The article describes the current situation of training mode of community nurses in community health service institutions in Hubei province from several aspects,including training object,training target,training base,teaching staff,training organization and government,training method and time,training curriculum,training effect evaluation and certification.The article suggests a multitude of factors influencing the training quality,such as formal training,dominant job training,and monotonous community training content and less training time.Overall,the government should be done something to increase government support and funding and accelerate the community nursing services and community nursing education.It is also essential to establish community nursing personnel training mechanism,improve and perfect the community health personnel training system,increase the construction of community nursing practice base and facilities and strengthen clinical practice skills.

BACKGROUND: Preparing the tracheal prosthesis by biomaterials is crucial for studying the implant of long tracheal defect.The biocompatibility and biodegradability of collagen/hydroxyapatite (Col/HAp) and poly(lactic-co-glycolic acid) (PLGA) in vivo, as a artificial material for tracheal prosthesis, need to be observed.OBJECTIVE: To explore in vivo biodegradability of Col/HAp and PLGA of tracheal prosthesis in rats.DESIGN: Randomized controlling observation.SETTING: Department of Thoracic and Cardiovascular Surgery, Clinical College of Yangzhou University; Department of Thoracic and Cardiovascular Surgery, Changzheng Hospital of the Second Military Medical University of Chinese PLA.MATERIALS: The experiment was carried out in the National Experimental Animal Center of the Second Military Medical University of Chinese PLA from March 2003 to December 2004. Sixteen SD rats of either gender were offered by this center, aged three months and weighed 150-170 g. Col/HAp and PLGA (the copolymer of polylactic acid and polyglycolic acid according to the percent of 90:10) were self-made.METHODS: ①Empirical process: Rats were fed adaptively for 1 week and anesthetized. Then undermining dissection was performed along with musculi dorsal surface toward spine bilaterally, so as to form two capsular gaps, which were implanted with Col/HAp sponge and PLGA fiber mesh cloth respectively, in a size of 10 mm ×10 mm. ②Empirical evaluation: The postoperative activity, incision healing and rejection of rats were observed; 2, 4, 6, 8 weeks postoperatively, the Col/HAp sponge and PLGA mat that were embedded subcutaneously as well as surrounding tissues were determined using scanning electron microscope or transmission electron microscope.MAIN OUTCOME MEASURES: In vivo biodegradability of two materials implanted in rats at different time points.RESULTS: ①All the animals could carry out normal activity, respiration and diet; no incision infection, fluidity, necrosis or sinus tract appeared; there was no edema in the skins of implanted area, neither hypersensitiveness nor toxicity was found; the implant materials had no rejection. ②The features of the implanted materials varied throughout the implantation. During the follow-up, the infiltration of inflammatory cells was found in the interface between the implants and neighboring host tissues in the early stage, phagocytes and fibroblastic cells were also observed later. As the process went on, the materials were biodegraded gradually, encapsulated by phagocytes, and replaced by newly generated fibrous tissues. No remarkable harmful influences of the composite materials on the neighboring host tissues such as apomorphosis, necrosis, hyperplasia and foreign body reaction were observed grossly and microscopically.CONCLUSION: All the implants show a good biocompatibility and biodegradability. Both Col/HAp and PLGA go through a gradual process of biodegradability, biological absorption and replacement by host tissues ultimately in vivo, which suggest that these two kinds of composite biomaterials will be used safely in developing tracheal prosthesis.

From the standpoint of training mode,the paper makes an effort to analyze the present situation on Sino-Foreign cooperation in nnning schools in mode of nursing personnel training in Hubei Province,find out the existing problems and put forward the corresponding proposals in order to ensure sustainable development of the Sino-Foreign cooperation in running schools in mode of nursing personnel training.

Objective: To replace esophageal defects with artificially composed biodegradable materials and non-biodegradable materials. Met hods: A two-layered tube consisting of a collagen-chitosan sponge and an inner polyurethane stent was used to replace 5 cm esophageal segmental defect s in 15 dogs. The inner polyurethane stent was removed endoscopically at weekly intervals from 2 or 4 weeks. Results: Partial regeneration of es ophageal epithelia was observed in 5 dogs at week 2, and progressing constricti on occurred and the dogs became unable to swallow within 1 month. In the 10 dog s that the polyurethane stent was removed at week 4, regenerated esophageal tiss ue successfully replaced the defects, and complete epithelization was observed 1 month after surgery. Complete regeneration of esophageal mucosa structures, inc luding mucosal smooth muscle and mucosal glands were observed 3 months after surgery, and partial regeneration of esophageal muscle tissue was also observed 6 months after surgery. Conclusion: Our artificial prosthesis i n reconstruction of the cervical esophagus segment in dogs is feasible. Through temporary polyurethane tube, collagen-chitosan sponge provides a three-dimensi onal structure suitable for the regeneration and sufficient degradation time for the complete regeneration of esophagus.

Adult ; Anastomosis, Surgical ; Esophagus ; surgery ; Humans ; Male ; Stents ; Stomach ; surgery ; Tracheoesophageal Fistula ; surgery

OBJECTIVETo investigate the feasibility of using new tracheal prosthesis made of biomaterials to replace extensive circumferential tracheal defects in mongrel dogs.

METHODSThree types of tracheal prostheses were developed, whose basic skeleton of tubular mesh was knitted with polypropylene monofilament and poly (lactic-co-glycolic acid) fiber. The inner side of type-I tubular mesh was first coated with polyurethane solution and then with collagen. The exterior of type-I was then immobilized with collagen-hydroxyapatite composites. In contrast, the internal and external walls of type-II were coated with polyurethane solution, which produced a prosthesis similar to a nonporous one, while type-III was coated only with collagen solution. Surgical resection and replacement of a segment of the cervical trachea was performed in 16 adult mongrel dogs. The efficacy of the implanted prosthesis periodically evaluated postoperatively.

RESULTSIn group A, only one died from prosthetic dehiscence, another from anastomotic leakage, and the others had uneventful postoperative courses. The implanted prosthesis was completely incorporated with the recipient trachea, where different length of reepithelialization occurred on the luminal surface of the reconstructed trachea. Macroscopic examination showed scattered and different sizes of neo-ossification surrounding the implanted prosthesis. The prosthesis was roentgenopaque when exposed to routine X rays. In contrast, a relatively high number of complications occurred postoperatively in group B and C.

CONCLUSIONType-I tracheal prosthesis may be used effectively for long-segment circumferential tracheal replacement, and appears very promising for clinical application, with further improvements in promoting the epithelialization.

Animals ; Biocompatible Materials ; Collagen ; Dogs ; Female ; Male ; Polyglycolic Acid ; Polypropylenes ; Polyurethanes ; Prostheses and Implants ; adverse effects ; Prosthesis Design ; Prosthesis Implantation ; Trachea ; surgery

Objective:To compile the evaluation scale of the quality of education in the clinical practice base of full-time Master of Specialist Nursing (MNS) based on student participation and the SERVQUAL model, evaluate the quality of clinical practice base, and provide reference for the evaluation of clinical practice base.Methods:Based on the theory of student participation and the SERVQUAL model, the evaluation scale of the educational quality of clinical practice base of MNS was constructed. By facilitating sampling methods, 176 MNS students from 11 universities in 6 provinces were selected, and a questionnaire of self-compiled general information and a survey of the evaluation scale of education quality of MNS clinical practice base were distributed.Results:The evaluation scale of education quality of clinical practice base of MNS contained 28 entries in five dimensions: tangibility, reliability, responsiveness, guarantee and empathy. The total Cronbach alpha coefficient of the scale was from 0.983 to 0.987, item level content validity index was from 0.92 to 0.96, scale level content validity index was 1 and the correlated coefficient of the structural validity Pearson was from 0.785 to 0.966. To explore factor analysis, the dimension value of the scale KMO value was greater than 0.7, and the expected part and the actual feel part KMO value were 0.956 and 0.963 respectively. The number of common factors was 2 and 3 respectively, and the cumulative interpretation variation was 79.1% and 78.4% respectively.The actual perception of the quality of education in the clinical practice base of MNS was lower than expected, and the differences in entries were statistically significant ( P<0.05). The analysis of multiple linear regression showed that the teaching time and level of clinical practice base undertaken by clinical practice base were the main factors affecting the expectation and actual feeling value ( P<0.05). The importance performance analysis analysis found that 11 entries were in the advantage zone, 3 entries were in the maintenance area, 12 entries were in the minor improvement area and 2 entries were in the priority improvement area. Conclusions:The evaluation scale of the quality of education of the clinical practice base of MNS have good confidence and validity. The actual degree of educational quality of the clinical practice base of MNS is lower than expected. The teaching time and level of clinical practice base undertaken by clinical practice base are the main factors that affect expectation and actual feeling. It is urgent to improve the theoretical knowledge and practice level of tutors and deal with occupational exposure experienced by MNS students.

OBJECTIVEX-linked adrenoleukodystrophy (ALD) is a genetically determined disorder that involves the nervous system white matter, axons, adrenal cortex and testes. The typical clinical manifestations are progressive psychomotor regression, vision and/or auditory impairment and adrenal insufficiency. The clinical manifestation, biochemical change and genetic counseling work of X-linked ALD were analyzed.

METHODSThe clinical features of 29 cases with ALD were summarized and analyzed, including symptoms and signs, measurement of blood very long chain fatty acids (VLCFA), adrenal function, cranial magnetic resonance imaging (MRI) and pedigree investigation.

RESULTSAmong these 29 cases, the clinical phenotype could be classified into childhood cerebral (22 cases), adolescent cerebral (4 cases), adrenomyeloneuropathic (1 case), Addison's disease (1 case) and asymptomatic or presymptomatic (1 case) types. Nine of them had positive family history. Pedigree investigation was consistent with typical sex-linked recessive inheritance. There were 45 ALD patients in these 29 pedigrees. The neurological manifestations varied among members of the same family. Nine cases died during follow up. The causes of death were central respiratory failure or other complications of ALD and so on. Laboratory tests demonstrated abnormally high plasma levels of VLCFA in ALD patients; MRI demonstrated symmetric butterfly-like low T(1) and high T(2) signals in the parieto-occipital white matter. The impairment in the splenium of corpus callosum made the bilateral lesion region converge into one. It could progress anteriorly and injure the bilateral posterior limb of internal capsule and the temporal lobe, and could injure the brainstem inferiorly. Following intravenous injection of contrast material, thin stripe of lacelike enhancement could be observed.

CONCLUSIONSThe atypical initial symptom of ALD was seizures. The MRI showed abnormal signal in the cerebellar white matter. This disease can influence the normal development of children, this was more pronounced in the childhood cerebral ALD type. It tended to progress rapidly with dementia, vegetative state or death. Since antenatal diagnostic method is available now, emphasis should be made on the antenatal examination in order to make an early diagnosis and abort pregnancy if necessary.

Adolescent ; Adrenoleukodystrophy ; blood ; diagnosis ; therapy ; Child ; Child, Preschool ; China ; Fatty Acids ; blood ; Female ; Follow-Up Studies ; Humans ; Male ; Pedigree ; Treatment Outcome

OBJECTIVETo study changes in the drug-resistance of Pseudomonas aeruginosa (PA) and the use of antibiotics in burn wards so as to optimize the use of antibiotic in the future.

METHODSBacteria were isolated from specimens of blood, venous catheter, stool, sputum, urine, wound tissue from 5717 patients hospitalized in our burn wards within the duration of January 2005 to December 2009. The number of specimens examined and positive rates of bacteria were calculated. Changes in constituent ratio of cocci and bacilli, spectrum of bacteria, the drug-resistance rate of PA, and the usage of antibiotics were analyzed. The number of specimens examined, constituent ratio of cocci and bacilli, drug-resistance rate were processed with chi-square test. Bivariate correlation analysis was performed between the usage of antibiotics and the drug-resistance rate.

RESULTS(1) The number of specimens examined showed no statistical difference during the five years (with rates from 73.2% to 76.1%, χ(2) = 5.583, P > 0.05), while constituent ratio of cocci and bacilli showed statistical difference (with ratios from 105:134 to 169:126, χ(2) = 14.806, P < 0.01). The positive rates of bacteria were increasing in the five years. (2) One thousand six hundred and seventy-five strains were identified during the five years from different kinds of specimens, with 29 from blood, 39 from venous catheter, 3 from stool, 157 from sputum, 13 from urine, and 1434 from wound tissue. Among them, Staphylococcus aureus accounted for 28% to 42%, PA accounted for 10% to 25%, Acinetobacter baumannii accounted for 10% to 19%, and they were the predominant strains. (3) The difference among drug-resistance rates of PA to each kind of 12 antibiotics during the five years were statistically significant (with χ(2) values from 47.911 to 308.095, P values all below 0.01). The drug-resistance rates of PA to some antibiotics showed downward trend in the former four years, including amikacin, ceftazidime, and imipenem/cilastatin, but it rebounded in the fifth year. (4) There was descending trend in usage of cefoperazone/sulbactam and levofloxacin, but vancomycin was always used widely. (5) Drug-resistance rates of PA to 7 antibiotics, including amikacin, imipenem/cilastatin, and ciprofloxacin, etc., were positively correlated with usage of various antibiotics (with r values from 0.879 to 0.978, P < 0.05 or P < 0.01).

CONCLUSIONSIn our burn wards, drug-resistant PA was prevalent. Disinfection and isolation measures, appropriate use of antibiotics, etc. can reduce PA infection.

Anti-Bacterial Agents ; therapeutic use ; Burn Units ; Burns ; drug therapy ; microbiology ; Drug Resistance, Bacterial ; drug effects ; Female ; Humans ; Male ; Pseudomonas Infections ; drug therapy ; microbiology ; Pseudomonas aeruginosa ; drug effects ; isolation & purification

OBJECTIVETo design and develop a novel esophageal prosthesis by selecting appropriate biomaterials, developing special manufacturing techniques, and investigating the feasibility of replacement of cervical esophagus in mongrel dogs.

METHODSIn accordance with the requirements of ideal esophageal substitutes, we designed a new type of esophageal prostheses. The inner stent were made with polyurethane of medical grade, and the outer surface of the prosthesis was coated with collagen-chitosan sponge. The silicone tube was used as a control. Thirteen adult mongrel dogs that were divided into two groups were used to establish the experimental models.

RESULTSIn the experimental group (n = 8), the esophageal prostheses were completely incorporated with the native esophagus and adherent to the surrounding host connective tissues. Epithelial linings of varying degrees were formed on the luminal surface, and complete epithelization was seen in 1 month postoperatively. The granulation at the sites of the anastomosis in this group was less significant than that of the control group. One dog has been surviving for 12 months up to now without any complications. In the control group (n = 5), esophageal epithelial was not observed on the luminal surface, constriction of the regenerated esophagus progressed and all the dogs died within 2 months after operation.

CONCLUSIONThese observations suggest that this esophageal prosthesis made of composite biomaterials has high biocompatibility and potential for long-segment esophageal reconstruction, which is promising for the clinical repair of esophageal defects.

Absorbable Implants ; Animals ; Artificial Organs ; Biocompatible Materials ; Chitosan ; Collagen ; Dogs ; Esophagus ; Implants, Experimental ; Models, Animal ; Polyurethanes ; Prosthesis Design ; methods ; Prosthesis Implantation