"In memoriam"

For too long members of the helping professions have let our own emotional needs go unmet. Taught in school to provide postmortem care for the deceased and consoling words for the family, we were never taught to grieve for our patients.     

Experiences with "incident reporting" at the East Switzerland Childrens Hospital

Our healthcare system has become a "high-tech" industry and, as a consequence, incidents are almost "normal" events. It is one of the most important obligations in the quality management to get control of these very dangerous and therefore extremely important problems. The Children's Hospital in St. Gallen (Switzerland) introduced in 1998 a reporting system in order to monitor incidents and mistakes and to be able to introduce preventive action. For this we have been using the so called "system approach", i.e. we are not trying to find a guilty person or a single source for a mistake, but we analyze the complete working system involved in the action. According to our experience, such reporting systems have to respect a number of specific rules and prerequisites in order to be successful. The most crucial one is a "change of culture", which means, that we are not looking for a guilty person, but for the weak elements which are responsible for the mistakes in our working systems. In Switzerland a National Foundation for Patient Safety has been created for supporting all the acting professionals in the healthcare system in their challenging task.     

Ten years neurologic follow up--part of the "Vorarlberg Rehabilitation Model"

Within our framework of "comprehensive and permanent" rehabilitation, the follow-up neurological rehabilitation service is an important element. Based on the findings of an anterospective computerized documentation, a ten year survey is given concerning more than 600 patients and over 15,000 home visits. Aside general epidemiologic data, such as age, gender distribution, etc., our findings above all show that improvements in rehabilitation profiles can be achieved even after prolonged periods of time (i.e., 12 months and over) after onset. This, for one thing, may help in countering a widespread rehabilitation pessimism and, for another, serve in motivating the responsible cost-carrying agencies to pay increased attention to the field of neuro-rehabilitation. Literature concerning systematic assessment of long-term rehabilitation outcomes is sparse and fragmental. Available data to a large extent are in line with our findings. Further accompanying rehabilitation research into these respects is urgently needed. A number of important service delivery/organizational aspects have in addition been traced, which we are already trying to implement within our Vorarlberg rehabilitation model.     

“天使暖心亭”的建立与实践

在大学生心理健康教育备受关注的背景下，针对护理学专业特点和高校大学生的心理需求，建立“天使暖心亭”，实施心理健康教育，满足学生心理需求。“天使暖心亭”是我系进行心理健康教育的名称，它的理念是“你的烦恼我来开导”，有6种实践方式。重点介绍了设立“天使暖心亭”的指导思想、建立过程、实践方式、实践结果等。     

The Disappearance of the "Cold Patch" in Recovered Migraine Patients: Thermographic Findings

In a previous paper we suggested that the vascular cold patch may be a useful prognostic index to followup migraine patients. Considerable criticism against our contention has been raised by Swerdlow and Dieter (Headache 29:562-568, 1989, ref. 1), who claim that the cold patch constitutes a "fixed geography" of the vasculature of migraine patients. In the present paper we replicate and extend our previous findings reporting the results of facial thermography in a sample of 246 consecutive migraine patients. Of these the 206 exhibiting a typical cold patch or a significant asymmetry in the forehead thermal dissipation were admitted to prophylactic treatment (beta blocker or calcium channel blocker). The thermography was performed at entry in the study and after six months of active treatment. The clinical outcome was compared to the thermographic findings. The patients were subdivided in three classes on the basis of the clinical outcome. Among the 136 patients who experienced complete or substantial relief from headache the cold patch disappeared or markedly improved in 85% of the cases. In the 46 patients with partial relief the thermogram showed an improved pattern in 48% of cases, most of the time of smaller extent than in the previous class. In 24 patients we observed no clinical improvement. Among these the thermogram remained unchanged in 85% of cases. Taken together these findings corroborate our previous suggestion that thermography is useful to monitor the clinical course of the disease. One additional suggestion from the present data is that thermography closely parallels the clinical course so as to represent a useful criterion for the decision of discontinuing the therapy.     

"Race" and the difficulties of language

"Race," a construct created by scientists, is deeply ingrained in everyday discourses. Using postmodern theories to help us think through the complexities of language in relation to race, we come to understand that truths about race are changing, contingent, and contested products of cultural construction. It is impossible to understand or represent race as an object of study such that it can be known, yet untouched, by language. Health effects are one important consequence of race, particularly related to quality, access, marginalization, and privilege. Analyzing the effects of race bring it visibly into being, and makes evident how language shapes our understandings of the world and its human inhabitants.     

"Mixing triptans": patient satisfaction

(Headache 2011;51:135‐140) Background.— Although some patients may prefer using an oral triptan other than sumatriptan and injectable sumatriptan to treat an attack of persistent migraine, administration of 2 different triptans within a 24‐hour period currently is contradicted. Objective.— We sought to determine patient satisfaction with an acute migraine treatment regimen wherein patients were permitted to administer an oral triptan other than sumatriptan and injectable sumatriptan within 24 hours of one another Methods.— We evaluated a consecutive series of migraine patients who either had tried and failed oral sumatriptan or were using another oral triptan and were satisfied with it. We advised subjects that they could administer their oral triptan and injectable sumatriptan within a single 24‐hour period (but not within 2 hours of one another); we termed such treatment “mixing triptans.” We asked all subjects to keep detailed written headache diaries for the 6‐month treatment period, and at the 6‐month end‐of‐study visit we asked subjects who had treated at least 3 migraine attacks by mixing triptans to rate their satisfaction with that treatment according to a 5‐point Likert scale. Results.— Of the 200 subjects enrolled, 132 (66%) used an oral triptan other than sumatriptan and injectable sumatriptan within a 24‐hour period on at least 3 occasions. At their final follow‐up visits, 117 (89%) of the 132 reported themselves “very satisfied” or “satisfied” with this specific treatment regimen. No serious adverse events were recorded. Conclusion.— The option of sequentially using an oral triptan other than sumatriptan and injectable sumatriptan to treat a given attack of migraine appears to correlate with a high rate of patient satisfaction. While in our subject population this treatment regimen was well tolerated, our study results do not suffice to establish the safety of “mixing triptans.”     

Riting" cultural safety within the postcolonial and postnational feminist project: toward new epistemologies of healing

The concept of cultural safety, developed by indigenous nurses in the postcolonial climate of New Zealand, has not been widely examined in North America. In this article we explicate the theoretical and methodological issues that came to the forefront in our attempts to use this concept in our research with different populations in Canada. We argue that this concept prompts us to "think critically" about ourselves and our patients, and to be mindful of our own sociocultural, economic, and historical location. This critical reflection has implications for how we live, relate to one another, and practice in our various professional disciplines. On the basis of our findings, we discuss how the concept might be rewritten within a critical postcolonial and postnational feminist discourse.     

The concept of "psychosomatic" in general practice. Reflections on body language and a tentative model for understanding

In medicine, the concept "psychosomatic" indicates both dualism and polarisation. "Could it mean something psychic or is it something somatic?" This artificial dichotomy and body/mind split is not as apparent in general practice as it is in other medical disciplines. In general practice, the prerequisites for a division are overlooked. Following the work of Piaget, the article outlines manifestations of a body/mind unity as exposed in the language. Words and expressions describing the way we move, stand and walk therefore indicate our attitude and state of mind. Our body language conveys a message. The importance of breathing and its relation to our emotions is highlighted. The function of breathing is said to represent a bridge between the conscious and the unconscious--breathing can be controlled by our will, but generally we breathe reflexively. Restricted breathing is not just a mechanical process; it is shown that there is a connection between breathing and our emotions. Finally, a model of the "human organism" is presented linking four concepts, "human activity", "organ functions", "physical body" and "neurophysiological functions". Activities within the different systems are linked and relate to each other. The model supports the necessity to overcome the body/mind split, which is one of the obstacles to the fulfillment of good quality general practice.     

Home total parenteral nutrition in a "no-bowel" patient in Spain.

OBJECTIVE: To report a case of a patient with no functional bowel who was receiving home total parenteral nutrition in a country that has had a few professional experiences in this area of therapy. CASE SUMMARY: A woman with a history of scattered colonic polyposis developed a mesenteric tumor that caused intestinal obstruction. Tumor withdrawal required the excision of 1.5 m of jejunum-ileum. Postoperative complications required further surgical intervention and subtotal intestinal resection. Duodenocolic anastomosis was not possible and a high output and permanent fistula remained. DISCUSSION: The complications of home parenteral nutrition addressed in the literature are reviewed. The problems encountered in our patient have been resolved. CONCLUSIONS: After three years of postoperative survival, we believe the quality of life of our patient has increased and the parenteral nutrition team members are much better prepared to manage patients with similar problems.     

“九化式”服务在特需病房的应用及效果评价

为倡导人性化的服务理念,顺应时代发展趋势,满足广大患者对服务的需求,结合特需病房特点实行"九化式"服务。通过改进工作方法,加强培训,规范服务,细化服务流程,建立了和谐的新型护患关系,提升了护理文化,创建了护理服务品牌,使患者满意度大大提高。     

The Unna "cap" as a scalp donor site dressing

Deep scalp donor sites can be difficult to manage because of the higher incidence of healing complications that can make daily wound care exquisitely painful. When faced with this problem, we prospectively studied the Unna "cap" dressing on the scalp. Group 1 received our standard treatment--Xeroform gauze (Sherwood Medical, St Louis, Mo) and daily wound care. Group 2 received the Unna cap--Aquaphor gauze (Beiersdorf, Norwalk, Conn) and Dome Paste gauze (Bayer Corp, West Haven, Conn) with wound care every 3 days. Pain, healing time, and costs were compared. Twelve patients between the age of 1 and 54 years were studied. A significant number of patients in Group 1 developed wound complications after initial healing, resulting in a longer length of stay and higher costs. Group 2 reported significantly less procedural pain, comparable healing (11 days +/- 2 SD), and fewer dressing changes, resulting in an institutional savings of $5.51 to $16.25 per patient up to postoperative day 13. This study supports use of the Unna cap as a less painful, safe, and cost-effective alternative to our standard deep scalp donor site dressing.     

临床实践指南如何“保鲜”

临床实践指南是医疗实践的指导性文件, 及时修订的指南推荐意见对于指导医生进行临床决策具有重要意义和价值。因此, 指南应基于最新的研究证据, 形成对当前医疗实践的最佳推荐意见, 并保持与时俱进。本文针对指南修订的现状、方法、流程及存在的问题展开讨论, 提出指南修订最长周期为5年, 最短可以做到实时更新; 修订方法目前国内外无统一标准, 建议可参考本文提出的流程及RIGHT和CheckUp报告清单。此外, 本文就如何有效开展修订工作, 从指南管理者、制订者、研究者和使用者四个层面提出思考与建议。     

重构生物样本库建设理念，促进临床研究资源协同应用与发展

自2009年起，我国生物样本库建设进入了快速发展时期。在发展过程中，由于建设理念和认识不同，生物样本库建设目标各异且相互之间协同性差，导致生物样本库资源共享与应用陷入困境。针对生物样本库发展面临的主要问题，本文引用计算机软件开发行业中的“重构(refactoring)”理念，讨论和阐明生物样本库建设和发展面临的主要问题及相应改进方式，旨在建议通过调整建设生物样本库的程序改善生物样本库的质量和功能，提高生物样本库建设成果的可维护性及建设模式的可扩展性，使生物样本库的设计模式和架构更趋于合理化。     

Creating the joint commission "super user": an innovative plan to ensure survey readiness

Preparing for The Joint Commission accreditation survey can be a daunting process. To ensure staff readiness, we created a plan to disseminate updated information to all hospital staff. Harnessing the momentum of increased staff involvement through shared governance and the past successes of the "super user" role, The Joint Commission Super User (TJCSU) role was created. This article discusses the role of the TJCSU and its positive impact on our hospital's readiness for and results of The Joint Commission accreditation survey.     

"Stop the noise!" From voice to silence

Nurses are frequently portrayed in the literature as being silent about ethical concerns that arise in their practice. This silence is often represented as a lack of voice. However, in our study, we found that nurses who responded to questions about moral distress were not so much silent as silenced. These nurses were enacting their moral agency by engaging in diverse, multiple and time-consuming actions in response to situations identified as morally distressing with families, colleagues, physicians, educators or managers. In many situations, they took action by contacting other healthcare team members, making referrals and coordinating care with other departments such as home care and hospice, as well as initiating contact with groups such as professional regulatory bodies or unions. Examining the relationship between ethical climate, moral distress and voice offers insights into both the meaning and impact of being silenced in the workplace.     

The successful use of "high level" PEEP in near fatal Endrin poisoning.

The insecticide Endrin is a highly toxic chlorinated hydrocarbon which can cause severe CNS and respiratory derangement. Death usually follows intoxication within 24 hours. A 19-year-old male developed convulsions and gross pulmonary edema after the ingestion of Endrin. His trachea was intubated and constant positive pressure ventilation with PEEP of up to 28 cm H2O was instituted. The patient survived and recovery appeared to be complete. Severe pulmonary edema is not a common finding in patients who have Endrin poisoning. The use of PEEP above 15 cm H2O is a controversial issue; however, we believe that it contributed significantly to the survival of our patient.     

Overestimation of HDL-cholesterol using a homogeneous "direct" assay

Direct HDL-cholesterol (HDLc) assays have several advantages over other assays that are more laborious and time-consuming. A recent College of American Pathologists (CAP) report indicates that at least 385 Beckman LX-20 analyzers use the selective detergent (homogeneous or direct) method for analyzing HDLc. There is no published evaluation of direct HDLc assays on the Beckman platform. Here we report our evaluation of a direct HDLc assay marketed by Beckman for the Beckman LX-20 analyzers. In general, the assay performed well; however, the total error was not within National Cholesterol Education Program (NCEP) guidelines. This was largely because of a significant positive bias that appeared to be due, at least in part, to triglycerides. This bias was worse at HDLc concentrations <40 mg/dL, which may make it difficult to identify a low HDLc concentration and consequently an increased risk for cardiovascular disease (CVD).     

Comment on "A study on tetrahedron-based inhomogeneous Monte-Carlo optical simulation"

The Monte Carlo (MC) method is a popular approach to modeling photon propagation inside general turbid media, such as human tissue. Progress had been made in the past year with the independent proposals of two mesh-based Monte Carlo methods employing ray-tracing techniques. Both methods have shown improvements in accuracy and efficiency in modeling complex domains. A recent paper by Shen and Wang [Biomed. Opt. Express 2, 44 (2011)] reported preliminary results towards the cross-validation of the two mesh-based MC algorithms and software implementations, showing a 3-6 fold speed difference between the two software packages. In this comment, we share our views on unbiased software comparisons and discuss additional issues such as the use of pre-computed data, interpolation strategies, impact of compiler settings, use of Russian roulette, memory cost and potential pitfalls in measuring algorithm performance. Despite key differences between the two algorithms in handling of non-tetrahedral meshes, we found that they share similar structure and performance for tetrahedral meshes. A significant fraction of the observed speed differences in the mentioned article was the result of inconsistent use of compilers and libraries.