综合模拟实验在院内急救护理教学中的应用

目的探讨综合模拟实验在急危重症护理教学的院内急救环节中的应用与效果。方法以110名护理三年级本科学生为研究对象,完成3学时的心肺复苏、球囊面罩通气、除颤团队训练后,进行2学时的院内急救临床情境模拟教学,课后使用自制反馈问卷进行测评。结果各评价条目得分均在4分以上;90.9%以上的学生认为观察患者的能力和解决问题的能力得到提高,82.7%能有效应对患者的病情变化,90.9%对自身课堂表现感到满意。≥90.0%的学生掌握了急诊分诊流程、处理口头医嘱、心肺复苏团队配合知识与技能、外伤出血包扎等内容。结论综合模拟实验在急重症护理教学中取得良好效果,为课堂多元化教学拓宽了思路。     

失效模式和效应分析预防护士静脉给药错误的实践

目的运用失效模式和效应分析对临床护士给药的各个环节进行改造,以减少护士静脉给药错误。方法根据FMEA方法,成立预防护士静脉给药错误工作小组;列出临床护士给药的流程;指出子流程下可能导致错误的环节及原因;提出解决问题的整改方案;跟踪整改的成效。结果改进后失效模式和效应分析的风险值(RPN)从1 120下降至270,护士静脉给药错误发生率显著下降(P0.05)。结论失效模式和效应分析作为一种风险管理工具,将发生护理安全事件后的消极处理转变为事件发生前的积极预防,可减少护士发生静脉给药错误的概率。     

中西医结合治疗脂质沉积性肌病患儿的护理

目的 总结中西医结合治疗脂质沉积性肌病患儿的护理方法.方法 对16例脂质沉积性肌病患儿予以口服左卡尼汀治疗的同时,辅予辨证施治(脾胃虚弱证9例,脾肾阳虚证7例),均以七味白术散合补中益气汤为基本治疗方剂,脾胃虚弱证去赤芍、丹参,加莲子、大枣,脾肾阳虚证去当归,加山萸肉、半夏,连服10 d为1个疗程;按辨证实施生活护理、病情观察、饮食护理及康复训练等.结果 治疗10个疗程,显效12例、好转3例、无效1例,总有效率93.75％.结论 对脂质沉积性肌病患儿行中西医结合治疗和辨证施护及康复训练,可达到较好的治疗效果.     

Embryo fossilization is a biological process mediated by microbial biofilms

Fossilized embryos with extraordinary cellular preservation appear in the Late Neoproterozoic and Cambrian, coincident with the appearance of animal body fossils. It has been hypothesized that microbial processes are responsible for preservation and mineralization of organic tissues. However, the actions of microbes in preservation of embryos have not been demonstrated experimentally. Here, we show that bacterial biofilms assemble rapidly in dead marine embryos and form remarkable pseudomorphs in which the bacterial biofilm replaces and exquisitely models details of cellular organization and structure. The experimental model was the decay of cleavage stage embryos similar in size and morphology to fossil embryos. The data show that embryo preservation takes place in 3 distinct steps: (i) blockage of autolysis by reducing or anaerobic conditions, (ii) rapid formation of microbial biofilms that consume the embryo but form a replica that retains cell organization and morphology, and (iii) bacterially catalyzed mineralization. Major bacterial taxa in embryo decay biofilms were identified by using 16S rDNA sequencing. Decay processes were similar in different taphonomic conditions, but the composition of bacterial populations depended on specific conditions. Experimental taphonomy generates preservation states similar to those in fossil embryos. The data show how fossilization of soft tissues in sediments can be mediated by bacterial replacement and mineralization, providing a foundation for experimentally creating biofilms from defined microbial species to model fossilization as a biological process.     

Serum nitric oxide metabolites and disease activity in patients with systemic sclerosis

There is no surrogate marker in serum for defining disease activity in scleroderma (SSc). Nitric oxide (NO), which regulates vasodilation and possesses pro-inflammatory actions, has been implicated in the pathogenesis of SSc. We compared serum NO _x (total nitrate and nitrite) level in SSc patients to healthy controls and evaluated its correlation with detailed symptomatology and scoring systems for various organ involvement. Symptoms and physical findings that suggested disease activity in regard to various organs were documented. Lung function test, high-resolution computed tomographic (HRCT) scan of thorax and echocardiography were performed. Serum NO _x was measured by chemiluminescence. Serum NO _x levels in SSc (n = 43) were significantly higher (72.4 ± 47.8 μM) than age- and sex-matched controls (n = 41; 37.1 ± 13.5 μM; p < 0.001). Serum NO _x were not found to be associated with lung fibrosis defined by lung function parameters or inflammation and fibrosis scores on HRCT. Twenty-two patients were found to have elevated serum NO _x level defined as mean ± 2 SD of normal controls. Logistic regression analysis revealed that age (OR 1.12, p = 0.02) and elevated pulmonary arterial pressure (PAP) (n = 9; OR 145.3, p = 0.01) were predictive factors for elevated serum NO _x . Prednisolone use was associated with lower serum NO _x level (OR 0.06, p = 0.04). Elevated PAP of increasing severity was found to be associated with higher level of serum NO _x (p = 0.004 by trend). Serum NO _x in SSc patients were elevated compared to healthy controls. Serum NO _x level was determined by multiple factors including age, prednisolone use, and elevated PAP.     

乳腺癌术后乳房重建的策略

乳房重建已成为乳腺癌综合治疗的重要组成部分。成功的乳房重建通常不是一次手术就可以完成,而需要进行一系列手术。在临床工作中需要注意以下几方面问题:选择适当的乳房重建时机和方式,对重建乳房及健侧乳房进行必要的修整,并最终完成乳头乳晕重建和纹色。为此,需要手术医生全面熟练掌握肿瘤外科和整形外科的原则和技术,将医学和美学完美结合。     

Performance of cardiopulmonary resuscitation during prolonged basic life support in military medical university students: A manikin study

BACKGROUND: The quality of chest compressions can be significantly improved after training of rescuers according to the latest national guidelines of China. However, rescuers may be unable to maintain adequate compression or ventilation throughout a response of average emergency medical services because of increased rescuer fatigue. In the present study, we evaluated the performance of cardiopulmonary resuscitation(CPR) in training of military medical university students during a prolonged basic life support(BLS).METHODS: A 3-hour BLS training was given to 120 military medical university students. Six months after the training, 115 students performed single rescuer BLS on a manikin for 8 minutes. The qualities of chest compressions as well as ventilations were assessed.RESULTS: The average compression depth and rate were 53.7±5.3 mm and 135.1±15.7 compressions per minute respectively. The proportion of chest compressions with appropriate depth was 71.7%±28.4%. The average ventilation volume was 847.2±260.4 m L and the proportion of students with adequate ventilation was 63.5%. Compared with male students, significantly lower compression depth(46.7±4.8 vs. 54.6±4.8 mm, P0.001) and adequate compression rate(35.5%±26.5% vs. 76.1%±25.1%, P0.001) were observed in female students.CONCLUSIONS: CPR was found to be related to gender, body weight, and body mass index of students in this study. The quality of chest compressions was well maintained in male students during 8 minutes of conventional CPR but declined rapidly in female students after 2 minutes according to the latest national guidelines. Physical fitness and rescuer fatigue did not affect the quality of ventilation.