Forensic mental health nurses (FMHN) provide care to address the needs of people who have mental illnesses across a range of diverse settings. The Clinical Reasoning Cycle (CRC) has been identified as a potential framework to assist FMHNs; however, adaptations were required to reflect the unique nature of the clinical setting. This study aimed to explore adaptations made to determine suitability prior to implementation in practice. Nominal Group Technique was used to explore suggested adaptations determined from a previous study and reach a consensus on the changes. Fourteen senior nurses from a state-wide Forensic mental Health (FMH) service participated. A consensus was reached for two proposed changes. Data were analysed using thematic analysis. Three main themes were interpreted from the data; FMH adaptations are warranted, the focus of the CRC, and who owns the cycle? Nurses in this study considered the need to include offence and risk issues due to the impact these factors have on the therapeutic relationship and cognitive bias; however, they also identified the need to focus on recovery-oriented care while engaging in clinical reasoning. Nurses in this study also expressed some reluctance for nursing to ‘own' the model, due to concern that ownership may cause division among the team or result in inconsistency in care. However, some participant's suggested the CRC with adaptations assisted FMH nurses to articulate their specialist skills and knowledge to others and highlight the nursing contribution to care. Further work is needed to finalize adaptations with a focus on engaging the consumer carer workforce and interdisciplinary team. 相似文献
Magnetic resonance (MR) images of the pelvis in 63 women (40 healthy and 23 with various adnexal diseases) were assessed retrospectively. When imaged with contiguous sections without gaps, adnexa were demonstrated bilaterally in 13 of the 15 healthy women of reproductive age, but in only seven of the 15 healthy postmenopausal women. Normal adnexa demonstrated low to medium signal intensity on images obtained with short repetition time (TR) (0.5 sec) and echo delay time (TE) (28 or 30 msec). Their signal intensity approached that of fat on images with a long TR (2.0 sec) and TE (56 or 60 msec). The adnexal origin of the pelvic masses was correctly identified in every case. Lesions containing fluid with little or no protein, fat, or blood content (simple fluid) had characteristically long T1 and T2 relaxation times and low signal intensity on images obtained with a short TR (0.5 sec) and TE (28 or 30 msec); they could be readily differentiated from all the other types of lesions. 相似文献
Regional wall motion (RWM) abnormalities are sensitive indicators of left ventricular (LV) dysfunction, but quantitation of RWM with gated radionuclide ventriculography (RVG) has been limited, particularly in the left anterior oblique (LAO) projection. Regional LV performance was studied in 18 patients undergoing LAO RVG immediately prior to contrast ventriculography (CVG). Wall motion was analyzed by semiautomated and visual methods using several coordinate systems. For semiautomated methods, RVG and CVG wall motion were closely related in the two 90 degrees polar sectors at the apex and posterior wall (r = .85) and in the five 45 degrees polar sectors from midseptum through posterior wall (r = .82). The basal sectors on RVG had weak relationship to CVG, due to adjacent vascular structures. Semiautomated and visual grades for polar sectors on both CVG and RVG were closely related (r = .88- .94). Measured regional wall motion on LAO RVG compared favorably with near-simultaneous CVG in nonoverlapping portions of the LV and allowed objective quantitation of regional LV performance. 相似文献
As part of the Anthropology Component, the distribution of HLA-B35 alleles (B*3501 to 3513) was studied in 16 different populations by group specific amplification and SSOP hybridization. The results were as follows:
The predominant alleles in most Caucasian populations were 3501 > 3503 > 3502 > 3508. However, B*3502 predominated in Jews, B*3508 in Arabs, B*3503 in Gypsies and Sardinians seem to have only B*3501 and 3502. B*3504, 3505, 3506 and 3509 were restricted to Amerindians, where there are still other new B35 variants to be characterized. In most individuals the different B35 alleles were found in phenotypic combinations with HLA-Cw4, suggesting that the B35, Cw4 haplotype may have existed before subtype diversification. A detailed analysis of HLA-B35 alleles in other populations might help to draw a precise picture of B35 evolution. 相似文献
Multiple Sclerosis (MS) is a common chronic central nervous system disease
in young adults. Relative familial risk appears to be determined largely by
genes while population risk is strongly influenced by environmental
factors. This is supported by genetic epidemiological studies which also
suggest an oligogenic inheritance of susceptibility. The HLA DRB1*1501,
DQA1*0102, DQB1 0602 haplotype is associated with the disease but HLA
contributes only modestly to overall susceptibility. The results of three
genomic searches are concordant with the genetic epidemiology and imply a
number of genes with interacting effects will be found. Importantly, no
single region has been identified with a major influence on familial risk.
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The hallmark of Kangaroo Mother Care (KMC) is the kangaroo position: the infant is cared for skin‐to‐skin vertically between the mother’s breasts and below her clothes, 24 h/day, with father/substitute(s) participating as KMC providers. Intermittent KMC (for short periods once or a few times per day, for a variable number of days) is commonly employed in high‐tech neonatal intensive care units. These two modalities should be regarded as a progressive adaptation of the mother‐infant dyad, ideally towards continuous KMC, starting gradually and progressively with intermittent KMC. The other components in KMC are exclusive breastfeeding (ideally) and early discharge in kangaroo position with strict follow‐up. Current evidence allows the following general statements about KMC in affluent and low‐income settings: KMC enhances bonding and attachment; reduces maternal postpartum depression symptoms; enhances infant physiologic stability and reduces pain, increases parental sensitivity to infant cues; contributes to the establishment and longer duration of breastfeeding and has positive effects on infant development and infant/parent interaction. Therefore, intrapartum and postnatal care in all types of settings should adhere to a paradigm of nonseparation of infants and their mothers/families. Preterm/low‐birth‐weight infants should be regarded as extero‐gestational foetuses needing skin‐to‐skin contact to promote maturation. Conclusion: Kangaroo Mother Care should begin as soon as possible after birth, be applied as continuous skin‐to‐skin contact to the extent that this is possible and appropriate and continue for as long as appropriate. 相似文献