"Natural cause of death or not?" How do nursing home physicians act when in doubt of natural cause of death?

The objective of the study was to explore if nursing home physicians act by law, when they doubt the natural cause of death. In May 1999, a questionnaire was sent to 153 nursing home physicians in the region of Utrecht and Nijmegen. They were asked if they consult the coroner when they have doubts about the natural cause of death. Eighty-six percent (104) returned the questionnaire. Thirty-two percent of the nursing home physicians always consult the coroner and 52% does so most of the time. Only 12% does not consult the coroner most of the time and 2% never does. The main reasons for not consulting the coroner were that nursing home physicians judge a death after a fall as an incident that fits in the descending lifeline of patients and that some nursing home physicians had bad experiences consulting the coroner. We conclude that this policy may lead to underregistration of unnatural deaths. Changing the definition or changing the law may reduce this problem. Education and information can also contribute to change in physician's attitudes.     

Best Practice Updates for Nursing Care in Weight Loss Surger

The objective of this study is to update evidence‐based best practice guidelines for nursing in weight loss surgery (WLS). We performed a systematic search of English‐language literature on WLS and perioperative nursing, postoperative, anesthesia, and discharge published between April 2004 and May 2007 in MEDLINE, CINHAL and the Cochrane Library. Key words were used to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence‐based models. From these, we developed evidence‐based best practice recommendations from the most recent literature on nursing in WLS. We identified >54 papers; the most relevant were reviewed in detail. Regular updates of evidence‐based recommendations for best practices in WLS nursing are required to address advances in surgery and anesthesiology, as well as changes in the demographics and levels of obesity in WLS patients. Key factors in patient safety include staff education, comprehensive admission assessment, patient education, careful preoperative surveillance and postoperative care, and long‐term discharge follow‐up.     

Nursing does affect the duration of the post-partum to ovulation interval in cotton-top tamarins (Saguinus oedipus)

Reports on callitrichid monkeys have not revealed a significant effect of nursing on interbirth intervals or on post-partum to ovulation intervals. We examined 25 post-partum intervals in cotton-top tamarin females to determine whether nursing infants would affect the length of the post-partum to ovulation interval. Urinary LH/CG and oestrone conjugates were measured in urine samples collected in the 6 weeks after birth. The post-partum to ovulation interval is the number of days between parturition and the rise of urinary LH and oestrone conjugates associated with ovulation. There was an 84% conception rate post partum. Neither mother's parity nor sex of the infants influenced the length of the post-partum to ovulation interval. The post-partum to ovulation interval for females nursing 2 infants was twice as long as for those not nursing or nursing 1 infant (P less than 0.05). The range of post-partum to ovulation interval lengths was more variable in nursing than in non-nursing females (P less than 0.01). Females spent less than 50% of observed time in contact and less than 20% of observed time nursing their infants. Neither the number of tamarins within the family nor the amount of time the mother was in contact with infants correlated with the length of the post-partum to ovulation interval. However, there was a positive correlation between the percentage time that mothers nursed 1 infant at a time and the length of the post-partum to ovulation interval (r = 0.75, P less than 0.02). The underlying mechanisms of suckling-induced delay of ovulation are present in the cotton-top tamarin as in other primate species. However, these nursing effects do not cause the substantial delay in fertility post partum that is associated with non-callitrichid primates.     

Best Practices for Perioperative Nursing Care for Weight Loss Surgery Patients

Objective: To describe the unique nursing responsibilities involved in providing nursing care to severely obese weight loss surgery patients and to develop evidence‐based guidelines for safe patient care. Research Methods and Procedures: We performed a systematic review of the scientific literature using MEDLINE and CINAHL. A specific search of nursing journals from 1985 to 2004 identified 134 articles; 16 were found to be pertinent. These were reviewed in detail and used in the context of this report. The quality of the evidence was graded according to a system derived from established evidence‐based models. Recommendations were developed from published evidence and expert opinion. Results: This Task Group found that safe and competent nursing care requires assessment of, and provision for, the complex physical and psychological needs of weight loss surgery patients. We developed evidence‐based guidelines for preoperative, perioperative, and postoperative care that address risk factors unique to severely obese patients. We also addressed issues related to the use of proper body mechanics and positioning to avoid on‐the‐job injury to nursing staff. Discussion: We found that patient safety is best served when nurses are specifically trained to deal with the physical, medical, and psychosocial needs of severely obese patients and when they play an integral role in the multidisciplinary healthcare team. This role should start with a patient's first contact with the system and continue through discharge and follow‐up. Special attention needs to be paid to the widespread bias and discrimination that severely obese individuals often experience.     

Primiparous females do not exhibit reduced maternal care in gray seals (Halichoerus grypus)

We compared the behaviors of primiparous and multiparous gray seal (Halichoerus grypus) females over the course of lactation to examine whether poorly developed maternal behaviors may play a role in the reduced lactation performance observed in primiparous females. Overall, primiparous females spent as much time interacting with their pups as multiparous females. The proportion of time spent nursing their pup increased significantly between early and peak lactation in both primiparous and multiparous females. Although there was no significant difference in the duration of nursing bouts as a function of reproductive status, primiparous females nursed significantly more frequently (bouts/hour) and, therefore, spent a significantly greater proportion of time nursing than multiparous females throughout lactation. Primiparous gray seal females were also significantly more active than multiparous females, however, the difference in activity represented only a small proportion of the overall time budget. We conclude that poorly developed maternal behaviors resulting from a lack of prior reproductive experience are unlikely to account for lower levels of milk energy transfer to pups in primiparous gray seals.     

The curious case of aging plasticity in honey bees

As in all advanced insect societies, colony-organization in honey bees emerges through a structured division of labor between essentially sterile helpers called workers. Worker bees are sisters that conduct all social tasks except for egg-laying, for example nursing brood and foraging for food. Curiously, aging progresses slowly in workers that engage in nursing and even slower when bees postpone nursing during unfavorable periods. We, therefore, seek to understand how senescence can emerge as a function of social task performance. The alternative utilization of a common yolk precursor protein (vitellogenin) in nursing and somatic maintenance can link behavior and aging plasticity in worker bees. Beneficial effects of vitellogenin may also be mediated by inhibitory action on juvenile hormone and insulin-like signaling.     

Non-offspring nursing in social carnivores: minimizing the costs

We compare the nursing behavior of two species, African lions(PanfheraLeo) and spotted hyenas(Crocuta Craig Packer crocuta), and showthat non-offspring nursing is much less common in hyenas thanlions. Hyenas spend less time with their cubs, are more alertduring the suckling attempts of cubs, and more frequently resistthe attempts of non-offspring. Vigilance against milk theftmay therefore influence the distribution of non-offspring nursingacross species. Our detailed study of non-offspring nursingin lions shows that females preferentially nurse their own offspringand that cubs are more surreptitious when attempting to sucklefrom other females. Non-offspring nursing in lions is most commonwhen the costs are lowest. First, non-offspring nursing is morecommon among close kin. Second, females with small litters,and presumably more milk to spare, give a higher proportionof their nursing to non-offspring. Third, females give a higherproportion of their nursing to non-offspring as their own cubsgrow older and need less milk. Cubs reared in créchesdo not appear to gain more milk that cubs raised alone, andfemales do not show any evidence of reciprocity in nursing oneanother's offspring. We suggest that non-offspring nursing inlions occurs as a by-product of the females' communal defenseof their cubs against infanticide.     

Mental competence and long term care: an uncomfortable relationship

Competency is an important concept in medical ethics as well as in law. It refers to the moral principles of self-determination and autonomy, which are of central importance in the ethics of health care. These moral principles also prevail in nursing home care. Societal prejudice concerning nursing home patients suggests that the inhabitants of a nursing home are almost by definition incompetent. We assert that such prejudice rests on certain societal delusions and misinterpretations of incompetency five of which are subsequently analysed. Next we discuss the dominant conception of competency in terms of decisional capacity. This conception is predominantly oriented towards cognitive abilities and underplays affective capacities. We confront this dominant conception with an alternative proposal of competency in terms of 'the capacity to value', which--to our opinion--more properly reflects nursing home practice concerning questions of competency. Finally we address the limitations of any concept of competency or decisional capacity in relation to the moral issues of 'good care' for demented elderly. As an alternative we draw attention to the moral perspective of the 'ethics of care'.     

Persistence of hormonal and metabolic rhythms during fasting in 7- to 9-day-old rabbits entrained by nursing during the night

Rabbit does nurse their litter once every 24 h during the night. We hypothesized that corticosterone, ghrelin, leptin, and metabolites such as glucose, liver glycogen, and free fatty acids could be affected in the pups by the time at which does nurse them. Therefore, we measured these parameters in pups nursed at 02:00 h (nighttime for the doe) to compare them with results from a previous study where does nursed at 10:00 h, during daytime. From postnatal day 7, pups were sacrificed either just before their scheduled time of nursing or at 4, 8, 12, 16, or 20 h after nursing (n = 6 at each time point); additional pups were sacrificed at 4 h intervals between 48 and 72 h after nursing to study the persistence of oscillations during fasting. All pups developed locomotor anticipatory activity to nursing. Corticosterone, ghrelin, and free fatty acids exhibited a rhythm that persisted in fasted pups. Glucose concentrations were lower in fasted than in nursed pups, and glycogen was only detected in nursed subjects. Leptin values were stable and low in nursed subjects but increased significantly in fasted subjects up to 72 h after the expected nursing time. The rhythm of ghrelin persisted during fasting, contrary to our previous findings in pups nursed during daytime (i.e., outside the natural time of nursing for this species). Therefore, in 7-day-old rabbit pups, night nursing is a strong zeitgeber for corticosterone, ghrelin, free fatty acids, and energy metabolites but not for leptin.     

Nursing behavior in lactating rats--the role of the vomeronasal organ

The vomeronasal organ (VNO) of female Wistar-Imamichi rats was removed completely. The females were impregnated and gave birth to young. The question addressed was whether such dams would show deficits in nursing behavior. The data indicated that removal of the VNO severely depressed nursing behavior. We conclude that the VNO contributes to the nursing behavior of lactating rats.     

Nursing dependency in registered nursing homes and long term care geriatric wards in Edinburgh.

There has been growing interest and public investment in registered nursing homes, apparently based on the assumption that these homes are the private equivalent of hospital long term care. We have tested this hypothesis in a survey comparing 400 patients in 18 registered nursing homes with 217 patients in 11 geriatric long term care wards in Edinburgh. The nursing home patients formed a distinct and separate group: 362 (92%) were women, 392 (98%) were single or widowed, and 358 (90%) were self financing, whereas in the geriatric long term care group 148 (68%) were women and 35 (16%) were still married. Patients in nursing homes were also far less dependent than those in geriatric long term care wards (p less than 0.005). This study suggests that there may be large differences between the patients in these two types of institution, particularly with regard to nursing dependency. This finding has important implications in the future planning of long term places for the dependent elderly.     

综合护理模式对慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭患者的影响

目的探讨综合护理模式对无创呼吸机治疗慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭患者的临床疗效。方法选取2013年1月~2016年1月我院收治行无创呼吸机治疗的AECOPD合并Ⅱ型呼吸衰竭患者120例,随机分为对照组和实验组各60例,对照组采用常规护理模式,实验组在常规护理模式的基础上给予综合护理干预,分别采用焦虑自评量表(SAS)、抑郁自评量表(SDS)对AECOPD合并Ⅱ型呼吸衰竭患者护理前后进行评分,分析护理前后两组患者血气分析指标、SAS评分、SDS评分及护理满意度情况。结果护理前,两组患者的动脉血气分析指标(PO2、PCO2、pH)、SAS评分、SDS评分比较,差异无统计学意义(P0.05)。护理后,两组患者动脉血气分析指标(PO2、PCO2、pH)均有改善,实验组的各项指标改善程度显著优于对照组,SAS评分和SDS评分均低于对照组,患者满意度(96.7%)显著高于对照组(78.3%),差异均有统计学意义(均P0.01)。结论综合护理可显著提高无创呼吸机治疗AECOPD合并Ⅱ型呼吸衰竭患者的临床疗效,有效缓解其焦虑及抑郁情绪,提高患者护理满意度。     

De nieuwe redactieadviesraad van het Tijdschrift voor Gerontologie en Geriatrie

It is unknown how often choking occurs in geriatric wards and in nursing homes and what the treatment and outcomes are in regular practice. A questionnaire was sent to Dutch geriatricians (N = 130), nursing home physicians (N = 130), and trainees for these disciplines (N = 215), in order to gain information about the experience, practice and competence of physicians in choking in geriatric and nursing home patients. We also analysed to what extent geriatric and nursing home wards were prepared for accurate handling of choking. The response rate was 30%. More than half of the responders had experienced an episode of food choking at least once in the past five years. The mortality rate in the reported cases was high (30%). The majority of the patients who died of choking had not received the Heimlich-manoeuvre. Physicians who had attended resuscitation training long ago felt as competent to manage a choking episode as physicians that had recently attended resuscitation training. Of all geriatric wards and nursing homes, the majority lacked a guideline on how to handle in acute food choking. Geriatric wards and nursing homes do not seem to be well prepared for acute food choking in several aspects. Despite methodological shortcomings of this study, the results underline the necessity of clarification of the terms used, and development and implementation of guidelines for this important problem.     

优质服务对结肠癌手术患者早期康复治疗的效果及满意度调查

目的:探讨优质护理服务对结肠癌患者术后恢复的临床效果,为提高临床护理质量提供参考。方法:选取2011年4月-2013年9月在我院胃肠外科接受手术治疗并住院观察的患者76例,随机分为优质服务组和常规护理组,每组38例。优质服务组患者接受心理护理、饮食管理及健康教育等优质护理服务,而常规护理组则接受基本的护理方法。比较两组患者术后的临床疗效,并对护理服务的满意度进行问卷调查。结果:优质护理服务组患者术后拔管时间、排气时间、下床活动时间及住院时间均显著优于常规护理组,且并发症的发生率较低,差异具有统计学意义(P0.05)。优质护理服务组患者对心理护理、饮食管理、健康教育、护患沟通、服务态度及专业技能的满意度评分明显高于常规护理组,差异具有统计学意义(P0.05)。结论:优质护理对结肠癌患者术后的早期康复治疗具有良好的效果,充分满足患者的合理需求,提高了护理质量及患者满意度,值得推广采用。     

特需病房护理工作面临的问题及对策

摘要目的：探讨在特需病房护理工作中所面临的相关问题及相应的解决办法。方法：选取2010年11月至2012年11月在我院特需病房接受过“一切以病人为中心”的护理观念和人性化护理方式的1000例相关病症患者的临床资料,并对患者在护理过程中的护理方式的满意度评价等进行回顾性分析。结果：该护理方法得到了患者以及患者家属的一致好评。在我院接受特需病房护理的1000例患者中,有900例（90．00％）患者表示非常愿意接受该种护理方法。有950例（95．00％）患者的家属也十分赞同该护理方法。但仍有部分患者在护理过程中对人性化护理有更高的要求,这对于护理人员是一个重大的挑战;另外,特需病房护理人员的素质以及专业技能也存在不足;护理环境以及护理方法仍存在些许漏洞。结论：本着“一切以病人为中心”的原则,结合患者的相关病症及相应需求采用人性化的护理模式,与患者以及患者家属进行合理的沟通。在进行特需病房患者的护理过程中注重人性化对于患者的康复具有重要的意义。     

Which objectively assessed limitations in health status, activities of daily living, or in psychological and social spheres are decisive for referral to a nursing home or to a home for the aged

Which type of limitation is most decisive for a positive indication for a residential home or a somatic or psycho-geriatric nursing home, and to what extent do data on living situation (independent, adapted or intramural) and the social situation (alone or living together) influence this qualification? To obtain an answer to this question three experiments with an integrated, objective and independent assessment-for-care system were set up in the Netherlands. We studied one of them, in the town of Meppel, started in 1996. The study population consisted of all older people living in and around Meppel who had a positive indication for either a residential home, or a somatic or psycho-geriatric nursing home (N = 206 in 1998). Differences in limitations were computed by means of analysis of variance and the types of limitation and their impact on the type of allocated institutions were computed by logistic regression. The limitations only partially explain the types of indication. Indication for a residential home is based on physical limitations. When these increase they become a contra-indication for a residential home and a somatic nursing home indication is given. Mental limitations primarily yield indications for psycho-geriatric nursing homes. Social limitations have a higher incidence among persons with an indication for a somatic nursing home but cannot fully explain this indication. Persons with a residential home indication were significantly more often from an adapted living situation background. The living situation -alone or together-does not have an impact on the indication. We may not conclude that the assessment took place objectively, for, based on the registration it is impossible to conclude for what criteria a person was indicated for a specific type of institution. The objective of assessment, the allocation and distribution of collectively financed care in residential homes and nursing homes based on verifiable assessment methodology could not be realised.     

Comparison of the "nursing" and other parental behaviors of nulliparous and lactating female rats

Virgin female rats display maternal behaviors after continuous exposure to pups (sensitization) that are in some respects similar to those of postpartum females. We herein provide a detailed comparison of the "nursing" and other parental behaviors of maternally sensitized virgin females and postpartum lactating dams. Ovariectomized and intact virgin females were exposed to pups until displaying maternal behavior. On the females' fourth day of maternal responsiveness, the pups were removed for 3 h and then returned, and subject-litter interactions were observed for 45 min. Behavior of maternal virgins was compared with that of lactating dams observed on day 4 postpartum interacting with either suckling pups or pups unable to suckle due to perioral anesthesia. Ovariectomy had no effect on behavior of virgins. Retrieval and licking of pups were deficient in virgins compared with lactating dams. Suckled dams showed prolonged kyphosis (upright crouched nursing), whereas nonsuckled dams displayed little kyphosis but rather were often in a hunched position over pups. Some aspects of quiescent "nursing" behaviors of virgins were surprisingly similar to those of suckled dams, including the latency to and duration of quiescence. Nonsuckling pup stimulation elicited more kyphosis in virgins than in lactating dams, which was still much less than in suckled dams. Virgins also "nursed" pups in hunched and prone postures. Differences between sensitized and postpartum females in their maternal behaviors likely reflect differences in motivation as well as sensory inputs they receive from pups. In particular, sensory regulation of "nursing" behaviors is influenced by reproductive state because nonsuckling pups elicit different postural responses in sensitized and lactating mothers.     

“情绪管理”在临床护理管理工作中的应用体会

目的：探讨情绪管理在临床护理管理工作中的应用和效果,为临床护理管理的实践提供指导和帮助。方法：选取我院244名护士为研究对象,随机分为常规管理组和情绪管理组,每组各122名护士。常规管理组采取常规的护理管理模式,情绪管理组则对护士进行情绪调节、以适当方式释放压力等情绪管理方法。比较两组研究对象在解决问题、求助、合理化、退避、自责、幻想等方面的评分情况。结果：实施不同的管理措施后,情绪管理组护士在解决问题、求助、合理化、退避、自责、幻想等方面的得分结果明显优于常规管理组护士的得分结果,差异显著有统计学意义（P〈0．05）。结论：情绪管理对临床护理管理工作的实践具有重要意义,可有效调节护理人员的工作情绪,从而提高临床护理的质量。     

Nursing practices and lactation amenorrhoea

The purpose of this study is to test the hypothesis that nursing behavior is an independent underlying factor of importance in duration of amenorrhea. Multivariate analysis is applied to information on frequency and duration of nursing practices, maternal age, and nutritional status assessed by weight for height in a sample of 32 middle-class American women with a wide range of nursing behavior. The mothers were followed for 2 years postpartum, data being collected during 8 home visits by interview and by nursing records kept by the mothers. Amenorrhea lasted 1.3 to 27.1 months in the sample as a whole. Those women who nursed frequently (8/day) during exclusive breastfeeding remained amenorrheic longer than infrequent nursers, introduced supplements later, and did not resume menses as promptly thereafter. They continued an hour or more of night nursing during supplemented nursing. Duration of exclusive nursing and night nursing after supplementation were the major influences on duration of amenorrhea. This strong association favors the hypothesis that the underlying factor is nursing behavior. Mother's age, weight-for-height, and nursing frequency before supplementation showed no significant effect. Those women who introduced supplements late and maintained at least an hour of night nursing had a prolonged period of amenorrhea. The median for this group was 6-10 months longer than that for those who started supplements early and/or reduced subsequent night nursing to less than an hour. The recommendation that women must suckle their babies at least 5 times a day with a total suckling duration of more than 65 minutes per day is not sufficient. The findings reported here suggest that if women nurse exclusively for the 1st half year, maintaining night nursing after introducing supplements is important. If they supplement earlier, then they will lose the contraceptive protection of lactation, irrespective of how they nurse.     

分层管理对大面积烧伤患者早期康复治疗的临床意义

目的：重度烧伤早期易合并多种并发症且病情复杂、死亡率高,严重影响患者的生存周期和生活质量。本研究分析并探讨不同干预措施对重度烧伤患者早期并发症的效果,为临床研究提供可借鉴的方法。方法：选取2011年1月．2012年11月我院收治的重度烧伤患者66例,随机分为常规护理组和分级管理组,每组各33例。常规组采取基本护理模式对患者进行康复期护理,分级管理组根据病情对患者进行分级,分配不同专业技能等级的护理人员进行护理。观察并比较两组患者的临床效果及对护理服务的满意度。结果：分层管理组患者并发症发生率为42.3％,明显低于常规护理组69．7％（P〈0．05）;分层管理组的护理质量、患者依从性及对护理服务的满意度均显著高于常规护理组,差异具有统计学意义（P〈0．05）。结论：对大面积烧伤患者实施分层管理的护理模式具有积极的作用,不仅有效降低并发症发生率,而且能够合理分配护理人员,优化服务质量,提高患者满意度,值得在临床护理实践中推广应用。