Sex on the wards: Conundra for clinicians

Should psychiatric inpatients be allowed to engage in sexual activities? Do clinicians have a right to prevent them from doing so? If so, when may sexual interaction be restricted? What sorts of clinical issues and problems are posed for nursing staff, and how should psychiatrists and administrators respond to these? These and related questions have received little attention from either medical or legal scholars, in sharp contrast to the extensive analysis devoted to other issues affecting the lives of psychiatric inpatients, and in especially sharp contrast to our culture's inundation with media messages about sex. This article summarizes the modest body of scholarship concerning sexual interactions among hospitalized patients, the clinical and administrative questions faced by psychiatrists who work with inpatients, and the potential medicolegal problems that inpatients' sexual activities can create. It concludes with a conceptual framework that clinicians can use to devise solutions to the problems arising from inpatients' sexuality.     

Nursing burn wounds on general wards

In this article, the author predicts that patients with intermediate and minor burn injuries will be increasingly nursed on general wards. In this context, she describes developments in the treatment and management of wounds caused by burns, and examines the advantages and drawbacks of current nursing treatments and how these should be used.     

Pupillographic sleepiness testing in hypersomniacs and normals

BACKGROUND: Pupillary oscillations in darkness are considered to be a sign of sleepiness. The purpose of this pilot study was to ascertain whether pupillary oscillations were more pronounced in patients with hypersomnia than in normals. METHODS: Seven patients (four with sleep apnea syndrome, three with narcolepsy) and seven age-matched controls underwent pupillography for 11 min in complete darkness. The changes in pupil size were analyzed mathematically to determine quantitatively the amount of pupillary instability. RESULTS: Hypersomniacs had much higher amounts of pupillary oscillations in darkness than normals. The differences were significant. Baseline pupil size did not differ significantly between the two groups. CONCLUSION: This study showed that a pupillographic sleepiness test based on the evaluation of spontaneous pupillary changes in darkness is applicable in hypersomniacs and may facilitate therapy control, i.e. diagnostic grading by measuring daytime sleepiness objectively.     

Mismatch negativity during objective and subjective sleepiness

The mismatch negativity (MMN) and P3 of auditory event-related potentials were studied during subjectively and objectively (physiologically) defined sleepiness under optimal stimulus conditions for MMN elicitation. The MMN and P3 were elicited by either small or large unattended auditory deviants presented to the left ear. The participant's task was to detect either rare auditory targets presented to the right ear or rare changes in the light flashes. Eleven young adults served as participants in a nighttime experiment. The MMN declined especially at Fz and Cz but not so markedly at the right mastoid as either subjective or objective alertness decreased. The amplitude of P3 also decreased during sleepiness. The attenuation of the MMN was paralleled by a decline in behavioral performance. The results show that the MMN is attenuated by a decrease in alertness even before an actual sleep state is reached.     

Two roads to coma: the Scottish hypothesis

Clinical experience seems to indicate two separate types of entry to coma. Some patients follow a pathway characterized by confusion, hallucinations, mumbling delirium, myoclonic jerks, and seizures. The author has called this sequence of symptoms the high road to coma and hypothesized that its basic underlying pathophysiology involves increased neuronal firing rates. Other patients develop somnolence, lethargy, obtundation, and unresponsiveness without seizures or muscle twitches. This low road to coma involves either anatomical compression of the midbrain reticular formation or a metabolic or toxic disorder characterized by membrane stabilization and decreased neuronal excitability.     

Record-keeping and routine nursing practice: the view from the wards

This paper examines general nurses' views of the nursing record and its routine usage in contemporary hospital practice. It draws on ethnographic data generated on a surgical ward and a medical ward in a single District General Hospital in the United Kingdom (UK). A key research finding was ward nurses' equivocal attitudes to the nursing record. On the one hand, because of its links with the nursing process, the nursing record was highly valued as a symbol of professionalism and ward staff were loathe to criticise it directly. On the other hand, however, the nurses in this study clearly found it difficult to reconcile their professional ideals with the ways in which the nursing record was routinely employed on the wards. In this paper it is suggested that at one level, nurses' ambivalence towards the nursing record reflected the distortion of its founding philosophy by the new managerialism in the contemporary UK health care context. At another level, however, there are also difficulties which arise from the tension between the assumptions about the nature of nursing work which underpin the nursing record and the workplace reality on hospital wards.     

An investigation into the application and maintenance of Hamilton Russell traction on three orthopaedic wards

This study is concerned with the application and maintenance of Hamilton Russell traction, a form of vectored skin traction. It may be used in the treatment of fractures of the femur for the purposes of immobilization and for pain relief prior to surgery. A preliminary questionnaire demonstrated a poor level of knowledge in nurses working in an orthopaedic area. It was therefore speculated that application and maintenance of the traction would be inaccurate. The angles making up the resultant traction forces were measured in 11 systems. The theoretical traction force was established using mathematics. The actual force was measured using a goniometer. A comparison was then made. The results in all 11 systems demonstrated a highly statistically significant difference between the theoretical and actual positions of the traction force (P < 0.0005). The practical implications of this are discussed and recommendations for a protocol of application and maintenance suggested. Areas for further research are identified.     

Assessment of the social atmospheres of psychiatric wards.

Describes the development of a Ward Atmosphere Scale, which differentiates between the social atmospheres of psychiatric inpatient wards. An initial form of the scale was given to Ss and staff on 14 wards from Veterans Administration, state, community, private, and university hospitals. The 2nd form of the scale consists of items which significantly differentiate between wards for Ss and/or staff. This form includes 12 subscales, e.g., Spontaneity, Autonomy, Affiliation, Aggression, Variety, and Support, each of which measures the emphasis on 1 dimension of ward atmosphere. Ward profiles which compare average S perceptions of different wards have been constructed. The importance of developing measures of psychological environments and the implications relating to the matching of individual needs and environmental press are discussed. (30 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

浅谈降低钢球消耗

介绍了钢球的应用状况，供应方式，影响钢球消耗的因素及降低钢球消耗的途径。     

Patients' information needs in intensive care and surgical wards

Meeting the information and psychosocial support needs of surgical patients who have been in intensive care can contribute significantly to their recovery. In this article, the author examines the nursing opportunities for meeting these needs and suggests how they can be addressed.     

关于降低燃料比的反思

通过对首钢长钢8号高炉近两年的指标对比以及原、燃料情况对比,说明炼铁生产中精料是非常关键的因素,要努力改善、提高其质量,但不能完全依赖它;在现有条件下要通过优化日常操作来提高技术经济指标,降低生铁成本.