Quality of life and the right to die: an ethical dilemma

In an increasingly 'patient-centred' health service individuals are demanding to make independent judgements about their own fate. In keeping with this trend there is now a growing drive to review the current laws on euthanasia and assisted suicide. The issues in the euthanasia debate usually revolve around patients who are terminally ill and/or suffering intractable pain. However, pain is not the only determinant of an intolerable existence and the problems become more complex when existential quality of life issues are the focus. This can lead to difficult decision making for the health workers involved in care. The paper uses a case study approach to examine the ethical and legal issues surrounding euthanasia. The dilemma under discussion involves a quadriplegic patient who wished to commit suicide by refusing nutrition. The discussion offered centres around the principles of beneficence, non-maleficence and autonomy in relation to whether it was morally or legally appropriate to intervene with this patient's wishes by artificial feeding. Conclusions and recommendations are offered.     

The need for using single-stage reconstructive operations following the removal of malignant head and neck tumors

The paper discusses the results of treatment of 102 cases of locally-advanced malignant tumors of the head and neck. Myocutaneous flaps including m.m. platysma, sternocleidomastoideus, trapezius and pectoralis major were used to rectify primary postexcisional defects. Preoperative radiation treatment (30-100 Gy) was given to 92 patients. Primary reconstruction for defects of the head and neck failed to stimulate recurrence development or affect survival as compared to controls. Frequency of complications involved in the said method proved lower while stay at the hospital shorter as compared to other reconstructive procedures. The above method assured a shorter period of rehabilitation and thus saved funds.     

Applying aspects of educational psychology to the practice of nurse teaching

One of the many facets of educational psychology to which the nurse teacher should give consideration is the nature of human knowledge. An individual interacting with his environment forms ideas or concepts which coalesce to create a mental organisation, or ‘conceptual framework’, that is unique to that individual. The nurse teacher takes account of this uniqueness of such a framework by assessing the conceptual position occupied by each of his learners, and by adapting his teaching strategies accordingly. Failure to do this can result in the inadequate learning of new ideas or concepts, in particular complex concepts such as are found in nursing. With reference to certain of the literature it is shown that the direct teaching of concepts does not occur, while the effectiveness of active learner participation is demonstrated as aiding the ‘personalisation’ of newly offered concepts, which then become truly part of the learner's conceptual framework.     

Sarcoidosis: correlation of extent of disease at CT with clinical, functional, and radiographic findings

Computed tomography (CT) was compared with chest radiography in the assessment of disease severity in 27 patients with sarcoidosis. The CT scans and radiographs were each read twice by two independent observers. Disease extent was assessed on CT scans by visual scoring (0%-100% involvement of the lung parenchyma) and on radiographs by using an adaptation of the International Labour Office classification. The severity of parenchymal changes on the CT scan and on the radiograph was significantly correlated with the severity of dyspnea (r = .61 and .58, respectively; P less than .001), diffusing capacity (r = -.62 and -.52, P less than .01), and vital capacity (r = -.49 and -.51, P less than .01). Patients with predominantly irregular opacities had more severe dyspnea and lower lung volumes than patients with predominantly nodular opacities (P less than .05). The authors conclude that in patients with sarcoidosis, the radiographic and CT assessments of disease severity show similar correlation with clinical and functional impairment.     

Transport and Electrochemical Properties of Li4Ti5O12-Li2TiO3 and Li4Ti5O12-TiO2 Composites

The study demonstrates that the introduction of the electrochemically inactive dielectric additive Li₂TiO₃ to LTO results in a strong decrease in the grain boundary resistance of LTO-Li₂TiO₃ (LTC) composites at a low concentration of Li₂TiO₃. With the increase in the concentration of Li₂TiO₃ in LTC composites, the grain boundary resistance goes through a minimum and increases again due to the growth of the insulation layer of small Li₂TiO₃ particles around LTO grains. For LTO-TiO₂ (LTT) composites, a similar effect was observed, albeit not as strong. It was found that LTC composites at low concentration of Li₂TiO₃ have unusually high charge–discharge capacity exceeding the theoretical value for pure LTO. This effect is likely to be caused by the occurrence of the electrochemical activity of Li₂TiO₃ in the vicinity of the interfaces between LTO and Li₂TiO₃. The increase in the capacity may be qualitatively described in terms of the model of two-phase composite in which there is the interface layer with a high capacity. Contrasting with LTC composites, in LTT composites, no capacity enhancement was observed, which was likely due to a noticeable difference in crystal structures of LTO and TiO₂ preventing the formation of coherent interfaces.     

Stabilization of thrombin-activated porcine factor VIII:C by factor IXa phospholipid

The activation of porcine factor X by an enzymatic complex consisting of activated factor IX (factor IXa), thrombin-activated factor VIII:C (factor VIII:Ca), phospholipid vesicles, and calcium was studied in the presence of an irreversible inhibitor of factor Xa, 5-dimethylamino- naphthalene-1-sulfonyl-glutamyl-glycyl-arginyl- chloro met hyl ketone ( DEGR -CK). The formation of factor Xa was measured continuously by monitoring the increase in solution fluorescence intensity that occurs upon formation of DEGR -factor Xa. Omission of any component from the enzymatic complex reduced the reaction rate to a negligible level. In the presence of fixed excess factor IXa, the velocity of factor X activation was linearly dependent on the concentration of factor VIII:C, and thus, provided a plasma-free assay of factor VIII:C. Activation of factor VIII:C by 0.1 NIH U/ml thrombin in the presence of factor IXa, phospholipid vesicles, and calcium, followed at variable time intervals by the addition of factor X and DEGR -CK, was complete within 5 min, as judged by the fluorometric assay, and resulted in little or no loss of factor VIII:C activity over a period of 20 min; whereas, activation in the absence of either IXa or phospholipid vesicles decreased the half-life of factor VIII:C to approximately 5 min. Analysis of 125I-factor VIII:C-derived activation peptides by sodium dodecyl sulfate polyacrylamide gel radioelectrophoresis revealed identical results, regardless of whether factor IXa and/or phospholipid vesicles were included in the activation, suggesting that the lability of factor VIII:Ca is not due to a major alteration of its primary structure. We conclude that the activated porcine factor VIII:C molecule is stabilized markedly because of its interaction with factor IXa and phospholipid.     

Nursing research: a position paper

It is argued herein that orthodox approaches to nursing research reflect a fundamental misunderstanding concerning the nature of nursing, a misunderstanding that results in the production of findings that are perceived as irrelevant to clinical practice. The reasons for this are analysed and two specific research monographs, Hayward (1975) and Ogier (1982) are criticized where appropriate in order to illuminate the analysis. Nursing is explicated as a social phenomenon and practice discipline and the peculiar suitability of action research to its investigation is demonstrated.