Traumatic asphyxia--fatal accident in an automatic revolving door.

Due to continuing modernisation, the number of automatic doors in routine use, including powered revolving doors, has increased in recent years. Automatic revolving doors are found mostly in department stores, airports, railway stations and hospitals. Although safety arrangements and guidelines concerning the installation of automatic doors are in existence, their disregard in conjunction with obsolete or incorrect installation can lead to fatal accidents. In this report, a 19-month-old boy is described whose right arm was caught between the elements of an automatic revolving door. As a direct result of rescue attempts, the child's body was drawn further into the narrow gap between elements of the door. To get the boy's body out of the 4-cm-wide gap between the fixed outer wall of the revolving door and the revolving inner, back-up batteries had to be disconnected so as to stop the electrical motor powering the door. Cardiopulmonary resuscitation was begun immediately after the rescue but was unsuccessful; the child was declared dead at the hospital he was taken to. The cause of death was a combination of compression-related skull and brain injury together with thoracic compression. This case shows an outstanding example of the preventive aspect as a special task of forensic medicine. Additionally, it serves as a warning for the correct installation and use of automatic revolving doors. Even so, small children should not use these doors on their own, but only with an alert companion, so as to prevent further fatal accidents of this sort.

Tumour cell proliferation (Ki-67) in non-small cell lung cancer: a critical reappraisal of its prognostic role.

BACKGROUND: Uncontrolled proliferation is a hallmark of malignant tumour growth. Its prognostic role in non-small cell lung cancer (NSCLC) has been investigated in numerous studies with controversial results. We aimed to resolve these controversies by assessing the Ki-67 proliferation index (PI) in three large, independent NSCLC cohorts. METHODS: Proliferation index was retrospectively analysed by immunohistochemistry in a cohort of 1065 NSCLC and correlated with clinicopathological data including outcome and therapy. RESULTS were validated in two independent cohorts of 233 squamous cell carcinomas (SQCC) and 184 adenocarcinomas (ADC). RESULTS: Proliferation index (overall mean: 40.7%) differed significantly according to histologic subtypes with SQCC showing a mean PI (52.8%) twice as high as ADC (25.8%). In ADC PI was tightly linked to growth patterns. In SQCC and ADC opposing effects of PI on overall (OS), disease-specific and disease-free survival were evident, in ADC high PI (optimised validated cut-off: 25%) was a stage-independent negative prognosticator (hazard ratio, HR OS: 1.56, P=0.004). This prognostic effect was largely attenuated by adjuvant radio-/chemotherapy. In SQCC high PI (optimised validated cut-off: 50%) was associated with better survival (HR OS: 0.65, P=0.007). CONCLUSIONS: Our data demonstrate that PI is a clinically meaningful biomarker in NSCLC with entity-dependent cut-off values that allow reliable estimation of prognosis and may potentially stratify ADC patients for the need of adjuvant therapy.

Palliative and supportive needs of older adults with heart failure.

BACKGROUND: Chronic heart failure (CHF) affects older people and carries a heavy burden in terms of poor prognosis and quality of life. Palliative and supportive care services are being advocated in the UK to relieve that burden but older people's needs require further understanding to ensure effective service models. AIM: To explore the experiences of older adults with CHF to gain a deeper understanding of their palliative and supportive needs and the value of possible interventions. METHODS: This qualitative study collected data from ten patients with CHF in New York Heart Association Classes II to IV, aged 80-90 years, attending a support programme. Semi-structured interviews were conducted and transcripts were analysed using constant comparative analysis. FINDINGS: The narratives revealed the consequences of living with heart failure in terms of physical symptoms and disability, psychological sequalae, social isolation and existential concerns. The variety of ways in which participants adjusted to and coped with these consequences was revealed in terms of their approach to their illness, and utilizing the resources available to them, including the support programme. Needs were conceptualized in terms of requirements to supplement deficits in coping resources. CONCLUSIONS: Services designed to meet palliative and supportive needs of older people should aim to identify individual coping strategies and resources and highlight deficits in order to target appropriate interventions.

Anti-racist innovation and nurse education.

The focus on institutional racism within the Higher Education (HE) sector in the United Kingdom and nurse education, in particular, has so far been seriously lacking in investigation and scrutiny. The Race Relations (Amendment) Act (RRAA2000) has pushed institutional racism to the forefront of debates in public services, including both education and health services. This paper seeks to operationalise some key aspects of the debate over institutional racism and relates it to both these sectors. Based on empirical work funded by the Higher Education Funding Council for England and Wales (HEFCE) Innovations Project, this paper offers nurse education a framework to not only comply with the legal requirement of 'promoting racial harmony' (RRAA 2000) and the expectations from nursing as enshrined in the Code of Professional Conduct (NMC, 2000. The Code of Professional Conduct: Protecting the Public Through Professional Standards. NMC, London), but goes further to consider some key questions for anti-racist interventions.

Culture, values and racism: application to nursing.

The prevention and management of cancer have been identified as health priorities in most countries. In order to achieve this, many oncology nurses need to face the additional challenge of caring for patients from different cultures. This article progresses beyond previous literature, which generally adopts a solely multicultural approach, and explores the concepts of culture, values and racism with inter-related concepts such as self-awareness, cultural encounter, skills and cultural knowledge and their relationship to cancer nursing practice. The case is then argued for enhancing patient care through the application of these concepts to nursing practice.

The way forward for transcultural nursing.

This paper suggests that the incorporation of a sociological perspective into transcultural nursing would enhance the present anthropological approach. The discussion considers the concept of ethnicity, which encompasses a wider perspective than that of culture alone, and is inclusive of both dominant and subordinate human social groupings. Anthropological understanding explores the beliefs and values of a particular community whereas sociological understanding reflects the position of that community within society and their associated experiences. The case is made by discussion of transcultural nursing, its roots in anthropology and the contribution that a sociological perspective can provide. Concepts of assimilation and acculturation are discussed, as is the adaptive nature of culture. A need for application of theoretical understanding to professional practice is demonstrated and a requirement for development of cultural competence is highlighted. The implications for curriculum development are discussed. This paper adopts a perspective that considers transcultural health care from the focal point of the user of health care service rather than the more usual dominant provider viewpoint.

Caring as experienced by minority ethnic patients.

International nursing literature associates 'nursing' as inextricably linked with 'caring'. However, as Leininger (1995) suggests, although caring is a universal phenomenon, its manifestation is very much dependent on culture. For caring to be effectively received, the conceptualization of caring at both individual and community level needs to be realized in practice. This paper focuses on a qualitative research study on a sample of 20 male and 18 female respondents from Pakistani communities in Bradford, West Yorkshire. UK, using face-to-face in-depth semi-structured interviews. The significance of ethno-linguistics, or the relationship between language and culture, has been addressed by a number of anthropologists. People associate what is meaningful to them as defined by their culture. By eliciting various linguistic terms used for 'care' terms and applied to health and 'well-being', the cultural meanings within an 'emic' perspective, as well as variability of the use of the care terms in different contexts, could be discovered. Hence the first stage of this study focused on the respondents' understanding and perceptions of caring. Care themes and patterns emerged to form seven themes. The same sample was later facilitated in exploring their recent experiences of 'care' as delivered by nurses in hospital. The findings suggest that a lack of congruence between patients' expectations and experiences of caring received from nurses did exist. The paper concludes by suggesting possible strategies to address the identified deficits, for example a cultural knowledge base and enhancing assessment skills in nurses.

Perceptions and experiences with nursing care: a study of Pakistani (Urdu) communities in the United Kingdom.

The population of the United Kingdom reflects rich cultural diversity. Hence, nursing must respond to the challenges of meeting the needs of different ethnic groups and fulfilL the requirements of the Code of Professional Conduct. This article presents the findings of a study using grounded theory to explore the lived experience of Pakistani (Urdu-speaking) communities that received nursing care in a hospital setting in the United Kingdom. The study reflects national initiatives toward "consumer led" health care delivery. The findings illustrate a lack of congruence between the group's expectations and their experiences. Nurses were perceived to have a poor understanding of ethnic needs, portraying ethnocentric attitudes and behaviour. The participants attributed the lack of congruence mainly to the presence of racism in British health care systems. The author suggests possible changes at the strategic, managerial, and educational levels of health care delivery.

Nutrition and the hospitalized patient: implications for nurses.

This article, in response to the recent report by the Association of Community Health Councils (CHCs) England and Wales 'Hungry in Hospital', explores nutrition in the hospitalized patient. Nutrition is instrumental to health and perhaps, more importantly, III health. CHCs have a statutory responsibility to monitor the delivery of health care on behalf of the general public. It is suggested that the issue of nutrition in hospitals is of concern and that there are numerous factors which contribute to this. However, this aspect of patient care is not identified as the specific responsibility of hospital staff. Nurses should play a pivotal role in preventing malnutrition in hospital but, in most cases, they do not. The article concludes with a set of recommendations to improve the nutritional status of patients and stresses the importance of health professionals listening to patients' views.

The future of ethnic minority nurses in the NHS.

The subject of discrimination especially with regard to the ethnic minority workforce in the NHS was the focus of a specially commissioned Task Force funded by the Department of Health and the King's Fund in 1991 followed by the PSI Report published last year to help health authorities to address racial discrimination. The first of these reports, for example, states quite clearly that 'racial inequalities between managers and staff in the service are glaring... black and ethnic minority staff will not join or remain in a service which they do not see to be providing good and fair employment prospects. This perhaps influenced the Secretary of State for Health, in 1993, to set up a programme of action which included a number of targets to be achieved. Goal seven, for example, specifically addresses nursing by stating that NHS authorities and trusts are to set local objectives to achieve representation of ethnic minority nurses at ward manager level within 5 years. This programme seems to focus on the issue of equal opportunities but although in does make reference to 'racial harassment' it does not include 'racism'. Hence the purpose of this paper is to address the issues of equal opportunities and anti-racism from a theoretical and practice base. It also intends to offer alternatives for the way forward by focusing on local initiatives.

Measuring the quality and quantity of information-giving to in-patients.

Community health councils (CHCs) were set up in the United Kingdom in 1974 as part of the reorganization of health care delivery. They were intended to have a 'watch dog' function, monitoring the quality of health care in their own district and acting as a link between the providers of care and the public, who are the health care consumers. This paper describes a year-long survey undertaken by one CHC to monitor the quality of information-giving in acute hospital care. A large sample of 1500 discharged patients were sent questionnaires relating to satisfaction with information-giving, and a good response rate was achieved. Results indicate a generally high level of satisfaction, particularly relating to information about surgical and other technical procedures. Information was less satisfactory about non-technical aspects of care and about administrative procedures.