Sjuksköterskans förhållningssätt vid omvårdnad av patient med akut smärta

Abstrakt Bakgrund: Smärta är ett fenomen som upplevs olika, alla individer som någon gång drabbas av smärta reagerar olika starkt. Hur individen tolkar och bemästrar smärtupplevelsen är beroende av vilken ålder, kön, kulturell och social bakgrund de tillhör. Syftet med denna litteraturstudie var att belysa om sjuksköterskans förhållningssätt och patientens upplevelse av bemötandet vid ett akut smärttillstånd. Metod: Studien är baserad på fjorton artiklar från 2002-2007 och vi har funnit dom i databaserna PubMed och Cinahl. Resultat: Snabb identifiering av smärta är viktigt vid behandling av smärta. För att behandlingen skall bli så god som möjligt är dialogen mellan patient och sjuksköterska viktig. Utbildning samt rutin har visat sig vara till stor fördel vid behandling då hela patienten är i fokus och inte endast symtomet. Smärtinstrument är bra som hjälpmedel vid behandling av smärta men bör vara ett komplement till patientens verbala beskrivning av tillståndet. Konklusion: Efter en sammanställning av denna studie kan det konstateras att kommunikation och smärtlindring samt vårdpersonalens attityder påverkar människor som drabbats av tillståndet akut smärta

Accuratezza nella diagnosi prenatale di malformazione fetale

OBJECTIVE: One major problem in counselling couples with a prenatal diagnosis of a correctable fetal anomaly is the ability to exclude associated malformations that may modify the prognosis. Our aim was to assess the precision of fetal sonography in identifying isolated malformations. METHODS: We retrospectively reviewed the prenatal and postnatal records of our center for cases with a prenatal diagnosis of an isolated fetal anomaly in the period 2002-2007. RESULTS: The antenatal diagnosis of an isolated malformation was made in 284 cases. In one of this cases the anomaly disappeared in utero. Of the remaining cases, the prenatal diagnosis was confirmed after birth in 251 (88.7%). In 8 fetuses (7 with a suspected coarctation of the aorta, 1 with ventricular septal defect) the prenatal diagnosis was not confirmed. In 24 fetuses (8.5%) additional malformations were detected at postnatal or post-mortem. In 16 of these cases the anomalies were mild or would not have changed the prognosis. In 8 cases (2.8%) severe anomalies were present (1 hypoplasia of the corpus callosum with ventriculomegaly, 1 tracheal agenesis, 3 cases with multiple anomalies, 1 Opitz Syndrome, 1 with CHARGE Syndrome, 1 COFS Syndrome). Two of these infants died. CONCLUSIONS: the prenatal diagnosis of an isolated fetal anomaly is highly reliable. However, the probability that additional malformations will go undetected albeit small remains tangible. In our experience, it was 2.8%.

Ärztliche Haltung zur Komplementärmedizin in der Region Burgdorf

Hintergrund: Komplementärmedizinische Methoden sind in der Schweiz seit langem sehr beliebt. Gemäss den Schweizerischen Gesundheitsbefragungen 2002/2007 lassen sich mehr als 30% der Bevölkerung über 15 Jahren innerhalb eines Jahres komplementärmedizinisch behandeln. Auf Lebensfrist steigt diese Zahl auf 63.4%. Eine aktuelle Untersuchung der KIKOM zeigt, dass ca. 30% der befragten Grundversorgern in der ganzen Schweiz mehr als einmal pro Woche von Patienten nach Komplementärmedizin gefragt werden. Dieselbe Studie zeigt, dass ein Grossteil der befragten Grundversorger selber Komplementärmedizin anbieten oder Patienten für komplementärmedizinische Behandlungen überweisen. Zur Einstellung von Ärzten gegenüber Komplementärmedizin existieren viele Studien. Kaum untersucht ist bisher, ob und wie sich die Haltung von Spitalärzten und zuweisenden Ärzten nach Einrichtung eines Ambulatoriums/Konsiliartätigkeit mit Komplementärmedizin ändert. Fragestellung Wie ist die Haltung gegenüber Komplementärmedizin bei den Ärzten in der Region Burgdorf (Spital Burgdorf, zuweisende Ärzte) vor der Einrichtung einer Sprechstunden-/Konsiliartätigkeit von drei komplementärmedizinischen Methoden (Akupunktur/TCM, Anthroposophische Medizin, Klassische Homöopathie) am Spital Burgdorf und wie ist die Haltung nach einem Jahr und nach zwei Jahren? Methode: Mittels eines Fragebogens werden Meinung und Entschiedenheit dieser Aussage gegenüber Komplementärmedizin und ganzheitlichem Heilungsverständnis erfasst. Der Fragebogen steht Online zur Verfügung und wird zusätzlich allen Ärzten per Post zugeschickt. Die erste Befragung Ende 2010/Anfangs 2011 dient der Erhebung der Ausgangsdaten vor der Aufnahme der Sprechstundentätigkeit. In jährlichen Abständen wird die Umfrage wiederholt. Ergebnis: Von 170 verschickten Fragebogen wurden 6 nicht zugestellt. Lediglich 5 Teilnehmer haben den Fragebogen online ausgefüllt. 43 Fragebogen kamen spontan zurück. Nach telefonischem und schriftlichem Reminder konnten nochmals 26 Fragebogen eingeholt werden. Die Rücklaufquote beträgt damit 45% (74 von 164). Die weiteren Resultate sind in der Auswertung und werden im August zur Verfügung stehen.

Risk attribution of Campylobacter infection by age group using exposure modelling

Knowledge on the relative importance of alternative sources of human campylobacteriosis is important in order to implement effective disease prevention measures. The objective of this study was to assess the relative importance of three key exposure pathways (travelling abroad, poultry meat, pet contact) for different patient age groups in Switzerland. With a stochastic exposure model data on Campylobacter incidence for the years 2002-2007 were linked with data for the three exposure pathways and the results of a case-control study. Mean values for the population attributable fractions (PAF) over all age groups and years were 27% (95% CI 17-39) for poultry consumption, 27% (95% CI 22-32) for travelling abroad, 8% (95% CI 6-9) for pet contact and 39% (95% CI 25-50) for other risk factors. This model provided robust results when using data available for Switzerland, but the uncertainties remained high. The output of the model could be improved if more accurate input data are available to estimate the infection rate per exposure. In particular, the relatively high proportion of cases attributed to 'other risk factors' requires further attention.

Hodgkin lymphoma in the Swiss HIV Cohort Study

Hodgkin lymphoma (HL) risk is elevated among persons infected with HIV (PHIV) and has been suggested to have increased in the era of combined antiretroviral therapy (cART). Among 14,606 PHIV followed more than 20 years in the Swiss HIV Cohort Study (SHCS), determinants of HL were investigated using 2 different approaches, namely, a cohort and nested case-control study, estimating hazard ratios (HRs) and matched odds ratios, respectively. Forty-seven incident HL cases occurred during 84,611 person-years of SHCS follow-up. HL risk was significantly higher among men having sex with men (HR vs intravenous drug users = 2.44, 95% confidence interval [CI], 1.13-5.24) but did not vary by calendar period (HR for 2002-2007 vs 1995 or earlier = 0.65, 95% CI, 0.29-1.44) or cART use (HR vs nonusers = 1.02, 95% CI, 0.53-1.94). HL risk tended to increase with declining CD4(+) cell counts, but these differences were not significant. A lower CD4(+)/CD8(+) ratio at SHCS enrollment or 1 to 2 years before HL diagnosis, however, was significantly associated with increased HL risk. In conclusion, HL risk does not appear to be increasing in recent years or among PHIV using cART in Switzerland, and there was no evidence that HL risk should be increased in the setting of improved immunity.

Long-term trends of HIV type 1 drug resistance prevalence among antiretroviral treatment-experienced patients in Switzerland

BACKGROUND:Accurate quantification of the prevalence of human immunodeficiency virus type 1 (HIV-1) drug resistance in patients who are receiving antiretroviral therapy (ART) is difficult, and results from previous studies vary. We attempted to assess the prevalence and dynamics of resistance in a highly representative patient cohort from Switzerland. METHODS:On the basis of genotypic resistance test results and clinical data, we grouped patients according to their risk of harboring resistant viruses. Estimates of resistance prevalence were calculated on the basis of either the proportion of individuals with a virologic failure or confirmed drug resistance (lower estimate) or the frequency-weighted average of risk group-specific probabilities for the presence of drug resistance mutations (upper estimate). RESULTS:Lower and upper estimates of drug resistance prevalence in 8064 ART-exposed patients were 50% and 57% in 1999 and 37% and 45% in 2007, respectively. This decrease was driven by 2 mechanisms: loss to follow-up or death of high-risk patients exposed to mono- or dual-nucleoside reverse-transcriptase inhibitor therapy (lower estimates range from 72% to 75%) and continued enrollment of low-risk patients who were taking combination ART containing boosted protease inhibitors or nonnucleoside reverse-transcriptase inhibitors as first-line therapy (lower estimates range from 7% to 12%). A subset of 4184 participants (52%) had >or= 1 study visit per year during 2002-2007. In this subset, lower and upper estimates increased from 45% to 49% and from 52% to 55%, respectively. Yearly increases in prevalence were becoming smaller in later years. CONCLUSIONS:Contrary to earlier predictions, in situations of free access to drugs, close monitoring, and rapid introduction of new potent therapies, the emergence of drug-resistant viruses can be minimized at the population level. Moreover, this study demonstrates the necessity of interpreting time trends in the context of evolving cohort populations.

Racial disparities in patient survival after liver transplantation in the United States

Background. Racial disparities in healthcare span such areas as access, outcomes after procedures, and patient satisfaction. Previous work suggested that minorities experience less healthcare and worse survival rates. In adult orthotopic liver transplantation (OLT) mixed results have been reported, with some showing African-American recipients having poor survival compared to Caucasians, and others finding no such discrepancy. ^ Purpose. This study’s purpose was to analyze the most recent United Network for Organ Sharing (UNOS) data, both before and after the implementation of the Model for End-Stage Liver Disease (MELD)/Pediatric End-Stage Liver Disease (PELD) scoring system, to determine if minority racial groups still experience poor outcomes after OLT. ^ Methods. The UNOS dataset for 1992-2001 (Era I) and 2002-2007 (Era II) was used. Patient survival rates for each Era and for adult and pediatric recipients were analyzed with adjustment. A separate multivariate analysis was performed on African-American adult patients in Era II in order to identify unique predictors for poor patient survival. ^ Results. The overall study included 66,118 OLT recipients. The majority were Caucasian (78%), followed by Hispanics (13%) and African-Americans (9%). Hispanic and African-American adults were more likely to be female, have Hepatitis C, to be in the intensive care unit (ICU) or ventilated at time of OLT, to have a MELD score ≥23, to have a lower education level, and to have public insurance when compared to Caucasian adults (all p-values < 0.05). Hispanic and African-American pediatric recipients were more likely have public insurance and less likely to receive a living donor OLT than were Caucasian pediatric OLT recipients (p <0.05). There was no difference in the likelihood of having a PELD score ≥21 among racial groups (p >0.40). African-American adults in Era I and Era II had worse patient survival rates than both Caucasians and Hispanic (pair-wise p-values <0.05). This same disparity was seen for pediatric recipients in Era I, but not in Era II. Multivariate analysis of African-American recipients revealed no unique predictors of patient death. ^ Conclusions. African-American race is still a predictor of poor outcome after adult OLT, even after adjustment for multiple clinical, demographic, and liver disease severity variables. Although African-American and Hispanic subgroups share many characteristics previously thought to increase risk of post-OLT death, only African-American patients have poor survival rates when compared to Caucasians. ^

Inflación, transferencias y distribución del ingreso en la Argentina post-convertibilidad : ¿Cómo se gestan y a quiénes benefician?

El trabajo analiza cómo se distribuyen las cargas y beneficios del modelo de acumulación post-convertibilidad, 2002-2007, entre las fracciones de clase. En este sentido exploramos la constitución de un sistema de transferencias de ingresos en el que convergen en un proceso dinámico la inflación, las políticas económicas y las estrategias de acumulación de los agentes económicos. Desde una perspectiva que amplía el modo de abordaje del debate sobre la distribución del ingreso, postulamos la conformación de un sistema de transferencias en base al análisis de dos núcleos vinculados: uno ligado a transferencias operadas a partir de la articulación de políticas económicas y transformaciones estructurales, y otro que es en sí mismo un mecanismo de transferencia de importante relevancia y alcance explicativo: la inflación. La evolución diferencial de los precios afecta la capacidad de apropiación, por los agentes económicos, del ingreso socialmente producido, expresando así cambios en las relaciones de fuerzas

Inflación, transferencias y distribución del ingreso en la Argentina post-convertibilidad : ¿Cómo se gestan y a quiénes benefician?

El trabajo analiza cómo se distribuyen las cargas y beneficios del modelo de acumulación post-convertibilidad, 2002-2007, entre las fracciones de clase. En este sentido exploramos la constitución de un sistema de transferencias de ingresos en el que convergen en un proceso dinámico la inflación, las políticas económicas y las estrategias de acumulación de los agentes económicos. Desde una perspectiva que amplía el modo de abordaje del debate sobre la distribución del ingreso, postulamos la conformación de un sistema de transferencias en base al análisis de dos núcleos vinculados: uno ligado a transferencias operadas a partir de la articulación de políticas económicas y transformaciones estructurales, y otro que es en sí mismo un mecanismo de transferencia de importante relevancia y alcance explicativo: la inflación. La evolución diferencial de los precios afecta la capacidad de apropiación, por los agentes económicos, del ingreso socialmente producido, expresando así cambios en las relaciones de fuerzas

Inflación, transferencias y distribución del ingreso en la Argentina post-convertibilidad : ¿Cómo se gestan y a quiénes benefician?

El trabajo analiza cómo se distribuyen las cargas y beneficios del modelo de acumulación post-convertibilidad, 2002-2007, entre las fracciones de clase. En este sentido exploramos la constitución de un sistema de transferencias de ingresos en el que convergen en un proceso dinámico la inflación, las políticas económicas y las estrategias de acumulación de los agentes económicos. Desde una perspectiva que amplía el modo de abordaje del debate sobre la distribución del ingreso, postulamos la conformación de un sistema de transferencias en base al análisis de dos núcleos vinculados: uno ligado a transferencias operadas a partir de la articulación de políticas económicas y transformaciones estructurales, y otro que es en sí mismo un mecanismo de transferencia de importante relevancia y alcance explicativo: la inflación. La evolución diferencial de los precios afecta la capacidad de apropiación, por los agentes económicos, del ingreso socialmente producido, expresando así cambios en las relaciones de fuerzas

El nuevo desarrollismo como superación dialéctica del neoliberalismo en Argentina

A fines de 2001 Argentina llegó al clímax de la crisis del proceso neoliberal iniciado en los setenta. La crisis y su salida produjo la transición hacia un nueva modalidad de desarrollo periférica. Transición que no fue ruptura sino más bien superación dialéctica: lo nuevo surge de lo viejo que no desaparece sino que constituye el fundamento de aquello que está naciendo. El nuevo o neodesarrollismo nace así de las entrañas del neoliberalismo y de sus consecuencias económicas y sociales. Por un lado, resultará de la consolidación de un capitalismo periférico, dependiente y transnacionalizado. Por otra parte, supone el reconocimiento del peso de los nuevos movimientos populares que articularon la resistencia al ajuste durante los años noventa. Todo esto da cuenta de la impronta del proceso de crecimiento acelerado iniciado en 2002-2003 y de los cambios y continuidades manifiestos en la forma del Estado y sus políticas. Este texto pretende aportar elementos para comprender la novedad y la permanencia, lo estructural y lo accesorio, los límites y barreras del nuevo proceso. Por último, buscamos dar cuenta de las posibilidades de superar esos límites en la construcción de una alternativa popular.

(Table 1) Mean temperatures in january and july, and total annual snowfall at Great Bear Lake and Great Slave Lake, Canada

The sensitivity of brightness temperature (T(B)) at 6.9, 10.7, and 18.7 GHz from Advanced Microwave Scanning Radiometer-Earth Observing System (AMSR-E) observations is investigated over five winter seasons (2002-2007) on Great Bear Lake and Great Slave Lake, Northwest Territories, Canada. The T(B) measurements are compared to ice thicknesses obtained with a previously validated thermodynamic lake ice model. Lake ice thickness is found to explain much of the increase of T(B) at 10.7 and 18.7 GHz. T(B) acquired at 18.7 GHz (V-pol) and 10.7 GHz (H-pol) shows the strongest relation with simulated lake ice thickness over the period of study (R**2 > 0.90). A comparison of the seasonal evolution of T(B) for a cold winter (2003-2004) and a warm winter (2005-2006) reveals that the relationship between T(B) and ice growth is stronger in the cold winter (2003-2004). Overall, this letter shows the high sensitivity of T(B) to ice growth and, thus, the potential of AMSR-E mid-frequency channels to estimate ice thickness on large northern lakes.

Trade of Heilongjiang Province (China) with Russia

Local trade between the Far East region of the USSR and the Northeast region of the People’s Republic of China started in 1957, arranged by the public trade organizations in the respective borderlands. Heilongjiang Province of China has been the main actor in trade with the Far East region of the USSR, and more recently, Russia. After 1957, Heilongjiang Province’s trade with the Russian Far East developed rapidly until 1993, except a period of interruption (1967-1982). Thereafter, the Heilongjiang Province’s trade with the Russian Far East underwent a stagnation period (1994-1998), a recovery period (1999-2001), a rapid development period (2002-2007) and a period of change of tendencies and radical decrease (2008-2009). Heilongjiang Province’s trade with the Russian Far East consists of three main forms: general trade, Chinese-style border trade (Bianjing Trade which includes Bianjing Small Trade and trade between private persons (Hushi Trade)) and Travel Trade. The rapid increase of Heilongjiang Province’s trade with the Russian Far East from 2002 to 2007 is mainly attributable to the increase in the export of ordinary consumer goods, especially textile clothing and footwear, and to Bianjing Small Trade.

The gap between recognition and the 'compensation business' : the claim against Britain for compensation by Kenya's former Mau Mau fighters

During the first Kibaki administration (2002-2007), a movement by the former Mau Mau fighters demanded recognition for the role that they had played in the achievement of independence. They began to demand, also, monetary compensation for past injustices. Why had it taken over 40 years (from independence in 1963) for the former Mau Mau fighters to initiate this movement? What can be observed as the outcome of their movement? To answer these questions, three different historical currents need to be taken into account. These were, respectively, changing trends in the government of Kenya, progress in historical research into the actual circumstances of colonial control, and a realization, based on mounting experience, that launching a legal action against Britain could turn out to be a lucrative initiative. This paper concludes that, regardless of the actual purpose of the legal case, neither of their objectives was certain to be achieved. Two inescapable realities remain: the doubts cast on the reputation of the government by its decision to lift the Mau Mau‟s outlaw status – a decision that was widely seen as a latter-day example of the „Kikuyu favouritism‟ policy followed by the first Kibaki administration – and the popular interpretation of the involvement of Leigh Day, well known in Kenya ever since the unexploded bombs case for its success in obtaining substantial compensation payments, as a vehicle for squeezing large amounts of money from the British government for the benefit of the Kikuyu people.