Case of the month: Lesson of the week: don't forget scombroid

We describe five cases of scombroid that presented as one incident. We discuss the aetiology, clinical features, differential diagnosis and treatment of this condition.     

Nephrology nursing: blurring the boundaries: the reality of expert practice

Background. Expertise in nursing has been widely studied; there have been no previous studies into what constitute expertise in nephrology (renal) nursing. This paper describes a ‘real‐world’ characteristic of expert nephrology nursing practice. Aims and objectives. This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the concept blurring the boundaries. Design. The study utilized grounded theory methodology and symbolic interactionism. Methods. The study took place in one renal unit in New South Wales. Sampling was purposive then theoretical; the sample consisting of six non‐expert and eleven expert nurses. Simultaneous data collection and analysis using participant observation, review of nursing documentation and semi‐structured interviews was undertaken. Results. The study revealed that only expert nephrology nurses ‘blurred the boundaries’ of professional nursing practice. They did this by moving intermittently and purposefully, for the benefit of particular patients, into medical domains in the areas of prescribing, dispensing and ordering of pathology tests. Non‐expert nurses did not cross these professional boundaries. Conclusions. Blurring the boundaries was a significant feature of expert nursing practice, and this study was the first to describe explicitly nursing boundaries as two distinct entities; that is, formal and informal. Relevance to clinical practice. There are some nephrology nurses who have sufficient knowledge and experience to prescribe some medications and to order certain investigations.     

Report from the meeting: Gastrointestinal Tonometry: State of the Art

Gastrointestinal (GI) tonometry, the only clinically available method for the accurate diagnosis of compromised GI blood flow, has been shown to be a sensitive predictor of increased morbidity, mortality and prolonged hospitalization. The recent introduction of the Tonocap, as a means of performing automated air tonometry, has simplified the application of GI tonometry in the clinical setting. Despite this the utility of GI tonometry remains controversial. The GI Tonometry: State of the Art meeting brought together a group of clinicians with a proven track record of research, clinical interest and expertise in this field. The aim of the meeting was to come to a consensus regarding certain issues such as the past and future roles of GI tonometry and standards for its correct usage and interpretation. Finally suggestions as to further research and clinical evaluation were made within a broader discussion regarding the complexities of applying the principles of evidence-based medicine to the introduction of a new piece of medical technology.     

Presence: the eye of the needle

This column explores the meanings of presence from philosophical, theological, psychological, and nursing perspectives. The eye of the needle is used as a metaphor to emphasize the capacities required for living presence. The humanbecoming concept of true presence is emphasized and examples are given of living true presence in nursing.     

Telithromycin: the first of the ketolides

OBJECTIVE: To review the chemistry, spectrum of activity, pharmacology, clinical efficacy, and safety of telithromycin. DATA SOURCES: A MEDLINE search from 1966 to December 2000 was performed via OVID and PubMed using the following search terms: HMR 3647, HMR3647, Ketek, RU 66647, and telithromycin. An extensive review of retrieved literature, abstracts from international scientific conferences, and minutes from regulatory authority meetings was also performed. DATA EXTRACTION: Medicinal chemistry, in vitro, animal, and human trials were reviewed for information on the antimicrobial activity, clinical efficacy, pharmacology, and safety of telithromycin. DATA SYNTHESIS: Several chemical modifications to the macrolide structure have led to the development of telithromycin, the first ketolide antimicrobial that demonstrates improved activity against penicillin- and macrolide/azalide-resistant Streptococcus pneumoniae due to its unique binding to the ribosomal target site. Although telithromycin may be useful in the treatment of community-acquired respiratory tract infections due to its activity against common typical and atypical pathogens, questions concerning its reliable activity against Haemophilus influenzae need to be addressed. Telithromycin's pharmacokinetics permit once-daily dosing for abbreviated periods and good distribution into lung tissue and phagocytic cells. Clinical and bacteriologic cure rates have been similar to those of comparator agents in human efficacy trials; however, the incidence of adverse gastrointestinal events were generally higher with telithromycin patients. Like other macrolides and many newer fluoroquinolones, telithromycin's ability to prolong the QTc interval is a potential safety issue, especially in elderly patients with predisposing conditions or those who are concurrently receiving drugs that are substrates for CYP2D6 and 3A4. Liver function test elevations demonstrated during clinical trials, although not overtly severe, may warrant monitoring in some patients taking multiple hepatically metabolized/cleared agents. CONCLUSIONS: Telithromycin offers potential advantages over traditional macrolides/azalides for community-acquired respiratory tract infections caused by macrolide-resistant pathogens. Further studies are needed to elucidate its clinical efficacy against H. influenzae, potential drug interactions, and safety in various subpopulations.     

More on: calibration for the measurement of microparticles: the authors respond

See also Chandler WL, Yeung W, Tait JF. A new microparticle size calibration standard for use in measuring smaller microparticles using a new flow cytometer. J Thromb Haemost 2011; 9: 1216–24; Robert S, Poncelet P, Lacroix R, Raoult D, Dignat‐George F. More on: calibration for the measurement of microparticles: value of calibrated polystyrene beads for flow cytometry‐based sizing of biological microparticles. This issue, pp 1676–8; Mullier F, Bailly N, Chatelain C, Dogné JM, Chatelain B. More on: calibration for the measurement of microparticles: needs, interests, and limitations of calibrated polystyrene beads for flow cytometry‐based quantification of biological microparticles. This issue, pp 1679–81.DOI: 10.1111/j.1538‐7836.2011.04384.x .     

Control of cancer: the promise of the future

OBJECTIVES: To review the progress being made against cancer and a new legislative approach, the National Cancer Act of 2002, to renew the nation's resolve towards eliminating cancer. DATA SOURCES: Government reports, books, and newspaper and magazine articles. CONCLUSIONS: The major issues affecting cancer have to do with the economy, the status of employment, the environment, and the health care delivery system and access to it. IMPLICATIONS FOR NURSING PRACTICE: Nurses can participate in the major issues affecting cancer and influence the political process to eradicate cancer as a major public health problem.