Healthcare provider–child–parent communication in the preoperative surgical setting

Objectives:  Although preoperative preparation programs were once common, most children currently undergoing outpatient surgery are first exposed to the hospital on the day of the procedure. It is advocated that these outpatient children undergo the preparation just prior to surgery.
Aim:  To assess the amount of time that healthcare providers spend with children and families on the day of surgery in the preoperative area.
Materials and Methods:  The study used video infrastructure in the preoperative holding area of Yale New Haven Children's Hospital to record all interactions between children, families, and healthcare providers. Videotapes were coded to characterize and quantify behaviors of healthcare professionals.
Results:  On the day of surgery, healthcare providers spent medians of 2.75–4.81 min interacting with children and parents in the preoperative area. Families spent a median of 46.5 min in the preoperative area. Healthcare professionals spent the most time in medical talk (averages of 42.5–48.2% of time spent with family) and little time was spent in nonmedical talk (range of 6.2–6.9% of time spent with family). Anesthesiologists and surgeons spent 28% and 18% of the interview in talk to children; admitting nurses spent more of the interview talking to children (43%).
Conclusions:  Families interact with healthcare providers for only a small proportion of the time they spent in the preoperative area. This is likely to be a result of increased production pressure in the perioperative settings and has implications for providing preparation for surgery on the morning of the procedure.     

《感受nurse的爱抚》之十:《MaMoRu》

在日本的一个大城市里,有一家拥有637张病床的城市医院,我帮助那家医院创建了一个心理咨询联络护理的岗位,因此,我成了那家医院的第一个也是唯一的一个心理咨询联络护理专家。 一天,内科病室的护士请我去看一个叫MaMoRu的病人。MaMoRu已经71岁了,患了胃癌和肺炎。对临床护士的要求做出反应是我的职责的一部分。 MaMoRu坐在轮椅上,由他的妻     

RENIN, ANGIOTENSIN, CORTICOSTEROIDS, AND ELECTROLYTE BALANCE IN ADDISON'S DISEASE

Two patients with previously untreated Addison's disease werestudied. Both showed defective adrenal responsiveness to infusionsof corticotrophin and angiotensin, and both had abnormally lowplasma sodium and high plasma renin concentrations. Plasma potassiumwas elevated in one and normal in the other. Steroid replacement therapy was accompanied by an increase inNa_E, correction of plasma electrolyte concentrations, and areduction of plasma renin concentration to normal. K_E was virtuallyunchanged in the first weeks of treatment in either patient. In Case 1 treatment caused a movement of water and sodium fromICF to ECF, and probably of potassium from ECF to ICF. ECF volumeincreased more than TBW. Angiotensin infusion caused abdominal pain in this man, suggestingthat the elevated plasma renin may contribute to the characteristicabdominal pain of Addison's disease. In Case 2 treatment restored the normal nyothemeral rhythm ofurine flow, and caused a slight initial loss of TBW and weight.     

Malignant Sustained Ventricular Tachyarrhythmias in Women:

Implantable Defibrillators in Women. Clinical rhythm, heart disease, ejection fraction, defibrillation threshold, recurrent arrhythmias, and mortality were compared in 268 consecutive recipients (213 men and 55 women) of their first implantable cardioverter defibrillator for life-threatening ventricular tachycardia or fibrillation. Women were younger than men, less likely to have structural heart disease, and more likely to have clinical ventricular fibrillation, a higher ejection fraction, and a lower defibrillation threshold. Complications of defibrillator placement were similar in both sexes. Unadjusted survival tended to be higher in women than in men (97% vs 90%, respectively, at 2 years, P = 0.08), largely due to fewer deaths from noncardiac causes or cardiac causes other than arrhythmia (P = 0.04). Women also tended to be at lower, albeit still substantial, risk for recurrent arrhythmias during follow-up (37% vs 52% in men at 2 years, P = 0.11). After adjustment for baseline differences, overall survival, arrhythmia death-free survival, nouarrhythmia death-free survival, and frequency of recurrent arrhythmias were not found to be gender related. Despite their apparent "lower risk" status on initial presentation, women remained at substantial risk for recurrent arrhythmias. This underscores the need to avoid being unduly biased by the "appearance" of health in managing women with malignant arrhythmias. That survival and other clinical endpoints were all ultimately independent of gender emphasizes the importance of other clinical variables in assessing risk from ventricular tachyarrhythmias.     

Intrastriatal grafts of rat colonic smooth muscle lacking myenteric ganglia stimulate axonal sprouting and regeneration

Grafts of living or freeze-killed freshly dissected colonic smooth muscle from young inbred Fischer rats were implanted into the corpus striatum of adult Fischer rats. Sections of brain were examined electron microscopically 3 and 6 wk after implantation. At both times, living grafts were vascularised and contained healthy differentiated smooth muscle cells, fibroblasts, interstitial cells of Cajal and some macrophages. Large bundles of small nonmyelinated axons, identified as CNS axonal sprouts, could be observed in the brain at and near the interface between the living smooth muscle and the CNS tissue. Bundles of regenerating CNS axons, often associated with astrocyte processes, had grown into the grafts. Some axons within the grafts had matured, enlarged and become myelinated by oligodendrocyte processes or Schwann cells. In some cases, smooth muscle cells were observed in close and intricate association with axons. In contrast to the living grafts, grafts of freeze-killed smooth muscle, examined 3 and 6 wk after implantation, contained macrophages, fibroblasts, collagen and large amounts of cellular debris, but no living muscle cells, astrocytes or Schwann cells. The striatal neuropil around freeze-killed grafts did not contain large bundles of CNS axonal sprouts and bundles of axons were not observed within the freeze-killed graft. This study demonstrates that cells from the smooth muscle layers of the colon, in the absence of myenteric ganglia, can stimulate a vigorous regenerative response from CNS axons when implanted into the corpus striatum of adult rats.     

Community Views About the Role of General Practitioners in Disease Prevention

The role of preventive medicine in reducing mortality and morbidityis now widely recognized. Although general practitioners appearto be in an excellent position to offer preventive care, thereis evidence that they currently do not detect or intervene forcommon risk behaviours. One reason for this may be the generalpractitioner's perception that patients do not expect such preventiveactivities to be a part of the doctor's role. A postal surveyof 309 people randomly selected from the community was undertakento examine perceptions about the general practitioner's rolein detection and intervention for smoking, alcohol abuse, emotionalproblems and hypertension. Responses to the survey from 264usable questionnaires indicated that people in the communityaccepted the general practitioner's role in preventive care,with most respondents indicating that they would appreciatebeing asked about the risks examined, would like the offer ofintervention and would try treatments in these areas offeredby the doctor. Few respondents indicated that they would changedoctors as a result of preventive activity.     

United We Stand — Divided We Fall

ABSTRACT: In June, 1992, the NSW Health Department released their Discussion Paper on 'The Role and Function of Nurse Practitioners in NSW'. The paper recommends legislative changes to enable nurse practitioners to initiate certain diagnostic tests, prescribe from a limited list of drugs, refer directly to specialist medical officers in certain circumstances and be reimbursed for some of the services they provide. Strict criteria for accreditation and evaluation are also recommended. Overseas literature confirms that nurse practitioners provide a safe, competent and cost effective service, which is well accepted by consumers. Opponents of the nurse practitioner concept in Australia have argued that it would be 'dangerous practice' and a 'duplication of services' to implement the Discussion Paper's recommendations. These arguments can not be substantiated. Of more concern is the attempt to divide nurses and nursing on the issue. To suggest that it is acceptable for nurse practitioners to provide services where doctors don't choose to practice or to provide service to disadvantaged groups of people, with whom doctors don't choose to work is unacceptable to nursing. Nurses provide nursing care, they do not provide medical care. Wherever nurses happen to be located, nurses are nurses and do nursing. Whether or not there is a doctor available is not the issue. Nurses do not seek to be doctors. Nurses do not seek to practice medicine. Nursing as a profession stands alone. This paper discusses the nurse practitioner concept as it is proposed for NSW, the implications for urban, rural and remote area nurses, the deliberate attempts to create division amongst nurses on the issue and the need for nurses to stand together to protect, validate and legitimise nursing practice.     

Working with families of children with special needs: the parent adviser scheme

This paper describes a project in which an attempt is made to provide regular, ongoing support and counselling for families of children with severe developmental delays and intellectual or physical impairments. This service is available to both English speaking and Bangladeshi families, and is concerned with the needs of the whole family, not just the child. Professionals already working in this field are trained in counselling skills and then work in partnership with the families, attempting to develop a respectful, open relationship based upon active listening.     

Two Techniques to make the Lymphocytotoxic Crossmatch more Sensitive: Prolonged Incubation and the Antiglobulin Test

Two techniques capable of increasing the sensitivity of the Iymphocytotoxic crossmatch test were compared for sensitivity and practicality using the fluorochromasia modification of the cytotoxicity test. Prolonging the incubation period after addition of complement in the standard test resulted in further positive reactions. Modification of the test by addition of antiglobulin reagent increased the reactivity more than prolonged incubation of the standard test. The fluorochromasia adaptation of the antiglobulin test had sensitivity equivalent to the original antiglobulin method. The antiglobulin technique had a number of disadvantages, and neither the prolonged incubation nor the antiglobulin procedure meet the requirements of a busy histocompatibility testing service in view of the time consumed for the first and the complexity of the second.     

DECREASED LH RESPONSE TO THE SECOND OF CONSECUTIVE DAY LUTEINIZING HORMONE RELEASING HORMONE (LHRH) INFUSIONS AMONG PATIENTS WITH CONSTITUTIONAL DELAY OF PUBERTY: A PHENOMENON OF PUBERTAL MATURATION?

Consecutive day LHRH stimulation by continuous infusion has been used to evaluate pituitary reserve. Different responses on the 2 days were not present among non-pubertal hypopituitary patients, pubertal growth hormone deficient patients or adult males. However, patients with constitutionally delayed puberty demonstrated a greater serum LH response on day 1 than day 2. Urinary LH responses suggest a similar but not statistically significant pattern. This response may be a normal phenomenon of puberty or may represent part of the reason for constitutionally delayed puberty.