Nursing as science: a critical question.

Nursing is a profound human activity generally influenced by two dynamics--the relationship between patient and nurse and the scientific paradigm. Often overlooked, however, are the incongruities that arise between these two dynamics. The patient-nurse relationship encompasses sameness, closeness, and connection, whereas science requires distance, detachment, and differentiation to fulfil the demands of objectivity. The patient-nurse relationship is both profound and intangible, whereas science attends only to that which can be observed and measured. The authors explore these dynamics and the incongruities between them. They consider the demands made by science on the patient-nurse relationship and, conversely, the place of the patient-nurse relationship in the development of nursing as science. These issues are critical to the advancement and practice of nursing.     

A fuzzy approach to the rate control in an artificial cardiac pacemaker regulated by respiratory rate and temperature: a preliminary report

Fuzzy theory was applied to the rate control of a cardiac pacemaker which uses two parameters, respiratory rate and temperature, as the parameters for rate regulation. Using 25 fuzzy reasoning rules derived from five mongrel dogs, the pacing rates in three animals were calculated and compared with the intrinsic heart rates. It is concluded that the fuzzy method is well suited for the rate determination of a multi-parameter rate-responsive cardiac pacemaker.     

General practitioners: child accident prevention and 'The Health of the Nation'

It has recently been suggested in the ‘Health of the Nation’that specific accident prevention activities should be undertakenby general practitioners. This study reports the findings froma survey of general practitioners in Nottinghamshire assessingknowledge, attitudes and current practices in accident prevention.The findings suggest that more than two-thirds of respondinggeneral practitioners are aware of the extent of childhood mortalityfrom accidental injuries and of the risk factors for accidentalinjury. Knowledge scores were higher for women, those aged 44years and under, those on the child health surveillance list,those with experience of hospital or community paediatrics,and those with postgraduate qualifications in paediatrics. Morethan 50% of general practitioners hold positive views towardsthe activities suggested in the ‘Health of the Nation’and more than 40% are already carrying out such activities.Positive attitudes are more commonly held in women and thoseon the child health surveillance list. There was a significantcorrelation between knowledge score and attitude score. Forall accident prevention activities covered in the questionnaire,fewer practitioners undertook an activity than held a positiveattitude towards that activity. Accident prevention work iscurrently more likely to be undertaken by general practitionerson an opportunistic basis than on a systematic population basis.If general practitioner intervention is demonstrated to be effective,a shift towards a population approach may be more successfulin reducing injury rates.     

Orthognathic surgery for a patient with trichorhinophalangeal syndrome type I: a case report.

Trichorhinophalangeal syndrome (TRPS) type I is characterized by slowly progressing systemic osseous dysplasia, exhibiting craniofacial and other skeletal deformities. However, there have been few reports describing this syndrome after undergoing orthognathic surgery. In this report, we present a patient with TRPS I who successfully underwent orthognathic surgery. In addition, we examined the skeletal stability of the patient for 2 years after the surgery.     

Factors associated with contraceptive practices of married women in Bangladesh with respect to their employment status.

OBJECTIVE: There might be a difference between non-working and working women in their perception of rights and privileges which may influence their contraceptive behavior. The purpose of this study was to examine contraceptive behavior among non-working and working women in Bangladesh determining associated factors. METHOD: Analysis was based on data from the 1999-2000 Bangladesh Demographic and Health Survey which employs nationally representative sample. RESULTS: The prevalence of current contraceptive use (any method) was 58.2% among non-working women and 65.5% among working women. Both rates are still low for the country. Some factors, such as discussed family planning with husband, husband approves family planning, desire for more children, and husband lives together, were influential determinants of lower contraceptive prevalence among the non-working women. CONCLUSION: The results indicate a necessity for social activities promoting husband-wife communication and women's participation in employment to enhance the use of contraceptives among Bangladeshi women, especially non-working women.     

Trancranial Doppler Monitoring of Response to Therapy for Meningovascular Syphilis

Meningovascular syphilis is now quite uncommon, but there have been increasing reports in patients immunocompromised with human immunodeficiency virus. The response of syphilis affecting the central nervous system to antibiotic therapy remains a challenge. This is an even greater challenge in patients who have underlying compromise of the immune system. The authors present a 46-year-old male with recurrent stroke who was found to have cerebrospinal fluid compatible with syphilitic involvement of the central nervous system and a cerebral arteriogram, which revealed focal narrowing of the right middle cerebral artery. The baseline transcranial Doppler study demonstrated increased mean and peak flow velocity within the right middle cerebral artery. Despite a 10-day course of intravenous penicillin, with substantial improvement in the cerebrospinal fluid results, this flow velocity elevation persisted, in a remarkably consistent pattern, over a 4-month follow-up period. Thus, the involved vessel remained patent following treatment, but no clear resolution of the stenotic lesion was observed.     

FDA-Approved Sodium Tetradecyl Sulfate (STS) versus Compounded STS for Venous Sclerotherapy

BACKGROUND: In the area of endovenous chemical ablation (sclerotherapy), there has been much debate regarding sclerosant quality and efficacy. Only sodium tetradecyl sulfate (STS) has garnered Food and Drug Administration (FDA) approval in the United States. OBJECTIVE: The primary objective of this study was to compare clinical performance measures of compounded STS from 27% industrial-strength stock (compounded STS) versus FDA-approved Sotradecol (Bioniche Pharma USA, Inc., Belleville, Ontario, Canada). MATERIALS AND METHODS: Phase I of this study focused on the chemical composition of the drugs, whereas Phase II studied the ablative abilities of the two drugs at comparable concentrations of 3%. RESULTS: We documented the presence of various impurities in compounded STS. No impurities in AngioDynamics STS were found. Our studies suggest that compounded STS may have significant variation in concentration. The AngioDynamics STS concentration was found to be manufactured within a tight tolerance. Segments of incomplete ablation were more frequent in the compounded STS group when compared to the AngioDynamics STS group. This reached statistical significance (p=.02). Primary closure using the Kaplan-Meier statistic demonstrated a trend in the favor of AngioDynamics STS when compared to compounded STS. CONCLUSION: When product quality, efficacy, and liability are carefully considered, we conclude that it would behoove physicians to use pharmaceutical-grade, FDA-approved sclerosant when treating their patients.     

A randomized clinical trial with a 0.6% amino acid/ 1.4% glycerol peritoneal dialysis solution.

BACKGROUND: Glucose is an accepted osmotic agent for peritoneal dialysis (PD) although it has several drawbacks. Some of these drawbacks have been addressed by the introduction of solutions with low glucose degradation products and physiological pH in dual-chambered bags. Despite this achievement, there is a need for alternative osmotic agents.This randomized clinical trial analyzes 3-month's clinical experience with a mixture of 0.6% amino acids and 1.4% glycerol. METHODS: The study was performed at the renal units of the University Hospitals Ghent, Belgium, and Utrecht, The Netherlands. Stable PD patients were randomized for either protocol A (test solution, n = 5) or protocol B (control regimen, n = 5). In both protocols, there was a run-in phase of 1 month with a dialysis regimen of 2 x 2 L 2.27% glucose solution (Dianeal; Baxter, Nivelles, Belgium), 1 x 2 L Extraneal (Baxter), and 1 x 2 L glucose solution (Dianeal). After this month-long run-in period, patients in group A received during 3 months 2 x 2 L amino acid/glycerol solution, 1 x 2 L Extraneal, and at least 1 x 2 L of a classic glucose solution. RESULTS: Glucose absorption decreased in the test group during the test phase (from 84.2 +/- 8.7 to 11.7 +/- 11.6 g/24 hours, p = 0.001). Dialysate levels of cancer antigen 125 (CA125) increased in the test group, from 17.5 +/- 11.0 to 32.4 +/- 4.6 units/L (p = 0.04), whereas, in the control group, the levels remained stable (15.5 +/- 8.7 and 14.9 +/- 9.8 units/L respectively, p = 0.4).There were no differences in serum urea, serum bicarbonate, serum osmolarity, serum albumin, or parameters related to skin-fold thickness or serum glycerol levels between control and test solutions. No differences were observed in obtained ultrafiltration after a 4-hour dwell with 2.27% glucose or the test solution, both measured at week 4 of the run-in period and week 12 of the test period. CONCLUSION: This study demonstrated that the use of a new 0.6% amino acid/1.4% glycerol-containing dialysis solution is safe and well tolerated. Glucose load was reduced significantly and dialysate CA125 levels improved significantly. Ultrafiltration was comparable with that of a 2.27% glucose solution. All these factors, in combination with the potential nutritional benefits, can contribute to a beneficial impact on the success of the PD technique. Further long-term studies in larger patient groups are warranted to explore the potential of this promising new solution.