Parents' experiences of general hospital admission for adults with learning disabilities

General hospital care for people with learning disabilities is strongly emphasized in recent health policy. Ten sets of parents were interviewed about their experiences of general hospital inpatient care for their adult sons and daughters with learning disabilities. Findings in the areas of placement, occupation, basic nursing care, feeding, toileting, nursing attitudes, staffing and procedures are presented. Recommendations are made for changes to reported nursing practice to improve the quality of general hospital care for people with learning disabilities.     

Cooperation between hospital and general practice in multipractice studies. Personal experiences from a study on early diagnosis for gastric cancer

In this study close cooperation between general practice and out patient clinic made it possible to establish earlier diagnosis of serious disease using advanced diagnostic methods on patients seen only in general practice. However, the cooperation established in an attempt to diagnose gastric cancer at an early stage using endoscopic technique revealed major practical problems. It was difficult to make exact calculations of the background population because of the degree of the patients' right to choose a general practitioner. Furthermore, referral of all patients wanted for investigation proved a major obstacle, because of differences in workload and lack of understanding of scientific principles among the participating general practitioners. The desired cooperation between general practice and out patient clinics cannot easily be established in a way which gives us exact and scientifically reliable data, and such cooperation-for scientific purposes--can only involve smaller groups of doctors. However, the education of general practitioners in scientific methods and understanding, and hospital doctors in knowledge about the consequences of working conditions in general practice should be considerably improved.     

Therapy of arterial hypertension with verapamil hydrochloride in patients after myocardial revascularization

Verapamil hydrochloride, a calcium blocker from a group of phenyl alkylamines, was tested for its effect on central hemodynamics (CH) and blood oxygen-transporting function (BOTF) in 14 patients with arterial hypertension after surgical myocardial revascularization. CH and BOTF were studied by using a Swan-Hanz catheter and directly measuring blood pressure (BP). There was a significant reduction in BPmean, total peripheral vascular resistance index, left ventricular stroke outcome index, and oxygen delivery index. Verapamil in an average dose of 80.4 +/- 18.02 mg at the injection rate of 24.6 +/- 3.9 micrograms/kg/min was shown to make BPmean normal 16.8 +/- 6.35 min later. The agent is comparable with other calcium blockers, such as nifedipine and isradipine in its action on CH and BOTF, as well as in its efficiency and safety.     

Direct revascularization of the myocardium and left ventricular diastolic function in patients with ischemic heart diseases

Echocardiography (echo-CG) and stress-doppler echo-CG were performed in 78 patients with ischemic heart disease (IHD) before and 1 to 8 years after the operation of direct myocardial revascularization (DMR). Polyposition coronarography with shuntography was used as a reference method. After DMR, stress-doppler echo-CG showed in capable shunts (vs resting values) that in insignificant reduction of early filling maximal rate (73.6 +/- 4.2 cm/s and 68.8 +/- 3.1 cm/s, respectively) the rate of late filling lowered significantly (64.7 +/- 4.5 cm/s and 58.1 +/- 3.9 cm/s, respectively), time of early filling inhibition (0.24 +/- 0.02 s and 0.18 +/- 0.04 s, respectively) and time of isovolumic relaxation (104.2 +/- 1.5 ms and 100.1 +/- 1.2 ms, respectively). An opposite picture was observed in patients with occlusive shunts. Thus, improvement of left ventricular diastolic function in IHD patients after aortocoronary bypass operation occurred only in capable shunts. Time course changes in the readings of stress-doppler-echoCG can indirectly characterize shunt function after DMR.     

Nurses' experiences of caring for South Asian minority ethnic patients in a general hospital in England

Healthcare provision for minority ethnic groups in the UK has generally revealed inequalities in access and differential service provision. British healthcare policy has started to address such issues. However, very few studies have specifically examined the experiences of nurses caring for minority ethnic patients. This paper focuses on the focus group interviews of a broader ethnographic study, aimed at describing nurses' experiences of caring for South Asian minority ethnic patients, in a general hospital in the south of England. A sample of 43 nurses of all grades from six medical wards took part in the focus groups: three ward sisters, 22 staff nurses and 18 care assistants; 40 participants were white, one was African-Caribbean and two were South Asian. Data analysis revealed eight themes: changes in service provision; false consciousness of equity; limited cultural knowledge; victim blaming; valuing of the relatives; denial of racism; ethnocentrism, and self-disclosure. The study revealed a good local service response to government policies in addressing inequality. However, there was a tendency to treat all minority ethnic patients the same, with evidence of ethnocentric practices, victim-blaming approaches and poor cultural competence in nursing staff, which raise questions about the quality of service provision. The study indicates that ongoing training and development in the area of cultural competence is necessary.     

Adrenergic innervation of the myocardium in patients with cardiac syndrome X]

11 syndrome X patients and 8 healthy controls were investigated by myocardial scintigraphy (SPECT) with 123-I-MIBG. Regional defects in cardiac 123-I-MIBG uptake were found in 90% syndrome X patients. Total cardiac 123-I-MIBG uptake appeared significantly higher in syndrome X patients. Perfusion defects on stress 99m-Tc-MIBI scintigraphy were found in 10 syndrome X patients who had also abnormal 123-I-MIBG scintigrams. It is suggested that impairment of efferent cardiac adrenergic nerve fiber function in syndrome X patients may contribute to pathophysiologic and clinical features of syndrome X.     

Experiences with early fibrinolysis in coronary infarct at an acute care hospital. Second report of experiences with 200 patients 1980 to 1985

Over the past two decades patients with acute myocardial infarction have been treated with intravenous streptokinase therapy at the hospital in Geldern. Based on experiences in the first study from 1970 to 1979, the second study emphasized instruction on early thrombolytic therapy. Informations were given to general practitioners and to patients at risk for acute myocardial infarction. In the study from 1980 to 1985 the percentage of patients with acute myocardial infarction being treated with thrombolytic agents within two hours after the acute event was 69%. Patients with a duration of ischemia of less than two hours had a significantly decreased in-hospital mortality compared to patients who received therapy more than two hours after onset of symptoms. We conclude that intensified information and instruction of physicians and of patients at risk for myocardial infarction enables early thrombolytic therapy and results in reduced in-hospital mortality of acute myocardial infarction.     

Results of early rehabilitation treatment of patients with ischemic heart disease with cardiovascular failure after surgical revascularization of the myocardium

AIM: To estimate effects of early 12-month combined rehabilitation treatment on modification of risk factors, cardiorespiratory reserve and physical performance in IHD patients with cardiovascular failure (CVF) initiated 2-4 weeks after surgical revascularization of the myocardium. MATERIAL AND METHODS: 87 IHD patients (mean age 61.3 +/- 8.6 years) of NYHA functional class I-III were divided into 4 groups by K.T. Weber, J.S. Janicki criteria. The tests were made before and 12-week after the rehabilitation. RESULTS: The rehabilitation program proposed by the authors modified risk factors, cardiorespiratory reserve and physical performance. Early multimodality rehabilitation treatment with individually adjusted aerobic exercise in IHD patients with CVF after surgical revascularization of the myocardium raises cardiorespiratory reserve and exercise tolerance. Adaptation reserves enhanced more in patients with the lowest values of the above parameters. The 12-week program of rehabilitation did not reduce overweight significantly. CONCLUSION: Physical exercise is indicated to all the patients after surgical revascularization of the myocardium in individual doses. Modification of the risk factors should be continued.     

Oxidative stress before and after exercise conditioning in patients following surgical revascularization of the myocardium

The main purpose of the study was to evaluate changes in the extent of oxidative stress and its associations with the indices of cardiorespiratory reserve and functional capacity in 35 patients enrolled in a 12-week exercise conditioning programme 2-4 weeks after surgical revascularization of the myocardium. The following markers of oxidative stress were measured spectrophotometrically before and after the programme: lipid peroxidation products (thiobarbituric acid reactive substances, diene conjugates and lipid hydroperoxide) and markers of blood antioxidant status (blood glutathione markers, blood antioxidative capacity and lag phase of low-density lipoprotein (LDL)). To evaluate the functional indices of the cardiorespiratory system the patients underwent bicycle cardiopulmonary testing before entering and after completing the programme. On the basis of peak oxygen consumption (peak VO2) +/- 1 SD, three subgroups with different aerobic capacity were identified: >/=19 ml/min per kg (GR I, n = 7), 11-19 ml/min per kg (GR II, n = 24) and 相似文献