Alert assistants in managing chronic illness: the case of mothers and teenage sons

In this paper the organising concept of the 'alert assistant' is developed to identify and explore the skilled and often invisible work which mothers of teenage boys with a chronic illness carried out on behalf of their sons. The term 'alert assistant' implies that the needs of the person being assisted are identified, or preferably anticipated and subsequently met, by the assistant. Two inter-relating factors influenced how mothers constructed the need of their sons for an alert assistant; mothers' perceptions of the self-care abilities of their sons, and the gendered ways in which boys lived with chronic illness. Dilemmas for the alert assistant, including being blamed for mollycoddling, are discussed. It is suggested that the incisive concept of the alert assistant not only has the potential to increase understandings of the gendered management and experience of illness, but that it could also be useful in other diverse settings.     

Early awareness of emerging risks associated with food and feed production: Synopsis of pertinent work carried out within the SAFE FOODS project

This introduction to the journal’s supplement on emerging food and feed safety issues summarizes the objectives and activities of the EU-funded SAFE FOODS project in general and its work package focusing on the early identification of emerging food safety risks, in particular. Within this work package, a number of studies have been carried out on methods enabling the early awareness, identification, and prevention of emerging issues before they can become real risks. The various reviews in this supplement explore the background of the emergence of known food safety risks, both of microbial and chemical/biochemical nature, as well the methods that can be used to identify such risks. Another review identifies a number of chemical and microbiological hazards that are likely to be affected by a changing climate. A major conclusion from these explorative reviews is that monitoring and information exchange systems or procedures are in place to detect, in an early phase, the emergence of potential food safety risks linked to known hazards. Additional systems are needed to predict the development of new potential food safety risks, which are linked to either new hazards or known hazards to which exposure has been altered.     

Critical laboratory values in hemostasis: toward consensus

The term “critical values” can be defined to entail laboratory test results that significantly lie outside the normal (reference) range and necessitate immediate reporting to safeguard patient health, as well as those displaying a highly and clinically significant variation compared to previous data. The identification and effective communication of “highly pathological” values has engaged the minds of many clinicians, health care and laboratory professionals for decades, since these activities are vital to good laboratory practice. This is especially true in hemostasis, where a timely and efficient communication of critical values strongly impacts patient management. Due to the heterogeneity of available data, this paper is hence aimed to analyze the state of the art and provide an expert opinion about the parameters, measurement units and alert limits pertaining to critical values in hemostasis, thus providing a basic document for future consultation that assists laboratory professionals and clinicians alike.

• KEY MESSAGES

• Critical values are laboratory test results significantly lying outside the normal (reference) range and necessitating immediate reporting to safeguard patient health.

• A broad heterogeneity exists about critical values in hemostasis worldwide.

• We provide here an expert opinion about the parameters, measurement units and alert limits pertaining to critical values in hemostasis.

     

The experiences of professional nurses who have migrated to Canada: cosmopolitan citizenship or democratic racism?

This interpretive research analyses the discourse of nurses who migrated to Canada and experienced racism. They also experienced reprisals when they formally complained about racism in a context of denial of the problem of racism by colleagues and employers. The present work focuses on two issues arising from the data: the problem of how to make racism visible among those who have a vested interest in denying its existence and the emotional cool of those filing grievances or complaints in contrast with the hot reaction of those being challenged when racism is named. We introduce two theoretical perspectives to address these phenomena called democratic racism and cosmopolitan citizenship, respectively. The former, as defined by Henry et al. (The Colour of Democracy: Racism in Canadian Society. Harcourt Brace, Canada, Toronto, 1996), describes the coexistence of both democratic values and practices that discount people of colour advertently or inadvertently. We outline the notion of cosmopolitan citizenship that is argued by Turner (Politics of the Global City. Routledge, London, 2000) to be an orientation resulting from global microcosms in cities teeming with diversity. The characteristic orientations of cool and stewardship are useful for describing some of the discourse expressed by each participant in our study all of whom challenged racism practices, not on nationalistic grounds, but rather out of concern for universal human rights. Their characteristics qualify them for cosmopolitan citizenship under Turner's perspective. We suggest that anti-racist activists have been cosmopolitan citizens for decades and argue that while cosmopolitan citizenship may have taken root in neo-liberal movements, it appears to have tactical attributes in the struggle with democratic racism. In conclusion, we advocate for a cosmopolitan citizenship ethic to facilitate a rational move toward racial integration in the profession through the sharing of power and privilege. One goal in confronting racism is the accountability for whiteness: immunity from responsibility or apology.     

Comparison of a basic and an advanced pharmacotherapy-related clinical decision support system in a hospital care setting in the Netherlands

Objective

To compare the clinical relevance of medication alerts in a basic and in an advanced clinical decision support system (CDSS).

Design

A prospective observational study.

Materials and methods

We collected 4023 medication orders in a hospital for independent evaluation in two pharmacotherapy-related decision support systems. Only the more advanced system considered patient characteristics and laboratory test results in its algorithms. Two pharmacists assessed the clinical relevance of the medication alerts produced. The alert was considered relevant if the pharmacist would undertake action (eg, contact the physician or the nurse). The primary analysis concerned the positive predictive value (PPV) for clinically relevant medication alerts in both systems.

Results

The PPV was significantly higher in the advanced system (5.8% vs 17.0%; p<0.05). Significant differences were found in the alert categories: drug–(drug) interaction (9.9% vs 14.8%; p<0.05), drug–age interaction (2.9% vs 73.3%; p<0.05), and dosing guidance (5.6% vs 16.9%; p<0.05). Including laboratory values and other patient characteristics resulted in a significantly higher PPV for the advanced CDSS compared to the basic medication alerts (12.2% vs 23.3%; p<0.05).

Conclusion

The advanced CDSS produced a higher proportion of clinically relevant medication alerts, but the number of irrelevant alerts remained high. To improve the PPV of the advanced CDSS, the algorithms should be optimized by identifying additional risk modifiers and more data should be made electronically available to improve the performance of the algorithms. Our study illustrates and corroborates the need for cyclic testing of technical improvements in information technology in circumstances representative of daily clinical practice.     

推拿配合奇正青鹏膏剂治疗膝关节炎128例的临床体会

目的观察推拿配合奇正青鹏膏剂外用治疗膝关节炎的临床疗效。方法推拿前在膝关节前后及上下部涂抹适量奇正青鹏膏剂,用抹法使药膏渗入肌肤后,再用推揉、抹、点、弹拔、拔伸等手法在患部施治。每日治疗1次,10天为1疗程。结果一至三个疗程,痊愈56例,占43．8％,显效50例,占39％,好转18例,占14％,无效4例,占2．3％,总有效率97,7％。结论推拿手法配合奇正青鹏膏剂外用治疗膝关节炎对疼痛疾病疗效显著,值得推广。     

医院门诊短信平台的实现

手机短信息方便、快捷、经济、准确的优点,使其应用日趋广泛。医院信息系统要实现全面数字化。也需要与短信应用相结合。在实践医院门诊系统与短信平台结合的前提下,探讨了主动为病人提供个性化服务、优化门诊就诊流程的方式,以期借短信平台来进一步提高医院服务质量。     

The influence of text messaging on oral hygiene effectiveness

Objective:To investigate whether text message reminders regarding oral hygiene have an effect on plaque removal in orthodontic patients.Materials and Methods:In this randomized, controlled clinical trial, 50 orthodontic patients were assigned to either a text message or control group. Patients in the text message group received 12 text messages over the course of 4 weeks and one text message for 8 weeks thereafter. Photos were taken at baseline (T0), at 4 weeks after baseline (T1), and at 12 weeks after baseline (T2). For each subject, photos of eight teeth were taken and then the area of the tooth and amount of plaque were measured using planimetry.Results:There was a statistically significant difference in plaque coverage between baseline and both T1 and T2 in the text message group as measured using planimetry. This was demonstrated by comparing the average measurements of the control group and the treatment group.Conclusion:This study demonstrated that the use of automated text message reminders sent from an orthodontic office was effective in improving oral hygiene compliance in orthodontic patients.     

生理信息微机处理的应用研究

目的用微机作为生理信息的处理设备。方法３８６型微机系统（主机、Ａ／Ｄ卡、显示器和打印机）作为生理信息处理的硬件，处理软件的主菜单包括六个功能选择项，可记录不同类型的生理信息。用该方法记录了豚鼠的微音器电位、听神经复合动作电位和人的脑干听觉诱发电位，以检验其可靠性。结果用微机记录出清晰的豚鼠的微音器电位，听神经复合动作电位和人脑干听觉诱发电位的波形，测得人脑干听觉诱发电位Ⅰ－Ｖ波潜伏期分别是１．７９１±０．０９１；２．９３１±０．１４８；３．８７９±０．１５５；５．０９３±０．１７９；５．７２３±０．１４２；Ⅰ－Ⅲ，Ⅲ－Ⅴ，Ⅰ－Ｖ波间期的值分别是２．０８８±０．１４２；１．８４４±０．１５２；３．９３２±０．１８２（ｘ±ｓ，单位ｍｓ）。记录的和测量的波形数据与文献报告一致。结论用微机对生理信息进行采集和处理，所测结果精确、有效，值得在生理学实验中推广应用。     

手机健康教育在2型糖尿病患者自我管理中的应用

目的 探讨以手机通信技术(短信和微信)辅助的健康教育模式在2型糖尿病患者自我管理中的应用。方法 抽取符合标准的2型糖尿病住院患者60例进行健康教育前后的对比,应用糖尿病自我效能量表和患者满意度调查表进行资料收集。健康教育是从患者出院后开始,为期4周,每周三次以手机短信和微信发布健康教育信息,并且每周开放答疑时间。结果 56例患者完成了这次研究,有效率为93.3%。总的糖尿病自我效能(p<0.005)和患者满意度都有明显的提高(p<0.01)。结论 手机健康教育顺应了科技发展潮流,满足了患者需求,弥补了传统健康教育的缺点,减少了经济的浪费,增加了医患之间的沟通,在2型糖尿病患者自我管理中起到了重要的作用。