Objective To evaluate the effect of standardized patient (SP) used in nursing fundamental. Methods Randomized controlled trials (RCTs) or quasi randomized controlled trials (q-RCTs) about comparing standardized patients with traditional teaching method in nursing fundamental were searched from the following electronic databases: PubMed, EMbase, The Cochrane Library, CNKI, CBM, VIP and so on. The methodological quality of the included RCTs was assessed according to the quality assessment scale developed by Smits PB, and the valid data were extracted and meta-analyzed with the Cochrane Collaboration’s RevMan 5.0.17 software. Results Five RCTs and one q-RCT involving 585 participants were included. The results of quality evaluation showed that the scores of five studies were more than or equaled 30. Descriptive analyses were only used because there was clinical heterogeneity between different studies. Comparing with traditional teaching method, SP teaching method in nursing fundamental improved the nursing procedure skills, the communication ability with patients and the ability of clinical judgment for nursing students. Conclusion The standardized patient teaching method is a prospective teaching mode. Because of the lack of RCTs about SP used in nursing fundamental, and the big difference of the teaching method and examine criteria in different studies, it is necessary to be verified in future by unified assessment methods and more researches with high quality.
Objective To systematically evaluate the effectiveness and accuracy of brain natriuretic peptide (BNP) for predicting postoperative cardiovascular events of non-cardiac surgery. Methods Databases including The Cochrane Library, PubMed, Ovid, EMbase, WanFang Data and CNKI were searched electrically to collect literature published from 2000 to 2011, and relevant periodicals and references of the included studies were also manually retrieved. According to the inclusion and exclusion criteria, related cohort studies were selected, data were extracted, and quality of the included studies was evaluated by two reviewers independently. Then meta-analysis was conducted using RevMan 5.0 software. Results A total of 11 studies involving 3 649 patients were included. The results of meta-analysis showed that, compared with patients with lower BNP levels than the cut-off point before surgery, patients with higher BNP levels than the cut-off point before surgery suffered from a higher incidence of cardiovascular events, with a significant difference (OR=27.54, 95%CI 17.49 to 43.35, Plt;0.000 01), while the result of N-terminal pro-brain natriuretic peptide (NT-proBNP) was similar to that of BNP (OR=19.53, 95%CI 13.54 to 28.17, Plt;0.000 01). Conclusion Postoperative higher levels of BNP and NT-BNP can be used to predict postoperative cardiovascular events of non-cardiac surgery patients. This conclusion needs to be further proved by more high quality studies due to the quality limitation of the included studies.
Objective To investigate the effective, economic and viable long-term mechanism of Sichuan college students’ social practice. Methods A questionnaire was designed to investigate the students from North Sichuan Medical College and other 7 colleges in Sichuan province randomly. A secondary research of China students social practice status was combined and the results of Sichuan and other areas were compared. Results A total of 2 200 questionnaires were issued, of which 1 920 effective ones were taken back with the recovery rate of 87.27%. The most common forms of social practice were social investigation (47.5%), public welfare labor (42.3%), novitiate/internship (38.7%); the most interesting contents of social practice were social morality education (54.79%), credit morality education (53.07%), professional skill education (51.88%), and near 80% college students thought the contents had close relationships with their major. College students hoped that the contents could combine their job-hunting, characteristics of their major, local economy, and needs of social development. The social practice department they wanted to go most was public welfare or civil service departments (43.7%), corporations (27.8%), and government bodies (19.2%). The most difficult thing was to get connected with target department, shortage of fund, empty topics, hard-to-determine practice projects (44.1%), and lack of teachers’ guidance (43.6%). Degree of satisfaction from the students was moderate. Compared with other universities, social practice of Sichuan undergraduate students had broader coverage and was more closely related to students’ majors with more attention on the combination with moral education and employment. Conclusion Sichuan college students have higher expectations of social practice. However, the range and the time of actual participation are limited. The students are not very satisfied with status of social practice. The social practice of Sichuan college students should give prominence to the local features, be close to the students and serve the local place, strengthen the construction of practice bases, and establish effective systems of teacher training, funding, principle security mechanism and evaluation system.
Objective To investigate the choleenterostomy type and the longterm results in treatment of benign diseases of biliary tract. MethodsA total of 614 cases of choleenterostomy from January 1981 to December 2000 were followed up and analysed. The original diseases: 321 were original hepatolithiasis and/or bileduct stricture (52.3%)， 106 congenital cyst of common bile duct (17.3%), 151 iatrogenic bile duct injury (24.6%) and others 36 cases (5.9%). Choledochoduodenostomy was performed in 89 cases and choledochojejunostomy in 525 cases. Five hundred and twentyfour cases have been followed up for 1 to 20 years. The rate of followup was 87.9%. ResultsIn 84.5% of the cases, excellent or good longterm results were achieved. Reoperation rate were 49.4% in cases of choledochoduodenostomy or cystoduodenostomy, 14.2% in sideside (cyst) cholangiojejunostomy and 4.4% in endside cholangiojejunostomy, respectively. Conclusion The choledochoduodenostomy should be abolished. The endside cholangiojejunostomy shoud be the best choice when it is needed to perform choledochojejunostomy in benign bile duct diseases and can promise a satisfactory longterm result.
Objective To investigate the change of N-terminal pro-B-type natriuretic peptide ( NT-proBNP) levels in plasma of patients with stable chronic obstructive pulmonary disease ( COPD) at exertion. Methods Pulmonary function testing, increamental and constant cycle ergometer exercise testing were performed in 19 patients with stable COPD and 10 healthy subjects. Arterial blood gas analysis were measured at rest and maximal exertion in incremental testing. Venous blood samples were drawn both at rest and maximal exercise in constant-load exercise testing and NT-proBNP levels were measured. Results NT-proBNP levels did not change significantly during exercise in the patients with stable COPD[ ( 4803. 86 ±1027. 07 ) ng/L vs ( 4572. 39 ±1243. 33 ) ng /L, P = 0. 542 ] and the control group [ ( 4303. 18 ±771. 74) ng/L vs ( 4475. 71 ±1025. 50) ng /L, P = 0. 676] . NT-proBNP levels were not correlated with parameters of cardiopulmonary exercise testing. Conclusion The factors other than cardiac function may contribute to the exercise intolerance in stable COPD patients without heart failure.
Objective To develope a novel rabbit carotid body and carotid common artery model in vivo for the simulation of various intermittent hypoxia ( IH) intensities, IH durations, IH reoxygenation ( ROX) durations and continuous hypoxia ( CH) modes. Methods Forty-five adult New Zealand rabbits ( 2. 5-3. 0 kg) were anesthetized while spontaneous breathing kept intact. The tissue surrounding the right carotid common artery and carotid sinus nerve ( CSN) were cleared and " single" chemoreceptor bundle of the CSN was revealed. Then suction electrodes were placed and CSN afferent activity was monitored and recorded carefully. The right common carotid artery was exposed, cannulated to distal part and its proximal part was ligated. Preparations were challenged by changing the PO2 of the gas mixture equilibrating the perfusate. Alternatively perfusion ( 2 mL/min) of equilibrated perfusate bubbled with normoxia or hypoxia gas mixtures formed IH/ROX cycles in carotid common artery, simulating the pattern of hypoxic episodes seen in obstructive sleep apnea syndrome ( OSAS) , or with continuously perfusing hypoxia perfusate to form CH modes. All the perfusing procedures were regulated by a customized computer-controlled set and monitored using O2 gas analyzer. After the systematic exposures, carotid body, carotid common artery part distal to cannula, and carotid bifurcation were harvested as samples. Results The frequencies and average amplitudes of CSN chemoreceptor bundles afferent activities with normoxia perfusion were ( 0. 17 ±0. 03) impulse/ s and ( 46. 2 ±4. 4) μV, and with hypoxia perfusion were ( 0. 64 ±0. 09) impulse/ s and ( 87. 4 ±6. 6) μV, respectively. PO2 was ( 139 ±1. 5) mm Hg in normoxia perfusate and ( 35. 2 ±1. 3) mm Hg in hypoxia perfusate. Conclusion This new carotid body and carotid common arterymodel is a valuable tool to study neurological and biochemical changes in various IH and CH modes.
睡眠过程中反复出现呼吸暂停造成的间歇低氧是阻塞性睡眠呼吸暂停低通气综合征( OSAHS) 的主要病理生理学特点, 它能够导致自主神经, 特别是交感神经兴奋性异常增高[1] , 后者可能是OSAHS合并心血管疾病包括高血压、充血性心力衰竭、心肌梗死以及心律失常的主要危险因素之一[2,3] 。现将慢性间歇低氧( chronic intermittent hypoxia,CIH) 所致交感神经异常兴奋的相关研究作一综述。
Objective To investigate the mutations of quinolone resistance determinational region ( QRDR) in fluoroquinolon-resistant Pseudomonas aeruginosa strains isolated from patients with nosocomial pneumonia. Methods Eight-four Pseudomonas aeruginosa strains isolated from patients with nosocomial pneumonia in Xinhua Hospital during January 2006 to December 2007, from whom fluoroquinolon-resistant resisitant ( case) and fluoroquinolon-susceptible ( control ) Pseudomona aeruginosa were identified. The mutation of QRDR was tested by restriction fragment length polymorphism ( RFLP) and gene sequencing.The relationship between QRDR mutations and clinical prescription was analyzed. Results Mutation in QRDR was found in 42 isolates among the 50 fluoroquinlon-resisitant isolates( 84. 0% ) , while no mutation was found in fluoroquinlon-susceptible isolates. The mutation in GyrB Ser464 was found in 34 isolates ( 68. 0% ) . There was statistical difference in the usage of β-lactams between the GyrB-Ser464-mutated group and the non-GyrB-Ser464-mutated group( OR = 11. 3, P = 0. 003 and OR = 3. 5, P = 0. 023) , also in the time of fluoroquinolon usage before isolated ( P = 0. 038) . Conclusions The mutation of QRDR is contributing to fluoroquindor-resisitance of Pseudomona aeruginosa, most of which lies in GyrB Ser464.Abuse of β-lactams and fluoroquinolon may be the risk factors of mutation in GyrB Ser464.
Objective To investigate the prognostic factors of severe chronic obstructive pulmonary disease ( COPD) in elderly patients, and to guide the clinical assessment and appropriate interventions. Methods A prospective cohort study was carried out from May 1993 to December 2010. A total of 178 elderly patients with severe COPD were recruited for baseline survey, and followed up for the living conditions, whether used non-invasive ventilation, and causes of death. A survival analysis was performed on all patients stratified by lung function. The significant factors on survival rate were analyzed. Results In this cohort the survival rates were 49% and 12% in five and ten years, respectively. The important factors for prognosis were age [ relative risk( RR) = 1. 043, 95% confidence intervals( 95% CI = 1. 010-1. 050] , forced expired volume in one second ( FEV1 , RR = 0. 019, 95% CI = 0. 007-0. 052) , FEV1% pred ( RR = 1. 045, 95% CI = 1. 012-1. 079) , lung function grade ( RR = 2. 542, 95% CI = 1. 310-4. 931) , body mass index ( BMI, RR= 0. 945, 95% CI = 0. 895-0. 952) , and pulmonary heart disease ( RR = 1. 872, 95% CI = 1. 188- 2. 959) . In severe COPD, non-invasive ventilation ( NIV, RR = 1. 167, 95% CI = 0. 041-1. 674) , pulmonary heart disease ( RR = 3. 805, 95% CI = 1. 336-10. 836) , FEV1 ( RR = 0. 081, 95% CI = 1. 001-1. 168) , and arterial partial of oxygen ( PaO2 , RR=0. 956, 95% CI =0. 920-0. 993) were the independent predictors.The patients using NIV had longer survival than those without NIV. The 5 and 10 years survival rate in the patients with NIV were 78% and 50% , much higher than those without ventilation which were 30% and 25% , respectively. In extremely severe COPD, FEV1 ( RR=1. 059, 95% CI =1. 015-1. 105) , arterial partial of carbon dioxide ( PaCO2 , RR=1. 037, 95% CI = 1. 001-1. 074) , age ( RR= 1. 054, 95% CI = 1. 013-1. 096) and pulmonary heart disease ( RR = 1. 892, 95% CI = 1. 125-3. 181) were the independent predictors. Conclusions Age, BMI, FEV1 , PaO2 , PaCO2 , pulmonary heart disease, and NIV were prognostic factors in elderly patients with severe COPD. The prognostic factors between severe and extremely severe COPD were not identical. Patients with severe COPD should be given early intervention, including progressive nutritional support, and long-term home oxygen therapy combining with NIV.
Objective To explore the daytime variables which are predictive to nocturnal hyoxemia among COPD patients unqualified for long-term oxygen therapy ( LTOT) . Methods Forty-eight stable COPD patients with SaO2≥90% were enrolled in this study and regarded as patients unqualified for LTOT. All patients underwent lung function examination during daytime. Their nocturnal oxygen saturation was monitored with overnight pulse oximetry ( OPO) . ResultsDaytime oxygen saturation was positively correlated with nocturnal mean SaO2 ( r =0. 79, P lt;0. 0001) , and negatively correlated with time spend with saturation below 90% ( TB90) ( r = - 0. 75, P lt; 0. 0001) . No significant relationship was found between lung function parameters and nocturnal SaO2 . The patients with daytime oxygen saturation between 90% and 95% were more likely to have lower nocturnal oxygen saturation and longer TB90 ( P lt;0. 05) .Conclusions Daytime oxygen saturation may effectively predict the occurrence of nocturnal hyoxemia in stable COPD patients unqualified for LTOT. To reduce COPD complications and improve prognosis, we suggest a relative indication of LTOT for patients with daytime oxygen saturation between 90% and 95% and with nocturnal hyoxemia.