[Rash invocation of the Ingelfinger rule hinders scientific communication]. / Ondoordacht beroep op de regel van Ingelfinger belemmert wetenschappelijke communicatie.

The results of a Dutch trial on the use of probiotics in patients with severe pancreatitis were withheld from the public and the scientific community by The Lancet for several weeks until the time of publication. The public need for information was strong, but the researchers were not allowed to provide information and the journal did not make the article available immediately on its website for everyone to appraise the study results. The Ingelfinger rule was wrongly applied in this instance.

[Premature and over-simplified publication of mortality differences between hospitals in the media]. / Voortijdige en ongenuanceerde publicatie over sterfteverschillen tussen ziekenhuizen in de media.

Prismant, the major institute for health-care research in the Netherlands, presented differences in mortality data from hospitals in the Netherlands. The data from the Prismant study were front-page news. However, the Prismant study was only published on their own website, and contained only raw data. The author did not consider relevant issues, e.g., the differences in case mix in the various hospitals and demographic factors. The public debate on quality of health care would benefit greatly if research institutes published only data that were peer reviewed and if journalists checked with experts before they published an article on such a specialist medical issue.

[The biased information given to women about population screening for breast cancer makes a well considered informed choice to participate unlikely]. / Eenzijdige voorlichting voor vrouwen over het bevolkingsonderzoek naar borstkanker maakt geïnformeerde en weloverwogen keuze onwaarschijnlijk.

The 'Wet op de Geneeskundige Behandelingsovereenkomst' (Act on Agreement Concerning Medical Treatment) requires that patients are clearly informed about 'the risks and consequences that can be expected from an intended treatment or investigation'. The information received by women aged 50-74 years when invited for a biannual investigation for breast cancer does not satisfy the requirements: the available knowledge is presented too favourably and it is therefore not possible to make a well-considered informed choice to participate. For example, in the group to be screened, 4000 cases of breast cancer are diagnosed each year, yet in the information leaflet a figure of 9000 is stated, the number for all age categories. Furthermore, these 9000 cases include 1500 cases detected only as a result of screening. In the information leaflet no mention is made of the fact that 1 in 5 women will die despite screening and the risk of interval carcinomas is not examined; 40% of malignant mammary tumours are still found outside of the screening programme.

[Nursing science in oncologic nursing]. / Pflegewissenschaft in der Krebskrankenpflege.

The nursing care of cancer patients has increased in complexity over the past 20 years. Cancer nurses are offering highly specialized care that is frequently delivered in teamwork in hospitals as well as in the community. Cancer nursing uses the development of nursing science and research. Nurses could not be accountable for their practice if this expert knowledge was not made accessible to them. This article focuses on nursing science as a new development in clinical nursing practice in Germany, it identifies why cancer nursing is so demanding on part of the patients, their families (significant others) and professional nurses. Research studies are discussed to demonstrate how scientific knowledge can support the nursing expert in the development of cancer nursing care, a well developed domain of nursing science.

Curriculum innovation for gerontological nursing in Canada: a health for all systems based approach.

This paper presents an educational model that follows the General Systems approach and illustrates the advancement of gerontological nursing education in Canada. The model's primary focus is placed on baccalaureate education, the mandate of the nursing discipline group. The paper also touches briefly on Masters and Doctoral education. Implications for use of this model in nursing education are then linked to nursing care of the elderly.

Nursing in transition: an analysis of the state of the art in relation to the conditions of practice and society's expectations.

The discipline of nursing is in a process of rapid transition. In this paper, the developments are discussed that have affected nursing in its advancement to a full-grown profession. Nursing and medicine are the products of Cartesian thinking that has fragmented our perspectives on man and his living world. The consequences of this scientific viewpoint are reflected in all aspects of life. Attention is paid to advances in nursing practice and education, the development of nursing research and the emergence of a nursing science. These aspects are discussed in the context of professionalization and the position of nursing in the health care system and in society. The study findings of the Styles Report Project on the Regulation of Nursing (1985) serve as a framework of analysis. Links are made between the recommendations given in this report and the development of primary health care, the new tomorrow of a modern discipline.

Being old does not always mean being sick: perspectives on conditions of health as perceived by British and American elderly.

The process of ageing is frequently described in terms of decline and deterioration. Limited attention is paid to the gains in later life. Studies among self-defined healthy American-born elderly and ill-healthy British-born older persons, indicated that the perception of health was determined by many dimensions other than the absence of disease and illness. The older the person, the more emphasis was placed on health as a state of mind, even in situations of a gradually failing body. It was evident that these respondents, among them the ill-healthy elderly challenged the current beliefs of health and illness as perceived by health providers.

Improvement of quality of nursing care: a goal to challenge in the eighties.

Some general thoughts on the use of the quality concept as a means to structure critical reflection on patient-client care and health services is discussed. The continuous request for more health care facilities and quality of services occupies not only the minds of the health workers, but also of the consumer who is becoming more aware of his rights and privileges. Health care should not be identified with curative care only. It involves prevention and promotion of people's status of health as well. Nurses have an important contribution to make in the promotion of health. The paper deals also with the evaluation of quality of care. If nurses become involved in the evaluation of nursing care they should have a clear concept of what nursing is. The nursing profession has a responsibility to develop standards and criteria for the evaluation of nurses' contribution in patient care. An example of a well-tested monitoring quality instrument is given. In the last part of the paper some practical suggestions for managers who are responsible for the quality care improvement in their own health care institutions are given.

Perspectives and problems on quality of nursing care: an overview of contributions from North America and recent developments in Europe.

The author focuses on the quality of nursing care and discusses the major problems inherent in control of the quality of nursing care. The concept of quality is analysed and the approaches of health care professionals to the concept are discussed. An overview of the American contribution to the relevant research is presented together with ongoing deveopments in Europe.