以临床胜任力为导向的CBL在急危重症护理本科教学中的实践

目的　探讨临床胜任力为导向的病例教学（case-based learning，CBL）在急危重症护理学本科教学中的可行性和有效性。方法　将急危重症护理本科生120人随机分为CBL教学组和传统教学组。根据每次实习学生人数，CBL教学组分为数个小组，每小组固定一个带教教师，并以小组为单位进行临床教学实践；传统教学组采用既往的临床实习教学方式，即一个学生固定跟随一个带教教师。采用理论考试、技能考试以及问卷调查等多种考核方式评价两组的教学效果，采用SPSS 21.0软件行t检验和卡方检验。结果　与传统教学组相比，CBL教学组在理论考试[（92.5±3.0） vs. （85.3±3.3）]和技能考试[（93.1±4.5） vs. （88.1±3.4）]方面均更好，且差异有统计学意义（P<0.05）；在对教学满意度调查方面，CBL教学组优于传统教学组。结论　以临床胜任力为导向的CBL教学应用于急危重症护理本科教学是可行的，能有效培养学生的临床思维和提高实际的临床胜任力。     

Postpartum urinary incontinence: a comparison of vaginal delivery, elective, and emergent cesarean section

The aim of this study was to assess the impact of delivery on the pelvic floor and whether cesarean section (C/S) can prevent pelvic floor injury. Five hundred thirty nine women were divided into three groups according to the delivery method adopted: elective C/S, emergent C/S, and vaginal delivery. A urinary incontinence questionnaire survey was conducted around 1 year postpartum. Emergent C/S may be a major risk factor for postpartum urinary incontinence and interfere with the benefit of elective C/S for preventing pelvic floor injury. Hence, not all C/S deliveries can reduce the likelihood of postpartum urinary incontinence. The key lies in whether the C/S is performed before labor.     

紧急纤维支气管镜在老年高危患者中的应用

目的　研究紧急纤维支气管镜 (纤支镜 )在老年高危患者中的应用。方法　老年急危重症患者 77例 ,其中急性生理和慢性健康评估 (APACHEⅡ )计分 >14分者 65例。所有患者共行 10 2例次紧急纤支镜操作 ,其中肺泡灌洗、气道分泌物吸引 76例次 ;纤支镜引导下经鼻气管插管 19例次 ;异物吸出 6例次。结果　 10 2例次紧急纤支镜操作抢救总有效率为 80 .3 % ,无危及生命的并发症发生。结论　紧急纤维支气管镜是抢救急危重症患者呼吸道病变紧急处理的有力武器 ,高龄严重心、肺功能障碍不是纤支镜操作的禁忌证     

急诊冠状动脉内支架植入治疗急性心肌梗死——围术期死亡和近期预后的研究

为评价急性心肌梗死(AMI)患者急诊经皮冠状动脉腔内成形(PTCA)和冠状动脉内支架植入围术期死亡和近期预后的影响因素,通过对74例行急诊冠状动脉内支架植入的AMI,术后6个月内的临床随访和冠状动脉造影随访,进行多因素相关回归分析。结果表明,多支病变患者的糖尿病、高血压和高血脂的合并比例明显高于单支病变患者;总围术期内死亡率为5.4％,剔除合并心源性休克患者后,死亡率为1.4％;12例75岁以上的患者中,2例死于心源性休克,1例死于心脏破裂,5例心源性休克患者死亡3例;术中非致命性合并症的发生率在单支和多支病变组之间差异无显著性(P>0.05);多元回归分析表明血流动力学状态和患者的年龄是决定AMI患者围术期死亡的独立相关因素;多支病变患者术后6个月内心脏事件发生率明显高于单支病变组;术前和术后6个月内的患者左心室射血分数(LVEF)明显改善;而且单支和多支病变组之间术后6个月时的LVEF之间无显著性差异。     

低龄危重患儿的紧急血液透析疗法

目的：探讨低龄儿血液透析技术实施的特点，以提高婴幼儿危重症抢救成功率。采用瑞典产Gambro AK90s血透机与宁波产0.5-0.8cm醋酸纤维透析器对33例年龄5个月至7岁危重儿实施紧急血液透析疗法，其中急性肾衰竭20例，氟乙酰胺毒鼠药中毒13例。结果：33例患儿均成功地实施39例次紧急血液透析，透析中发生并发症17例（43.59％）经对症处理缓解。30例治愈，治愈率90.9％。结论：紧急血液透析技术是成功地抢救婴幼儿危重症最为快速、有效的措施之一。     

Unusual association of Axenfeld-Rieger syndrome and wandering spleen:A case report

BACKGROUND Axenfeld-Rieger syndrome(ARS)is an autosomal dominant genetic disease characterized by ocular developmental disorders and its association with torsion of wandering spleen(WS)has not been reported to date to the best of our knowledge.This study aimed to describe a rare case of ARS observed at our emergency department.CASE SUMMARY A 25-year-old female presented with a constant lower abdominal pain of increasing severity.Diagnostic computed tomography with intravenous contrast material showed a non-homogenously enhanced splenic parenchyma with a twisted vascular pedicle.Further,an emergent laparoscopic exploration was performed,and an ischemic spleen without its normal ligamentous attachments was noted.Notably,the spleen did not regain its normal vascularity after detorsion;thus,we performed the laparoscopic total splenectomy.The postoperative course was uneventful,and the patient was discharged on the 5th postoperative day.This case demonstrates a rare association of WS and ARS.CONCLUSION Early diagnosis of WS in the emergency department is important to prevent pedicle torsion or splenic necrosis and to avoid splenectomy.     

Randomized,double-blind,placebo-controlled,safety and immunogenicity study of 4 formulations of Anthrax Vaccine Adsorbed plus CPG 7909 (AV7909) in healthy adult volunteers

A new anthrax vaccine that could accelerate the immune response and possibly reduce the number of injections needed for protection would be desirable in a post-exposure setting.     

CHANGING PATTERNS OF “DRUG ABUSE” IN THE UNITED STATES: CONNECTING FINDINGS FROM MACRO- AND MICROEPIDEMIOLOGIC STUDIES

Trend analyses of the U.S. monitoring data systems (the National Household Survey on Drug Abuse and the Monitoring the Future Study) and of the country's surveillance program, the Community Epidemiology Work Group (CEWG), indicate that several new “drug abuse” patterns have emerged over the past several years. For adolescents, drug use rates are converging for females and males, the mean age at which youngsters initiate drug use has declined, and more young adolescents are reporting using drugs. Furthermore, emergent new drug use patterns are being observed by the CEWG. The use of drugs such as Rohypnol, the injecting of crack-cocaine, and the spread of methamphetamines by new traffickers challenge our existing knowledge and understanding of drug use and its prevention. The National Institute on Drug Abuse has funded several large longitudinal studies that follow selected children and adolescents into their twenties, and some into their thirties. This research has been a rich source of information on the determinants of initiating and continuing drug abuse. Yet the findings from the surveys have not been well explored by the longitudinal studies, nor have the findings from the longitudinal studies been used in the surveys to better understand the observed changing trends in drug use patterns. This paper addresses six issues that have been observed from the findings from analyses of data from the surveys or macro-epidemiologic studies. Information from the sub-population or micro-epidemiologic studies are reviewed for possible hypotheses to explain each issue. Suggestions for further research and implications for prevention also are presented.     

Mothers’ Implicit Theories of Early Literacy Instruction: Implications for Children's Reading and Writing

Subjects in this exploratory study were 19 five‐ to six‐year‐old children and their mothers. Mothers completed surveys of family literacy practices and beliefs about early reading Instruction and children's emergent literacy skills were assessed. Results showed that one group of mothers held implicit theories that resembled whole language models of literacy Instruction. A second group of mothers held views that resembled a phonics orientation, while a smaller group of mothers had more varied and idiosyncratic beliefs. Mothers’ implicit theories were associated with their modeling of literacy behaviors, helping their children write, and with their children's independent exploration of writing and current levels of literacy skill. Results point to the importance of parents’ implicit developmental theories and the heed to understand how parental belief systems affect the roles that families play in literacy acquisition.