Trusting patients, trusting nurses

Abstract  The general expectation that patients should be willing to trust nurses is rarely explored or challenged despite claims of diminishing public trust in social and professional institutions. Everyday meanings of trust take account of circumstance and suggest that our understanding of what it means to trust is contextually bound. However, in the context of health care, to trust implies a particular understanding which becomes apparent when abuses of this trust are reported and acknowledged as scandals. The predominant assumption in the literature that trust is something that occurs between equally competent adults cannot explain trust in nursing precisely because of the unequal power relationships between patients on the one hand and healthcare professionals on the other. Moreover, the tendency to conflate terms such as trust, reliance, confidence and so on suggests that confusion permeates discussions of trust in nursing. In this paper, I argue in support of Annette Baier's requirement of good will (or lack of ill will) as the essential feature of trust, and outline how this account (i) enables us to make the necessary distinctions between trust on the one hand and 'trust pretenders' on the other; and (ii) lays the foundations for understanding trust in relationships, such as those between patients and nurses, where power differentials exist.     

Developing nurse practitioners to develop practice: the experiences of nurses working on a Nursing Development Unit

Aim To elicit nurses' accounts of their involvement with nursing research and their interpretations of the meaning of these projects for their practice.
Background The links between research and practice development in health care are poorly understood and require further exploration in the light of the emerging research and development agenda within the National Health Service.
Methods Semi-structured interviews were conducted with 15 qualified nurses working on a Nursing Development Unit. The interviews were tape recorded, transcribed and analysed thematically.
Findings Data analysis identified two distinct groups—a core group of nurses actively engaged in the research projects and a peripheral group involved in data collection. The characteristics of the core group mirror the characteristics of those involved in non-research-based practice development activities.
Conclusions Engaging in research activities does not always result in the development of practice, however, there appears to be a link between practice development and critical thinking.     

Lettuce anaphylaxis: identification of a lipid transfer protein as the major allergen

BACKGROUND: Allergy to plant-derived foods is associated with birch pollinosis in central and northern Europe. Symptoms elicited are usually limited to the oropharyngeal system. By contrast, in the Mediterranean area, allergy to the same foods manifests more frequently with systemic reactions caused by nonspecific lipid transfer proteins (nsLTP), independently of an associated pollinosis. OBJECTIVE: We sought to investigate the pattern of immunoglobulin E (IgE) binding protein bands implicated in lettuce allergy, in particular the presence of an nsLTP. METHODS: Consecutive lettuce allergic patients were selected. Determination of serum-specific IgE, immunoblot, and inhibition experiments were performed in order to study the pattern of IgE binding proteins and the potential cross-reactivity to pollens. Inhibition studies with recombinant allergens were conducted to identify the lettuce allergens. The major allergen was subjected to N-terminal amino acid sequencing. RESULTS: Fourteen patients were diagnosed as being allergic to lettuce. All were sensitized to Platanus pollen. Ten of them showed specific IgE to a lettuce protein of 9-kDa. The IgE binding to this protein was completely inhibited by the cherry-LTP and peach extract. The N-terminal sequence of the 9-kDa protein showed a high degree of amino acid sequence identity to other nsLTPs. A clear partial cross-reactivity was observed between lettuce-LTP and Platanus-pollen extract. CONCLUSIONS: An LTP has been demonstrated to be a major allergen in patients suffering from lettuce allergy.     

Sublingual immunotherapy for hazelnut food allergy: a randomized, double-blind, placebo-controlled study with a standardized hazelnut extract

BACKGROUND: Food allergy may be life-threatening, and patients affected need to receive accurate diagnoses and treatment. Hazelnut has often been implicated as responsible for allergic reactions, and trace quantities can induce systemic reactions. OBJECTIVE: The aim of this study was to evaluate the efficacy and tolerance of sublingual immunotherapy with a standardized hazelnut extract in patients allergic to hazelnut. METHODS: This was a randomized, double-blind, placebo-controlled study. Inclusion criteria were a history of hazelnut allergy and positive skin prick test and double-blind placebo-controlled food challenge results. Patients were then randomly assigned into 2 treatment groups (hazelnut immunotherapy or placebo). Efficacy was assessed by double-blind, placebo-controlled food challenge after 8 to 12 weeks of treatment. Blood samples were drawn for measurement of specific IgE, IgG(4), and serum cytokines before and after treatment. RESULTS: Twenty-three patients were enrolled and divided into 2 treatment groups. Twenty-two patients reached the planned maximum dose at 4 days. Systemic reactions were observed in only 0.2% of the total doses administered. Mean hazelnut quantity provoking objective symptoms increased from 2.29 g to 11.56 g (P = .02; active group) versus 3.49 g to 4.14 g (placebo; NS). Moreover, almost 50% of patients who underwent active treatment reached the highest dose (20 g), but only 9% in the placebo. Laboratory data showed an increase in IgG(4) and IL-10 levels after immunotherapy in only the active group. CONCLUSION: Our data confirm significant increases in tolerance to hazelnut after sublingual immunotherapy as assessed by double-blind, placebo-controlled food challenge, and good tolerance to this treatment.     

手术治疗46例胸腰椎爆裂骨折的临床分析

目的探讨前路、后路、前后路联合手术治疗胸腰椎爆裂骨折的特点。方法依据对患者所选择的前路、后路、前后路联合手术术式分为三组,进行影像学评价和神经功能评价。结果各组末次随访脊髓功能评价分级提高情况采用R×C表x2检查方法进行统计学分析,各组差异无显著意义。各组术后cobb氏角改善率应用秩和检验方法进行统计学分析,各组差异无显著意义。结论我们综合应用Denis和McAfee的分型,结合了骨折形态、损伤机制和稳定性评价,对胸腰椎爆裂骨折的治疗有较好的指导意义。手术方式的选择更多基于脊柱机械性稳定性、神经性稳定性评价。综合考虑骨折部位、骨折后时间、患者年龄、工种以及术者对入路的熟悉程度等。     

恶性淋巴瘤危险因素病例对照研究

[目的]探讨恶性淋巴瘤发病的危险因素。[方法]采用1：2配比病例对照研究的方法，对南通市及其周围地区48例经细胞学或病理学确诊的恶性淋巴瘤患者及96例对照进行问卷调查，相关资料采用条件Logistic回归分析。[结果]三废污染（OR=3.07,90%CI1.23-7.67)、有机溶剂（OR=3.88,90%CI1.18-13.97)、避孕药（OR=2.26,90%CI1.15-6.60)、家族肿瘤史（OR=17.30,90%CI4.42-57.66)和饮酒（OR=0.66,90%CI 0.43-1.00)与恶性淋巴瘤的发病有关。[结论]三废污染、有机溶剂、避孕药和家族肿瘤史可能是恶性淋巴瘤的危险因素，而少量饮酒可以降低恶性淋巴瘤的发病危险性。     

腹膜外盆腔淋巴结清扫及保留卵巢功能的宫颈癌根治

目的探讨年轻早期宫颈癌患者行宫颈癌根治术中．腹膜外盆腔淋巴结清扫加卵巢移位术的安全性及可行性。方法研究资料选择45例年龄为26～40岁宫颈癌Ⅰb-Ⅱa期的患者。其中，研究组（22例）宫颈癌根治术行腹膜外盆腔淋巴结清扫＋卵巢移位术，对照组（23例）行传统的官颈癌根治术。比较两组术中及术后情况，并随访1～4年。结果研究组与对照组比较．手术时间、出血量、术后排气时间、并发症．差异有硅著意义（P〈0．01）。研究组术后2年卵巢功能正常。两组复发率及生存率差异无显著意义（P〉0．05）。结论腹膜外盆腔淋巴结清扫＋卵巢移位的宫颈癌根治术术中出血少、恢复快、并发症少，可保留卵巢功能．不影响患者的生存率和肿瘤复发率。