The challenge of extended care: a Victorian view.
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Biomedical subjects
Publications and source records attributed to M Shaw.
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The research on which this paper is based was designed to investigate nurses' perceptions of relationships in their work. The most important issue to emerge from their descriptions of relationships was that of the nature of authority. From their own accounts; examples of which are included in this paper; it can be seen that views of authority in the hospital setting are both complex and varied. We have identified four different types of authority as seen by nurses: parental, reciprocal, political and arbitrary. Our research suggests that any analysis of authority relationships based purely on structural arrangements would be too simplistic. One possible implication of the findings we present might be that more explicit discussion of the nature of authority in nursing relationships should be encouraged both in training and subsequently.
A major objective of the Report of the committee on senior nursing staff structure (Salmon Report) was to clarify the role of middle-management nurses. This paper analyses the views of 170 nurses in two general, one psychiatric, and one mental subnormality hospital, about nursing officers. A nursing officer was mentioned as the person with most say or influence over them by more nurses of all grades in the two non-general than in the two general hospitals, a difference explained in terms of the greater role of the medical model, and hence the sister consultant relationship in the latter. There were, however, also marked differences between the responses received from staff in the two general and between the two non-general hospitals in the perceived influence of the nursing officer which could not be explained in this way. Analysis of repertory grids suggested more problems in relations with senior nurses overall in the general hospitals. Nurses' descriptions of relationships with superiors suggested that nursing officer superiors were seen more as 'socio-emotional' whilst sisters and charge nurses were seen as 'instrumental' leaders. Asked to choose a person who had annoyed them at work, nurses chose a nursing officer more frequently than other grades of nurse, particularly in the non-general hospitals. Reasons for annoyance with a nursing officer included unwarranted interference, destructive criticism, and lack of specialized knowledge.
Brainstem electric responses were obtained on a group of 70 normal hearing children, aged 5-11 years, matched by age and sex. The recordings were examined for differences in latencies between the sexes at each age. The results showed that males have a longer latency than females, but when broken down into age groups, the latency of children aged 5-7 years was the same, and the latency of children aged 8-11 years differed. The results for latency of wave V of the whole group showed the greatest difference. The reason why such a sex difference should occur in middle childhood is discussed, but no physical cause found.
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A 15-month-old baby girl with extensive skin burns developed within the burned areas multiple lesions with the clinical and histological characteristics of granuloma pyogenicum. These lesions seem to differ from those reported by others as pyogenic granuloma with multiple satellites.
A case is presented of squamous cell carcinoma developed from carcinoma in situ of the nail bed of the first finger in a 79-year-old patient. Stress is laid upon the importance of the differential diagnosis. Surgery is considered the treatment of choice for this uncommon condition.
A case of a picture described by Huriez et al. under the title of scleatrophying and keratodermic genodermatosis of the limbs usually degenerative is presented. In the genealogic study it was observed that seven out of the sixteen members that belonged to this primary family group were affected or probably affected and it is stressed that one of them died from metastasis of spinocellular epithelioma.
Two cases of a condition including palms and soles keratoderma, ectodermal dysplasias and basal cell epitheliomas are reported by the authors, with clinical, genetical and pathological data. The condition is called Keratodermal Genodermatose with hydrocystomas, milium cysts, xanthelasma, dental and nail dysplasias and basal cell epitheliomata (Borda's syndrome).
Osmotic pressures of solutions of hyaluronate (HA) (mol wt 117,000) and mixtures of HA and bovine serum albumin (BSA) in phosphate-buffered saline, pH 7.2 were measured with a membrane osmometer. The data were fit with a virial expansion in integral powers of total nondiffusible solute concentration. Values of number average molecular weight were calculated for HA and the mixtures from the first virial coefficients. The excluded volume of HA in the single nondiffusible solute solution was calculated from the second virial coefficient extracted from the data on the HA solution. The excluded volume of HA with respect to BSA was estimated from the "osmotic parameters" of HA and BSA by an approach developed in 1976 by Shaw. The resulting excluded volume of HA with respect to BSA was compared with those obtained from a lightly cross-linked HA gel and from solutions of HA (mol wt 1.5 x 10(6)) studied in 1964 by Laurent. The development of this cross-linked HA gel and its subsequent calibration are described.
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Osmotic pressure data from aqueous solutions of nondiffusible serum albumin (BSA), chondroitin sulfate (CHS), and dextran T110 (D110), taken singly and in binary combinations, were interpreted in terms of excluded volume. The principal solvent was phosphate-buffered saline, pH 7.2, at 23 degrees C. Osmotic pressures were measured with a membrane osmometer fitted with Amicon PM-10 membranes. Data from each solution were fit by stepwise regression with a three- or four-term polynomial in integral powers of total nondiffusible solute concentration in accordance with the general solution theory of McMillan and Mayer (1945, J. Chem. Phys. 13:276) as extended by Yamakawa (1971, Modern Theory of Polymer Solutions, Harper & Row, New York). The date display a high internal consistency, and the results correlate well with published molecular weights and exclusion data where available. Number average molecular weights calculated from the "first virial coefficients" are: BSA, 67,000 +/- 11%; D110, 76,000 +/- 11%, CHS, 39,000 +/- 6%. Excluded volumes (in cubic centimeters per molecule) calculated from the "second virial coefficients" are: BSA, 0.97 X 10(-18); D110, 3.04 X 10(-18); CHS, 14.3 X 10(-18); BSA-D110, 6.8 X 10(-18); BSA-CHS, 7.8 X 10(-18). Uncertainty is about 30%. An empirical model for interpretation of calculated excluded volumes is proposed. It appears that CHS has the "largest" exclusion effect of the three molecules.
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A description is given of the clinical and histologic characteristics of chronic discoid lupus erythematosus. At the same time the authors describe the results of the cytologic study carried out in keeping with the Papanicolau technique. Although no specifically indicated in the disease under consideration, the cytological method, added to the clinical study, enables a prompt presumptive diagnosis to be arrived at. However, under no circumstances does it exclude a biopsy study.
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In March of 1972, the Southwest Oncology Group initiated a Phase II study, No. 7200, utilizing methyl-CCNU in the treatment of patients with solid tumors and lymphomas. Initially, they received 200 mg/m2 orally as a single dose every 6 weeks. The dose was subsequently reduced in poor-risk patients to 150 mg/m2. There were 69 responses noted in 675 evaluable patients (10%). The highest response rates were noted in patients with Hodgkin's disease (13/31, 35%), malignant gliomas of the brain (8/29, 28%), anaplastic carcinomas of the lung (5/20, 25%), and squamous cell carcinomas of the head and neck (5/29, 17%). Squamous cell tumors appeared to be more responsive than adenocarcinomas (15% vs. 5%, respectively). Hematologic toxicity was cumulative, and was influenced by dose and prior treatment. There appeared to be no cross-resistance in patients previously treated with alkylating agents. Methyl-CCNU is an active antineoplastic agent. Further studies are indicated in order to determine relative effectiveness.