Nursing and the Emergence of Egoless Care: A Discussion on Social Engineering in Mental Health

The narrowing of the diverse fields of psychiatry to just the single dimension of the biomedical model has resulted in a situation where professions with a focus on curing (psychiatrists and psychologists) are favoured over those with a focus on caring and encouraging near communities to care for each other (nurses). The social engineering of mental problems leads to a state of helplessness. This paper contributes to an understanding of the barriers to utilise the social resources of people with mental health problems and argues for forms of “indirect social engineering” and “egoless care,” and, ultimately, a rediscovery of nursing, using the mental health care in the Netherlands as a case study.     

Deficiencies in the transfer and availability of clinical trials evidence: a review of existing systems and standards

ABSTRACT: BACKGROUND: Decisions concerning drug safety and efficacy are generally based on pivotal evidence provided by clinical trials. Unfortunately, finding the relevant clinical trials is difficult and their results are only available in text-based reports. Systematic reviews aim to provide a comprehensive overview of the evidence in a specific area, but may not provide the data required for decision making. METHODS: We review and analyze the existing information systems and standards for aggregate level clinical trials information from the perspective of systematic review and evidence-based decision making. RESULTS: The technology currently used has major shortcomings, which cause deficiencies in the transfer, traceability and availability of clinical trials information. Specifically, data available to decision makers is insufficiently structured, and consequently the decisions cannot be properly traced back to the underlying evidence. Regulatory submission, trial publication, trial registration, and systematic review produce unstructured datasets that are insufficient for supporting evidence-based decision making. CONCLUSIONS: The current situation is a hindrance to policy decision makers as it prevents fully transparent decision making and the development of more advanced decision support systems. Addressing the identified deficiencies would enable more efficient, informed, and transparent evidence-based medical decision making.     

Simple posterior vestibuloplasty for central introital dyspareunia

The aim of this study is the evaluation of a simple surgical widening plasty of the posterior vestibulum for central introital dyspareunia. This study takes place in gynecological infectious diseases clinic in secondary and tertiary care centers. The subjects are one hundred forty-five consecutive patients with introital pain during or when attempting sexual intercourse. One-digit examination of the posterior hymenal rim of the vulva elicits the specific pain and clinical examination reveals nothing abnormal or only focal redness on the central posterior vestibulum. This condition should be clearly differentiated from the focal-provoked vestibulodynia, although mixed forms are frequent. A questionnaire was composed to assess the level of pain experienced during intercourse and of satisfaction of their sexual life in general at 1 to 3?years after the intervention. After a mean of 3?years, 90% of the patients were very satisfied with the improvement of the sexual health due to the intervention. Eighty percent had less pain during intercourse. The proportion of patients forced to interrupt sexual intercourse because of pain dropped from 64% to 26% (p?<?0.0001). The number of women only having infrequent intercourse (once a month or less) decreased more than fourfold and the mean number of occasions that sexual intercourse took place increased by 27% after the intervention. Simple surgical widening plasty of the posterior vestibulum without excision of tissue led to a significant improvement of the sex life of at least 80% of a group of women with primary and secondary central introital dyspareunia of any cause. Correct and specific diagnosis is crucial prior to any intervention.