Analysis of the relation between the evaluation and the passed rate of health education

Wechosetheevaluationofhealtheducationfrompatientstonursesasthemethodofnursingcaremanagement，andanalyzedtherelationbetweentheevaluationandthepassedrateofhealtheducation．Nowwesummarizethemasbelow．１Subjectsandmethods１．１SubjectsThepatientswerecamefromtworegionsinde－partmentofinternalmedicinefromSeptember１９９８toDecember２０００．Theirageswerefrom１８to５５．Theyallhadelementaryorsecondaryeducation，andwerefarmerorworker．TheyreceivedIIGradenursingcareandhadnohandicapincommunications…     

Guidelines--for the obedience of fools and the guidance of wise men?

Guidelines for medical management are now part of medical life. A fool--loosely defined as someone who does not know much about a particular area of medicine--will do well to follow guidelines when treating patients, but a wise man (again, loosely defined as someone who does know about the disease in question) might do better not to follow them slavishly. The problem is that the evidence on which guidelines are based is seldom very good. Clinical trials have a variety of problems which often make their relevance to 'real world' medicine dubious. The interpretation of trial results depends heavily on opinion, and a guideline that purports to be evidence based is actually often opinion based. A guideline will depend on the opinions of those who wrote it, and the wise man will use his judgement and give due weight to his own opinions and expertise.     

Relation research of the expression and function of VEGF and its receptor

VEGF stimulates the formation of vessle and proliferation of endothelial cells．VEGF and its rece ptor，FLK －１have the function of chemotaxing and division．Now ，it is well known that VEGF is involved in growth and metastasis of a number of experimental tu－mors［１］．Neuroblastoma is characterized by higher malignace，early metastasis，abundant vessels．The mechanism of its high malignace is not clear now．We detected expressio n and distribution of VEGF and its receptor in neruob…     

Test–retest reliability and comparability of paper and computer questionnaires for the Finnish version of the Tampa Scale of Kinesiophobia

Objectives

To estimate the internal consistency, test–retest reliability and comparability of paper and computer versions of the Finnish version of the Tampa Scale of Kinesiophobia (TSK-FIN) among patients with chronic pain. In addition, patients’ personal experiences of completing both versions of the TSK-FIN and preferences between these two methods of data collection were studied.

Design

Test–retest reliability study. Paper and computer versions of the TSK-FIN were completed twice on two consecutive days.

Participants

The sample comprised 94 consecutive patients with chronic musculoskeletal pain participating in a pain management or individual rehabilitation programme. The group rehabilitation design consisted of physical and functional exercises, evaluation of the social situation, psychological assessment of pain-related stress factors, and personal pain management training in order to regain overall function and mitigate the inconvenience of pain and fear-avoidance behaviour.

Results

The mean TSK-FIN score was 37.1 [standard deviation (SD) 8.1] for the computer version and 35.3 (SD 7.9) for the paper version. The mean difference between the two versions was 1.9 (95% confidence interval 0.8 to 2.9). Test–retest reliability was 0.89 for the paper version and 0.88 for the computer version. Internal consistency was considered to be good for both versions. The intraclass correlation coefficient for comparability was 0.77 (95% confidence interval 0.66 to 0.85), indicating substantial reliability between the two methods.

Conclusion

Both versions of the TSK-FIN demonstrated substantial intertest reliability, good test–retest reliability, good internal consistency and acceptable limits of agreement, suggesting their suitability for clinical use. However, subjects tended to score higher when using the computer version. As such, in an ideal situation, data should be collected in a similar manner throughout the course of rehabilitation or clinical research.     

Influence of the route of exposure and the matrix on the sensitisation potency of a major cows’ milk allergen

Background

Allergic sensitisation to food may occur through non-gastrointestinal routes such as via skin or lung. We recently demonstrated in mice that cutaneous or respiratory pre-exposures to peanut proteins on intact epithelia induce a Th2 priming and allow subsequent oral sensitization without the use of adjuvant. We then aimed to assess the impact of a similar pattern of exposure to another relevant food allergen, cows’ milk.

Findings

The humoral and cellular immune response induced in BALB/cJ mice after repeated cutaneous applications on intact skin or after intranasal administration of cows’ milk proteins was analysed. In order to assess the potential effect of the food matrix, we used either a purified major cows’ milk allergen, β-lactoglobulin (BLG), or whole cows’ milk containing the same amount of BLG. We then studied the impact of these pre-exposures on a subsequent oral exposure to milk in the presence or absence of the mucosal Th2 adjuvant, Cholera toxin (CT). Cutaneous applications of milk induced production of BLG-specific IgE and IgG1 in 5 and 8 mice out of 20 respectively, whereas purified BLG alone did not. Intranasal exposure to milk, but not to BLG, led to BLG-specific IgG1 production in 8 out of 20 mice. Notably, cutaneous pre-exposure to milk favours further oral sensitisation without CT, while intra-nasal pre-exposure to BLG prevents further experimental sensitisation.

Conclusions

Altogether, our results thus demonstrated that the immune response induced after non-gastrointestinal exposure to food depends on the allergen, the matrix and the route of exposure.     

Do the self-concept and quality of life decrease in CP patients? Focussing on the predictors of self-concept and quality of life

Purpose.?To find out if the quality of life (QOL) and self-concept of the children with cerebral palsy (CP) was different from that of children without disability, to investigate predictive variables that could affect self-concept and QOL.

Methods.?A total of 40 children with CP and 46 age-matched peers were included. The baseline characteristics including sex, type of CP, the level of disability according to Gross Motor Function Classification System (GMFCS) were recorded. Education levels of both children and parents, demographic features of parents, features of living area, usage of devices and associated impairments were filled out. Self-concept was measured using Piers–Harris Self-concept (PH) Scale. Quality of life was measured by Pediatric Quality of Life Inventory 4.0 (PedsQL). The physical and psychosocial health subscale scores of PedsQL (P-PedsQL and PS-PedsQL) were recorded.

Results.?Significant differences in mean scores favouring the control group were found for PH scale, PedsQL scale (p?<?0.001). P-PedsQL and PS-PedsQL of the CP group were lower than the control group (p?<?0.001). PS-PedsQL report was significant predictor of self-concept. The presence of incontinence and GMFCS level were significant predictors of PedsQL and PPedsQL, respectively.

Conclusion.?Self-concept and QOL of the CP children were lower than the children without CP. Presence of incontinence, self-concept rating and GMFCS level were important to predict domains of QOL.     

Bone and the ‘Comforts of Life’

Coffee drinking, smoking and especially alcohol abuse are considered to be risk factors for fractures and osteoporosis. Caffeine causes acute increase in urinary calcium excretion, but epidemiological evidence for the effects of coffee consumption on the risk of fractures is contradictory. Many, (but not all) studies point to decreased bone mass or increased fracture risk in smokers. Alcohol abuse is associated with deleterious changes in bone structure detected by histomorphometry, and with a decrease in bone mineral density (BMD). These changes may also be produced by factors commonly associated with alcohol abuse, e.g. nutritional deficiencies, liver damage and hypogonadism. Alcohol, however, has clear-cut direct effects on bone and mineral metabolism. Acute alcohol intoxication causes transitory hypoparathyroidism with resultant hypocalcaemia and hypercalciuria. As assessed by serum osteocalcin levels, prolonged moderate drinking decreases the function of osteoblasts, the bone-forming cells. In addition, chronic alcoholics are characterized by low serum levels of vitamin D metabolites. Thus, alcohol seems to have a direct toxic effect on bone and mineral metabolism. In contrast, it has recently been reported that moderate alcohol consumption by postmenopausal women may have a beneficial effect on bone.     

What are the benefits and the pitfalls of preoperative fasting?

Preoperative fasting has been a traditional practice for many years to reduce the risk of aspiration while the patient is under general anaesthetic and to eliminate the risk of postoperative nausea and vomiting. Although it is generally accepted that fasting is beneficial, the fasting regimens that patients undergo are not dependent on the individual patient or the timing of their operation.     

Is the combination of remifentanil and propopfol suitable for transsphenoid resection of the hypophysis?

In a multi-center trial, the feasibility of combining remifentanil (RF) and target-controlled infusion of propofol (P) for patients undergoing transsphenoidal resection of the pituitary gland was tested. After IRB approval, 74 patients (29 male/45 female) were included in the study. The concentration of RF and the target concentration of P were recorded as were heart rate (HR) and mean arterial blood pressure (MAP). For intubation the RF dosage was 0.26 +/- 0.06 microgram.kg-1.min-1 and the target concentration of P was 3.16 +/- 0.63 micrograms.ml-1. After induction, HR and MAP decreased significantly. The painful events of the operation were preparation of the nasal mucous membrane and penetration of the sella turcica. By adjusting the RF dose to 0.31 +/- 0.09 microgram.kg-1. min-1 and the target concentration of P to 3.48 +/- 1.49 micrograms.ml-1, an increase of HR and MAP above initial values was avoided at this time. Hypotension and bardycardia were treated in eight patients (10.8%) with a vasopressor, in four patients (5.4%) with atropine and in four more patients (5.4%) with a combination of these drugs. Two patients (2.7%) needed antihypertensive therapy. The average time interval between the end of P-TCI and spontaneous breathing was 6 +/- 3 min (median 6 min) and till patients opened their eyes 9 +/- 4 min (median 9 min). After 13 +/- 4 min (median 13 min) the patients became orientated. The average doses of analgetics were 19.5 +/- 19.9 mg piritramide and 1.8 +/- 1.0 g metamizol during the first 12 hours postoperatively. Eight patients (10.8%) did not need any analgetics. We suggest that the combination of RF and P as a "fast track concept" can supplement the repertoire of anaesthetic managements used for transsphenoidal resection of the pituitary gland.     

Self-reported function and disability in late life – cross-cultural adaptation and validation of the Swedish version of the late-life function and disability instrument

Abstract

Purpose: To translate and perform a cross-cultural adaptation of the Late-Life Function and Disability Instrument (LLFDI) to Swedish, to investigate absolute and relative reliability, concurrent validity, and floor and ceiling effects within a Swedish-speaking sample of community-dwelling older adults with self-reported balance deficits and fear of falling. Method: Translation, reliability and validation study of the LLFDI. Sixty-two community-dwelling, healthy older adults (54 women and 8 men) aged 68–88 years with balance deficits and fear of falling performed the LLFDI twice with an interval of 2 weeks. Results: Test–retest agreement, intra-class correlation coefficient was very good, 0.87–0.91 in the LLFDI function component and 0.82–0.91 in the LLFDI disability component. The standard error of measure was small, 5–9%, and the smallest real difference was 14–24%. Internal consistency (Cronbach’s alpha) was high (0.90–0.96). Correlation with the SF-36 PCS and PF-10 was moderate in both LLFDI function, r?=?0.39–0.68 and r?=?0.35–0.52, and LLFDI disability, r?=?0.40–0.63 and 0.34–0.57, respectively. There was no floor or ceiling effects. Conclusion: The Swedish version of the LLFDI is a highly reliable and valid instrument for assessing function and disability in community-dwelling older women with self-reported balance deficits and fear of falling.

• Implications for Rehabilitation

• The Swedish LLFDI is a highly reliable and valid instrument for assessing function and disability in older women with self-reported balance deficits and fear of falling.

• The instrument may be used both in clinical settings and in research.

• The instrument is sensitive to change and a reasonably small improvement is enough to detect changes in a group or a single individual.

     

Psychological misunderstandings of medication and psychological rehab ili-tation of the aged

INTRODUCTIONInthemedicalserviceforpeopleacceptingrestingtherapyandsenilecadres，somepsychologicalmisunderstandingofmedicationoftheagedoftenareobserved．Meantime，theproblemofreasonablemedi－cationmoreandmorecauseattentionofpeople．PSYCHOLOGICALMISUNDERSTANDINGSOFMEDICA－TIONOFTHEAGEDPsychologyofseekingexpensionInthemedicalserviceforpeopleacceptingrestingtherapyandsenilecadres，wefindthattheagedoftenthinkthatexpensivedrugsaregoodonessothepsychologicalmisunderstandingsof…