Equality as a central concept of nursing ethics: a systematic literature review

Scand J Caring Sci; 2010; 24; 824–832
Equality as a central concept of nursing ethics: a systematic literature review Background: Equality is a central concept in the Western way of thinking and in health care. In ethics research within nursing science, equality is a key concept but the meaning of its contents is more or less presumptive. Aim: The purpose of this study was to define the concept of equality as a value of nursing ethics research. Method: Data were collected through systematic literature review and analysed using deductive and inductive content analysis. Findings: Equality has been studied as a concept and in relation to ethical theories. In nursing ethics, research on equality on theoretical and functional level is presented. These levels consist of dimensions, i.e. themes, that equality is related to. The dimensions of the theoretical level are the equality of being, i.e. universal human value, and distributive equality, i.e. equal opportunities, circumstances and results. The dimensions of functional equality included themes such as critique of distributive equality, context, difference, power and care. Critique is aimed at incompatibility of theoretical level with practice. Context raises questions of each nursing situation in relation to equality. Variation within context is closely related to differences involving parties to nursing, and it is a starting point to questions of equality. Power is understood as comprising knowledge, skills and authority that create differences and questions of equality between nurses and patients and nurses and other professionals or students. Nursing as care always includes relationship between two or more persons and needs to be inspected from the point of view of equality. Conclusion: The concept of equality has been complex to achieve in practice. The dimensions of the levels of equality defined in this study provide an opportunity to reach a better understanding of equality in nursing ethics. There is still a great demand for more research on the concept of equality.     

Internal fixation of forearm fractures in children

Fourteen children with severely displaced diaphyseal fractures of both bones of the forearm treated with open reduction and internal fixation were reviewed; these operations represented 9 per cent of all the diaphyseal forearm fractures in children during a 9-year period. The mean age of the patients at the time of the injury was 12 (7-14) years; they were reexamined 8 (5-11) years later, all after cessation of growth.

At follow-up, limited prosupination, observed in 8 patients, was associated with a fracture of the proximal third of the forearm; limited motion of the radiocarpal joint, in 2 patients, was associated with shortening of the ulna. Only 4 patients complained of pain or were aware of restricted motion, and the average function was good.

Open reduction and internal fixation is indicated in displaced fractures of the forearm even in children.     

An HRP study of the central projections from primary sensory neurons innervating the rat masseter muscle

Retrograde and transganglionic transport of horseradish peroxidase has been used to study the cell bodies of origin and the central projections of neurons innervating the rat masseter muscle. Labeled cell bodies were observed both in the trigeminal ganglion and in the mesencephalic trigeminal nucleus. Major central projections from mesencephalic trigeminal neurons were traced to the supratrigeminal nucleus and to the brainstem reticular formation. Smaller projections from these neurons could be followed to the borders of the solitary tract and hypoglossal nuclei as well as to lamina V of nucleus caudalis and corresponding areas in the dorsal horn at C₁−C₂ spinal cord segments. Labeling from trigeminal ganglion neurons was observed close to the trigeminal tract in all subdivisions of the trigeminal sensory nuclear complex and in the dorsal horn lamina I at C₁ and C₂ levels.     

A discrepancy of <Emphasis Type="Italic">Chlamydia trachomatis</Emphasis> incidence and prevalence trends in Finland 1983–2003

Background  

Reported rates of Chlamydia trachomatis are on the rise contradicting the declining rates of C. trachomatis associated reproductive sequelae in Western countries. Population based evaluation of the real trend of C. trachomatis infection is important to contemplate prevention efforts. We studied C. trachomatis occurrence during the past 20 years in Finland comparing incidence rate data based on serology and reported C. trachomatis laboratory notifications.     

Quality of myocardial perfusion single-photon emission tomography imaging: multicentre evaluation with a cardiac phantom

The aim of the study was to evaluate quality of myocardial perfusion single-photon emission tomography (SPET) imaging in Finnish hospitals. Nineteen nuclear medicine departments participated in the study. A myocardial phantom simulating clinical stress and rest conditions was filled with routinely used isotope solution (technetium-99m or thallium-201). The cardiac insert included three reversible defects (simulating ischaemia): 30×30×14 mm³ septal (90% recovery at rest), 30×20×14 mm³ posterobasal (full recovery) and 20×20×14 mm³ lateral (full recovery). There were two fixed defects (simulating infarct): 30×20×14 mm³ postero-apical and 10×10×6 mm³ apical. The phantom was imaged and interpreted as a myocardial perfusion patient. Reconstruction, printout and reporting were performed according to the clinical routine of each centre. Three nuclear medicine specialists anonymously evaluated the quality of the image sets. The visual scores of the experts were ranked from 1 to 5. Additionally, points from 0 to 8 were given to research reports according to how well perfusion defects were detected. Quantitative points were calculated by comparing background-subtracted and -normalized counts from 12 regions of interest between stress and rest images. Results for technetium studies (12 departments) were better than those for thallium (7 departments). The average visual scores of the experts were 3.7±0.9 for all image sets, 3.2±0.5 for thallium users and 3.9±0.6 for technetium users (P=0.003). Five laboratories received a low score which, according to the specialists, is barely sufficient for limited clinical use. Average points for the reports were 5.6±2.1, 4.9±1.5 and 6.5±1.7 (P=0.051), and for the quantitation 8.2±1.0, 7.9±0.4 and 8.4±1.1 (P=0.185), respectively. Seven out of 22 interpreters did not detect the lateral 20×20×14 mm³ defect; five of them used thallium. This study demonstrated the heterogeneity of myocardial perfusion SPET in Finland. The participating laboratories used a wide scale of methods and, sometimes, inappropriate imaging protocols. The need for quality assurance in nuclear cardiology, correct use of SPET instrumentation and objective comparison of clinical studies is evident. The method described is suitable for external quality assurance and quality improvement of myocardial SPET imaging, and is recommended for regular use in nuclear medicine. Reiceived 15 March and in revised form 9 May 1999     

Reduced Fluoroquinolone Susceptibility in Salmonella enterica Isolates from Travelers, Finland

We tested the fluoroquinolone susceptibility of 499 Salmonella enterica isolates collected from travelers returning to Finland during 2003–2007. Among isolates from travelers to Thailand and Malaysia, reduced fluoroquinolone susceptibility decreased from 65% to 22% (p = 0.002). All isolates showing nonclassical quinolone resistance were from travelers to these 2 countries.     

Recurrent low back pain and early disc degeneration in the young.

STUDY DESIGN: A prospective 9-year follow-up study involving randomized matched subgroups of 15-year-old schoolchildren with or without low back pain at baseline. OBJECTIVES: To evaluate the long-term persistence of initially reported recurrent low back pain, and to examine the significance of abnormalities found in magnetic resonance imaging of lumbar discs in individuals 15 and 18 years of age as possible contributors to persistently recurrent low back pain. SUMMARY OF BACKGROUND DATA: In surveys among children and teenagers during the past few years, as many as half of all children in a community report a history of low back pain. The current results, in accordance with previous findings, indicate that there is a subgroup of adolescents with more chronic symptoms which, in the authors' opinion, deserves more attention. Disc disease accompanying low back pain is a key issue both in research and clinical practice. The significance of early degenerative findings in the lumbar discs is not known. METHODS: In the survey of 14-year-olds (n = 1503), a subgroup (7.8%) with recurrent low back pain was found. A random sample of individuals with recurrent low back pain (n = 40) and an equal number of completely asymptomatic control subjects were selected for a comparative study. The selected groups were examined by magnetic resonance imaging at 15 and 18 years of age. The participation rate of youth at 14, 18, and 23 years of age for all three questionnaires was 82% (29 boys and 33 girls). Imaging data were interpreted by two blinded radiologists experienced in low-field-strength magnetic resonance imaging. In calculations of relative risks, the participants reporting recurrent low back pain in all phases of the study were compared with participants who had no persistently recurrent pain. RESULTS: Eleven participants (35%) in the original group with low back pain persistently reported recurrent pain. In 15-year-old participants with disc degeneration, the relative risk of reporting recurrent low back pain up to the age of 23 years was 16 (95% confidence interval 2.2-118) compared with those having no disc degeneration. In addition, disc protrusion and Scheuermann-type changes at 15 years contributed to the risk of persistently recurrent low back pain. CONCLUSIONS: The authors' earlier findings already favored the hypothesis of a causal relation between the early evolution of a degenerative process of lower lumbar discs and recurrent low back pain in the near future. The current results further strengthen this hypothesis, indicating that individuals with disc degeneration soon after the phase of rapid physical growth not only have an increased risk of recurrent low back pain at this age, but also a long-term risk of recurrent pain up to early adulthood.     

Technical developments for cerebral thermal treatment: water-cooled diffusing laser fibre tips and temperature-sensitive MRI using intersecting image planes.

The aim was to determine if water-cooled diffusing tips could produce larger and safer (better controlled) thermal lesions than non-cooled diffusing tips at 980 nm. Thermal lesions were induced in beef myocardium in vitro with and without water cooling using a 980 nm diode laser at various power levels. Seven intracerebral treatments were performed in six canines using water-cooled diffusing tips with four animals having intracerebral transmissible venereal tumours grown from inoculate. Magnetic resonance thermal imaging (MRTI)-based feedback software using a fast, radio frequency-spoiled gradient echo acquisition with two intersecting image planes was used for on-line monitoring and control of treatment and for the evaluation of in vivo laser lesion production. In cases where two-plane MRTI was employed, the maximum calculated temperature was compared in each plane. Using water-cooled tips and 400 micro m core diameter laser diffusing fibres in in vitro beef myocardium, power of up to 9.5 W was applied for 8 min without tip failure. Without cooling, tip failure occurred in under 4 min at 6 W, in under 2 min at 7 W and instantaneously at 8 W. Additionally, char accompanied lesions made with uncooled tips while cooled application resulted in only minimal char at only the highest thermal dose. Achieved lesion cross-sectional diameters in in vitro samples were up to 26.5 x 23.3 mm when water cooling was used. In canine brain and transmissible venereal tumours, up to 18.1 x 21.4 mm lesions were achieved. It is concluded that water cooling allows safe application of higher power to small core diameter diffusing tip fibres, which results in larger thermal lesions than can be achieved without cooling. Two-plane MRTI enhances on-line monitoring and feedback of thermal treatment.