循证护理教学在外科护士规范化培训中的应用研究

目的探讨循证护理教学在外科护士规范化培训中的应用效果。方法将笔者所在医院外科20名新毕业大々护士随机分成2组,分别应用循证护理教学法与常规护理教学法进行护士规范化培训,培训2个月、工作10个月后对阿组护士的理论、操作考核成绩、患者满意度进行比较。结果实验组护士理论成绩和操作考核成绩高于对照组（t=2．611,P〈0．05）;实验组满意度均高于对照组（x2=8．303,P〈0．01）,差异有统计学意义。结论应用循证护理教学,能提高护士的学习能力、分析与解决问题能力、与患者的沟通能力,并有效地提高护理质量,提高患者对护理工作的满意度。     

基于微课件的翻转课堂在新护士岗前技能培训中的应用

目的评价基于微课件的翻转课堂在新护士岗前技能培训中的应用效果。方法将2017年入职的64名新护士设为对照组,采用传统技能教学法进行技能培训;将2018年入职的67名新护士作为观察组,采用基于微课件的翻转课堂进行技能培训。结果观察组新护士理论和操作考核成绩、自我导向学习能力得分显著高于对照组(均P0.01),观察组新护士对技能培训方法的满意度达77.61%～98.51%。结论基于微课件的翻转课堂在新护士岗前技能培训中的应用,可培养新护士的自主学习能力,提高护理技能培训效果。     

互动平台在膝关节置换手术护理培训中的应用

目的探讨基于优慕网(UMU)互动平台下的混合式教学在膝关节置换手术(TKA)护理培训中的应用价值。 方法选取广州医科大学附属第一医院参加TKA护理培训计划的手术室护士，根据培训批次，将2020年11月至12月参加培训的护士30人作为对照组，采用传统培训模式；将2021年5月至6月参加培训的护士30人作为观察组，采用基于UMU互动平台下的混合式教学模式。完成培训1周后，进行理论与操作考核；两组培训成员的6个月单独配合率比较采用卡方检验；两组理论成绩、操作成绩、与同一组医生进行TKA的平均手术用时比较采用t检验；两组手术的配合能力满意度采用非参数检验。 结果观察组的理论考核分数、操作考核分数均显著高于对照组(t＝3.870、5.142，均为P<0.05)。培训结束后6个月内，观察组单人器械护士的单独配合率为84.9%，显著高于对照组的46.9%(χ²＝16.516, P<0.05)。观察组的手术配合能力满意度明显优于对照组(Z＝5.138, P<0.05)。观察组的平均手术时间为(152±10)min，显著短于对照组的(160±11)min(t＝3.542, P<0.05)。 结论将基于UMU互动平台下的混合式教学应用于TKA护理培训中效果较优，值得进一步推广。     

改良Peycon四步教学法在新入职护士岗前操作培训中的应用

目的 提高新入职护士岗前护理操作技能培训效果.方法 选取2019年度新入职护士32人作为对照组,将2020年度新入职护士30人作为观察组,对照组采用传统方法进行护理操作培训,观察组采用改良Peycon四步教学法进行护理操作培训.结果 对照组护理操作考核成绩(90.63±1.27)分,观察组为(96.03±1.35)分,...     

微课结合翻转课堂在新护士通科知识技能培训中的应用

目的探讨在新护士通科知识技能培训中运用微课结合翻转课堂教学的可行性及应用效果。方法将136名新护士随机分成对照组76人和观察组60人。对照组采用常规新护士通科知识技能培训方法,观察组采用微课结合翻转课堂培训方法。结果培训后观察组操作成绩和临床应用成绩显著高于对照组(均P0.01),观察组新护士对培训形式的满意度显著高于对照组(P0.05,P0.01)。结论微课结合翻转课堂的培训方法有利于激发学习兴趣,提高新护士操作技能和临床实际运用能力。     

微课结合翻转课堂教学模式在手术室新护士培训中的应用

目的探讨微课结合翻转课堂教学模式在手术室新护士培训中的应用效果。方法选取2014年进院的22名手术室新护士为对照组,2015年进院的20名手术室新护士为观察组,对照组采用传统的教学方式,观察组采用微课结合翻转课堂教学模式进行培训。结果规范化培训结束后,观察组理论成绩和临床操作成绩显著高于对照组,观察组对培训教学方法中营造轻松的学习氛围及利于理论与实践结合2个方面的满意度显著高于对照组(P0.05,P0.01);临床带教老师对观察组综合能力的评价显著优于对照组(均P0.01)。结论微课结合翻转课堂教学模式用于手术室新护士培训,有利于新护士对知识和技能的掌握,提高其临床综合能力,增强对手术室工作的适应能力。     

全景式案例教学用于儿科新入职护士规范化培训的效果评价

目的探讨全景式案例教学在儿科新入职护士规范化培训中的应用效果。方法对2015年招收的72名新入职护士(对照组)和2016年招收的80名新入职护士(观察组)分别采取传统培训及全景式案例教学培训。结果观察组考核成绩及对护理工作的满意度显著高于对照组(均P0.01)。结论全景式案例教学有利于新入职护士掌握相关专科知识和技能,提升其岗位胜任力及对护理工作满意度。     

翻转课堂联合教练式教学在护生实习岗前培训中的应用

目的探讨翻转课堂联合教练式教学法在护生实习岗前护理操作培训中的应用效果。方法采取历史对照设计,将2016年6月的35名实习护生纳入对照组,在岗前护理操作培训中采取翻转课堂教学法,将2017年6月的35名实习护生归入观察组,采取翻转课堂联合教练式教学法。结果观察组护生学习满意度显著高于对照组(P0.01);理论知识、实践操作考核成绩显著优于对照组(均P0.01)。结论翻转课堂联合教练式教学能显著提升实习护生岗前操作培训的效果及学习满意度。     

降阶梯思维法在急诊科新护士轮转培训中的应用

目的 探讨降阶梯思维法在急诊科新护士培训中的应用效果.方法 将2011年3～9月入科的28名新护士作为对照组,采用传统教学法;2012年3～9月入科的28名新护士作为观察组,采用降阶梯思维法进行教学.结果 观察组案例操作考核及临床综合能力考核成绩显著高于对照组（均P＜0.01）,对培训的满意度显著高于对照组（P＜0.05）.结论 应用降阶梯思维培训能提高新护士识别及处理急症和危重症患者的抢救能力,保障护理安全.     

移动学习平台在老年专科疾病理论知识培训中的应用

目的探索移动学习平台在老年科护士专科疾病理论知识培训中的应用效果。方法整群抽取老年科护士108名,按病房分为观察组58人和对照组50人。在专科疾病理论知识培训中,对照组采用传统集中理论授课教学法,观察组采用基于即刻学堂的移动学习平台进行教学。结果观察组护士专科理论考核成绩显著高于对照组(P0.01),对培训形式设置,获取知识的及时高效性,激发学习兴趣,促进知识掌握记忆,有效调动学习主动性,提高解决问题能力,培训时间安排合理性的满意度及继续参与培训的意愿显著高于对照组(均P0.01)。结论基于即刻学堂的移动学习平台打破了传统教学的时空束缚,改进了教与学的方式,促进了在职护士理论学习的积极性和效果提高,有利于在职护士掌握理论知识。     

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.