Paradigms for mental health nursing: fragmentation or integration?

Debate about the best paradigm for mental health nursing is compounded by threats from mainstreaming and genericism. In nursing education, integrated practice may have been devalued in a matrix of reductionist disciplines. The 'gendered' nature of professional knowledge may create a schismatic and self-defeating attitude in nurses. Conversely, nurses may be exhorted to adopt a 'male' paradigm in order to gain academic credibility, in which the caring dimension may be lost. Other polarities such as ideological distinctions between treatment in hospital and care in the community lead to conceptual confusion. These schisms in care are detrimental to both professionals and users. The writers argue that these tensions may be addressed in an 'androgenous' model which presents a challenge to both value systems, rejects the dominance of schismatic models, and offers the potential for a new professional integrity.     

Renal acid excretion in early infancy

In early infancy, complex disorders of acid base metabolism are more frequent than in any other age group, with a predisposition to metabolic acidosis due to an age-related low renal capacity for acid excretion and an unphysiologically high actual renal acid load in nutrition with common formulas. Recently in preterm and small-for-gestational-age infants, persistent maximum renal net acid excretion (NAE) with subnormal or normal blood acid base status, impaired weight gain, and adaptive hormonal reactions have been observed. Incipient late metabolic acidosis is one example of a mixed disorder of acid base metabolism with maximum renal NAE in early infancy. Alkali therapy is highly effective and can be realized both on an individual basis, using urine pH screening as a diagnostic criterium for maximum renal acid stimulation, or on a general preventive level using modified standard formula with a reduced actual renal NAE similar to that seen on alimentation with human milk. From an integrated point of view, the low glomerular filtration rate and renal capacity for acid excretion beyond the developmental age of more than 44 weeks, may well be interpreted as the result of a specific adaptation to breast feeding sparing energy, and thus an evolutionary advantage for the survival of mother and child. Received July 10, 1996; received in revised form and accepted October 7, 1996     

Midnight reckonings: on a question of knowledge and nursing

Abstract The paper contrasts understandings of knowledge grounded in Enlightenment norms with the departures from those norms taken by some strands of feminism and hermeneutics, as well as the contributions made by the writing of Michel Foucault. A reading of Foucault's writings on knowledge, power and the discursive constitution of self and world is offered as a potentially useful frame within which to raise questions about nursing, nurses and knowledge.     

听性脑干反应和蜗神经直接动作电位联合听觉监护在侧颅底手术中的应用

目的:通过听性脑干反应(ABR)和蜗神经动作电位(CNAP)在侧颅底外科手术中的应用,分析造成听力损伤的原因,并对这两种听觉监测技术作出评价。方法:在手术过程中对14例保留听力的侧颅底手术的患者进行听觉监测。ABR在整个手术过程中监测,CNAP在打开脑膜、暴露蜗神经后进行监测。在患者出院后1个月左右随访听力。结果:所有患者在手术过程中都有不同程度的ABR变化,尤其是耳科电钻使用后[相对使用前延长(0.19±0.16)ms)]和颅内操作时[相对操作前延长(0.29±0.25)ms]。部分患者的波形潜伏期延长在术毕时有所恢复[10例,平均缩短(0.27±0.16)ms]。结论:侧颅底手术中应用听觉监护能防止听觉损伤。电钻使用造成的震动和噪声对听力有损伤,解除引起波形潜伏期延长的诱因后可恢复部分听力。术后的听力预后与术毕潜伏期的延长有相对应关系。术中监测的新趋势是联合应用ABR和CNAP,取长补短。     

全科医学基层实践基地师资综合评价指标体系的构建

目的 构建一套科学、系统的全科医学基层实践基地师资综合评价指标体系,为全科基层实践基地的师资遴选、评价和考核提供参考。方法 在文献研究、专家咨询和小组讨论的基础上,初步构建全科基层实践基地师资原始指标体系。选择具有中级及以上职称,并长期从事医学教育管理、全科医疗与教学、基层医疗卫生服务与管理工作的32名专家,进行两轮德尔菲专家函询,并对函询结果进行统计分析,确定全科基层实践师资综合评价指标。运用层次分析法计算各指标权重并进行一致性检验。运用Yaahp统计学软件进行数据录入和处理。结果 构建出包含3个一级指标、12个二级指标和61个三级指标的全科医学基层实践基地师资综合评价指标体系。3个一级指标分别为师资遴选纳入标准、教学能力评价标准、师资考核标准;权重系数分别为0.334、0.525、0.142。结论 本研究构建的指标体系具有较好的科学性和系统性,为进一步加强全科基层实践基地师资队伍的建设和管理、提升全科住院医师培养质量,提供了理论依据。     

基于慢性肾脏病管理的精准分级诊疗应用实践

分级诊疗制度是优化基本医疗卫生制度的重要步骤,但落地实施时遇到阻碍,因存在转诊标准不一、空间不连贯和时间滞后等问题,医联体模式推进存在难度。上海市浦东新区人民医院联合7家社区卫生服务中心,构建了一套以信息化为支撑的川沙医联体慢性肾脏病（CKD）专病精准分级诊疗管理方案。以CKD病种为例,基于指南梳理CKD患者的疾病管理规律,建立医疗信息联通共享、转诊规则标准的CKD专病分级诊疗知识库,设计区域CKD专病分级诊疗系统,构建了基于医院-社区联动管理的专病分级诊疗一体化管理模型。且实证应用评价显示,基于CKD知识库的专病分级诊疗模式,可以精准定位易发和高危人群,及时筛查评估CKD早期患者,提升CKD患者的健康管理和诊疗效率。     

急诊科护士对新发传染病知信行调查问卷的编制

目的 编制急诊科(emergency department,ED)护士对新发传染病(emerging infectious diseases,EID)知信行(knowledge attitude practice,KAP)调查问卷,并进行信效度检验。方法 以KAP理论为基础,通过文献回顾、德尔菲专家函询形成问卷初稿;于2021年5月方便抽样上海市3所三级甲等综合医院293名ED护士进行预调查,完成问卷条目筛选和信效度检验。结果 形成含有34个条目的ED护士对EID知信行调查问卷,其中知识维度12个条目、态度维度10个条目、行为维度12个条目。问卷整体Cronbach's α系数为0.926,各维度Cronbach's α系数为0.617~0.968;问卷整体分半信度为0.846,各维度分半信度为0.614~0.958。问卷水平内容效度指数(scale-level content validity index,S-CVI)为0.99,条目水平内容效度指数(item-level content validity index,I-CVI)为0.99~1.00;探索因子分析显示,知识、态度、行为3个维度分别提取公因子4个、1个、2个,累计方差贡献率分别为50.192%、78.319%、73.341%,问卷整体累计方差贡献率67.242%;验证因子分析显示,问卷整体及各维度拟合度较好。结论 EID知信行调查问卷具有良好的信效度,可作为ED护士对EID KAP的评估工具。     

Developmental Progression in Children's Knowledge of AIDS: Implications for Education and Attitudinal Change

The effectiveness of curricula designed to enhance a child'sunderstanding of AIDS may hinge partially upon incorporatinginformation adjusted to the child's developmental status. Accordingly,we examined the developmental progression of children's understandingof illness transmission in general and AIDS in particular, aswell as explored the relation between a child's knowledge ofAIDS and his/her attitudes toward persons with AIDS. Knowledgeof AIDS was manipulated through use of a brief educational intervention.Results support a developmental progression in knowledge aboutAIDS that is consistent with progressions related to illnessesin general. Knowledge enhancement was associated with positivechanges in attitude.     

Knowledge and attitudes towards preimplantation genetic diagnosis in Germany

BACKGROUND: Preimplantation genetic diagnosis (PGD) is a technique which is often related to emotional debates because of its ethical and social implications. Worldwide there are different forms of legislation; Germany constitutes an interesting case because of the historical background concerning eugenics and dealing with handicapped persons at the time of national socialism. PGD is currently not legal but there are still polarized positions and legalization remains an issue. Studies about the attitudes of the general population towards PGD are rare. METHODS: Data were collected in a representative survey carried out in November 2003. Subjects were 2110 persons in Germany aged 18-50 years. RESULTS AND CONCLUSIONS: Respondents had little knowledge about PGD. There were incorrect assumptions about the diagnostic possibilities and a lack of basic genetic knowledge. A tendency towards a general acceptance of PGD for medical indications was found. Non-medical indications such as sex selection were generally not accepted. It could be observed that respondents who already had a notion about PGD overestimated the diagnostic possibilities and would eventually use PGD in the future more than respondents who had never heard about PGD before.     

神经导航辅助眉弓锁孔入路量化研究及临床意义

目的:报道经眉弓锁孔入路对鞍区结构的显微外科解剖和显微技术。方法:在15例(30侧)经颈内动脉、椎动脉灌注红色乳胶的成人头标本上模拟经眉弓锁孔入路,借助手术显微镜(6~25倍)观察鞍区显微解剖结构,并在神经导航下量化Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ间隙面积,颈内动脉及分支、视神经长度。结果:眉弓锁孔入路对5间隙结构有很好暴露,通过第Ⅱ间隙打开Liliequist膜后可见基底动脉(BA)分叉,大脑后动脉(PCA),小脑上动脉(SCA)及其穿通血管和动眼神经出脑干处及其行程,各间隙面积Ⅰ(85.64±6.87mm2)、Ⅱ(46.62±5.34mm2)、Ⅲ(18.97±2.78mm2)、Ⅳ(49.27±4.86mm2)、Ⅴ(35.95±3.41mm2);颈内动脉眼段长(6.64±1.45mm),交通段长(3.35±0.46mm),脉络膜段长(3.75±0.67mm),仔细分离切断周围的蛛网膜小梁,充分游离血管及其分支,在视交叉后上方可充分显露大脑前动脉(ACA)A1、A2段,前交通动脉复合体及Heubner返支,A1长(22.12±3.65mm)。左侧视神经为(15.15±2.54mm),右(14.42±1.89mm)。结论:眉弓锁孔入路可对鞍区结构很好暴露,第Ⅰ间隙面积最大,Ⅰ、Ⅳ与入路方向一致,显露更为满意,通过Ⅱ间隙可观察Willis后环周围结构;处理鞍区肿瘤,以鞍区4个常规解剖间隙为主,联合第Ⅴ间隙可获得满意效果。