首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到10条相似文献,搜索用时 140 毫秒
1.
Cancer may be considered a particularly challenging diagnosis for adolescents. Treatment for adolescents in the United Kingdom may be provided in paediatric or adult settings or, more rarely, in specialist adolescent cancer units. An ethnographic approach was adopted to gather ‘insiders’ views of one such unit using in-depth interviews with patients, parents and professionals, as well as non-participant observation of key events. Two data themes ‘cancer and the cancer unit’ and ‘changes over time’ are discussed in this paper. Benefits of the unit included shared understandings and the manner in which the privations of adolescent cancer were contained and managed by those involved.  相似文献   

2.
The analytical result of a laboratory examination is a scientific fact and has no medical meaning as such. It must be interpreted to become a medical finding. To explain the very complex cognitive procedure of the interpretation a three-level model is used. In an environment of cost containment in health care systems the quality of medical laboratory findings is very important. Analytical results are monitored by quality control procedures. For measuring the performance of medical findings the concept of the ‘validity’ of a laboratory test is used. Validity means the ‘degree of achieving the objective’. Accordingly, a valid laboratory finding is one which correctly answers the question which the physician at the sick-bed directs to the laboratory. Quantitative measures for the validity of interpretation can be developed by an analysis of the underlying classification processes. Characteristic indices describing the validity quantitatively in terms of conditional probabilities can be derived from decision tables. Examples of ‘validity indices’ are diagnostic (or prognostic) ‘sensitive’ and ‘specificity’. These indices are powerful tools for developing strategies for the clinical use of laboratory examinations in diagnosis, prognosis and therapy management. Moreover, validity indices are appropriate output quantities for the estimation of effectiveness and efficiency of a diagnostic or prognostic examination.  相似文献   

3.
The aim of this paper is to describe a Hermeneutical phenomenological study of the experience of being diagnosed with colorectal cancer. The research objective was to understand this particular lived experience and uncover the meanings and structures within it. Eight patients who had been diagnosed with colorectal cancer in the preceding four weeks were purposively sampled to describe their experiences. Data was generated using semi-structured, in-depth, face-to-face interviews. The data was analysed using the method described by Benner. Six themes were identified as the main components of this experience for these patients. An overview of the participants’ experiences is presented followed by a more detailed discussion of one of the most poignant themes, which is entitled ‘Feeling ‘on your own’’.  相似文献   

4.
This article uses the case of presenile and senile dementia to discuss ethical concepts that have potential to guide nursing action. The concepts of ‘sanctity of life’ versus ‘quality of life’ or ‘dignity’ are both unsatisfactory for directing nursing intervention whenever proxy judgement is necessary. Guidelines for action must involve from research, the search for clinical knowledge. As an underlying attitude and additional guide the author describesa Jewish ethical perspective which difines dependences and interdependence as an essential part of human existence and accepts the inevitability of living with moral uncertainty.  相似文献   

5.
Förderreuther S  Sailer U  Straube A 《Pain》2004,110(3):756-761
To investigate neglect, extinction, and body-perception in patients suffering from complex regional pain syndrome (CRPS). So-called ‘neglect-like’ symptoms have been reported in CRPS, however no studies have yet analyzed this phenomenon which might substantiate the theory of the central nervous system involvement in the pathophysiology of CRPS. A total of 114 patients with CRPS of the upper limb underwent bedside neurological examination. ‘Neglect-like’ symptoms were determined by asking all patients what kind of feeling they had toward the affected hand (feeling of foreignness). Hemispatial neglect was tested with the line bisection task in 29 patients and sensory extinction to simultaneous stimulation in 40 patients. The ability to identify fingers after tactile stimulation was tested in 73 patients. Independently of the affected side and disease duration, 54.4% of the patients reported that their hand felt ‘foreign’ or ‘strange’. The ability to identify fingers was impaired in 48% on the affected hand and in 6.5% on the unaffected hand (X2=33.52, df=1, p<0.0001). These findings were related to pain intensity, illness duration and the extent of sensory deficits. No typical abnormalities indicating neglect were found in the line bisection test. Sensory extinction was normal in all patients. A large proportion of CRPS patients have disturbances of the self-perception of the hand, indicating an alteration of higher central nervous system processing. There are no indicators that classic neglect or extinction contribute to these findings. Physical therapy of such patients should take this observation into consideration.  相似文献   

6.
Quality specifications for analytical imprecision and bias based on ‘the state of the art’, ‘biology’ and ‘analysis of clinical situations’ have been proposed by several scientists. Most interesting is the assessment of ‘diagnostic misclassifications’ based on direct evaluation of the consequences of analytical bias on the percentage of false positives and false negatives from a clinical decision situation, or based on the percentage of healthy individuals outside each reference limit when common reference intervals are used. With use of graphical or computer simulations assuming increasing (positive or negative) analytical bias, the expected percentage of misclassifications can be estimated — and, for the error for which the outcome (the fraction of misclassifications) is considered unacceptable, the maximum allowable analytical bias can be defined. An overview is given of previous proposals for specification of allowable analytical bias, and new examples are presented: (i) for S-transferrin, an analytical bias of + 10% will increase the percentage of healthy individuals with measured concentration values above the upper reference limit from 2.5 to 10%; (ii) the percentage of healthy men with concentration values for S-cholesterol above 6.2 mmol/1 (240 mg/dl) will vary between 25 and 85% for analytical bias from − 1.0 to + 1.0 mmol/l (± 16%); (iii) for glycated haemoglobin, two examples are given which illustrate the effect of analytical bias on the risk of retinopathy and so-called ‘microalbuminuria’ for measured values identical to the target 7.5% and 10.1% glycated haemoglobin, respectively. It is concluded that analytical bias may have significant impact on diagnostic performance, better standardization is needed, and quality specifications for allowable analytical bias should be based on medical usefulness criteria or, if such data are not available, on biological criteria.  相似文献   

7.
In this article I will critically examine the social context of learning in nurse education from a sociological perspective. 1 will begin with a brief review of recent developments in the philosophy and practice of nurse education. The concepts of ‘tokenism’, ‘relative autonomy’, ‘de-mystification’, and ‘social control’ will be used to identify what the present socio-political status of the nurse-learner is.Whilst it is recognised that major improvements in the quality of nurse education have occurred over recent years, the application of these concepts helps to highlight the need for further radical developments before students can be said to have attained educational ‘self-actualisation’.Finally, I will suggest positive strategies aimed at advancing the quality of learning for nurses in the future.  相似文献   

8.
The literature indicates that the elderly form a substantial proportion of surgical patients and that a disproportionate number of them suffer an abnormal temporary change in mental state which can have an adverse effect on their recovery. A computer search using ‘Medline’ and the ‘Nursing and Allied Health Database’ from 1966–1988 revealed very few references which related directly to post-operative confusion in the elderly. One study in 1984 located only “one prospective, cohort, analytical study of post-operative confusion” which was undertaken in 1979. Two further studies have since been published in 1985, but there is obviously a paucity of literature in this area.  相似文献   

9.
An increase of ‘Lowry protein’ was observed in plasma supernatants obtained after TCA precipitation (final concentration 30.6 mmol/l) from patients with catabolic states. Therefore, a study was performed to evaluate whether this increase of ‘Lowry protein’ in plasma supernatants from post-traumatic ARF patients is caused by amino acids, peptides and low molecular weight proteins. Mixing different TCA concentrations with different proportions of plasma PTC-amino acids represent 16.0 ± 4.9% to 42.2 ± 5.9%) of ‘Lowry protein’ in ARF patients, whereas in controls a percentage between 35.4 ± 4.6% and 74.6 ± 10.6% was found. Therefore, we tried to find factors responsible for this difference. Urea, creatinine, uric acid, guanidines or dopamine are not responsible for this effect. Performing fast protein liquid chromatography and PTC-amino acid analyses of the peaks we could confirm that increased ‘Lowry protein’ observed in ARF patients is caused only in a small part by protein degradation products. Plasma free amino acid concentration showed no difference between ARF patients (2054±162 μmol/l) and controls (2503 ± 105 μmol/l). Our data demonstrate that determination of ‘Lowry protein’ may be helpful in evaluation of catabolic state. However, this increase results mainly from non-protein related and until now not identified factors.  相似文献   

10.
Epidural blood patch in the treatment of post-lumbar puncture headache   总被引:5,自引:0,他引:5  
Post-lumbar puncture headache is a common complication of dural puncture. Treatment of severe cases with an epidural ‘blood patch’—injection of 10–20 ml autologous blood into the epidural space at the site of the dural puncture—is an effective and safe method with few and generally mild complications. The method has been used by anesthesiologists for many years with good results, but only rarely by radiologists, neurologists and other specialists who often perform lumbar punctures. The technique of ‘blood patching,’ its indications, effects, and complications and the epidural blood patch as post-lumbar puncture headache prophylaxis are discussed.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号