Hypnosis in Labor

The pregnant woman who appears at the doctor's office is not only someone with a condition that will deliver in nine months, but has a specific psyche relating to her condition, to her doctor and to her environment.

During the prenatal period the patient has the chance, if allowed, to set up a rapport with, and trust in, her doctor which if encouraged will allow for freer and easier communication both before, during and after labor. It is with the knowledge of this communication and its use, while the patient is in the hypnotic state, that the doctor may help his patients achieve therapeutic goals. Great care should be used in the choice of words in communicating with potential aborters, and women subject to premature labor. In many instances, the family physician is the ideal specialist since he can detect emotional disorders at the earliest time. Frequently, he can incorporate psychotherapeutic treatment into medical treatment.

Hypnosis allows the physician to apply the science of communication to achieve therapeutic goals desired by the patient. Some diagnostic and therapeutic uses of hypnosis and communication in obstetrics have been presented.

     

When a family member has a malignant brain tumor: the caregiver perspective.

The incidence of primary malignant brain tumors has remained stable over the past 10 years, with median survival reported as 12 months. Once the patient has been diagnosed, providing care for him or her is primarily performed by family members. Although previous research has documented the stress, depression, anxiety, and burden associated with caregiving, when these conditions occur is not known. The purpose of this study was to explore the caregiver perspective of providing care while the patient was receiving chemotherapy as initial treatment for the disease. Using phenomenological techniques, data were obtained from semistructured interviews with family caregivers and self-disclosed demographic data. Each interview occurred while the patient was receiving treatment; all patients were within 6 months of initial diagnosis. Interview data were analyzed using Colaizzi's method, which allowed themes universal to the participants to be uncovered. Interview data from 10 participants provided saturation and identified three themes: (a) the diagnosis of a brain tumor is a shock; (b) immediate family role changes occur; and (c) there are psychosocial effects for the caregiver, his or her family, and the person with the brain tumor.     

Patient with COPD. Comprehensive assistance in home care

In order to respond to the objectives of a Home Care Patient Program bearing in mind the patient as the fundamental element from his/her individual and human dimensions, considering his/her family and family environs, it is necessary to establish and integrated, interdisciplinary therapeutic method based on a coordinated program involving all the professional involved in the process. The work of nurses, an essential element in this program, should be based on a conceptual model. It is important to elaborate an integral care plan based on the detection of the needs, objectives to achieve, team interventions both on the patient as the caretaker and to evaluate the results in order to achieve the highest degree of effectiveness and efficiency in home care of patients.     

Implementation of a patient-family pathway: effects on patients and families.

The purpose of this study was to discover whether implementation of a patient-family pathway with patients and families undergoing coronary artery bypass graft (CABG) surgery impacted anxiety, information with care planning, and patient length of stay. Using an experimental design, a sample of 60 patients and family members was studied. Each patient and his or her designated family member received either the patient-family pathway or the hospital's standard care planning. Findings indicated no statistically significant differences in state anxiety or information with care planning between patients and family members receiving the patient-family pathway and those receiving standard care planning. There was no statistically significant difference in length of stay between the two patient groups. The results indicate that the CABG patient-family pathway has limited value to patients and families as measured in this study. Resources can be real-located to other uses that may have a more positive impact on the patient and family experience.     

An experience providing home care to a victim of cerebral vascular accident and purple urine bag syndrome

This article presents the case of a victim of cerebral vascular accident with long duration of urinary catheterization, who developed a purple urine bag syndrome (PUBS) because of deficiency of knowledge and skills in home care and lack of communication and support among family members. In this case, the main caregivers also experienced psychophysical fatigue and fear, which diminished family coping ability. During the period of nursing care, from March 10 to August 15, 2006, we carried out 10 home care visits and eight telephone consultations. Exiting urinary tract infection, constipation, and compromised coping and ineffective family were identified as the three main nursing care issues. As we successfully instilled trust and developed a positive relationship with the patient, we provided continuous and comprehensive nursing care to resolve the PUBS issue her which was causing her anxiety, and her constipation, as well as stabilizing her family function. Consequently, through this care experience involving a sick elderly patient, we promoted the function of nursing home care. From this case intervention, we found that health education should be closely followed up in order to maintain its effectiveness. Insufficient communication skills, however, were identified through meetings with the patient's family. We suggested related family communication skills and practices should be included in clinical nursing training courses to enhance skills in dealing with family issues and life quality among patients and their families.     

Educational frame of reference: an additional model for rehabilitation medicine

Since much of medical rehabilitation is actually training which is focused on helping the patient and/or his/her family become active in the patient's daily care, the addition of the educational frame of reference can make rehabilitation professionals more effective. A recommended model for patient-family education has these components: (1) Identification of patient-family understanding necessary for dealing with his/her problems or potential problems; (2) assessment of current patient-family knowledge, attitudes, and life style; (3) setting of educational goals based on individual patient and family needs; (4) planning an appropriate method of achievement of those goals; (5) implementing the plan; and (6) evaluating according to goals.     

Family-centered critical care: an option or obligation?

The patient was dying after undergoing aggressive treatment for a malignancy. Patient and family wanted "everything" to be done and the patient was transferred to the ICU for treatment of acute respiratory failure. The next day the patient's condition deteriorated further. The family decided against chest compressions or defibrillation; however, other aggressive treatment was continued. A "chemical code" was initiated and the patient was ventilated. The family was informed. As they stood in the hall outside the unit, the patient's wife asked if she could be with her husband. A nurse explained what she would see and accompanied her to the bedside. She stood at the head of the bed, stroked her husband's head and spoke softly in his ear. The patient's son came to the bedside and said his last words to his father. The wife was present when treatment was stopped and the patient was pronounced dead. She said to the nurse who had accompanied her, "You have given me the greatest gift possible--you allowed me to be with my husband at the end."     

Understanding the patient in all his human needs*

The ‘patient’ whether an individual, family or group has multiple human needs. These needs vary with the characteristics of the patient, the state of health/illness and the setting in which care is delivered. Needs may be of a psychological, physical and/or social nature, with dynamic interaction between and within these areas. The patient is part of a large system, the family and society, and here also mutual impact takes place. Time and space take on new meaning in periods of stress and the nurse must be sensitive to the humans needs which grow out of these changed perceptions. Factors which may contribute to meeting patient needs are a systematic method of learning about the patient, basing care on his specific needs, knowledgeable and skilled care givers and an appropriate environment.     

一个Rett综合征合并努南综合征家系的基因诊断

目的：对1例发育迟缓患儿及其家系进行基因检测,了解其基因突变的类型和遗传模式,以对其进行临床诊断。方法：提取先证者及其家系成员的外周血DNA,利用高通量测序技术对先证者进行基因筛查,结合临床表型资料,寻找候选基因致病位点,结合Sanger测序技术对先证者及其家系成员进行致病位点验证。按照美国医学遗传学与基因组学学会（American College of Medical Genetics and Genomics, ACMG）变异分类指南判断致病性。结果：高通量测序结果发现, 先证者MECP2基因、PTPN11基因存在杂合错义变异,分别为第4号外显子c.398G>A,p.Arg133 His及第3号外显子c.188A>G,p.Tyr63Cys。Sanger测序结果显示,MECP2基因变异遗传自母亲,导致Rett综合征;PTPN11基因变异遗传自父亲,导致努南综合征（Noonan syndrome, NS）。这2个错义变异均为致病性变异,与先证者及其父母的临床表型相一致。结论：本研究通过高通量测序发现1例发育迟缓患儿存在2个不同基因的致病性变异,导致同患2种不同的遗传性综合征,提示遗传性疾病患者中可能同时存在2种或以上的疾病表型,需加以重视。     

Colice's story and the effects of generational loss

In 1934, Colice Sayer was forcefully removed from her home and involuntarily committed to a state mental hospital following a legal proceeding she was not allowed to attend. Colice's husband initiated the complaint against her. Colice remained in the institution for 43 years as a ward of the state of New York. This study examined her life to gain an understanding of how the lives of successive generations were altered. The life history method was used to elicit the stories of the central character and her family. Hermeneutic phenomenology was used to gather and analyze the data. Two themes emerged from the data: learned expectations and retreating behaviors. Learned expectations were family rules taught to successive generations. Retreating behaviors were indirect actions observed or obliquely communicated. The loss of a mother by means of forced, legal separation and the subsequent disintegration of the family can pervasively affect successive generations.     

The silence and the silencing of the nurse's voice: a reading of patient progress notes.

Content analysis of text offers a method for exploring experiences which usually remain unquestioned and unexamined. In this paper the authors analyse a set of patient progress notes by re-framing them as a narrative account of a significant event in the experience of a patient, her family and attending health care workers. Examination of these notes provides insights into aspects of clinical practice which are usually dealt with at a taken-for-granted level. An interpretation of previously unexamined therapeutic practices within the social and political context of institutional health care is offered.     

Conceptual frameworks for clinical practice

The patient with neurologic dysfunction is confronted with an enormous challenge. First, he/she is faced with the physiologic and psychological changes associated with the condition. Secondly, this individual may require hospitalization, which demands adaptations in his/her self-concept and family roles and responsibilities. Thirdly, treatment of the dysfunction may necessitate long-term medical management which would challenge his/her self-care abilities and the functioning of the family system. The concepts of body image, self-concept, self-care, and family systems have been synthesized into a conceptual framework relevant to patient populations experiencing neurologic/neurosurgical problems. This conceptual framework provides a structure which can be utilized to explain the reactions and behavior of patients, formulate generalizations relevant to this population, and develop and test clinical protocols. Individual nurses interacting with neurological/neurosurgical patients need to utilize this conceptual framework to develop and test clinical protocols that are pertinent to their own unique clinical situation. Communication of the results of this process will foster the expansion of the scientific knowledge base for clinical practice.     

Duchenne muscular dystrophy in a female patient with a karyotype of 46,X,i(X)(q10)

Duchenne muscular dystrophy (DMD) is a severe recessive X-linked form of muscular dystrophy caused by mutations in the dystrophin gene and it affects males predominantly. Here we report a 4-year-old girl with DMD from a healthy family, in which her parents and sister have no DMD genotype. A PCR-based method of multiple ligation-dependent probe amplification (MLPA) analysis showed the deletion of exons 46 and 47 in the dystrophin gene, which led to loss of dystrophin function. No obvious phenotype of Turner syndrome was observed in this patient and cytogenetic analysis revealed that her karyotype is 46,X,i(X)(q10). In conclusion, we describe the first female patient with DMD who carries a de novo mutation of the dystrophin gene in one chromosome and isochromosome Xq, i(Xq), in another chromosome.     

An immunoreactive xanthine oxidase protein-possessing xanthinuria and her family.

The presence of immunoreactive xanthine oxidase protein was proven in a xanthinuric patient, using a polyclonal antibody against xanthine oxidase. The antibody was raised against purified human liver xanthine oxidase in a rabbit. Double immunodiffusion method demonstrated the existence of an immunologically reactive xanthine oxidase which did not possess xanthine oxidase activity. In addition, urinary excretion of oxypurines in the patient and her family was investigated. The results indicated that a brother and a sister had xanthinuria.     

Promoting family-centered care in high risk pregnancy

Complications during pregnancy heralds a time of increased stress and anxiety for the obstetric patient and her family. Separation from family and home is a common stressor. Incorporating key elements of family-centered care into the policies of the obstetric units that support the health care team to include the family in the plan of care are crucial to family functioning during this difficult time. Assessment of the family and interventions to support family functioning can be structured using the Calgary Family Assessment Model and the Calgary Family Intervention Model. Models that emphasize the family assist the health care team to shift from a plan focused on the medical aspects of care to one that is incorporated to include the woman's family, the base of her support.     

General principals of management: education

Asthma education is an essential part of the treatment of this disease. Health care professionals must establish a partnership with the patient with asthma and the patient's family to devise a plan of care with which the patient voluntarily will comply. The partnership with the patient begins at the first encounter and continues throughout the therapeutic relationship. Each member of the health care team can be instrumental in reinforcing the crucial information the patient must know to be an informed participant in his or her care. Nursing professionals are in a particularly advantageous position to foster this partnership because of their patient-focused outlook and the quality of time spent with patients. When the partnership is based on mutual trust and cooperation, the clinician can direct asthma care that is consistent with current expert guidelines. Educational interventions should be meaningful to the patient, learner centered to incorporate the patient's needs, and sensitive to the patient's cultural influences. The patient and his or her significant social and family support should be actively involved. The clinician should be alert to the patient's readiness to learn and tailor the message to suit the setting in which it is delivered. The patient should receive information that allows his or her participation in goal setting for treatment. Essentials to be included are the significance of the diagnosis, basics about inflammation as the primary cause of symptoms, the difference between controllers and relievers, how to use the medications and monitoring devices, how to reach the provider, and the need for continuous ongoing interaction with the clinician. Goals set in the partnership are objectified in the asthma action plan or guided self-management plan. The success of the treatment can be assessed from the patient's improved asthma control and reduced reliance on emergency treatment. Every health care provider is a potential wealth of patient education. Every patient encounter is an opportunity to reinforce knowledge and proficiency in asthma management. Nursing professionals can play a fundamental and crucial role in asthma education by maintaining the focus of the medical treatment on the priorities in asthma care--the learning needs and goals of the patient.     

Hypercholinesterasemia with isoenzymic alteration in a family

A family with hypercholinesterasemia with isoenzymic alteration is reported. The propositus, a 55-year-old woman, was admitted to our hospital because of diabetes mellitus. Because her cholinesterase activity (delta pH 3.2) was supranormal, with no other abnormal liver-function test result throughout the hospitalization period, and was independent of her disease state, we investigated whether this condition might be familial. We studied six of her 17 family members in three generations. All six had above-normal serum cholinesterase activity. Gradient gel electrophoresis on polyacrylamide showed that the normal control individuals had seven isoenzymes, but all the family members with hypercholinesterasemia had two additional isoenzymes. The enzymic properties of the affected members were similar to those of the normal individuals. Hypercholinesterasemia in this family seems to be the result of an increased number of enzyme molecules, but how this isoenzymic alteration emerged remains obscure.     

Families in crisis: making the critical difference

As nurses, we are educated to care for the whole patient, to provide care for the body, mind, and spirit, and to improve the quality of life. When a patient has a crisis, his or her family is propelled into the crisis as well. Although critical care nurses have always participated in a caring manner by interacting with families of critically ill patients, nurses must be encouraged to actively seek ways in which to help these families. This article has provided guidelines and strategies for caring for families in crisis. The most effective way to care for family members in crisis is by demonstrating a conscientious concern for their loved one, that is, the patient. The knowledge that our nursing actions make a difference in the lives of family members gives us renewed insight into maintaining the care in critical care nursing.     

Dominant inheritance of the complex of myxomas, spotty pigmentation, and endocrine overactivity

We describe a family in which lentigines were present in the index patient, in three of her seven siblings, in their mother, and in a niece (the daughter of an affected sister). Cutaneous myxomas were present in the index patient, in two of her brothers, and probably in their mother. In addition, the index patient had two cardiac myxomas. multiple myxoid mammary fibroadenomas, and the Cushing syndrome, and an affected brother had acromegaly caused by a growth hormone-secreting tumor of the pituitary gland. Thus, at least one manifestation of the complex of myxomas, spotty pigmentation, and endocrine overactivity has occurred in three successive generations of this family. Both male and female family members were affected, and 5 of the 11 children of affected persons had the disorder. The karyotypes of two affected persons were normal. These observations are consistent with mendelian dominant inheritance of the syndrome.     

A case of occupational allergic bronchopulmonary aspergillosis unique to Japan

A 15-year-old female was diagnosed in 1980 as having allergic bronchopulmonary aspergillosis (ABPA) due to Aspergillus fumigatus based on Rosenberg and Patterson's criteria for the disease. The patient is the eldest daughter of a family of domestic brewers of soy sauce and bean paste in a small village, an occupation unique to Japan. The brewing process involved the use of Aspergillus oryzae as a fermenting agent. The patient had experienced episodic wheezing and pulmonary infiltrates during the same seasons in the previous three years, corresponding to the time of the highest A oryzae spore concentrations in the living area, suggesting high exposure to the Aspergillus spores in the aetiology of her exacerbations. She had a prominent family history of atopy and was demonstrated to be sensitive to a variety of aeroallergens in addition to A fumigatus. She was treated effectively by bronchial toiletting via broncho-fibrescope and theophylline medication until April 1981, when she moved to another city. During her life there, chest X-rays repeatedly showed abnormal shadows, and she was treated with inhalations of amphotericin B and bronchial toiletting several times at a hospital. She returned to her home town after seven years in April 1988 and visited the hospital to check her condition. Although she had been away from heavy exposure to A oryzae spores for seven years, precipitins to the culture medium of A oryzae were demonstrated to be far more prominent than those to A fumigatus antigen. Although her family had been exposed to A oryzae spores continuously, the patient was the only family member with ABPA due to A fumigatus and possibly due to A oryzae.(ABSTRACT TRUNCATED AT 250 WORDS)