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131.
BACKGROUND: District nurses are frequently involved in the care of patients immediately prior to death and could therefore provide support to bereaved relatives. However, little is known about nurses' views on bereavement support or their actual involvement. AIMS OF THE STUDY: To survey a representative sample of district nurses to ascertain their current practice and perceived role in supporting bereaved people and to identify factors that influence their practice. DESIGN AND METHOD: A self-completed postal questionnaire was distributed anonymously to 522 district nurses in the central southern coastal area of Britain. It comprised five sections: interest in and education about bereavement; a Likert scale to measure nurses' views about bereavement care; information about the practice with which the nurse had links; bereavement care provided by the practice; and demographics. RESULTS: A 62% response rate was achieved following two reminders. Sixty-nine per cent reported having an interest in bereavement support. Logistic regression modelling identified older age of the nurse and district of employment as the best predictors of interest in bereavement, and older age of the nurse, district of employment and higher level of academic qualification (having a diploma or degree) as the best predictors of active follow-up bereavement visiting. Ninety five percent of district nurses believed their role should involve visiting bereaved relatives/carers of patients they have nursed, but only 19% believed they should visit bereaved people when the deceased was not their patient. CONCLUSIONS: Older age, higher qualifications and district of employment among district nurses were associated with greater interest in bereavement and more proactive care of bereaved people. The findings of this survey have important implications for the training, continued education and the extended role of the nurse in bereavement support. 相似文献
132.
Eric J. Finnesgard T.K. Pandian Michael L. Kendrick David R. Farley 《American journal of surgery》2018,215(3):447-449
Background
The effects of replacing a surgeon's familiar, experienced certified surgical assistant (CSA) on perioperative outcomes in complex surgery were investigated.Methods
An interrupted time series of totally laparoscopic pancreatoduodenectomies performed by a single surgeon was retrospectively studied. Segmented regression analysis estimated replacement effects on estimated blood loss (EBL) and operative time.Results
The cohort was composed of the last 100 cases with the familiar CSA and the first 100 cases with the replacement CSA. Study groups were similar. Unadjusted segmented regression of operative time and EBL predicted replacement effects of 70 min (95%CI, 18–122; p = 0.008) and 114 cc (95%CI, -93-320; p = 0.3), respectively. Adjusted regression predicted replacement effects of 40 min (95%CI, 0.9–78; p = 0.04) and 27 cc (95%CI, -156-210; p = 0.3).Conclusions
The replacement of a familiar, experienced CSA was associated with longer operative times. Despite confinement to a single surgeon and procedure, these results suggest what all surgeons know: excellent help is priceless. 相似文献133.
Kathy Kendrick 《Journal of PeriAnesthesia Nursing》2005,20(1):7-12
Pseudocholinesterase deficiency is usually identified when an anesthetized patient has prolonged paralysis after receiving neuromuscular blocking agents dependent on pseudocholinesterase enzymes for hydrolysis. This rare complication, most frequently associated with succinylcholine, can occur with the use of mivacurium, one of the newer nondepolarizing muscle relaxants also hydrolyzed by pseudocholinesterase. Prolonged paralysis has occurred 3 times in the past 2 years at this pediatric hospital after administration of mivacurium. The following case study describes causality and interventions for a patient with prolonged paralysis after receiving mivacurium. 相似文献
134.
There is abundant evidence of immune modulation induced by exposure to blood transfusions. Some studies have demonstrated a detrimental effect of transfusion on the recurrence of malignant disease and survival. We retrospectively studied the impact of blood transfusion exposure on 229 patients with breast cancer who were seen from July 1973 to September 1980, had at least 5 years' follow-up and had been randomized by therapy at the time of diagnosis. The patients were divided into four groups according to transfusion history: Group 1 (111 patients), no transfusion; Group 2 (34 patients), first transfusion after mastectomy; Group 3 (41 patients), first transfusion at mastectomy; and Group 4 (43 patients), first transfusion before mastectomy. All transfused patients received red cells or whole blood or both. At the time of analysis, 124 (54%) of the patients had died. Only Group 2 was statistically associated with decreased survival; recurrence of disease was 85 percent in this group, compared with 53 percent to 61 percent in the other three groups (p = 0.006, log-rank test). In general, Group 2 patients received transfusions because of recurrent disease. We conclude that transfusions before or at mastectomy are not associated with increased recurrence or reduced survival in patients with breast cancer. 相似文献
135.
Zoltán Kekecs Juliette Bowers Alisa Johnson Cassie Kendrick 《The International journal of clinical and experimental hypnosis》2016,64(3):285-304
Measuring hypnotizability is an integral part of hypnosis research and is also relevant for predicting effectiveness of hypnosis-based therapies. The Elkins Hypnotizability Scale (EHS) was designed to meet the needs of modern hypnosis research and clinical practice. Reliability, validity, and normative data were explored by subjecting 230 participants to the EHS and Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C). The EHS demonstrated adequate internal consistency (α = .78), its items showed good discriminating ability, and scores of the two scales were highly correlated (ρ = .86). Results indicate that the EHS is a reliable and valid tool to assess hypnotizability. Further research is needed to establish its role as a surrogate for the SHSS:C. 相似文献
136.
Hyperprolactinaemia was induced in castrated, testosterone-treated male rats using ectopic pituitary grafts under the kidney capsules. After 6 weeks the absolute refractory period of stria terminalis neurones in these animals did not differ significantly from long-term castrated rats (mean = 1.72 vs 1.69 ms) in spite of the presence of normal testosterone concentrations. Gonadally intact animals, and sham-operated castrated animals treated with testosterone, showed by comparison the characteristic significantly shorter absolute refractory period normally associated with testosterone stimulation (mean = 1.15 and 1.08 ms respectively). These results provide the first demonstration that hyperprolactinaemia can abolish central sensitivity to testosterone. 相似文献
137.
138.
The main olfactory system and social learning in mammals 总被引:2,自引:0,他引:2
There is increasing evidence for specialised processing of social cues in the brain. This review considers how the main olfactory system of mammals is designed to process social odours and the effects of learning in a social context. It focuses mainly on extensive research carried out on offspring, mate or conspecific learning carried out in sheep and rodents. Detailing the roles of the olfactory bulb and its projections, classical neurotransmitters, nitric oxide, oestrogen and neuropeptides such as oxytocin and vasopressin in mediating plasticity changes in the olfactory system arising from these different social learning contexts. The relative simplicity of the organisation of the olfactory system, the speed and robustness of these forms of social learning together with the similarity in brain regions and neurochemical contributions across the different learning paradigms make them important and useful models for investigating general principles of learning and memory in the brain. 相似文献
139.
Martin D. Zielinski Thomas D. Atwell Peyton W. Davis Michael L. Kendrick Florencia G. Que 《Journal of gastrointestinal surgery》2009,13(1):19-25
Background Polypoid lesions of the gallbladder (PLG) have been a common finding on ultrasound examinations of the abdomen and are more
prevalent since our use of equipment incorporating pulse shaping increased bandwidth, and enhanced phase use for image reconstruction
began in 1996. Our study correlates the pre-operative ultrasonographic findings of these lesions to the surgically resected
specimen with specific regard to identifying neoplastic polyps.
Methods A retrospective review was performed of 130 patients who had a pre-operative ultrasound of the gallbladder and subsequently
underwent cholecystectomy between August 1996 and July 2007 at the Mayo Clinic Rochester.
Results Seventy-nine pseudopolyps (cholesterol polyps, inflammatory polyps, and adenomyomas) and 15 neoplastic polyps were identified
on histopathologic analysis. However, 36 patients (27%) did not have a PLG upon histopathologic analysis. Thirty-one polyps
had suspicious ultrasonographic characteristics for neoplastic changes. Twenty-nine were ≥10 mm, 12 had vascularity, and one
demonstrated invasion. Of these, there were 23 pseudopolyps and six true polyps with neoplastic changes on final pathology
(four dysplastic adenomas and two adenocarcinomas). Three asymptomatic polyps ≤10 mm (4%) in maximum diameter based on pre-operative
ultrasound imaging (US) had neoplastic changes at pathology (two dysplastic adenomas and one adenocarcinoma). Several statistically
significant risk factors were identified that increased the likelihood for malignancy in a PLG: history of primary sclerosing
cholangitis (PSC), local invasion, vascularity, and ≥6 mm maximum diameter based on pre-operative US. Of PLGs ≤10 mm, 7.4%
were neoplastic. Twenty-five patients were followed up with at least two serial ultrasound examinations. Of these, seven demonstrated
polyp growth. None of these specimens demonstrated neoplastic changes. The positive predictive value (PPV) and negative predictive
value (NPV) for ultrasound diagnosing neoplastic changes based on current criteria was 28.5% and 93.1%, respectively, with
a false negative rate of 5.0%. Expanding the criteria to include cholecystectomy for PLGs ≥ 6 mm changes the positive predictive
value and negative predictive value to 18.5% and 100%, respectively, with a false negative rate of 0%.
Conclusion Histopathologic analysis of polypoid lesions of the gallbladder continues to be the gold standard to identify malignancy.
Ultrasound has been used extensively in the pre-operative management of these lesions, but modern ultrasound techniques are
unable to differentiate between benign and malignant PLGs with any certainty. We recommend that strong consideration be given
to surgical resection of PLGs ≥ 6 mm based on pre-operative US due to the significant risk of neoplasm. Additionally, PLGs
in all patients with PSC, any patient in whom diligent long-term follow-up cannot be completed, and lesions that demonstrate
growth, vascularity, invasion, or are symptomatic require cholecystectomy.
Presented at SSAT at the DDW 相似文献
140.
Joshua G. Barton John P. Bois Michael G. Sarr Christina M. Wood Rui Qin Kristine M. Thomsen Michael L. Kendrick Michael B. Farnell 《Journal of gastrointestinal surgery》2009,13(11):2050-2058