层流洁净新生儿重症监护病房早产儿实施床旁手术的可行性分析

 目的 探讨层流洁净新生儿重症监护病房(NICU)早产儿实施床旁手术的效果与可行性。方法 回顾性分析某军队三甲综合医院2017年9月—2020年10月NICU住院并进行床旁动脉导管扎闭术(PDA)及腹部探查术的危重新生儿的临床资料,在NICU行床旁手术者列为NICU组,转入手术室进行手术者列为手术室(OR)组,比较两组新生儿术后体温、切口感染率及病死率的差异。结果 共计纳入258例新生儿,其中NICU组166例,OR组92例。NICU组新生儿出生胎龄、出生体质量、手术时体质量、新生儿危重病例评分均低于OR组;NICU组新生儿术前应用呼吸机通气比例高于OR组,差异均有统计学意义(均P＜0.05)。NICU组与OR组新生儿术中抽检空气培养微生物菌落数、术前体温、PDA与剖腹探查术的构成比例、术后切口感染发病率及病死率比较,差异均无统计学意义(均P＞0.05),但手术后OR组新生儿平均体温低于NICU组,差异有统计学意义(P＜0.05)。结论 层流洁净NICU早产儿行床旁PDA和腹部手术临床可行,且床旁手术更有利于减少术后低体温的发生。对层流洁净病房进行日常规范化维护,可以有效保障危重早产儿床旁手术的安全。     

Assessing Southeastern Advanced Practice Registered Nurses’ Business and Operational Skill Sets

As advanced practice registered nurses (APRNs) open private practices in medically underserved areas, clinical, practice management, and business skills are needed conjunctively to remain operational. Further information is needed to understand APRN business and entrepreneurial skill needs. A convenience sample assessed perceptions of confidence in business and operational skill sets needed for entrepreneurial roles in 102 APRNs, representing diversity of subspecialties and practice locations in 4 southeastern states with provider shortages: Alabama, Florida, Mississippi, and Tennessee. Sustaining practices in underserved areas requires providing innovative educational offerings to address APRN business skills needs.     

2035年中国入围科技期刊“世界第一方阵”:基础、差距与推进思路

【目的】 在“中国科技期刊卓越行动计划”实施三周年之际,有必要对我国科技期刊2035年迈入“世界第一方阵”目标的具体任务进行重新审视和预判,以进一步明确发展方向,动态调整推进思路。【方法】 采用国内外科技期刊、科技论文、科技期刊评价成果的系统性发展数据对科技期刊“世界第一方阵” 国家(或地区)在高水平科技期刊数量与质量层面的入围标准进行界定,在深入总结现有基础和优势的同时,对我国科技期刊综合实力与“世界第一方阵”国家(或地区)的现实差距进行逐一梳理和剖析,并对实现目标的可行性和推进思路进行研判和设计。【结果】 必须继续加强高水平英文科技期刊创办和培育力度、持续加大优秀中文科技期刊的建设强度、快速推进国内外科技期刊论文等质同效评价制度的建设与引导,并积极探索建立科学家和科研机构办好一流科技期刊的责任制度和贡献激励机制、创新发展编辑人才队伍培养与激励管理思路、深入实践灵活多样的期刊出版市场资本运作模式、稳步推进期刊出版市场机制和管理制度改革,为我国科技期刊事业的高质量发展提速增效。【结论】 虽然当前阶段目标任务艰巨,但迈入“世界第一方阵”未来可期。     

模拟环境下间隔学习对临床技能习得与保持的影响研究进展

临床技能习得与保持一直是医学教育发展面临的重要问题,而随着医学教育的发展与改革,模拟环境下的间隔学习模式受到广泛关注。文章对模拟环境下间隔学习对临床技能习得与保持的影响研究进展进行综述:首先,阐述间隔学习可能的机制;然后,揭示间隔学习在国内外模拟教育的应用现状。文章指出间隔学习在临床技能教学实践中需要注意"加大临床投入,重视临床实践""深入理论基础,完善实证研究""基于我国现状,由浅入深探究"。     

Optimize the management of urological tube-related emergencies during the coronavirus disease 2019 (COVID-19) pandemic

BackgroundTo introduce and determine the value of optimized strategies for the management of urological tube-related emergencies with increased incidence, complexity and operational risk during the global spread of coronavirus disease 2019 (COVID-19).MethodsAll emergent urological patients at Tongji Hospital, Wuhan, during the period of January 23 (the beginning of lockdown in Wuhan) to March 23, 2020, and the corresponding period in 2019 were recruited to form this study’s COVID-19 group and control group, respectively. Tongji Hospital has the most concentrated and strongest Chinese medical teams to treat the largest number of severe COVID-19 patients. Patients in the control group were routinely treated, while patients in the COVID-19 group were managed following the optimized principles and strategies. The case incidence for each type of tube-related emergency was recorded. Baseline characteristics and management outcomes (surgery time, secondary complex operation rate, readmission rate, COVID-19 infection rate) were analyzed and compared across the control and COVID-19 periods.ResultsThe total emergent urological patients during the COVID-19 period was 42, whereas during the control period, it was 124. The incidence of tube-related emergencies increased from 53% to 88% (P<0.001) during the COVID-19 period. In particular, the incidence of nephrostomy tube-related (31% vs. 15%, P=0.027) and single-J stent-related problems (19% vs. 6%, P=0.009) increased significantly. The mean surgery times across the two periods were comparable. The number of secondary complex operations increased from 12 (18%) to 14 (38%) (P=0.028) during the COVID 19-period. The number of 2-week postoperative readmission decreased from 10 (15%) to 1 (3%) (P=0.049). No participants contracted during the COVID-19 period.ConclusionsUrological tube-related emergencies have been found to have a higher incidence and require more complicated and dangerous operations during the COVID-19 pandemic. However, the optimized management strategies introduced in this study are efficient, and safe for both urologists and patients.