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Kathleen L Meert Celia S Thurston Sherylyn H Briller 《Pediatric critical care medicine》2005,6(4):420-427
OBJECTIVE: Death is common in pediatric intensive care units. A child's death can shatter parents' personal identities, disrupt their relationships, and challenge their worldviews. Spirituality is a human characteristic that engenders transcendence; seeks meaning, purpose, and connection to others; and helps to construct a coherent worldview. Greater attention to spiritual needs may help parents cope with their loss. Our objective is to gain a deeper understanding of parents' spiritual needs during their child's death and bereavement. DESIGN: Prospective, qualitative study. SETTING: University-affiliated children's hospital. Participants: Thirty-three parents of 26 children who died in the pediatric intensive care unit between January 1, 1999, and August 31, 2000. INTERVENTIONS: Semistructured, in-depth, videotaped interviews with parents 2 yrs after their child's death. MEASUREMENTS AND MAIN RESULTS: The main spiritual need described by parents was that of maintaining connection with their child. Parents maintained connection at the time of death by physical presence. Parents maintained connection after the death through memories, mementos, memorials, and altruistic acts such as organ donation, volunteer work, charitable fund raising, support group development, and adoption. Other spiritual needs included the need for truth; compassion; prayer, ritual, and sacred texts; connection with others; bereavement support; gratitude; meaning and purpose; trust; anger and blame; and dignity. CONCLUSIONS: Bereaved parents have intense spiritual needs. Health care providers can help to support parents' spiritual needs through words and actions that demonstrate a caring presence, impart truth, and foster trust; by providing opportunity to stay connected with the child at the time of death; and by creating memories that will bring comfort in the future. 相似文献
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A George VM Srivastava GD Sundararaj 《Journal of Medical Imaging and Radiation Oncology》1997,41(2):199-200
A young man presented with desmoplastic fibroma in the proximal ulna. This rare tumour was treated by curettage and bone grafting. 相似文献
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A Blanco G Solis E Arranz GD Coto A Ramos J Telleria 《Acta paediatrica (Oslo, Norway : 1992)》1996,85(6):728-732
The purpose of this study is to measure soluble CD14 (sCD14) levels in sera from newborn with sepsis, to compare it with other markers, and to study its evolution in Gram-negative and Gram-positive sepsis. Forty normal newborns were included (26 were full term and 14 were preterm infants), 20 babies had a positive blood culture (11 Gram-positive and 9 Gram-negative) and 16 cases were suspected of having sepsis based on clinical and laboratory findings, but a negative blood culture. Interleukin-6 (IL-6), sCD14, and tumour necrosis factor-α (TNFα) were measured by enzyme immunoassay, and fibronectin (FN) and C-reactive protein (CRP) by radial immunodiffusion. Neonates with a positive blood culture had increased levels of sCD14(3.20 ± 1.26μgml-1 , p < 0.001), CRP(69 ± 46 μgml-1 , p < 0.001)and IL-6 (134 ± 150 pg ml-1 , p < 0.001), and decreased values of FN (12.3 ± 6.6 mg ml-1 , p < 0.001). TNFα levels were also high (160 ± 37 pg ml-1 ), but this increase was not statistically significant. Newborn infants suspected of having sepsis but a negative blood culture had similar but milder abnormalities. Soluble CD 14 levels correlated with CRP values; however, there was no correlation between sCD 14, TNFα and IL-6. Neonates with sepsis by Gram-positive bacteria had lower sCD14 levels than patients with Gram-negative sepsis (2.63 ± 1.2 versus 4.04 ± 1.0μgml-1 , p < 0.05). In conclusion, the sCD14 level is increased in newborn infants with sepsis, and this is higher in infections by Gram-negative bacteria, suggesting a different contribution of monocyte and macrophage cells. In contrast, IL-6, TNFα, CRP and FN values are similar in infections by Gram-positive and Gram-negative bacteria. 相似文献
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Thurston G Maas K Labarbara A Mclean JW McDonald DM 《Clinical and experimental pharmacology & physiology》2000,27(10):836-841
1. Chronic inflammation is associated with blood vessel remodelling, including vessel proliferation and enlargement, and changes in vessel phenotype. We sought to characterize these changes in chronic airway inflammation and to determine whether corticosteroids that inhibit inflammation, such as dexamethasone, can also reduce microvascular remodelling. 2. Chronic airway inflammation was induced in C3H mice by infection with Mycoplasmapulmonis and the tracheal vessels treatment also decreased the immunoreactivity for P-selectin and the number of adherent leucocytes (595 +/- 203 vs 2,024 +/- 393 cells/ mm2 in treated and non-treated infected mice, respectively). 6. We conclude that microvascular enlargement and changes in vessel phenotype are features of some types of chronic inflammation and, furthermore, that dexamethasone reverses the microvascular enlargement, changes in vessel phenotype and leucocyte influx associated with chronic inflammatory airway disease. 相似文献
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A. C. Tugwell D. R. Thurston C. W. Barrett 《Journal of clinical pharmacy and therapeutics》1984,9(4):311-319
In recent years there has been a renewed interest in the use of local hospital ‘formularies’. The development and preparation at The London Hospital (Whitechapel) of a guide to prescribing which embraces and extends the concept of a formulary is described. A method of involving staff in the preparation of text was developed to ensure the rapid production of a reasonably comprehensive guide which would command respect and a high degree of compliance. The use of word-processing techniques and graphic design expertise are described. The guide has been carefully introduced together with plans for monitoring compliance and its influence on drug expenditure. These are discussed in the light of one year's experience with the guide. 相似文献