What Kind of Dignity?

We tend to think that "dignity" means that someone is sophisticated and well-mannered or that human dignity points to great achievements. There is, though, a special dignity in those who are vulnerable for they provide a focal point for love and generally respond enthusiastically to that love; they draw love out of others.

Electronic cigarettes: a safer alternative or potential poison?

Electronic cigarettes have been marketed as a safer alternative to cigarettes, and their use is expanding exponentially. However, there is a severe lack of scientific data about the ingredients in the liquid used in the device and the health consequences of using electronic cigarettes. As technology has outpaced regulations, the production and sale of electronic cigarettes are, as yet, unregulated and do not fall under the purview of the Food and Drug Administration. This article will review the mechanism of action and what is currently known about the safety of electronic cigarettes. The risk of poisoning for children will also be identified, as well as the implications for home healthcare clinicians.

The advanced practice wound ostomy continence nurse in homecare.

Wound ostomy continence (WOC) programs are essential in any healthcare organization, including home care agencies, to provide comprehensive, high-quality care. Advanced practice nurses (APNs) with assessment, diagnostic, and coordination skills are well suited to manage the complex patients being cared for by home care agencies. A number of research studies have assessed the credibility and value of APNs in the home care setting, caring for complex, frail patients. This article describes the role of the APN, and the role of the WOC specialist nurse, comparing similarities and differences. The advanced practice WOC nurse is now essential in the home care setting to manage the care of complex patients.

Post-prostatectomy incontinence: implications for home health clinicians.

Prostate cancer is the most frequently diagnosed cancer in men in the United States, often requiring a prostatectomy. Incontinence is an almost inevitable consequence of this surgery, either temporary or ongoing. It is important that this quality-of-life issue be considered preoperatively and that patients considering surgery have information about the potential for incontinence. Teaching about noninvasive management of incontinence can begin before surgery and continue in the postoperative period. Home healthcare clinicians and Wound, Ostomy and Continence (WOC) nurses can play a pivotal role in educating patients on the potential sequela of surgery and ways to prevent or treat these conservatively.

Synthesis of the pyoverdin chromophore by a biomimetic oxidative cyclization.

The fluorescent dihydropyrimido[1,2-a]quinoline chromophore of the pyoverdin siderophores has been synthesized by a biomimetic oxidative cyclization using an iodine(III) reagent, followed by elimination and dehydrogenation.

Preliminary results of sacral neuromodulation in 23 children.

PURPOSE: Sacral nerve stimulation with InterStim is approved in the United States for use in adults. Limited data on the effectiveness of sacral nerve stimulation in children are available. We report our experience with patients who underwent InterStim placement for the treatment of severe dysfunctional elimination syndrome, which is defined as a constellation of functional urinary and gastrointestinal symptoms in patients without anatomical anomalies or obvious neurological disease, in whom intensive medical and behavioral therapies have failed to improve symptoms. MATERIALS AND METHODS: A total of 23 patients 6 to 15 years old with presenting symptoms of dysfunctional voiding, enuresis, incontinence, urinary tract infections, bladder pain, urinary retention, urgency, frequency, constipation and/or fecal soiling were followed for a mean of 13.3 months after InterStim placement. RESULTS: Of the 19 patients with urinary incontinence 3 (16%) had complete resolution, 13 (68%) had improvement, 2 (11%) were unchanged and 1 (5%) was worse (sign test, p = 0.002). Among the 16 patients with nocturnal enuresis 2 (13%) had resolution, 9 (56%) improved, 4 (25%) were unchanged and 1 (6%) was worse (sign test, p = 0.0063). Of the 15 patients with urinary retention requiring intervention 9 (60%) had improvement and 1 had worsening symptoms (sign test, p = 0.022), while 2 of 6 patients (33%) on intermittent catheterization were able to stop. One patient had development of new incontinence and enuresis. Bladder pain, urgency, frequency and constipation improved in 67% (8 of 12), 75% (12 of 16), 73% (11 of 15) and 80% (12 of 15) of the patients, respectively. Medications required postoperatively decreased by an average of 3 per patient (p < 0.001). The overall patient satisfaction rate was 64%, while that of the caregiver was 67%. Two leads were explanted from the 23 patients. Complications encountered included 1 seroma, 1 episode of skin sensitivity, 2 device failures and 1 lead revision. CONCLUSIONS: Sacral nerve stimulation in children is an option for carefully selected patients who have failed other therapies. Our results show that sacral nerve stimulation was effective in the majority of patients with the dysfunctional elimination syndrome. However, longer followup is needed.

Are natural and unnatural appetites equally controllable? A response to Jensen's "Is continence enough?".

This response challenges Jensen's analysis in no substantial way. Rather, it explains more fully some of the moral character categories that Aristotle provides. It argues that Aristotle understood there to be two forms of continence: the continence that enables us to control natural appetites and"some form"of continence directed towards unnatural appetites, generally engendered by some pathology or abuse.

Sterilizations reconsidered?

Cowdin and Tuohey argue for a rethinking of Catholic bioethical principles and the Church's moral authority. Citing the Second Vatican Council for support, they argue that if the Church were to respect the proper autonomy of medicine, it would allow sterilizations. In this essay I argue against Cowdin and Tuohey's understanding that the Church has derived its moral laws independent of consultation with medicine and that it treats medicine simply as a source of technical expertise. I also argue that they misunderstand that nature of autonomy as well as the Church's position regarding the type of autonomy they request for medicine. I will especially argue against their understanding of the principles of totality and double effect as "dispensations" from the moral order. I conclude that they have provided no grounds to cause the Church to reconsider its condemnation of all sterilizations.