Building a relationship: communications and relationships between staff and stroke patients on a rehabilitation ward

Communications among staff and patients on a stroke rehabilitation ward form the focus of this article, which reports on some aspects of a larger study using a grounded theory approach. Tape-recorded interviews were transcribed and analysed concurrently according to recommendations for the approach. A main theme entitled building a relationship was identified, and this process was found to occur in a context varying from participative at one end of a continuum to hierarchical at the other. Building a relationship was found to be influenced by role, personal qualities and organizational context. Appropriate relationships between role-holders were subject to negotiation, leading to a resulting congruence or incongruence between participants' expectations of each other and their roles. Personal qualities were brought into play in the process, with patients' views of staff and staff views of patients both being influential. Some of these views seemed to parallel what has been described in earlier literature as ‘the sick role’ and the labelling of patients as ‘good’ or ‘bad’. Responses to personal qualities led to nurses ascribing meaning to patients' behaviour in terms of adjustment to their stroke, giving time to them to help them to adjust, and withdrawal and handing over to other staff if this strategy failed. Organizational context also had an influence on building a relationship, with time constraints being identified particularly by nurses, and the need to fit in the most essential aspects of care. Place was also important, in that nurses were confined to the ward as a work location, whereas other therapists and doctors worked in other places and sometimes had the facility to take patients off the ward to concentrate on therapy. The findings are discussed against the background of related literature and the conclusion is drawn that the crucial role of nurses in rehabilitation is not recognized and valued, and that shortages of resources - especially suitably qualified and trained nursing staff- are a negative influence on building the relationships which are vital to successful rehabilitation.     

The application of percolation theory to the compaction of pharmaceutical powders

Based on the concepts of percolation theory the compaction process is interpreted as a site-bond percolation phenomenon. The combination of the Heckel equation with an equation derived earlier yields a simple relationship between the tensile strength σ_t, or the deformation hardness P and the relative density. This mathematical model is identical with the fundamental law of percolation theory i.e., X = s(p − p_c)^q with X= system property equivalent to tensile strength or deformation hardness, S = scaling factor, p = site occupation or bond formation probability corresponding to the relative density p,p_c = percolation threshold and critical exponent q = 1 according to percolation on a Bethe lattice. In the case of the tensile strength σ_t and the deformation hardness p, two percolation thresholds p_c(1) and p_c(2) corresponding to p_c(1) and p_c(2) could be identified. The relative density p_c(1) which is close to the relative poured or relative tapped density can be interpreted as a bond percolation threshold. The particles are bonded by weak interparticulate forces and form only loose compacts as used for filling of capsules. The relative density p_c(2) is the relative density where the first stable pharmaceutical compact is achieved which can no longer be disintegrated mechanically into its primary particles. It is of special interest that the above equation is also valid for the elastic modulus with the only percolation threshold p_c(1) = p_c(1).     

人本原理在医院管理中的应用价值

目的:研究人本原理在护理管理中的应用。方法:把人本原理的管理原则、动力原则、行为原则、能级原则应用于护士长的管理中,尊重、关心、帮助和激励护士,人人参与管理。选择2005年上半年住院病人180例作为改革组,应用人本原理管理。2004年下半年住院病人150例作为传统组,用传统方法管理。结果:通过人本原理管理原则的应用,提高了护理质量,各项指标应用后高于应用前(P<0.05或P<0.01),无投诉、无差错事故发生,病人满意度一直在95%以上,护士参与管理意识增强,团队精神加强,护士按期晋升。护士对病人实行人性化服务,为医院赢得了相应的社会效益和经济效益。结论:人本原理应用于护理管理行之有效,值得推广。     

胃微小腺癌的组织发生研究

从２１０５例胃癌癌旁组织中找出微小腺癌３１例（〈０．１ｃｍ），观察其组织发生的特征，发现胃腺癌的发生有８种形式：①腺颈部干细胞癌变；②表面上皮癌变；③腺上皮癌变；④肠化生上皮癌变；⑤微腺囊癌变；⑥溃疡边缘上皮癌变；⑦扁平腺瘤癌变；⑧贲门交界处柱状上皮癌变。     

磷酸铝凝胶剂的研制

以微粒沉降速度、粒度分布、粘度大小等为指标，利用正交试验法筛选出磷酸铝凝胶剂的最佳处方。结果表明，磷酸铝凝胶剂的沉降容积比可达９３．１％，其粒度均小于１０μｍ，而且沉降速度较小。     

胃癌增殖活性的研究—Ki—67单克隆抗体标记与核分裂计数对比观察

作者用Ki—67单克隆抗体对30例胃癌标本做了免疫组化标记观察,并与核分裂计数作了对比研究.结果发现Ki—67标记阳性率在6.3%～81.3%之间(平均33.04±21.94),Ki—67标记阳性率与核分裂计数之间呈显著正相关(r=0.686,P<0.01),未发现Ki—67标记阳性率在有无淋巴结转移、胃壁侵犯深度、不同分化程度和生长方式之间存在差异( P >0.05).     

Innervation of the monotreme gastrointestinal tract: A study of peptide and catecholamine distribution

The distribution of neurons and endocrine cells containing various peptides or catecholamines was examined in the digestive tracts of the echidna (Tachyglossus aculeatus) and the platypus (Ornithorhynchus anatinus). Comparisons were made with published studies in other species in order to obtain a broader view of the phylogenetic distribution and possible functions of gut peptides and catecholamines. Further comparisons between the echidna and platypus were made in light of their different dietary features and gut histology. The distribution of neurons and axons containing catecholamines or various peptides resembled that in other species (such as the frequent appearance of axons containing substance P and vasoactive intestinal peptide in the intestinal mucosa, and axons containing substance P or enkephalins in the circular muscle). In both species, the stomach histologically resembles the esophagus, being aglandular and lined with stratified squamous epithelium. Innervation of these two organs was similar but not identical, with a greater array of peptides found in the gastric muscle. The intestinal mucosa was densely innervated in both species. The platypus small intestine is unusual in having a thick and deeply folded mucosa (but no villi), in which the superficial epithelium is absent or incomplete at many sites; many axons travel close to these luminal surfaces. Many (putative noradrenergic) axons associated with blood vessels contained neuropeptide Y, but there was no evidence for intrinsic catecholamine-containing neurons. Somatostatin and cholecystokinin were present in some endocrine cells, but unlike many mammals, absent in neuronal tissue. These studies have shown that there are many strong similarities between monotremes and other mammals in the distribution and array of peptides found within nervous and endocrine tissues of the digestive tract. However, numerous small differences of the echidna and platypus innervation may be correlated with their different digestive structures. © 1993 Wiley-Liss, Inc.     

Advancing Nursing Practice with a Unit-based Clinical Expert

Objective: To explore patterns in the practice of nursing and patient outcomes.
Design: Qualitative field research.
Population, Sample, Setting: Populations were critical care nurses and critically ill adult patients in the 10-bed medical critical care unit of a 900-bed teaching hospital. A convenience-purposive sample of 27 nurses and 31 patients was studied in 1985.
Methods: Six months of participant observation, unstructured interviews, and the constant comparison method of grounded theory.
Findings: Markedly different patterns were found in expert and nonexpert practice. The substantive theory of conversion helped explain how the majority of nonexpert nurses advanced their practice. The metaphor of catalyzed conversion captures how a unit-based expert nurse serves as a catalyst to advance the practice of nonexperts. Presence, defined as the way of being within a given clinical context, differentiated nurses.
Conclusions: (a) Expert and nonexpert practices are substantively different, (b) Expert and nonexpert practice results in different patient outcomes, (c) Conversion helps explain changes in nonexpert practice.
Clinical Implications: A unit-based expert nurse can increase patient-focused care.     

Similarities between the relaxations induced by vasoactive intestinal peptide and by stimulation of the non-adrenergic non-cholinergic neurons in the rat stomach

Summary The characteristics of the non-adrenergic, noncholinergic inhibitory response of the rat stomach fundus to transmural nerve stimulation were compared with the relaxation induced by vasoactive intestinal polypeptide (VIP). Treatment with -chymotrypsin (5 U/ml) or VIP antiserum (1:200) significantly reduced the relaxation induced by transmural nerve stimulation at 30 Hz, indicating that the possible transmitter in the non-adrenergic, non-cholinergic nerves is a peptide and may be VIP or a closely related peptide. VIP was able to relax, fully and dose-dependently, the stomach fundus that had previously been constricted by treatment with 10^–6 M serotonin, and the IC₅₀ value for VIP was 2.4 × 10^–9 M. VIP elevated levels of cyclic AMP in a dose-dependent manner and the EC₅₀ value was 2.8 × 10^–9 M in the presence of 10^–6 M atropine and 10^–6 M guanethidine. The stomach fundus was relaxed by transmural nerve stimulation (30 Hz, 50 mA) and transmural nerve stimulation also caused production of cyclic AMP in the rat stomach in the presence of atropine and guanethidine. The basal level of cyclic AMP in the stomach was 8.7 ± 0.26 pmole/mg protein. When transmural nerve stimulation was applied for 5 min, the contraction of the stomach, induced by 10^–6 M serotonin, was inhibited by 54% in the presence of atropine and guanethidine and the level of cyclic AMP was increased to 13.0 ± 0.73 pmol/mg protein. Apamin inhibited the transmural nerve stimulation-induced relaxation and shifted the dose-response curve for VIP to the right. These results suggest that one of the putative neurotransmitter from non-adrenergic, non-cholinergic nerves in the rat stomach is VIP and that VIP-induced relaxation may be mediated by the production of cyclic AMP and by the opening of apamin-sensitive K⁺-channels.Send offprint requests to K. Kamata at the above address     

于阴阳与基因调控关系辨治胃黏膜上皮内瘤变

胃黏膜上皮内瘤变是胃癌前病变,具有发展为胃癌的危险。阳主动,阴主静,文章基于阴阳理论,衷中参西,微观辨证与宏观辨证结合,以阴阳消长失调和基因调控紊乱的关系为出发点,认为胃黏膜上皮内瘤变发生时胃黏膜细胞凋亡周期紊乱和细胞异常增殖分化是阴阳消长失衡在细胞基因调控水平上的体现,进而探讨胃黏膜上皮内瘤变的病因病机以及辨证论治过程,为中医药治疗胃黏膜上皮内瘤变提供更多的理论依据,丰富治疗该病的临床手段。