Visiting rights only: the diplomas in nursing in the UK in the interwar period

The aim of this article is to explore the institution and organisation of the diplomas in nursing at the universities of Leeds and London, which were established in 1921 and 1926, respectively. It will be argued that the success of these courses for the individuals who undertook them, and the profession as a whole was ultimately limited. It is accepted that the purpose of the diplomas was at least in part for the nursing elite to maintain their grip on the leadership. Nevertheless, the institution of the courses, when few women in general attended university, identifies a 'radicalness' within the profession, which has rarely been considered. Moreover, that there was a body of nurses capable of university level education challenges previous assumptions.     

Pitfalls in the Care of the Psychiatric Patient in the Emergency Department

Background

Care of the psychiatric patient in the Emergency Department (ED) is evolving. As with other disease states, there are a number of pitfalls that complicate the care of the psychiatric patient.

Objective

The purpose of this article is to update Emergency Physicians concerning the pitfalls in caring for the psychiatric patient, and possible solutions to deal with these pitfalls.

Discussion

The article will address the burden of the psychiatric patient, staff attitudes, medical clearance process, treatment of the agitated patient, suicidal patients, and admission decisions.

Conclusions

Alternative care resources, collaboration with Psychiatry, staff education, improvement in the medical clearance process, proper use of restraint and seclusion, and appropriate choice of medication for agitated patients can help avoid some of the top pitfalls in the care of the psychiatric patient in the ED.     

Choosing the choices in the USA: examples in the maternity area

The concept of choice has featured prominently in both the recent united Kingdom (UK) health care reforms and in the debate relating to the care of childbearing women. An invitation to the USA facilitated contemplation of the health care system on which the recent UK reforms have been modeled. The impact of the health system on mother's choices was a source of particular interest. The implications for midwives, their practice and their relationships with their clients and colleagues emerge clearly. It may be that the United States' model of health care does not answer the needs of the UK.     

Changes in the parameters of the rhythms of the electrolyte-excreting function of the kidneys in women in relation to the seasons of the year

The characteristics (period, mesor, amplitude) of the rhythms of urinary excretion of sodium, potassium, chlorine, calcium, magnesium, and phosphorus were examined in normal women during various seasons. The urine was collected for 5 days with 4-hour intervals. The rhythms were detected and their parameters established with the use of mathematical methods for the assessment of the tested curve fragments repetitions and by the least squares nonlinear method. The rhythms of renal urinary and electrolyte excretion were found very smooth, particularly so in the fall and winter. The circadian rhythms have been found the most stable during all the seasons. Examinations of individual electrolyte excretion have shown that Na and K excretion is more stable all the year round and therefore this parameter is the most informative for the detection of disorders in renal electrolyte excretion.     

Change in the drug-metabolizing function of the liver in patients in the postoperative period in relation to the type of anesthesia]

Anesthesia-dependent changes in pharmaco-metabolic liver function have been studied in patients operated on for cosmetic facial defects. It has been established that the postoperative period in patients subjected intraoperatively to general combined anesthesia and controlled lung ventilation was characterized by inhibited drug metabolism in the liver, which required correction of the drug doses to reduce the risk of side and toxic effects of pharmacotherapy. Patients operated on under local procaine anesthesia had no considerable changes in pharmaco-metabolic liver function in the postoperative period.     

Health in the USSR in the era of Perestroika

For years, the Health Service of the USSR was considered a model and a guide. Countries in the Third World were invited to follow its various elements in organizing their own national health systems. But, since August 1987, everybody has known that the Health Service of the USSR is in a very bad situation. Official reports, journals of the Party and declarations of the health authorities all emphasized the catastrophic state of the health care organization in USSR: rising mortality rates, alcohol and drug abuse, extensive pollution, hospitals without hygiene or equipment, lack of professionalism and extended corruption among medical doctors and other health workers, patients' dissatisfaction etc... Of special concern are the cardiovascular and maternal mortality rates which are now much higher than in other countries. In the wake of perestro?ka, a plan of reform was initiated by the Party and the Government, and was announced in 1988 by Health Minister E.N. Tchazov. The basic principle of the Health Service in the USSR remains prevention. Nevertheless, a great number of new measures will be implemented. Health information and care will be brought to the people by health workers. Mass screening for the most frequent diseases will be performed. Computers will be used on a large scale for managing high risk groups. Health centers will be strengthened. But the most revolutionary element of the reform will be the extension of the "paying sector", with increased number of facilities having financial autonomy. These facilities provide care and require some payment from the patients. They existed previously, but in the future they will be increased and strengthened. This means that the patients will have to pay more money but the services will be likely improved. The future will show whether the plan will succeed or fail.     

Voluntary breath-holding in the morning and in the evening

The aim of the present study was to determine whether or not voluntary breath-holding time (BHT) changes with the time of the day. BHT with airways closed at end-expiration was measured in six male subjects in the sitting position during the morning (08.00-12.00 hours, on days 1, 6, 7 and 8) and evening (20.00-24.00 hours, on days 2 and 4). BHT increased with the number of days of testing and, at day 8, the morning values averaged 160% of those on day 1. Also, Delta P ACO2 [the difference between end-tidal partial pressure of CO2 ( P CO2) and alveolar P CO2 ( P ACO2) at the breaking point] increased in proportion to BHT. Hence the BHT/Delta P ACO2 ratio remained nearly constant. Voluntary hyperventilation prolonged BHT and increased Delta P ACO2. Conversely, in hypoxia (13% O2 for 1-2 h), BHT and Delta P ACO2 were reduced proportionally. During the evening sessions, most of the BHT/Delta P ACO2 ratios in normoxia, hypoxia or after hyperventilation were higher than the corresponding morning values, with the group difference reaching statistical significance for the measurements in normoxia and hypoxia. In conclusion, voluntary BHT varies in both duration and its relationship with Delta P ACO2 between the morning and evening hours. The results should also imply that, with an interruption of breathing, changes in alveolar and arterial gases are not the same at different times of the day.     

On the Mechanism of the Splay in the Glucose Titration Curve in Advanced Experimental Renal Disease in the Rat

Glucose titration studies were performed in rats with unilateral chronic pyelonephritis before and after removal of the contralateral control kidneys. Identical studies were performed in animals with unilateral partial renal infarction in which the experimental kidneys had a marked reduction in nephron population but no anatomic deformation in the surviving nephrons. In the initial studies, both groups of animals were free of clinical and chemical abnormalities of uremia. In the follow-up studies uremic abnormalities were present. Minimal splay was observed in the titration curves in the initial studies; marked splay was present in the group data from the same kidneys in the subsequent studies. Thus a marked reduction in the nephron population was associated with the evolution of splay in both groups of animals. In association with the increase in splay, the mean values for maximal glucose transport increased; thus a defect in glucose transport can be excluded as the basis of the splay. Glomerular filtration rate increased proportionately more than the maximal transport of glucose; hence the ratios of glomerular filtration rate to maximal glucose transport increased consistently. The possibility of asymmetric hypertrophy of glomerular and tubular functions among the nephron population imposed by scar tissue or other anatomic deformities was considered, but the results in the animals with partially infarcted kidneys militate against this explanation. The splay also could reflect an asymmetric alteration in the distribution of glomerulotubular balance among the residual units initiated by functional adaptations. Finally, the splay could relate to an alteration in the kinetics of glucose transport without any change in the level of functional homogeneity. The possible nature of these has been considered in the text.     

Glutamine metabolism in the brain and in the liver in critical conditions

Experiments on cats and rats have established that critical conditions caused by acute hemorrhage, hepatotoxin, and hepatectomy lead to ammonia accumulation in the brain and liver due to the predominance of decay of glutamine over its formation in these organs. With this, the depressed formation of glutamine is a universal cell response to a pathogenic agent whereas a change in glutamine deamination in disease depends on both the nature of a pathogenic agent and the organ wherein this reaction occurs.     

2020年度输血医学科研新进展

随着科研的发掘以及各种新技术新材料在输血医学领域的交叉和应用,输血医学的内容每一年都在不断被补充和完善.本文总结了2020年度输血医学相关重要研究进展.     

疗养护理病历存在的缺陷分析及防预对策

目的调查疗养护理病历存在的缺陷,探求提高护理疗案质量的改进措施。方法对2002年10月至2004年10月的护理病历检查结果进行归纳分析。结果医嘱记录单存在的质量缺陷146次,一般护理记录单存在的质量缺陷142次,体温单存在的质量缺陷68次。结论注重护士的在职培训、实施有效的监督管理是护理疗案质量的保障。