Live a legacy or live a lie: a choice

This article is about the result of a choice to Live a Legacy or Live a Lie. The choice led to the development and implementation of a clinical practice model (CPM) designed to create a healthy, healing integrated practice culture. The focus is on the foundation of the model that is a unique ongoing process called the Core Belief Review. The purpose of the review is to uncover those things that matter most for both those who give and receive care. The ongoing open communication process provides insights and truths about reality and a sense of direction related to the nature of the work necessary to create and sustain the best places to give and receive care. The results of the review feedback from 2500 providers and recipients of care are correlated to the actions taken to address the complexities of the point-of-care reality and the clinical outcomes reached as a result of collaboration and lessons learned within an International Consortium.     

Intensive care use in a developing country: a comparison between a Tunisian and a French unit

Objectives: To compare the variations in intensive care (ICU) outcome in relation to variations in resources utilization and costs between a developed and a developing country with different medical and economical conditions. Design and setting: Prospective comparison between a 26-bed French ICU and an 8-bed Tunisian ICU, both in university hospitals. Patients: Four hundred thirty and 534 consecutive admissions, respectively, in the French and Tunisian ICUs. Measurements: We prospectively recorded demographic, physiologic, and treatment information for all patients, and collected data on the two ICU structures and facilities. Costs and ICU outcome were compared in the overall population, in three groups of severity indexes and among selected diagnostic groups. Results: Tunisian patients were significantly younger, were in better health previously and were less severely ill at ICU admission (p < 0.01). French patients had a lower overall mortality rate (17.2 vs 22.5 %; p < 0.01) and received more treatment (p < 0.01). In the low severity range, the outcome and costs were similar in the two countries. In the highest severity range, Tunisian and French patients had similar mortality rates, while the former received less therapy throughout their ICU stays (p < 0.05). Conversely, in the mid-range of severity, mortality was higher among Tunisian patients, and a difference in management was identified in COPD patients. Conclusion: Although the Tunisian ICU might appear more cost-effective than the French one in the highest severity group of patients, most of this difference appeared in relation to shorter lengths of ICU stay, and a poorer efficiency and cost-effectiveness was suggested in the mid-range severity group. Differences in economical constraints may partly explain differences in ICU performances. These results indicate where resource allocation could be directed to improve the efficiency of ICU care. Received: 15 December 1997 Accepted: 8 July 1998     

Caring for a patient with a urostomy in a community setting

Around 7500 people in the UK have a urostomy. A urostomy is normally performed if a person has bladder cancer, congenital bladder abnormalities. Many people who have a urostomy have long term conditions and may require the help and support of community nurses. This article examines common complications of urostomy including stomal complications, urinary tract infections and dermal complications. Although stoma complications are common and can affect quality of life, many people with a stoma tend not to seek help. Community nurses can provide care and support to optimize stoma management and enable the person with a urostomy to enjoy the best possible quality of life.     

Fatal haemorrhage from a caput medusae: a differential to a stabbing

Fatal haemorrhage from caput medusae is reported once previously in the literature. We report the case of a 48-year-old man who presented to the ED in hypovolaemic shock, with a suspected stab wound to the abdomen. He was subsequently found to have exsanguinated from a cutaneous varix secondary to chronic liver disease.     

FXTAS: a bad RNA and a hope for a cure

Background: Fragile X-associated tremor/ataxia syndrome (FXTAS) is a newly identified neurodegenerative disorder due to intermediate expansion of trinucleotide CGG repeats (55 - 200 repeats) in the 5' untranslated region (UTR) of the Fragile X mental retardation 1 (FMR1) gene. FXTAS is now considered to be one of the most common inherited neurodegenerative disorders in males. Objective: To examine the future of potential therapies for this late-onset disease. Methods: Examination of relevent literature. Results/conclusions: Accumulating evidence indicates that overproduced riboCGG repeats in the 5' UTR of FMR1 mRNA are toxic. Recently, proteins that bind specifically to rCGG repeats were identified. Progress in understanding the molecular pathogenesis of FXTAS, plus the availability of different animal models are discussed.     

社区发烧、咳嗽初诊病例讨论

目的：1．根据循证医学指南知识诊治社区肺炎病人；2．根据指征安排病人门诊或住院；3．了解下呼吸道感染病人的药物选择；4．评估头孢菌素在下呼吸道感染病人治疗中的作用；5．正确诊断出现并发症的下呼吸道感染病人；6．合理使用抗生素，避免滥用抗生素和产生抗药性；