Presenting,analysing & discussing the results

The purpose of clinical evaluation is to identify changes due to a treatment. The Results section is where these changes are presented as data summarised in tables, graphs and dots, so that any changes and their extent can be easily seen. Statistical tests are used to confirm that these changes are due to treatment and not due to chance. The choice of test depends on factors such as the measurement scales and data distribution and these are outlined. Finally, the meaning of the results and their ramifications are given in the Discussion section.     

Assessment and measurement of health literacy: An integrative review of the literature

Research linking health literacy to health knowledge, health behaviors, health outcomes, health disparity, health status, and increasing health-care costs is prevalent around the globe. Given the importance of health literacy, it is prudent to examine the tools available to assure that patients are health-literate. This article provides an integrative review in order to investigate what has been developed to evaluate health literacy in the health-care setting. The research questions considered include: (i) Which instruments or screening tools are available to assess or measure health literacy in the clinical setting?; and (ii) What are the psychometric properties, advantages, and limitations of the identified tools? A number of databases are utilized to locate research specific to this topic. The research is analyzed, the findings are summarized, and the limitations are mentioned. The implications, recommendations, and the need for future research are discussed.     

Comparative study of four HDL-cholesterol assay methods

Four methods for HDL-cholesterol assay are compared using the plasma of 119 subjects. Results for the entire population and for subgroups defined by triglyceridemia and cholesterolemia levels are determined. The methods used are: ultracentrifugation, electrophoresis, dextran sulfate precipitation, and concanavalin A precipitation. The results indicate that ultracentrifugation and electrophoresis are not easily adapted to routine work, require large investments and do not separate the lipoproteins according to physiopathological criteria. The HDL values obtained with the different methods show significant differences, even though the correlations between the methods are highly significant. The precipitation methods are easiest to perform; however, the HDL-cholesterol values from dextran sulfate precipitation are higher than those from concanavalin A precipitation. The authors discuss the best choice for determining the atherogenic risks of hyperlipoproteinemia in clinical practice.     

Human fibrinogen

The structure and physical properties of human fibrinogen and fibrin are reviewed along with methods for the detection of products of their metabolism. Interactions of human fibrinogen with thrombin, factor XIII, plasminogen, glycoprotein IIb/IIIa, and other proteins are related to their relevance to thrombosis and hemostasis. To the extent information is available, the structural determinants of these interactions are delineated, and kinetic and thermodynamic parameters associated with the interactions are listed. Individual steps in the reaction pathway for the conversion of fibrinogen to cross-linked fibrin are characterized. The altered hemostatic properties of mutational variants of fibrinogen are related to their altered structure. The structures of the genes coding for the polypeptide chains of fibrinogen are discussed along with the current state of knowledge of the control and regulation of fibrinogen synthesis. Fibrinogen catabolism and fibrinolysis are also reviewed.     

Theory of nursing: creating effective care.

Aspects are identified which are to be considered when attempting to identify those activities we wish to call nursing. Using conceptual analysis by means borderline and model cases, an exposition of the nature of nursing is reached, The process of theory building, the function of theories and their application to what has been identified as the sphere of nursing are explained. The relationship of 'micro theory' and 'paradigmatic theory' are described. The application of theory to nursing education are linked by the use of Peters' (1966) criteria for education. A model attempts to demonstrate the relationships pointed out in the text.     

Is MS an auto-immune disease or a chronic gammaherpesvirus infection?

The geographical-epidemiological findings of MS over the past 75 years are reviewed. Evidence concerning PR latitude-gradients, clusters, migration patterns, and enhancement-protective factors are critically reviewed and analyzed. The evidence in genetics, twin-studies and auto-immune theories are also thoroughly scrutinized as to their possible involvement as causative factors in MS- and found to be somewhat lacking. Environmental discoveries in the Faroes and Key West clusters are reviewed for possible similar environmental causes by a deadly agent. Exogenous-environmental candidate agents over the past 35 years from measles to Marek's are reviewed and analyzed. The undisputed positive laboratory findings of MDV are discussed in relation to Bray's unusually high positive findings with EBV antigen and MS serums. The important discovery of HHV-6 in oligodendrocytes of MS brains but not controls is considered and how this might relate to MDV. The conclusion is that genetics are indeed important in the natural resistance of individual immune systems to invading infectious agents (especially herpesviruses) but genetics in general have little to do with the pathogenesis of multiple sclerosis (but HHV-6, EBV, and MDV do).     

Involving families in end of life care

The authors outline the benefits of an initiative piloted at North Tees and Hartlepool NHS Foundation Trust. Family members of people at the end of their lives are asked to fill in diaries to provide feedback about care, and the information is used to address issues raised. The data and comments are collated, audited and fed back to clinical staff and managers across the trust to benchmark patient-reported outcome measures and quality markers for achieving a 'good death'. The term 'family' refers here to family, friends, carers and significant others who are present at the bedside of patients who are dying in hospital and who are on the Liverpool Care Pathway.     

Functional Electrical Stimulation: An Overview

The development of future neural prostheses involves much more than connecting commercially available stimulators to disabled individuals. Safe and effective operation of prostheses requires fundamental studies of the electrode-tissue interface. The electrochemistry of the interface must be controlled to prevent toxic byproducts. Histopathological studies of stimulated tissue are necessary to establish safe limits of stimulation and to determine mechanisms of neural damage when it does occur. Electrophysiological studies elucidate which neural pathways are excited and help in the design of more selective electrode arrays. Biomaterials are required that protect the implant from the hostile environment of the body. Presently available materials are being improved and totally new materials are being developed. One of the goals of neural prostheses developers is a nonhermetic packaging material that can be applied to miniature implants without appreciably increasing their size. The techniques used to make integrated circuits on silicone substrates are ideally suited to making ultraminiature electrodes with self-contained electronic signal processing. Both integrated circuit stimulating and recording electrodes are being designed and fabricated.     

Annotated psychodynamic bibliography for residents in psychiatry

The author provides an annotated bibliography to introduce psychodynamic psychotherapy and psychoanalysis to residents in psychiatry. The emphasis of the selection is on relevance to practice. The entries are grouped by topic, levels of difficulty are noted, and readings are identified as being of either current or historic relevance.     

Forensic Medicine

The characteristics common to both the pyridoxine-deficiency and the pyridoxine-dependency syndromes in infants are convulsions exclusively controlled by pyridoxine. The author reviews the clinical literature pertaining to these syndromes and gives a brief introduction to their biochemical and metabolic aspects. The differences and similarities between the two syndromes are discussed and certain clinical implications are noted.

The author particularly emphasizes the importance of a diagnostic trial with a single intramuscular injection of 50 to 100 mg. pyridoxine in cases of idiopathic neonatal seizure. Clinical observation and alertness to the possible existence of this disorder are the principal means of diagnosis.     

Diagnosis in rehabilitation: woolly thinking and resource inequity

The diagnostic process in rehabilitation has traditionally been termed assessment. However the goals of assessment are no different to the goals of diagnosis in traditional medical practice. The purpose is, in both instances, to acquire sufficient information to understand the cause(s) of the presenting problem(s), to allow more-or-less specific intervention(s) to be undertaken and, where appropriate, to allow a prognosis to be given. The main difference is that in rehabilitation the presenting problems are limitations in activities and the main items investigated are impairment and contextual matters, whereas in medicine the presenting problems are symptoms, and the goals are the diagnosis and treatment of the underlying disease. Unfortunately it is commonly assumed that rehabilitation diagnosis is simple and unimportant. Consequently few resources are allocated by purchasers to the process of making a rehabilitation diagnosis, in comparison to the huge resources devoted to achieving disease diagnosis.     

Inflatable splints--what are they doing?

The pressure to which splints were inflated was measured to determine whether splintage was effective and if vascular complications were likely. The prevalence of their use by the ambulance service was also investigated. The findings indicate that inflatable splints are in common use, and are rarely inflated to pressures likely to cause vascular complications. However, they are extremely inefficient in holding their pressure and rapidly become ineffective as splints. The therapeutic range between effective splinting and risk of complications is narrow and it is recommended that blow-off valves are incorporated into the manufacture of all such devices.     

Interdisciplinary and distance education in the Delta: the Delta Health Education Partnership

The purpose of this article is to describe the activities and outcomes of the Delta Health Education Partnership (DHEP), an interdisciplinary and distance education program developed to promote 'anytime, anywhere' education. The goal of the project is to recruit, educate, and retain interdisciplinary groups of primary care health practitioners to increase access to health care in medically underserved and health professional shortage areas of the lower Mississippi Delta. The targeted health providers are certified nurse midwives, physician assistants, and family nurse practitioners. The DHEP program spans six universities across four primarily rural states. Primary health care students in the lower Mississippi Delta region are taught using asynchronous technology strategies including Internet-based coursework. Opportunities to expand educational options for distance learners and geographically bound students are explained. In addition, methods of building community partnerships in an effort to recruit and retain primary care providers are also explained. The advantages and limitations of the asynchronous Internet-based courses are explored as part of the program evaluation.     

Infusion therapy in uretero-enterostomy]

The special problems of the uretero-enterostomy, which is often followed by disturbances of the electrolyte metabolism such as hyperchloremia, metabolic acidosis and hypokalemia with all complications, are dealt with. The pre-operative treatment of the patient and the postoperative infusion therapy are discussed in detail, suggestions as to the infusion, electrolyte and calorie quantity to be administered are made. The postoperative complications are demonstrated on the basis of a special case, the theories on the causes of the electrolyte imbalances are also mentioned.     

An investigation into the assertive behaviour of trained nurses in general hospital settings

Nurses are often considered to be lacking in assertive skills. This exploratory study compares the assertive behaviour of trained nurses at work and in general life situations. Questionnaire and interview techniques are used to investigate the behaviour of a small sample of sisters, staff nurses and enrolled nurses in general hospital settings. Trained nurses are found to be less assertive at work than in general life situations. In the work situation sisters are more assertive than staff nurses. The enrolled nurses are the least assertive of the trained nurses. The complex nature of assertive behaviour becomes apparent. Factors which promote assertiveness at work include knowledge, confidence, experience and the wearing of uniform. Factors which inhibit this behaviour are tradition, training and the hierarchical structure within the hospital. The use of assertiveness tends to be situation specific. Assertiveness is viewed as a positive behaviour and is of value to nurses, but there are mixed feelings about the usefulness of assertiveness training.     

Disorders of excessive daytime sleepiness

The complaint of excessive daytime sleepiness (EDS) is associated with a number of disorders. The frequently disabling symptoms of EDS are just beginning to be addressed. This article offers nurse practitioners background information to help in evaluating EDS symptoms. Disorders related to the physiological need for sleep and the response to disrupted sleep or the effect of psychobiological sleep disruption are presented. Differential diagnoses are reviewed and keys to case management are offered. The management of sleep disorders may involve a collaborative role with other health professionals in order to provide optimal patient care. To assist the NP in referring the patient to specialized care, referral services are described.     

The consequences for children of explosive remnants of war: Land mines, unexploded ordnance, improvised explosive devices, and cluster bombs

Land mines are particularly a problem for children. The deaths and loss of body parts have been publicized, but the secondary effects - the loss or maiming of parents, the loss of physical and social space the loss of access to education, and the loss of cultivatable land with the resultant malnutrition and sickness, are less frequently considered. "Explosive Remnants of War" (ERW) is becoming the generic term to refer to land mines, unexploded ordnance, improvised explosive devices and cluster bombs. The United Nations estimates that there are currently as many as 100 million unexploded landmines with an equal number stockpiled around the world waiting to be planted. Mines are designed to be difficult to locate and their clearance is costly. Children in at least 80 countries are at risk due to ERW. The type of mine, the proximity of the child to the explosion, and location of the mine in relation to the child's body are the important determinants of the nature and severity of the injury. Children are especially susceptible to picking up explosive remnants thinking they are toys. The result is commonly loss of the hands, facial injuries, blindness and deafness. Rehabilitation for these children is extremely difficult due to remoteness and the limited resources available.     

THE NORMAL FATE OF ERYTHROCYTES : II. BLOOD DESTRUCTION IN PLETHORIC ANIMALS AND IN ANIMALS WITH A SIMPLE ANEMIA.

1. The increased destruction of red cells in animals rendered plethoric by transfusion takes place predominantly by a fragmentation of the corpuscles without loss of hemoglobin. 2. The microcytes and poikilocytes observed in animals with a severe anemia due to hemorrhage are not put forth as such by the bone marrow, but are portions of cells fragmented while circulating. 3. The cells thus fragmented are for the most part those newformed to meet the exigencies of the situation. Such cells are in large part unable to withstand the wear and tear of function. There results a vicious circle. The anemia renders the bone marrow unable to put forth proper cells, and those it does produce are soon destroyed, thus prolonging the condition. A similar state of affairs probably exists in many human anemias. 4. The occurrence of large accumulations of microcytes and poikilocytes in the spleen of anemic and plethoric animals indicates that the organ exercises some important function in connection with these forms. The same is true of normal animals, for the findings in them are similar, though less striking. 5. The normal fate of the red corpuscles, in those species in which phagocytosis is negligible, is to be fragmented one by one, while still circulating, to a fine, hemoglobin-containing dust. The cell fragments are rapidly removed from the blood, but their ultimate fate remains to be determined. The facts indicate that they are removed from the blood by the spleen, and under exceptional conditions, by the bone marrow.     

Conceptual problems in current research on cognitive vulnerability to psychopathology

Four problems with the concepts used in research on the role of cognitions in psychopathological conditions are identified. The concepts are too intricate or too isolated, are too indistinguishable, and are too incontrovertible. The difficulties presented to the researcher by the use of such concepts are described and alternative approaches are recommended.     

Prevention and management of hyperthermia during a heatwave

Many older people in the UK are at risk of developing and dying from heat-related illnesses during a heatwave. The aims of this article are to define the term heatwave and identify the normal thermoregulatory responses to hot weather. The effects of the ageing process on thermoregulatory responses are discussed and the presenting symptoms of heat exhaustion and heatstroke are outlined. Finally, the treatment of heat-related illnesses and their prevention are explained.