New insights in the treatment by levofloxacin

Levofloxacin is widely regarded as one of the most important fluoroquinolones available today. It possesses excellent activity against a wide range of important pathogens, including those resistant to many other antimicrobials. While rates of resistance to other previously useful antimicrobial classes has grown, levofloxacin has maintained its efficacy, with generally very low rates of resistance around the world. It is indicated for a wide range of infections including community-acquired respiratory infections in adults, particularly community-acquired pneumonia (CAP), acute bacterial exacerbations of chronic bronchitis (AECB), and acute sinusitis. In addition, it is recommended for infections of skin and soft tissue, and the urinary tract. With postmarketing surveillance data available for the last decade, levofloxacin possesses an unparalleled database to demonstrate its clinical efficacy and safety. Remarkably, levofloxacin continues to expand its list of indications. The development of a new high-dose 750-mg schedule has the potential to decrease the duration of treatment as well as reduce the emergence of resistance.     

New Zealand Emergency Medicine Network: A collaboration for acute care research in New Zealand

The specialty of emergency medicine in Australasia is coming of age. As part of this maturation there is a need for high‐quality evidence to inform practice. This article describes the development of the New Zealand Emergency Medicine Network, a collaboration of committed emergency care researchers who share the vision that New Zealand/Aotearoa will have a world‐leading, patient‐centred emergency care research network, which will improve emergency care for all, so that people coming to any ED in the country will have access to the same world‐class emergency care.     

New insights into neuromodulatory approaches for the treatment of pain.

Two lines of evidence about the association between the experience of pain and brain state (measured via electroencephalogram or EEG) have recently come to light. First, research from a number of sources suggests a link between brain EEG activity and the experience of pain. Specifically, this research suggests that the subjective experience of pain is associated with relatively lower amplitudes of slower wave (delta, theta, and alpha) activity and relatively higher amplitudes of faster wave (beta) activity. Second, there has been a recent increase in interest in interventions that impact the cortical neuromodulation of pain, including behavioral treatments (such as self-hypnosis training and neurofeedback) and both invasive and noninvasive brain stimulation. Although a direct causal link between experience of pain and brain activity as measured by EEG has not been established, the targeting of pain treatment at a cortical level by trying to affect EEG rhythms directly is an intriguing possibility. PERSPECTIVE: Preliminary evidence suggests the possibility, which has not yet adequately tested or proven, that the experience of chronic pain is linked to cortical activity as assessed via an electroencephalogram. Support for this hypothesis would have important implications for understanding the mechanisms that underlie a number of pain treatments, and for developing new innovative treatments for chronic pain management.     

Paediatric respite care: a literature review from New Zealand

This paper reviews relevant international and New Zealand literature, policy documents and reports on respite provision for children who are dying and their families. The literature describes why respite care for children is necessary, and evaluates present respite services in accord with recent reports and literature. The service provisions needed for dying children and their families are explored, including suggestions for the improvement of services and future research. The literature reveals that, although respite care for terminally ill children and their families is necessary, service provisions are uncoordinated, not always culturally sensitive and very limited for children and their families. Improvement in paediatric respite services is necessary and research needs to be conducted in this area to facilitate the development of more appropriate respite services for children and their families.     

Migraine and the neck: New insights from basic data

The clinical presentation of pain in patients with migraine showing spread and referral of pain throughout the trigeminal and cervical innervation territories accompanied by hyperalgesia and allodynia indicates a dynamic trigeminocervical interaction. The physiologic mechanisms may be convergence of trigemino-cervical afferents and central sensitization of trigemino-cervical neurons leading to dynamic neuroplastic changes during migraine. This review highlights the clinical phenotype and mechanisms of how nociceptive input from neck structures of the upper cervical spine are integrated into the trigemino-cervical system. The nociceptive input into the spinal cord also is subject to a modulation by segmental mechanisms in the spinal cord and by inhibitory projections from brain stem structures such as the periaqueductal gray. The functional relevance of these basic mechanisms is discussed with reference to recent studies using neurostimulation of afferent nerves aiming at pain modulation in patients with migraine.     

Job satisfaction and stress in staff working in a specialist psychiatric unit for the elderly following relocation from a traditional psychiatric hospital setting

AIM: This study examines self-reported stress and job satisfaction of staff working in a specialist psychiatric unit for the elderly (n = 79) following relocation from a traditional psychiatric hospital setting (n = 66). The levels of reported stress were examined in relation to the two staff groups before and after the relocation, and in relation to data available for similar occupational groups. METHODS: Stress and job satisfaction levels were surveyed using the Occupational Stress Indicator. The analysis of data included t-test for independent groups. FINDINGS: The results suggested that that there were no significant changes in the patterns of the staff groups' experience of stress at the traditional psychiatric hospital and later at the new purpose-built unit. However, it was felt that there may have been different factors contributing to staff stress at the two time-points. The staff groups in this survey reported similar, and in some areas more positive levels of occupational stress than both community and other health authority samples. However, it was felt that, due to the limited response rate of staff at both times (63 and 59%), the results may be an underestimate of stress levels. In the absence of a measure of general health and symptomatology it was not possible to assess the impact of stress levels on the psychological well-being of staff. CONCLUSIONS: Routine audit of staff stress would be beneficial to identify potential for staff training, and individual professional development plans. This is particularly important in view of the current difficulties both locally and nationally in the recruitment and retention of qualified staff in this speciality.     

Diabetic neuropathy: Diagnosis and treatment for the pain management specialist

Diabetic neuropathy is the name used by clinicians to describe a heterogeneous group of diseases that affect the autonomic and peripheral nervous systems of patients suffering from diabetes mellitus. This article provides the pain management specialist with an overview of the pathophysiology and current trends in the diagnosis and treatment of these diseases. Because of the significant morbidity and suffering associated with diabetic neuropathy, this article emphasizes practical steps to prevent, treat, and manage diabetic neuropathy to assist the pain management specialist in caring for patients suffering from this common malady.     

Palliative care philosophy in care homes: lessons from New Zealand

Increasing numbers of people are dying in care homes yet little is known about the nature and quality of their deaths. The limited research available suggests that there is a need to promote a philosophy of palliative care that is not confined to the terminal phase of life. However, adopting such an approach appears to be inhibited by a lack of understanding, education and training, as well as continuing reluctance to discuss issues of death and dying in an open and honest way. Drawing on data from a large convenience sample of caregivers in New Zealand, this article argues for a reappraisal of the way in which care homes view death and dying and advocates the more widespread adoption of a palliative care philosophy.     

Future prospects for the treatment of rapidly evolving viral pathogens: insights from evolutionary biology

The evolutionary dynamics of viruses must be taken into consideration in designing preventive and therapeutic treatments. Here we review mechanisms by which viruses adapt in response to antiviral interventions. We propose combination therapy and multiepitopic vaccines as adequate to circumvent virus adaptability. An alternative design, termed lethal mutagenesis or virus entry into error catastrophe is presented. It exploits the high error rates inherent in RNA virus replication, to provoke virus extinction through excess of mutations.