全机器人辅助低温灌注下肾部分切除术的护理配合

目的：探讨全机器人辅助低温灌注下肾部分切除术下的护理配合流程,提高护士的手术配合质量。方法通过配合10例全机器人辅助低温灌注下肾部分切除手术,对术前物品准备、手术间布局,术中体位摆放及手术精准配合进行总结。结果10例手术顺利完成,无中转开腹,手术配合满意。结论准备好特殊手术物品,熟练的手术操作步骤,与手术医生积极沟通,掌握机器人各系统的使用情况是确保手术成功的关键。     

2例感染性腹主动脉瘤合并主动脉肠瘘患者行“牛心包”原位重建术的护理

目的 总结2例感染性腹主动脉瘤合并主动脉肠瘘行牛心包原位重建术后治疗护理经验。方法 术前实施血压进阶式管理,降低血管破裂风险;严格落实消毒隔离措施,注意多种药物不良反应;术后实施个体化营养方案,实施全程管理预防再感染,延续药物重整服务;严防吻合口破裂出血及下肢动脉栓塞。结果 经过积极的治疗和护理,2例患者恢复良好,顺利康复出院。微信、电话随访半年,患者恢复良好。结论 腹主动脉瘤合并主动脉肠瘘患者病情复杂而危重,提供个体化围术期全程管理,降低感染等并发症发生率,可为临床工作提供借鉴及参考。     

短板理论促进护理管理持续改善的实践

目的探讨运用短板理论进行护理管理体系重建和流程再造以达到促进护理管理持续改善的效果。方法运用精细化管理的ORTCC理论模型寻找医院护理管理体系中的短板,改善"目标、规则、训练、考核、文化"5个系统中存在系统化和细化的问题,重建医院护理管理体系,落实标准化护理工作流程和各护理岗位规范化工作程序,逐步实施同质化护理服务。结果管理前(2012年)和管理后(2013年)医院护理质量与安全管理年终考核平均分分别为89.40、93.10分,患者对护理工作满意率分别为88.74%、92.25%;护士对护理工作满意率分别为83.27%、91.12%。结论护理管理体系的最短木板是整体绩效的决定因素,补齐短板是提升整体绩效的关键要素,短板的存在和不断变化要求改善绩效必须是持续的,短板的加长赋予整体绩效改善以必然。     

mini-CEX在实习护生出科专科操作考核中的应用

目的探讨中文版迷你临床演练评估(mini-CEX.cn)应用于实习护生出科专科操作考核的效果。方法将162名本科护生随机分为对照组80名和观察组82名。对照组应用传统考评方法进行出科专科操作考核,观察组应用mini-CEX.cn进行出科专科操作考核。结果对照组考核结果优秀率43.75%、符合要求率50.00%,观察组优秀率85.37%,符合要求率14.63%;96.34%的观察组护生认为mini-CEX.cn能有效反映受试者的综合能力,95.12%认为能够体现以考促学,97.56%认为对提高临床能力有较大的帮助。结论实习护生出科专科操作考核应用mini-CEX.cn兼具教学与评量的作用,教学相长,能够有效评价护生的能力。     

DC-SIGN expression on podocytes and its role in immune and inflammatory responses of lupus nephritis

Objective To explore the expression of DC-SIGN, the phenotype of dendritic cells (DCs), on podocytes, and its role in immune and inflammatory responses of lupus nephritis (LN). Methods DC-SIGN and IgG1 expression in renal tissues of lupus nephritis patients were observed by immunohistochemistry and immunofluorescence. The 4-week old LN mice were randomly divided into the experimental group and the intervention group. C57BL/6J mice were used as normal control group. Mice of the intervention group were injected anti-DC-SIGN antibody at 6-week old. Mice were sacrificed at 16, 20, 24, 28-week old respectively, to observe the mice renal function and pathological changes. And DC-SIGN and IgG1 expression in renal tissue were observed by immunohistochemistry and immunofluorescence. In addition, mice podocytes were treated with serum of LN mice. Flow cytometry was used to investigate the expression of MHC II, CD80 and DC-SIGN expression on podocytes. Mixed lymphocyte reaction was used to detect the ability of stimulating T cells proliferation. IFN-gamma and IL-4 in supernatant were determined by ELISA. Results (1) Expression of DC-SIGN and IgG1 was found in glomeruli of lupus nephritis patients. (2) Accompanied by increased proteinuria of LN mice from 20-week old (P＜0.01), DC-SIGN and IgG1 expression was found in glomeruli, and the renal function deteriorated up to 24 week-old (P＜0.01). Mice with anti-DC-SIGN antibody intervention appeared reduced proteinuria and remission of renal function (P＜0.01). (3) After stimulated by serum of LN mice, the expression of DC-SIGN, MHC II and CD80 was up-regulated, stimulation of T cell proliferation was enhanced (P＜0.01), and IFN-gamma/IL-4 ratio increased (P＜0.01). Anti-DC-SIGN antibody treatment down-regulated the expressions of DC-SIGN, MHC II and CD80 on podocytes, decreased the ability of stimulating T cell proliferation and lowered the ratio of IFN-gamma/IL-4 (P＜0.01). Conclusions Podocytes in lupus nephritis can play DC-like function through the expression of DC-SIGN, which may be involved in immune and inflammatory responses of renal tissue. However, inhibiton of DC-SIGN can depress immune function of podocytes and have prevention and treatment effect.     

Single‐ and Multiple‐Dose Randomized Studies of Blosozumab,a Monoclonal Antibody Against Sclerostin,in Healthy Postmenopausal Women

Two clinical studies were conducted to assess the safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of single and multiple doses (intravenous [iv] and subcutaneous [sc]) of blosozumab in postmenopausal women, including prior/current bisphosphonate (BP) users. In these phase 1, randomized, subject‐ and investigator‐blind, placebo‐controlled studies, subjects received escalating doses of blosozumab: single iv doses up to 750 mg, single sc doses of 150 mg, multiple iv doses up to 750 mg every 2 weeks (Q2W) for 8 weeks, multiple sc doses up to 270 mg Q2W for 8 weeks, or placebo. Six subjects were randomized to each dose in the single‐dose study (12 to placebo) and up to 12 subjects to each arm in the multiple‐dose study. Blosozumab was well tolerated with no safety concerns identified after single or multiple administrations up to 750 mg. Dose‐dependent responses were observed in sclerostin, N‐terminal propeptide of procollagen type 1, bone‐specific alkaline phosphatase, osteocalcin, C‐terminal fragment of type 1 collagen, and bone mineral density (BMD) after single and multiple (up to 5) administrations of blosozumab. There was up to a 3.41% (p = 0.002) and up to a 7.71% (p < 0.001) change from baseline in lumbar spine BMD at day 85 after single or multiple administrations of blosozumab, respectively. Prior BP use did not appear to have a clear impact on the effects of single doses of blosozumab when considering bone biomarker and BMD responses. Antibodies to blosozumab were detected by a screening assay, but no patterns with regard to dose or route of administration and no clear impact on blosozumab exposure or PD responses were identified. In summary, blosozumab was well tolerated and exhibited anabolic effects on bone. These findings support further investigation of blosozumab as a potential anabolic therapy for osteoporosis. © 2014 American Society for Bone and Mineral Research.