湖南省护理员养老护理知识状况及对培训内容重要性评价

目的了解湖南省基层养老护理员养老护理知识掌握现状及对培训内容重要性的评价。方法自制调查问卷对参与养老护理培训的256名基层养老护理员进行调查。结果养老护理知识得分由高到低依次为生活照料、疾病护理、安全知识、康复指导、道德法律和心理护理,总分(15.36±5.26)分;女性养老护理员疾病护理、心理护理、康复指导、安全知识维度得分及养老护理知识总分显著高于男性(均P0.01);工作年限较长者各方面得分显著高于工作年限较短者(均P0.05);学历相对较高者得分显著高于学历相对较低者(均P0.01);培训内容重要性评价由高到低依次是生活照料、健康观察、康复护理、疾病护理、用药护理、急救护理、安全护理、心理护理和道德法律。结论基层养老护理员有关养老护理知识掌握度较差,与学历低及工作年限短等有关,应采取多种形式加强培训,培训课程内容应加重心理护理、职业道德法律等的比重,提高培训效果。     

山东省养老机构护理员现状调查

目的了解山东省养老机构护理员现状,为完善老年护理服务体系提供参考。方法采用整群随机抽样法抽取山东省8个城市83所养老服务机构的648名养老护理员,针对职业态度、职业能力、制约因素、职业发展及一般情况进行问卷调查。结果山东省养老机构护理员平均年龄(43.0±2.3)岁,工作年限为(5.6±0.3)年,日平均工作时间9.2h,专科及以上学历占47.2%,月均收入2 000元以下占62.0%,具有养老护理员资质者仅占22.3%,从事养老护理工作最大的困难是缺乏相关知识、技能和工资福利待遇低。主要制约因素是社会相关保障制度不到位(67.6%)、福利待遇低(41.7%)、工作环境差(25.0%)。结论山东省养老机构护理员年龄偏大、学历及待遇均偏低、整体素质不高,养老护理人员队伍建设有待加强。     

新护士转型冲击状况与工作满意度的相关分析

目的调查新护士转型冲击及工作满意度现状,探讨两者的相关性,为制定针对性管理措施,提高新护士工作满意度提供参考。方法采用新护士转型冲击评价量表和工作满意度量表对228名新护士进行问卷调查。结果新护士转型冲击状况总分3.44±0.77,工作满意度总分3.45±0.45;工作满意度总分及各维度得分与转型冲击总分及维度得分呈负相关(P0.05,P0.01)。结论新护士转型冲击及工作满意度处于中等水平,转型冲击程度越高的新护士工作满意度越低。护理管理者需采取措施降低新护士转型冲击,以提高其工作满意度。     

护士职业态度现状分析及对策

目的 探讨护士的职业态度及其影响因素,为护理管理者规划护士职业生涯提供依据.方法 自行设计护士职业态度调查问卷对389名三级甲等综合医院护士进行调查.结果 护士职业态度总均分3.94±0.35.不同职称、用工性质及择业原因护士职业态度的3.个维度得分比较,差异有显著性意义(P＜0.05,P＜0.01);不同护龄护士行为及认知维度得分比较,差异有显著性意义(均 P＜0.01);不同婚姻状况护士行为维度得分比较,差异有显著性意义(P＜0.01).结论 护士职业态度总体处于满意水平,护龄、婚姻状况、职称、用工性质及择业原因对职业态度有不同程度的影响.护理管理者应针对上述影响因素采取有效措施规划护士职业生涯,保证护理人力资源.     

护理本科新生老年护理职业认知与就业意愿相关性研究

目的了解护理本科新生老年护理职业认知水平及其与老年护理就业意愿的相关性,为老年护理专科人才培养提供参考。方法采用自制调查表和对老年人态度量表对某高等医学院校2014级240名护理本科新生进行调查。结果护生对老年人态度得分为133.68±20.16;对老年护理职业认知总分及工作认知、现状认知维度得分为27.71±5.19、14.53±2.83及13.18±2.47。40.8%的护生表示非常或比较愿意从事老年护理工作,65.0%首选公立性养老机构。对老年人态度、老年护理职业认知总分、老年护理工作认知、老年护理现状认知与老年护理就业意愿相关(r=-0.169~0.197,均P0.05)。结论护理新生老年护理职业认知水平及就业意愿偏低,就业意愿与其老年护理职业认知水平相关;应进行针对性教育以提高其认知水平和老年护理就业意愿。     

分离转换障碍患者认知闭合需要与应对方式研究

目的探讨分离转换障碍患者认知闭合需要与其疾病应对方式的关系,为改善其应对方式提供参考。方法采用认知闭合需要量表和中文版医学应对方式问卷对217例分离转换障碍患者进行问卷调查。结果分离转换障碍患者认知闭合需要总分215.54±22.56;疾病应对方式中的面对得分18.23±2.60,屈服得分12.82±1.57,回避得分17.20±2.32;面对得分与认知闭合需要总分及各维度得分呈显著负相关(-0.272~-0.499,均P0.01);屈服、回避得分与认知闭合需要总分和各维度得分呈显著正相关(0.333~0.494,均P0.01)。认知闭合需要为疾病应对方式的影响因素(R2=0.238~0.297)。结论分离转换障碍患者认知闭合需要处于较高水平,影响患者的疾病应对方式。     

护士患者安全文化认知及专业实践环境调查分析

目的了解护士对患者安全文化的认知及专业实践环境状况,分析影响因素,为改进护理工作环境和加强患者安全文化建设提供参考。方法汉化患者安全文化量表及专业实践环境量表,对744名临床护士进行问卷调查。结果患者安全文化认知12个维度条目均分(3.27±0.54)~(4.52±0.37)分,同意率72.93%,得分最高和最低的维度分别为对错误的非惩罚反应、人员配置;专业实践环境8个维度条目均分(2.34±0.62)~(3.25±0.45)分;护理实践环境、护士工作满意度及护士职称是患者安全文化认知的影响因素(P0.05,P0.01)。结论护理实践环境得分越高、工作满意度及职称越高的护士患者安全文化认知越好。     

护士心理授权与健康相关工作效率低下的相关性分析

目的了解护士心理授权与健康相关工作效率低下的现状,探讨两者之间的关系。方法运用心理授权量表与工作受限情况调查问卷对便利抽取的郑州市某三级甲等医院360名护士进行调查。结果护士心理授权总分为(38.13±5.86)分,工作受限得分(41.32±10.78)分,护士心理授权3个维度与工作受限总分呈显著负相关(均P0.01)。结论护士心理授权处于中等偏上水平,健康相关工作受限处于中等偏低水平,提升护士心理授权水平可提高工作效率。     

养老机构老年人保健品知信行现况及影响因素分析

目的调查太原市养老机构老年人保健品知信行现况,为养老机构及社区管理者开展健康教育提供参考。方法采用保健品知信行问卷对5所养老机构的287名老年人进行调查。结果老年人保健品知识得分19.44±3.28、态度得分51.65±3.53、行为得分20.66±3.07;不同文化程度、慢性疾病、职业、收入、知识途径、服用保健品种数的老年人保健品知识、态度、行为得分差异有统计学意义(P0.05,P0.01)。结论养老机构老年人对服用保健品态度较积极,但知识与行为状况不佳。养老机构管理者应针对服用保健品的老年人开展健康教育讲座,纠正其对使用保健品的错误认知,从而纠正不合理行为。     

助产士共享管理与职业嵌入的相关性研究

目的了解助产士的共享管理及职业嵌入现状,分析共享管理对其职业嵌入的影响,为稳定助产士职业队伍提供参考。方法应用护士专业治理指数问卷、护士职业嵌入量表对7所医院的246名助产士进行调查。结果 246名助产士共享管理、职业嵌入得分分别为(162.72±50.76)分、(43.15±15.54)分;职业嵌入总分及其各维度与共享管理及其6个维度呈正相关(P0.05,P0.01);助产工作年限、月收入、共享管理是影响助产士职业嵌入的因素(调整R2=0.534)。结论助产士职业嵌入水平不佳,提高共享管理,有助于加强其职业嵌入。     

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 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.     

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.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

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.     

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.     

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.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.