Power imbalance between nurses and patients: a potential inhibitor of partnership in care

The Patient's Charter identifies the need for nurses to respect patients' rights to influence their care, and contemporary nursing practice advocates that nurses work in partnership with patients. Hence nurses are encouraged to share their power and facilitate empowerment in their patients by giving them information and support. However, the literature indicates that nurses are not very successful in making patients feel empowered to make informed decisions. This study, conducted in 1998, provides some answers as to why this may be the case. The aim of the study was to explore and describe nurses' and patients' views regarding partnership in care in hospital. Using the grounded theory approach, participants were drawn from four hospitals in Western Australia. A purposive sample of 33 nurses and 32 patients were interviewed in-depth. Participant observation was also conducted and field notes were written. The interviews were transcribed verbatim and analysed using the constant comparative method. The findings showed that nurses viewed involving patients in care as requiring them to give patients information and to share their decision-making powers with them. With the exception of a few, the majority of nurses were unwilling to share their decision-making powers. This created a situation of power imbalance with subsequent little patient input. Factors identified included nurses' beliefs that they "know best", the view that patients lacked medical knowledge and the perceived need for nurses to hold onto their power and maintain control. If nurses and patients are to work as partners, it is important that nurses make every effort to equalize the power imbalance. One way to do this is for nurses to share and give information to patients readily and to be open in their communication with them.     

轴向载荷分担比指导外固定器动力化的临床应用

目的:探讨轴向载荷分担比用于胫腓骨骨干骨折术后指导外固定器轴向动力化促进骨折愈合的有效性。方法:选取外固定器治疗的胫腓骨骨干骨折患者100例,随机分为观察组50例,对照组50例。观察组在轴向载荷分担比指导下行外固定器轴向动力化治疗,对照组未行动力化,随访比较两组的治疗效果。结果:所有患者均获随访,随访时间4～12个月,平均6.5个月,治疗期间所有患者均未出现外固定针断裂、松动及再骨折等并发症,观察组1例骨搬移患者轴向载荷分担比5%,X线片显示骨折断端有连续性骨痂通过,拆除外固定器连接杆后发生移位,恢复原数值行轴向加压再动力化,现已愈合。观察组除外1例骨搬移患者,其余49例患者外固定器固定时间为[(24.4±4.7)周],骨折临床愈合时间为[(22.4±4.7)周],与对照组50例患者外固定器固定时间[(29.3±5.6)周],骨折临床愈合时间[(27.3±5.6)周]比较,显著减少(P0.05)。结论:外固定器轴向载荷分担比指导胫腓骨骨干骨折外固定术后轴向动力化可以加速骨折愈合,但不适合骨搬移截骨端已硬化患者。     

HLA haplotype sharing in rheumatoid arthritis sibships: Risk estimates subdivided by proband genotype

There is a well-known association between rheumatoid arthritis (RA) and HLA-DR4. Recent research has indicated that both DR4 haplotypes are important in disease predisposition (favoring a recessive mode of inheritance). Others have suggested that certain combinations of genotypes, in particular Dw4/Dw14 heterozygotes, may be more important than others. We examined the mode of inheritance of RA using data from the Arthritis and Rheumatism Council's national repository of family material [Worthington et al. (1994) Br J Rheumatol 33:970–976]. There were 85 affected sibships consisting of 77 sib pairs, 6 trios, 1 quintuplet, and 1 sextuplet. The affected sibs shared two, one, and zero parental HLA haplotypes in a ratio of 0.42:0.43:0.15, which was significantly different from random expectations (P = 0.00009). Risk estimates for RA to sibs were calculated based on an overall sibling recurrence risk of 3.9%. Risks for those sharing two, one, and zero parental HLA haplotypes were 6.5% [95% confidence interval (CI) = 5.1–7.9%], 3.3% (95% CI = 2.6–4.0%), and 2.5% (95% CI = 1.5–3.5%), respectively. We also examined the risk of RA based on the DRβ1 genotype status of sib and proband. After excluding genotypic combinations with small numbers, the highest genotype-specific risks were seen for sibs sharing two haplotypes with either a DRβ1*0401/DRβ1*0404 (12.5%, 95% CI = 6.9–15.2%) or a DRβ1*0401/DRβ1*0408 (11.1%, 95% CI = 4.5–15.1%) proband. An independent assessment based on the AGFAP methodology confirmed the increase in risk for these genotypes, in particular for DRβ1*0401/DRβ1*0408. The excess being due to *0401/*0408 rather than to *0401/*0404 may explain why the Dw4/Dw14 effect is not always observed. Genet. Epidemiol. 15:403–418,1998. © 1998 Wiley-Liss, Inc.     

人口健康科学数据中个人敏感信息分类研究

目的：细化人口健康科学领域个人敏感信息类型,以期推进人口健康科学数据的开放和共享及个人敏感信息的立法保护提供参考,为人口健康科学数据平台的数据管理工作提供借鉴。方法：基于文献调研法考察了国内外个人敏感信息的界定,基于内容分析法总结了人口健康领域中个人敏感信息的类型,并进行了多维特征分析。结果：将人口健康领域中个人敏感信息细化为身份标识信息、生物特征信息、健康医疗信息3个大类,下分9个小类。结论：个人敏感信息细化分类符合依据不同领域特点将敏感个人信息具体化的国际立法的趋势,可作为制定人口健康科学数据收集管理策略和共享策略的参考。     

军队医学图书馆文献资源的共建共享

阐述了军队医学图书馆文献信息资源共建共享的意义及开展的情况,提出了深入发展军队医学图书馆文献信息资源共建共享的建议。     

医院共享信息资源网的开发与应用

以病人医疗信息为核心、共享医院应用数据库为纽带利用宽带网络,整合医院内部应用数据库,建设一个集宣传、商务与服务为一体的丰富的共享信息资源网,面向社会,共享和交换医院信息资源库,展示医院实力,树立形象,拓展服务。     

Bed‐sharing among six‐month‐old infants in western Sweden

Aim: In spite of several reports of an increased risk of sudden infant death syndrome (SIDS) in connection with bed‐sharing, it is not an uncommon practice. The aim of this study was to examine bed‐sharing at 6 months of age and the factors that are associated with bed‐sharing. Methods: Our cohort comprised 8176 randomly chosen families. At 6 month of age, the families received an invitation to the study, with a questionnaire, which was completed by 5605 families (response rate 68.5%). Results: Of the families, 19.8% bed‐shared. In the multivariate analysis, we found a correlation between breast‐feeding and bed‐sharing (breast‐feeding at 6 months: OR 1.94; 95% CI 1.56, 2.41). Moreover, we found an association with 3+ nightly awakenings at 6 months (2.70; 2.20, 3.32). It was more common to share a bed if the parent was single (2.04; 1.19, 3.51) and less common if the infant was bottle‐fed in the first week (0.70; 0.54, 0.90). Never using a pacifier was associated with a higher frequency of bed‐sharing. Conclusion: We found a correlation between breast‐feeding and bed‐sharing as well as between sleeping problems and a single parent. A lower percentage of infants sleeping in the parental bed were seen in association with formula feeding in the first week after birth.     

基于大功率X线机电源共享的设计

目的：基于多台X线机同时曝光时供电源内阻上将产生很大的线路压降,而直接影响X线机的曝光参数,通过汇编程序来实现多台X线机的电源共享。方法：用发光二极管替代大功率X线机进行电源共享模拟实验。该程序应用了中断技术使计算机能实时地进行处理,特别是对紧急情况的处理,它体现了优先级。结果：在同一个时刻只允许1个发光二极管发光,即在实际工作中保证了在同一时刻只允许1台X线机曝光;3个发光二极管实现了电源共享,即3台X线机实现了电源共享。结论：电源共享技术能够使多台X线机更安全、更有效地工作。     

Methadone maintenance treatment reduces heroin injection in New South Wales prisons

The purpose of this study was to examine whether methadone maintenance treatment reduces injecting risk behaviour (and therefore transmission of blood-borne viral infections) among prisoners in New South Wales (NSW), using comparison of retrospective reports of drug use in prisons for people who received standard drug treatment, time-limited methadone treatment and methadone maintenance treatment. The setting for the study was the NSW prison system. One hundred and eighty-five injecting drug users who had been recently released from NSW prisons were recruited in 1993. Self-reported drug use and injecting risk behaviour were compared in inmates who received standard drug treatment (counselling), time-limited methadone treatment and methadone maintenance treatment. HIV status was determined by serology. Intervention comprised high and low dose methadone treatment and counselling. The groups were similar in terms of most basic demographic characteristics but subjects who had been maintained on methadone reported a significantly lower prevalence of heroin injection, syringe sharing and scored lower on an HIV Risk-taking Behavioural Scale than subjects who received standard drug treatment and time-limited methadone treatment. This study suggests that methadone treatment is associated with reduced injecting risk behaviour in prison with adequate (greater than 60 mg) dose and duration in treatment. These treatment conditions are known to increase effectiveness in community-based methadone programmes. Prospective studies are required to evaluate the effectiveness of methadone programmes in the prevention of HIV and other blood-borne viral infections among IDU prisoners.     

以家庭为中心护理模式在造口患儿中的应用研究

目的探讨以家庭为中心护理模式在造口患儿护理中的应用效果。方法将67例肠造口患儿按时间段分为对照组(34例)和观察组(33例),对照组按照常规方法护理,观察组采取以家庭为中心护理模式,包括心理护理和人文关怀,鼓励照护者参与全程护理,多途径的健康教育,建立出院指导标准。比较两组患儿术后住院时间,造口周围皮肤情况,以及家庭造口护理能力。结果观察组术后住院时间显著短于对照组(P0.01),造口周围皮肤情况显著优于对照组(P0.01),家庭造口护理能力4个维度及总分显著高于对照组(P0.05,P0.01)。结论以家庭为中心护理模式可有效改善患儿造口周围皮肤问题,缩短患儿术后住院时间,提高家庭造口护理能力。