Dealing with death: An audit of family bereavement programs in Australian intensive care units

Patient death in Intensive Care Units (ICU) can be sudden and unexpected, leading to emotionally charged situations and life changing circumstances for family members. Supporting families during and after this critical period is particularly challenging for ICU nurses who often feel dissatisfied with the way they deal with the situation. Bereavement programs in various areas of nursing have been reported to be beneficial in promoting normal grief patterns. There is, however, a lack of research in the area of evaluation of bereavement programs in adult ICUs. This paper presents the results of an Australia-wide audit on current practices in the area of bereavement programs within adult ICUs.

Surveys were sent to 117 adult Australian ICUs; 99 surveys were returned completed (84.6% response rate). It was identified that most surveyed units offer minimal components of bereavement programs, such as viewing of the deceased and communicating with family members. Less than one third (n=26) provide additional follow-up services in the form of telephone calls and sympathy cards or referral to additional services. Ten units employ some form of program evaluation. Verbal feedback from staff and families is the primary assessment method. Over half of responding ICUs indicated they are considering or interested in providing a bereavement program in their unit.

This study highlights the need for research-based data to support the introduction or deletion of strategies for bereavement programs using family-centred outcome measures. ICU nurses are interested in this area of clinical practice and require considerable support. It is recommended that this support can come via postgraduate and on-going education, hospital policies and procedures.     

二(二甲氨基)-二苯甲烷的抗心律失常作用

碘杂环化合物(IHC-64,IHC-65,IHC-66)有抗心律失常、降血压,并表现钙拮抗效应。4,4′-二(二甲氨基)-二苯甲烷[4,4′-bis(dimethyl amino)-diphenyl methane,BDDM]是合成碘杂环化合物的前体物,与抗心律失常药利多卡因、安博律定(aprindine)等在化学结构上有相近之处,如苯环和碱性氨基。本实验观察了碘杂环前体物BDDM的抗实验性心律失常作用。并进一步探讨本系列合成物的构效关系。     

住院患者药物不良反应的发生率：前瞻性研究的汇总 …

目的－对住院患者严重和致命药物不良反应（ａｄｖｅｒｓｅｄｒｕｇｒｅａｃｔｉｏｎｓ，ＡＤＲ）的发生率进行评价。资料来源－检索１９６６－１９９６年４种电子资料库。研究的选择－在１５３项研究中，选择了３９项来自美国各医院的前瞻性研究。资料的提取－对２位研究者各自提取物的采用随机－效果模式进行分析。为了取得患者ＡＤＲｓ的总发生率，我们将住院期间ＡＤＲｓ的发生率与ＡＤＲｓ所致住院的发生经合并计算，我们除外了     

捐献全血对献血者的不良反应:对1000名献血者捐献全血3个星期后的采访研究

以前曾对献血过程中和献血后献血者的献血的负面影响做过研究。血管迷走神经反应,尤其是伴有昏厥的反应,一直是献血安全研究的主要关注所在,但献血者手臂受伤、创伤以及非血管迷走神经的系统反应也已见报道,但都没有主动地向献血者征求意见,其结果是有限的和不全面的。本研究对1,000名献血者在献血3周后进行了采访,以确定发生了哪些全身反应和手臂伤害。     

＂Anti-HBc alone＂ in human immunodeficiency virus-positive and immuno-suppressed lymphoma patients

Hepatitis B virus （HBV） infection is endemic in various parts of the world. A proportion of patients have resolved prior exposure to HBV, as evidenced by the clearance of circulating hepatitis B surface antigen and the appearance of antibody to hepatitis B core antigen （anti-HBc）, which could produce protective antibody to hepatitis B surface antigen （anti-HBs）. With time, anti-HBs in some patients may become negative. Such patients are described as having occult HBV infection or ＂anti-HBc alone＂. In the context of immunodeficient patients, such as HIV patients or lymphoma patients undergoing immunosuppressive immunotherapy, the lack of protective anti-HBs may increase the risk of hepatitis B reactivation. Serum HBV DNA testing may be necessary in ＂anti-HBc alone＂ patients, to detect patients at a high risk of developing HBV infection allowing appropriate prophylactic management.     

The individual and combined influence of HIV and hepatitis C virus on dyslipidaemia in a high-risk Hispanic population

Objectives

To assess the effects of chronic hepatitis C (HCV) and HIV infection on dyslipidaemia in a Hispanic population at high risk of insulin resistance.

Methods

We compared serum lipids and C‐reactive protein (CRP) in 257 Hispanic adults including 47 HIV‐ mono‐infected, 43 HCV‐mono‐infected and 59 HIV/HCV‐co‐infected individuals as well as 108 healthy controls. We also assessed the effect of HCV on lipid alterations associated with antiretroviral therapy (ART), and the impact of HCV and HIV on the associations among insulin resistance, triglycerides and cholesterol.

Results

HCV infection was associated with lower total and low‐density lipoprotein (LDL) cholesterol, but not high‐density lipoprotein (HDL) cholesterol or triglycerides compared with healthy controls. HIV infection was associated with higher triglycerides and lower HDL, but not total or LDL cholesterol. HCV mitigated the elevation of triglycerides associated with ART. In healthy Hispanic adults, insulin resistance was significantly correlated with higher triglycerides, CRP and lower HDL. HIV infection nullified the association of insulin resistance with triglycerides and HDL, and the association of triglycerides with LDL. HCV infection nullified the association of insulin resistance with triglycerides, HDL and CRP.

Conclusions

HCV co‐infection alters the profile of HIV‐associated dyslipidaemia. The clinical significance of these findings for cardiovascular complications in HIV merits further study.