A comparison of mite populations in mattress dust from hospital and from private houses in Cardiff, Wales.

Fifty mattress dust samples from private houses were examined--all were mite infested. Dermatophagoides pteronyssinus occurred in all samples and accounted for 81% of all mites. In thirty-two paired samples the total mite population of bedroom floor dust was only 10% of that found in the corresponding mattress dust. D. pteronyssinus was the dominant species in both and the population of this mite amounted to 7-5% of that found in the mattress dust. An analysis of mattress dust from 100 hospital beds showed that ninety-four mattresses were mite free; the other six contained only seven mites, all D. pteronyssinus. It is suggested that frequent changing and washing of bed linen and brushing and cleaning of mattresses were the main factors in preventing mite infestation in the Cardiff hospitals.     

近似熵和互近似熵脑电非线性分析在意识障碍评价中的应用

目的:利用近似熵和互近似熵脑电非线性分析方法评价意识障碍程度,研究其非线性动力学特性的变化规律.方法:本研究病例组由30例严重颅脑外伤或卒中的意识障碍患者组成,所有患者经临床以及神经电生理方法评估.30例正常意识状态的腩损伤患者作为对照组.所有患者依次采集安静闭眼、声音刺激和痛觉刺激三种状态下的脑电信号,并计算脑电信号的近似熵和互近似熵非线性指数.结果:三种状态下,病例组的非线性指数均明显低于对照组.对照组在声音刺激和痛觉刺激状态下,近似熵和互近似熵非线性指数明显高于安静闭眼状态.病例组声音刺激和痛觉刺激与安静闭眼状态相比,脑电非线性指数几乎无变化.结论:近似熵和互近似熵非线性指数均能够直接用于评估意识障碍患者大脑皮质受抑制的程度.互近似熵能够同时反映大脑功能活动在时间上和空间上的变化特点,脑电非线性分析能提供有关意识觉醒和知晓水平的信息.     

A patient-focused evaluation of breast care nursing specialist services in North Wales

Background to the study: Breast care services for Wales have developed in response to government requirements that breast cancer care should be delivered only by specialist multi-disciplinary teams in cancer units treating at least 100 new breast cancer patients per year.Study aims: This paper presents the findings of the third stage of a three-stage project. The aim of this phase of the study was to evaluate the Breast Care Nursing Specialist (BCNS) service from the patients’ perspective.Methodological issues: A postal questionnaire was distributed to women with breast cancer who had experienced the BCNS service (n=172). The questionnaire included a 4-point, 28-item Likert scale as well as open and closed questions.Findings/conclusion: The findings revealed positive perceptions of the value of the BCNS service, particularly in relation to support around the time of diagnosis. Areas requiring improvement included meeting information needs of women with breast cancer, availability of BCNSs, and providing emotional support to family members and to women in the longer term as well as providing practical care. It is concluded that increasing the numbers of BCNSs, and providing training in counselling as well as access to information and how this can be shared with women, would do much to address these deficits in service provision.     

The evaluation of a national interprofessional palliative care workshop

Abstract

The purpose of this study was to evaluate the impact of a palliative/end-of-life care workshop on students’ perceptions of professional identity, team understanding, and their readiness for interprofessional education (IPE). A before-and-after design was used combining both qualitative and quantitative methods. A survey was completed by 25 undergraduate students from a variety of health care professional schools across Canada, both before and after they attended the five-day workshop. There was a significant increase in students’ readiness for IPE, perceptions of professional identity, and team understanding after they attended the palliative care workshop. Students stated that learning about other professionals’ backgrounds and becoming more sensitive to other team members and their scopes of practice helped change the way they would practice. The findings from this study will contribute to our understanding of student attitudes around IPE and palliative care.     

A phenomenological study of medically induced unconsciousness in intensive care.

Critically ill patients who require mechanical ventilation in intensive care units (ICUs) are usually sedated with drugs such as Morphine and Midazolam in order to facilitate ventilation, relieve pain and lower metabolic demands. Participants in this research were sedated to the point of 'medically induced unconsciousness' in that they were non eye opening nor responsive to verbal directives. A purposive sample of five individuals who had experienced the phenomenon of 'medically induced unconsciousness' were interviewed indepth. These interviews were transcribed verbatim and then analysed using a Husserlian phenomenological approach. Three essences were revealed within the data, each with associated themes. These essences were utter helplessness, cognition and succour. Utter helplessness was linked to: an inability to communicate either verbally or physically; pain during procedures; a sense of threat to personal safety; depersonalisation; loss of control and a sense of loneliness. Rather than an alteration of cognition, the themes that emerged within this second essence revealed attempts by participants to understand the experiences associated with 'medically induced unconsciousness'. These themes were: dreams; dissociation of self from the physical body; time-space relatedness and chaos. The final essence to emerge was that of succour. This essence portrays some of the more positive aspects of the experience. The themes revealed were: security in the ventilator; comfort in voices; human presence; painfree and purpose. Participants in this study were experiencing many things as they lay unresponsive on their beds in the ICU. The absence of physical responses should not be misinterpreted to mean that cognitive processes are not occurring. Participants appeared to be attempting to make sense of their immediate environment through their dreams.     

Cultural sensitivity training: description and evaluation of a workshop

We describe the materials used to develop cultural sensitivity within 350 nursing students. These involved a lecture on dimensions of difference between east and west, exercises on names and early memories and the construction of a cultural genogram. In addition, we report the results of an evaluation study which was both quantitative and qualitative. The questionnaire data indicated that the workshop was useful and clear. Using IPA analysis, the interview data indicated seven major themes: a close, safe space in which to talk, increased cultural awareness, freedom to inquire, awareness that cultural self-knowledge is essential for developing cultural sensitivity, impact of cultural sensitivity training on professional work with people, limitations and suggestions for future workshops and wanting more workshops in a similar vein. Second stage IPA analysis indicated four levels of cultural sensitivity: 'Them', 'Us and Them', 'We' and 'Transcendent'. Integrating the findings of both the qualitative and the qualitative data, we conclude that the workshop was highly appreciated and that there is a demand for more training in this area. Implications for further training in cultural sensitivity are considered.     

A Therapeutic Day Programme for problem substance users in Cardiff and the Vale of Glamorgan: development and client-centred evaluation

As a result of the on-going evaluation of mental health service provision for problematic substance users, the Community Addiction Unit set up a structured day programme focusing on key psychosocial elements relevant to preventing relapse in this client group. We provide here an overview of the process involved in the development of this new service and details of a client-orientated service evaluation (rather than an outcome-orientated assessment) performed since its inception. Results of the evaluation indicate an overall improvement in the relevance of the sessions to these clients, an increased perception of service quality and an enhanced atmosphere conducive to participation within the programme sessions. Key areas for future development are identified as issues of client preparation prior to commencing the programme. Further, attracting and retaining male and female drug clients has been shown to be an area that warrants attention. The Therapeutic Day Programme offers problematic substance users a research-based and effective service, worthy of continuation, further development and outcome evaluation.     

An interprofessional train-the-trainer evidence-based practice workshop: Design and evaluation

Abstract

Evidence-based practice (EBP) is a core skill of health professionals and one that is regularly taught in health sciences programs. This report covers the design and results of an interprofessional EBP workshop at a large university aimed at improving faculty’s confidence in practicing and teaching EBP. The two-day workshop was designed by the University’s Health Sciences Libraries and emphasized small-group work, with the first day focused on critical appraisal and searching and the second on effective teaching strategies. Twenty-five faculty from the schools and colleges of Medicine, Nursing, Pharmacy, Dentistry, and Veterinary Medicine and the Center for Allied Health Programs attended this study. Nine faculty and librarians served as instructors. Attendees rated the workshop and individual lectures highly and reported that it improved their ability to both practice and teach EBP. In addition, they reported a preference for learning in an interprofessional environment. This report suggests that a short EBP workshop can improve faculty members’ self-reported confidence and ability to practice and teach core EBP skills.     

Prolonged unconsciousness in a patient on automated peritoneal dialysis.

A 79-year-old man with end-stage renal disease treated by automated peritoneal dialysis was referred to the emergency department for altered consciousness. The first investigations, including toxicology screening, failed to reveal the precise etiology. The patient was treated for a possible seizure. After the progression of central nervous system depression with bradypnea, the patient was intubated and mechanically ventilated. It appeared later on that he had ingested by mistake one of his wife's medications, baclofen. Baclofen was detected in the blood sampled on admission at a level above the therapeutic range. Baclofen is mainly excreted by the kidney. A short-term administration of low-dose of baclofen is not effectively removed by peritoneal dialysis and may result in prolonged but reversible coma.     

Report from the 2nd workshop on quantitative evaluation of metabolism in the intact liver

Around 35 participants took part in one-and-a-halfday's presentations and discussions of on-going research.     

脑电非线性分析在意识障碍监测中的应用

目的：探讨意识障碍患者脑电非线性动力学特性的变化规律,应用脑电非线性分析来定量评估其意识障碍程度。方法：本研究包含30例严重颅脑外伤或卒中的意识障碍患者,所有患者格拉斯哥昏迷评分量表（GCS）评分≤8分。依次采集患者安静闭眼、声音刺激和痛觉刺激三种状态下的脑电信号,并计算了三种状态下的脑电信号的关联维数、近似熵和复杂度非线性指数。结果：安静闭眼状态下,关联维数、近似熵和复杂度非线性指数分别保持在2.84、0.53、0.26的低水平,声音刺激和痛觉刺激与安静闭眼状态相比,脑电非线性指数几乎无变化。结论：脑电非线性分析能够实时监测和直接度量意识障碍患者大脑皮质受抑制的程度。脑电非线性指数监测有可能成为一种观察临床促醒措施疗效的新检测手段。