Use of Technology in the Classroom to Increase Professional Preparation

The American Association of Colleges of Nursing Essentials of Master’s Education require advanced practice nursing students to be familiar with electronic technologies and consult with other disciplines to coordinate care. To expand beyond learning basic electronic medical record documentation, collaboration with school of pharmacy students for submitting and incorporating consults on specific patients was included into the assignments of learning clinical SOAP (subjective, objective, assessment, and plan) notes. Significant revision of the original Cerner (Kansas City, MO) cases was required to provide a primary care focus and meet the needs of 7 different majors. Technology facilitated an interprofessional experience that benefited both student groups. The key lessons learned are shared.     

Pulse Width Dependent Increase in the Pacemaker Automatic Interval

From a total of 51 patients equipped with rate and pulse width adjustable pulse gen erators (Microlith-P 0505, Microthin-PI 0522) implanted over the last 3 years, 10 (19.6%) showed an un expected drop in pacemaker pulse rate during pulse width programming. For one of the pulse gen erators used (Microthin-PI 0522), unexpected rate decrease occurred in 7/13 cases (53.8%). For all ex cept one patient, decrease in pacemaker pulse rate corresponded with the total refractory period of the pulse generator (320 ms), at a certain pulse width when rate drop first occurred. In seven of the patients the pulse generator automatic interval was extended from 13 ms to 171 ms beyond the re fractory period. In two patients it was necessary to replace the pulse generators. Our study strongly proves that this abnormal pacemaker functioning is a result of sensing of the polarization voltage at the pacemaker electrode/tissue interface and/or the T-wave. The polarization voltage is highly dependent on the total pacemaker electrode/tissue interface impedance. Using typical values for pulse genera tor output and input resistance and output capacitance, Faraday resistance, Helmholtz capacitance and tissue resistance at the electrode/tissue interface it was shown mathematically that in some cases the polarization voltage alone would be of sufficient amplitude and slew rate for pacemaker inhibi tion. The study demonstrates an urgent need for change in the filter characteristics by making the pulse generators less sensitive in the low frequency region and reducing the polarization voltage by reducing the output circuit capacitance. (PACE, Vol. 5, May-June, 1982)     

Domoic Acid Attenuates the Adenosine-5'-Triphosphate-Induced Increase in

BACKGROUND: Although domoic acid (DA), a shellfish neurotoxin, carries a negative surface charge at physiological pH like that of adenosine-5'-triphosphate (ATP), very little is known about its cellular effects. In view of the potentially significant role of extracellular ATP as a signaling molecule for increasing the intracellular concentration of Ca(2+) ([Ca(2+)](i)), we examined the possibility that DA may interfere with this signal transduction mechanism in the myocardium. METHODS AND RESULTS: Cardiomyocytes were isolated from rat heart and loaded with Fura-2 to measure the [Ca(2+)](i). ATP produced a gradual rise in [Ca(2+)](i), reaching a peak level in 25-30 seconds and declining thereafter. DA did not affect the [Ca(2+)](i) in cardiomyocytes; however, it diminished the ATP-induced elevation in [Ca(2+)](i) in the concentration-dependent manner. Kainic acid, an analogue of DA, had a similar effect but at a 25-fold higher concentration, whereas glutamate and aspartate did not modify the action of ATP. Well-known inhibitors of L-type voltage-sensitive Ca(2+) channels, nifedipine and nicardipine, depressed the ATP-induced increase in [Ca(2+)](i), but DA did not produce additive effects with either of these agents. On the other hand, DA potentiated the KCl-induced increase in [Ca(2+)](i) in quiescent cardiomyocytes and augmented the nicardipine-sensitive Ca(2+) transients in electrically stimulated cardiomyocytes. CONCLUSIONS: These results suggest that DA may diminish the ATP-induced increase in [Ca(2+)](i) by inhibiting the ATP interaction with cardiomyocytes in a specific manner.     

在护理本科教育中增加职业认同教育

本文分析了护理本科生在校学习期间,由于护生自身、专业特点、社会影响及教育体制造成护理本科生职业认同感较低,而职业认同感低是造成护理人才流失的主要原因。根据这些原因,本文提出了在护理本科教育中增加职业认同教育的方法和重要性,并指出职业认同教育需要长期计划和各个阶段配合。     

Moricizine Induced Increase in Pacing Threshold

GIROD, J.P., et al. : Moricizine Induced Increase in Pacing Threshold. A 72-year-old woman who was experiencing incessant ventricular tachycardia and recurrent automatic implantable cardioverter defibrillator (AICD) firing despite amiodarone therapy was referred to the Cleveland Clinic Foundation. Myocardial ischemia and infarction were ruled out by standard means. Several antiarrhythmic medications were tried previously without success. Moricizine, 200 mg three times daily, was initiated and controlled the ventricular tachycardia. However, after the dose of moricizine was titrated upward, the patient became symptomatically bradycardic and the ECG exhibited 2:1 block of her paced rhythm and an increased ventricular pacing threshold. (PACE 2003; 26[Pt. I]:110–111)     

患肢枕的改良

患肢枕是用于抬高患肢、促进静脉回流、减轻肢体肿胀的一个软垫 ,临床上多用于抬高上肢。目前 ,常见的患肢枕形状有扁平长方形、正方形和近似不规格的梯形。在使用过程中 ,扁平长方形患肢枕用于肢体消肿不太理想 ;正方形和近似不规格的梯形枕 ,用时稍长 ,易出现肢体疲劳。为此 ,通过临床实践 ,笔者对现有患肢枕进行了一定的改良 ,制作了一种直角长斜面形患肢枕。1　制作方法　　直角长斜面形患肢枕底边长 31ｃｍ (相当于成人前臂的长度 ) ,宽 2 5ｃｍ ,高 15ｃｍ ,斜面长 34ｃｍ。枕芯用成形的不太松软的海绵填充 ,外层由人造革或橡胶布包裹…     

Mechanisms of the Fasting-Induced Increase in Insulin Binding to Rat Adipocytes

Fasting leads to an increase in the ability of adipocytes to bind insulin, and this was accounted for by an increase in the affinity of the receptors for insulin without any change in the number of receptors per cell. Binding affinity can increase because of a decrease in the dissociation rate constant (k_d), an increase in the association rate constant (k_a), or both. Kinetic studies demonstrated that fasting leads to a striking decrease in the rate at which insulin dissociates from its receptor, and the near two-fold prolongation of the time at which 50% of the bound ¹²⁵I-insulin dissociates (28±4 vs. 50±5 min) correlated quite well with the two-fold increase in binding affinity. On the other hand, the rate at which insulin associates with its receptor was essentially unchanged. Negatively cooperative interactions between receptors were readily demonstrated in cells from control and fasting animals, and the magnitude and sensitivity of this effect was the same in both groups of cells. It seemed likely that during fasting a change in the concentration of some substrate or hormone could lead to these effects on insulin binding. However, in vitro attempts to recreate the substrate and hormonal changes which occur in fasting produced no evidence to support this idea. In conclusion: (a) fasting leads to an increase in the ability of adipocytes to bind insulin because of an increase in binding affinity; (b) this increase in the affinity of the receptor for insulin was primarily accounted for by a decrease in the rate at which insulin dissociates from its receptors; and (c) fasting did not appreciably alter the negatively cooperative interactions displayed by adipocyte insulin receptors.