不同层次护生对临床教学质量的评价

目的分析不同层次护生对临床教学质量评价的差异,以便采取有针对性的教学方法.方法护生在每个科室实习结束后,采用自行设计的临床教学评价表对每名护生进行问卷调查,然后分别从中专、大专、本科护生填写的调查表中各随机抽取30%进行分析.结果对病房教学氛围和护士长教学管理的评价,本科与中专、大专护生间比较,差异有显著性意义(均P<0.05),中专与大专护生间无差异(P>0.05);对带教老师的评价,本科与中专、大专与中专护生间均差异有显著性意义(P<0.01,P<0.05),本科与大专间无差异(P>0.05).结论不同层次护生对临床教学质量评价的侧重点不同,本科生对病房教学氛围及护士长教学管理的要求较高,大专生次之.在临床教学中应根据护生的学历层次,采取有针对性的教学方法,以便不断提高临床教学质量.     

不同学历护生时间管理倾向的调查分析

目的了解不同学历护生时间管理倾向的特点，为开展教学提供依据。方法采用青少年时间管理倾向量表对330名不同学历（本科组55名、大专组150名、中专组125名）护生进行调查。结果不同学历护生时间管理倾向评分比较，差异有显著性意义（P〈0．01），本科护生最高，中专护生次之，大专护生最低。三组护生时间价值感及其各维度评分、时间效能感及其各维度评分比较，差异有显著性意义（P〈0．01，P〈0．05），本科组和中专组评分显著高于大专组（P〈0．01，P〈0．05）。不同学历护生的时间监控观评分比较，差异无显著性意义（P〉0．05）。结论不同学历护生时间管理倾向有各自的特点，应有针对性地进行指导，提高其时间管理能力。     

不同层次护生对护理学基础教学方法兴趣差异性的研究

目的了解不同层次护生对护理学基础教学方法兴趣的差异性，为教师在教学活动中有针对性地选择护生易接受的教学方法提供参考。方法采用自编的护理学基础教学方法兴趣调查问卷对护理学院3个层次的护生进行随机调查。结果本科护生对多媒体教学、板书与讲授相结合、实体练习、尝试教学法、护生操作教师指导5种教学方法感兴趣程度得分与专升本护生比较，差异有统计学意义（P〈0．05，P〈0．01）。本科护生对角色扮演、抽查回示教学方法感兴趣程度得分与专科护生比较，差异有统计学意义（均P〈0．05）。专科护生对板书与讲授相结合，护生操作教师指导，角色扮演，抽查回示教学方法感兴趣程度得分与专升本护生比较．差异有统计学意义（P〈0．05，P〈0．01）。结论不同层次护生对不同教学方法感兴趣的差异与其学习经历和培养目标有关，不同层次护生对教学方法的运用均有自己的要求，关注的侧重点不一样。在教学中需根据不同层次护生对教学方法的兴趣，进行有针对性的教学安排，调动护生学习的积极性和主动性，不断提高教学质量。     

不同学历实习护生对临床教学需求的调查

目的了解不同学历实习护生对临床实践教学需求的情况,以提高临床教学质量。方法随机抽取湖南省某重点大学医学院和职业技术学院不同学历（本科、大专、中专）的实习护生120名,采用自行设计的调查问卷进行调查。结果不同学历实习护生对临床实践带教教师的学历、职称及理论水平和科研能力方面的需求比较,差异有显著性意义（均P〈0.01）;在教学内容方面,掌握护理文书的记录、健康教育的技能、护理仪器设备的使用、病房管理的方法4个条目比较,差异有显著性意义（P〈0.05,P〈0.01）。结论不同学历实习护生对临床实践教学的需求不同,教学管理人员应根据其学历,制订切实可行的教学计划,尽量满足其对临床实践教学的需求,以提高临床教学质量和成效。     

不同层次护理专业毕业生主观幸福感及应对方式的调查

目的 了解护理专业中专、大专及本科毕业生的主观幸福感和应对方式，为进一步开展不同层次护理专业毕业生心理健康教育提供参考。方法 以总体幸福感量表（GWB）和应对方式问卷对护理专业临毕业的在枝中专（134名）、大专（136名）、本科（95名）学生进行自评调查。结果不同层次护理专业毕业生主观幸福感比较，差异无显著性意义（P〉0．05）；但应对方式中解决问题、自责、求助、退避和合理化因子得分比较，差异有显著性意义（P〈0．05，P〈0．01）；采用成熟型应对方式（解决问题、合理化）的毕业生幸福感较高（P〈0．01）。结论 不同层次护理专业毕业生的应对方式存在差异，应加强毕业生（尤其是中专、本科毕业生）应对方式的指导。     

不同层次护生对临床能力培养的需求比较

目的了解本科护生和大专护生对临床能力培养需求的差异。为临床有重点地培养护理人才提供依据。方法采用自制护生临床能力培养需求问卷调查本科护生76名和大专护生53名。结果不同层次护生对临床护理能力、沟通协作能力、护理科研能力、护理职业素质的需求评分及总分比较,差异有统计学意义（P〈0．05,P〈0．01）。本科护生呼声较高的需求是应急事件反应能力、专科护理操作能力、实施配合抢救的能力等,而大专护生呼声较高的需求是专科护理操作能力、护理法律意识、基础护理操作能力等。结论不同层次的护生对临床能力的培养需求不同,应针对其学历层次有重点地进行培养。     

专业认同与学业自我效能对护生学习倦怠的影响

目的了解本、专科护生的专业认同、学业自我效能与学习倦怠现状及差异,探讨护生专业认同、学业自我效能对其学习倦怠的影响,为我国护理教育改革提供参考。方法采用护生专业认同调查问卷、学业自我效能量表和大学生学习倦怠调查量表对309名在校护生进行调查。结果本科护生专业认同总分及专业认识、专业情感、专业意志、专业价值观维度评分显著低于大专护生（P〈0．05,P〈0．01）,专业期望得分显著高于大专护生（P〈0．01）;本科护生学习能力自我效能维度得分显著高于大专护生（P〈0．05）;护生学习倦怠发生率为36．25％;护生的专业认同、学业自我效能与学习倦怠呈显著负相关（均P〈0．01）。结论专业认同、学业自我效能是护生学习倦怠的重要预测因子,且本、专科不同层次存在差异。护理院校在培养护生时,应结合不同层次护生的特点,重视其专业认同、学业自我效能的培养,提高护生的专业学习兴趣,降低学习倦怠感。     

不同学历护理专业毕业生岗位分布状况

目的探讨不同学历护理专业毕业生的岗位分布工作状况，为医院合理配置护理人员提供依据。方法将我院10年期间接收的高护生（本科、大专学历）、中护生（中专学历）的业务技术、岗位分布情况进行统计；并通过问卷调查，客观评价高护生的优势所在，并对优势不明显之处给予分析。结果高护生居管理岗位者多于中护生（P〈0．05）；高护生论文撰写水平、知识竞赛获奖率高于中护生（均P〈0．05）；问卷评价，用人单位偏重高护生；不选择高护生的主要原因是高护生进院时的年龄偏大。结论高护生在临床有其明显优势，是医院护理人力资源的必然选择，而加强临床继续护理教育是医院迫在眉睫的任务。     

大专护生不同阶段毕业实习效果比较

目的探讨大专护生在不同毕业实习阶段的实习状况及实习效果。方法采用问卷调查法对307名大专实习护生（下称护生）进行实习早期、中期及后期问卷调查。评估护生在不同时期的专业态度与专业技能情况。结果专业技能方面，操作技能随实习时间的延长而显著提高（均P〈0．05）；沟通能力、自主学习能力与科研能力。实习中期显著优于初期（均P〈0．05），后期无显著提高（均P〉0．05）；专业态度方面，服务态度实习中期显著高于初期、后期（均P〈0．05），敬业精神实习中期显著高于初期与后期（均P〈0．05），热爱护理实习初期显著高于实习中、后期（均P〈0．05）；检查知识与技能随实习时间的延长而升高和显著升高（均P〈0．05）。结论实习初期。护生专业技能掌握较差，专业态度较好；实习中期，护生专业技能提高快，专业态度好；实习后期。护生操作技能好，专业态度退步。教师应于护生不同实习时期采取针对性教学管理措施，引导护生在提高专业技能的同时，建立良好的专业态度。     

大专护生专业知识学习认知能力调查

目的评估大专护生识记、理解、应用、分析、综合、评价6项专业知识学习认知能力,为针对性教学提供依据。方法对2005、2006级271名护生应用自行设计的护生认知能力自我评估表进行测评。结果护生认知能力总均分（0．667&#177;0．104）分,6项得分为0．627&#177;0．0880．747&#177;0．104;2个年级比较,差异无统计学意义（均P〉0．05）;6项能力中识记、评价能力分别显著高于其他各项（均P〈0．05）。结论大专护生专业认知能力呈中等水平,识记和评价能力较强,理解、综合、应用和分析能力有待改进教学方法,以提高其教学效果。     

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.