他们不再是孩子了 关于“新失业群体”现状的社会学报告

The “New Unemployed” consists of young people with low education in the Chinese cities. They differ from the cohorts of their parents because they have no work experiences in any state- or collective-owned enterprise, and are subject to completely different policies designated by the government. Investigations of their daily living lead to the conclusion that the “New Unemployed” has gone through a “system withdrawal” process. They are now facing an environment of “system vacuum” that none of other unemployed groups has ever encountered before. The author emphasizes in the paper a strategic employment principle of “For Future Generations” so that focused attention and care can be provided and this toughest challenge in China can be dealt with.

Practical strategies for increasing efficiency and effectiveness in critical care education

Technological advances and evolving demands inmedical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs.

Prevention of stress-related ulcer bleeding at the intensive care unit: Risks and benefits of stress ulcer prophylaxis

Stress-related mucosal disease is a typical complication of critically ill patients in the intensive care unit(ICU). It poses a risk of clinically relevant upper gastrointestinal(GI) bleeding. Therefore, stress ulcer prophylaxis(SUP)is recommended in high-risk patients, especially those mechanically ventilated > 48 h and those with a manifest coagulopathy. Proton pump inhibitors(PPI) and, less effectively, histamine 2 receptor antagonists(H2RA) prevent GI bleeding in critically ill patients in the ICU. However, the routine use of pharmacological SUP does not reduce overall mortality in ICU patients. Moreover, recent studies revealed that SUP in the ICU might be associated with potential harm such as an increased risk of infectious complications, especially nosocomial pneumonia and Clostridium difficile-associated diarrhea. Additionally, special populations such as patients with liver cirrhosis may even have an increased mortality rate if treated with PPI. Likewise, PPI can be toxic for both the liver and the bone marrow, and some PPI show clinically relevant interactions with important other drugs like clopidogrel. Therefore, the agent of choice, the specific balance of risks and benefits for individual patients as well as the possible dose of PPI has to be chosen carefully. Alternatives to PPI prophylaxis include H2 RA and/or sucralfate. Instead of routine SUP, further trials should investigate risk-adjusted algorithms, balancing benefits and threats of SUP medication in the ICU.

Validation of a Questionnaire to Diagnose the Baumann Skin Type in All Ethnicities and in Various Geographic Locations

The Baumann Skin Typing System diagnoses patients as having one of 16 skin types based on their answers to a validated questionnaire [i] known as the Baumann Skin Type Indicator [ii]. The BSTI questionnaire has been tested over the last decade on over 200,000 people of various ages and ethnicities in different geographic locations around the world. In this study, data were collected from 52,862 patients to compare skin type prevalence between those who presented to doctor’s offices and those who took the quiz without supervision online. The most common skin types varied only slightly between patients that took the quiz online and those that completed the questionnaire in their doctor’s office. This indicates that the prevalence of skin types seen in the doctor’s office is similar to that in the general population and that supervision is not necessary to get an accurate result on the BSTI. [iii] In addition, comparison of data gathered in China, Korea, and the US did not show a significant difference in skin type prevalence between Asian and Caucasian skin types. [iv] This study demonstrates that the English version of the BSTI is valid for English speaking patients online, and in doctors’ offices in the US, China and Korea.

Reform and Reconstruction of the Rural Elderly Care Service System in the New Era

With decades of hard work,socialism with Chinese characteristics has crossed the threshold into a new era.The transformation of the principal contradiction in the new era has imposed new and higher requirements on the rural elderly care service system.However,the current service system based on welfare-multiplex and urban community environment is often difficult to operate in the rural areas of central and western China.And the urban home care service for the aged is inappropriate to the rural reality;community service for the aged faces difficulties in practice;institution care for the aged develops slowly;the synergy among different elderly care service models is poor.Through observing the rural areas of central and western China in the field for a long time,this paper proposes to build the rural elderly care service system based on family supporting,supported by community mutual assistance care,supplemented by institution care for the aged,combined with medical care,and localized with diversified forms for targeted groups according to different realities.And the system should follow the fundamental guidance of development-oriented family policy,adhere to the governance mode of multiple subjects with one core and respect rural reality,which could provide a feasible way for the reform and reconstruction of the rural elderly care service system.

Antibiotic sensitivity pattern of bacterial pathogens in the intensive care unit of Fatmawati Hospital,Indonesia

Objective:To evaluate the sensitivity pattern of bacterial pathogens in the intensive care unit(ICU) of a tertiary care of Falmawati Hospital Jakarta Indonesia.Methods:A cross sectional retrospective study of bacterial pathogen was carried out on a total of 722 patients that were admitted to the ICU of Fatmawati Hospital Jakarta Indonesia during January 2009 to March 2010. All bacteria were identified by standard microbiologic methods,and(heir antibiotic susceptibility testing was performed using disk diffusion method.Results:Specimens were collected from 385 patients who were given antimicrobial treatment,of which 249(64.68%) were cultured positive and 136(35.32%) were negative.The most predominant isolate was Pseudomonas aeruginosa(P.aeruginosa)(26.5%) followed by Klebsiella pneumoniae(K.pneumoniae)(15.3%) and Staphylococcus epidermidis(14.9%).P.aeruginosa isolates showed high rate of resistance to cephalexin(95.3%),cefotaxime(64.1%),and ceftriaxone(60.9%).Amikacin was the most effective(84.4%) antibiotic against P.aeruginosa followed by imipenem(81.2%),and meropenem(75.0%).K.pneumoniae showed resistance to cephalexin(86.5%),ceftriaxone(75.7%),ceftazidime(73.0%),cefpirome(73.0%) and cefotaxime(67.9%),respectively.Conclusions:Most bacteria isolated from ICU of Fatmawati Hospital Jakarta Indonesia were resistant to the third generation of cephalosporins,and quinolone antibiotics.Regular surveillance of antibiotic susceptibility pallerns is very important for setting orders to guide the clinician in choosing empirical or directed therapy of infected patients.

Protocol for the management of oral surgery patients on warfarin utilizing a Point-of-Care In-Office international normalized ratio monitoring device

Purpose: This study was performed to assess the utility and safety of an In-Office INR Monitoring Device and present a safe and efficient protocol for the management of patients on oral anticoagulants and/or antithrombolytics requiring routine office oral and maxillofacial surgery. Patients and Methods: Sixty-one patients requiring “minor” oral and maxillofacial surgery being treated chronically with oral anticoagulation (warfarin) were entered into the study and compared in 2 groups. The control group (n = 29) was managed by discontinuing warfarin and any anti-platelet medication(s) prior to surgery. In the study group (n = 30), the decision to continue or withhold warfarin was determined by a protocol in which patients are 1) stratified based on risk for thromboembolism, and 2) classified as requiring “major” or “minor” surgery. Procedures categorized as “minor” surgery included dental extraction(s), dental implants, soft tissue and bone biopsies, and preprosthetic bone surgery, and incision and drainage. Warfarin and antiplatelet medication were not withheld in these patients, and a Point-of-Care In-Office INR Monitoring Device was used to obtain INR levels on the day of consultation and surgery. Local measures including removal of granulation tissue, packing, suturing, etc. were utilized for hemostasis. Results: The 30 patients in the study group maintained on warfarin readily achieved hemostasis using intraoperative local measures. The mean INR measured by the In-Office INR Monitoring Device was 2.36 with a range from 1.3 to 3.2. Study group patients underwent a total of 131 separate procedures including 108 dental extractions (impactions), placement of dental implants, preprosthetic bony surgery, bone cyst removal, soft tissue biopsies, facial skin cancer repair, and incision and drainage. One patient (3%) required “minor” intervention with removal of a “liver clot” on postop day 2 with repacking and suturing. The 29 patients in the control group discontinued off of war farin underwent a total of 99 procedures. One patient (3%) also required a “minor” intervention (repacking of extraction site). There were no “major” complications in either group. Conclusions: This study supports previous studies that minor oral surgery procedures can be safely performed while maintaining patients on warfarin minimizing the risk of a potentially devastating thromboembolic event. When deciding whether or not to withhold warfarin, this study supports the use of the proposed protocol based on 1) risk stratification for thromboembolism, 2) the need for “minor” versus “major” surgery, 3) and utilization of an In-Office INR Monitoring Device. An In-Office Point-of-Care INR measuring device can be a very effective tool to safely simplify and make the perioperative management of the anticoagulated patient more efficient for the patient and oral and maxillo facial surgeon.

Unmodified autologous stem cells at point of care for chronic myocardial infarction

BACKGROUND Numerous studies investigated cell-based therapies for myocardial infarction(MI).The conflicting results of these studies have established the need for developing innovative approaches for applying cell-based therapy for MI.Experimental studies on animal models demonstrated the potential of fresh,uncultured,unmodified,autologous adipose-derived regenerative cells(UAADRCs)for treating acute MI.In contrast,studies on the treatment of chronic MI(CMI;>4 wk post-MI)with UA-ADRCs have not been published so far.Among several methods for delivering cells to the myocardium,retrograde delivery into a temporarily blocked coronary vein has recently been demonstrated as an effective option.AIM To test the hypothesis that in experimentally-induced chronic myocardial infarction(CMI;>4 wk post-MI)in pigs,retrograde delivery of fresh,uncultured,unmodified,autologous adipose-derived regenerative cells(UA-ADRCs)into a temporarily blocked coronary vein improves cardiac function and structure.METHODS The left anterior descending(LAD)coronary artery of pigs was blocked for 180 min at time point T0.Then,either 18×106 UA-ADRCs prepared at“point of care”or saline as control were retrogradely delivered via an over-the-wire balloon catheter placed in the temporarily blocked LAD vein 4 wk after T0(T1).Effects of cells or saline were assessed by cardiac magnetic resonance(CMR)imaging,late gadolinium enhancement CMR imaging,and post mortem histologic analysis 10 wk after T0(T2).RESULTS Unlike the delivery of saline,delivery of UA-ADRCs demonstrated statistically significant improvements in cardiac function and structure at T2 compared to T1(all values given as mean±SE):Increased mean LVEF(UA-ADRCs group:34.3%±2.9%at T1 vs 40.4±2.6%at T2,P=0.037;saline group:37.8%±2.6%at T1 vs 36.2%±2.4%at T2,P>0.999),increased mean cardiac output(UA-ADRCs group:2.7±0.2 L/min at T1 vs 3.8±0.2 L/min at T2,P=0.002;saline group:3.4±0.3 L/min at T1 vs 3.6±0.3 L/min at T2,P=0.798),increased mean mass of the left ventricle(UA-ADRCs group:55.3±5.0 g at T1 vs 71.3±4.5 g at T2,P<0.001;saline group:63.2±3.4 g at T1 vs 68.4±4.0 g at T2,P=0.321)and reduced mean relative amount of scar volume of the left ventricular wall(UA-ADRCs group:20.9%±2.3%at T1 vs 16.6%±1.2%at T2,P=0.042;saline group:17.6%±1.4%at T1 vs 22.7%±1.8%at T2,P=0.022).CONCLUSION Retrograde cell delivery of UA-ADRCs in a porcine model for the study of CMI significantly improved myocardial function,increased myocardial mass and reduced the formation of scar tissue.

The Next Era:Flourish of National Health Care & Medicine with the World Leading Artificial Intelligence

MODERN medical diagnosis and practice heavily rely on biological data and information from patients’ body.The progress of biomedical sensor,material and mathematical technology provided ever-increasing methods to gather data.While providing more choices and more comprehensive picture of patients’ conditions to doctors and practitioners,these progresses also require more labor efforts to read,analyze,and make decisions based on those data.It is very difficult for the medical human resources to grow at a speed that matches such need for diagnosis-related expert knowledge.The shortage of expertise has caused long waiting time for check report and fatal misjudged diagnosis in public health system,and it will compromise our ability to move towards a more precise,more personalized and more efficient future of medicine.

Performance Evaluation of Healthcare Monitoring System over Heterogeneous Wireless Networks

The wide diffusion of healthcare monitoring systems allows continuous patient to be remotely monitored and diagnosed by doctors. The problem of congestion, namely due to the uncontrolled increase of traffic with respect to the network capacity, is one of the most common phenomena affecting the reliability of transmission of information in any network. The aim of the paper is to build a realistic simulation environment for healthcare system including some of the main vital signs model, wireless sensor and mesh network protocols implementation. The simulator environment is an efficient mean to analyze and evaluate in a realistic scenario the healthcare system performance in terms of reliability and efficiency.

Generalizable items and modular structure for computerised physician staffing calculation on intensive care units

Intensive care medicine remains one of the most costdriving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician's workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks(performed in every patient) and additional tasks(necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society ofAnesthesiology and Intensive Care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs.

改进基本医疗(初级保健)研究报告内容的CRISP共识声明

基本医疗(初级保健)是一门独特的临床专业和研究学科,具有其自身的视角和方法。该领域的研究使用多种研究方法和研究设计来调查各种主题。基本医疗(初级保健)的多样性对其研究内容的报告提出了挑战,尽管已有大量报告指南问世,但没有一项指南专门针对基本医疗(初级保健)学科的需求而设。基本医疗(初级保健)研究报告内容的条目共识(CRISP)清单,旨在指导基本医疗(初级保健)研究的报告,包括提供基本医疗(初级保健)相关人群(从业者、患者和社区)所需的信息。CRISP清单完善了现有指南,有利于基本医疗(初级保健)研究结果的报告、传播和应用。先前的CRISP研究,探索了在该领域改善研究内容报告的可能性。工作组通过对国际化、跨学科和跨专业的基本医疗(初级保健)社区的调查,确定了基本医疗(初级保健)研究报告中需要包含的基本条目。工作组开展了一项包含两轮德尔菲的研究,对必要的条目达成了共识,并汇总成清单。CRISP清单包含24个条目,涵盖了基本医疗(初级保健)研究报告中的研究团队、患者、研究参与者、健康状况、临床接触、护理团队、干预、研究测量、照护环境,以及研究结果的实施等方面。并非全部条目都适用于每种研究设计或主题。CRISP指南为设计和报告以下三类研究提供了参考信息:(1)基本医疗(初级保健)研究人员开展的研究,(2)其他研究人员在基本医疗(初级保健)人群和环境中开展的研究,(3)旨在应用于基本医疗(初级保健)实践中的研究,从而改进对临床服务和研究过程背景的报告。这对于解释研究结果并将其应用于基本医疗(初级保健)的不同人群和环境至关重要。

Utilizing Anesthesiologists, Emergency and Critical Care Physicians with Telemedicine Monitoring to Develop Intubation and Ventilation Services in an Intensive Care Unit in the Austere Medical Environment: A Case Series. Expansion of the EP/CC GAS Project

Background: Significant resource constraints and critical care training gaps are responsible for the limited development of intensive care units (ICUs) in resource limited settings. We describe the implementation of an ICU in Haiti and report the successes and difficulties encountered throughout the process. We present a consecutive case series investigating an anesthesiologist, emergency, and critical care physician implemented endotracheal intubation and mechanical ventilation protocol in an austere environment with the assistance of telemedicine. Methods: A consecutive case series of fifteen patients admitted to an ICU at St. Luc Hospital located in Portau-Prince, Haiti, between the months of February 2012 to April 2014 is reported. Causes of respiratory failure and the clinical course are presented. Patients were followed to either death or discharge. Results: Fifteen patients (eight women and seven men) were included in the study with an average age of 37.7 years. The mean duration of ventilation was three days. Of the fifteen patients intubated, five patients (33.3%) survived and were discharged from the ICU. Of the five surviving patients, two were intubated for status epilepticus, one for status asthmaticus and one for hyperosmolar coma associated with intracerebral hemorrhage. Of the patients dying on the ventilator, four patients died from pneumonia, two from renal failure, and one from tetanus. The remaining three died from strokes and cardiac arrests. Conclusions: Mortality of mechanically ventilated patients in a resource-limited country is significant. Focused training in core critical care skills aimed at increasing the endotracheal intubation and ventilatory management capacity of local medical staff should be a priority in order to continue to develop ICUs in these austere environments. Collaborative educational and training efforts directed by anesthesiologists, emergency, and critical care physicians, and aided by telemedicine can facilitate realizing this goal.

Relationship between information technology functionalities and hospital-acquired injurious fall rates in US acute care hospitals

The purpose of this exploratory study was to determine health information technology functionalities in inpatient care units that were associated with reduced fall risk among adult patients aged 65 years or older in acute care hospitals in the United States. This study compared the differences in the hospital-acquired injurious fall rates for hospitals in California, Florida, and New York with and without fully implemented IT functionalities in their general medical and surgical inpatient units. It used publicly available 2007 datasets, the hospital was the unit of analysis, and teaching and non-teaching hospitals were analyzed separately. Hospital-acquired injurious falls were identified based on fall-related primary and secondary diagnoses and were flagged by the hospitals as not “present on admission” in the 2007 California, Florida, and New York State Inpatient Database data. The 4 health IT functionalities in general medical and surgical inpatient units were 1) electronic clinical documentation, 2) results viewing, 3) computerized provider order entry, and 4) decision support. The research question was What are the effective health IT functionalities in the general medical and surgical units for reducing fall risk among adult patients aged 65 years or older at their hospitals? Independent t tests were used. The results showed that no significant difference was found in the hospital-acquired injurious fall rates between hospitals with and without each of the 4 functionalities and between the teaching hospitals with and without each of the 4 functionalities. Significant differences were found in the injurious fall rates between non-teaching hospitals with and without electronic clinical documentation and result viewing. Future research may focus on assessing the clinicians’ use of the IT functionalities of electronic clinical documentation and results viewing, as well as the effect of the clinicians’ use patterns on patient outcomes.

Development of a Freeze-Dried Skin Care Product Composed of Hyaluronic Acid and Poly(γ-Glutamic Acid) Containing Bioactive Components for Application after Chemical Peels

Eight types of spongy sheet were prepared by freeze-drying aqueous solutions of hyaluronic acid (HA) and poly(γ-glutamic acid) (PGA) with or without bioactive components including vitamin C derivative (VC), glucosylceramide (GC), and epidermal growth factor (EGF). Spongy sheets were categorized into the following groups: Group I (HA/PGA), Group II (HA/PGA + VC), Group III (HA/PGA + GC), Group IV (HA/PGA + VC, GC), Group V (HA/PGA + EGF), Group VI (HA/PGA + VC, EGF), Group VII (HA/PGA + GC, EGF), and Group VIII (HA/PGA + VC, GC, EGF). In the first experiment, we examined fibroblast proliferation in conditioned medium that had been prepared by immersing each spongy sheet in a conventional culture medium. EGF-incorporating spongy sheets (Groups V-VIII) enhanced fibroblast proliferation more than EGF-free spongy sheets (Groups I-IV). In the second experiment, cytokine production by fibroblasts was evaluated using a wound surface model. This involved elevation of fibroblasts-incorporating collagen gel sheets to the air-liquid interface, on which a spongy sheet (Groups I, IV, V and VIII) was placed and cultured for 1 week. EGF-incorporating spongy sheets (Groups V and VIII) enhanced the production of vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) by fibroblasts more than EGF-free spongy sheets (Groups I and IV). The effect of these four types of spongy sheet on wounds was investigated in animal experiments. Chemical peel was performed by contacting 50% trichloroacetic acid (TCA) on the dorsal region of mice, after which a spongy sheet was placed, and the wound condition was then observed in a two-week period. Angiogenesis was facilitated to a greater degree in Group VIII compared with Groups I, IV and V. This finding indicates that Group VIII spongy sheet is a promising aid for skin recovery after chemical peel.

Concept Development and Implementation of Family Care/Caring Theory in Concentric Sphere Family Environment Theory

Caring is directed toward a variety of things. One of them is thought to be the concept of “family caring” aimed at families. This study attempts to clarify family caring and develop Family Care/ Caring Theory (FCCT), with the aim of implementing it in conjunction with an existing family nursing theory, the Concentric Sphere Family Environment Theory (CSFET). In Japan and in Hong Kong, family ethnography (including formal interviews) was conducted. As a result, the item “family health care nurses and their colleagues” was added to the family external environment of the CSFET. In the family environment, evidence was obtained to the effect that the family system unit is cared for by the nursing professional, and conversely the family system unit cares for the nursing professional, in a circular transaction. Observing the two-dimensional plane formed by the structural distance and functional distance, family caring assumes a structure of concentric circles, and according to transactions, the structural distance and functional distance between the nursing professional and family system unit are gradually approached, and through deepening of mutual trust maintain an appropriate distance. Moreover observing the three-dimensional space-time continuum which is created through addition of the temporal distance, family caring forms a helical structure. As transactions are repeated along the temporal axis, the family system unit’s self-actualization of other individuals and the self-actualization of the nursing professional are realized. Through these processes, a family care/caring relationship is reinforced and established. This is the concept of FCCT. Through future utilization in clinical settings this will be empirically substantiated, and it will be necessary to continue making creative corrections and revisions.

Evaluating the average access to care and continuity of care patients in Tehran teaching hospitals

Background: Standards of Joint Commission International emphasize on the organizational performance level in basic functional domains including patient right, patient care, medical safety and infection control. These standards are focused on two principles: expectations of the actual organizational performance and assessment of organizational capabilities to provide high quality and safe health care services. The aim of this study is to evaluate the possibility of improvement in Access to Care and Continuity of Care for patients (ACC) in teaching hospitals of Tehran University of Medical Sciences. Methods: This cross-sectional study was conducted in hospitals affiliated to Tehran University of Medical Sciences during 2012. Data collection was performed using author-designed questionnaire of “Access to Care and Continuity of Care patients” based on JCI standards (2013). A total of 171 questionnaires were sent to 26 hospitals and 154 (90%) questionnaires were successfully completed and used for data analysis. The questionnaire was reviewed by experts and the Cronbach’s alpha was calculated to be 0.967. The effects of the two variables of hospital type (general, specialty) and the number of beds on mean scores of ACC standards and each of its domains were analyzed using T-test or Mann-Whitney test depending on the distribution due to Kolmogorov-Smirnov test result. Results: In general, the mean of ACC standards was found comprehendible and applicable by 82.3 (SD = 11) of the respondents. The highest and lowest mean scores of ACC questions belonged to hospitals H21 (90 ± 6) and H14 (67 ± 12), respectively. There were not any significant effects of hospital type and the number of beds on the ACC scores. Conclusion: There was not any important effect of hospital type and bed numbers on ACC, although there was a 9%-15% possibility of improvement in accreditation scores of ACC standards in hospitals of Tehran University of Medical Sciences. A complete accreditation score in this domain didn’t seem achievable in these hospitals. However, it is proposed that future managerial planning of the studied hospitals lead to a complete accreditation score.

New avenues for reducing intensive care needs in patients with chronic spinal cord injury

Relatively soon after their accident, patients suffering a spinal cord injury(SCI) begin generally experiencing the development of significant, often life-threatening secondary complications. Many of which are associated with chronic physical inactivity-related immune function problems and increasing susceptibility to infection that repeatedly requires intensive care treatment. Therapies capable of repairing the spinal cord or restoring ambulation would normally prevent many of these problems but, as of now, there is no cure for SCI. Thus, management strategies and antibiotics remain the standard of care although antimicrobial resistance constitutes a significant challenge for patients with chronic SCI facing recurrent infections of the urinary tract and respiratory systems. Identifying alternative therapies capable of safe and potent actions upon these serious health concerns should therefore be considered a priority. This editorial presents some of the novel approaches currently in development for the prevention of specific infections after SCI. Among them, brain-permeable small molecule therapeutics acting centrally on spinal cord circuits that can augment respiratory capabilities or bladder functions. If eventually approved by regulatory authorities, some of these new avenues may potentially become clinically-relevant therapies capable of indirectly preventing the occurrence and/or severity of these lifethreatening complications in people with paraplegic or tetraplegic injuries.

The Impact of Health Care Reform Initiatives on Ethical Conflict and Opportunities for Nurses to Improve Quality of Care While Enhancing Their Work Environments

Background: After more than a decade of the nursing profession contending that healthcare reform based almost exclusively on cost cutting was creating an array of serious ethical issues for nurses, healthcare organizations and other providers are now facing increasing demands primarily from payers to demonstrate improvement in both quality of care and patient experience along with continued cost reduction. Research Question: Have efforts by healthcare organizations to comply with these recently imposed requirements influenced the ethical environment faced by nurses and nurse leaders and if so, how? Materials and Methods: Data for assessing the current ethical environment was gathered with a close-ended survey mailed in October 2012 to a random sample of 3000 members of the American Organization of Nurse Executives. Results and Discussion: Statistical analysis of the data and comparison with the findings of a similar study conducted in 2000 indicated that along with five highly rated issues in the earlier study attributed largely to economic constraints imposed by healthcare organizations, the top-10 key ethical issues today included five issues primarily attributable to interprofessional conflict. Conclusion: Given the success of many ongoing efforts aimed at weakening these key sources of ethical conflict that have blocked many proposals to improve the quality of care, opportunities should arise for the nursing profession to more fully achieve its goals of improving the quality of care, safety and patient satisfaction and enhancing nurses’ work environments essential to that effort.

海带面包的制作工艺

海带中含有大量的粗纤维和较多的糖类,还含有多种有机物和碘、钙、磷、铁、钴、氟等10多种矿物质元素.海带中还含有维生素A,B1,B2,D和烟酸等,其蛋白质中包含有18种氨基酸.海带淀粉硫酸酯是多糖类物质,有降血压的功效,对血管硬化、冠心病、高血压和肥胖症有一定的预防和辅助治疗作用.通过正交试验确定了海带保健面包加工工艺的最佳配方即海带粉为5%、白砂糖为8%、面包改良剂为1.2%、酵母用量为3%,并且分析了海带粉对面包质量品质的影响.此产品风味独特、营养丰富,适合于中老年人群食用.