Challenges to nurse prescribers of a no‐antibiotic prescribing strategy for managing self‐limiting respiratory tract infections

Aims. To report a qualitative study of the experiences of nurse prescribers in managing patients with self‐limiting respiratory tract infections. Background. Patients frequently attend primary care with respiratory tract infections. Although a no‐prescribing strategy is recommended for these consultations, general practitioners frequently prescribe antibiotics, citing non‐clinical reasons such as patient pressure. Nurses increasingly manage people with respiratory tract infections, but research has not yet explored their experiences within such consultations. Design. Semi‐structured interviews and focus groups. Methods. Fifteen semi‐structured interviews and three focus groups (n = 5, n = 4, and n = 12) with a purposive sample of nurse prescribers (n = 34) and other non‐medical prescribers (n = 2) were conducted between November 2009–November 2010. A qualitative approach was used to develop conceptual categories from the dataset, and emerging themes were explored in subsequent interviews/focus groups. Findings. Although participants reported experiencing numerous challenges within these consultations, they believed that they possessed some of the communication skills to deal effectively with patients without prescribing antibiotics. Participants reported that protocols supported their decision‐making and welcomed the benefits of peer support in dealing with ‘demanding’ patients. However, the newness of nurses and other non‐medical prescribers to the prescribing role meant that some were cautious in dealing with patients with respiratory tract infections. Conclusion. Training for nurses and other non‐medical prescribers should focus on building their confidence and skills to manage people with respiratory tract infections without recourse to antibiotics. Further work should seek to explore which strategies are most effective in managing respiratory tract infections while maintaining patient satisfaction with care.     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

Objective To explore the relation between chronic and persistent cough of children and MP infection and clinical observation and treatment.Methods Retrospective Study of the 55 children chronic and persistent cough cases, with a clinical features as pneumonia MP infection, in my hospital from March 2005 to March 2008.Results ①Clinical Feature:major symptom of these 55 children chronic cough cases is chronic and persistent cough.58%(32/55)of the cases showed no symptoms in their lungs.②Peripheral Blood:85％(47/55)cases showed no obvious changes in peripheral blood, with their WBC ranging from(4～10)×109/Land their eosinophile granulocyte increased.③Special Test:47.27%(26/55)IgM (MP-IgM)antibody positive,83.64%(46/55)cased showed pneumonia MP DNA specificity after PcR Test.④X-Rate Report:Results varied.Conclusion Pneumonia MP Infection is one of the pathogeny causing chronic and persistent cough of children.Treating the infection is a very important solution in curing chronic and persistent cough of children.     

Complementary and integrative medicine: An observational study on pediatric clinicians’ knowledge,beliefs and practices

ObjectiveComplementary and Integrative Medicine (CIM) is a group of diverse health care therapies that often serve as adjuncts to conventional medical treatments. Our aim for this study was to evaluate the current knowledge, beliefs and practices of pediatric clinicians regarding CIM.MethodsClinicians from the pediatric unit of a large US based teaching hospital in Connecticut were surveyed, through self-administered questionnaires.ResultsWe sampled 70 participants with a response rate of 99 %. Of the 70, 32 were Registered Nurses, 9 were Attendings, 7 were Fellows, 15 were Residents and 4 were Nurse Practitioners. Regarding use, 24 % had referred a patient to a CIM practitioner, 43 % reported using CIM while 47 % had a family member who had used CIM in the past year. Respondents were most familiar with massage (70 %) and yoga (69 %) least familiar with Ayurvedic medicine (20 %) and Qi Gong (24 %). Regarding attitude, 67 % believed that some CIM therapies hold promise for the treatment of symptoms while 59 % believed that incorporation of CIM would increase patient satisfaction. Most of the respondents indicated that they did not have easy access to clinical information on many CIM treatment modalities. Nurses were more familiar (p = 0.024), had more positive attitudes and beliefs (p = 0.001) and thought CIM therapies had a higher impact (p = 0.002) on patient care compared to physicians, even when controlled for gender.ConclusionThis study highlights the need to bridge the gap in evidence based medicine and clinician’s knowledge with the rise in CIM use. It also stresses the need for standardized learning competencies in the field of PIM.     

Primary and community care workforce planning and development

AIM: This article reports a study that provided primary and community care managers with information, allowing them to: (a) evaluate the size and mix of their workforce; and (b) develop knowledgeable and skilled teams to meet the demands of growing and changing services. BACKGROUND: Primary and community care services are growing in the United Kingdom, but workforce planning and development, despite their wide-ranging cost and quality implications, have not received the same attention. Indeed, most primary and community care workforce planning and development issues are universal. Demand 1-1 side workforce planning is concerned not only with the number, but also with staff mix; but how these autonomous and isolated practitioners spend their time is unique. The other side of the equation, workforce supply, raises many recruitment and retention challenges for managers in many countries. Any country's main workforce planning methods apply equally well to primary care, but each is flawed. A second, main problem is that the methods lead to fragmented services, whereas modern workforce planning methods should be multidisciplinary. Consequently, it has never been more important for managers to have data and algorithms to develop appropriate care teams. METHOD: A large and versatile workforce database, profiling 304 English primary care trusts using demographic, socio-economic, mortality, morbidity, staffing and performance workforce-related variables, compiled in 2002 and updated yearly, is described. Data were supplemented with a systematic literature review leading to a 340-item annotated bibliography; and qualitative interviews with managers. RESULTS: Workforce size and mix are historical and irrational at best. Moreover, the number of variables that influence staffing is growing, thereby complicating workforce planning. CONCLUSION: Evaluating and adjusting the size and mix of teams using empirically determined community demand and performance variables based on the area's socio-economic characteristics is feasible.     

头体针治疗脑卒中临床观察

目的观察头体针结合治疗脑卒中的临床疗效。方法 183例脑卒中患者分头针、体针、头体针 3组进行治疗 ,疗程满2个月后比较疗效。结果头针组与体针组之间、体针组与头体针组之间无显著性差异 ,但头体针组与头针组之间有显著性差异 (P<0 .0 5 )。结论头体针结合较单纯的头针或体针治疗能获得更好的临床疗效     

加强对人类健康影响重大的内分泌代谢病防治

以联合国名义直接作出决议的疾病只有艾滋病和糖尿病,国际糖尿病联盟(IDF)发表的新的糖尿病防治指南,展现了在糖尿病预防与诊治方面的最新进展。甲状腺疾病流行病学、临床及实验室研究和长期随访,填补了我国在世界卫生保健数据库中的空白。     

介入放射技术在妇产科临床运用探讨

目的探讨介入放射技术在妇产科临床诊断与治疗的应用可行性与安全性．方法临床34例患者，16例为剖宫产术后反复大出血者，3例为顽固性功能性子宫出血者，10例为晚期官颈癌者，5例为子宫肌瘤者。34例经Scldinger介入放射技术诊断与治疗。结果经介入放射技术诊断与治疗，34倒不同的患者得到及时、准确、有效的诊断与治疗，未见并发症和后遗症。结论介入放射技术在妇产科临床运用安全、有效。     

Drugs and Medical Devices: Adverse Events and the Impact on Women’s Health

A large number of medications and medical devices removed from the market by the US Food and Drug Administration over the past 4 decades specifically posed greater health risks to women. This article reviews the historical background of sex and gender in clinical research policy and describes several approved drugs and devices targeted for use in women that have caused major morbidity and mortality. The intended population for the medications and devices, population affected, approval process, and the basic and legal actions taken against the medication/drug company are also discussed. It is recognized that women are still at risk for harm from unsafe medications and devices, and continued improvements in legislation that promotes inclusion of sex and gender into the design and analysis of research will improve safety for both men and women.     

Molecular and point-of-care diagnostics for Ebola and new threats: National POCT policy and guidelines will stop epidemics

Introduction: US hospitals that admitted Ebola virus disease (EVD) patients mitigated risk by using point-or-care testing (POCT) for critical support in isolation units. Success proved unequivocally the need for POCT. Additionally, molecular diagnostics have been used to help stop new outbreaks, and even handheld diagnostic solutions are emerging.

Areas covered: This update of ‘Molecular detection and point-of-care testing in Ebola virus disease and other threats’ [Expert Reviews 2015;15(10):1249–1255], assesses the impact of EVD epidemics, documents insights from recent reviews, summarizes evolving POC molecular technologies, presents General Accountability Office (GAO) recommendations, identifies the role of POC Coordinators, and casts a vision for national POCT policies and guidelines. Factual updating comprised summarizing EVD outbreaks including 2017–2018, analyzing reviews and evidence-based publications since the 2014–2016 epidemic, and tabulating published technical and molecular diagnostics. New graphics illustrate POC error mitigation/risk reduction, a framework for national POCT policy and guidelines, modular adaptations for country-specific solutions, and a logic diagram for future progress embedding artificial intelligence.

Expert commentary: The USA is still not prepared for highly infectious diseases. Key is lack of community rapid response and resilience, which must be enhanced not via mechanisms distant, but instead by molecular diagnostics directly at critical points of need.     

婴幼儿流动注射车的研制与临床应用

目的 为了提高婴幼儿头皮静脉穿刺成功率，减轻护士的体力消耗。方法 根据儿科临床实际的需要，经过二年来的设计及二次改进，研制出实用新型的“婴幼儿流动注射车”，并应用于儿科临床操作过程中。结果 经统计学处理，表明应用“婴幼儿流动注射车”对提高婴幼儿头皮静脉穿刺成功率具有显著意义，对缩短婴幼儿头皮静脉注射时间具有非常显著的意义。结论 在流动车上实施头皮静脉穿刺，能充分利用自然光线，提高头皮静脉穿刺成功率并减轻护士体力消耗。     

Oral infections related to radiation and immunosuppressive therapy

Abstract. The frequency of oral infection complications after cytotoxic chemotherapy andradiochemotherapy is significant, often contributing to serious septic infectious complications. Generally, the more intense the cytotoxic therapy, the more common are the oral infection complications. In the present review, the spectrum of oral infections related to radiation and immunosuppressive therapy are evaluated and the different local and systemic treatment modalities are presented.     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

The effect of altitude on P-wave and QT duration and dispersion

Background: Short-term and long-term exposure to high altitude has been reported to change the surface electrocardiogram. We aimed to compare P-wave and QT parameters between healthy people living at high altitude and sea level.
Methods: Twelve-lead electrocardiographies of 38 healthy people living at sea level (Antalya,Turkey) and 38 healthy people living at high altitude (Van, Turkey; 1,700–1,800 m) were obtained. Minimum and maximum P-wave durations, P-wave dispersion, minimum and maximum corrected QT intervals, and corrected QT dispersion were calculated.
Results: There was no significant difference between the two groups in respect to heart rate and QT variables. Mean Pminimum values were slightly but significantly lower in the high altitude group (P = 0.029). Mean Pmaximum values tended to be lower at high altitude but did not reach statistical significance (P = 0.085). However, there was no significant difference in respect to P-wave dispersion values.
Conclusions: In a sample of men and women living at high altitude in Turkey, significant reduction of Pminimum and borderline reduction of Pmaximum duration, but no significant change of P-wave and QT dispersion, were observed.     

白血病化疗后肛肠感染的诊断和治疗特点

目的：总结和讨论白血病患者化疗后出现肛肠感染时的诊断和治疗特点。方法：对36例出现肛肠感染表现的白血病患者的临床资料进行回顾分析。结果：其中15例表现为肛门直肠感染或脓肿形成,14例表现为阑尾炎,4例表现为局限性盲肠炎,3例表现为肛管坏死、肛门失禁。36例中33例进行了外科手术治疗,2例阑尾炎早期及1例盲肠炎不伴出血的患者行内科抗感染治疗。手术分别采用病变肠段切除吻合术、阑尾切除术、结肠造瘘直肠肛管感染旷置引流术、肛周脓肿切开引流肛瘘切开术等。所有病例均痊愈出院。外科手术治疗的33例中,经手术及病理检查证实为白血病盲肠浸润1例、阑尾浸润2例,其余为普通炎性感染或脓肿形成。结论：白血病化疗后出现肛肠感染的患者,以肛门直肠中、重度感染,急性阑尾炎和急性盲肠炎多见,通常病情较重,肛管直肠壁脓肿形成或溃烂、坏死,阑尾穿孔等概率高,出血风险大,术后并发症多。当诊断明确而内科治疗难以控制时,应积极进行外科手术治疗。围手术期妥善处理是手术成功的关键。     

Does Nutrition Counseling Affect Glycosylated Hemoglobin and Estimated Glomerular Filtration Rate in Patients With Diabetes and Stage 3 Chronic Kidney Disease?

This study evaluated glycosylated hemoglobin (HbA_1c) and estimated glomerular filtration rate (eGFR) for adult patients with diabetes and stage 3 chronic kidney disease after disease and nutrition counseling interventions were performed. A retrospective electronic medical record audit was used (n = 88) during a 12-month period. Use of the paired samples t test at 3 and at 6 months after the initial counseling visit reflected a statistically significant improvement in the HbA_1c at 3 and at 6 months (mean outcome, 0.000; P < .05), and the eGFR at 6 months (mean outcome, 0030; P < .05). These outcomes support implementation by advanced practitioners.