The relentless rise of resistance?

Antibiotics have undoubtedly made a major contribution to improvements in both human and animal health and welfare. Recent years have brought alarming rises in the prevalence of resistance to some agents among certain groups of bacteria. Concern is growing that therapeutic options will become increasingly limited if resistance rates continue to rise. There is widespread agreement that action is required to reverse or at least slow this process. Necessary steps to manage the situation include better surveillance to assess accurately the extent of problems, more prudent use of the available antibiotics to conserve valuable therapeutic resources and improved infection control to limit the spread of resistant organisms. Achieving these goals will not be possible without government, the medical profession and the public being better informed and educated. Regulatory bodies and the pharmaceutical industry need to work together to ensure a steady supply of new antimicrobials. Our understanding of the processes driving resistance at both the molecular and population levels is advancing. However, the relative contributions of the various uses of antimicrobials to the resistance problem and which will be the most effective containment measures are still hotly debated. Progress is being made, but continued concerted action is necessary if the usefulness of this most important group of therapeutic agents is to be preserved.     

The game of what if?

When he fought so hard to live, it seemed heartless to ask him how he wanted to die.     

The origins of classical homoeopathy?

Writers on homoeopathy frequently refer to classical homoeopathy, usually with the implication that this is the most complete and authoritative version of Hahnemann's views. However, such claims do not correspond with the historical facts. Homoeopathy arrived in the USA early in the 19th century and there underwent considerable modifications at the hands of its most influential adherents, who were deeply influenced by the ideas of Emanuel Swedenborg. J.T. Kent is particularly important in this respect and he also introduced ideas from other sources. The 'extremist' character of Kentian homoeopathy goes far to explain the gulf that has separated homoeopathy from orthodox medicine until comparatively recently. Kentian views were brought to Britain by Margaret Tyler early in the 20th century and became dominant after the First World War, to give rise to what is called classical homoeopathy today. This is not only a considerable modification of Hahnemann's teaching, but it fails to take account of Hahnemann's late ideas which he developed in his Paris years and incorporated in the sixth edition of 'The Organon', published posthumously in 1920. Whatever one's opinion of the value of classical homoeopathy, it cannot be legitimately represented as a purely Hahnemannian teaching.     

The day of the triffids?

This is a case report of two children who presented with a widespread bullous erythematous rash secondary to exposure to the hogweed plant.     

The perils of great medical care--overuse?

This essay, a personal reflection on the major medical center diagnosis and treatment odyssey, in which it is not clear that more testing and greater interventions achieve the highest value.     

The secret of good 'l?yly'

The nature of good "l?yly" (sauna vapor/sauna heat) is hard to describe. Essentially, it is determined by the purity, temperature, moisture content of the air contained inside the sauna: as well as its thermal radiation. A suitable temperature for sauna air ranges between 80 and 100 degrees C and the humidity from 40 to 60 g per kg of air. The bathers should be able to vary the humidity to their liking by casting water on the stones heated in or on the sauna oven. The inner surfaces of the oven and the sauna room should produce as even a field of thermal radiation concentrated on the bather's body as possible. The purity of the sauna air is above all a factor contributing to the enjoyment of the bathing experience. The sauna air must not contain any obnoxious extent gaseous impurities, particles, or micro-organisms. The purity of the sauna air is ensured primarily by effective ventilation. Particular attention should be paid to the arrangement of correct ventilation, for the internal size of modern saunas is steadily diminishing. The sensation of experiencing good "l?yly" is also affected by the overall condition of the sauna. It should have an agreeable and relaxing effect on the bather.     

Real nursing? The development of telenursing

Title. Real nursing? The development of telenursing Aim. This paper is a report of a study to understand the impact of telenursing from the perspective of nurses involved in its provision, and in more traditional roles. Background. Nurse‐led telephone helplines have recently been introduced across the United Kingdom, a major step in the development of nursing practice. Method. A structured questionnaire was sent to all nurses working in the NHS Direct (National Health Service Direct) Wales telephone service (n = 111). Ninety‐two completed questionnaires were returned (response rate 83 per cent). Two focus groups were conducted: one with telephone service nurses (n = 8) and one with other nurses (n = 5). The data were collected in 2002. Findings. Respondents represented a highly educated workforce from a range of healthcare specialties. They reported that they joined the telephone service for improved salary and flexible working. Two‐thirds reported improved job satisfaction. All focus group participants reported that the development of nursing skills was affected by the use of decision support software and the remote nature of the consultation. Participants reported opportunities for skill development, although the role could be stressful. All agreed that the service was popular with callers, but the nurses from outside raised concerns about whether telenursing was ‘real’ nursing and about the evidence base for the service and access by disadvantaged groups. Conclusion. Differences between the groups reflect policy tensions between the need to develop new nursing skills, including the use of technology, to improve efficiency and recognition of the worth of hands‐on nursing. These tensions must be addressed for the telephone service to function as part of an integrated healthcare system.