Helping motives in late modern society: values and attitudes among nursing students

This article reports a follow-up study of Norwegian nursing students entitled 'The helping motive an important goal for choosing nursing education'. It presents and discusses a significant ambiguity within the altruistic helping motive of 301 nursing students in the light of classical and modern virtue ethics. A quantitative longitudinal survey design was used to study socialization and building professional identity. The follow-up study began after respondents had completed more than two-and-a-half years of the three-year educational programme. Data were collected using a questionnaire with closed questions, supplemented by 18 semi-structured, in-depth, audiotaped interviews. A motive such as 'desire for human contact/to help others' appeared to be highly significant. The research questions employed were: What motivates nursing students at the end of their studies to help other people? What does helping others mean for nursing students? Factor analysis revealed two factors. Factor 1 can be expressed as an altruism factor and factor 2 can be interpreted as an 'acknowledgement-from-the-patient factor' that in fact indicates an ambiguity within the helping motive itself. Findings from the interviews also reveal ambiguous helping motives. On one hand the students want to be altruistic and on the other they wish to receive positive feedback from patients when giving help. The findings indicate that this positive feedback is essential to the students in order for them to provide altruistic care.     

Extended interval for retrieval of Günther Tulip filters

PURPOSE: To evaluate the Gunther Tulip vena cava filter with regard to ease of placement, complications, and retrieval over long time periods. MATERIALS AND METHODS: In 53 patients (ratio of men to women, 24:29; mean age, 52.8 years) retrievable Gunther Tulip filters (Vena Cava M Reye Filter Set; William Cook Europe, Denmark) were inserted. Indications included planned major surgery with recent pulmonary embolus or high pulmonary embolus risk (n = 16), extensive ilio-femoral thrombus (n = 11), deep vein thrombosis with anticoagulant complications (n = 9), breakthrough pulmonary embolus despite anticoagulant therapy (n = 4), and contraindication to anticoagulant therapy (n = 13). All patients were followed-up for immediate and long-term complications. RESULTS: Fifty-three filters were successfully placed in 52 of 53 patients, yielding a success rate of 98.1%. Nineteen patients underwent attempted retrieval of their filter. Sixteen of 19 retrieval procedures were successful (84%). In three patients, the filter could not be removed on attempted retrieval (extensive filter thrombus in two patients and attachment to the wall in one patient). One patient received two filters, which were both successfully retrieved at a later date. Median implantation time for retrievable filters was 34 days (range, 7-126 days). Mean follow-up for patients with permanent filters was 13 months. Two major complications (pneumothorax and break through pulmonary embolus) and three minor complications (right internal jugular vein thrombosis in two patients and transient Horner's Syndrome in one patient) were recorded. CONCLUSION: Insertion and retrieval of filters is safe and feasible. Preliminary data suggest that Gunther Tulip filter retrieval is feasible over and above the manufacturer's recommended retrieval interval of 14 days.     

High-resolution MR-imaging of the liver with T2-weighted sequences using integrated parallel imaging: comparison of prospective motion correction and respiratory triggering

PURPOSE: To compare high-resolution T2-weighted images of the liver with and without integrated parallel acquisition techniques (iPAT) using either breath-hold sequences in combination with prospective acquisition motion correction (PACE) or respiratory triggering. MATERIALS AND METHODS: Ten volunteers and 10 patients underwent each four different high-resolution fast spin echo (FSE) T2-weighted sequences with 5 mm slice thickness and a full 320 matrix: a multi-breath-hold FSE sequence with and without iPAT and PACE and a respiratory-triggered FSE sequence with and without iPAT. Image quality was rated with a five-point scale by two independent readers. Signal intensity measurements were performed on a water phantom. RESULTS: The sequences with iPAT required a substantially shorter acquisition time without loss of image quality. Overall image quality was rated equal for all sequences by both readers. Image time for nine slices with iPAT was 13 seconds (19 seconds without iPAT) with multi-breath-hold and on average 4:00 minutes (7:02 minutes without iPAT) with respiratory triggering. Imaging with the PACE technique resulted in more correct positioning of the image stacks. CONCLUSION: T2-weighted fast imaging with iPAT is feasible and results in high-quality images within a short acquisition time. Overall image quality is not negatively affected by iPAT.     

Hepatitis after sevoflurane exposure in an infant suffering from primary hyperoxaluria type 1

An 11-mo-old child with primary hyperoxaluria was scheduled for a nephroureteromia procedure. Anesthesia was induced and maintained with sevoflurane. Two days after the operation, a hepatomegaly was diagnosed, and a considerable increase in liver enzymes was observed. These pathologic findings disappeared without treatment within 7 days. In a subsequent operation 2 wk later, general anesthesia was performed (sevoflurane was avoided). After the second operation, no pathologic findings could be detected. Nothing in this patient's disease or the conduct of the anesthesia suggested a cause for the injury other than an idiosyncratic response to sevoflurane.     

Doping with artificial oxygen carriers: an update

There is a long history of science seeking to develop artificial substitutes for body parts damaged by disease or trauma. While defective teeth and limbs are commonly replaced by imitations without major loss of functionality, the development of a substitute for red blood cells has proved elusive. There is a permanent shortage of donor blood in western societies. Nevertheless, despite whole blood transfusions carrying measurable risks due to immunogenicity and the transmission of blood-borne infectious diseases, red blood cells are still relatively inexpensive, well tolerated and widely available. Researchers seeking to develop products that are able to meet and perhaps exceed these criteria have responded to this difficult challenge by adopting many different approaches. Work has focussed on two classes of substances: modified haemoglobin solutions and perfluorocarbon emulsions. Other approaches include the creation of artificial red cells, where haemoglobin and supporting enzyme systems are encapsulated into liposomes. Haemoglobin is ideally suited to oxygen transport when encased by the red cell membrane; however, once removed, it rapidly dissociates into dimers and is cleared by the kidney. Therefore, it must be stabilised before it can be safely re-infused into humans. Modifications concomitantly alter the vascular half-life, oxygen affinity and hypertensive characteristics of raw haemoglobin, which can be sourced from outdated blood stores, genetically-engineered Escherichia coli or even bovine herds. In contrast, perfluorocarbons are entirely synthetic molecules that are capable of dissolving oxygen but biologically inert. Since they dissolve rather than bind oxygen, their capacity to serve as a blood substitute is determined principally by the oxygen pressure gradients in the lung and at the target tissue. Blood substitutes have important potential areas of clinical application including red cell replacement during surgery, emergency resuscitation of traumatic blood loss, oxygen therapeutic applications in radiography (oxygenation of tumour cells is beneficial to the effect of certain chemotherapeutic agents), other medical applications such as organ preservation, and finally to meet the requirements of patients who cannot receive donor blood because of religious beliefs. Given the elite athlete's historical propensity to experiment with novel doping strategies, it is likely that the burgeoning field of artificial oxygen carriers has already attracted their attention. Scientific data concerning the performance benefits associated with blood substitutes are virtually nonexistent; however, international sporting federations have been commendably proactive in adding this category to their banned substance lists. The current situation is vulnerable to exploitation by immoral athletes since there is still no accepted methodology to test for the presence of artificial oxygen carriers.     

Combination therapy with peginterferon alpha-2B and ribavirin in liver transplant recipients with recurrent HCV infection: preliminary results of an open prospective study

Allograft reinfection with hepatitis C virus (HCV) in transplant recipients occurs commonly and represents a major concern in the transplant setting. Suppression of viral replication in HCV transplant patients should prevent or delay progression to cirrhosis and graft failure. In this ongoing study, we present preliminary data from a prospective trial of standard interferon (IFN) alpha-2b (2 million units daily) for 3 months and subsequent peginterferon (PEG IFN) alpha-2b (1.5 microg/kg/week) for 9 months. IFN therapy was combined with ribavirin (10 to 12 mg/kg). So far, HCV has become undetectable by qualitative PCR in 33% of patients while 25% had a reduction of HCV RNA to undetectable by the bDNA assay and 42% had no virological response after 6 months of therapy. A biochemical response was detected in 42% of patients. Improvement of inflammatory activity was observed in 42% of patients after 6 months. In three patients anemia necessitated administration of erythropoietin and three patients received granulocyte-colony stimulating factor (G-CSF) due to leucopenia [corrected] In conclusion, we observed that daily IFN alpha-2b and subsequent PEG IFN alpha-2b therapy in combination with ribavirin provides biochemical and virological benefits in transplant recipients with established recurrent HCV infection.     

Total laparoscopic repeat aortic surgery

We report our initial experience with total laparoscopic repeat aortic surgery between June 2002 and October 2003. There were 4 patients, 3 men and 1 woman, ages 83, 67, 49, and 61 years, respectively. First operations were performed to treat aortoiliac occlusive disease. Repeat aortic surgery was indicated to treat para-anastomotic aneurysms (n = 2) and graft occlusion (n = 2). All patients underwent total laparoscopic surgery. There were no postoperative deaths. Only 1 patient had postoperative complications that required complementary surgical treatment. All patients were alive with patent revascularization after a mean follow-up of 14, 17, 20, and 12 months, respectively.     

Endozepine stupor: disease or deception? A critical review

Presentation of patients with recurrent stupor associated with apparently elevated levels of an endogenous benzodiazepine-like agent, endozepine-4, has been reported from several centers, and a new syndrome, endozepine stupor has been proposed. We recently reported a case with typical features of this syndrome, which proved to be an example of surreptitious administration of exogenous benzodiazepine. This and other examples of clandestine drug use, together with uncertainties about the validity of tests used to distinguish exogenous and endogenous benzodiazepines, prompted us to undertake a reappraisal of this clinical syndrome.