Concept analysis of susceptibility

This conceptual analysis of susceptibility used the method described by Walker & Avant (1995) to analyze the attributes, antecedent and consequence of susceptibility. By review and analysis of the related literature we found that the defined characteristics of susceptibility were the following: (1) A person (or a group of people) has some specific characteristics. (2) A person (or a group of people) has a relatively high degree of probability of experiencing influences while being exposed at a certain time point to a certain environment. (3) The changes caused by the influences usually result in some harm to a person (or a group of people). (4) The changes will usually occur within an expected timeframe. The antecedent to susceptibility is that a person (or a group of people) should be exposed to the specific influencing environment. The consequence is an increase in the possibility and level of harm, defect and negative outcome. The person nevertheless retains some ability to control the changes. The article hopes that nursing professionals can precisely apply the results from this conceptual analysis of susceptibility as they provide health care services.     

Empowering sibship analyses with reference pedigrees

BACKGROUND: In sibship analysis, the usual comparison of an alleged (test) sibling's short tandem repeat (STR) types with those of a reference sibling may prove inconclusive. Increasing the number of examined STR loci may not change sibship probabilities very much. We increased the number of verified reference siblings to resolve problematic cases of alleged sibship. STUDY DESIGN AND METHODS: (A) Ten paternity cases were chosen in which there were three highly probable children of each alleged father. Pairs of the alleged father's children were analyzed for full sibship. The test sib with the lowest likelihood of sibship was reanalyzed by a comparison with two reference siblings combined. (B) Five problematic sibship cases are presented to demonstrate how two‐person reference pedigrees can improve diagnosis over tests using one reference person. RESULTS: (A) Two‐person pedigrees exponentially increased sibship probabilities of true siblings above those produced by one reference person. (B) In problem cases, reference pedigrees provided data that: 1) statistically verified some alleged sibships in which analyses using one reference person yielded inconclusive results, 2) allowed exclusion of some alleged sibships, or 3) suggested alternate blood relationships to the alleged one. CONCLUSIONS: Use of reference pedigrees often resolves sibship questions left unsettled by tests using reference individuals. Adding reference relatives is a far more powerful analytical strategy than adding test loci. Whenever possible, verified blood relatives should be incorporated into a reference pedigree to retest an alleged sibling whose initial results were unclear.     

灾后心理救助与情绪变化最近发展区

大灾难过后人们的身心会受到严重创伤,灾后心理救助是缓解这种创伤的重要手段之一。灾后人们通常处于极度的消极情绪当中,根据积极心理学的理论,灾后心理救助的重点不是消除灾民的消极情绪,而是帮助他们在当时的消极情绪状态下仍可以正常地生活。人的情绪影响或变化存在一个最近发展区(ZPD),即个体在受到外在刺激而出现情绪问题时,心理学所能施加的外在影响具有一个特定范围。因此,基于情绪变化ZPD的灾后心理救助主要关注3个方面:①诱导强度要适中;②诱导方式最好采用个体之前较为熟悉的娱乐方式来进行诱导;③诱导的时间最好是在灾难发生过一段时间后。     

Allen's test: a tool for diagnosing ulnar artery trauma

Trauma to the ulnar artery was first reported by Von Rosen in 1934. In more recent years this condition has been termed ulnar-artery thrombosis, hypothenar hammer syndrome or post-traumatic digital ischemia. Trauma to the ulnar artery is caused by the repeated use of the hand as a hammer in order to apply force to an object. Any person who presents with a history of trauma to the hypothenar eminence of the hand should be screened for ulnar artery thrombosis. This screening can easily and quickly be performed by the nurse utilizing the Allen test. Early detection of vascular insufficiency coupled with cessation of chronic trauma may help the client avoid reconstructive vascular surgery.     

Chronic sorrow: analysis of the concept

Emotionally close relationships can be disrupted at any time in the life cycle. When a relationship of attachment is disrupted following an event that renders a loved one forever changed from the hoped-for child or from the known person, recurrent sadness, or chronic sorrow, is a frequently encountered response. The genesis of sadness is one's recognition of a negative disparity between the person who was known prior to the onset of disability (or the imagined, hoped-for child) and the now-disabled person. Though each episode of sadness resolves somewhat over time, renewed recognition of a negative disparity in the disabled loved one triggers sadness again. Besides being recurrent, the sadness of chronic sorrow is also permanent, variable in intensity between situations and persons, and interwoven with periods of neutrality, satisfaction and happiness. The concept is analysed and contrasted with the prevalent model of linear, time-bound grief.     

Gut feelings, intuition, and emotions: an exploratory study

OBJECTIVE: Investigate whether the gut feelings of one person, as measured with an electrogastrogram (EGG), respond to the emotions of a distant person. DESIGN: In a double blind protocol, EGG activity was recorded in an individual relaxing in a heavily shielded chamber while, at a distance, a second person periodically viewed the live video image of the first person along with stimuli designed to evoke positive, negative, calming, or neutral emotions. SUBJECTS: Twenty-six (26) pairs of healthy adult volunteers. OUTCOME MEASURES: EGG maximum values recorded while the distant person was exposed to emotional stimuli were compared to similar values recorded during exposure to neutral stimuli. RESULTS: EGG maximums were significantly larger on average when the distant person was experiencing positive (p = 0.006) and negative (p = 0.0009) emotions, as compared to neutral emotions. Nonparametric bootstrap procedures were employed to evaluate these differences, and the results survive correction for multiple analyses. CONCLUSIONS: EGG activity increases in response to the emotions of a distant person, beyond the influence of ordinary sensory interactions. Relationships commonly reported between gut feelings and intuitive hunches may share a common, poorly understood, perceptive origin.     

Advance directives, best interests and clinical judgement: shifting sands at the end of life

End-of-life issues for clinical practice present complex ethical, moral and legal dilemmas that have been heightened by advances in medical technology enabling a dying patient to be kept alive for longer than ever before. Respect for patient autonomy and dignity are fundamental ethical components that engage in end-of-life decision-making. A mentally competent individual has the absolute right to refuse medical treatment for any reason and a valid advance directive for the refusal of treatment is binding in the event that the person loses capacity. In the incompetent patient, the withdrawal of life-sustaining treatment is based on the 'best interests' test, developed on a model that takes into account the welfare considerations of the person concerned. It is questioned whether the test should be more subjectively based, and accord greater weight to the wishes that might have been in the mind of the incompetent person approaching the end of life. The Mental Capacity Act 2005 (expected to come into force in 2007) provides a statutory framework for the law relating to advance directives, capacity and best interests. This paper examines contemporary issues surrounding end-of-life decision-making against the backdrop of the existing and proposed legal framework.     

Throat culture or rapid strep test?

Clearly, rapid tests for streptococci identification are here to stay, and development of the technology is likely to continue. The most rational use of these tests is to identify streptococcal pharyngitis when patients have severe symptoms or when special situations warrant early detection. Throat culture alone is sufficient for most other patients, and all negative rapid tests should be confirmed by throat culture. Specific antistreptococcal therapy should be initiated if either the rapid test or culture is positive. If the physician decides on the basis of clinical criteria to treat pharyngitis with an antibiotic that covers group A beta-hemolytic streptococci, a rapid test is not necessary. If confirmation of the infection is warranted in these cases, throat culture alone should suffice. No rapid strep test kit clearly outperforms others. With any test, good results depend on the quality of the specimen.     

Chest pain in a young woman

Chest pain in a young person is often caused by chest wall tenderness, associated with mitral valve prolapse, or attributed to psychologic factors. Ischemic cardiac pain may be overlooked because of its rare occurrence in this age group. A 35-year-old woman complained of substernal chest pressure precipitated by exertion and relieved by rest. The symptom had been noted for 15 years. Worsening of the symptom during dancing prompted her to seek medical advice. She had no other illnesses, was taking no medications, was a nonsmoker, and had no family history of coronary disease. Physical examination disclosed a grade 1 (on the basis of 1 to 6) systolic ejection murmur, an ejection click, and a grade 2 diastolic murmur. An exercise test produced symptoms at 4 minutes. Coronary arteriography showed the absence of a left coronary ostium and filling of the entire coronary system from the right ostial injection through collateral vessels from the right coronary artery. Surgical repair was recommended. Operative intervention showed a dysplastic bicuspid aortic valve with a membrane that covered the left coronary ostium. Excision of the membrane reestablished antegrade blood flow to the left coronary system. A follow-up exercise test revealed normal findings. Because chest pain in a young person is rarely ischemic in origin, benign or noncardiac causes are usually considered; however, if the history suggests ischemic pain, the possible presence of unusual cardiovascular abnormalities should not be disregarded.     

Getting personal on overdiagnosis: On defining overdiagnosis from the perspective of the individual person

How can overdiagnosis be defined, explained, and estimated on an individual level? The answers to this question are essential for persons to be able to make informed choices and give valid consents for tests. Traditional conceptions of overdiagnosis tend to depend on counterfactual thinking and prophetic abilities as you would have to know what would happen in the future if you did not test now. To avoid this, overdiagnosis can be defined in terms of the chance of diagnosing a person with a disease when this does not avoid or reduce manifest disease. To be able to relate this to 1's own life and deliberation, I argue that we need answers to specific questions such as the following: If I am tested, and the test and subsequent test results are positive, but I am not treated, what is the chance that I would not experience and suffer from manifest disease? A definition of overdiagnosis that aims at providing answers to this question is as follows: Prospectively overdiagnosis (of an individual person) is given by the estimated chance that a person having a positive test result would not experience and suffer from manifest disease if not treated or followed up in any way. Getting personal on overdiagnosis directs the attention of overdiagnosis estimates towards what matters in medicine: the experience of individual persons.     

A Causal Model of Depression Among Older Adults in Chon Buri Province,Thailand

The purposes of this study are to develop and empirically test a theoretical model that examines the relationships between a set of predictors and depression among older adults. A biopsychosocial model was tested with 317 community dwelling older adults residing in Chon Buri Province, Thailand. A face-to-face interview was used in a cross-sectional community-based survey. A hypothesized model of depression was tested by using path analysis. It was found that the modified model fitted the data and the predictors accounted for 60% of the variance in depression. Female gender, activities of daily living, loneliness, stressful life events, and emotional-focused coping had a positive direct effect on depression. Social support and problem-focused coping had a negative direct effect on depression. Additionally, perceived stress, stressful life events, loneliness, and income had a negative indirect effect on depression through social support. Female gender, activities of daily living, and perceived stress also had a positive indirect effect on depression through emotional-focused coping. Stressful life events, perceived stress, and income had a negative indirect effect on depression through problem-focused coping. These findings contribute to a better understanding of the variables that predict depression in older adults. Thus, health care providers should consider the effects of these contributing factors on depression in the older adult person and can devise a program to prevent and promote health in older adults alleviating depression.     

The death of a patient with AIDS in Turkey: thoughts on the ethical dimensions

A Turkish patient with AIDS attempted to commit suicide. Turkey is one of the countries where AIDS education in society and for health personnel has started rather late. This article documents what this patient, his sister and his friends, who helped him to survive for a short while, experienced in the hospital environment. This is a real case history and should be considered from various aspects because suicide was attempted by a person with AIDS who was near the terminal stage. The patient's friends made a remarkable effort to help him to survive. They were unsure about what to do because they had not respected his wishes and they experienced deep alienation because of the extremely negative attitude of the medical staff.     

Safety of immediate treadmill testing in selected emergency department patients with chest pain: A preliminary report

To determine the feasibility and safety of an immediate, symptom-limited, treadmill test on selected emergency department (ED) patients, a convenience sample of 28 patients underwent an exercise treadmill test (ETT) within the first several hours after hospital arrival using the modified Bruce protocol. Patients were included in the study if they presented with otherwise unexplained chest pain consistent with (but not characteristic for) angina pectoris and had a normal electrocardiogram. A negative ETT was seen in 23 of 28 patients, and five of 28 patients had a positive ETT. No patients had serial enzyme or electrocardiogram evolution suggestive of myocardial ischemia, and all patients with a negative ETT were discharged after a full inpatient evaluation designed to rule out unstable coronary disease. At a mean follow-up period of 6.1 months there has been no cardiac morbidity or mortality in the patients with negative ETTs. It was concluded that early ETTS of selected ED patients with chest pain is safe, and an exercise test administered during the ED visit which is negative can preclude unnecessary hospitalization.     

A causal model of depression among older adults in Chon Buri Province, Thailand

The purposes of this study are to develop and empirically test a theoretical model that examines the relationships between a set of predictors and depression among older adults. A biopsychosocial model was tested with 317 community dwelling older adults residing in Chon Buri Province, Thailand. A face-to-face interview was used in a cross-sectional community-based survey. A hypothesized model of depression was tested by using path analysis. It was found that the modified model fitted the data and the predictors accounted for 60% of the variance in depression. Female gender, activities of daily living, loneliness, stressful life events, and emotional-focused coping had a positive direct effect on depression. Social support and problem-focused coping had a negative direct effect on depression. Additionally, perceived stress, stressful life events, loneliness, and income had a negative indirect effect on depression through social support. Female gender, activities of daily living, and perceived stress also had a positive indirect effect on depression through emotional-focused coping. Stressful life events, perceived stress, and income had a negative indirect effect on depression through problem-focused coping. These findings contribute to a better understanding of the variables that predict depression in older adults. Thus, health care providers should consider the effects of these contributing factors on depression in the older adult person and can devise a program to prevent and promote health in older adults alleviating depression.     

A rapid latex agglutination test for detection of elevated levels of myoglobin in serum and its value in the early diagnosis of acute myocardial infarction

A latex agglutination test for detection of elevated levels of myoglobin in serum has been studied, and its clinical value in diagnosis of acute myocardial infarction (AMI) has been evaluated on a retrospective material of fifty-five patients consecutively admitted to hospital on suspicion for AMI within 4 h after onset of symptoms. The analysis time was less than 10 min. There was no evidence of interference with other related proteins, as judged from analysis of sera with high content of aspartate and alanine aminotransferase, lactate dehydrogenase and creatine kinase, nor was the test sensitive to haemolysis. However, unspecific agglutination was seen with some sera containing a high concentration of rheumatoid factors. In sera with known concentrations of myoglobin, quantitated by a radioimmunoassay, the test was negative in all sera below 80 micrograms/l (n = 187), and positive in all sera above 140 micrograms/l (n = 209). In the range 80-140 micrograms/l the latex test could be either positive or negative (n = 105). The day-to-day reproducibility was high in the ranges below 80 micrograms/l and above 140 micrograms/l, but range 80-140 micrograms/l. In the diagnosis of AMI the predictive value of a positive result was 0.64, and the predictive value of a negative result was 1.0. The latex agglutination test is therefore clinically useful as an emergency test, and as a very early and sensitive indicator for AMI. Patients with a negative test result during the first 12 h after debut of symptoms can with great certainty be identified as not suffering from AMI, whereas patients with a positive test result should be monitored by further laboratory analyses.     

Promoting nutrition in older people in nursing and residential homes

Malnutrition and dehydration are serious and common problems among older people in nursing and residential care homes. The situation is exacerbated because staff may not be trained to recognize the signs and symptoms of malnutrition and dehydration and hence opportunities for early intervention are missed. A nutrition assessment should form part of the admission process to identify whether an individual has, or is at risk of developing, malnutrition and dehydration. This article suggests key questions that should be asked to assist this process. The individual and organizational risk factors that affect nutrition and health status are discussed, and practical suggestions given to help address any problems recognized. The causes and consequences of dehydration are explained and practices that place an individual at risk of dehydration considered. Suggestions are given to help identify when a person is not drinking sufficiently so that early rapid intervention can be initiated. Helping an older person to eat and drink independently is a practical activity that is often undervalued. Its importance needs to be recognized in all nursing and residential care settings.     

Ambulante Versorgung chronisch Schmerzkranker. Ein Stück Lebensqualität

The care of severely ill patients, whether in hospital, in residential homes or in their own homes, should be characterized by humanity and dictated by efforts to make life worth living for the person concerned. Preservation of the quality of life should be paramount if the doctor can no longer effect a cure. Being cared for at home in the domestic setting is an enhancement of the quality of life in itself. A change in surroundings and in the daily round is particularly burdensome for a person who is ill. Close contact with members of the family and with friends and neighbours is particularly important in this phase of life. A sick person's quality of life is what the legislator had in mind when domiciliary care was given priority over residential care at the time of the legal changes to reform the health care system.     

Caregiver perceptions of accomplishment from assisting people with multiple sclerosis

Objectives: Identify factors of informal caregivers, caregiving, and people with multiple sclerosis (MS) receiving assistance that are associated with perceptions of caregiver accomplishment. Methods: National data were collected in a telephone interview survey of 530 informal caregivers and analyzed using an ordered logistic regression model to identify factors associated with perceptions of caregiver accomplishment among 442 of these informal caregivers (caregivers providing all data in their survey responses needed for the regression model). Results: We found that age of the person with MS and duration of caregiving measured by the number of hours per week the caregiver assisted the person with MS were significantly linked to positive perceptions of accomplishment. Conversely, the caregiver’s perception that assisting the person with MS was emotionally draining, a spousal relationship, and caregiver education levels were significantly associated with negative perceptions of accomplishment. Conclusions: Health professionals treating people with MS and their caregivers should be sensitive to the impact caregiving has on the emotional needs of caregivers and to the unique support needs of spousal caregivers. Health practitioners also should be sensitive to the variety of benefit-finding themes expressed by caregivers to facilitate the caregivers’ efforts to discover gains in their experiences assisting people with MS, such as perceptions that caregiving provides a sense of accomplishment.

Implications for Rehabilitation

• Assistance from informal caregivers enables people with multiple sclerosis to remain in their homes as their functional dependence becomes more permanent and their need for personal assistance increases.

• Caregiver perceptions that assisting the person with multiple sclerosis was emotionally draining and a spousal relationship were significantly associated with negative perceptions of accomplishment.

• Health professionals who treat informal caregivers, as well as health professionals treating people with multiple sclerosis, should be sensitive to the impact care giving has on the emotional health of caregivers, especially spousal caregivers.

     

Promoting safer home environments for persons with Alzheimer's disease. The Home Safety/Injury Model

This article describes a Home Safety/Injury Model derived from Social Cognitive Theory. The model's three components are safety platform, the person with dementia, and risky behaviors. The person with dementia is in the center, located on the safety platform composed of the physical environment and caregiver competence. The interaction between the underlying dementia and indicators of frailty can lead to the person with dementia performing risky behaviors that can overcome the safety platform's resources and lead to an accident or injury, and result in negative consequences. Through education and research, the model guides proactive actions to prevent risky behaviors of individuals with dementia by promoting safer home environments and increased caregiver competence.