Application of blended learning combined with Jigsaw teaching in arterial blood specimen collection of undergraduate intern nurses / 中华医学教育探索杂志

Objective:To explore the application effect of online and offline blended learning combined with Jigsaw teaching in arterial blood specimen collection of undergraduate nursing interns.Methods:A total of 135 undergraduate nursing interns were randomly divided into the experimental group ( n=66) and the control group ( n=69). The experimental group used the blended learning combined with Jigsaw teaching, while the control group adopted the blended learning combined with PBL teaching. The theoretical examination before and after class, the skill assessment after training, the nursing clinical decision-making consciousness scale, and the teaching satisfaction survey were conducted in the two groups. SPSS 28.0 was used for t-test and Chi-square test. Results:After teaching, the total score of courses and the score of theoretical examination and skill assessment of the experimental group were higher than those of the control group, and the differences were statistically significant ( P<0.05). The total score and the multi-dimension scores of the nursing clinical decision-making consciousness scale in the experimental group were higher than those in the control group, and the differences were statistically significant ( P<0.05). The teaching satisfaction of the experimental group was 92.42% (61/66), which was significantly higher than that of the control group [69.57% (48/69)], and the differences were statistically significant ( P<0.05). Conclusion:Blended learning combined with Jigsaw teaching is applied to collect arterial blood specimens for undergraduate nursing interns, which is beneficial to improve the academic performance and clinical decision-making ability of nursing students.

Calcitonin gene-related peptide (CGRP) concentrations outside migraine attacks in peripheral blood as a potential biomarker for chronic migraine / Concentrações de peptídeo relacionado ao gene da calcitonina (CGRP) fora dos ataques de enxaqueca no sangue periférico como um potencial biomarcador para enxaqueca crônica

Introduction: Chronic migraine is a debilitating condition that affects a significant portion of the population. Accurate diagnosis and treatment of chronic migraine remain a challenge due to the lack of objective biomarkers. Calcitonin gene-related peptide (CGRP) is a neuropeptide involved in the pathophysiology of migraine and has been proposed as a potential biomarker for migraine. Methods: We measured CGRP levels in peripheral blood samples collected from 142 participants with chronic or episodic migraine and 24 healthy controls during ictal periods, i.e., outside migraine attacks. We compared CGRP levels between the three groups and assessed the correlation between CGRP levels and clinical features of chronic migraine. Conclusion: Our study provides evidence that CGRP levels in peripheral blood during ictal periods may serve as a potential biomarker for chronic migraine. Further studies are needed to validate these findings and to explore the clinical utility of CGRP as a biomarker for chronic migraine.

Introdução: A enxaqueca crônica é uma condição debilitante que afeta uma parcela significativa da população. O diagnóstico preciso e o tratamento da enxaqueca crónica continuam a ser um desafio devido à falta de biomarcadores objetivos. O peptídeo relacionado ao gene da calcitonina (CGRP) é um neuropeptídeo envolvido na fisiopatologia da enxaqueca e foi proposto como um potencial biomarcador para enxaqueca. Métodos: Medimos os níveis de CGRP em amostras de sangue periférico coletadas de 142 participantes com enxaqueca crônica ou episódica e 24 controles saudáveis ​​durante períodos ictais, ou seja, fora das crises de enxaqueca. Comparamos os níveis de CGRP entre os três grupos e avaliamos a correlação entre os níveis de CGRP e as características clínicas da enxaqueca crônica. Conclusão: Nosso estudo fornece evidências de que os níveis de CGRP no sangue periférico durante os períodos ictais podem servir como um potencial biomarcador para enxaqueca crônica. Mais estudos são necessários para validar estes resultados e explorar a utilidade clínica do CGRP como biomarcador para enxaqueca crónica.

Effects of peripheral and umbilical cord blood sampling on transfusion and complications in very low birth weight infants during hospitalization / 中华围产医学杂志

Objective:To analyze the effects of different blood sampling methods on the incidence of iatrogenic blood loss, anemia, transfusion, and complications in very low birth weight infants (VLBWI) during hospitalization.Method:A retrospective analysis was performed on VLBWIs (birth weight <1 500 g) admitted to the neonatal intensive care unit of the Second Hospital of Yangtze University, Jingzhou Central Hospital, Hubei province, from January 2014 to December 2018. According to the first blood sampling method, these infants were subjected to the umbilical cord blood and peripheral blood groups. Blood sampling, transfusion, complications, and outcomes were compared between the two groups. Independent samples t-test, rank-sum test, and Chi-square (or Fisher's exact) test were used for statistical analysis. Results:(1) Totally 240 neonates enrolled, including 104 cases in the umbilical cord blood group and 136 in the peripheral blood group. There was no statistical significance in the general information and blood test results for the first time between the two groups. (2)The blood volume collected in the first week in the umbilical cord blood group was lower than that in the peripheral blood group [6.5 ml (1-23 ml) and 10 ml (1-30 ml), Z=－4.706, P<0.01]. Differences between the two groups in the blood volume at 2-9 weeks were insignificant (all P>0.05). The number of blood collection procedures in each of the first four weeks after birth in the umbilical cord blood group was less than that in the peripheral blood group ( Z value was－9.124,－2.272,－4.688, and－2.017, respectively, all P<0.05), but no statistical difference was found at the fifth week ( P>0.05). The time of the first red blood cell transfusion (RBCT) in the umbilical cord blood group was later than that in the peripheral blood group [4 weeks (1-7 weeks) vs 3 weeks (1-5 weeks), Z=－2.839, P<0.05]. The proportion of infants who have received RBCT twice or more times in the umbilical cord blood group was lower than that in the peripheral blood group [39.7% (25/63) vs 56.8% (50/88), χ2=4.312, P<0.05]. The rate of RBCT during the first three weeks in the umbilical cord blood group was lower than that in the peripheral blood group [34.9% (22/63) vs 59.1% (52/88), χ2=8.583, P<0.05]. There were no significant differences in the volume of RBCT per time, adverse reactions after transfusion, and the erythrocyte count, hemoglobin, and hematocrit before and after the first RBCT between the two groups. (3) The incidence of neonatal respiratory distress syndrome, neonatal necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, and intraventricular hemorrhage (grade Ⅲ-Ⅳ) and their outcomes were similar between the two groups (all P>0.05). Conclusion:Blood sampling methods show no significant effect on the total incidence of anemia and RBCT in VLBWIs during hospitalization. Umbilical cord blood sampling may delay the first RBCT time of VLBWIs and reduce the rate of RBCT in the first three weeks, but do not affect the incidence of complications.

Nivel de conocimiento de los aptos no incorporados a donar de la Guabina / Level of knowledge of those who are apt but not willing to donate blood in la Guabina people's council

RESUMEN Introducción: las donaciones de sangre se realizan a través de personal calificado proveniente de los bancos e instituciones preparadas para dicha actividad. Objetivo: evaluar el nivel de conocimientos sobre donaciones de sangre de los aptos no incorporados a donar, de tres consultorios del consejo popular La Guabina. Métodos: se realizó una investigación observacional, descriptiva y transversal en los consultorios 45, 35 y 25 pertenecientes al consejo popular La Guabina del municipio Pinar del Río, en el período comprendido entre 1ro de septiembre de 2017 y 15 de marzo de 2018. El universo de estudio estuvo constituido por 236 pacientes de 18 a 65 años, aptos para donar sangre no incorporados a dicho proceso de los tres consultorios seleccionados. Resultados: predominó el sexo femenino (52,97 %). El grupo etario que predominó fue de 45 a 49 (13,98 %). La principal causa por las que no donaban los no incorporados era el miedo a la punción (61,44 %). En cuanto a los conocimientos sobre donación de sangre, predominó el nivel regular en temas donación voluntaria de sangre (48,73 %), sangre de la donación (52,12 %) y lo que sucede con una donación de sangre (50,85 %); se alcanzaron altas calificaciones de regular en el nivel de conocimientos global sobre donación de sangre (40,25%). Conclusiones: una intervención educativa sobre donaciones de sangre podría incrementar el nivel de conocimientos de los participantes e incorporarlos al proceso de donación de sangre.

ABSTRACT Introduction: qualified personnel who work in blood banks and institutions prepared for such activity perform blood donations. Objective: to assess the level of knowledge concerning blood donation of those who are apt but not willing to donate at three doctor's offices in la Guabina people's council. Methods: an observational, descriptive and cross sectional research was conducted at 45, 35 and 25 doctor's offices from la Guabina People's Council, Pinar del Rio municipality from September 1 ,2017 to March 15, 2018. The target group comprised 236 patients (18 to 65 years old); who are apt to donate blood but not willing to be involved in such process from the doctor's offices chosen. Results: female gender prevailed (52,97 %). The age group that predominated was 45-49 (13,98 %). The main cause of denial was the fear of puncture (61,44 %). The level of knowledge concerning blood donation, fair level predominated in topics related to voluntary blood donation (48,73 %), the donation of blood (52,12 %), along with what follows with the donation (50.85 %); reaching high grades of fair concerning the level of global knowledge of blood donation (40,25 %). Conclusions: an educational intervention concerning blood donation could increase the levels of knowledge in the participants, aimed at including them into the process.

Procedimiento metodológico para el estudio del extendido de sangre periférica en la licenciatura en Bioanálisis Clínico / Methodological procedure for the study of extended peripheral blood in the degree in Clinical Bioanalysis

RESUMEN Fundamento: el extendido de sangre periférica o lámina periférica, como también se conoce, es la evaluación morfológica semicuantitativa de las tres series hematopoyéticas en una extensión de sangre periférica coloreada y observada a través del microscopio. Objetivo: elaborar un procedimiento metodológico para el extendido de sangre periférica desde una perspectiva interdisciplinar en la licenciatura en Bioanálisis Clínico. Métodos: se realizó un estudio descriptivo transversal desde septiembre a noviembre de 2018, en la facultad Tecnológica perteneciente a la Universidad de Ciencias Médicas de Camagüey. Se emplearon métodos teóricos como el análisis y síntesis, el inductivo y deductivo. De los métodos empíricos, fueron aplicados el análisis de documentos, la prueba diagnóstica exploratoria, resultados de controles a clases, la entrevista y encuesta para la validación de la propuesta. Resultados: insuficiencias en cuanto al establecimiento de las relaciones interdisciplinarias entre los contenidos de Histología y el componente hematológico de la asignatura Diagnóstico de Laboratorio I, los estudiantes mostraron dificultades en la realización de la técnica y no lograron caracterizar morfológicamente algunas de las células hematopoyéticas. Conclusiones: se elaboró un procedimiento metodológico para la técnica lámina periférica desde una perspectiva interdisciplinar y la validación de la propuesta mediante el método de consenso conformado por un grupo nominal, donde resultan las categorías de muy adecuado y adecuado para el desarrollo de la técnica lámina periférica, pues la observación de extendidos periféricos es un elemento importante en la orientación del análisis de las diferentes enfermedades, componente esencial del diagnóstico integral del laboratorio clínico.

ABSTRACT Background: the peripheral blood extension or peripheral lamina, as it is also known, is the semi-quantitative morphological evaluation of the three hematopoietic series, in an extension of peripheral blood colored and observed through the microscope. Objective: to develop a methodological procedure for the extension of peripheral blood from an interdisciplinary perspective in the degree in Clinical Bioanalysis. Methods: cross-sectional descriptive study in the period from September to November 2018, in the Technological Faculty belonging to the University of Medical Sciences of Camagüey. Theoretical methods such as analysis and synthesis and inductive and deductive methods were used. Of the empirical methods, the analysis of documents, the exploratory diagnostic test, results of controls to classes, the interview and survey for the validation of the proposal were applied. Results: insufficiencies regarding the establishment of interdisciplinary relationships between the contents of Histology and the hematological component of the Laboratory Diagnostic subject I, the students showed difficulties in performing the technique and failed to characterize morphologically some of the hematopoietic cells. Conclusions: a methodological procedure was developed for the peripheral lamina technique from an interdisciplinary perspective and the validation of the proposal by means of the consensus method formed by a nominal group where the categories of very adequate and suitable for the development of the peripheral lamina technique result. The observation of extension peripherals is an important element in the orientation of the analysis of the different diseases, an essential component of the integral diagnosis of the clinical laboratory.

Utilização da técnica broken needle para punção venosa periférica na assistência a recém-nascidos prematuros / Using the broken needle technique for peripheral venous puncture in assistance to premature newborn / Utilización de la tecnica broken needle para punto venosa periférica en la asistencia a reciénnos prematuros

Objetivo: compreender a utilização da técnica broken needle de punção venosa periférica na prática profissional de assistência a neonatos prematuros. Método: estudo qualitativo realizado por meio de entrevista a profissionais da assistência neonatal submetida à Análise de Conteúdo segundo Bardin. Resultados: foram identificadas as categorias: percepções dos profissionais quanto aos benefícios da técnica broken needle para o neonato; e aprendizado e vivência profissional da técnica broken needle. Conclusão: a transferência do conhecimento de um profissional ao outro favoreceu a incorporação da técnica na instituição. A equipe se preocupa em realizar técnicas que sejam menos agressivas ao neonato e, portanto, realizam a broken needle porque acreditam que seja mais vantajosa e benéfica e não tenha efeitos adversos ao neonato. Os profissionais decidem qual técnica utilizar, levando em consideração as características anatômicas e clínicas do neonato, a sua habilidade e a segurança na execução

Objective: to understand the use of the broken needle technique peripheral venous puncture in the professional practice of assistance to preterm infants. Method: qualitative study conducted through interviews with neonatal care professionals submitted to Content Analysis to Bardin. Results: the following categories were identified: Professional perceptions regarding the benefits of the broken needle technique for the neonate; Learning and professional experience of broken needle technique. Conclusion: the transfer of knowledge from one professional to another favored the incorporation of the technique in the institution. The team is concerned with performing techniques that are less aggressive to the newborn and therefore perform the broken needle because they believe it is more advantageous and beneficial and has no adverse effects on the neonate. The professionals decide which technique to use taking into account the anatomical and clinical characteristics of the neonate, their ability and safety in the execution

Objetivo: comprender el uso de la técnica broken needle de punción venosa periférica en la práctica profesional de asistencia a neonatos prematuros. Método: estudio cualitativo realizado por medio de entrevista a profesionales de la asistencia neonatal sometida al Análisis de Contenido según Bardin. Resultados: se identificaron las categorías: Percepciones de los profesionales en cuanto a los beneficios de la técnica broken needle para el neonato; Aprendizaje y vivencia profesional de la técnica broken needle. Conclusión: la transferencia del conocimiento de un profesional al otro favoreció la incorporación de la técnica en la institución. El equipo se preocupa de realizar técnicas que sean menos agresivas al neonato y, por lo tanto, realizan la técnica porque creen que es más ventajosa y benéfica y no tiene efectos adversos al neonato. Los profesionales deciden qué técnica utilizar teniendo en cuenta las características anatómicas y clínicas del neonato, su habilidad y seguridad en la ejecución

VIDA - Nursing v1. 0 immersive virtual reality in vacuum blood collection among adults / VIDA - Enfermagem v1. 0 realidade virtual imersiva na coleta de sangue a vácuo em adulto / VIDA - Enfermería v1. 0 realidad virtual inmersiva en la recolección de sangre al vacío en adultos

Objective: to develop and validate the first immersive virtual reality simulation addressing vacuum blood collection in adult patients - VIDA-Nursing v1.0. Method: methodological study to validate 14 steps of the vacuum blood collection procedure in adults, designed to develop the immersive virtual reality simulator VIDA-Nursing v1.0. It was assessed by 15 health workers and 15 nursing undergraduate students in terms of visual, interactive, movement simulation reality, teaching and user-friendly aspects. Results: the workers considered 79.6% of the items to be valid, while the students considered 66.7% of the items valid; most of the demands can be implemented in the system by improving future versions. Conclusion: the simulator was considered a promising and innovative tool to teach vacuum blood collection in adults as it can be combined with other resources currently used to introduce this topic and technique in the education of undergraduate nursing students.

Objetivo: desenvolver e validar a primeira versão do simulador de realidade virtual imersiva no procedimento de coleta de sangue a vácuo no paciente adulto - VIDA-Enfermagem v1.0. Método: estudo com delineamento metodológico para validar 14 etapas do procedimento de coleta de sangue a vácuo no adulto, projetadas para o desenvolvimento do simulador de realidade virtual imersiva VIDA-Enfermagem v1.0, o qual foi avaliado por 15 profissionais da saúde e 15 graduandos de enfermagem em relação aos aspectos visual, interativo, realidade de simulação do movimento, pedagógico e esforço de utilização. Resultados: de maneira geral foram considerados válidos 79,6% dos itens avaliados pelos profissionais e 66,7% dos itens avaliados pelos graduandos, sendo que a maioria das necessidades de melhorias do sistema é passível de correção no incremento das próximas versões. Conclusão: o simulador foi considerado como ferramenta promissora e inovadora para o ensino da coleta de sangue a vácuo no adulto, enquanto estratégia a ser combinada com recursos utilizados atualmente na educação de graduandos de enfermagem que estão iniciando o estudo da temática e da técnica.

Objetivo: desarrollar y validar la primera versión del simulador de realidad virtual inmersivo en el procedimiento de recolección de vacío de sangre en pacientes adultos: VIDA-Enfermería v1.0. Método: estudio con diseño metodológico para validar 14 pasos del procedimiento de extracción de sangre al vacío en adultos, diseñado para el desarrollo del simulador inmersivo de realidad virtual VIDA-Enfermería v1.0, que fue evaluado por 15 profesionales de la salud y 15 estudiantes universitarios de enfermería con relación a los aspectos visual, interactiva, realidad de movimiento, pedagógico y esfuerzo de uso. Resultados: en general, el 79.6% de los ítems evaluados por los profesionales y el 66.7% de los ítems evaluados por los estudiantes de pregrado se consideraron válidos, y la mayoría de las necesidades de mejoras del sistema están sujetas a corrección en el incremento de las próximas versiones. Conclusión: el simulador fue considerado como una herramienta prometedora e innovadora para enseñar la extracción de sangre al vacío en adultos, como una estrategia que se combina con los recursos utilizados actualmente en la educación de estudiantes de enfermería que están comenzando a estudiar el tema y la técnica.

Indications of percutaneous umbilical cord blood sampling in prenatal diagnosis / 中华围产医学杂志

Objective@#To investigate the tendency and safety of percutaneous umbilical cord blood sampling (PUBS) in prenatal screening and diagnosis, and the possibilities of avoiding unnecessary PUBS.@*Methods@#This was a retrospective study of pregnant women who underwent PUBS for prenatal diagnosis in Peking University First Hospital from January 2015 to December 2017. Clinical indications, timing of PUBS, further investigations (chromosome karyotype, molecular genetics and pathogen testing), results, and pregnancy outcomes were collected and analyzed. One-way analysis of variance (ANOVA), Chi-square test for linear trend, Fisher's exact probability test/Cochran-Armitage analysis and Cruskal-Wallis rank-sum test were used for statistical analysis.@*Results@#(1) A total of 412 singleton pregnancies underwent PUBS at 20-38 gestational weeks during the study period, and 379 (92.2%) of them received PUBS before 34 gestational weeks. The positive test results accounted for 10.4% (43/412). There were six (1.5%) miscarriages after PUBS. In vitro cell culture failure occurred in two cases, one in 2015 and the other in 2016. (2) Among the 412 cases, 304 (73.8%) had only one indication. Fourteen cases could be identified as high risk in the first trimester, such as advanced maternal age (AMA, >35 years), pregnant history with chromosomal abnormal fetus and one of the couples carrying abnormal genes. There were four, zero and one case receiving PUBS only for AMA in 2015, 2016 and 2017, respectively. Indications, including high risk suggested by serum screening and fetal abnormality found by ultrasound were identified in 290 cases (70.4%) in the second or third trimester. Other than AMA, there were no statistically significant differences in single indicators. The proportion PUBS with double indicators increased from 2015 to 2017 but without significant difference. AMA and positive serum screening as indicators of aneuploidy screening accounted for 7.6% (8/105) in double-indicator group and 1.9% (8/412) in all. (3) There were 363 PUBS (88.1%) performed for ultrasound abnormalities. Among them, 76.9% (280/363) only had abnormal ultrasound findings, and the percentage was decreased year by year. The other 83 cases (80 with double indicators and three with triple indicators) also presented with other indicators, including AMA, adverse pregnancy history and positive serum screening. The proportion of PUBS performed with the presence of multiple indicators tended to increase recently, but no statistically significant difference was found. All the 18 cases with abnormality diagnosed by molecular genetic testing had abnormal ultrasound findings.@*Conclusions@#Although PUBS's complications are rare, it carries some risks. The constitution of single indication has been declined every year. With the improvement of prenatal screening system and application of molecular karyotyping, the necessity of invasive prenatal diagnosis with PUBS is greatly reduced. An improvement in reasonable and standardized application of PUBS needs to be achieved.

Indications of percutaneous umbilical cord blood sampling in prenatal diagnosis / 中华围产医学杂志

Objective To investigate the tendency and safety of percutaneous umbilical cord blood sampling (PUBS) in prenatal screening and diagnosis,and the possibilities of avoiding unnecessary PUBS.Methods This was a retrospective study of pregnant women who underwent PUBS for prenatal diagnosis in Peking University First Hospital from January 2015 to December 2017.Clinical indications,timing of PUBS,further investigations (chromosome karyotype,molecular genetics and pathogen testing),results,and pregnancy outcomes were collected and analyzed.One-way analysis of variance (ANOVA),Chi-square test for linear trend,Fisher's exact probability test/Cochran-Armitage analysis and Cruskal-Wallis rank-sum test were used for statistical analysis.Results (1)A total of 412 singleton pregnancies underwent PUBS at 20-38 gestational weeks during the study period,and 379 (92.2％) of them received PUBS before 34 gestational weeks.The positive test results accounted for 10.4％ (43/412).There were six (1.5％) miscarriages after PUBS.In vitro cell culture failure occurred in two cases,one in 2015 and the other in 2016.(2) Among the 412 cases,304 (73.8％) had only one indication.Fourteen cases could be identified as high risk in the first trimester,such as advanced maternal age (AMA,＞35 years),pregnant history with chromosomal abnormal fetus and one of the couples carrying abnormal genes.There were four,zero and one case receiving PUBS only for AMA in 2015,2016 and 2017,respectively.Indications,including high risk suggested by serum screening and fetal abnormality found by ultrasound were identified in 290 cases (70.4％) in the second or third trimester.Other than AMA,there were no statistically significant differences in single indicators.The proportion PUBS with double indicators increased from 2015 to 2017 but without significant difference.AMA and positive serum screening as indicators of aneuploidy screening accounted for 7.6％ (8/105) in double-indicator group and 1.9％ (8/412) in all.(3) There were 363 PUBS (88.1％) performed for ultrasound abnormalities.Among them,76.9％ (280/363) only had abnormal ultrasound findings,and the percentage was decreased year by year.The other 83 cases (80 with double indicators and three with triple indicators) also presented with other indicators,including AMA,adverse pregnancy history and positive serum screening.The proportion of PUBS performed with the presence of multiple indicators tended to increase recently,but no statistically significant difference was found.All the 18 cases with abnormality diagnosed by molecular genetic testing had abnormal ultrasound findings.Conclusions Although PUBS's complications are rare,it carries some risks.The constitution of single indication has been declined every year.With the improvement of prenatal screening system and application of molecular karyotyping,the necessity of invasive prenatal diagnosis with PUBS is greatly reduced.An improvement in reasonable and standardized application of PUBS needs to be achieved.

Qualitative study on barriers of evidence-based practice in venous blood specimen collection / 中国实用护理杂志

Objective To identify barriers of evidence-based practice in venous blood specimen collection. Methods Totally 12 nurses from Zhongshan Hospital Fudan University participated in the non-structure interviews. Data were analyzed by category analysis. Results There were 8 barriers, including standard operation procedure of blood specimen collection was not updated in time, lacking of education and professional support for evidence-based nursing, lacking of effective superintendence, rising economic cost, deficiency of technology and equipment, sufficient nurses, deficiency of evidence-based practice environment. Conclusions Establishing and implementing an evidence- based standard operation procedure, strengthening personnel education, looking for professional support, developing link management, reasonable allocation of human resources and flexible scheduling, creating an evidence-based practice environment, seeking technical and equipment support and evaluating evidence to control costs are benefit to promote the best evidence of venous blood collection to achieve clinical transformation.

Qualitative study on barriers of evidence-based practice in venous blood specimen collection / 中国实用护理杂志

Objective@#To identify barriers of evidence-based practice in venous blood specimen collection.@*Methods@#Totally 12 nurses from Zhongshan Hospital Fudan University participated in the non-structure interviews. Data were analyzed by category analysis.@*Results@#There were 8 barriers, including standard operation procedure of blood specimen collection was not updated in time, lacking of education and professional support for evidence-based nursing, lacking of effective superintendence, rising economic cost, deficiency of technology and equipment, sufficient nurses, deficiency of evidence-based practice environment.@*Conclusions@#Establishing and implementing an evidence-based standard operation procedure, strengthening personnel education, looking for professional support, developing link management, reasonable allocation of human resources and flexible scheduling, creating an evidence-based practice environment, seeking technical and equipment support and evaluating evidence to control costs are benefit to promote the best evidence of venous blood collection to achieve clinical transformation.

Exames laboratoriais da Pesquisa Nacional de Saúde: metodologia de amostragem, coleta e análise dos dados / Laboratory exams of the National Health Survey: methodology of sampling, data collection and analysis

RESUMO: Introdução: O artigo teve o objetivo de descrever a metodologia de coleta dos dados dos exames laboratoriais da Pesquisa Nacional de Saúde (PNS). Metodologia: Foi selecionada uma subamostra de 25% dos setores censitários, obedecendo à estratificação da amostra da PNS, com probabilidade inversamente proporcional à dificuldade de coleta. A coleta de sangue e urina dos moradores selecionados para entrevista individual foi realizada nos domicílios por um agente de laboratório. Por conta das dificuldades encontradas no trabalho de campo,a amostra não atingiu número suficiente em alguns estratos da pesquisa, então para a análise dos dados foi proposto procedimento de pós-estratificação. Resultados: A coleta de material biológico foi realizada em 8.952 indivíduos. Os exames realizados foram: hemoglobina glicada; colesterol total; colesterol LDL; colesterol HDL; sorologia para dengue; hemograma série vermelha (eritograma) e série branca (leucograma); cromatografia líquida de alta eficiência (HPLC) para diagnóstico de hemoglobinopatias; e creatinina. Na urina, estimativa de excreção de potássio, sal, sódio e creatinina. A base de dados dos exames laboratoriais foi ponderada e disponibilizada para os usuários no site da PNS da Fundação Oswaldo Cruz, sem necessidade de autorização prévia para uso. Conclusão: A subamostra total coletada é de grande valia, pois permitiu estabelecer parâmetros de referência nacionais adequados às características sociodemográficas e geográficas da população brasileira, fornecendo informações relevantes e complementares para a análise da situação de saúde do Brasil.

ABSTRACT: Introduction: This article aims at describing the National Health Survey (Pesquisa Nacional de Saúde- PNS) methodology of collecting laboratory exams data. Methodology: A subsample of 25% of the census tracts was selected, according to the stratification of the PNS sample, with a probability inversely proportional to the difficulty of collection. The collection of blood and urine was done in the households by a laboratory agent, among residents selected for individual interview. Due to the difficulties found in the field work, the sample did not reach the minimum expected number in some strata, and a post-stratification procedure was proposed for the data analysis. Results: The collection of biospecimens was performed in 8,952 individuals. Laboratory tests were: glycated hemoglobin; total cholesterol; LDL cholesterol; HDL cholesterol; serology for dengue; red blood cell count (erythrogram) and white series count (leukogram); high performance liquid chromatography (HPLC) for diagnosis of hemoglobinopathies; creatinine. Theexcretion of potassium, salt and sodium and creatinine was estimated in the urine. The database of laboratory exams was weighed and made publicly available on the Oswaldo Cruz Foundation's PNS website and can be accessed without prior authorization. Conclusion: The total subsample of laboratory exams is of great value, since it allowed us to establish national reference parameters adequate to sociodemographic and geographic characteristics of the Brazilian population, providing relevant and complementary information for the analysis of the health situation of Brazil.

Caracterización de los procedimientos para la realización de hemocultivos en pacientes adultos, en instituciones hospitalarias del Área Metropolitana del Valle de Aburrá / Characterization of procedures for performing blood cultures in adult patients, in hospitals of the Metropolitan Area of Aburrá Valley

Objetivo: Caracterizar procedimientos para la toma, análisis, reporte y aseguramiento de la calidad en hemocultivos en pacientes adultos, en instituciones hospitalarias. Material Y método: Estudio descriptivo en 15 Hospitales de Medellín y alrededores. Se empleó un formulario semiestructurado para recolectarla información, se utilizó SPSS(r) para el análisis. Resultados: Todas las instituciones tienen protocolos basados en fuentes de autoridad reconocida; con diferencias importantes en procesos pre-analíticos y postanalíticos. Los Productos más empleados para la antisepsia fueron gluconato declorhexidina al 2-4%(66,7%) Y alcohol isopropílico o etílico al 70% (20,0%),Con discrepancias en los tiempos de acción. El 73,3% emplea guantes estériles y la misma proporción usa sistema abierto (jeringa) para la venopunción. En el 46,6% se toman dos botellas aerobias y una anaerobia por episodio y en 33,3% dos botellas aerobias. El 66,6% lleva un indicador de contaminación, 53,3% de positividad y 26,6% de volumen de sangre. La tasa promedio de hemocultivos contaminados durante el semestre de seguimiento fue 1,61%. Conclusión: Se observa heterogeneidad en los procedimientos, especialmente en fases pre-analítica y post-analítica. En La búsqueda de la excelencia y la seguridad del paciente son necesarios protocolos estandarizados e indicadores para medir y controlar el desempeño de los hemocultivos.

Objective: To characterize the procedures that are performed for the collection, analysis, reporting and quality assurance of blood cultures in adult patients in hospital institutions. Material and Methods: Descriptive study in 15 hospitals of Medellin and its surroundings. A semi-structured collection instrument was used to collect the information provided by each hospital; SPSS(r) was used for the analysis. Results: All Institutions have protocols based o nauthorized sources; there were important differences in the pre-analytic and post-analytic processes. The Products employed for skin antisepsis were2-4% Chlorhexidine gluconate (66.7%)And70% Isopropyl or ethyl alcohol(20.0%), with discrepancies in product action times. 73.3% use sterile gloves and an equal proportion uses an open system (syringe) for venipuncture. Two aerobic and one anaerobic bottles are taken per episode in adult patients in 46.6% of institutions and only two aerobic bottles in 33.3% of them. Indicators of contamination were used by 66.6 % of institutions, of positivity in 53.3% and of blood volume in 26.6%. The average rate of contaminated blood cultures during the follow-up period was 1.61%. Conclusion: Heterogeneity in the procedures was observed especially in the pre-analytic and post-analytical phases. In the pursuit of excellence and patient safety, standardized protocols and the use of indicators to measure and control the performance of blood cultures are needed.

A survey of the best evidence communication and application of blood specimen collection / 中国实用护理杂志

Objective@#To investigate the present situation about the best evidence communication and application of blood specimen collection.@*Methods@#A total of 312 nurses from Zhongshan Hospital Affiliated to Fudan University were investigated with self-designed questionnaire.@*Results@#The scores of the best evidence knowledge of blood specimen collection was 15.23±2.45, 1.9% (6/312) nurses obtained full score. The scores of the best evidence behavior of blood specimen collection was 38.11±2.93, 1.6% (5/312) nurses got full score.@*Conclusions@#The nursing staff had a poor knowledge in the best evidence of blood specimen collection. There was a gap between the best evidence of blood specimen collection and clinical practice. The state of communication and application of the best evidence of blood specimen collection is not good.

Simulação de realidade virtual imersiva no procedimento de punção venosa periférica para coleta de sangue a vácuo / Immersive virtual reality simulation in the peripheral venipuncture procedure for vacuum blood collection

A punção venosa periférica é a inserção de dispositivos por veia periférica para acesso à corrente sanguínea, como na coleta de sangue para exames; embora seja um procedimento comum no tratamento intra-hospitalar, é complexo e exige competência profissional. A realização desse procedimento de forma inadequada pode colocar em risco a saúde do paciente, podendo provocar diversas complicações ao seu tratamento. A pesquisa teve como objetivo desenvolver e validar a primeira versão de um simulador de realidade virtual (RV) imersiva para o procedimento de punção venosa periférica para coleta de sangue a vácuo no paciente adulto. Revisão integrativa da literatura permitiu verificar as estratégias de ensino de punção venosa periférica na enfermagem. Procedeu-se, em seguida, um estudo com delineamento metodológico para desenvolver e validar a primeira versão do simulador. O uso de recursos tecnológicos como estratégias de ensino em enfermagem está em expansão, porém a simulação com RV, principalmente no ensino de punção venosa periférica, ainda é um vasto campo a ser explorado. Foi desenvolvida a primeira versão de um simulador de RV para a coleta de sangue à vácuo no adulto - o VIDA-Enfermagem v1.0, o qual foi avaliado por profissionais e graduandos de enfermagem. Foram considerados válidos 79,6% dos itens avaliados pelos profissionais e 66,7% dos itens avaliados pelos graduandos. As sugestões propostas pelos sujeitos da pesquisa para melhorias do sistema, em sua maioria, são passíveis de aceitação no decorrer do incremento das versões seguintes. Mesmo havendo necessidade de revisão de diversos itens, na avaliação dos participantes, o simulador foi considerado uma ferramenta promissora e inovadora para o ensino do procedimento de punção venosa periférica para coleta de sangue a vácuo em paciente adulto, para graduandos de enfermagem que estão se iniciando no estudo da temática e da técnica, como estratégia a ser combinada com os recursos já utilizados atualmente no ensino do procedimento. É relevante que se invista em estratégias inovadoras e motivadoras para aplicação no ensino de enfermagem, principalmente com o uso da realidade virtual imersiva

Peripheral venipuncture is the insertion of a peripheral venous device to access bloodstream, such as in blood collection for tests; although it is a common procedure in in-hospital treatment, it is complex and requires professional competence. Failure to perform this procedure may put the patient's health at risk, and may cause several complications to his/her treatment. This study aimed to develop and validate the first version of an immersive virtual reality (VR) simulator for the peripheral venipuncture procedure for vacuum blood collection in adult patient. Teaching strategies of peripheral venipuncture in nursing were verified through an integrative literature review. Then, a study with a methodological design was performed to develop and validate the first version of the simulator. The use of technological resources such as teaching strategies in nursing is expanding; however, the simulation with VR, mainly in the teaching of peripheral venipuncture, is still a vast field to be explored. The first version of a VR simulator for vacuum blood collection in adult patient was developed - VIDA-Enfermagem v1.0, which was evaluated by professionals and undergraduate nursing students. 79.6% of the items evaluated by the professionals and 66.7% of the items evaluated by the undergraduate students were considered valid. The suggestions proposed by the research subjects for system improvements, for the most part, may be included in the following versions. Although it was necessary to review several items, in the evaluation of the participants, the simulator was considered a promising and innovative tool for the teaching of the peripheral venipuncture procedure for vacuum blood collection in adult patients, for nursing undergraduate students who are beginning the study of the subject and technique, as a strategy to be combined with the resources already used in the teaching of the procedure. It is relevant to invest in innovative and motivating strategies for application in nursing teaching, especially with the use of immersive virtual reality

Simulação de realidade virtual imersiva no procedimento de punção venosa periférica para coleta de sangue a vácuo / Immersive virtual reality simulation in the peripheral venipuncture procedure for vacuum blood collection

A punção venosa periférica é a inserção de dispositivos por veia periférica para acesso à corrente sanguínea, como na coleta de sangue para exames; embora seja um procedimento comum no tratamento intra-hospitalar, é complexo e exige competência profissional. A realização desse procedimento de forma inadequada pode colocar em risco a saúde do paciente, podendo provocar diversas complicações ao seu tratamento. A pesquisa teve como objetivo desenvolver e validar a primeira versão de um simulador de realidade virtual (RV) imersiva para o procedimento de punção venosa periférica para coleta de sangue a vácuo no paciente adulto. Revisão integrativa da literatura permitiu verificar as estratégias de ensino de punção venosa periférica na enfermagem. Procedeu-se, em seguida, um estudo com delineamento metodológico para desenvolver e validar a primeira versão do simulador. O uso de recursos tecnológicos como estratégias de ensino em enfermagem está em expansão, porém a simulação com RV, principalmente no ensino de punção venosa periférica, ainda é um vasto campo a ser explorado. Foi desenvolvida a primeira versão de um simulador de RV para a coleta de sangue à vácuo no adulto - o VIDA-Enfermagem v1.0, o qual foi avaliado por profissionais e graduandos de enfermagem. Foram considerados válidos 79,6% dos itens avaliados pelos profissionais e 66,7% dos itens avaliados pelos graduandos. As sugestões propostas pelos sujeitos da pesquisa para melhorias do sistema, em sua maioria, são passíveis de aceitação no decorrer do incremento das versões seguintes. Mesmo havendo necessidade de revisão de diversos itens, na avaliação dos participantes, o simulador foi considerado uma ferramenta promissora e inovadora para o ensino do procedimento de punção venosa periférica para coleta de sangue a vácuo em paciente adulto, para graduandos de enfermagem que estão se iniciando no estudo da temática e da técnica, como estratégia a ser combinada com os recursos já utilizados atualmente no ensino do procedimento. É relevante que se invista em estratégias inovadoras e motivadoras para aplicação no ensino de enfermagem, principalmente com o uso da realidade virtual imersiva

Peripheral venipuncture is the insertion of a peripheral venous device to access bloodstream, such as in blood collection for tests; although it is a common procedure in in-hospital treatment, it is complex and requires professional competence. Failure to perform this procedure may put the patient's health at risk, and may cause several complications to his/her treatment. This study aimed to develop and validate the first version of an immersive virtual reality (VR) simulator for the peripheral venipuncture procedure for vacuum blood collection in adult patient. Teaching strategies of peripheral venipuncture in nursing were verified through an integrative literature review. Then, a study with a methodological design was performed to develop and validate the first version of the simulator. The use of technological resources such as teaching strategies in nursing is expanding; however, the simulation with VR, mainly in the teaching of peripheral venipuncture, is still a vast field to be explored. The first version of a VR simulator for vacuum blood collection in adult patient was developed - VIDA-Enfermagem v1.0, which was evaluated by professionals and undergraduate nursing students. 79.6% of the items evaluated by the professionals and 66.7% of the items evaluated by the undergraduate students were considered valid. The suggestions proposed by the research subjects for system improvements, for the most part, may be included in the following versions. Although it was necessary to review several items, in the evaluation of the participants, the simulator was considered a promising and innovative tool for the teaching of the peripheral venipuncture procedure for vacuum blood collection in adult patients, for nursing undergraduate students who are beginning the study of the subject and technique, as a strategy to be combined with the resources already used in the teaching of the procedure. It is relevant to invest in innovative and motivating strategies for application in nursing teaching, especially with the use of immersive virtual reality

Analysis of success rate and safety of artery blood-collection in 600 cases / 心血管康复医学杂志

Objective:To analyze the success rate and safety of artery blood-collection from related artery and provide reference for clinical work.Methods:A total of 600 patients in need of artery blood-collection ,who visited to our hospital from Jul 2013 to Sep 2013,were selected.They were randomly divided into femoral artery blood-collection group (n=120,femoral group),radial artery blood-collection group (n= 240,radial group)and brachial artery blood-collection group (n=240,brachial group).Success rate of puncture and incidence rate of adverse reactions were compared among three groups.Results:Success rates of puncture in femoral group and brachial group were sig-nificantly higher than that of radial group (95.00%,92.92% vs.86.67%,P 0.05;incidence rate of adverse reactions in femoral group was significantly higher than those of radial group and brachial group (11.67% vs.5.83%,5.00%),there was no significant difference between radial group and brachial group,P >0.05. Conclusion:Synthetic judgment:Success rate of puncture is higher and incidence rate of adverse reactions is lower for brachial artery blood-collection,so it may be regarded as preferred.

Resultados de la realización del hemocultivo al ingreso hospitalario en pacientes con neumonía adquirida en la comunidad / Results of Performing Blood Cultures at Hospital Admission in Patients with Community-acquired Pneumonia

Fundamento: la neumonía adquirida en la comunidad constituye un importante problema de salud a nivel mundial, en Cuba y en la provincia de Cienfuegos. Objetivo: comunicar los resultados obtenidos con la realización de hemocultivos al ingreso hospitalario en pacientes con neumonía adquirida en la comunidad. Métodos: estudio descriptivo y prospectivo realizado en el Hospital Gustavo Aldereguía, de Cienfuegos, durante segundo semestre del año 2012, que incluyó 52 pacientes con neumonía adquirida en la comunidad a los que se les realizó hemocultivo a su ingreso hospitalario.Resultados: en solo cinco pacientes el examen arrojó un resultado positivo (9,6 % de los casos); en un solo caso con cultivo positivo se aisló Streptococcus pneumoniae; en el resto fueron aislados Staphylococcus aureus y Klebsiella pneumoniae. Conclusiones: el porcentaje obtenido reafirma el bajo rendimiento diagnóstico del hemocultivo al ingreso en los pacientes con neumonía adquirida en la comunidad, fue llamativo, también, el bajo porcentaje de aislamiento de S. pneumoniae en este estudio.

Background: community-acquired pneumonia is a major health problem worldwide, in Cuba and in the province of Cienfuegos. Objective: to report the results of blood cultures performed at hospital admission in patients with community-acquired pneumonia. Methods: a prospective descriptive study was conducted in the Gustavo Aldereguía Lima Hospital in Cienfuegos, during the second half of 2012. It included 52 patients with community-acquired pneumonia who underwent blood culture at their admission to the hospital. Results: only five patients (9.6% of the cases) had a positive test result; Streptococcus pneumoniae was isolated from only one positive culture; Staphylococcus aureus and Klebsiella pneumoniae were isolated from the rest. Conclusions: the percentage obtained in this study confirms the low diagnostic yield of blood cultures performed at admission in patients with community-acquired pneumonia; the low isolation rate of S. pneumoniae in our study was also significant.

Epidemiological investigation on cases of blood alcohol concentration test in Zhangjiagang City / 重庆医学

Objective To investigate the current status of drunk driving among the automobile drivers in Zhangjiagang city by detecting the blood alcohol concentration (BAC) on the divers or casualties and the statistical survey in order to provide the scientific basis for preventing drunk driving .Methods The cases of BAC detection accepted by the the judicial expertise institute of this hos-pital from January 2012 to April 2013 were retrospectively analyzed for conducting the statistical analysis according to the cases character(traffic accident or seizing) ,transportation modes ,time of the cases and the BAC detection results .Results Among 1464 cases of BAC detection during this period ,328 cases were seized by traffic police(22 .4% ) ,1134 cases were the traffic accidents(77 . 5% ) and 2 cases were other accidents(0 .1% ) .The motor vehicle involved in 1164 cases ,accounting for 79 .6% ,the other 298 cases were caused by non-motor vehicle or pedestrians(20 .4% );838 cases(57 .3% ) were drunkenness ;203 cases(13 .9% ) were after drinking .Conclusion The situation of drunk driving in Zhangjiagang city is still severe ,which needs to strengthen the law enforce-ment efforts and the publicity and education to decrease the the unlawful behaviors of drunk driving and reduce the occurrence rate of traffic accidents .

Laboratory artifacts caused by various sample collection times and types in cardiovascular disease / 中华检验医学杂志

Cardiovascular diseases is a common disease and induces high mortality.Blood tests are very important for the diagnosis,prognosis,monitoring and treatment of CVD.Clinicians are frequently presented with laboratory test results that are not consistent with preconceived expectations for a given case.It has been confirmed that pre-analytical quality control may be influenced by factors such as the time of sample collection.In this article different times and styles of sample collection are discussed.