What does it mean to involve consumers successfully in NHS research? A consensus study

OBJECTIVE: To obtain consensus on the principles and indicators of successful consumer involvement in NHS research. DESIGN: Consensus methods were used. An expert workshop, employing the nominal group technique was used to generate potential principles and indicators. A two-round postal Delphi process was used to obtain consensus on the principles and indicators. SETTING AND PARTICIPANTS: Participants were drawn from health, social care, universities and consumer organizations. A purposive sampling strategy was used to identify people who had experience and/or knowledge of consumer involvement in NHS research. Six researchers and seven consumers participated in an expert workshop. Ninety-six people completed both rounds of the Delphi process. MAIN OUTCOME MEASURES: Consensus on principles and indicators of successful consumer involvement in NHS research. RESULTS: Eight principles were developed through an expert workshop and Delphi process, and rated as both clear and valid. Consensus was reached on at least one clear and valid indicator by which to measure each principle. CONCLUSIONS: Consensus has been obtained on eight principles of successful consumer involvement in NHS research. They may help commissioners, researchers and consumers to deepen their understanding of this issue, and can be used to guide good practice.     

改良的羟基磷灰石义眼座植入术

目的　寻求眼内容摘除术后义眼座植入的最佳手术方法。方法　将内直肌缝标记线并于附着处剪断 ,常规眼内容摘除后 ,将羟基磷灰石义眼座从内侧放入巩膜壳后肌锥内 ,复位内直肌 ,分层缝合。结果　 3 8例患者术后反应轻 ,未发现有义眼座暴露、脱出等并发症 ,结膜囊腔光滑、宽阔 ,放置义眼后水平方向活动达 15°～ 2 5° ,垂直方向活动达 10°～ 15°。结论　该术式操作简便 ,患者痛苦小 ,术后反应轻 ,恢复快 ,美容效果好。     

外伤性和医源性上睑提肌腱膜损伤致上睑下垂

目的分析外伤性和医源性上睑提肌腱膜损伤的原因及治疗。方法对54例各种外伤及手术引起的上睑提肌腱膜损伤所致上睑下垂进行回顾性分析。结果各种眼外伤及一些医源性原因所引起的不同程度的上睑提肌损伤，造成上睑提肌腱膜与睑板分离，形成腱膜性上睑下垂，上睑皱襞过高，上眶区凹陷，二次手术行上睑提肌腱膜折叠术及断端缝合术，效果良好。结论外伤和医源性原因引起的腱膜性上睑下垂，经过手术矫正效果理想。     

Integrity and moral residue: nurses as participants in a moral community

Abstract This paper will examine the concepts of integrity and moral residue as they relate to nursing practice in the current health care environment. I will begin with my definition and conception of ethical practice, and, based on that, will go on to argue for the importance of recognizing that nurses often find themselves in the position of compromising their moral integrity in order to maintain their self‐survival in the hospital or health care environment. I will argue that moral integrity is necessary to a moral life, and is relational in nature. When integrity is threatened, the result is moral distress, moral residue, and in some cases, abandonment of the profession. The solution will require more than teaching bioethics to nursing students and nurses. It will require changes in the health care environment, organizational culture and the education of nurses, with an emphasis on building a moral community as an environment in which to practise ethically.     

Perspectives on colorectal cancer screening: a focus group study

Objective To assess attitudes and acceptability of Ontario consumers and doctors towards colorectal screening with faecal occult blood testing (FOBT) and colonoscopy. Design, setting and participants Focus groups with gender‐specific samples of the population, high‐risk gastroenterology patients and family doctors. Method Semi‐structured interview guides used by facilitator to lead groups through knowledge of risk factors and prevention of colorectal cancer, the screening modalities, requirements for implementing screening programmes, barriers to screening and preferences towards screening. Main findings There were low levels of knowledge about colorectal cancer and its prevention in the general population. FOBT was an acceptable screening modality, but considerable education about its use and benefits would be necessary to implement a screening programme. Colonoscopy was not perceived to be a good choice for a primary screen in the general population. The high‐risk group supported use of FOBT in the general population and emphasized the need for education. The doctors were more reluctant about screening, requesting clear guidelines. They also identified the time and resources that would be required if a screening programme were initiated. Conclusion While colorectal screening is acceptable in this sample, information and decision aids are required to enable consumers and providers to make effective decisions. Implementation of colorectal screening programmes requires substantial educational efforts for both consumers and doctors.     

硅油支持眼的人工虹膜膈植入

目的 总结硅油支持眼的人工虹膜膈植入的临床效果。方法 回顾性研究11例硅油支持眼人工虹膜膈植入手术适应症，手术效果及手术并发症。结果 11例人工虹膜膈植入眼原发眼病中，7例(7／11，64％)为严重外伤眼，2例(2／11，18％)为增埴期糖尿病性视网膜病变合并牵引性视网膜脱离眼，1例(1／11，9％)为严重PVR后复发性视网膜脱离眼，1例(1／11。9％)为Coats病眼；7例(／11，64％)人工虹膜膈有效地防止了硅油接触角膜，11例人工虹膜膈植入眼。均未引起视力的进一步下降；其手术后并发症主要为低眼压和人工虹膜膈表面的纤维膜形成。结论 硅油支持眼的开放性人工虹膜膈植入可通过自然隔断，建立房水循环来维持眼压，有效地防止硅油接触角膜引起并发症。     

渗出型老年性黄斑变性视网膜脉络膜血管吻合与视网膜色素上皮脱离的关系分析

目的 探讨老年性黄斑变性（AMD）视网膜脉络膜血管吻合（RCA）与视网膜色素上皮脱离（PED）的关系。 方法 回顾分析2000年10月～2003年12月诊治的渗出型AMD患者70例75只眼的光相干断层扫描（OCT）和眼底血管造影检查资料，观察有无RCA形成以及与PED 发生的关系。 结果 75只渗出型AMD患眼中，34只眼有RCA形成，占45.3% ；41只眼未见RCA ，占54.7%。有RCA形成同时存在PED者30只，占88.2%；不伴有PED者4只眼，占11.8%。无RCA 形成但存在PED者33只眼，占80.5%；不伴有PED者8只眼，占19.5%。有无RCA形成的患眼PED的发生率比较，差异无显著性的意义（χ2=0.83，P=0.5290）。无RCA形成的33只PED患眼中，发生PED裂孔者17只眼，占51.5%；有RCA形成的30只PED患眼中，发生PED裂孔者26只眼，占8 6.7%，二者比较，差异有显著性的意义（χ2=8.9612，P=0.0030）。 结论 RCA形成在渗出 型AMD患眼中并不少见；RCA多与PED并存，但两者之间无直接的因果关系；PED裂孔发生与RCA形成密切相关。 （中华眼底病杂志，2004，20：295-298）