Urological and gynaecological surgery in the elderly

Urological and gynaecological procedures are commonly performed in the elderly. Usually, urinary tract endoscopy and surgery should only be performed if the urine is made sterile. Infection of the urinary tract is always a threat, specifically in obstructive diseases and in patients with permanent bladder catheters. Simple measures may prevent most of the transurethral resection of the prostate (TURP) syndrome cases. The elderly patient taking anti-platelet or anticoagulant drugs and presented for endoscopic urological surgery are at special risk because these may lead to life-threatening haemorrhage, and stopping these drugs can lead to life-threatening cardiovascular and embolic phenomenon. For most of these procedures, the choice between general and regional (mainly spinal) anaesthesia must be influenced by the specific medical condition of the patient, his/her wishes, and the planned procedure.

The Significance of Gender in Phenomenological Nursing Research

The aim of this paper is to discuss in the light of phenomenological philosophy, whether it can be argued that men and women have different lifeworlds and how this may legitimize the segregation of men and women in empirical nursing research. We analyzed peer-reviewed papers from 2003-2012 and scrutinized the arguments used for dividing men and women into separate groups in empirical nursing studies based on phenomenology. We identified 24 studies using gender segregation and posed the following questions: 1. What is the investigated phenomenon as explicated by the authors? 2. What arguments do the authors use when dividing participants into gender specific groups? The analysis showed that a variety of phenomena were investigated that were all related to a specific medical condition. None appeared to be gender-specific, though the authors argued for a sole focus on either women or men. The most common argument for segregating men and women were reference to earlier studies. A few studies had references to methodology and/or philosophy as argument for a segregation of men and women. Arguments for gender segregation in empirical nursing studies based on a phenomenological approach tend to build on the conviction that experiences of health related phenomena are gendered. However, it seems to be difficult to identify conclusive arguments for this division within phenomenological philosophy. Therefore we recommend that segregation should be used with caution. Otherwise other research approaches may be more suitable.

Working with Standardized Patients: A Primer

This paper presents concepts and strategies for using standardized patients (SP) in teaching and evaluation of nursing students. SP encounters are an alternative to clinical experiences and a standardized criterion for student performance evaluation. Careful development of encounters, selection and training of SPs, support and debriefing of all participants are essential to a positive SP encounter. SP encounters should be developed based on objectives and competency criteria and relate to actual events. Encounter scripts incorporating any "traditional" language often associated with a specific medical condition are beneficial to standardizing the process. SP preparation involves providing background on medical conditions, feedback when practicing the role-play, and validation of performance consistency. Orientation of students and faculty to the SP experience ensures that participants stay in role. SPs can also be utilized to complete written evaluation tools and provide verbal feedback to students. All participants should evaluate the encounter process for future improvement.

Think Stop before Going 'Off-Label'

Only after careful and extensive review of all available safety and efficacy data derived from preclinical and clinical trials will a regulatory body approve the licensing of a drug for a specific medical condition ('indication'). Experience with thalidomide, fialuridine and troglitazone, to name a few, reveal that despite these efforts, the process is not infallible. What then can we expect when a drug is used for a medical condition in which no such review process has been undertaken ('offlabel' use of the drug)?

Dealing with Chronic Illness in Childhood

Most pediatricians treat Children who are well or who, at worst, have an acute but Curable illness. Children with chronic illnesses don't fit. Our appointment schedules aren't structured to deal with them and they clash with our "health and normality" mind-set. Chronic diseases, incurable and possibly lethal, conflict with our need to heal, and the obvious pain and dismay of the parents is painful and dismaying to us as well. Practice might be more comfortable without them. Yet no group of patients can benefit more from the understanding of healthy development and knowledge of management of disease that are combined in today's pediatrician. The child with chronic illness is not just a case of a specific medical condition; he or she is also a child, with all of the development, psychosocial, and physical needs that are characteristic of children in general. This discussion will focus on the ways in which a child and his or her family may be affected by chronic disease, and what the responses of each to chronic disease are likely to be. The physician's responses will also be examined, as well as how the physician caring for a child with chronic illness can facilitate the adjustments and adaptations that will allow the child and his or her family to attain their greatest potential for a normal and fulfilling life.