Influence of Lung Aeration on Pulmonary Concentrations of Nebulized and Intravenous Amikacin in Ventilated Piglets with Severe Bronchopneumonia

Background: Pulmonary concentrations of aminoglycosides administered intravenously are usually low in the infected lung parenchyma. Nebulization represents an alternative to increase pulmonary concentrations, although the obstruction of bronchioles by purulent plugs may impair lung deposition by decreasing lung aeration.

Methods: An experimental bronchopneumonia was induced in anesthetized piglets by inoculating lower lobes with a suspension of 106 cfu/ml Escherichia coli. After 24 h of mechanical ventilation, 7 animals received two intravenous injections of 15 mg/kg amikacin, and 11 animals received two nebulizations of 40 mg/kg amikacin at 24-h intervals. One hour following the second administration, animals were killed, and multiple lung specimens were sampled for assessing amikacin pulmonary concentrations and quantifying lung aeration on histologic sections.

Results: Thirty-eight percent of the nebulized amikacin (15 mg/kg) reached the tracheobronchial tree. Amikacin pulmonary concentrations were always higher after nebulization than after intravenous administration, decreased with the extension of parenchymal infection, and were significantly influenced by lung aeration: 197 +/- 165 versus 6 +/- 5 [mu]g/g in lung segments with focal bronchopneumonia (P = 0.03), 40 +/- 62 versus 5 +/- 3 [mu]g/g in lung segments with confluent bronchopneumonia (P = 0.001), 18 +/- 7 versus 7 +/- 4 [mu]g/g in lung segments with lung aeration of 30% or less, and 65 +/- 9 versus 2 +/- 3 [mu]g/g in lung segments with lung aeration of 50% or more.     

血管紧张素转换酶基因多态性与肺源性心脏病的相关性

①目的　探讨血管紧张素转换酶 (ACE)基因的插入 缺失 (I D)多态性与肺源性心脏病 (肺心病 )的关系。②方法　选取肺心病病人 63例 ,正常对照组 40例。常规制备外周血白细胞DNA ,采用多聚酶链反应 (PCR)检测两组人群ACE基因的I D多态性。③结果　肺心病组和正常对照组均检测到ACE基因的II,ID及DD 3种基因型 ,肺心病组 3种基因型的频率分别为 0 .45 ,0 .41和 0 .1 4 ,正常对照组为 0 .42 ,0 .41和 0 .1 7,两组比较差异无显著性 (χ2 =2 .1 57,P >0 .0 5) ;两组I,D等位基因频率分别为 0 .54 ,0 .46和 0 .61 ,0 .39,两组间比较差异无显著性(χ2 =1 .2 57,P >0 .0 5)。④结论　ACE基因I D多态性与肺心病发生无明显相关性     

A critical reflection on the personal impact of managerial hegemony within nurse education

This paper, written by two male nurse teachers, describes and analyses their experience of working in a nurse education culture permeated by the philosophy of business management The introduction of business management practices to nurse education is discussed as a reflection of the current political hegemony of market forces and individualism The authors discuss the implications for nurse teachers of being continually exposed to these politically motivated forces which increasingly provide the paradigm for service developments within the United Kingdom health services In discussing the impact of this exposure it is argued that at the personal level individual teachers are experiencing a degree of apathy and personal dissonance which undermines their professional value system, resulting in emotional distress and a crisis of identity It provides a critical reflection on the way organizational dynamics and power relations influence the subjective sense-making of individuals The authors use a multiplicity of perspectives, including those provided by individual psychology, power relations, feminism and personhood, to argue for the need to develop an alternative paradigm which is characterized by the valuing of individual persons, empathic sensitivity and the fostering of creativity been important to us from a personal and professional     

What should nurse teachers be doing? A preliminary study

There is little doubt that the role of the nurse teacher is complex and multifaceted in nature. The apparently conflicting demands of NHS trusts and education in the United Kingdom, at the time of integration of nurse education into the higher education sector, further complicates the role. This recognition underlines the need to capture and measure key aspects of nurse teacher function in order to maximize educational gain. Using a comprehensive literature review, focus group discussions and a small number of individual semi-structured interviews, this preliminary study explored the issue of teacher workload, from the perspective of the principal stakeholders in nurse and higher education. Competing research and clinical practice objectives for nurse teachers are identified against a background of changing health care provision, reduced availability of placements and an increased need for evidence-based practice.     

Invasive ventilation in the emergency department: Part 2: Implications for patient safety

The use of mechanical ventilation in the Emergency Department requires adequate resources in order to maintain patient safety and avoid potential risks. Moreover, developments in technology require increased knowledge of mechanical ventilation techniques to address the complexity of decision-making involved. Organisational issues and system factors have the potential to negatively impact on the ability of the emergency service to provide optimum care to patients receiving mechanical ventilation. These issues include staffing and skill-mix, demand on emergency services, role-delineation, scope of practice, and current mechanisms for monitoring of quality and safety. Furthermore, in response to advances in ventilator technology, current education programs for both nursing and medical staff require review to ensure that they provide comprehensive information about the types of ventilation techniques now available and the relative risks and benefits associated with their application.This article is the second in a two-part series and explores the educational and organisational factors that impact upon safety and quality of care delivered to patients receiving mechanical ventilation in the emergency department. Recommendations for future policy development, curriculum review and reporting mechanisms to support further research in the application of mechanical ventilation in the emergency department are made.     

心理支持疗法对机械通气患者应激反应的影响

目的 观察心理支持疗法(PST)对ICU患者机械通气应激反应的影响。方法 将34例连续机械通气时间在20h的清醒患者，随机分为采用标准的PST方法进行治疗的观察组和对照组，观察焦虑抑郁程度和应激反应改变情况。结果 对照组患者的焦虑抑郁程度明显高于观察组，部分应激反应激素水平升高幅度也明显大于观察组。结论 PST可通过缓解机械通气患者的焦虑抑郁等不良情绪状态减轻机械通气带来的各种心身应激反应，有利于提高机械通气治疗的有效性和安全性。     

Evaluating clinical educators: an employer's perspective

An Australian school of nursing's attempt to introduce an evaluation process required by management for clinical educators involved in undergraduate preregistration education is discussed Reliance on student feedback and clinical agencies' perceptions of the quality of teaching were seen as inadequate mechanisms for evaluation The evaluation process adopted incorporated observation of the educators together with self-reflection on their performance We conclude that post-briefings were poorly used and generally not reflective Educators relied heavily on their clinical skills and used a limited range of teaching strategies Whilst evaluation of clinical educators was time consuming and therefore costly, it is argued that it is essential to the integrity of the course The evaluation process has provided direction for support and development of clinical educators within the context of the curriculum     

麻醉机呼吸环路碱石灰尘埃污染的情况

目的：观察通气时碱石灰尘埃向呼吸环路中的排放及被呼吸道阻留的情况。方法：麻醉机环路连接集尘袋及筛装新碱石灰。ＪＴ库尔特颗粒计数仪动态测定排尘量。其颗粒测量范围为１～１２５μｍ３，通气１０分后测定呼吸环路加集尘袋内的尘埃量即为总尘量，收取称干重得尘埃分散度。通过对Ｎａｒ－ｃｏｍｅｄ、Ｄｒａｇｅｒ、Ｓｕｌａｒ８０８和１０３麻醉机行上述测量后，另以前者（Ｎ机）为例，其环路按相应处理分干燥、湿化和过滤三组，志愿者模拟通气１０分测定环路含尘量后与总尘量差得气管肺的阻留量。结果：四种麻醉机环路内碱石灰尘埃的分散度达１３ｍｇ／ｍ３以上。尘埃排放量与通气时间呈正比（ｒ＝０．９５，Ｐ＜０．０１）。Ｎ机干燥组中总排尘量的半数以上被气管肺阻留。湿化组该阻留量明显下降（Ｐ＜０．０５），而过滤组环路内总排尘量和气管肺阻流量下降更为显著（Ｐ＜０．０１）。结论：使用新碱石灰通气时，麻醉机环路内存在严重的尘埃污染，环路内湿化有一定的防尘作用，但以滤过处理效佳。     

Factors influencing routine cognitive impairment screening in older at-risk drinkers: Findings from a qualitative study in the United Kingdom

Cognitive Impairment (CI) screening is recommended for those engaged in harmful levels of alcohol use. However, there is a lack of evidence on implementation. This paper explores the barriers and facilitators to CI screening experienced across a service specifically for older drinkers. The findings draw on data gathered as part of an evaluation of a multilevel programme to reduce alcohol-related harm in adults aged 50 and over in five demonstration areas across the United Kingdom. It is based on qualitative interviews and focus groups with 14 service providers and 22 service users. Findings are presented thematically under the section headings: acceptability of screening, interpretation and making sense of screening and treatment options. It is suggested that engagement with CI screening is most likely when its fit with agency culture and its purpose is clear; where service providers have the technical skills to administer and discuss the results of screening with service users; and where those undertaking screening have had the opportunity to reflect on their own experience of being screened. Engagement with CI screening is also most likely where specific intervention pathways and engagement practices can be accessed to respond to assessed need.