A Changing Healthcare System Model: The Effectiveness of Knowledge, Attitude, and Skill of Nursing Assistants Who Attend Senile Dementia Patients in Nursing Homes in Xi'an, China - A Questionnaire Survey.

BACKGROUND: In 2010, China had an elderly population of 1.78 billion people. As in other societies around the world, China is facing a growing challenge in providing care for its elderly citizens. Ensuring the highest quality of care for elderly patients, many of whom have senile dementia, is directly related to the performance of nursing assistants. METHODS: With the goal of investigating the knowledge, attitudes, and skills of nursing assistants who care for senile dementia patients in nursing homes in Xi'an, China, we distributed a survey and analyzed the responses. RESULTS: Nursing assistants showed dedication and sincerity in their care for senile dementia patients. However, their performances in the categories of life nursing and mental nursing reveal room for improvement. Further, the nursing assistants did not display adequate knowledge about senile dementia. Based on survey results, the knowledge of the nursing assistants concerning nursing safety was comparatively adequate. CONCLUSION: Nursing assistants who care for senile dementia patients in nursing homes in Xi'an, China, require further training that expands their knowledge and increases their capabilities. We recommend that nursing homes in Xi'an offer a standardized professional nurse/nurse assistant training course that focuses on care for elderly patients with senile dementia.

Practical guide to the management of acute and chronic pain in the presence of drug tolerance for the healthcare practitioner.

BACKGROUND: Drug tolerance has been on the rise in recent years worldwide, and consequently, pain management in our population has become challenging. METHODS: Discussed in this review are commonly abused drugs and considerations for treating acute and chronic pain states in patients with substance disorders. RESULTS: After marijuana, alcohol, and tobacco, the most widely abused substances are oxycodone (Oxycontin), diazepam (Valium), and methylphenidate (Ritalin). Urine testing can detect metabolites of drugs used by patients and is useful for assessing drug abuse, medication diversion, and drug interactions. The comprehensive treatment of pain in a patient with addictive disorder or tolerance must address 3 issues: the patient's addiction, any associated psychiatric conditions, and the patient's pain. Eliciting a detailed history of drug abuse-illicit drugs as well as prescription drugs-and ascertaining if the patient is currently enrolled in a methadone maintenance program for the treatment of drug addiction is vital. CONCLUSION: Medical observation, supportive care, multidisciplinary pain management, and timely interventions as necessary are the keys to safe outcomes in these patients.

Role of κ-opioid receptor in hypoxic pulmonary artery hypertension and its underlying mechanism.

The objective of this study were to determine the mechanism of action and role of the κ-opioid receptor (κ-OR) on hypoxic pulmonary artery hypertension (HPH) in the rat and its underlying mechanisms. The effect of U50,488H, a selective κ-OR agonist, on the proliferation of pulmonary arterial smooth muscle cells (PASMCs) under hypoxic conditions were measured by monotetrazolium assay and [H]-thymidine incorporation. Effects of U50,488H and nor-BNI, a highly selective κ-OR antagonist, on expression of κ-ORs were determined by Western blot technique. The results of our study demonstrated that U50,488H significantly lowered both mean pulmonary artery pressure and right ventricular pressure in HPH rats (P < 0.01). Further, this effect was abolished by nor-BNI (P < 0.01). Further, the effect of the agonist U50,488H was abolished by the antagonist nor-BNI (P < 0.01). mean pulmonary artery pressure and right ventricular pressure were both significantly upregulated in HPH rats treated with nor-BNI versus HPH control group rats (P < 0.01). Moreover, U50,488H inhibited proliferation of the PASMCs that were induced by hypoxia, and this inhibition lasted for 48 hours in a dose-dependent manner (P < 0.01). The inhibitory effect that U50,488H exerted on PASMC proliferation was also abolished by nor-BNI. During hypoxia, the expression of κ-ORs increased in the pulmonary artery. This increase of κ-OR expression was both enhanced by U50,488H and abolished by nor-BNI. The results demonstrate that U50,488H attenuates HPH through both the stimulation and upregulation of κ-ORs.

Vasculoprotective effect of U50,488H in rats exposed to chronic hypoxia: role of Akt-stimulated NO production.

Impairment of pulmonary endothelium function in the pulmonary artery is a direct result of chronic hypoxia. This study is to investigate the vasculoprotective effects of U50,488H (a selective κ-opioid receptor agonist) and its underlying mechanism in hypoxia-induced pulmonary artery endothelial functional injury. Chronic hypoxia was simulated by exposing the rats to 10% oxygen for 2 wk. After hypoxia, right ventricular pressure (RVP) and right ventricular hypertrophy index (RVHI) were measured. The pulmonary vascular dysfunction, effect of nitric oxide synthase inhibitor (l-NAME) on the relaxation of U50,488H, and level of nitric oxide (NO) were determined. In vitro, the signaling pathway involved in the anti-apoptotic effect of U50,488H was investigated. Cultured endothelial cells were subjected to simulated hypoxia, and cell apoptosis was determined by TUNEL staining. U50,488H (1.25 mg/kg) significantly reduced RVP and RVHI in hypoxia. U50,488H markedly improved both pulmonary endothelial function (maximal vasorelaxation in response to ACh: 74.9 ± 1.8%, n = 6, P <0.01 vs. hypoxia for 2 wk group) and increased total NO production (1.65 fold). U50,488H relaxed the pulmonary artery rings of the hypoxic rats. This effect was partly abolished by l-NAME. In cells, U50,488H both increased NO production and reduced hypoxia-induced apoptosis. Moreover, pretreatment with nor-binaltorphimine (nor-BNI, a selective κ-opioid receptor antagonist), PI3K inhibitor, Akt inhibitor or l-NAME almost abolished anti-apoptotic effect exerted by U50,488H. U50,488H resulted in increases in Akt and eNOS phosphorylation. These results demonstrate that pretreatment with U50,488H attenuates hypoxia-induced pulmonary vascular endothelial dysfunction in an Akt-dependent and NO-mediated fashion.

Development of a rat respiratory mask and its application in experimental chronic myocardial ischaemia.

In addressing the challenge of the low survival rates of rats with myocardial ischaemia, we developed a novel respiratory mask. We tested this mask on the rat model. We gave attention to several features of the mask: (1) shape, (2) size, (3) inlet, (4) outlet, (5) compatibility between rat head and the mask, (6) connection between mask and ventilator. We found certain features, especially to influence mask efficacy. These features include: mask shape, mask inlet and outlet, mask connection to the respiratory machine, mask mount on the rat head. We examined the rat mask in a model of chronic myocardial ischaemia; our model was the ligation of the coronary artery. The rats with the masks experienced an increase in survival by a factor of 50-90% compared with rats deprived of the masks. Towards the examination of myocardial ischaemia, our new mask may offer a platform replete with both efficiency and stability.