Token economy in a hospital rehabilitation system

A ward-based token economy programme which formed one part of a larger rehabilitative service for long-stay psychiatric patients is described. The clinical effectiveness of the programme is examined by the use of various nursing, psychological and psychiatric assessments before and after the patients' treatment on the ward, and the progress of former patients is followed-up as they move to different parts of the rehabilitation service. Significant clinical gains in patients' psychiatric symptomatology and problem behaviour on the ward are reported, although there were indications that improvement was not fully maintained as the patients moved on to other parts of the service. Comparison of the present clinical programme with the earlier research programmes on the ward indicated that the present regime was superior. The advantages and problems of token economy as a rehabilitative facility are discussed, outlining the various different roles for token economy with psychiatric rehabilitation. Finally, the future of token economy for long-stay patients is considered, questioning whether it might more appropriately be replaced by other structured ward programmes.     

Patient expectations and satisfaction with medical care for upper respiratory infections

To describe the determinants of patient satisfaction with medical care, self-administered questionnaires were given to a consecutive sample of 237 patients coming to an ambulatory care practice for the treatment of upper respiratory infections (URIs). Patients' most important goal was to obtain a diagnosis (57%). They usually got more reassurance, medication, and personal interest than they had expected (p = 0.0001). In a multivariate model, patients' satisfaction was related to the degrees of personal interest and reassurance they had received and to whether they felt they had received the right medication (r2 = 0.45, p = 0.0001). The authors concluded that patients with URIs generally want a diagnosis but are primarily satisfied by the personal interest, the reassurance, and the medication they receive.     

Changes in responses of parafascicular nuclei during adjuvant-induced acute arthritis and effect of acupuncture in the rat

We have previously demonstrated that during acute arthritis in the rats induced by local intraplanter adjuvant, there are dramatic alterations in the behavioral responses to noxious stimulation. The purpose of this study was to observe the changes in responses of parafascicular nuclei (Pf) neurons during acute arthritis and effect of acupuncture (EA) in the rats. It was shown that: (1). for the whole populations of somatosensory neurons there was no statistical significant between arthritic rat and normal rat (P greater than 0.05). However, nociceptive neurons activated exclusively by noxious stimulation were less in the arthritic rat (21/60) than in the normal rat (35/46) (P less than 0.01); nociceptive-non-nociceptive neurons activated by both noxious and non-noxious stimulation were more in the arthritic rat (30/60) than in the normal rat (9/46) (P less than 0.01), and there was no statistical significant different for population of non-nociceptive neurons between two groups. (2). Nociceptive responses of Pf neurons (n = 16) could be markedly inhibited by EA at Xuanzhong (G39) and Kunlun (B60) in acute arthritic rat. In particular, the inhibitory effect was of great significance (P less than 0.01) during 0-10 and 20-35 minutes following cessation of EA. These results suggest that rats were hyperalgesic during adjuvant-induced acute arthritis and EA produces a fine analgesic effect in acute arthritic rats. The results also support the view that adjuvant-induced acute arthritic rat can be considered as a model for research of pain and analgesia.     

Shelf-lives and factors affecting the stability of morphine sulphate and meperidine (pethidine) hydrochloride in plastic syringes for use in patient-controlled analgesic devices

Published reports regarding the stability of morphine are at variance, especially in syringes used in patient-controlled analgesia (PCA) devices. In addition to the effects of container type and vehicle, reasons for this variation include the effect of excipients temperature and light during storage. Furthermore, the literature varies regarding the mechanisms of decomposition for morphine. To our knowledge, the stability of meperidine (pethidine) stored in plastic syringes has not been reported. The purposes of this study were to investigate the stability of morphine sulphate (1 and 5 mg/ml) and meperidine hydrochloride (5 and 10 mg/ml) in plastic syringes for use in PCA devices for a duration of 12 weeks, and evaluate the influence of light (240 foot-candies), temperature (-20, 4 and 23d?C), diluent (5% dextrose or normal saline), and drug concentration on the stability of these narcotic analgesics. Samples were taken bi-weekly for solutions protected from light and weekly for solutions exposed to light. Morphine sulphate and meperidine hydrochloride concentrations were quantified using independent, stability-indicating, high performance liquid chromatographic assays. The within-day and between-day coefficients of variation for these assays were 4% over each of the concentration ranges studied. Under the conditions of this study, it is proposed that although decomposition of morphine to its main product, pseudomorphine, can be interpreted using first-order kinetics, consecutive (to form the N-oxide) and parallel mechanisms (to form apomorphine) exist. Morphine solutions were more stable in normal saline than in 5% dextrose. SheIf-life data indicate that morphine is stable for at least 6 weeks when protected from light. Exposure to light accelerates morphine decomposition two to six-fold depending on the concentration, and the shelf-life is reduced to about 1 week in some instances. Meperidine solutions in both vehicles under all conditions had shelf-lives of at least 12 weeks. No effects of light were detected and no changes in solution colour were observed. This study illustrates that patients using PCA devices must be advised about shelf-lives as well as correct storage conditions to protect solutions of these drugs from environmental factors that may alter shelf-lives. Pharmacists should also note that other formulation factors such as: antioxidants, preservations, buffers, impurities, and the source and quality of containers, may significantly alter the shelf-lives of these drugs.     

安定东莨菪碱在产程中的联合应用（附176例分析）

产程延长传统处理方法是应用催产素静脉点滴，根据安定能选择性使宫颈肌纤维松驰；东莨菪碱能扩张血管，改善微循环，解除平滑肌痉挛，使宫颈水肿消失或减轻，我院妇产科自1988年5月至1989年4月，对176例在产程延长或宫颈水肿的产妇，联合应用安定、东莨菪碱，取得良好的效果，本文介绍了应用方法，并对二药的药理作用进行了讨论。     

带环后月经过多机制的超微结构研究

带宫内避孕环系常用之节育措施,不正常子宫出血系常见之并发症。本文旨在研究发生出血的机制,提出改进意见,以利于带环妇女的健康,提高带环率。本文对12例带不锈钢环后月经过多妇女的子宫内膜进行超微结构研究,与6例带环而月经正常的妇女对比,结合基础体温、血雌孕激素测定等资料加以讨论。研究结果表明:(1)带环不影响卵巢功能。(2)环周围区与远离区内膜发育的不同步可能是出血过多的重要原因。(3)选择大小适宜的环(宁小勿大)既提高避孕效果又避免出血过多。     

Diffusion‐Weighted MRI in Creutzfeldt‐Jakob Disease: A Better Diagnostic Marker Than CSF Protein 14‐3‐3?

Two middle-aged patients presented with rapidly progressive dementia and ataxia, nonspecific electroencephalography findings, and negative cerebrospinal fluid (CSF) protein 14-3-3. Both patients underwent brain magnetic resonance imaging (MRI) scans that demonstrated abnormalities on diffusion-weighted imaging (DWI) sequences, and both were later confirmed to have Creutzfeldt-Jakob disease. (CJD) by tissue examination. Because a recent position paper from the American Academy of Neurology characterized CSF protein 14-3-3 as a gold standard for clinically diagnosing CJD, the authors reviewed studies of CJD in which DWI-MRI imaging and CSF protein 14-3-3 studies were both performed. Among 19 reported cases of CJD with DWI-MRI lesions, CSF protein 14-3-3 was negative in 6 cases and positive in 2 others. The authors' findings suggest that multifocal cortical and subcortical hyperintensities confined to gray matter regions in DWI-MRI may be a more useful noninvasive diagnostic marker for CJD than CSF protein 14-3-3. These observations provide a compelling rationale for a prospective comparative study.     

Nursing: Caring or Codependent?

Can nurses practice caring within a healthcare system that promotes codependency? Caring promotes mutual empowerment of all participants while codependent caring disempowers. Nurses are expected to practice caring with clients, The authors contend, however, that nursing, as historically and currently practiced within bureaucratic/patriarchal organizations, is founded on a vlue system that fosters codependency. Until nursing is practiced within the context of caring organizations and a caring healthcare system, nurses will continue to be powerless to shape their own practice as carers and burnout will continue to be a problem.     

甲壳素制备工艺改进——天然甲壳素的提取

甲壳素制备工艺改进为统一常温进行,操作简便,产品相对收率提高5～10％,同时降低了能耗、机械要求强度、劳动保护条件和生产成本,并经热分析说明产品维持了甲壳素的天然特性,即分子中每结构单元含有1/2分子缔合水,是天然的甲壳素产品并有益于其脱乙酰化物──壳聚糖质量的提高。     

DNA探针的高效标记和哺乳动物细胞转化子的检测

本实验采用随机引物法标记探针DNA.探针DNA加热变性成单链,以单链DNA为模板,六聚脱氧核苷酸为引物,在DNA多聚酶I大片段的作用下进行放射性标记.标记探针的比放射性达10~8cpm/μg DNA以上.放射性底物的掺入率为60%.用该方法标记的人高度重复顺序探针,可以检出微微克水平的阳性分子.与人HeLa S_3细胞DNA转化的小鼠LTK~+细胞DNA打点杂交呈阳性,与未经转化的小鼠LTK~-细胞DNA杂交为阴性,证明小鼠转化细胞中存在HeLa细胞DNA,DNA转化是成功的.