We conducted an on-line search and manual searches for 1966 through 1992 to determine the incidence, diagnosis, risk factors, and treatment of postoperative delirium. Of the 374 citations found, 277 articles were excluded after criteria of relevance were applied. After methodologic criteria for validity were applied to the remaining 80 articles, 26 studies were retained for the final information synthesis. The incidence of postoperative delirium was 36.8% (range, 0% to 73.5%). Primary reasons for this disparity were insufficient sample size and inconsistent application of numerous diagnostic tools. One study provided statistically significant data that demonstrated that postoperative delirium is underdiagnosed by physicians and nurses. Four of the articles that met the established criteria provided risk factor data. Although age, preoperative cognitive impairment, and the use of anticholinergic drugs were significantly associated with postoperative delirium, gender, type and route of anesthesia, and sleep deprivation were not. Two studies demonstrated a decreased incidence of postoperative delirium when patients underwent preoperative psychiatric counseling or participated in a structured perioperative program. These findings indicate a need for (1) accurate incidence data with further definition of risk factors and (2) studies that address the diagnosis and treatment of this common postoperative problem. (Arch Intern Med. 1995;155:461-465)

Postoperative Delirium: A Review of 80 Primary Data-Collection Studies

Planning theories and environmental impact assessment

My name is Dr. Stuart Grassian. I am a Board Certified Psychiatrist and have been on the faculty of the Harvard Medical School since 1974. I have very substantial experience in evaluating the psychiatric effects of solitary confined, and have been retained in class action suits concerning this issue in the states of Massachusetts, New York, Kentucky, and California, and have also evaluated and testified regarding the effects of such conditions in other lawsuits in Massachusetts, Texas, Georgia, and Florida.

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Psychiatric Effects of Solitary Confinement

The concept of comfort is an important one for nursing, but because of its complexity, it has not been analyzed, operationalized or structured for nursing science. In this paper, three technical senses of the term are derived from: (a) contemporary and archaic lexical entries; (b) analysis of how the concept is used in contemporary and historical nursing literature; and (c) theoretical support found in the disciplines of nursing and ergonomics. Next, the contexts of patients' needs are explored and four contexts are derived from the nursing literature on holism. When the three senses and the four contexts of needs are juxtaposed, a 3 x 4 grid with 12 elements emerges that encompasses the total domain of patient comfort. Each element describes an aspect of comfort from which empirical indicators, antecedents, consequents and test items can be developed. The grid represents a taxonomic structure of the concept that organizes the meanings of this complex concept. The structure can be used to develop comfort pretests as the nurse assesses possible needs in a given situation and to develop comfort post tests, to assess the effectiveness of comfort measures.

A taxonomic structure for the concept comfort.

It is often held that planning theory has little influence on planning practice. Some speak of an evident ‘theory-practice gap’. In reality, the opposite seems to be the case. The so-called ‘theorypractice gap’ is not the main issue at all; the real question is ‘which theory for what kind of practice’? Assuming this view, the article presents two different theories of public regulation: the teleocratic approach and the nomocratic approach.They can be interpreted as general approaches regarding the role of the state, but the article focus particularly on the consequences of accepting them in the specific field of land-use regulation. For the teleocratic approach, planning must be the central and most important instrument of land-use regulation, while for the nomocratic approach planning has only a secondary role and different kind of regulative instruments are proposed.

Rethinking the theory and practice of land-use regulation: towards nomocracy

The practitioner as theorist

When Culliver traveled to Laputa, land in the clouds, he jound rapt theorists wandering about constructing useless ideas. And, generally, that is waht we think of theorists. This author, though, says that the-orists in nursing are not the ivory-tower thinkers; they are the nurses who work direcltly with patients. With every patient, she explains, we select an approach, then use, modify, and expand it—whether or not we are conscious of doing so. Because the-ories in a field have a powerful, long-term influence on the direction that field will take, the author pleads that we struggle to make already-existing, implicit nursing theories—such as TLC, jor example—clear and explicit, so that nursing will develop in the direction of more skilled bedside care.

Rosemary Ellis

Papers

The practitioner as theorist

The practitioner as theorist.

Unusual sensory and thought disturbances after cardiac surgery.

After stroke; sitting problems.