国际肝病学会分委员会对急性和亚急性肝功能衰竭命名的建议

SKAcharya编者按：本期刊出国际肝病学会分委员会有关专家对急性肝功能衰竭（AHF）和亚急性肝功能衰竭（SHF）命名的建议。此命名将AHF和SHF视为两个独立的疾病,而不是一个综合征的两个亚型,与我国1995年“病毒性肝炎防治方案”中的重型肝炎分类有诸多差别：①病因方面：AHF和SHF由各种病因（病毒、药物和毒物等）所致,而重型肝炎仅以病毒性肝炎为病因;②病程和时间：AHF在症状出现后4周内、SHF在症状出现后1～6个月内发生,而急性或亚急性重型肝炎均在症状出现后10天内或以后（有的定为4～8周内）发生;③症状特征：AHF及…     

Genetic mosaic analysis based on Cre recombinase and navigated laser capture microdissection

Defining molecular interactions that occur at the interface between "normal" and "abnormal" cell populations represents an important but often underexplored aspect of the pathogenesis of diseases with focal origins. Here, we illustrate an approach for conducting such analyses based on mosaic patterns of Cre recombinase expression in the adult mouse intestinal epithelium. Transgenic mice were generated that express Cre in the stem cell niche of crypts located in specified regions of their intestine. Some of these mice were engineered to allow for doxycycline-inducible Cre expression. Recombination in all pedigrees was mosaic: Cre-expressing crypts that supported recombination in all of their active multipotent stem cells were located adjacent to "control" crypts that did not express Cre at detectable levels. Cre-mediated recombination of a floxed LacZ reporter provided direct evidence that adult small-intestinal crypts contain more than one active multipotent stem cell, and that these cells can be retained in both small-intestinal and colonic crypts for at least 80 d. A method was developed to recover epithelial cells from crypts with or without recombination for subsequent gene expression profiling. Stained sections of intestine were used to create electronic image templates to guide laser capture microdissection (LCM) of adjacent frozen sections. This navigated form of LCM overcomes problems with mRNA degradation encountered when cells are marked directly by immunohistochemical methods. Combining Cre-engineered genetic mosaic mice with navigated-LCM will allow biology and pathobiology to be explored at the junction between normal and perturbed cellular cohorts.     

Staff perceptions of leadership during implementation of task-shifting in three surgical units

Background Registered nurses are difficult to recruit and retain. Task shifting, which involves reallocation of delegation, can reduce demand for registered nurses. Effective leadership is needed for successful task shifting. Objective This study explored leadership styles of three surgical nurse unit managers. Staff completed surveys before and after the implementation of task shifting. Task shifting involved the introduction of endorsed enrolled nurses (licensed nurses who must practise under registered nurse supervision) to better utilize registered nurses. Methods Implementation of task shifting occurred over 4 months in a 700-bed tertiary hospital, in southeast Queensland, Australia. A facilitator assisted nurse unit managers during implementation. The impact was assessed by comparison of data before (n = 49) and after (n = 72) task shifting from registered nurses and endorsed enrolled nurses (n = 121) who completed the Ward Organization Features Survey. Results Significant differences in leadership and staff organization subscales across the settings suggest that how change involving task shifting is implemented influences nurses’ opinions of leadership. Conclusion Leadership behaviours of nurse unit managers is a key consideration in managing change such as task shifting. Implications for nursing management Consistent and clear messages from leaders about practice change are viewed positively by nursing staff. In the short term, incremental change possibly results in staff maintaining confidence in leadership.     

Student evaluation of simulation in undergraduate nursing programs in Australia using quality indicators

Student evaluation of the implementation of evidence‐based quality indicators for simulation experiences in undergraduate nursing programs in 2012 was explored in this study. The evaluation instrument used five specific measures derived from quality indicators. Students evaluated 10 simulation learning experiences in the first and second years of undergraduate nursing programs at two universities in Australia. Overall, students (n = 85) reported that simulation contributed to their achievement of objectives, but they did not always feel supported in these sessions. Student preparation and orientation was scored lower than other components of the simulation experience. Students reported very good scores for perceived realism and fidelity of simulation sessions, particularly the silicone mask and high‐fidelity sessions, which implies that learning from simulation is transferable into the clinical practice setting. However, patient charts and other clinical documents were not always considered to be realistic. Debriefing was scored very highly overall and for both approaches used for debriefing. The student‐evaluation instrument was an effective means of measuring student‐related quality indicators across a range of simulation sessions. It identified areas for the improved delivery of simulation sessions.