基于计算机控制模拟人的仿真情景设计及在澳门护理本科生的实践（英文）

目的探讨运用计算机控制模拟人训练护生临床技能的情景设计,并了解护生对仿真模拟设计的看法。方法运用计算机控制模拟人设计5个高度仿真模拟的情景,包括阑尾炎、慢性阻塞性肺疾病、胃肠道出血、心肌梗死及严重创伤。113名护理本科生(二年级77名,三年级36名)完成36个学时的模拟情景训练。结果护生对学习场所、学习目标、学习安排、知识迁移以及决策技能等感到满意;认为仿真模拟学习是最好的学习体验,希望有机会再次参加。但他们也指出模拟人对真实情况的模仿还不够逼真:没有面部和情绪反应,对问询的应答迟缓,呕吐物或痰的气味、颜色性质和量没有演示。结论护生对仿真模拟学习满意,但情景的逼真度需改进。建议将标准化病人运用于仿真模拟情景设计,以模仿面部表情以及情感、心理社会的互动反应。     

循证护理理念指导下的仿真模拟学习过程与评价方法

阐述了基于实证主义与建构主义理念的仿真模拟学习过程与评价方法.提出将循证护理与仿真模拟学习融合能使学生有效地检索相关的研究文献、评判性地评鉴所获得的信息,并在模拟情境中运用最佳证据解决临床问题.学习的过程包括学习准备、情境澄清、确立问题、文献检索与评鉴、护理评估、护理计划与实施、学习反思与知识整合.直接观察法、小组焦点讨论及个人或小组访谈法等都可作为教学评价方法.     

急重症护理综合情景模拟实训体系的构建与实施

目的探讨急重症护理综合情景模拟实训体系的构建与实施效果。方法建立综合情景模拟实训体系,对2150名高职护生进行综合情景模拟实训,采取营造高仿真临床环境,打造ICU模拟病房;构建相对独立实训新体系;设计综合性考核指标;加强课程及教学队伍建设等方法建立综合情景模拟实训体系等措施。结果 94.5%护生对综合情景模拟教学较为满意;临床带教老师评价2007~2008级护生急救意识和处理急重症患者的能力强;学生参赛结果成绩优异;综合情景模拟实训体系的建立也为本课程成功申报2010年度浙江省高校精品课程打下了坚实基础。结论急重症护理综合情景模拟实训体系构建了"知识+能力+素质"三位一体的人才培养模式,有助于护生职业情感、临床解决问题能力、团队合作精神的培养;能提升护生的岗位适应能力和社会竞争力,满足社会对护理人才培养的需求。     

虚拟案例结合情景模拟教学在护理综合实训中的应用研究

目的探索适合高职护理院校护理学生临床实习前的护理综合实训教学方法,提高护理综合实训教学效果。方法将2015级护理专业学生299人随机分为2个班,实验班147人,对照班152人。在第4学期临床实习前开设护理综合实训课程,对照班按照传统教学方法进行教学,实验班采用虚拟案例结合情景模拟教学方法。课程结束对学生进行客观结构化临床考试(OSCE)来评价学生的综合护理能力,并对实验班学生进行半结构式访谈。结果实验班OSCE考试成绩显著高于对照班(P0.01)。实验班学生认为虚拟案例结合情景模拟教学有助于提升护理安全意识、增强人文关怀意识、有助于激发学习兴趣和提高学习积极性、提升沟通能力和团队协作能力、加强自我反思的能力。结论虚拟案例结合情景模拟教学方法能够激发学生学习兴趣,提高综合护理能力。     

合作学习理论在护理自考专科护生实习带教中的应用

目的 促进护理自学考试专科护生临床实习工作的发展。方法 采用合作学习理论的4个模式即小组效率模式、小组教学模式、表现判断模式、明确态度模式，对护理大专自学考试实习护生进行训练。结果 强化了自学考试护生的整体护理意识；培养和提高了自学考试护生和带教老师的素质，教学相长；促进护理理论与护理实践相结合。结论 合作学习是通过小组学习形式，帮助护生学习各类专科知识、提高技能、明确学习态度，是一项民主、实用、灵活的学习，将有利于自学考试护生顺利通过考试。     

学生对基础护理学自主学习教学模式改革的思考

目的引起护理教学改革者的重视和反思,为完善基础护理学自主学习教学模式改革提供参考。方法从学生的角度总结基础护理学自主学习教学模式改革实践过程中出现的问题。结果学生主要表现为6个方面的问题,包括学生主观"懒"的问题、有些同学对学生授课的不接纳和消极听课、学生中存在合作意识淡薄与协作能力不足的问题、小组或学生个体能力不同对教师课前指导的需求存在差异、传统教育模式下的考核制度影响学生自主学习的积极性、学生可支配时间的不够。结论自主学习教学模式改革取得了一定的成效,可采取针对性措施解决学生在自主学习过程中出现的问题,以不断完善这种新的教学模式。     

高仿真生理驱动模拟系统在麻醉管理培训中的应用

目的 探讨高仿真生理驱动模拟系统(HPS)在麻醉管理培训中的应用以及存在的问题.方法 采用美国MFTI公司HPS,自主设计高级生理驱动程序12项,分别模拟12类危重病人的麻醉情景,针对中高级职称麻醉医师进行危重病人麻醉管理综合模拟训练.培训形式为"简短授课+单项训练+HPS综合训练+录像反馈总结".培训对象16人,其中中级职称12人,高级职称4人.建立危重病人高仿真模拟培训评价量表,分析HPS培训的应用意义.结果 高仿真模拟危重病人麻醉培训与临床相似性评分(8.8±0.7)分,对综合能力培养方面必要性评分(9.3±0.6)分,与单一理论授课相比获益性评分(9.6±0.6)分,在麻醉教学领域的作用评分(9.2±0.7)分.该项目主要问题有:高仿真模拟危重病人的训练时间短,与真实的临床病例仍有差距.结论 HPS可以有效构建临床麻醉中的多种危重情景,能有效地训练麻醉医师临床应急能力及危重病人的麻醉管理水平.     

高职儿科护理技术操作的多情景模拟教学法

目的探讨多情景模拟教学法在高职儿科护理技术操作实训教学中的应用效果。方法将181名学生随机分为两组。实验组(91人)采取多情景模拟教学法,由学生根据不同的实训情景以小组为单位编写剧本和演示实训项目,以临床工作为背景、以学生为中心组织教学。对照组(90人)采用传统教学法,老师示教和学生练习相结合。课程结束后评价教学效果。结果实验组操作技能考核成绩、对教学方法的评价以及对教学模式的认同显著高于对照组(均P0.01)。结论在高职儿科护理技术操作实训教学中应用多情景模拟教学法,有利于学生灵活运用操作技能,受到学生的高度评价和普遍认同。     

情景模拟演练在急救技能教学中的应用

目的探讨情景模拟演练教学法在急救技能教学中的应用效果,以提高临床护理教学质量。方法将进入急诊科实习的72名护生随机分成实验组和对照组各36例,对照组采用传统单项技能三段式教学;实验组采用情景模拟演练法教学,根据教学内容模拟急诊科常见的急重症急救情景,进行演示训练,包括情景设置、角色安排、技能练习、角色互换、考核答疑等步骤。最后由考核小组对两组护生急救理论知识、急救技能和操作综合能力进行考核。结果实验组急救理论知识、急救技能及综合能力成绩均显著优于对照组（P〈0．05,P〈0．01）。结论情景模拟演练教学可提高护生急救理论知识、急救技能和操作综合能力的成绩;提高临床护理教学质量。     

基于BOPPPS模型的情景模拟教学法在护士急救培训中的应用

目的 探讨基于BOPPPS模型的案例情景模拟教学法在急救培训中的应用效果。 方法 采取类实验研究设计，以2019年60名临床护士为对照组，采用课堂讲授、技能示范、三人配合训练的教学方式。以2021年60名临床护士为试验组，采用导入、目标、前测、参与学习、后测与总结的参与式BOPPPS案例情景模拟教学方式，进行三人配合急救护理的教学实践。 结果 试验组操作考核成绩及团队合作得分显著高于对照组（均P＜0.05）。 结论 基于BOPPPS模型的案例情景模拟教学法，可提升护士急救技能和三人急救配合程度。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.