Doctorally-prepared nurses: different practice settings,different views

Nurse researchers in academic and clinical settings have the ultimate goal of improving nursing care while balancing the demands of education, the institution, research, and nursing service. The setting shapes the focus of research, the choice of research models, and the parameters of the position. The setting also influences available resources and the services rendered to the institution and the community. The functions of doctorally-prepared nurses in academic and clinical settings are compared. A better understanding of the functions of nurses in each setting could lead to better informed employment choices and improved collaborative efforts.     

骨水泥不同时相负载抗生素

背景:在人工关节置换中,骨水泥与何种抗生素配伍能起到有效预防和治疗置换后感染目前还存在争议。目的:观察抗生素骨水泥中不同抗生素及不同混合方法对动物体内抗生素释放特性以及骨水泥力学性能的影响。方法:36只大白兔随机抽签法分为6组,3个实验组在骨水泥固相与液相混合后分别加入2g硫酸庆大霉素、1g万古霉素、1.5g头孢呋辛钠,制成负载抗生素的骨水泥,置于实验兔体内。3个对照组分别在40g骨水泥固相与液相混合前加入2g硫酸庆大霉素粉剂、1g万古霉素粉剂、1.5g头孢呋辛钠。结果与结论:3种抗生素在兔体内持续平均释放时间均在31d以上,骨水泥固相与液相混合后加入抗生素的3组抗生素洗提总量分别高于混合前加入抗生素的3组(P<0.05),混合后加入万古霉素组的洗提总量高于其他各组(P<0.05)。各组抗生素骨水泥的力学性能均优于ISO5833国际标准,组间差异无显著性意义。提示抗生素能有效从骨水泥中释放,骨水泥中加入1.0～2.0g抗生素不影响骨水泥的机械强度;万古霉素的洗提效果较好;骨水泥固相与液相混合后加入抗生素的混合方法更有利于抗生素的释出。     

Research and quality improvement: different processes, different evidence

Two sources commonly used for evidence-based practice include research findings and quality improvement (QI) reports. However, they often are implemented improperly. It is important for nurses to distinguish between research and QI. A tool for making such a distinction is presented.     

不同气管切开套管常见并发症的比较研究

气管切开术可防止或迅速解除呼吸道梗阻,减少呼吸道解剖死腔的50%,增加有效通气量,也便于吸痰、使用机械通气、气管内滴药等[1],大大提高了抢救成功率。但如果护理不当,也会引起严重并发症,甚至危及患者生命。针对重症颅脑损伤患者病情危重、变化快、大多神志昏迷等特点,减少气     

CVVHDF前后稀释对不同相对分子质量溶质清除的影响

目的 通过建立血液净化连续静-静脉血液透析滤过(CVVHDF)模式前、后稀释方法的体外实验,探讨该模式前、后稀释法对各种不同大小的溶质分子清除效率的影响.方法 建立等容CVVHDF前、后稀释及CVVH单循环(无稀释、无透析)对照体外实验装置,比较不同相对分子质量物质钾(K+)、肌酐(Cr)、万古霉素(vancomycin)、胰岛素(insulin)和白细胞介素-6(IL-6)的清除率,实验重复4次(n=4).结果 CVVHDF后稀释法对K+、Cr、Vancomycin和Insulin清除率明显高于CVVHDF前稀释;CVVHDF前、后稀释对IL-6清除差异无统计学意义;对照组Insulin和IL-6实验结束时明显降低.结论 CVVHDF后稀释总体上对各种不同相对分子质量物质清除率高于前稀释,但随着相对分子质量的增大,两者间的差别缩小;对照组提示实验用滤器(AN69)对Insulin及IL-6有吸附作用.     

Platelet‐based coagulation: different populations,different functions

Summary. Platelets in a thrombus interact with (anti)coagulation factors and support blood coagulation. In the concept of cell‐based control of coagulation, three different roles of platelets can be distinguished: control of thrombin generation, support of fibrin formation, and regulation of fibrin clot retraction. Here, we postulate that different populations of platelets with distinct surface properties are involved in these coagulant functions. Platelets with elevated Ca²⁺ and exposed phosphatidylserine control thrombin and fibrin generation, while platelets with activated α_IIbβ₃ regulate clot retraction. We review how coagulation factor binding depends on the platelet activation state. Furthermore, we discuss the ligands, platelet receptors and downstream intracellular signaling pathways implicated in these coagulant functions. These insights lead to an adapted model of platelet‐based coagulation.     

不同时期十二指肠溃疡穿孔治疗的对比研究

目的 总结1995年前后各10年十二指肠溃疡穿孔的外科治疗经验,探讨治疗十二指肠溃疡穿孔的最佳方式.方法 对1985年1月至1995年1月221例（B组）和1995年2月至2005年1月149例（A组）,二个阶段十二指肠穿孔患者的临床资料进行回顾性分析.结果 B组治疗十二指肠溃疡穿孔术式首选胃大部切除术,行该术161例术后近期并发症14例（8.7%）,死亡4例（2.4%）;A组手术治疗明显倾向于单纯穿孔修补术加术后正规内科治疗,行该术98例中术后再穿孔1例、穿孔修补后愈合不良1例,无手术死亡,术后随访溃疡复发率28.7%,再手术率11.5%.结论 随着溃疡病病因研究和药物的临床应用进展,十二指肠溃疡穿孔行单纯穿孔修补术加术后正规内科治疗已成为一种较理想的治疗方式,效果满意.