老年患者不同证型红外热象舌图温度负荷的变化

目的 :探讨老年不同中医辨证分型的红外热象舌图温度负荷变化。方法 :被测试者分为阴虚证、阳虚证、气滞血瘀证、气血两虚证、湿热证五组。施以冷负荷后 ,红外舌图分析选取七个点温为代表 ,以计算机图像处理系统确定纵横坐标位置 ,对采录的所有红外舌图进行分析、处理。结果 :阴虚组舌尖、舌前两侧点冷负荷前后变化值与正常组比较 P<0 .0 5 ;阳虚组各点冷负荷前后变化值均低于正常组 (除 M点 ) ,且 T点、TL 点、TR点、M点均大于气血两虚组及湿热组 P<0 .0 5 ;气滞血瘀组舌温变化值低于正常 (T点 P<0 .0 5 ) ;气血两虚组各点温变化值均显著低于正常组 (P<0 .0 5～ 0 .0 1)及其他证型组 ;湿热组舌尖、舌前两侧点冷负荷前后变化值与正常组比较 P<0 .0 5 ,且低于阴虚组、阳虚组、气滞血瘀组。结论 :老年不同中医辨证分型的红外热象舌图各有其特征 ,红外热象舌图直观、重复性强 ,可作为中医辨证分型和疗效判断的临床指标     

腹腔镜术后病人的手术感受对术前病人的作用

目的:为帮助腹腔镜胆囊手术病人掌握健康教育的知识.方法:开展了由腹腔镜手术后的病人向术前病人介绍手术感受.结果:促进术前病人对有关的健康教育知识的掌握,并能延长其术前1d晚的睡眠时间.结论:使病人更好地掌握健康宣教知识,有利于病人的治疗.     

The introduction of a new assessment system in restorative dentistry: the undergraduate and patient experience

In 2000, the University of Bristol Dental School Division of Restorative Dentistry carried out a review of the assessment methods used within the undergraduate programme. Following this review, a number of key recommendations were made and the system of formative assessment within the division was changed. Audits were conducted immediately prior to the introduction of the new system and 2 years after it had been introduced, the results of these audits are presented. There was no change in the number of failed appointments between the initial audit and the second audit. There was a reduction in the number of patients treated by more than one student from 25% to 14% (approximating to 3% if student withdrawal from the course is taken into account). The length of time taken to complete treatment reduced between the two audits with more than half of all patients having their treatment completed within 3 months of their initial examination in the second audit. Ninety-five percent of treatment plans were completed in the second audit compared with only 62% in the first audit. In the second audit, the outstanding 5% of cases were signed off as incomplete for satisfactory reasons by the member of supervisory staff (e.g. patients who had moved away or were discharged due to poor attendance). Student comments were mostly positive, the small number of negative comments related to some students being confused by the paperwork in the new system. The overall process has been an extremely positive experience which has resulted in an assessment system with increased clarity which appears to have reduced the stress levels reported by the undergraduate students on the programme and improved the quality of patient care within restorative dentistry.     

Adherence to recommendations and improvement over time in men with erectile dysfunction

Men with erectile problems seen for a comprehensive urology-department-based medical and psychological evaluation were sent questionnaires 2 to 3 years later. A representative sample of 99 (52%) responded. The majority (51%) has taken no action and reported that their sexual function was no better. Patients were more likely to comply with a recommendation for sex therapy than with one for a penile prosthesis. This was related to their attitude towards mental health professionals. These findings suggest the need for more knowledge of patient psychology and expectations.These data were presented in preliminary form at the Tenth Meeting of the International Academy of Sex Research, Cambridge, England, September 1984.     

Nursing involvement in euthanasia: how sound is the philosophical support?

Abstract  Preference utilitarians are concerned to maximize the autonomous choices of individuals; for this reason, they argue that nurses ought to advocate for those patients who desire assistance with ending their lives. This approach prompts us to consider, then, the moral validity of nursing involvement in measures intended to end the lives of patients. In this article, the terms of preference utilitarianism are set out and considered in order to determine whether this approach offers sufficient philosophical support for sanctioning a role for nursing in euthanasia. Ultimately, it is found that preference utilitarianism is lacking in this respect, as well as in its fitness for guiding nursing activity in general. In particular, it is found that nurses are required to exchange a handmaiden relationship with the medical profession for an equally undignified relationship with patients. If nursing involvement in measures intended to end the lives of patients is to find sufficient philosophical support, then we need to look elsewhere.     

Teaching medical students about the appropriateness of social and sexual contact between doctors and their patients: evaluation of a programme

The purpose of this study was to assess the impact of an educational intervention on medical students' attitudes toward social and sexual contact with patients by doctors from three medical specialties (general practice, obstetrics/gynaecology and psychiatry). Medical students from two consecutive fifth year classes at one medical school participated in one 3 hour session that included instruction on the standards of the profession that prohibit doctor–patient sexual contact. Students were assigned to either intervention groups or control groups and responded to an anonymous questionnaire (overall response rate 66·8% ; n=141). As many as 14·5% of control group students thought it was (sometimes or usually) appropriate for general practitioners to date their own patients and at least 3% thought it appropriate for members of any of these three medical specialties to engage in sexual contact with their own patients. However, there were no significant differences in attitudes toward hugging, dating or sexual contact with current patients between those who had attended the seminar and the control groups. The session significantly influenced attitudes regarding obstetrician/gynaecologists and psychiatrists hugging and having sexual contact with former patients. These findings are discussed in relation to a need for expansion of such instruction.     

Development and evaluation of a breast cancer prevention decision aid for higher-risk women

Objective To develop and evaluate the effectiveness of a breast cancer prevention decision aid for women aged 50 and older at higher risk of breast cancer. Design Pre‐test–post‐test study using decision aid alone and in combination with counselling. Setting Breast Cancer Risk Assessment Clinic. Participants Twenty‐seven women aged 50–69 with 1.66% or higher 5‐year risk of breast cancer. Intervention Self‐administered breast cancer prevention decision aid. Main outcome measures Acceptability; decisional conflict; knowledge; realistic expectations; choice predisposition; intention to improve life‐style practices; psychological distress; and satisfaction with preparation for consultation. Results The decision aid alone, or in combination with counselling, decreased some dimensions of decisional conflict, increased knowledge (P < 0.01), and created more realistic expectations (P < 0.01). The aid in combination with counselling, significantly reduced decisional conflict (P < 0.01) and psychological distress (P < 0.02), helped the uncertain become certain (P < 0.02), and increased intentions to adopt healthier life‐style practices (P < 0.03). Women rated the aid as acceptable, and both women and practitioners were satisfied with the effect it had on the counselling session. Conclusion The decision aid shows promise as a useful decision support tool. Further research should compare the effect of the decision aid in combination with counselling to counselling alone.     

The popularization and application of cold storage red blood cells or whole blood at −80 °C of the Rh(D) negative patients in surgical operation

Summary The efficiency of cold storage red blood cells (CSRBC) or whole blood at −80 °C used in 27 Rh(D) negative patients during surgical operation was reported. The Rh(D) negative patients received the transfusion of CSRBC or whole blood stored at −80 °C for 180 to 360 days. The changes in the indexes, such as blood TB, DB, K⁺, Na⁺, BUN, Cr, urine protein (URPO), UOB, Hb, HCT, serum total protein, relative to hemolytic reaction and blood volume before and after transfusion were observed. The results showed that after transfusion of CSRBC or whole blood 27 cases were negative for urine protein and UOB, and the levels of BUN and Cr were normal (P>0.05). Blood TB, DB, Hb, and HCT were increased, while pH, blood K⁺ and blood Na⁺ was normal with the difference being not significant before and after operation (P>0.05). Plasma protein was decreased, but there was no significant difference before and after operation (P>0.05). It was suggested that CSRBC or whole blood at −80 °C could be safely infused to the Rh(D) negative patients without side effects during the surgical operation. YU Zhongqing, male, born in 1957, Technician in Charge     

Different opinions of physicians on the importance of measures to prevent acquisition of Pseudomonas aeruginosa from the environment

BACKGROUND: Since chronic infection with mucoid Pseudomonas aeruginosa (PA) is associated with deteriorating lung function, many parents of young children with cystic fibrosis (CF) fear the first PA positive throat swab as a milestone in the progression of the disease. To reduce the risk of PA acquisition from the environment, they perform preventive measures at home or outdoors. METHODS: In an attempt to evaluate the attitude of CF physicians towards these measures and the respective consulting practice, we mailed a questionnaire to all 65 certified paediatric CF centres in Germany. RESULTS: Physicians from 54 (83%) CF clinics replied. They expressed widely different ideas about the impact of the environment for the acquisition of P. aeruginosa, and recommended a large spectrum of preventive measures. Some physicians proposed only few precautions, which focussed on the prevention of cross-infection between patients, whereas others suggested prevention of any contact with moist or wet places, e.g. use different toothbrushes for mornings and evenings, or do without air-conditioning in the car. CONCLUSIONS: CF physicians have different opinions on the risk of PA acquisition from the environment. Doctors who recommend strict precautions could engender a parental fear of a ubiquous threat from invisible bacteria. The resulting extended safety measures might impair the family's quality of life.