Villous papilloma of the rectum presenting as infective gastro-enteritis

Three elderly patients have recently been admitted as emergencies to the Infection Unit of the Aberdeen Hospitals as presumed cases of infective gastro-enteritis. Investigation revealed the presence of a villous papilloma of the rectum in each case.     

Die effiziente Organisation

Definition of the problem The hospital as an organization has undergone substantial changes during recent decades due to reforms in the health care system. There have been necessary and quite helpful modifications; however, some modifications raise the question: what public tasks should hospitals fulfill in the future? The following question, thus, arises: what kind of effectiveness, besides cutting costs, should be achieved by the permanent increase of efficiency in hospitals? Paradoxically spoken, the change of the organization hospital seems to be entailed by economization which at the same time is meant to be a remedy for change. Arguments This article reflects on the process of economization from an ethical perspective using patterns from organizational and institutional theory, e.g., a model to evaluate levels of economization contributed by the French sociologist Pierre Bourdieu, applied in this case to German hospitals. Conclusion Market-driven incentives are no answer to the question which goals (i.e., morally, socially, and legally) the health care system should meet. Therefore, public deliberation and performance-orientated shaping of the institutions is required.     

Empirische Methodologien und Methoden der angewandten und der empirischen Ethik

Definition of the problem This paper deals with the question of adequate methodologies and methods to conduct empirical research and integrate empirical knowledge in the field of biomedical ethics. Arguments It starts with reflections about the main subject matter of ethics, the human being as a bio-psycho-social creature and its morals, and argues that social sciences are the adequate basic empirical science in the field of ethics in general. The next paragraph considers theory of science perspectives of the relationship of ethics, empirical findings, methodologies and theories and examples of the integration of empirical findings into ethical deliberations. Reasons for the tension between social science and ethics are scrutinized which are different in the yet to be defined field of empirical ethics compared to traditional applied ethics. Conclusion How a bio-psycho-social ethics that incorporates these criteria into its own body of work could look like is finally depicted.     

Die therapeutische Interaktion als moralische Vorgabe

Definition of the problem

Hospitals serve the general purpose to improve the health of patients. Health care professionals are a necessary means to achieve that end but have their own more specific professional ends. What is the due relationship between those kinds of ends with respect to the organisation of hospitals?

Arguments

Individual health care in hospitals is delivered by professionals who are dependent upon the hospital??s human, administrative and technical facilities. As organised social entities, hospitals use professionals as the means to an end we normally call health of patients. More precisely, the professional task consists in a specific, namely, therapeutic interaction, an asymmetric relationship between morally equals. Professionals have to explore, interpret and pursue patients?? interests according to their consent. From a moral perspective, this interaction should be kept free from distortion through external incentives which divert the professional??s intrinsic motivation. Although a professional responsibility, the individual professional would be overcharged with this organisational task.

Conclusion

The profession has a responsibility to protect and foster professional behaviour of its members including participation in organising hospitals and the individual professional should engage in organising the profession as a collective agent.     

Morphology of peripheral airways in current smokers and ex-smokers

To investigate the effect of smoking status on pulmonary function and pathologic changes in the peripheral airways, we studied 97 patients who underwent thoracotomy for coin lesions. The patients were divided into 4 groups: nonsmokers (n = 9), current smokers (n = 51), and those who had ceased smoking for less than (n = 18) or more than (n = 19) 2 yr prior to surgery. We found that current smokers had evidence of air-flow obstruction with abnormal lung volumes when compared with nonsmokers. Ex-smokers had lung volumes similar to those of nonsmokers, but showed evidence of obstruction, with the FEV1/FVC between the values found for nonsmokers and current smokers. Examination of the small airways showed that the membranous bronchioles of current smokers and ex-smokers displayed only increased goblet cell metaplasia when compared with those in nonsmokers; the respiratory bronchioles of current and ex-smokers showed increases in intraluminal and airway wall inflammatory cells, wall fibrosis, and pigment deposition. We conclude that patients who currently smoke cigarettes have reduced lung function that is associated with abnormalities of airway structure. Although those who have stopped smoking have function that is closer to the nonsmoking group, there is no apparent difference in structural change between current and ex-smokers.     

Cardiovascular and biochemical evidence of stress during major surgery associated with different techniques of anaesthesia

The relative merits of a potent narcotic and a spinal analgesic to affect the stress response to a standard operation have been assessed. Forty-five fit patients scheduled for abdominal hysterectomy were allocated at random to three groups, referred to as standard (i.v. anaesthesia alone), spinal (spinal plus i.v. anaesthesia) and fentanyl (fentanyl plus i.v. anaesthesia) groups. In the doses used, fentanyl produced the most effective attenuation of the cardiovascular, hormonal and metabolic responses to stress, but had the disadvantage of prolonged respiratory depression. Spinal anaesthesia gave only a modified blockade of the response to stress and did not obtund the response to intubation.     

基于PD控制的机器人轨迹跟踪性能研究与比较

定义同一个Lyapunov函数，分析了基于PD的3种常用机器人轨迹跟踪算法的稳定性和鲁棒性，得到了新的结论，PD加前馈控制按指数收敛到0，PD及修改的PD加前馈控制收敛到一封闭球，增大反馈系数可使球半径任意小，基于PD的轨迹跟踪算法对模型误差及有界不确定性干扰具有鲁棒性，实验研究验证了分析结果，并对3种轨迹跟踪算法的控制性能进行比较。