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1.
Aim  To identify nurses' priorities for topics and issues to be addressed by a developing nursing research program at a county hospital.
Background  Delphi surveys have been effective at other hospitals to identify research priorities of nurses.
Methods  A Delphi survey was performed in two rounds. Questionnaires were distributed to all 415 nurses who worked at the hospital.
Results  A total of 274 nurses returned the Round I questionnaire (response rate, 66%), and 249 returned the Round II questionnaire (response rate, 60%).
Conclusions  The Delphi survey was successfully used to identify nurses' research priorities at a county hospital. A total of 39 topics were identified from content analysis of research areas described by nurses. Factor analysis revealed three factors: work environment, newborn issues and effects of leadership.
Implications for nursing management  The Delphi survey is a useful way to begin a program of research. Nurses who have a successful experience with research are more likely to become further involved in research, which will allow them to more effectively participate in decision making and improving the work environment. In addition, items were identified that needed to be addressed by nursing managers.  相似文献   
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WIENER AS  WEXLER IB  HURST JG 《Blood》1949,4(9):1014-1032
Two unusual cases of severe erythroblastosis due to A and B sensitization havebeen presented. When injections of A and B group substances failed to arrest thedisease, exchange transfusions were carried out, using 900 to 1,000 cc. of freshgroup O blood. In each case the response was prompt and dramatic, although theconvalescence in one was prolonged by an intercurrent diarrhea. Both infants havemade complete recoveries and have developed normally both physically and mentally.

Observations have been presented regarding the pathogenesis of erythroblastosisand icterus precox due to A-B sensitization. The following conclusions seem to bewarranted on the basis of the evidence presented:

1. The greatest majority of cases of jaundice and anemia of the newborn thatcannot be explained on the basis of Rh incompatibility are caused by incompatibility of the major blood groups.

2. High maternal alpha and beta antibody titers per se are not necessarily correlated with disease in the infant.

3. Univalent alpha and beta antibodies present in the maternal serum traversethe placenta and are the cause of the disease in the infant. Bivalent antibodies areheld back by the intact placenta and play no or hardly any role in the causationof the disease. Univalent alpha and beta antibodies are demonstrable in the sera ofa large proportion of "normal" individuals.

4. A-B sensitization in pregnancy occurs mainly when the infant belongs to thesecretor type.

5. A theory is suggested that the quality of the alpha and beta antibodies,namely, whether they are homospecific or heterospecific, may affect the severityof the manifestations in the infant.

Technics of titrating alpha and beta and Rh antibodies are described and discussed. A table has been prepared which converts antibody titers into concentrations of immune globulin in the serum, and demonstrates the impossibility ofcertain extravagantly high titers claimed in the literature.

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WIENER AS  WEXLER IB 《Blood》1949,4(1):1-35
1. In the authors’ technic of exchange transfusion, citrated blood is introducedinto the saphenous vein at the ankle and the infant’s blood simultaneously withdrawn from the radial artery at the wrist, coagulation being prevented by the administration of small amounts of heparin. The procedure besides being simple, issafe, there having been no operative mortality in more than 40 transfusions.

2. The results of exchange transfusion therapy in erythroblastosis in our first28 cases are presented. Of these 28 cases, 16 were very severe and almost certainlywould have been lethal if left untreated, 6 were of moderate severity, and 6 weremild. Only 7 of the infants died, and the available data indicate that the mortalitywould have been at least twice as high had the usual treatment with simple transfusions been given.

3. Aside from its greater efficacy in reducing mortality, exchange transfusion ismore efficient, so that supplementary treatment is not required as a rule.

4. Fresh blood should be used instead of bank blood because of its greater survival time and smaller likelihood of introducing infection.

5. All infants who have survived have developed normally both physically andmentally and have shown no sequelae of liver or brain damage.

6. The most reliable index of the severity of the disease in the erythroblastoticinfant is provided by antenatal titrations of the maternal univalent Rh antibodies,as well as by tests for the presence of univalent antibodies in the infant’s blood.

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Summary Human blood monocytes were cultured within the wells of chamber slides in growth medium to which 0, 1, 2 or 3 mg ethanol per ml was added at the start of the culture. After incubation for 1 h, 1 day and 7 days, their ability to phagocytoze IgG-sensitized red cells and to phagocytoze and kill non-opsonized Candida albicans was assessed. In all alcohol-containing wells, the concentration of alcohol in the growth medium fell progressively, reaching negligible values after 3 days. When compared with control cells, monocytes incubated with 1, 2 or 3 mg ethanol/ml for 1 h showed impaired phagocytosis of IgG-sensitized RBC and non-opsonized C. albicans and those incubated with 1 or 2 mg ethanol/ml for 1 h showed impaired killing of Candida. After incubation for 7 days, the monocyte-derived macrophages in wells initially containing 1, 2 or 3 mg ethanol/ml showed increased phagocytic activity towards C. albicans but not towards sensitized RBC. In addition, in 4 of 5 experiments, the percentage of phagocytozed organisms killed was increased in wells initially containing 1 mg ethanol/ml. The results support the view that the susceptibility of chronic alcoholics to certain infections may be partly dependent on an ethanol-induced depression of the phagocytic and killing functions of macrophages. They also suggest that a few days after a brief period of exposure to ethanol there may be stimulation of certain but not all effector functions of macrophages.  相似文献   
8.
Neonatal respiration, feeding and neurobehavioural state   总被引:1,自引:0,他引:1  
P.C. WIENER  M.I. HOGG  M. ROSEN 《Anaesthesia》1979,34(10):996-1004
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