Domestic exposure to legionellae for Dutch Legionnaires' disease patients

The source of infection for travelers who develop Legionnaires' disease (LD) shortly after a journey abroad is difficult to ascertain. Infection is likely to have occurred abroad, but could also have occurred at the patient's own residence. The authors conducted a case-control study to determine risk for acquiring LD at home in the Netherlands after traveling abroad. They compared homes of 44 traveling LD patients with 44 homes of nontraveling LD patients, using logistic regression models. Geographic distribution was confounding the association between traveling and presence of Legionella spp. in residences; adjustment was necessary. In traveler's homes, legionellae were present more often, with crude and adjusted OR (95% CI) being 1.6 (0.5-5.0) and 1.4 (0.4-4.4), respectively. The authors' findings indicate that the patient's residence can be a potential source of infection after traveling.     

城乡细菌性痢疾家庭续发率外环境污染程度调查研究

作者对北京城乡急性细菌性痢疾家庭续发率和外环境志贺氏菌污染情况做了调查研究。结果,农村家庭续发率(10.55%)高于城区(4.83%);农村外环境污染率(3.41%)也高于城区(0.71%)。这两个率比以往报道均有所下降。     

Trust and trustworthiness in nurse–patient relationships

Abstract This paper explores the nature of trust in nurse–patient relationships from the perspective of the patient's trust in the nurse and what might be said to then render such a relationship trustworthy, from the patient's point of view. The paper commences with a general examination of the nature of trust, followed by consideration of the nature of professional–patient relationships in healthcare, with emphasis on nurse– patient relationships in particular. The nature of this relationship is used to provide grounds for arguing, both morally and conceptually, that the nature of patients’ trust in those who nurse them is generally such that for the nurse to respond in a trustworthy way, she must care about her patients, not just for them. In arriving at this conclusion, the paper deliberately restricts its focus to nurse–patient encounters where patients are adults and a relationship, as opposed to a brief engagement between two people, can be said to have taken place. The context for this focus is public sector health care in the United Kingdom. In the text, gendered pronouns referring to doctors, nurses and patients are meant to be inclusive of both sexes.     

惠普尔养障体重症肺炎1例报告

 惠普尔养障体是一种革兰阳性杆菌,属于苛养菌,临床常难以确诊。惠普尔氏病是由惠普尔养障体引起的一种慢性多系统感染性疾病,常见的靶器官是胃肠道、关节,肺部罕见受累。本文报告患者临床表现为发热、咳嗽、呼吸困难,双肺CT提示弥漫性磨玻璃影,支气管镜肺泡灌洗液宏基因测序提示为惠普尔养障体、热带念珠菌混合感染,给予美罗培南、复方磺胺甲唑、氟康唑治疗好转。本文就该例惠普尔养障体肺炎病例进行报告及文献复习,旨在提高临床对惠普尔养障体感染的认识,做到早诊断、早治疗。     

Only a whisper away. A philosophical view of the awake patient's situation during regional anaesthetics and surgery

In this study the awake patient's intraoperative situation and experiences during regional anaesthetics and surgery are reflected upon by using the work of the French philosopher Maurice Merleau‐Ponty. Merleau‐Ponty's phenomenological idea of the body as being at the centre of the world highlights the patient's embodied position and bestows significance onto the body as a whole, as a lived body. A case, based on the findings from a previous interview study, is presented as a contextual starting point where a patient goes from having a familiar body recognized as her own to having a partially anaesthetized body experienced as an unknown object. The intraoperative caring space is described in this context as the mutual ground where the awake patient and the nurse anaesthetist (NA) can interact to create meaning. The NA can act as the patient's bodily extension to bridge the gap between the patient's experiences and the situation. This calls for the NA's proximity and genuine presence in order to meet and understand the patient's awake experiences. Learning from the patient's situatedness gives information that is valuable for NAs to share with patients who are less experienced with this contextual situation. The challenge for the NA is not to perform routine‐based care, but to acknowledge every patient's lifeworld and uniqueness thus enabling the patient to move easily along the mind–body–world continuum. The core of intraoperative care is to provide support and promote well‐being of awake patients in the intraoperative environment. The use of a philosophical perspective is relevant for nurses who work in an intraoperative setting where patients undergo regional anaesthetics. This study shows how nursing research using phenomenological philosophy can help uncover new meanings known only to the patients living the experience.     

Patients' Satisfaction with Health Care Chaplaincy and Affecting Factors: An Exploratory Study in the German Part of Switzerland

Surveying patients' satisfaction with chaplaincy services contributes to improving the quality of health care chaplaincy. Therefore, 679 patients from 32 general hospitals and psychiatric clinics in the German part of Switzerland were surveyed in a cross-sectional design. Seven factors influencing patients' satisfaction with health care chaplaincy were identified. They pertain, on one hand, to the chaplain–patient relationship (“Respect and friendliness,” “Empathy,” “Negative relationship”) and, on the other hand, to the evaluation of chaplains' interventions (“Religious/spiritual interventions,” “Religious/spiritual issues,” “Clarification, coping and support,” “Conflict management and forgiveness”). Whereas the patient–chaplain relationship was significantly associated with the patient's age and religiosity, the apprehension of pastoral intervention was significantly associated with the patient's religiosity and denomination, length of stay, admission to hospital, and the patient's health status. The results suggest that chaplains have to take account of the situational circumstances and personal characteristics of patients in order to optimize their service.     

Factors associated with treatment failure after advice from infectious disease specialists

ObjectiveRisk factors associated with treatment failure after the infectious disease specialist's (IDS) advice remain unknown. We aimed to identify these risk factors.MethodsWe included patients hospitalized in our tertiary care center who consulted an infectious disease specialist between January 2013 and April 2015. Treatment failure was defined by a composite criterion: signs of sepsis beyond Day 3, ICU admission, or death. Treatment success was defined by the patient's sustained clinical improvement.ResultsA total of 240 IDS recommendations were made. Diagnosis was changed for 64 patients (26.7%) and 50 patients experienced treatment failure after the IDS advice. In multivariate analysis, compliance with the IDS advice was associated with a higher rate of success (OR = 0.09, 95%CI [0.01–0.67]). Variables associated with treatment failure in the multivariate analysis were Charlson comorbidity score at admission (OR = 1.24, 95%CI [1.03–1.50]), a history of infection or colonization with multidrug-resistant bacteria (OR = 8.27, 95%CI [1.37–49.80]), and deterioration of the patient's status three days after the IDS advice (OR = 12.50, 95%CI [3.16–49.46]).ConclusionReassessing IDS recommendations could be interesting for specific patients to further adapt and improve them.     

Pharmaconutrition

Background: Enteral supply of ω‐3 polyunsaturated fatty acids has been used in an attempt to modulate inflammation and improve outcome in critically ill patients. However, enteral administration may be slow to change membrane composition and therefore may not be the best route to supply these fatty acids in patients with acute conditions. This study evaluated the effects of short‐term intravenous (IV) administration of fish oil–based lipid emulsion (FLE) as pharmaconutrition on cytokine levels in critically ill elderly patients. Methods: Enterally fed patients (n = 40; aged 60–80 years) were recruited in the first 48 hours of intensive care unit (ICU) admission. Fifteen patients received IV FLE (0.2 g/kg body weight) over 6 hours for 3 consecutive days, and 25 patients did not receive IV lipid (control). Samples were collected before and 24 hours and 72 hours after the third FLE infusion. Nutrient intakes, clinical parameters, and serum cytokine concentrations were measured. Results: Compared with the control, FLE resulted in higher energy intake, lower serum tumor necrosis factor–α and interleukin (IL)–8 concentrations, and higher serum IL‐10. These differences occurred around 7–9 days of ICU stay at the time of the patient's extubation. ICU stay, mortality, and markers of coagulation and liver function did not differ between groups. Conclusions: Short‐term IV FLE modulates some inflammatory markers in critically ill elderly patients receiving enteral nutrition (EN), suggesting an anti‐inflammatory effect. This may be a benefit and suggests a role for FLE administration as a supplement in elderly ICU patients receiving standard EN.     

Comparison of single- and multiple-person mercury exposures

Elemental and organic mercury are extremely toxic. All mercury exposures reported to Texas poison centers during 2000–2013 were identified. The cases were divided into multiple- and single-person exposure groups and compared, including identification of statistically significant differences (SSDs). There were 6,521 single-person exposures and 214 multiple-person incidents involving 734 total persons; 45% and 27% of the multiple- and single-person exposures, respectively, involved patients aged 6–19 years (SSD). The multiple- and single-person exposures were, respectively, 87% vs 98% unintentional (SSD). The most frequent routes of multiple- and single-person exposures, respectively, involved ingestion (23% vs 72%, SSD), dermal (52% vs 23%, SSD), and inhalation (43% vs 5%, SSD). The most common site for multiple- and single-person exposures was the patient's own residence (56% vs 91%, respectively, SSD). Multiple-person mercury exposures are more likely to involve school-age children. A greater proportion of multiple-person exposures was intentional, involved dermal and inhalation routes, and occurred at school.