Is there a need for liver disease monitoring in HIV patients in Africa?

Liver disease is one of the leading causes of death in HIV-infected individuals from Europe and North America and has been attributed mainly to coinfection with hepatotropic viruses. Little data, however, has so far become available on liver disease in HIV-infected individuals from Africa. Results from a first study on liver disease staging by Fibroscan(?) in a large group of HIV-infected patients from rural Uganda suggest unexpectedly high rates of advanced fibrosis. These results were independent from hepatitis status, initiating a discussion on the need for future liver disease monitoring in these particular patient groups.     

Is postanesthesia care unit length of stay increased in hypothermic patients?

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INADVERTENT HYPOTHERMIA is one of the most common complications experienced by surgical patients who are transferred to the postanesthesia care unit (PACU).

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APPROPRIATE PACU LENGTH OF STAY (LOS) is defined as the time required for a patient to achieve a physiologically stable condition after anesthesia administration. In studies measuring appropriate LOS, patients who arrived hypothermic in the PACU had longer stays than those who arrived normothermic.

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THE AIMS OF THIS STUDY were to determine whether the actual and appropriate LOS in the PACU differs between hypothermic and normothermic patients and to identify differences between subgroups of patients according to age, gender, and type of anesthesia administered.

AORN J 81 (February 2005) 379-392.     

Is the complexity of care a paradox?

This paper looks at the phenomenon known as care and the medium through which it is expressed - caring. It explores some of the meanings of these terms but focuses particularly on nursing care. Superficially, nurses and society have a broad understanding of what 'care' means but common usage of the word belies its complexity. When examined alongside the writings of scholars the inconsistent nature of care and caring emerges. We reflect on the difficulties this presents for both the nurse and the cared for when, on the one hand care is promoted as the essence of nursing, while on the other there is no acceptable definition of care on which to base this claim. Encompassed within our discussion is the underlying theme that although care is an appropriate ideal for nursing it does not capture all of the day-to-day realities and hence it is not an overriding ideal. Care in nursing in this sense is contradictory and we describe it as paradoxical.     

Is there a difference between strong ion gap in healthy volunteers and intensive care unit patients?

Purpose

Abnormalities of strong ion gap (SIG) are common in critically ill intensive care unit (ICU) patients in conjunction with a high incidence of acid-base abnormalities. However, it is unknown whether abnormalities in SIG are also seen in ICU patients without active acid-base abnormalities. Thus, we conducted this pilot study to examine differences in quantitative acid-base variables between healthy adult volunteers and stable ICU patients with no suspected acid-base abnormalities.

Methods

The study used a prospective observational study of 2 cohorts, 15 healthy adult volunteers and 15 stable adult patients just before ICU discharge who were not receiving renal replacement therapy and had no known active acid-base derangements. We analyzed venous blood for acid-base variables (potential hydrogen in central venous blood [pH_CV], partial tension of carbon dioxide in central venous blood [p_CVco₂], standard base excess [SBE], lactate, Na⁺, K⁺, Cl⁻, Mg²⁺, Ca²⁺, phosphate, and albumin). From these, we calculated strong ion difference (SID) and SIG for both cohorts.

Results

Although mean values for pH_CV, p_CVCO₂, and SBE were within the normal range in both cohorts, 10 (66.7%) of 15 of ICU patients were found to have occult acid-base disorders. The ICU patients also had reduced albumin and SID measurements and significantly greater mean SIG (5.1 ± 2.9 mEq/L) compared to healthy controls (1.4 ± 1.8 mEq/L) (P = .0002). None of the healthy controls had a SIG higher than 5.0 mEq/L, whereas 7 (46.7%) of 15 of ICU patients had a SIG higher than 5.0 mEq/L. Even among ICU patients with no abnormalities of pH_CV, p_CVCO₂, and SBE, mean SIG was 6.4 (±3.3 mEq/L).

Conclusions

Stable ICU patients have much higher levels of unexplained anions when comparing with healthy controls. Whether this finding represents occult acid-base disorders or simply metabolic differences among the critically ill is uncertain. Further study in larger populations is warranted to establish the significance of high SIG in otherwise stable ICU patients.     

What information do patients need following a whiplash injury? The perspectives of patients and physiotherapists

Purpose: The aims of the present study were to identify information that individuals with whiplash associated disorders (WAD) need to know in the early stages of recovery and to establish whether there is a difference between what physiotherapists and whiplash-injured patients perceive as important information.

Method: Forty-one participants were recruited (20 whiplash-injured patients, 21 physiotherapists). Participants were asked to provide five statements to one open-ended question about what they believe is the most important information individuals with WAD need to know in the early stages of recovery. Participants provided 182 statements which were reviewed independently and organised into themes by two of the authors.

Results: Six key themes emerged from the statements. These included general information about whiplash injury, treatment and recovery, reassurance, provision of poor information and patients’ interaction with general practitioners, maintaining daily activities, and compensation claims and litigation. Both patients and physiotherapists agreed on the type of general whiplash information that should be provided however, major differences were found with regard to information pertaining to compensation claims and litigation and maintaining daily activities.

Conclusions: The findings of this study provide some insight into the type of information that WAD individuals require in the early stages of recovery.

• Implications for Rehabilitation

• The provision of reassurance can be an effective communication tool to decrease patients concerns about their injury and help strengthen the patient–health practitioner relationship.

• Although clinical guidelines for the management of whiplash injuries recommend that individuals must remain physically active post-injury, statements from the patient group indicate that this information is not always provided and clearly explained to patients.

• Keeping in line with the patient centred care approach of being responsive to patient needs and values, it is essential for health practitioners to be attentive to patients’ preferences regarding the level of participation in treatment decisions.

• Processes need to be developed to deliver individuals with WAD accurate information regarding compensation claims so that these factors do not distract from focusing on recovery.

     

Is there a potential role for attention bias modification in pain patients? Results of 2 randomised,controlled trials

Potential applications of attention bias modification (ABM) for acute and chronic pain patients are investigated. In study 1, 54 acute back pain patients (46 of whom completed the study) were recruited at their initial physiotherapy session and randomised to receive 1 session of ABM or placebo. Patients were followed up 3 months later. Participants who were randomised to receive ABM reported less average (P=0.001) and current pain (P=0.008) and experienced pain for fewer days (P=0.01) than those who received placebo. In study 2, 34 chronic pain patients were recruited and randomly assigned to receive either 4 sessions of ABM (n=22) or placebo (n=12), followed by 8 sessions of cognitive behavioural treatment (CBT). After ABM, there was a significant group-by-time effect for disability. By 6-month follow-up, differences had emerged between the 2 training groups, such that the ABM group had shown greater reductions in anxiety sensitivity and disability than the placebo group. Although the results of these studies show that there is potential in the application of ABM to pain conditions, the mechanisms of treatment could not be established. Neither group showed an initial bias towards the word stimuli or a training effect, and only in the acute pain group were changes in biases related to outcome. Nonetheless, the fact that 2 independent samples showed a positive effect of ABM on clinical outcomes suggests that ABM is worthy of future study as an intervention for pain patients.