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Exploring language about families.

When we work with families in health care settings, it is important to be aware of the way we communicate. Often overlooked is how the language we use to describe and understand families affects how we work with them. The language we use in thinking about a family can shape our perceptions of the family and may affect how we approach working with them. The language we use in describing a family to another health care provider can affect how that person will perceive and approach the family. The language families hear us use can affect families' perceptions of themselves, their perceptions of us, and, consequently, how they relate to us. In Project Copernicus' Family Centered Communication Skills: Facilitator's Guide (Edelman, Greenland, & Mills, 1993), an activity entitled "Watch Our Language" explores commonly used negative terminology about families and guidelines for better language. This exercise has been used with groups of nurses and other health care providers at several conferences and has generated thoughtful brainstorming about negative language related to families, its impact on families, and its impact on the nurses working with them. Those participating in the workshops explored better terminology about families and brainstormed a list of selected family strengths which are shared here.

Adult↗

Would measurement of C-reactive protein reduce the rate of negative exploration for acute appendicitis?

BACKGROUND: Appendicectomy for suspected acute appendicitis is a common procedure. The rate of normal appendices unnecessarily removed remains high (15-30%) despite several techniques and investigations used to improve the diagnostic accuracy. Many studies investigated the role of raised C-reactive protein in improving the diagnosis of acute appendicitis, but with conflicting results. This study emphasies the impact of a normal (rather than raised) serum C-reactive protein in reducing the rate of negative explorations. METHODS: In a double blind study, blood for the measurement of serum C-reactive protein (CRP) was collected pre-operatively from 78 patients just before going to the operating room for appendicectomy. The histopathology of the 78 appendices were grouped into positive (acute appendicitis) and negative (normal appendix). White blood count (WBC), CRP and the histopathology findings were correlated. RESULTS: In patients with histopathologically proven acute appendicitis both the WBC count and serum CRP level were significantly raised (P = 0.025 and P < 0.000,1 respectively). Serum CRP level was normal in 13 out of 15 negative explorations (normal appendix on histopathology). The specificity and sensitivity of serum CRP was 86.6% and 93.6%, respectively. CONCLUSION: A normal pre-operative serum CRP measurement in patients with suspected acute appendicitis is most likely associated with a normal appendix. Deferring surgery in this group of patients would probably reduce the rate of unnecessary appendicectomies.

Adolescent↗

Identity status formulae: generating continuous measures of the identity statuses from measures of exploration and commitment.

Mathematical formulae were devised for the purpose of generatin continuous measures of the four identity statuses from measures of exploration and com measures of exploration and commitment. The formulae were consistent with the conceptual definitions of the statuses. They were found to be effective both in terms of generating continuOUs measures of the statuses and in terms of deriving status assignments.

Achievement↗

Exploration of factors that impact mode of death in the hemodialysis patient.

The purpose of this quantitative and explorative qualitative study was to examine the illness trajectory, social integration, role change, and social support that may have influenced hemodialysis patients' mode of death. A quantitative archival medical record review recorded patients' mode of death as listed on the End Stage Renal Disease (ESRD) Death Notification form. Exploratory interviews were conducted with the deceased hemodialysis patient's significant other to explore patient's illness trajectory, end-of-life experiences, social integration, role change, and social support. Seventeen patients experienced a sudden, unexpected, unintentioned death, and 15 patients experienced an intentioned death after withdrawal of hemodialysis. Qualitative indicators of illness trajectory indicated either a fairly slow downward course with a sudden unintentioned death or a rapid downward spiraling course resulting in intentioned death after withdrawal of hemodialysis. While it was unknown if significant others would report of individuals withdrawing from treatment who lacked social integration or social support, findings suggest that some individuals in this study withdrawing from hemodialysis exercised their rights to self-determination and right to refuse life-saving treatments. Although findings of this study are not generalizable, it may be advisable for nurses to engage patients and family members in discussions regarding advance directives, rights to refuse treatment, and withdrawal from hemodialysis prior to a change in the patient's illness trajectory.

Aged↗

Exploration of the neck for hyperparathyroidism.

A step-by-step plan for exploration of the neck for hyperparathyroidism has evolved during a 15-year experience with 148 patients at the Toronto General Hospital. Selective catheterization of the veins of the neck with parathormone immunoassay has been a valuable aid in preoperative localization and is particularly helpful in those patients who have had a previous neck dissection. The success of the exploration is based on a practical knowledge of the embryology and anatomy of the parathyroid glands, meticulous dissection and the identification of all glands. The "angle of identification", as described, has been helpful in operative localization. The parathyroid gland or glands that are grossly abnormal are excised, and the remaining glands biopsied and examined by an experienced pathologist, expert in quick-section techniques.

Adenoma↗

Exploration of facilitators and barriers to prenatal care among military women.

Early and regular prenatal care has been shown to decrease the incidence of adverse pregnancy outcomes; however, little research has examined it experientially from the mother's perspective. The purpose of this qualitative study was to explore the experience of prenatal care from the military mother's perspective. Using purposive sampling, 16 women who had recently given birth were interviewed. The data were analyzed using a qualitative descriptive research methodology to elicit categories of substantive concepts, ideas, or themes. Data explored in this study included availability, use and satisfaction with prenatal care services, and barriers, preferences, and recommendations.

Female↗

[Exploration of the uterine cavity in the gynecologic preoperative diagnosis].

BACKGROUND: The diagnostic accuracy of dilatation and curettage (D & C) was studied comparing retrospectively the results of histologic findings of D & C with the correspondent specimen from hysterectomy. METHODS: During five years, at the Institute of Gynecology and Obstetrics, II University of Studies in Naples, 260 women underwent hysterectomy, 160 of which underwent D & C prior to hysterectomy. The histologic findings were classified in: a) physiological endometrium; b) hyperplasia; c) polyps; d) atrophia; e) adenomatous hyperplasia; f) adenocarcinoma. During the period January 1989-October 1993, 260 patients underwent hysterectomy. The age was between 32 and 65 years. The indications to the intervention were: menometrorrhagia, hypogastric pains, dysmenorrhea, metrorrhagia, genital prolapse, urinary incontinence, anemia. Two hundred-sixty patients underwent hysterectomy, 160 of which underwent D & C prior to hysterectomy. Curettage was performed using a right size curette after dilatation of the uterine cervix using Hegar's metallic dilatator. Patients were submitted to general anesthesia. Histologic tissues were fixed with formalin and were sent to the Institute of Anatomopathology for examinations. RESULTS: The histologic results obtained by cavitary exploration have been compared with those reached by the analysis of the surgical samples. The results obtained confirm the reliability of D & C for the identification of endometrial lesions. CONCLUSIONS: Therefore, the diagnostic utility of cavitary exploration before hysterectomy is confirmed, particularly in selected cases.

Adult↗

Reappraisal of timing for exploration of civilian peripheral nerve injuries.

Operative as well as electrophysiologic experience with 213 major nerve injuries over the last 8 years and primate experiments form the basis of this reappraisal. Those lesions in continuity resected (58 of 172) usually had no response to stimulation or nerve action potential (NAP) at 8 weeks or longer after injury but were not necessarily complete lesions on clinical examination or electromyography. Axonal organization and maturity were of such poor quality that functional regeneration would not have resulted. Despite preoperative evidence of an incomplete lesion, operative studies confirmed a complete lesion in 21 instances. In 103 lesions NAP's could be recorded and, where neurolysis was done, recovery was acceptable in 91 percent. Many of these lesions had appeared complete on preoperative evaluation. Nerves transected by glass and repaired primarily had superior electrical and functional recovery to those repaired secondarily, although variations in clinical settings prevented statistical analysis. Experimental work in 20 primates with glass-wounded nerves favored primary repair, for NAP, evoked muscle action potential, and strain gauge studies of muscle power were superior in 14. Lesions in continuity should have exploration delayed until 8 weeks so that physiologic decisions regarding need for resection and repair can be made. Transecting injuries should be explored primarily, those without contusinve element repaired immediately, and those with contusion repaired 3 weeks after injury.

Action Potentials↗

Planetary protection issues and the future exploration of Mars.

A primary scientific theme for the Space Exploration Initiative (SEI) is the search for life, extant or extinct, on Mars. Because of this, concerns about Planetary Protection (PP), the prevention of biological cross-contamination between Earth and other planets during solar system exploration missions, have arisen. A recent workshop assessed the necessity for, and impact of, PP requirements on the unmanned and human missions to Mars comprising the SEI. The following ground-rules were adopted: 1) information needed for assessing PP issues must be obtained during the unmanned precursor mission phase prior to human landings; 2) returned Mars samples will be considered biologically hazardous until proven otherwise; 3) deposition of microbes on Mars and exposure of the crew to Martian materials are inevitable when humans land; and, 4) human landings are unlikely until it is demonstrated that there is no harmful effect of Martian materials on terrestrial life forms. These ground-rules dictated the development of a conservative PP strategy for precursor missions. Key features of the proposed strategy include: 1) for prevention of forward contamination, all orbiters will follow Mars Observer PP procedures for assembly, trajectory, and lifetime. All landers will follow Viking PP procedures for assembly, microbial load reduction, and bioshield; and, 2) for prevention of back contamination, all sample return missions will have PP requirements which include fail-safe sample sealing, breaking contact chain with the Martian surface, and containment and quarantine analysis in an Earth-based lab. In addition to deliberating on scientific and technical issues, the workshop made several recommendations for dealing with forward and back contamination concerns from non-scientific perspectives.

Containment of Biohazards↗

Life sciences issues affecting space exploration.

The U.S. space program is undertaking a serious examination of new initiatives in human space exploration involving permanent colonies on the Moon and an outpost on Mars. Life scientists have major responsibilities to the crew, to assure their health, productivity, and safety throughout the mission and the postflight rehabilitation period; to the mission, to provide a productive working environment; and to the scientific community, to advance knowledge and understanding of human adaptation to the space environment. Critical areas essential to the support of human exploration include protection from the radiation hazards of the space environment, reduced gravity countermeasures, artificial gravity, medical care, life support systems, and behavior, performance, and human factors in an extraterrestrial environment. Developing solutions to these concerns is at the heart of the NASA Life Sciences ground-based and flight research programs. Facilities analogous to planetary outposts are being considered in Antarctica and other remote settings. Closed ecological life support systems will be tested on Earth and Space Station. For short-duration simulations and tests, the Space Shuttle and Spacelab will be used. Space Station Freedom will provide the essential scientific and technological research in areas that require long exposures to reduced gravity conditions. In preparation for Mars missions, research on the Moon will be vital. As the challenges of sustaining humans on space are resolved, advances in fundamental science, medicine and technology will follow.

Adaptation, Physiological↗

[Endoscopic exploration of the airways in children].

Airway endoscopic exploration in children has benefited from miniaturization of flexible bronchoscopes, allowing examination in young and even premature infants. Whether endoscopy is performed under conscious sedation and topical anesthesia or under deep sedation, the painlessness of the procedure are very important for the child's comfort. Bronchoscopy may provide direct anatomical information or indirect information from secretions sampling, bronchoalveolar lavage, or bronchial and transbronchial biopsies. Indications are wide, mainly detection of airway obstruction via an intrinsic or extrinsic mechanism, identification of an infectious agent in immunocompromised patients, exploration of chronic interstitial pneumonitis, and interventional endoscopy.

Adolescent↗

[Preliminary exploration on TCM literature of Heishuicheng collected in Russia].

The Heishuicheng literature collected in Russia was excavated by the Russian explorer Kotzlov at the remained site of Heishunicheng of Xixia in Inner Mongolia early this century, and carried back and preserved in Petersburg, Russia. This rare treasure was well and secretly hidden in clandestine room for a long period, not known to any other people. The detailed contents and characteristic and appearance of the valuable TCM literatures among them and its academic and research significance are explored here.

China↗

[Evaluation of historical exposure to silica dust for the workers employed in geologic exploration industry].

OBJECTIVE: To evaluate their level of exposure to silica dust in the workers employed in geologic exploration industry using a quantitative method. METHODS: Monitoring data of exposure to silica dust since 1950s were collected for the workers in various jobs from the factories and mines of the bureaux of geological exploration in the nine provinces, with 30,000 pieces of figures in total. Job title and history of employment were determined for 1,627 employees. Levels of exposure to silica dust in various factories and mines were estimated based on the data mentioned-above, including amount of respirable dust, total dust in the lungs, and proportion of free silica dust to the total silica dust. RESULTS: Concentration of total silica dust was 14 mg/m3 in average in the factories and mines, with a range of 29 mg/m3 during the earlier years to 3 mg/m3 in recent years, and that of respirable silica dust was 3 mg/m3, in average, with (28.0 +/- 8.2)% of free silica dust. Different indices of exposure to silica dust were calculated for individuals, based on their history of employment and level of exposure. CONCLUSION: Assessment of exposure to silica dust during the past years, based on the monitoring data, could provide basis for evaluation of dose-response relationship.

Air Pollutants, Occupational↗

[Missed ureteral injuries following surgical exploration with percutaneous nephrostomy and drainage treatment].

Twelve patients with missed ureteral injury and urinoma due to gunshot are evaluated following surgical exploration. All 12 had underwent surgical exploration at the other hospitals on admission. Fever, malaise, shocking chills, leucocytosis due to urinoma formation are the findings in the late postoperative period and CT (computer tomography) scan revealed urinoma. Intravenous urograms are nondiagnostic in 6 of patients and hematuria is detected in 6(%50) Percutaneous nephrostomy is emphasized as the first step of management for these lately diagnosed ureteral fistulas. Additionally, Urinoma is drained percutaneously. Hence we save the patients from a second operation following severe gunshot trauma. The presence of shock, intraoperative bleeding, colonic injury and blast effect of high velocity missile with delayed tissue necrosis are the cause of missed ureteral injury. At 8 patients, nephrostomy was the solution and total cure is achieved. Mean follow-up period after nephrostomy is 3 months. At 2, we perform psoas-hitch and ureteroneocystostomy, at one psoas-hitch, boary- flep and ureteroneocystostomy and at one ureteroureterostomy due to long ureteral obstruction on urinary fistula. As a conclusion, when treating missed ureteral injuries with urinary fistula and urinoma formation following complicated surgical intervention, percutaneous nephrostomy application and percutaneous drainage of urinoma may be the first step for management. Late surgical reconstitution is the second step when needed.

Adolescent↗

[Explorative laparotomy with splenectomy in malignant lymphomas (author's transl)].

Between January 1, 1971 and February 1, 1974, 31 patients have undergone laparotomy for staging of a malignant lymphoma, Hobgkin or not. Laparotomy consisted in a median incision, above and below the umbilicus allowing multiple node biopsies, hepatic and splenic biopsies. In 17 cases out of 31, i.e. 54% preoperative clinical stage was changed by this explorative pathology. Among untreated cases, the most frequent change was from a low to a higher stage and inversely, among treated cases, most frequent changes were from plus towards minus. Postoperative mortality is nill and morbidity 5/31, i.e. 16%. This technique yields better definition of the degree of lymphoma extension, in particular intra-abdominal, and thus allows better treatment. The author thus commends explorative laparotomy with splenectomy for all malignant lymphomas, Hodgkin or not, except for stage IV, proven biopsy.

Adolescent↗

Critical path plan for food and nutrition research required for planetary exploration missions.

In preparation for future planetary exploration, NASA-Johnson Space Center has developed a critical path plan for food and nutrition research needs. The plan highlights the risk factors pertaining to food and nutrition associated with exposure to the space flight environment as well as the possible consequences if no corrective measures are implemented. Included in the plan are the initiating events such as microgravity, remote environment and mission duration, which obviously impact the risk factors. The plan includes points of intervention where mitigating factors can be implemented to avoid outcomes such as malnutrition and unsafe foods. Physiological changes induced by lack of gravity, as well as increased exposure to radiation, may alter nutrient bio-availability, and/or nutrient requirements. An inadequate food system, whether due to technical limitations or nutritional shortcomings, can result in serious consequences. Additionally, microbial and chemical food contamination or psychological factors such as depression may lead to insufficient food intake. Critical questions define areas where further research is required to eliminate or ameliorate the risk from each of those factors. These questions delineate priorities for NASA food and nutrition research for planetary exploration missions.

Aerospace Medicine↗

Preoperative sestamibi localization combined with intraoperative parathyroid hormone assay predicts successful focused unilateral neck exploration during surgery for primary hyperparathyroidism.

A retrospective review of 54 cases of primary hyperparathyroidism operated upon by five general surgeons at Santa Barbara Cottage Hospital between March 1998 and March 2001 was performed to determine whether positive preoperative sestamibi localization (PSL) of a solitary adenoma combined with intraoperative parathyroid hormone assay (IOPHA) could predict successful focused unilateral neck exploration. A solitary adenoma was found in each of 50 patients (93%). PSL for solitary adenomas had an accuracy of 87 per cent, positive predictive value (PPV) of 96 per cent, sensitivity of 90 per cent, and specificity of 50 per cent. Forty-five patients (83%) achieved a 50 per cent reduction in IOPHA at 10 minutes after excision of a solitary adenoma for an accuracy of 85 per cent, PPV of 97 per cent, sensitivity of 88 per cent, and specificity of 50 per cent. All patients remain eucalcemic. The combination of PSL and IOPHA resulted in a PPV of 97.5 per cent and a sensitivity of 100 per cent. From these data we conclude that a focused unilateral neck exploration could have been performed successfully in 78 per cent of the cases.

Adenoma↗

Referral and consultation in asthma and COPD: an exploration of pulmonologists' views.

BACKGROUND: The burden of asthma and chronic obstructive pulmonary disease (COPD) on national healthcare systems is expected to increase substantially in future years. Referral guidelines for general practitioners (GPs) and pulmonologists may lead to more efficient use of healthcare facilities. We explored the prevailing views of pulmonologists regarding referral and once-only consultation in asthma and COPD, and compared these views with recently published transmural referral guidelines for GPs and pulmonologists. METHODS: Cross-sectional multiple case study. Twenty-nine Dutch pulmonologists working at non-university hospitals or specialised chest clinics participated in group discussion sessions. RESULTS: The outcome of the discussions and recently published referral guidelines for GPs and pulmonologists showed considerable similarity, but also some marked discrepancies. During the discussions, the main points of disagreement among the pulmonologists were: 1) should GPs or pulmonologists add long-acting beta2-agonists to asthma treatment regimens; 2) should the current cut-off point 'predicted FEV1 <50%' for referral of COPD patients be increased to 60 or 70%; and 3) should an annual exacerbation rate of two episodes a year be used as an undifferentiated referral criterion for COPD patients? For asthma, proposed back-referral (i.e. from pulmonologist to GP) criteria rested on: required dose of inhaled steroids, persistent need for long-acting beta2-agonists, duration of clinical stability and persistence of airway obstruction. Back-referral criteria for COPD rested on age, blood-gas abnormalities and ventilatory limitations. Primary care monitoring facilities and 'shared-care' constructions were considered to be facilitating conditions for back-referral. CONCLUSIONS: This explorative study provided insights into how pulmonologists visualise a rational referral policy for patients with asthma or COPD. These insights can be taken into consideration in future revisions of referral and back-referral guidelines for GPs and pulmonologists.

Adult↗