Tetanus.

Tetanus is a preventable disease with proper immunization. The marked decline in the incidence over the past several decades has resulted from widespread use of tetanus prophylaxis and improved wound management in the emergency department. Emergency physicians are among the most frequent providers of tetanus vaccination. We can stress the importance of proper immunization and encourage patients to keep accurate immunization records. This can maximize protection of patients from tetanus, and minimize adverse reactions from excessive administration of booster. Tetanus can be fatal even with proper treatment. Vital treatment measures can easily be completed in the emergency department.     

韶关市健康人群百日咳、白喉和破伤风抗体水平监测

目的　了解韶关市健康人群百日咳、白喉和破伤风免疫状况,及时为免疫策略提供科学依据。方法　随机抽查部分0～4 0岁健康人群进行了百日咳、白喉和破伤风抗体水平监测。结果　百日咳抗体几何平均滴度GeimetricMeanTiter(GMT)和抗体保护率分别为1∶374 2、67.74% ;白喉、破伤风抗毒素GMT分别为0.1699IU/ml、0.1804IU/ml,阳性率分别为88.94 %、91.83%。结论　对百日咳、白喉和破伤风已经形成了较好的免疫屏障,但人群百日咳抗体水平偏低,应大力推广应用吸附无细胞百日咳、白喉、破伤风联合疫苗.     

Tetanus. A threat to elderly patients.

Tetanus rarely occurs in young persons now that childhood immunization programs are widespread. Many older patients, however, are not completely immunized, and mortality in this group is high. Since many of the wounds from which tetanus arises are minor, patients may not bring them to medical attention. Thus, physicians should include assessment of immunization status during routine office visits in all age-groups and provide immunization against tetanus and against diphtheria if indicated.     

The management and prevention of tetanus

Tetanus is a rare disease in the United States, but it has a high mortality rate and is preventable through immunization. Using a computerized literature search, we reviewed English language articles on tetanus in the United States. We found that despite the availability of an effective vaccine, tetanus still causes considerable morbidity. The elderly are at great risk of tetanus, because they have never been immunized or their immunity has waned. Emergency physicians can reduce the likelihood of tetanus by ensuring appropriate wound care, including tetanus immunization and use of tetanus immune globulin, as appropriate.

Treatment consists of neutralization of circulating toxin, surgical excision to eliminate the source of toxin, control of muscle spasms, and prevention of respiratory and metabolic complications. A case-finding approach for all persons who receive care in emergency departments will reduce the size of the susceptible population.     

Tetanus.

Tetanus causes approximately 50,000 deaths per year worldwide, the incidence being greatest in undeveloped countries. Once tetanus occurs, the risk of death is substantial. Physician attention to the immunization status of patients who present with wounds, chronic and minor, can improve prevention of tetanus. It should be noted that more than 10% of the US population is not properly immunized against tetanus and that those at greatest risk are females of any age, males older than 50, blacks from the rural South, and those without any military experience.     

Tetanus: pathophysiology, management, and prophylaxis

As tetanus has become a rare disease in the developed world, physicians have become less comfortable with its diagnosis and management. The extent of adequate antitetanus immunity in the adult population, especially the elderly, is waning, in great measure because primary care physicians have not made prophylaxis a priority in their routine encounters with patients. Furthermore, as the population of immunocompromised hosts grows, an increasing percentage of our patients may not respond to standard active immunization routines. Unless these trends are reversed, we face a substantial increase in the incidence of this dread disorder. Tetanus is also of interest as a relatively simple model of disordered motor control that can instruct us in the management of the many more common causes of neurogenic muscular rigidity. The toxin produced by Clostridium tetani finds increasing use in laboratories investigating brain function as well. Clinical tetanus is divided into four symptomatic types: generalized tetanus, local tetanus, cephalic tetanus, and neonatal tetanus. This monograph discusses the diagnostic aspects of each type of tetanus, its pathophysiology, diagnosis, differential diagnosis, and treatment. Preventing tetanus should be a high priority for all primary care physicians. Active immunization with tetanus toxoid is remarkably effective and safe. Passive immunization with human tetanus immune globulin is indicated in certain circumstances, which are discussed below.     

Tetanus

Tetanus is produced by the action of the potent neurotoxin, tetanospasmin, which is elaborated during the growth of Clostridium tetani. The objectives of management of tetanus are to provide supportive care until the tetanospasmin that is fixed in tissue has been metabolized, to neutralize circulating toxin, and to remove the source of tetanospasmin. This disease, which is frequently fatal, is prevented by immunization.     

Rural Mobile Health Unit: Outcomes

Abstract The Mobile Health Unit was implemented to increase access to nursing services, to improve and/or maintain functional status and health status, and to increase health promotion behaviors of rural elderly residents experiencing difficulty obtaining health care due to illness, transportation problems, or financial factors. For 222 project participants 1,773 encounters were completed, with a mean number of visits per individual of 7.9. Participants in the project demonstrated increased breast and cervical cancer screenings, increased immunization rates for influenza, pneumonia and tetanus, and decreased utilization of the emergency room. This project represents an alternative model of health care delivery in a rural area with limited resources and health care providers.     

HIV & AIDS in older adults

Many Americans mistakenly believe that older adults are not at risk for HIV/AIDS. Older people do not perceive themselves to be at risk for HIV infection, either. In reality, approximately 10% of AIDS cases are among people older than 50. Many health care providers lack an awareness of the risk of HIV/AIDS in the elderly population, and as a result, many older people with these conditions are misdiagnosed with other ailments. Major manifestations of HIV/AIDS in elderly adults include Pneumocystis carinii pneumonia, herpes zoster, tuberculosis, cytomegalovirus, oral thrush, Mycobacterium avium complex, and HIV dementia. Elderly HIV-positive women have special health concerns, such as cervical cancer. Nurses and nurse practitioners can heighten their colleagues' awareness of the existence of HIV/AIDS in the elderly population and educate their older patients on HIV/AIDS. Furthermore, information about sexuality and sexual practices of older adults should be incorporated into all health science curricula. Additional research is needed to determine the extent of the problem and how health care providers can best serve their older patients' needs.     

Current concepts in the management of Clostridium tetani infection

This review summarizes the microbiology, management and prevention of tetanus. Tetanus is an acute toxemic illness caused by Clostridium tetani infection at a laceration or break in the skin. It can also occur as a complication of burns, puerperal infections, umbilical stumps (tetanus neonatorum) and surgical-site infection. Tetanus is an intoxication, manifested mostly by neuromuscular dysfunction, caused by tetanal exotoxin (tetanospasmin), a potent exotoxin produced by C. tetani. It starts with tonic spasms of the skeletal muscles and is followed by paroxysmal contractions. The muscle stiffness initially involves the jaw (lockjaw) and neck and later becomes generalized. Treatment goals include interrupting the production of toxin, neutralizating the unbound toxin, controlling muscle spasms, managing dysautonomia and appropriate supportive management. Specific therapy includes intramuscular administration of tetanus immunoglobulin to neutralize circulating toxin before it binds to neuronal cell membranes. The disease can be prevented by immunization with tetanal toxoid and appropriate wound care.     

Multi‐professional communication for older people in transitional care: a review of the literature

Aims and objectives. To synthesise research‐reporting literature about multi‐professional communication between health and social care professionals within transitional care for older people, with particular attention on outcomes, enabling contextual factors and constraints. Background. Older adults experience high rates of morbidity and health care usage, and frequently transit between health services, and community and social care providers. These transition episodes place elders at increased risk of adverse incidents due to poor communication of information. Integrated multi‐professional models of care built on enhanced communication have been widely promoted as a strategy to improve transitional care for older people. However, a range of findings exist in the literature to guide service providers and researchers. Design. Comprehensive literature search and review strategies were employed to identify, describe and synthesise relevant studies. Ten databases were searched in addition to Google Scholar. Conclusions. Specified discharge worker roles, multi‐professional care coordination teams, and information technology systems promote better service satisfaction and subjective quality of life for older people when compared with standard hospital discharge. Improved multi‐professional communication reduces rates of re‐admission and length of stay indicating greater cost effectiveness and efficiency for the health and social care systems. Systems of care emphasizing information exchange, education and negotiation between stakeholders facilitate communication in transitional care contexts for older adults. Conversely, lack of dialogue and lack of understanding of others’ roles are barriers to communication in transitional care. Implications for practice. Enhanced multi‐professional communication, transitional pathways, and role clarity are required to improve the quality, sustainability and responsiveness of aged care into the future. Recommendations for further research include: (i) Investigation of pathways promoting person‐centred care planning including the older person, their family and relevant practitioners; (ii) Development of interventions aimed at improving multi‐professional communication and transitional aged care with marginalised and socially disadvantaged elders on indicators of equity and access; (iii) Investigation of changing roles for practitioners in multi‐professional teams with a focus on community‐based teams including nurses specialising in aged care and general practice.     

Tetanus in the emergency department: a current review

Despite the availability of effective immunization to prevent tetanus, there are still up to one million cases per year worldwide. Although the majority of tetanus cases occur in third world countries, there are still significant numbers of cases occurring in countries such as the United States, where preventive immunization is easily accessible. The Emergency Physician has the opportunity to contribute to the decline of the incidence of tetanus through knowledge of those at greatest risk for inadequate immunization and through providing proper wound care and immunization prophylaxis.     

Inadequate tetanus protection among the rural elderly

Three cases of tetanus occurring in a community in southern West Virginia in five years prompted a survey of the immunization status of the population of this region. An immunization history was obtained from 540 consecutive patients seen at three different health care facilities. Of these, 386 (71.5%) had received prior tetanus protection, 65 (12%) had never been immunized, and 89 (16.5%) were uncertain or had received incomplete immunization. Of the 65 nonimmunized patients, 54 (83%) were older than 50 and only 11 (17%) were younger. Compared to the total group sampled, significantly more nonimmunized patients (both male and female) were older than 50 (P less than .001). Also, significantly more of these never immunized individuals lived in rural areas (P less than .001). In a group of 222 patients identified as being at increased risk of having tetanus, 65 (29%) had never been immunized, 89 (40%) were of uncertain or incomplete status, and 68 (30.5%) had been immunized more than ten years previously. One hundred twenty (54%) high-risk patients were older than 50 and 103 (46%) were younger. Compared to the entire population sampled, high-risk patients included significantly more who were older than 50 (P less than .001). Also, significantly more high-risk patients lived in rural areas (P less than .007). When treating injured patients, it is important to recall that many older adults living in rural areas are not adequately immunized against tetanus. Such patients should receive human tetanus immunoglobulin, as well as tetanus toxoid.     

Cephalic tetanus: a case report and review of the literature

Cephalic tetanus is a rare form of tetanus defined as trismus plus paralysis of one or more cranial nerves. The most frequently involved cranial nerve is the seventh. It accounts for 1 to 3% of the total number of reported cases of tetanus and has a mortality of 15 to 30%. The incubation period is 1 to 14 days, and approximately two thirds of cases progress to generalized tetanus. The mechanism of the paralysis is not completely understood. Treatment involves debridement of wounds, administration of penicillin and tetanus immune-globulin, aggressive supportive care, and initiation of active immunization.     

Mental health knowledge in residential aged care: a descriptive review of the literature

Health care staff knowledge of mental health is vital in the provision of quality care for older people in residential aged care settings. This paper aims to describe mental health knowledge competence of health care staff in residential aged care through a review of existing literature and to explore the link between knowledge, attitudes and education about older people and mental health. A literature review was conducted using electronic databases and library catalogues to identify articles published in English during the period 1982-2002. There is insufficient evidence within the literature to draw conclusions about staff knowledge levels in relation to mental health, however, the literature identified a link between continuing education, knowledge levels and staff attitudes to older people with mental health disorders. Future studies are needed to investigate existing levels of mental health knowledge among health care staff in residential aged care and to identify and evaluate strategies to enhance their ability to provide care for this population.     

Healthcare providers' perspectives: estimating the impact of chronicity

PURPOSE: To compare elders' self-ratings of the impact of their chronic conditions with healthcare providers' estimates of the impact of the same conditions on older adults. The effect of length of time in clinical practice and rural or urban clientele on healthcare providers' impact ratings was also explored. DATA SOURCES: A pen-and-paper survey was administered to 122 community-dwelling adults aged 55 years and older, attending health education or exercise programs held by a hospital in a city of approximately 60,000 people. Elders were asked to identify which of 11 common chronic conditions they had and then to rate the impact each condition had on their daily lives. A sample of 290 healthcare providers who are members of the Gerontological Society of America completed a mailed survey asking them to estimate the impact that each of the 11 conditions had on older adults. CONCLUSIONS: Healthcare providers consistently overestimated the impact that chronic health conditions had on older adults when compared with the elders' self-ratings of impact. Greater levels of experience were not significantly related to providers' impact ratings of chronic conditions. IMPLICATIONS FOR PRACTICE: Nurse practitioners, as primary care providers, must understand the impact of chronic conditions on older adults' daily lives in order to provide effective, efficient, and evidence-based health care. This study points to the need for more research to discover why older adults and healthcare providers have such different perspectives on the impact of chronic health conditions.     

Views on dignity in providing health care for older people

AIM: The aim of this study was to explore the salience and meaning of dignity and dignified care for care providers and the implications for the proviosion of care. The project forms part of an international study being undertaken in different European countries comparing health and social care workers' views on dignity. METHOD: Focus groups were chosen as the primary method of data collection. Twelve focus groups were carried out involving a total of 52 participants representing a range of occupational groups. RESULTS: All participants stated that dignity and respect were important for people of all age groups. The evidence that emerged from these focus groups showed that, in spite of the appropriate intentions of providers, older people were not consistently provided with dignified care. CONCLUSION: In order to ensure dignity in providing care for older people, tasks need to be organised around older people's needs and time frames. Without such changes there is a danger that 'institutional ageism' will persist in the health service.     

Parental refusal or delay of childhood immunization: Implications for nursing and health education

The purpose of this article is to review the current literature to ascertain reasons behind parental refusal or delay of childhood immunizations. Recurring themes highlighted issues involving parents and health care providers. Strategies to improve immunization compliance were proposed. Health care professionals and health educators were identified as instrumental in the effort to educate and positively influence immunization. As one of the most highly trusted members of the health care team, a nurse is vital to the success of this endeavor.