Change in process: bringing about change in health care through action research

• ? A 2-year action-research project aiming to facilitate the management of change was carried out in a district general hospital.
• ? Hospital managers and senior ward nurses had very different views concerning the source of challenges and problems within the hospital organization.
• ? A case-study of nurses' experience of change at ward level was produced as part of the diagnostic phase of the action research.
• ? The results of the case-study indicated that general managers and professionals had different agendas for change hut that there is common ground between them.

     

Reading research critically. I. An introduction to appraisal: designs and objectives

• ? This is the first of two articles providing an introduction to appraising published research critically.
• ? In this paper three styles of research are presented and the basic types of research objectives and designs are briefly described.

     

The development of guidelines for drug and alcohol dependence treatment: affecting policy and practice

The rationale and methodology behind the Australian Quality Assurance Project is described. The Project aimed to develop guidelines for treatment content based on three sources of information: research findings, current practice and expert opinion. The issue of the gap between research and practice is discussed, as well as the role of dissemination in altering clinician behaviour.     

Aspects of the aetiology of congenital heart disease

A concise overview of current knowledge on the aetiology ofcongenital heart disease is provided. At present, only 10 to20% of the cases occurring in neonates can be attributed toknown risk factors. Recurrence within relatives, chromosomalanomalies, genetic disorders, maternal diseases and teratogenexposure are addressed briefly; contemporary research modelsand methods, e.g. embryology and genetics and molecular biology,are referred to. A major innovation has been the introductionof the concept of common pathogenetic pathways. Thus, differentteratogenic factors or risk-factors may affect normal developmentat an identical stage and cause similar malformations. Also,the importance of timing of an event is stressed. If the timeframe of exposure does not coincide with embryogenesis any teratogeniceffect may be missed. Large-scale epidemiological studies on fetuses and neonateswith congenital heart disease are introduced as a third modeof research on the aetiology, although this approach is notused efficiently at present; cases of intra-uterine death canbe considered a valuable source of information that needs furtherattention. Combined, the above three lines of research may proveproductive, but the design of a comprehensive research projectwould need to be handled carefully. Possibilities for preventionof the occurrence of cardiovascular malformations are reported.Through lack of knowledge of causality, at present, only secondaryprevention may be possible and hence deserves attention. However,there appears to be no provision for thorough pre-natal screeningtests for congenital heart disease in an unselected population.     

Gynopia in nursing practice: the case of urethral catheterization

• ? A pilot study of catheterized women was designed to investigate their perceptions of pain and discomfort during the procedure.
• ? The study aimed to test the feasibility of conducting a larger randomized controlled trial.
• ? Problems were encountered during the execution of the study, due to the need to conform to established principles in clinical research.
• ? Restrictions on access to patients impinged upon the opportunity to ‘cast the net wide’ in order to generate meaningful data.

     

龚定国考

经考证,著《内府秘传经验女科》的龚定国是明末名医龚廷贤之子。     

补肾健脾法治疗胎怯的临床研究

目的:研究补肾健脾法治疗胎怯的临床疗效。方法:以补肾健脾方药制成助长口服液为治疗组,以不用药为对照组,进行治疗胎怯的临床对照观察。结果:治疗组疗效(78%)显著优于对照组(52%),P<0.001;治疗组在改善体重、身长、头围、胸围、上臂围等方面显著优于对照组,P<0.05～0.01;治疗组治疗后血清T3升高,T4下降,与对照组相比,P<0.05;在降低患病率方面,治疗组(43%)优于对照组(72%),P<0.05;治疗组远期疗效优于对照组,P<0.05。结论:补肾健脾法治疗胎怯有显著的临床疗效。