Pursuing a diagnosis in a Caribbean man

A case study of an HIV-infected Caribbean male with extrapulmonary tuberculosis details his diagnosis, treatment regimens, and follow-up. His presenting symptoms included epigastric pain and fever. Endoscopy and gastric biopsy showed gastritis and helicobacter infection, which were treated symptomatically, and TMP-SMX was given for possible salmonellosis. Serologic tests for common opportunistic infections were negative. After all other expected conditions were ruled out, concurrent symptoms were diagnosed as extrapulmonary tuberculosis, and multi-drug treatment was successfully conducted. The problem of interactions between protease inhibitors and anti-tuberculosis drugs in treating HIV and tuberculosis concurrently is discussed. Three options are addressed: (1) discontinue (or delay starting) the protease inhibitor until at least 6 months of a standard rifampin-containing tuberculosis regimen is completed; (2) discontinue (or delay starting) the protease inhibitor until 2 months of a standard rifampin-containing regimen are completed; and (3) use of rifabutin rather than rifampin.     

Caring relationship in a context: fieldwork in a medical ward

The aim of this study was to investigate how the caring relationship is formed in a medical context. The data were collected using participant observation with field notes and analysed by an interpretive phenomenological method. The context circumstances in a medical milieu demanded exacting efficiency and risks to oppress the caring relationship, subsequently causing demands in nursing practice. Three themes of the caring relationship were identified as respect for each other and for themselves, responsibility to reach out to each other and engagement. Patients' and nurses' awareness in encounters drove the forming of a caring relationship that went beyond the individual nurse and patient. This study implicates the importance of an understanding of how context circumstances create the foundation of the caring relationship.     

2019年广东省一起布鲁氏菌病暴发疫情调查分析

目的调查2019年广东省某县一起食源性布鲁氏菌病(布病)暴发疫情,为防控类似事件提供建议。方法通过个案调查、医院就诊系统查询等方式开展病例搜索,对调查对象开展布鲁氏菌感染初筛及确证实验;对结果进行描述与分析。结果共发现30例病例及6例隐性感染者;病例发病时间为7月10日至8月18日,呈现持续同源的暴发模式;临床表现主要为发热(70.00%)、肌肉、关节痛(46.67%)、乏力(43.33%)等;共从调查对象血液中分离出21株布鲁氏菌且均为羊3型;经分析,仅生饮H家羊奶是感染的危险因素,与未饮者相比相对危险度(RR)值为16.91(2.38~119.96),与煮沸饮者相比,RR值为36.36(5.07~260.58),且感染与饮奶存在剂量反应关系(χ^2=4.437,P=0.035)及时间上的关联。结论该布病暴发疫情为患者饮用受羊种3型布鲁氏菌污染的未煮沸羊奶所致。     

Caring for a patient with a urostomy in a community setting

Around 7500 people in the UK have a urostomy. A urostomy is normally performed if a person has bladder cancer, congenital bladder abnormalities. Many people who have a urostomy have long term conditions and may require the help and support of community nurses. This article examines common complications of urostomy including stomal complications, urinary tract infections and dermal complications. Although stoma complications are common and can affect quality of life, many people with a stoma tend not to seek help. Community nurses can provide care and support to optimize stoma management and enable the person with a urostomy to enjoy the best possible quality of life.     

Fahr syndrome discovered in adulthood revealing a rare GNAS mutation in pseudohypoparathyroidism type 1a in a Tunisian family

Pseudohypoparathyroidism (PHP) indicates a rare heterogeneous group of disorders characterized by hypocalcemia, hyperphosphatemia, increased serum concentration of parathyroid hormone (PTH), and insensitivity to the biologic activity of PTH. One of its most common types is PHP‐1a. In this report, we present a familial PHP‐1a and a novel mutation of the GNAS gene.     

Creating a patient-safe environment in a perioperative setting

•

AS A RESULT OF NEW regulatory requirements and consumer demands for optimal health care, a focus on patient safety is even more important.

•

IN 2001, A CORPORATE PATIENT SAFETY project was initiated by managers at one facility's six hospital-based perioperative suites. Although each suite had its own policies and procedures, no formal assessment of compliance with policies existed.

•

A PERIOPERATIVE SAFETY ASSESSMENT was designed by resource management department consultants. The assessment included a tool, a questionnaire, and an assessment process.

•

AFTER BEING TESTED AT ONE FACILITY, perioperative safety assessments were performed in the organization's six ORs and two ambulatory surgery centers. Best practices then were shared across the system. AORN J 81 (January 2005) 168-180.

     

Creating a research culture in a nursing school

BACKGROUND: Research in nursing schools still falls behind that in other disciplines. Schools need to develop a good research culture, in which those undertaking and supervising research are supported and guided. This requires commitment from management and effective leadership. CONCLUSION: To raise awareness the authors explore some of the ways in which a nursing school can foster a positive research environment.