鼻咽癌放疗患者专病护理质量评价指标体系的构建

目的构建鼻咽癌放疗患者专病护理质量评价指标,为鼻咽癌放疗护理质量评价提供工具。方法基于三维质量结构模型,在半结构式访谈、文献回顾法基础上拟定指标体系初稿,采用Delphi法对分别对23名、21名专家进行两轮函询。结果 2轮函询问卷的有效回收率分别为91.30%、100%,专家权威系数Cr值分别为0.869、0.876。最终形成的指标体系包括结构、过程、结果3项一级指标、9项二级指标和41项三级指标。结论鼻咽癌放疗患者专病护理质量评价指标体系构建科学、可靠,专病特色突出,进一步验证后可作为专病护理质量评价工具。     

基于CIPP评价模式构建临床护理教学质量评价指标体系

目的 构建适合教学医院的临床护理教学质量评价指标体系。方法 基于CIPP评价模式，通过文献研究法和半结构访谈法拟定临床护理教学质量评价指标体系初稿，采用Delphi法对29名专家进行两轮函询。结果 两轮函询的专家积极系数分别为96.67％、100％，专家权威系数分别为0.894、0.897，Kendall协调系数分别为0.331、0.415(均P<0.01)。最终临床护理教学质量评价指标体系包括教学背景评价、教学资源评价、教学过程评价、教学结果评价4个一级指标、13个二级指标和43个三级指标。结论 基于CIPP评价模式构建的临床护理教学质量评价指标体系可作为教学医院评价临床护理教学质量的评价工具。     

静脉用药调配中心静脉输液安全质量敏感指标构建

目的构建静脉用药调配中心静脉输液安全质量敏感性指标,为静脉输液质量评价与监测提供参考。方法通过检索国内外文献和研究小组讨论,初步确立静脉用药调配中心敏感性指标及其计算公式与资料收集方法。并采用德尔菲专家函询法,对24名专家进行3轮函询。结果构建的静脉输液安全质量敏感指标体系包括一级指标3项、二级指标13项、三级指标27项。3轮专家咨询积极系数分别为86.7%、92.3%和100%,权威系数分别为0.88、0.90和0.90,Kendall协调系数分别为0.189、0.302和0.487(均P0.01)。结论构建的静脉用药调配中心静脉输液质量敏感性指标具有一定可信度,可为静脉用药调配中心的静脉输液安全质量评价提供客观、可量化的评估工具。     

“双师型”临床护理带教教师培训方案的构建

目的构建"双师型"临床护理带教教师培训方案。方法采用文献法和半结构化访谈法初步拟定"双师型"临床护理带教教师培训方案,运用Delphi法对38名专家进行2轮函询对各指标进行评价筛选。结果 2轮函询有效问卷回收率分别为88.89%、95.00%;专家的权威系数为0.83;肯德尔协调系数分别为0.204、0.300(均P0.01)。最终构建的培训方案包括教学能力培训、临床护理能力培训、评判性思维能力培训、科研能力培训、专业发展能力培训、人际沟通能力培训、法律与伦理实践能力培训7个一级指标及其所属的31个二级指标和106个三级指标,确定了培训学时、方法及评价方式。结论该培训方案获得专家的认可,能够为各院校对"双师型"临床护理带教教师培训提供参考。     

基于德尔菲法构建泌尿外科护理安全管理评价体系

目的 构建泌尿外科护理安全管理评价体系,为提高泌尿外科护理安全管理提供依据。方法 通过文献回顾初步构建泌尿外科护理安全管理评价体系初稿,采用德尔菲法（Delphi）对16名泌尿外科护理专家进行2轮函询,最终形成泌尿外科护理安全管理评价体系。结果 2轮函询中问卷回收率分别为100%、94.12%,专家意见的集中程度波动在4.25～5.00,专家意见的协调程度波动在0.00～0.20,专家权威系数分别为0.910、0.929,专家Kendall’s W协调系数分别为0.119和0.114,最终构建包含10项一级指标,55项二级指标,41项三级指标的泌尿外科护理安全管理评价体系。结论 构建的泌尿外科护理安全管理评价体系内容全面,具有较高的科学性、权威性、实用性,为提高泌尿外科护理安全管理提供参考。     

思政视域下新护士规范化培训评价体系的构建

目的 构建思政视域下新护士规范化培训多维度评价体系，以全面评价培训效果。 方法 依据文献分析、半结构式访谈、小组讨论等拟订新护士规范化培训评价体系条目池，采用Delphi法对24名专家进行2轮函询，按指标入选准则及层次分析法确定指标及权重。 结果 构建的评价体系包含6项一级指标、24项二级指标及79项三级指标。2轮函询的专家积极系数分别为92.31%、100%，权威系数分别为0.859、0.867，协调系数分别为0.173、0.190。 结论 构建的新护士规范化培训评价体系，评价指标全面，专家权威性较高、一致性较好，经实用验证后可用于新护士规范化培训效果评价。     

基于CIPP评价模式构建护理学高仿真模拟教学评价框架

目的构建护理学高仿真模拟教学评价框架。方法经课题组讨论和专家会议,初步建立基于CIPP评价模式的护理学高仿真模拟教学评价框架,采用Delphi法对16名专家进行2轮函询。结果 2轮咨询专家积极系数分别为94.12%、100%,专家权威系数0.878,Kendall协调系数分别为0.141和0.351(均P0.01)。确立了教学背景、教学输入、教学过程、教学结果4个维度、9个一级指标和24个二级指标,初步构建了高仿真模拟教学评价框架。结论专家积极性和权威程度高,研究结果可靠。该评价框架可以全面综合地评价护理学高仿真模拟教学,指导护理教育者科学地反思教学实践。     

临床护士科研能力分层评价指标体系的构建

目的 构建临床护士科研能力分层评价指标体系,为评估临床护士科研能力提供方法和策略。 方法 在理论分析、文献回顾基础上,以能级进阶模式和教育目标模式为框架构建条目池,采用德尔菲法对4个省市的15名从事临床护理、护理管理、护理教育的专家进行2轮专家函询。 结果 2轮专家函询的积极系数均为100%, 权威系数均为0.895;第2轮各条目变异系数为0.000~0.188,指标的 协调系数为0.224~0.402。经过两轮函询后,构建的临床护士科研能力分层评价指标体系含有一级指标21个（初、中、高级各7个）,二级指标51个（初、中、高级各17个）。 结论 运用Delphi法构建的临床护士科研能力分层评价指标体系,其函询结果可靠,专家的积极程度、权威程度、协调程度及集中程度均较高,可作为临床护士科研能力的评价工具。     

支气管哮喘护理质量评价指标体系的构建

目的构建支气管哮喘护理质量评价指标体系。方法以"结构-过程-结果"框架为理论依据,采用文献回顾法、临床调研、德尔菲专家函询法的质性研究及层次分析法的量性研究相结合,确定各指标权重,构建支气管哮喘护理质量评价指标体系。结果2轮专家函询问卷有效回收率均为100%,专家权威系数Cr值分别为0.845、0.865,协调系数W值分别为0.252、0.286(P0.01)。形成了3个一级指标、14个二级指标、69个三级指标的哮喘护理质量评价指标,确立了各层级指标权重系数,均通过了一致性检验(CR0.1)。结论该指标体系层次分明,评价指标明确,权重分配合理,具有科学性,为进一步验证打好了基础。     

门诊分诊护士绩效考核指标的构建

目的构建门诊分诊护士绩效考核指标,提高分诊护士绩效考核的精确度。方法运用Delphi专家函询法,构建门诊分诊护士绩效考核的维度、评价指标及其权重。结果对16名专家进行2轮专家函询,问卷有效回收率分别为88.89%,100%;权威系数为0.91,一级指标协调系数0.345。构建了包含工作能力、工作态度、工作质量、团队意识、学习成长在内的5项一级指标,15项二级指标和30项三级指标,并对各指标进行相应的权重赋值。结论门诊分诊护士的绩效考核评价指标的构建有助于解决现有考核存在的不足,充分发挥对门诊护士的激励作用,从整体上提升门诊护理服务质量。     

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.     

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.     

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.