2012年某三甲医院实习护士锐器伤调查

目的 了解实习护士在实习期间发生医疗锐器伤的情况,探讨实习护士锐器伤的危险相关因素和防范对策.方法 对2012年实习的护士进行回顾性问卷调查,问卷为自制,内容包括调查对象基本情况、职业暴露防护知识教育或培训情况、锐器伤伤害的情况、防锐器伤的防护意识、锐器伤发生后的处理等.结果79.9％ （188/238）的实习护士在l～10个月的实习期间至少发生过1次锐器伤,平均每个实习护士发生锐器伤的次数为1.78次;实习头1个月发生的次数最多,实习护士中93.7％不同程度接受过职业防护知识培训,锐器伤主要发生在：儿科、急诊科、神经外科等比较忙的科室;导致锐器伤发生的主要操作为：徒手掰安瓿、处置医疗废物、双手回套针帽、拔针、静脉注射;76.1％的锐器伤案例能正确处理伤口,仅有9.9％锐器伤能正确报告.不同学历者、不同培训途径及是否接受过职业防护相关知识培训护士锐器伤发生率差异均有统计学意义（P＜0.05）.结论 实习护士锐器伤发生率目前处于较高水平,要加强实习护士的“三基”及职业防护相关知识培训,使她们尽快规范、熟练护理操作,提高锐器伤防范意识;医院要减少患者静脉输注治疗;尽可能用高分子材料的安瓿（如塑料）代替玻璃安瓿;建立健全职业防护制度,强化职业暴露报告意识,以降低实习护士锐器伤发生率.     

Efficacy of vasopressin during cardio-pulmonary resuscitation in adult patients: A meta-analysis

Background

Experimental and animal studies suggested that vasopressin may have a favorable survival profile during CPR. This meta-analysis aimed to determine the efficacy of vasopressin in adult cardiac patients.

Methodology

Meta-analysis of randomized control trials (RCTs) comparing the efficacy of vasopressin containing regimen during CPR in adult cardiac arrest population with an epinephrine only regimen.

Results

A total of 6120 patients from 10 RCTs were included in this meta-analysis. Vasopressin use during CPR has no beneficial impact in an unselected population in ROSC [OR 1.19, 95% CI 0.93, 1.52], survival to hospital discharge [OR 1.13, 95% CI 0.89, 1.43], survival to hospital admission [OR 1.12, 95% CI 0.99, 1.27] and favorable neurological outcome [OR 1.02, 95% CI 0.75, 1.38]. ROSC in “in-hospital” cardiac arrest setting [OR 2.20, 95% CI 1.08, 4.47] is higher patients receiving vasopressin. Subgroup analyses revealed equal or higher chance of ROSC [OR 2.15, 95% CI 1.00, 4.61], higher possibility of survival to hospital discharge [OR 2.39, 95% CI 1.34, 4.27] and favorable neurological outcome [OR 2.58, 95% CI 1.39, 4.79] when vasopressin was used as repeated boluses of 4–5 times titrating desired effects during CPR.

Conclusion

ROSC in “in-hospital” cardiac arrest patients is significantly better when vasopressin was used. A subgroup analysis of this meta-analysis found that ROSC, survival to hospital admission and discharge and favorable neurological outcome may be better when vasopressin was used as repeated boluses of 4–5 times titrated to desired effects; however, overall no beneficial effect was noted in unselected cardiac arrest population.     

大学生抗挫折能力现状及培养策略

挫折是大学生不得不面对的问题,抗挫折能力是大学生必备的素质之一,挫折教育也成为当代大学生重要的必修课程。本文简述了挫折的概念及挫折教育的意义,重点分析了大学生抗挫折能力的现状、影响因素及培养策略,旨在为提高大学生的心理素质,促进其健康成长提供依据。     

Self-regulated learning instructional support for students enrolled in an accelerated nursing program

BackgroundNursing students in accelerated programs come from diverse cultural and educational backgrounds and must adapt to the academic rigor and rapid pace inherent in accelerated programs. The student must progress to a level of independence and self-regulation to become a lifelong learner. However, there is little evidence of the impact of an accelerated program on students’ self-regulation.AimsTo determine if:

• •Teaching for SRL improved students’ self-regulatory strategy use in an accelerated nursing program.
• •There are differences between international and domestic students’ motivational and learning strategy use.

MethodsA quasi-experimental design using the Motivational Strategies for Learning Questionnaire (MSLQ) was employed to assess motivational behaviours and learning strategies of students before and after participating in instructional activities over the first semester of an accelerated program. Data from two open-ended questions were analysed using content analysis.FindingsSeventy-six students completed pre and post surveys. Student median scores were above average on motivational behaviours and learning strategies with a slight decrease post-intervention. High correlation of motivational behaviours and learning strategies of both groups were quantitatively identified and supported by qualitative data.At post-intervention, international students had statistically significantly lower task value and lower control of learning beliefs than domestic students. All median values for motivational behaviours and learning strategies decreased for both groups at post-intervention, except help-seeking which increased for domestic students.DiscussionThis study demonstrated the complexity and cognitive load of condensed programs can be challenging, particularly for novice learners and international students.ConclusionThis study contributes to the research base for curriculum development and learning outcomes for students in accelerated programs beyond nursing.     

Succinct Review of the New VTE Prevention and Management Guidelines

Venous thromboembolism is a major source of morbidity and mortality in the United States. The American College of Chest Physicians Antithrombotic Guidelines, 9th edition, includes a large number of clinical practice recommendations regarding the diagnosis, treatment, and prevention of venous thromboembolism. This succinct clinical review of these guidelines specifically focuses on the evaluation, treatment, and prevention of venous thromboembolic disease.     

Controversies in Barrett Esophagus

Barrett esophagus develops when metaplastic columnar epithelium predisposed to develop adenocarcinoma replaces esophageal squamous epithelium damaged by gastroesophageal reflux disease. Although several types of columnar metaplasia have been described in Barrett esophagus, intestinal metaplasia with goblet cells currently is required for a definitive diagnosis in the United States. Studies indicate that the risk of adenocarcinoma for patients with nondysplastic Barrett esophagus is only 0.12% to 0.38% per year, which is substantially lower than previous studies had suggested. Nevertheless, the incidence of esophageal adenocarcinoma continues to rise at an alarming rate. Regular endoscopic surveillance for dysplasia is the currently recommended cancer prevention strategy for Barrett esophagus, but a high-quality study has found no benefit of surveillance in preventing deaths from esophageal cancer. Medical societies currently recommend endoscopic screening for Barrett esophagus in patients with multiple risk factors for esophageal adenocarcinoma, including chronic gastroesophageal reflux disease, age of 50 years or older, male sex, white race, hiatal hernia, and intra-abdominal body fat distribution. However, because the goal of screening is to identify patients with Barrett esophagus who will benefit from endoscopic surveillance and because such surveillance may not be beneficial, the rationale for screening might be made on the basis of faulty assumptions. Endoscopic ablation of dysplastic Barrett metaplasia has been reported to prevent its progression to cancer, but the efficacy of endoscopic eradication of nondysplastic Barrett metaplasia as a cancer preventive procedure is highly questionable. This review discusses some of these controversies that affect the physicians and surgeons who treat patients with Barrett esophagus. Studies relevant to controversial issues in Barrett esophagus were identified using PubMed and relevant search terms, including Barrett esophagus, ablation, dysplasia, radiofrequency ablation, and endoscopic mucosal resection.     

A Summary and Critical Assessment of the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease Risk in Adults: Filling the Gaps

The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines has recently released the new cholesterol treatment guideline. This update was based on a systematic review of the evidence and replaces the previous guidelines from 2002 that were widely accepted and implemented in clinical practice. The new cholesterol treatment guideline emphasizes matching the intensity of statin treatment to the level of atherosclerotic cardiovascular disease (ASCVD) risk and replaces the old paradigm of pursuing low-density lipoprotein cholesterol targets. The new guideline also emphasizes the primacy of the evidence base for statin therapy for ASCVD risk reduction and lists several patient groups that will not benefit from statin treatment despite their high cardiovascular risk, such as those with heart failure (New York Heart Association class II-IV) and patients undergoing hemodialysis. The guideline has been received with mixed reviews and significant controversy. Because of the evidence-based nature of the guideline, there is room for several questions and uncertainties on when and how to use lipid-lowering therapy in clinical practice. The goal of the Mayo Clinic Task Force in the assessment, interpretation, and expansion of the ACC/AHA cholesterol treatment guideline is to address gaps in information and some of the controversial aspects of the newly released cholesterol management guideline using additional sources of evidence and expert opinion as needed to guide clinicians on key aspects of ASCVD risk reduction.     

Participatory action research: Involving students in parent education

Competition for scarce clinical placements has increased requiring new and innovative models to be developed to meet the growing need. A participatory action research project was used to provide a community nursing clinical experience of involvement in parent education. Nine Hong Kong nursing students self-selected to participate in the project to implement a parenting program called Parenting Young Children in a Digital World. Three project cycles were used: needs identification, skills development and program implementation. Students were fully involved in each cycle's planning, action and reflection phase. Qualitative and quantitative data were collected to inform the project. The overall outcome of the project was the provision of a rich and viable clinical placement experience that created significant learning opportunities for the students and researchers. This paper will explore the student's participation in this PAR project as an innovative clinical practice opportunity.