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1.
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. 相似文献
2.
3.
Pacemaker Current if. Since the hyperpolarization-activated current, if, was originally associated with the diastolic depolarization phase of action potential in the sinoatrial (SA) node in 1979, its central role in the generation and control of pacemaker activity has become increasingly clear through a series of experimental findings, some of which have substantially modified the pre-existing theories of cardiac pacemaking and its modulation by the autonomic transmitters. Thus, the pacemaker current of Purkinje fibers, formerly described as a deactivating pure potassium (K) current, was found to be in fact, like the nodal if, inward and activating on hyperpolarization. Furthermore, in SA node cells, as well as mediating rhythm acceleration induced by catecholamines, if was found to underlie the slowing effect of low acetylcholine (ACh) concentrations, in contrast with the generally accepted hypothesis that activation of a K conductance is the main process responsible for cardiac slowing. A final, atypical property of if recently demonstrated concerns the activating action exerted on if by intracellular cAMP. Unlike that on other voltage-gated, cAMP-modulated cardiac channels, this action is independent of phosphorylation and involves a direct binding of cAMP to if channels. (J Cardiovasc Electrophysiol, Vol. 3, pp. 334–344, August 1992) 相似文献
4.
Laparoscopic salpingotomy for tubal pregnancy: comparison of linear salpingotomy with and without suturing 总被引:5,自引:0,他引:5
Fujishita A Masuzaki H Khan KN Kitajima M Hiraki K Ishimaru T 《Human reproduction (Oxford, England)》2004,19(5):1195-1200
BACKGROUND: The study was carried out to clarify the incidence of post-operative tubal adhesions, patency rate and pregnancy outcome after laparoscopic salpingotomy with and without suturing for tubal pregnancy. METHODS: From May 1996 to December 2002, a total of 97 cases of tubal pregnancy were treated in our centre by laparoscopic conservative surgery. The successful salpingotomy cases were randomly assigned to undergo salpingotomy without suturing (group I; n = 43) or with suturing (group II; n = 32). We compared these patients and assessed their surgical and pregnancy outcome by second look laparoscopy (SLL) 3 months after the first operation. RESULTS: Seventy-five cases (77%) were treated successfully by salpingotomy at initial laparoscopic surgery, and the remaining 22 cases were unsuccessful because of bleeding or complete tubal damage. Pelvic findings were assessed at SLL in 21 of 43 cases (49%) in group I and 17 of 32 (53%) in group II. There were no significant differences in gestational age, ectopic site, tubal diameter, tubal condition, intraperitoneal haemorrhage and pre-operative HCG levels between the two groups. Only the operation time was longer in group II than in group I (91 +/- 15 versus 69 +/- 15 min, P < 0.05). The tubal patency rate of the treated side was 90% (19/21) in group I and 94% (16/17) in group II. Also the peritubal adhesions were observed in 33% (7/21) in group I and 29% (5/17) in group II, and were mostly comprised of filmy adhesions. A tubal fistula occurred in two cases in each group. Pregnancy rate was 79% (15/19) in group I and 92% (12/13) in group II, and this did not reveal any significant difference of cumulative pregnancy rate between the groups. CONCLUSION: We recommend laparoscopic linear salpingotomy as a useful method in the management of cases with tubal pregnancy who desire future pregnancy. This preliminary study emphasizes that the procedure involving suturing has no additional benefit over the non-suturing technique during salpingotomy. 相似文献
5.
We studied pacemaker current (i
f), the inward current activated by hyperpolarization in rabbit sinoatrial (SA) node myocytes, with the permeabilized-patch-clamp
technique. The tyrosine kinase inhibitors genistein (50 μM) or herbimycin A (35 μM) reduced the amplitude of i
f in response to step hyperpolarizations in the diastolic range of potentials. A two-step voltage-clamp protocol revealed that
the reduction in i
f is due to a decrease in maximal i
f conductance. The observed effects are due to tyrosine kinase inhibition since an inactive analog of genistein did not reduce
i
f. To further examine the mechanism of action, we added 2 mM chlorophenylthio cAMP (CPTcAMP, a membrane-permeant cAMP analog)
to the bathing Tyrode, which increased i
f. Genistein still reduced i
f in the presence of CPTcAMP. This suggests that the pathway mediating the actions of tyrosine kinase inhibition on i
f is independent of cAMP- or protein-kinase-A-mediated phosphorylation.
Received: 28 January 1997 / Received after revision: 21 April 1997 / Accepted: 22 April 1997 相似文献
6.
前列腺增生症趋于年轻化的探讨 总被引:1,自引:0,他引:1
目的:探讨不同年龄组前列腺增生症的检出率及原因,以达到早发现,早预防,早治疗的目的.方法:应用Acuson 128xp超声显像仪诊断前列腺增生症.结果:前列腺增生症检出率:35岁~39岁纽1053例,检出8例(0.76%);40岁~44岁组1550例,检出30例(1.68%);45岁~49岁组2855例,检出486例(17.0%);50岁~54岁组2784例,检出715例(25.7%);55岁~59岁2924例,检出1231例(37.5%);60岁~64岁组2450例,检出1521例(62.1%);65岁~69岁组1241例,检出826例(66.6%);70岁~74岁组1118例,检出711例(63.6%);≥75岁组588例,检出293例(49.8%).结论:前列腺增生症并非老年人特有疾病,似有年轻化趋势. 相似文献
7.
目的观察正常及模拟“缺血”时胺碘酮对绵羊心室浦肯野纤维起搏离子流(If)的影响。方法双微电极电压钳制术,使膜电位过度极化以激活If。结果胺碘酮1×10-5mol/L在正常台氏液中显著降低浦肯野纤维If幅值;模拟“缺血”也使If幅值降低,在此基础上,胺碘酮使If幅值进一步减小,加剧了“缺血”对If离子流的抑制作用。结论提示胺碘酮能抑制心肌缺血时心室正常自律性活动。 相似文献
8.
Gliomatosis peritonei: the value of a "second look" operation. 总被引:1,自引:0,他引:1
The case history of a 10-year-old black girl with gliomatosis peritonei, Grade 0, is presented. The primary tumour was resected and a "second look" operation carried out 3 months later. The glial implants demonstrated distinct circumferential and intra glial fibrosis (resolution). Because the peritoneal implants had undergone resolution, further therapy became unnecessary. We believe gliomatosis peritonei fully justifies a second laparotomy in order to be able to accurately grade the implants. The grade of the peritoneal implants influences the prognosis and therefore determines the type of therapy to be instituted. 相似文献
9.
三种补肾方对老年大鼠下丘神经递质的影响 总被引:3,自引:0,他引:3
目的:观察三种补肾方对24个月龄老年大鼠下丘氨基酸类神经递质的影响.方法:采用反相高效液相色谱(HPLC)荧光法、受体放射分析法、RT PCR法测定大鼠下丘的氨基酸递质含量、受体特异性结合量及受体亚单位的mRNA表达.结果:24个月龄大鼠下丘存在兴奋/抑制失衡,表现为下丘γ 氨基丁酸(GABA)能抑制作用减弱,可能与耳鸣发病率随年龄增长而增加有关.补肾息鸣经验方使24个月龄大鼠下丘氨基酸类神经递质介导的抑制作用上调和兴奋作用下调;左归丸及右归丸使24个月龄大鼠下丘兴奋性与抑制性氨基酸类神经递质(Asp、Tau、GABA)含量均有明显上升.结论:对肾虚耳鸣的治疗应在补肾的基础上结合开窍活血等药物. 相似文献
10.