Do Statins have a Role in Reduction/Prevention of Post‐PCI Restenosis?

The pathophysiology of post‐PCI restenosis involves neointimal formation that consists of three phases: thrombosis (within 24 h), recruitment (3–8 days), and proliferation, which starts on day 8 of PCI. Various factors suggested to be predictors/risks for restenosis include C‐reactive protein (CRP), inflammatory mediators (cytokines and adhesion molecules), oxygen radicals, advanced glycation end products (AGEs) and their receptors (RAGE), and soluble RAGE (sRAGE). The earlier noted factors produce thrombogenesis, vascular smooth muscle cell proliferation, and extracellular matrix formation. Statins have pleiotropic effects. Besides lowering serum cholesterol, they have various other biological effects including antiinflammatory, antithrombotic, CRP‐lowering, antioxidant, antimitotic, and inhibition of smooth muscle cell proliferation. They inhibit matrix metalloproteinase and cyclooxygenase‐2, lower AGEs, decrease expression of RAGE and increase levels of serum sRAGE. They also increase the synthesis of nitric oxide (NO) by increasing endothelial NO synthase expression and activity. Preprocedural statin therapy is known to reduce peri‐ and post‐PCI myonecrosis and reduce the need for repeat revascularization. There is evidence that statin‐eluting stents inhibit in‐stent restenosis in animal models. It is concluded that because of the above attributes of statins, they are suitable candidates for reduction of post‐PCI restenosis and post‐PCI myonecrosis. The future directions for the use of statins in reduction of post‐PCI restenosis and myonecrosis have been discussed.     

Canadian Nurse Practitioner Core Competencies Identified: An Opportunity to Build Mental Health and Illness Skills and Knowledge

In 2015, the Canadian Counsel of Registered Nurse Regulators released a report that identified entry-to-practice core competencies for adult, family/all ages, and pediatric nurse practitioners (NPs) across Canada. The report is expected to guide future decisions about NP entry-to-practice examinations and allow for Canadian Counsel of Registered Nurse Regulators member organizations to develop pan-Canadian requirements for licensure. Optimistically, it could set the stage for a national approach to NP education. This is an opportune time to highlight various stakeholders' call for increased mental health education for NPs and identify challenges and promising strategies for reaching that goal.     

基于岗位胜任力的康复治疗临床带教模式的探索

目的探讨基于岗位胜任力的以学生为教学主体的SOAP病例记录模式在康复治疗学临床带教中的应用效果。方法2018年9月-2020年1月教学期间,将55名康复治疗学专业学生随机分为SOAP记录组和传统记录组,SOAP记录组由学生自己针对患者存在的功能障碍进行分析并选取合适评估项目和制定治疗计划,传统记录组在老师的指导下进行评估和治疗计划制定,实习结束后对学生的病例分析报告进行考核,比较两种病例记录模式对学生成绩的影响,并对两组学生进行满意度问卷调查。结果SOAP记录组在客观资料搜集(P=0.017)、评估(P=0.009)、计划(P=0.006)、反思(P=0.029)及总成绩部分(P=0.007),成绩均明显高于传统记录组;问卷调查结果显示,学生高度认可采用SOAP病例记录模式的教学方式,与传统记录模式相比,认为它能明显激发学习积极性(P=0.012)、提高临床操作技术(P=0.035)、规范病例报告的书写(P=0.012)、提高临床诊疗思维(P=0.030)等。结论基于岗位胜任力的SOAP病例记录模式在康复治疗临床教学中的应用效果优于传统病例记录模式。