'This isn't very typical I'm afraid': observing community care complaints procedures

The new complaints procedures which local authority social services departments have been required to introduce represent an important mechanism for managing the change of culture associated with recent community care reforms. They also represent a new genre in mechanisms of redress for welfare recipients. This paper reports the findings of a study which has observed considerable diversity in the ways in which local authorities are interpreting the nature and purposes of the new procedures and, in particular, the functions of review panels established under those procedures. Variations in the composition of panels, in the style of review panel proceedings, in perceptions of the panels' powers, and in the ways that complaints and complainants are constituted are all discussed. Attention is drawn to four competing interpretations of the review panels' role and to the need for these to be clarified and prioritised.     

整体护理改善护患关系的体会

整体护理的实施,重塑了护士的职业价值观,增加了护患之间的接触。护士能够在自己的专业范围内积极主动地解决病人的问题,挖掘了护理人员的自身潜力,加深了护患交流,使护患关系明显改善。     

Unusual Delayed Manifestation of a Penetrating Chest Trauma

Abstract Pericardial tamponade remains a diagnostic challenge to the clinician especially when the patient is well compensated hemodynamically. We report an unusual case who sought medical help 1 month after having been stabbed in his chest. An investigation revealed a perforation of the myocardium and a pericardial tamponade. The patient survived thanks to a large organized clot that plugged the perforation. The patient was exposed to increased risk due to delayed onset, recognition, and therapy of the tamponade. Most reports on this subject deal with acute pericardial tamponade. Only few cases of delayed pericardial tamponade have been reported. A review of the relevant literature and the therapeutic approaches are discussed.     

气垫床工作模式转换器的研制

本文阐述了我院自行研制的气垫床工作模式转换器的结构、工作原理及应用效果。     

Impact of cosmetic care on quality of life in breast cancer patients during chemotherapy and radiotherapy: an initial randomized controlled study

BACKGROUND: Breast cancer is the most common cancer in women and therefore represents a major problem in public health. Data from patients' self-report questionnaires provide valuable information about the side-effects that patients may view as having a significantly detrimental impact on their quality of life (QOL) and yet are not always recognized as important by healthcare professionals. Cosmetology is a specific care for patients and there is actually no scientific evidence regarding effects on QOL for women with breast cancer. OBJECTIVE: The purpose of this study is to assess the impact of cosmetic care on QOL in breast cancer patients during chemotherapy and radiotherapy. METHODS: We developed a prospective, multicentre, randomized, controlled study including 27 patients. All the patients had to fill in a French-validated dermatologic specific quality-of-life questionnaire to compare the QOL of the two groups, the cosmetic group and the control group, at three different times of the adjuvant treatment. RESULTS: The results show a statistically significant difference between the cosmetic group and the control group in two areas of QOL: mood state and self-perception of the disease. CONCLUSION: This study emphasizes the interest of cosmetic care in breast cancer patients. However, further larger trials are needed to confirm this study.     

Approaches for end-of-life care in the field of gynecologic oncology: an exploratory study

We sought to explore the Society of Gynecologic Oncologists (SGO) members' opinions and decisions about end-of-life issues and incurable conditions. A survey was mailed to members of the SGO. Their responses were recorded on a Likert scale and entered into a database. The survey explored opinions, experiences, and decisions in managing terminally ill gynecologic oncology patients. Of 900 surveys, 327 were returned (response rate, 36%). Seventy-three percent were men, 89% were white, and 72% were of Christian denomination. Respondents believed that 97% of patients who are dying realize that they are dying but stated only 40% of these patients initiate conversations about end-of-life issues. In contrast, 92% of respondents stated that they initiate end-of-life discussions with patients. Ninety-two percent of respondents thought that the patients should be allowed to make end-of-life choices independently after the facts are given to them. However, 44% thought that it is important to influence the way information is presented, and 54% believe that the gynecologic oncologist (GO) controls the outcome of end-of-life discussions. Although the physicians' sex, race, religion, and age did not correlate with their treatment decisions, religion did correlate with less fear of death (P = 0.011) and less discomfort when talking with patients about death (P = 0.005). Fifty-four percent of respondents believed that the GO controls the outcome of end-of-life discussions, and 40% believe that their actions prolong the process of dying. Expanding our understanding of what motivates GOs to recommend continued treatment over palliation is important for preserving informed patient-motivated end-of-life decisions.     

骨外科患者拔尿管时注入药物对排尿的影响

目的探讨提高长时间留置导尿管病人拔管后2h内排尿成功率的方法。方法按入院先后随机将64例导尿的男性骨折病人分两组,单数为观察组,双数为对照组。对照组常规拔尿管,观察组拔尿管时遵医嘱注入地塞米松5mg+2%利多卡因5ml+生理盐水5ml+庆大霉素8万U,比较首次排尿的自觉症状,包括尿痛、排尿困难、排尿障碍等。结果观察组较对照组病人首次排尿出现自觉症状的例数明显减少(P<0.01),有显著性差异。结论拔尿管时注入药物安全有效,明显提高了长期置管病人拔除尿管后首次排尿的成功率,减轻了病人的痛苦,有广泛的应用价值。