Patients' expectations,experience and acceptability of postoperative analgesia: a nested qualitative study within a randomised controlled trial comparing rectus sheath catheter and thoracic epidural analgesia

Adequate postoperative analgesia is a key element of enhanced recovery programmes. Thoracic epidural analgesia is associated with superior postoperative analgesia but can lead to complications. Rectus sheath catheter analgesia may provide an alternative. In a nested qualitative study (within a two-year randomised controlled trial) focussing on the acceptability, expectations and experiences of receiving the interventions, participants (n = 20) were interviewed 4 weeks post-intervention using a grounded theory approach. Constant comparative analysis, with patient and public involvement, enabled emerging findings to be pursued through subsequent data collection. We found no notable differences regarding postoperative acceptability or the experience of pain management. Pre-operatively, however, thoracic epidural analgesia was a source of anticipatory fear and anxiety. Both interventions resulted in some experienced adverse events (proportionately more with thoracic epidural analgesia). Participants had negative experiences of the insertion of thoracic epidural analgesia; others receiving the rectus sheath catheter lacked confidence in staff members' ability to manage the local anaesthetic infusion pump. The anticipation of the technique of thoracic epidural analgesia, and concerns about its impact on mobility, represented an additional, unpleasant experience for patients already managing an illness experience, anticipating a life-changing operation and dealing with concerns about the future. The anticipation of rectus sheath catheter analgesia was not associated with such anxieties. Patients' experiences start far earlier than the experience of the intervention itself through anticipatory anxieties and fears about receiving a technique and its potential implications. Complex pain packages can take on greater meaning than their actual efficacy in relieving postoperative pain. Future research into patient acceptability and experience should not focus solely on efficacy of pain relief but should include anticipatory fears, anxieties and experiences.     

Isolation and characterization of cellulose from date palm tree spathe sheath

This study deals with a series of operations to isolate the micro-cellulose from the palm tree spathe sheath by using a modified chemical method to take into account the low cost and the completion speed and its characterization using X-ray diffraction technique (XRD), infrared spectroscopy (FTIR) and scanning electron microscope coupled with element analyzer (SEM/EDX). The results showed that the extraction method succeeded in obtaining very pure microscopic fibers with a width of 2–10 μm with a crystallinity index equal to 79.21%, containing the two cellulose features Iβ and II, that, the conversion ratio of the first to the second was estimated at 32, 87%.     

Shortening peel-away sheaths prior to dialysis line insertion--potential decrease of patient risk.

Placement of tunnelled dialysis lines is effective using ultrasoundand fluoroscopic guidance [1] and has a higher success ratethan ‘blind’ insertion [2]. After the ultrasound guided access into a neck vein, wires andcatheters are guided in to a suitable position in the     

国外经皮冠状动脉腔内成形术后留置动脉鞘管的护理进展

经皮冠状动脉腔内成形术（PTCA）是近30年来治疗冠心病的主要技术之一，其相应的护理技术在过去近10年里有着明显的改进。本文以穿刺股动脉途径为重点综述国外PTCA术后留置动脉鞘管的护理进展：动脉外鞘管拔除责任者、拔除时间、拔管后局部压迫方法等内容，旨在提升PTCA术后的护理质量。     

急性脑血管病患者血清髓鞘碱性蛋白含量研究

用酶联免疫吸附法对３０例急性脑血管病（ＣＶＤ）患者及３２位正常人血清髓鞘碱性蛋白（ＭＢＰ）含量进行检测。结果表明：急性ＣＶＤ组患者血清ＭＢＰ含量显著高于正常人组（Ｐ＜０．０１）；血清ＭＢＰ含量与急性ＣＶＤ的严重程度相关。提示检测血清ＭＢＰ含量对急性ＣＶＤ诊断及预后判断有重要价值     

Myelin-axon relationships established by rat vagal Schwann cells deep to the brainstem surface

The central-peripheral transitional zones of rat dorsolateral vagal rootlets are highly complex. Peripheral nervous tissue extends centrally for up to several hundred micrometers deep to the brainstem surface along these rootlets. In some instances this peripheral nervous tissue lacks continuity with the peripheral nervous system (PNS) and so forms an island within the central nervous system (CNS). In conformity with the resulting complexity of the CNS-PNS interface, segments of vagal axons lying deep to the brainstem surface are myelinated by one or more intercalated Schwann cells, contained in peripheral tissue insertions or islands, at either end of which they traverse an astroglial barrier. Intercalated Schwann cells are thus isolated from contact or contiguity with the Schwann cells of the PNS generally. They are short, having a mean internodal length of around 60% of that of the most proximal Schwann cells of the PNS proper, which lie immediately distal to the CNS-PNS interface and which are termed transitional Schwann cells. The thickness of the myelin sheaths produced by intercalated Schwann cells is intermediate between that of transitional Schwann cells and that of oligodendrocytes myelinating vagal axons of the same calibre distribution. This is not due to limited blood supply or to insufficient numbers of intercalated Schwann cells, the density of which is greater than that of transitional Schwann cells. These factors are unlikely to restrict expression of their myelinogenic potential. Nevertheless, the regression data show that the setting of the myelin-axon relationship differs significantly between the two categories of Schwann cell. Thus, the myelinogenic response of Schwann cells to stimuli emanating from the same axons may differ between levels along one and the same nerve bundle. Mean myelin periodicity was found to differ between sheaths produced by intercalated and by transitional Schwann cells.