Molecular modeling in cardiovascular pharmacology: Current state of the art and perspectives

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失血性休克紧急手术模拟演练在新入职护士培训中的应用效果分析

目的:探讨失血性休克紧急手术模拟演练在新入职护士培训中的应用效果。方法:选取2019年医院外科手术室新入职护士31人为对照组,另选2020年医院新入职护士31人为观察组,对照组实施常规培训方法,观察组在对照组基础上实施失血性休克紧急手术模拟演练,比较两组应用效果。结果:干预后观察组护士急救相关核心制度、急救抢救药物知识、抢救流程、紧急手术各类应急预案评分均高于对照组(P<0.05);干预后观察组护士除颤仪、呼吸机、心肺复苏仪、徒手心肺复苏操作技能评分均高于对照组(P<0.05);干预后观察组护士抢救配合能力、案例分析能力、应急处理能力、学习兴趣、沟通能力评分均高于对照组(P<0.05);观察组护士工作能力优良率为96.77%,高于对照组的70.97%(P<0.05)。结论:失血性休克紧急手术模拟演练应用于新入职护士培训中,不仅可有效提高其理论知识水平、操作技能及综合能力,还能提高其工作能力优良率。     

外柱细胞软化对Corti器感音影响的生物力学研究

Corti器的感音过程容易受到内部结构属性变化的影响。外柱细胞血管舒张刺激磷蛋白缺失会减缓肌动蛋白丝的形成,从而产生听力延迟。本研究运用COMSOL建立三维有限元模型研究肌动蛋白缺失导致外柱细胞软化时,Corti器感音过程中基底膜和外毛细胞与Deiters细胞结合点的力学行为变化。结果表明,外柱细胞软化会削弱外毛细胞主动力对基底膜位移增益的放大作用,但削弱作用并不会立即产生,Corti器存在维持正常功能的"缓冲"阶段。在100 dB和120 dB之间可能存在一个声压级临界值,在该临界值两侧外柱细胞软化对基底膜应力变化的影响是截然相反的。另外外柱细胞软化对不同外毛细胞与Deiters细胞结合点力学行为的影响也不同,位移增益优先级会因此产生改变。     

Hands-On Training in a Digital World: A Novel Simulation-Based Virtual Training Program for Placement and Removal of the Subdermal Contraceptive Implant

ObjectiveThe COVID-19 pandemic necessitated a shift from traditional in-person instruction for learning new technical skills to virtual delivery of medical education training. The objectives of this study were to develop and evaluate a virtual simulation-based training program for Canadian health care professionals (HCPs) on the insertion, localization, and removal of the etonogestrel subdermal contraceptive implant.MethodsA scientific committee of Canadian family planning experts developed a 2-part virtual training program during the COVID-19 pandemic. Core educational content (part 1) was provided in an asynchronous, self-directed, online format. Part 2 consisted of synchronous, simulation-based training using web conferencing. The HCPs were provided with model arms and placebo applicators; the trainers demonstrated implant insertion and removal techniques, and trainees received individual feedback. All trainees were asked to complete an online evaluation upon completion of the program.ResultsBetween September 22, 2020, and December 31, 2021, 83 trainers conducted 565 virtual training sessions. A total of 3162 HCPs completed part 1 of the training program, of whom 2740 had completed part 2 by December 31, 2021. Participants reported high levels of satisfaction with virtual simulation-based training; 96.5% of respondents (1570/1627) agreed that the virtual format was effective. Additional training prior to inserting the implant in clinical practice was requested by 4.5% of respondents (75/1671).ConclusionVirtual simulation-based learning provides effective education and technique training for etonogestrel implant insertion and removal. Online training for implant use can be scaled, as needed, to reach professionals in remote or underserved locations. This virtual training approach may be appropriate for other technical or minor surgical procedures.     

Event Documentation and Transfer of Care After Severe Contrast Reactions

PurposeRadiology residencies are increasingly using clinical simulation to teach contrast reaction management. The aim of this study was to evaluate resident documentation of management and transfer of care in severe contrast reactions after a clinical simulation.MethodsAfter a high-fidelity mannequin simulation of contrast-induced anaphylactic shock, residents (n = 18) were asked to document the event in a progress note and transfer care to a receiving medical team. A total of 22 prospectively determined criteria were selected, and notes were analyzed by a blinded reviewer.ResultsNotes contained between 12 and 21 of the prospectively determined 22 criteria (54%-95%). The median number of criteria contained in a note was 16. None of the notes fulfilled all 22 criteria. However, consistent deficiencies were found in documenting prior reaction to contrast (28%) and transfer-of-care criteria (22%-44%).ConclusionsAlthough standards for the documentation of advanced cardiovascular life support codes and other emergencies have been devised, no such standards exist for documentation in the management of contrast reactions. The results of this study suggest the need to develop a standardized documentation system for severe contrast-induced reactions. Education regarding transfer of care and documentation should be emphasized during clinical simulation.     

Model-based clinical drug development in the past,present and future: a commentary

Clinical drug development remains a mostly empirical, costly enterprise, in which decision-making is often based on qualitative assessment of risk, without properly leveraging all the relevant data collected throughout the development programme. Model-based drug development (MBDD) has been proposed by regulatory agencies, academia and pharmaceutical companies as a paradigm to modernize drug research through the quantification of risk and combination of information from different sources across time. We present here a historical account of the use of MBDD in clinical drug development, the current challenges and further opportunities for its application in the pharmaceutical industry.     

Theoretical Methods of Domain Structures in Ultrathin Ferroelectric Films: A Review

This review covers methods and recent developments of the theoretical study of domain structures in ultrathin ferroelectric films. The review begins with an introduction to some basic concepts and theories (e.g., polarization and its modern theory, ferroelectric phase transition, domain formation, and finite size effects, etc.) that are relevant to the study of domain structures in ultrathin ferroelectric films. Basic techniques and recent progress of a variety of important approaches for domain structure simulation, including first-principles calculation, molecular dynamics, Monte Carlo simulation, effective Hamiltonian approach and phase field modeling, as well as multiscale simulation are then elaborated. For each approach, its important features and relative merits over other approaches for modeling domain structures in ultrathin ferroelectric films are discussed. Finally, we review recent theoretical studies on some important issues of domain structures in ultrathin ferroelectric films, with an emphasis on the effects of interfacial electrostatics, boundary conditions and external loads.