Permanent Care Research Articles

Towards a Swedish repository for spent fuel

Nuclear power is producing electricity for the benefit of society but is also leaving radioactive residues behind. It is our responsibility to handle these residues in a safe and proper manner. The development of a system for handling spent fuel from nuclear power plants has proceeded in steps. The same is true for the actual construction of facilities and will continue to be the case for the final repository for spent fuel and other types of long-lived wastes. The primary objective in constructing the repository will be to isolate and contain the radioactive waste. In case the isolation fails for some reason the multibarrier system should retain and retard the radionuclides that might come into contact with the groundwater. A repository is now planned to be built in two steps where the first step will include deposition of about 400 canisters with spent fuel. This first step should be finished in about 20 years from now and be followed by an extensive evaluation of the results from not only this particular step but also from the development of alternative routes before deciding on how to proceed. A special facility to encapsulate the spent fuel is also required. Such an encapsulation plant is proposed to be constructed as an extension of the existing interim storage CLAB. Finding a site for the repository is a critical issue in the implementation of any repository. The siting process started a few years ago and made some progress but is by no means yet completed. It will go on at least into the early part of the next decade. When the present nuclear power plants begin to be due for retirement there should also be some facilities in place to take permanent care of the long-lived radioactive residues. Progress in siting will be a prerequisite for success in our responsibility to make progress towards a safe permanent solution of the waste issue.

A Special Dementia Unit (Hostel): Review of the First Eleven Years Operation

The aim of this review was to study the outcome of residents in a Special Dementia Unit (SDU) in the form of a hostel for 36 people during the first eleven years of operation. The participants were one hundred and seventy one residents admitted for permanent care during that period. The median length of stay in the hostel was 2.3 years. By the end of the period 113 residents (83 percent of those who had completed their time in the hostel) had been transferred to nursing homes. The average survival time after admission to the hostel was 4.7 years. In order to accommodate those who had been transferred from the SDU about the same number of hostel places were needed in nursing homes. We concluded that admission to an SDU hostel for selected people with dementia is more appropriate and less costly than direct admission to a nursing home, notwithstanding the need for subsequent nursing care for the majority. Adequate subsidy should be provided by the Commonwealth Government so that voluntary associations are encouraged to set up SDU hostels for this purpose. Nursing homes should be run in association with these hostels.

An Angelman syndrome clinic: report on 24 patients.

Angelman syndrome (AS) is a rare congenital neurodevelopmental disorder with complex genetic aetiology. Diagnosis may be difficult and there is severe life-long disability. An AS clinic was commenced in Sydney, Australia, in 1993 with the aim of gathering information about the natural history of AS, management issues and parental concerns. Patients were referred from metropolitan Sydney, rural New South Wales and interstate. A questionnaire, history, physical examination and diagnostic tests were undertaken. In the first year, 24 patients with AS were assessed. There were 11 males and 13 females, whose ages ranged from 3 to 30 years. The mean age of diagnosis was 12.8 years. The diagnosis was made by neurologists in four cases, by clinical geneticists in three cases, by paediatricians in two cases and 15 cases were diagnosed at the AS clinic. A clear history of epilepsy was obtained in 19 (79%) and in 15 of these patients the age of onset was during the first 4 years of life. An EEG had been performed in 21 patients, and in two the EEG was reported as normal. Fifteen of the patients (62.5%) could walk independently and in this cohort there was a significant sex difference in walking: 10/11 males compared to 5/13 females (P > 0.01). Five patients (21%) were in full-time permanent care. Genetic testing with appropriate DNA probes from chromosome 15 (q11-13), complete in 20 families, showed deletion in 12 patients (60%),uniparental disomy in 1(5%) and no detectable abnormality in 7 (35%). The diagnosis of AS should be considered in any patient with severe developmental disability particularly if there is a movement disorder and lack of speech. The control of epilepsy is a major management problem. Further research is needed to establish the frequency and type of seizures, the response to anticonvulsants and to determine if improvement can be expected with age. The mobility of patients should be assessed regularly, to determine the most appropriate options for intervention.

Dependency and community care in presenile Alzheimer's disease.

In a study of patients with presenile dementia of Alzheimer type (PDAT), we aimed to investigate functional dependency in relation to the time since diagnosis and place of residence. Use of community and support services and the time between diagnosis and entry to permanent residential care were also studied. Interviews with 109 cases of PDAT (diagnosed before age 65) and their carers. The need for assistance in activities of daily living (ADL) was progressive with time from diagnosis. Five years after diagnosis, 57% of patients remained at home, 20% of whom required some assistance in each of six areas of ADL. The need for assistance in each ADL category was significantly greater for cases in permanent residential care than for those at home. There were no significant differences between the Mini-Mental State Examination (MMSE) scores of patients at home and those of patients in permanent care. Incontinence and the relationship of the carer to the patient were the strongest predictors of permanent residential care. Respite care had been offered in 63% of cases; 71% of these offers had been accepted. Patients with PDAT who have a living relative are cared for at home for a considerable period of time despite severe cognitive impairment and loss of independence measured by ADL. The reports of carers suggest there is scope for improvement in supportive services to meet this community need.

Community care. Temporary address, permanent care.

Community care. Temporary address, permanent care.

Hague Convention of 29 May 1993 on Protection of Children and Cooperation in Respect of Intercountry Adoption

The Hague Conference had previously drafted a Convention on Jurisdiction, Applicable Law and Recognition of Decrees Relating to Adoption at its Tenth Session in 1964, but this Convention was not signed until 15 November 1965. It had not been a success mainly because it was based on the European situation of the 1960s: international adoptions spanning relatively short geographical distances and between countries with more or less comparable socio-economic, cultural and legal systems. When this Convention finally entered into force, in 1978, the social reality underlying intercountry adoption of children had already changed dramatically, as a result of increased placement of children from the Third World with families in industrialized countries. It is estimated that since the early 1980s, approximately 20,000 children have migrated annually for purposes of adoption to Western Europe, North America, Israel and Australia from rising numbers of developing countries, and more recently from Eastern Europe, as well. While this has opened up new avenues for permanent child care for the benefit of children, it has also increased uncertainty and delay in the proceedings, as well as the risks of ill-prepared adoptions and of abuse.

An ‘Ordinary’ Life for People with Learning Disability and Severe Sensory Impairment?

While life in small, ordinary type homes in the community is seen as desirable for the majority of people with learning disability, it may not serve the special needs of people with more complex impairment, such as those with additional severe sensory impairment. The case is made for retention and development of specialised residential provision for this group of people and for specialised service centres. This is on the condition that, firstly, such services see their function as the provision of intensive specialist help which equips people to make use of community services, as well as that of providing more permanent care for those whose severity of need requires it. Secondly, that they act as resource centres of ideas and practice which provide training for staff who work in a wide variety of situations with people with sensory impairment. Parallels are drawn between meeting children's special educational needs and the special needs of adults with learning disability. A flexible continuum of provision is seen as desirable to meet the diversity of need.

Final Report on the Safety Assessment of Sodium Bromate and Potassium Bromate

Sodium Bromate and Potassium Bromate are inorganic salts that act as oxidizing agents. Whereas there are currently no reported uses of Potassium Bromate, Sodium Bromate is used in permanent waves and related hair care products. No current data were available to indicate the concentrations at which this ingredient is used. Bromate was poorly absorbed, if at all, through the skin in several in vivo and in vitro studies. The oral median lethal dose of Potassium Bromate in rats was 200–400 mg/kg. A guinea pig sensitization study suggested at most a mild sensitizing potential for Sodium Bromate. Potassium Bromate was found to be mutagenic in a mammalian cell assay and in one of three bacterial strains tested. Potassium Bromate produced a dose-dependent increase in renal neoplasms in an oral feeding study in rats. A two-stage, 26-week carcinogenesis study in rats suggested that Potassium Bromate was both a tumor promoter and a tumor initiator. Renal cell tumors, of a type not seen in controls, were seen in male golden hamsters administered Potassium Bromate in drinking water. Potassium Bromate applied to the skin of mice or injected subcutaneously into newborn mice or rats, however, was noncarci-nogenic. The high reactivity/poor skin absorption of these oxidizing agents was considered a likely explanation for the difference between the results seen with different routes of exposure. Based on the test concentrations reported, it is concluded that Sodium Bromate and Potassium Bromate are safe in cosmetic permanent wave formulations at concentrations not to exceed 10.17%, measured as Sodium Bromate.

Principles of soft tissues repair at the foot and ankle

Soft tissue defects at the foot and ankle are a common and difficult problem because of the different features of juxtaposed tissues. One should distinguish several areas which require specific indications of coverage. These are the dorsum of the foot, the perimalleolar zone, the weight bearing area, the posterior aspect of the heel and the distal part of the achilleus tendon. The armamentarium of procedures comprises fascio-cutaneous and muscle flaps. As far as possible, we use island predicled flaps which are quicker, easier and more reliable than free revascularized flaps. Numerous loco regional island flaps are available as the dorsalis pedis, the latero supramalleolar, the medial plantar, the medialis pedis, the extensor digitorum brevis, the abductor hallucis and the peroneus brevis flaps. The coverage of the heel remains an unsolved problem. It seems preferable to employ fascio-cutaneous flaps to restore weight bearing areas. The cross leg flap is a good alternative to a loco regional flap or a free flap to repair the heel entirely. Complications and sequelae are usually due to shear stresses and require a permanent care. The restored sensibility does not seem to prevent the recurrent ulcerations which are provoked by mechanical factors.

French-language Health Care Services in Ontario

The French Language Services Act, 1986 has had an impact on the provision of health care services in Ontario. The Ontario Ministry of Health's implementation of French-language services is examined in light of three criteria: permanency, quality and accessibility of services. Issues are raised around the measurement and creation of demand for services; the health human resources shortage; health care priorities; what constitutes a high quality service; and the influence of the political and economic climates. The continuing challenge is to provide permanent and accessible high quality French-language health care services within an ailing health care system.

Farmcarts to Fords: A History of the Military Ambulance, 1790-1925.

This book is the first history of the techniques, systems, and technologies used to evacuate wounded from the battlefield. Historically, the word ambulance described those facilities that provided temporary assistance to the wounded, thus distinguishing them from stationary hospitals where military personnel received more permanent care. Americans and British, however, applied the term to the two-to four-wheeled transport conveyances that carried wounded from the battlefield to the war hospitals. With the aid of fifty-four illustrations, John S. Haller traces the histories of both meanings of the word from the Napoleonic era through the Great War and its aftermath. He concentrates on the development of British and American evacuation procedures and technology with a focus on hand conveyances and wheeled vehicles. His intent is not to cover all aspects of medical evacuation but to accurately recount the common medical evacuation problems, incongruities, and controversies that existed for warring nations.

Racines des politiques pour la ville des années cinquante aux années soixante-dix

Roots of Urban Policies Thirty years of French urban policies show a constant renewal of objectives and a permanent care, but a continuity of methodological answers in matters of budgets, human resources and institutions. The housing crisis, a main characteristic of post-war period, has been solved by putting in place new legal instruments. The following period has been marked by the creation of the ministry of equipment, which was complemented by a new organisation of field services, an important mobilisation of field officials and the 1969 Land Orientation Act, which founded the urban code. Eventually, during the preparation of the VIth plan, the commission in charge of "global urban policy" has considered the matter as a phenomenon with a much wider range than the housing issue and thus laid down the problematique of present day urban policy.

Six-year follow-up of multiple joint replacement surgery to the lower limbs.

We report a 6-yr follow-up study of an original population of 50 patients who had three or more major joints (hips and knees) replaced. Thirty-one of 32 surviving patients were still ambulant in the community, and all patients described significant pain relief. No RA patient was requiring permanent inpatient or residential care and the family remained the main social support. They remained a very disabled group with a median Health Assessment Questionnaire score of 2.75. Ten required revision surgery: three hips and seven knees; four patients required their fourth lower limb joint (hip/knee) replaced and seven patients required surgery to the upper limbs and nine feet during the follow-up period. The median 10-yr survival of hip and knee arthroplasties in multiple joint replacement (MJR) patients with RA was 90.5 and 78.6% respectively. There was an increased incidence of cervical myelopathy in MJR patients 16.9%. The mortality rate was higher than expected (standardized mortality ratio = 590) but the actual surgery was not implicated. MJR therefore appears to be a worthwhile policy, even at long-term follow-up.

The treatment of burn patients. What are the prospects for the northern area of Portugal?

The AA studied the distribution of age, sex, aetiology, and destiny of the 173 in-patients at the S. João Hospital (Central hospital that has no Burn Unit). In what concerns age, 38.1% are children less than 10 years old; the male/female ratio was 1.7:1. The fire and scalds are the most important aetiology. These findings are similar to those found in other countries (except in the Arabian Countries). Of these 99 burn patients have been treated in S. João Hospital, 71 patients were sent to the Burn Unit of Prelada Hospital and 3 to the Burn Unit of Coimbra University Hospital. These findings were compared to a Burn Unit of a Spanish Hospital (Alicante) which has 18 beds for adults and children, normally interning 132 patients per year. As the WHO suggest one special bed per 30,000 persons, we should be expected to have at least 110 beds for burn patients (we only have 9 beds at Prelada Hospital), the AA suggest the establishment of a Burn Unit at S. João Hospital, also due to the fact that is the only hospital that has a permanent emergency care for Plastic Surgery.

Multidisciplinary management from day one: the Neuro-care approach to motor neurone disease.

The Neuro-care approach offers a holistic, multidisciplinary, patient-centred, continuous strategy of care to unselected groups of neurological patients and their families including those with motor neurone disease (MND). The strategy for MND patients is an adapted version of one piloted on patients with Parkinson's disease. Between April 1990 and September 1992 12 MND patients were diagnosed, of whom five have died. The main features of the care strategy and the guidelines for giving the diagnosis are described. The characteristics of the patient group are identified and the high level of team activity vis-a-vis other patient groups is noted. The maintenance of patients in the community and the lack of resort to permanent institutional care are also recorded. Ethical issues arising during the project are discussed and the problems of measuring outcomes of care are acknowledged. General conclusions for MND management are drawn.

Survival prognosis in geriatric patients admitted to permanent institutional care.

The influence of clinical and laboratory findings on the two-year survival prognosis was investigated in 558 geriatric patients admitted to permanent institutional care. The patients surviving for two years (52%) were somewhat younger (79 vs 82 years, p less than 0.01), and on admission had significantly higher diastolic blood pressure (p less than 0.001), serum thyroxin (p less than 0.05), serum albumin (p less than 0.01) and blood haemoglobin (p less than 0.05), but lower treatment score (p less than 0.001), serum creatinine (p less than 0.001), and fasting plasma glucose (p less than 0.05). Decreased survival prognosis was also found in patients with abnormal serum sodium, chloride, and potassium (p less than 0.05 or less). However, an excess mortality of patients with abnormal laboratory data occurred within the first month after admission. Stepwise logistic regression analysis disclosed that the three-month survival prognosis was significantly impaired by low blood pressure (less than 110/70 mmHg), high treatment score (greater than 22), elevated serum creatinine (greater than 150 mumol/L), use of digitalis and atrial fibrillation. Poor two-year survival was further associated with the use of diuretics, and diabetes mellitus. The risk for death was lowest in patients with elevated blood pressure (greater than 160/95 mmHg). These data verify the significance of the clinically common diseases and indicators of homeostasis in the assessment of geriatric hospital patients, and demonstrate the nature of "terminal decline" in geriatric practice.

Note: Discounting a Partially Tax-Sheltered Income Stream

Abstract No abstract available.

Strengthening Hospital Nursing

The authors present an institution-wide approach to restructuring nursing practice. Unit action committees, restorative care paths, permanent care teams, and a physician/nurse liaison committee were four major strategies implemented. Nursing's major goals from this project were to increase autonomy, enhance collaborative practice, and reward with salary commensurate with management responsibility.

Problems in Teaching for Advanced Manufacturing and Design Techniques in the Field of Mechanical Engineering

SUMMARY Teaching, and especially higher engineering education, has to accept right now the challenge of new technologies. Consequently, schools are confronted with many questions which should be answered rapidly. What should its objectives be in this wide and fast-moving field? What are the means to reach them? How will the teachers acquire a training in sophisticated engineering? Which costly equipment will be needed and how to afford it? The objectives of our teaching are first to provide a high–quality tuition, open to the requirements of modern industry and mostly in step with it, if not ahead of it. Secondly, our future engineers should be familiar with new technologies without being too much involved in specialised topics. Basic principles and their universality should be stressed instead. Furthermore our ultimate purpose is to train leaders, for the benefit of either our own teachers or engineers kaving to take the lead in their firms as far as new technologies are concerned. After defining the objectives, we still have to determine the necessary means in order to satisfy the hardware and software requirements by taking the available budgets into account. Is it better to invest in a hardware solution specific to a software system or to move towards a broader scope of softwares and studies? Concerning studies, the specificity of some CAD– CIM softwares sets the trainer the double problem of software learning duration and its tools. Concurrently, the next question is how to approach the tuition of our students to fulfill the objectives. In such a context, a School– Industry synergy is absolutely essential if our wish is to ensure this change in education. However, all this may take shape provided the necessary tools are available. In this field, new technologies force schools to face very heavy and sometimes unbearable expenses. One school alone cannot afford the whole required equipment to implement its aims. The realisation of investments which would be concerted between schools of the same region can bring a solution to this problem. The creation of technology centres clears the way to more collaboration between teaching sectors concerning new technologies. Moreover it should meet the permanent care of working together with industry so that both sides put their human and scientific potentialities in common. By making moves in this way, tomorrow's education can face today's tremendous challenge. A list of the main abbreviations used is given at the end of the paper.

A systems approach to child abuse: Management and treatment issues

In the systems approach certain patterns of family interaction are seen as fitting with physical abuse to wards children in the family. If these interactions are blocked or changed using specific family therapy interventions, the risk of further abuse will be significantly reduced. Identifying typical patterns of interaction that fit with abuse is a useful first step in planning the management of physically abusing families. A full systemic formulation of the presenting problem will address numerous systems and sub-systems simultaneously, notably the family-professional system, the family within the extended family/friendship system, and the nuclear family. Interventions may have to be directed on a variety of these levels. The Marlborough Family Service has assessed and treated over 100 child-abusing families. A family day unit is used as the setting, and a multifamily group as the principle medium of treatment. Within the day unit real life stress situations are recreated around everyday issues, enabling families to find new and nonviolent solutions to the problems of daily life. In the cases seen, approximately one-third have resulted in a recommendation of permanent alternative family care for the children. In those families reunited, the re-injury rate has been found to be extremely low.