残疾预防计划对肢残者出院结局的影响。结果:两组样本具有可比性,两组样本在干预后的就业意愿发生变化,组间差异不显著(P>0.05);观察组在三个月内成功复工率(89.6%)高于对照组(71.8%),两组差异显著(P<0.05);两组复工人员的工作满意度无显著差异(P>0.05);多元线性回归分析显示,复工人群的工作满意度受工种及公司性质的影响。结论:残疾预防计划有助于提高肢残者出院后的复工率,但对其就业意愿及工作满意度效果不明显;工种、公司性质是肢残者复工后工作满意度的主要影响因素,可以从工种、公司性质两方面设计干预措施以提高肢残者工作满意度。     

Addressing Substance Use in Adolescents: Screening,Brief Intervention,and Referral to Treatment

Adolescent substance use is a national public health crisis. The most commonly used substances among adolescents are nicotine, alcohol, and marijuana. Use of these substances during adolescence has serious adverse effects on brain development, with impairments that can endure into adulthood. Advanced practice nurses in primary care can address substance use in the adolescent population with the use of evidence-based interventions, such as Screening, Brief Intervention, and Referral to Treatment (SBIRT). This article describes trends in adolescent substance use and use of the SBIRT intervention for low, medium, and high-risk use in this population.     

Avoiding iatrogenic vascular injury in tibial external fixation with half pins. An in-vivo study based on CT angiography

BackgroundExternal fixation is an important tool in the management of variety of tibial fractures. Appropriate half pin insertion is important, to provide stable fixation without compromising the surgical field for definitive surgical procedures, and avoiding further damage to the important structures of the traumatized limb. There is paucity of literature about the optimal trajectories and safe corridors for half pins insertion based on in vivo studies. The available studies are based on anatomic atlases, cadaveric studies or half pin related complications.The aim of the current study is to present the findings of CT angiograms, in patients with external fixation of tibia, to enhance our understanding of optimal trajectories in safe corridors for half pins insertion.Material and methodsWe performed a retrospective study of patients with external fixators on the tibia, who had undergone CT angiogram as part of pre-operative planning for orthoplastic reconstructive procedures. The relationship between the tips of the fixator half pins and named vessels of the leg were analyzed, pins within 5 mm of a named vessel were considered to be a risk of causing iatrogenic injury.ResultsA total 51 patients, with in situ temporizing external fixators, with 134 half pins in different segments of the tibia were analyzed. More than 5 mm of penetration beyond the far cortex was noted in 47%, while in another 16% of pins penetration was more than 10 mm beyond the cortex. A tip to vessel distance (TVD) of 5 mm or less was noted in 28/134 (21%) of the pins, which highlights potential risk to the neurovascular bundles of the leg.ConclusionRisk of iatrogenic injury to neurovascular structures from half pin insertion can be reduced by meticulous use of fluoroscopy, by avoiding penetration beyond the far cortex, and avoiding exiting with half pins on the lateral surface in the distal 1/3rd of segment II of tibia. Moreover observing optimal trajectories and safe corridors for pin insertion, and selection of appropriate type of half pin can mitigate the risk to these structures.