Background Virtual simulation and face-to-face simulation are effective for clinical judgment training. Rare studies have tried to improve clinical judgment ability by applying virtual simulation and face-to-face simulation together. This study aimed to evaluate the effect of an integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program on enhancing nursing students’ clinical judgment ability and understanding of nursing students’ experiences of the combined simulation. Methods A sequential exploratory mixed-methods study was conducted in a nursing simulation center of a university in Central China. Third-year nursing students ( n = 122) taking clinical training in ICUs were subsequentially assigned to the integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program arm ( n = 61) or the face-to-face simulation-only arm ( n = 61) according to the order in which they entered in ICU training. Clinical judgment ability was measured by the Lasater Clinical Judgment Rubric (LCJR). Focus group interviews were conducted to gather qualitative data. Results Students in both arms demonstrated significant improvement in clinical judgment ability scores after simulation, and students in the integrated arm reported more improvement than students in the face-to-face simulation-only arm. The qualitative quotes provided a context for the quantitative improvement measured by the LJCR in the integrated arm. Most of the quantitative findings were confirmed by qualitative findings, including the domains and items in the LJCR. The findings verified and favored the effect of the combination of non-immersive virtual simulation and high-fidelity face-to-face simulation integrated program on enhancing nursing students’ clinical judgment ability. Conclusions The integrated virtual simulation and face-to-face simulation program was feasible and enhanced nursing students’ self-reported clinical judgment ability. This integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program may benefit nursing students and newly graduated nurses in the ICU more than face-to-face simulation only.

Background Although simulated teaching was introduced to China in the 1990s, it remains underused in nursing education. Determining how Chinese nurse educators feel about using simulation in their institutions is very important for faculty training and has the potential to influence simulation implementation. Method This cross-sectional descriptive study was undertaken to identify the nurse educators’ experiences in the use of simulation from various regions of China. One hundred and thirty-six nurse educators provided demographic data and information about simulation implementation within their institutions and explored the perceived barriers and benefits of simulation usage. Results The survey data shows that 108 participants have used simulation in their work, but less than 92 (67.6%) of the respondents had used this teaching strategy more than ten times in last year. The study identified four factors hindering nurse faculty from simulation adoption: (1) concerns with student readiness; (2) the need for faculty team-building for simulation teaching; (3) lack of adequate simulation resources; and (4) thoughtful integration of simulation into nursing curricula. Conclusions Study data suggest that faculty training programs for simulation should be based on the nurse educators’ training needs, including systematically designed training topics, and the provision of hands-on learning simulation activities with expert feedback to help nurse educators achieve the competencies required for effective simulation-based education.

Lung interstitial macrophages (IMs) can be polarized towards an alternative activation phenotype in ovalbumin (OVA)-induced asthmatic mice. However, the role of alternative activation of lung IMs in Th2 cell responses in the asthmatic murine is still unclear. Here, we leverage an anti-F4/80 treatment which has been shown to selectively deplete IMs in mice and investigate how this treatment modulates Th2 cell responses in lung and whether the modulation is dependent on lung IMs in murine models of asthma. We show that anti-F4/80 treatment alleviates Th2 cell responses in mice immunized and challenged with OVA or house dust mite (HDM). The anti-F4/80 treatment does not target lung alveolar macrophages (AMs) in OVA-induced asthmatic mice or impact the abundance of other immune cell types, including B cells, T cells, and NK cells in wild-type mice. However, this treatment does inhibit the expression of polarized markers of alternatively activated macrophages, including arginase-1, Ym-1, and Fizz-1 in the lung tissues from OVA-induced asthmatic mice. Furthermore, we find that the inhibitory effects of anti-F4/80 treatment on Th2 cell responses can be reversed upon adoptive transfer of lung IMs. Taken together, our data show that anti-F4/80 treatment attenuates Th2 cell responses, which is at least partially related to depletion of lung IMs in murine models of asthma. This suggests that targeted lung IMs may provide a potential therapeutic protocol for the treatment of asthmatics.

Few studies have comprehensively examined the effectiveness of simulation-based triage education on clinical reasoning of nursing students. This study evaluated the impact of a simulation-based triage exercise on nursing students' self-reported clinical reasoning ability. Three cohorts of third-year nursing students were divided into intervention group a (IG a, n = 62), intervention group b (IG b, n = 57), and a control group (CG, n = 53). Students in IG a and IG b participated in a simulation-based triage education consisting of 2 h of multiple patient triage simulations and an hour of structured debriefing. The CG participated in a traditional didactic triage course consisting of a 3-h lecture. Self-reported clinical reasoning ability in pre and post-triage education was measured by the Nurses Clinical Reasoning Scale. There was no significant difference in mean clinical reasoning ability scores between the three groups in pre-test (p > 0.05). Clinical reasoning ability scores in post-test among students in IG a and IG b were significantly higher than those in CG (p < 0.001). Nursing students exposed to a simulation-based triage education had more improvement in self-reported clinical reasoning ability as compared with students who participated in a lecture-based triage education program.

Asthma is a common inflammatory pulmonary disorder involving a diverse array of immune cells such as proinflammatory T helper 2 (Th2) cells. We recently reported that intraperitoneal injection of α-galactosylceramide (α-GalCer) can stimulate the lung invariant natural killer T (iNKT) cells and does not lead to airway inflammation in WT mice. Other studies indicate that iNKT cells play an important role in inducing regulatory T cells (Treg cells) and peripheral tolerance. Using iNKT cell- knockout mice, functional inactivation of Treg cells, and co-culture experiments in murine asthma models, we investigated the immunoregulatory effects of α-GalCer treatment before allergen sensitization on Th2 cell responses. We also studied whether α-GalCer's effects require lung Treg cells induced by activated iNKT cells. Our results disclosed that intraperitoneal administration of α-GalCer before allergen sensitization could promote the expansion and suppressive activity of lung CD4+FoxP3+ Treg cells. These effects were accompanied by down-regulated Th2 cell responses and decreased immunogenic maturation of lung dendritic cells in WT mice. However, these changes were absent in CD1d-/- mice immunized and challenged with ovalbumin or house dust mites, indicating that the effects of α-GalCer on Treg cells mainly require iNKT cells. Moreover, functional inactivation of Treg cells could reverse the inhibitory ability of this α-GalCer therapy on Th2 cell responses in a murine asthma model. Our findings indicate that intraperitoneal administration of α-GalCer before the development of asthma symptoms induces the generation of lung Treg cells via iNKT cells and may provide a potential therapeutic strategy to prevent allergic asthma.

目的:观察iNKT细胞对哮喘小鼠肺树突状细胞(LDCs)表面分子和促炎性细胞因子表达水平的影响.方法:24只野生型BALB/c小鼠随机分为正常对照组、哮喘组和过继转移组,每组8只;12只CD1d-/--BALB/c小鼠随机分为CD1d-/-对照组和CD1d-/-哮喘组,每组6只.哮喘组、过继转移组和CD1d-/-哮喘组小鼠以卵清白蛋白致敏和激发,正常对照组和CD1d-/-对照组以等量PBS替代,其中过继转移组在第1次激发前1 h给予iNKT细胞尾静脉注射.采用流式细胞仪检测各组小鼠LDCs及表面分子MHCⅡ、CD80、CD86和CD40的表达水平;ELISA法检测LDCs体外培养上清液IL-12p70、IL-6、TNF-α和IL-10水平.结果:过继转移组小鼠LDCs数量和MHCⅡ、CD40、CD80、CD86表达水平及LDCs体外培养上清液IL-12p70、IL-6、TNF-α水平明显高于哮喘组(P<0.05或P<0.01);CD1d-/-哮喘组小鼠LDCs数量和MHCⅡ、CD40、CD80、CD86表达水平及LDCs体外培养上清液IL-12p70、IL-6、TNF-α水平明显低于哮喘组(P<0.05或P<0.01),但明显高于正常对照组和CD1d-/-对照组(P<0.05或P<0.01).结论:iNKT细胞可以增强哮喘小鼠LDCs表面分子和促炎性细胞因子的表达水平.

T-cell lymphoblastic lymphoma (T-LBL) is a rare non-Hodgkin lymphoma that requires rapid and accurate diagnosis and treatment. A quickly progressing mediastinal mass, body cavity effusions, and cervical lymphadenopathy are major manifestations of T-LBL. We report a 47-year-old male patient with a severe pleural effusion (PE), a small pericardial effusion, and a bulky mediastinal mass, but with a high level of adenosine deaminase (ADA) in the pleural fluid and a positive SPOT-Tuberculosis test (T-SPOT. TB test) and tuberculin skin test (TST). The possibility of tuberculous pleural effusion (TPE) was initially considered. However, the cell block (CB) method in combination with immunohistochemistry indicated that the pleural fluid was positive for CD1 alpha, CD3, and CD99; weakly positive for terminal deoxynucleotidyl transferase (TdT); and negative for CD20. Ultrasound-guided biopsy of the mediastinal mass followed by immunohistochemistry was further performed, confirming the diagnosis of T-LBL. Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy was initiated and led to progressive remission. This case highlights the notion that elevated ADA levels in PE should be cautiously considered as TPE in the absence of microbiological/histopathological confirmation, and that CB in combination with immunohistochemistry can enhance the diagnostic yield in cases of malignant PE.

Introduction Acute exacerbation of COPD (AECOPD) and left heart failure (LHF) commonly exist together in clinical practice. However, the identification of AECOPD concurrent with LHF is currently challenging. Our study aimed to investigate the role of plasma N-terminal brain natriuretic pro-peptide (NT-proBNP) in diagnosing elderly patients with AECOPD associated with LHF. Methods and results LHF was diagnosed in patients with AECOPD according to echocardiographic criteria, and the levels of NT-proBNP in plasma were measured by quantitative electrochemiluminescence assay. Among the 655 patients with AECOPD, 158 (24.1%) had comorbid LHF, whether systolic (n=108, 68.4%) or diastolic (n=50, 31.6%). The plasma concentrations of NT-proBNP in elderly patients with AECOPD associated with LHF were markedly elevated, compared with those with only AECOPD (4,542.5 and 763.0 ng/L, respectively, P<0.01). The receiver operating characteristic curve indicated a diagnostic cutoff value of 1,677.5 ng/L of NT-proBNP in plasma for ascertaining the presence of LHF in AECOPD, with a sensitivity of 87.9%, a specificity of 88.5%, and an accuracy of 88.4%. Conclusion The plasma level of NT-proBNP may be a useful indicator in diagnosing AECOPD associated with LHF.

Objective To explore the effect of use of concept map in high fidelity simulation to teach baccalaureate nursing specialty course.Methods Sixty two sophomore nursing students attending four year baccalaureate nursing education were selected by using convenience sampling.Concept map and high fidelity simulation were used in the Nursing Plan and Implementation Course.Results The median exam score was 73.5 points after completion of the course,with 75.81％ of students scoring above 70 points.Students scored nearly 4 points on simulation teaching design,above 4 points on learning effect and on teaching satisfaction.Conclusion The use of concept map in high fidelity simulation to teach baccalaureate nursing specialty course could help students under stand theoretical knowledge,enhance teaching outcomes of simulation teaching,and promote teaching quality.

Objective:To investigate the effect of anti-CD1d monoclonal antibody (mAb) on airway inflammation in a murine model of asthma.Methods:Fifteen BALB/c mice were randomly divided into anti-CD1d mAb group,asthma group and normal control group.The murine model of antiCD1d mAb group and asthma group were established by sensitization with intraperitoneal injection of ovalbumin (OVA) and intranasal challenged in all animals except for the normal control group which PBS was used instead.Anti-CD1d mAb group were treated wvith vein injection antiCD1d mAb at 1 hour before the first challenge,whereas PBS was administrated through vein injection in asthma group and normal control group.Lung histopathology and goblet cell hyperplasia were assessed by HE or PAS staining,respectively;total and differential cells count in bronchial alveolar lavage fluid (BALF) were analyzed by Wright-Giemesa staining;concentrations of OVA-specific IgE in the serum and IL-4,IL-5,IL-13 in BALF were delected by ELISA;the percentages of lung type Ⅰ NKT cells,IL-4+ and IFN-γ+ type Ⅰ NKT were analyzed by flow cytometry.Results:Inflammatory cells infiltration in lung tissue and goblet cell hyperplasia in the airway were decreased in Anti-CD1d mAb group;the number of total cells and eosinophils in BALF,concentrations of OVA-specific IgE in serum and IL-4,IL-5,IL-13 in BALF were significantly lower than those in asthma group (all P＜0.01).The frequency of lung type Ⅰ NKT cells,IL-4+ and IFN-γ+ type Ⅰ NKT cells in anti-CD1d mAb group was significantly lower than those in asthma group (all P＜0.01).Conclusion:Anti-CD1d mAb may attenuate airway inflammation in a murine model of asthma through inhibiting the activation of type Ⅰ NKT cells.

目的:观察Ⅰ型NKT细胞在哮喘小鼠气道炎症形成中作用.方法:24只BALB/c小鼠随机分为对照组、哮喘组和过继转移组,每组8只;随机选取8只CD1d-/-BALB/c小鼠为CD1d-/-组.对照组和哮喘组、CD1d /组分别采用PBS和卵清白蛋白(OVA)致敏和激发,过继转移组采用OVA致敏,在第1次激发前24 h给予Ⅰ型NKT细胞尾静脉注射.分别采用HE和PAS染色检测肺组织学和气道杯状细胞;姬姆萨染色检测支气管肺泡灌洗液(BALF)各细胞分类计数;ELISA法检测血清OVA特异性IgE和IgG1及BALF中IL-4、IL-5和IL-13水平;流式细胞仪检测肺Ⅰ型NKT细胞、IL-4+和IFN-γ+Ⅰ型NKT细胞的数量.结果:哮喘组小鼠肺Ⅰ型NKT细胞、IL-4+和IFN-γ+Ⅰ型NKT细胞的数量明显高于对照组(均P＜0.05);过继转移组小鼠肺组织炎性细胞和气道基底膜杯状细胞增多,过继转移组小鼠BALF中嗜酸细胞数量、血清OVA特异性IgE和IgG1及BALF中IL4、IL-5和IL-13水平明显高于哮喘组(均P＜0.05);CD1d+组小鼠肺组织炎性细胞和气道基底膜杯状细胞增多,CD1d-/-组小鼠BALF中嗜酸细胞数量、血清OVA特异性IgE和IgG1及BALF中IL4、IL 5和IL-13水平明显低于哮喘组,但明显高于对照组(均P＜0.05).结论:Ⅰ型NKT细胞可以增强哮喘小鼠气道炎症,但并不是哮喘小鼠气道炎症形成的必需因素.

目的 探讨灾难救护多站模拟在护理本科教学中的应用效果.方法 选取120名护理本科三年级学生作为研究对象,在3个学时的理论学习、1个学时的案例分析之后,接受3个学时的灾难救护多站模拟演练.结束后,使用学生学习满意度和自信心量表、模拟教学实践量表、模拟教学设计量表以及自行设计的模拟教学目标及反馈问卷结合小组会谈评价教学效果.结果 3个量表各维度得分均在4分以上,显示模拟取得良好效果;目标及反馈问卷显示114名学生(95.0％)对以模拟形式学习灾难救护感兴趣,学生对教学设置评分＞8.5分,绝大部分学生认为达到了教学目标;小组会谈显示学生喜欢灾难救护模拟演练,希望获得更多模拟机会以提升自身能力.结论 灾难救护多站模拟是一种有效的教学策略,提高了学生灾难救护与管理的知识水平和能力.

BACKGROUND:Invariant natural killer T cells (iNKT cells) are a unique subset of T lymphocytes and are considered to play an important role in the development of allergic bronchial asthma. Recently, iNKT cells were shown to play an immunoregulatory role in CD4+ and CD8+ T cell-mediated adaptive immune response. Allergen-specific Th2 inflammatory responses are an important part of the adaptive immune response in asthma. However, the regulatory functions of the Th2 inflammatory response in asthma have not been studied in detail.METHOD:In this study, we have investigated the regulatory functions of iNKT cells on the Th2 inflammatory response in an ovalbumin (OVA)-induced murine model of asthma.RESULTS:Our results demonstrate that α-Galactosylceramide (α-GalCer) administration activated iNKT cells but could not induce the Th2 inflammatory response in wild-type (WT) mice. In the OVA-induced asthma model, α-GalCer administration and adoptive transfer of iNKT cells significantly augmented the Th2 inflammatory responses, including elevated inflammatory cell infiltration in the lung and bronchoalveolar lavage fluid (BALF); increased levels of IL-4, IL-5, and IL-13 in the BALF and splenocyte culture supernatant; and increased serum levels of OVA-specific IgE and IgG1. In addition, the Th2 inflammatory response was reduced, but not completely abrogated in CD1d-/- mice immunized and challenged with OVA, compared with WT mice.CONCLUSION:These results suggest that iNKT cells may serve as an adjuvant to enhance Th2 inflammatory response in an OVA-induced murine model of asthma.

介绍了模拟教学的起源及模拟模型在医学领域的发展，主要综述了模拟教学在护理教学中的应用。提出护理教育者应当认识到模拟教学的优势和挑战，并充分利用模拟策略促进教学。

[目的]探讨递进式模拟教学方法在《护理学基础》课程中的应用及效果。[方法]对57名学习《护理学基础》的在读护理本科生进行递进式模拟教学方法研究;递进式模拟教学分为两个阶段:第一阶段为低仿真模块训练阶段,第二阶段为临床情景模拟阶段;整个学习过程结束后,采用自行设计问卷对模拟教学效果进行评价。[结果]学生在模拟教学方法有效有用,模拟教学提供多种资源促进了学习,模拟教学提供多种学习方法,促进独立解决问题能力的培养,模拟教学提供了自我学习评价等方面表示满意。[结论]递进式模拟教学方法在适应学生学习能力的基础上,循序渐进地培养学生对护理操作技能的理解及应用,为规范模拟教学在《护理学基础》课程中的应用提供了思路。

Background: High-fidelity simulation has been demonstrated to be an efficient teaching method, although high-fidelity manikins are more expensive than low-or moderate-fidelity simulation manikins. This study was designed to explore differences in outcomes related to use of moderate-fidelity versus high-fidelity simulations in Chinese nursing education.Method: A comparative, quasi-experimental design was employed among 59 junior students in a BSN program in the People's Republic of China.Results: The moderate-fidelity simulation received significantly higher scores in students' satisfaction and self-confidence ratings, while the high-fidelity simulation showed better implementation of the simulation design elements.Conclusion: Both simulation methods had beneficial outcomes for students. There is a need for additional research evaluating these simulation interventions. (c) 2013 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.

The paper introduces the implementation and valuable experience of simulation teaching in HOPE Nursing School,Wuhan University.We hope more teachers of nursing will think and practice regarding the course,teaching team,teaching resources,design,arrangement and evaluation of simulation teaching.

武汉大学HOPE护理学院自2003年实施本科护理教学改革以来,精神科护理学被整合入"对有心理状态改变服务对象的护理"单元,纳入为大学三年级学生提供的《护理计划与实施》课程[1]中.实行理论-实践同步式教学,每周理论课程结束后即进行2d的相应临床实习.为增强学生在精神科护理实习过程中的自我意识,我院充分发挥理论-实践同步式教学的优势,课堂采取互动的开教式、引导式、以案例为基础的概念式教学;实践教学则基于理论课程的概念采取相应的实习活动,鼓励学生不断探索、发掘、监测和记录实习过程中的自我意识并主动寻求解决方法.这一方法取得了较好的效果.现介绍如下.

Background: There is little research on the use of simulation in Chinese nursing education. This research was focused on the effects of using simulation in promoting a range of outcomes among Chinese nursing students in a baccalaureate nursing program in China.Method: In this descriptive study of 50 sophomore students, three instruments were translated and evaluated to determine the identified outcomes.Results: The students were satisfied with the simulation, and their confidence level was increased after participating in the simulation activity. Best practices were thought to be embedded in the simulation.Conclusion: This study showed that simulation is an effective teaching strategy for Chinese nursing students. (C) 2013 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.

Objective To develop and explore the effect of model of theory-clinic synchronous practice with double instructors on the nursing undergraduates.Methods Totals of 58 junior students received theory-clinic synchronous practice under the instructions of faculty and clinic instructors.They were investigated with a self-designed clinical teaching satisfaction questionnaire with the dimensions of cases learning (4 items),seminar before and after clinic practice (8 items),practice process (6 items),and its cronbach' s a respectively were 0.75,0.91,0.93.Results Scores of all items and dimensions of satisfaction questionnaire were higher than 4,and the satisfaction score of medium term and practice end were more than 4 too.Scores of dimensions of ‘ cases information',‘ pre and post conferrence' and the total satisfaction score measured at the end of practice were significantly higher than that of medium item (P ＜ 0.05).The score of self-efficacy after practice was significantly higher than that before practice [(3.15 ± 0.42) vs (2.85 ± 0.57)] (t ＝-2.28,P ＝ 0.027).Conclusions The model of theory-clinic synchronous practice with double instructors can improve satisfaction and self efficacy of nursing undergraduates,and will benefit the improvement of comprehensive ability of students.