Nursing and midwifery education, practice, and issues in Israel

Nurses deliver most of Israel's healthcare services, yet its nurse per population ratio is only 5.9 per 1000, one of the lowest in the developed world. For several years, the managers of the profession have been pushing to upgrade nursing and to move it into the academic sphere. The semiskilled qualification of the practical nurse has been eliminated and training programs for registered nurses are being transformed from diploma training to academic degree programs. A midwifery license is accessible only to registered nurses who take a further 1 year of advanced training and sit the State Midwifery Licensing Examination. Most deliveries in Israel are carried out by midwives. Alongside the Western-standard hospital system there operates both a well-developed community nursing network and a strong mother-and-child clinic system. The acute shortage of nurses in Israel is now coinciding with a rising number of academic job-seekers, which has encouraged the Ministry of Health to offer university graduates a career-change program. Special scholarships are on offer in return for a 4 year commitment to work in nursing after completing an accelerated training curriculum (2.5 years instead of the usual 3 years), plus a starting monthly wage that is higher than the national average wage.     

Anti-β<Subscript>2</Subscript>-glycoprotein I in Sjogren’s syndrome is associated with parkinsonism

The nervous system may be involved in up to 30% of patients with Sjogren’s syndrome (SS). We describe three patients with Sjogren’s syndrome and a concomitant parkinsonian syndrome. Elevated titers of anti-β₂-glycoprotein I IgG were found in the serum of all three patients. This autoantibody is strongly associated with anticardiolipin (aCL) antibodies, antiphospholipid syndrome (APS), and thromboembolic phenomena, but its role in the pathogenesis of the parkinsonian disorder in SS is unclear. These patients may present a subtype of SS patients in which the presence of aCL antibodies is associated with central nervous system involvement predominantly in the basal ganglia. Sharon Hassin-Baer and Levy Yair contributed equally to this work.     

Nursing and Home Care in Europe

The demographic trend of a rapidly ageing society becomes increasingly persuasive. More chronically ill patients will be discharged to home care. More people with psychotic problems and debilitating diseases will be living in communities. All require nursing care. This situation is recognized everywhere and no boundaries can change this future.     

Craniofacial augmentation with porous polyethylene implants (Medpor: first clinical results]

SUBJECT: Porous polyethylene (Medpor) is an alloplastic material commonly used in craniofacial reconstruction. We report about our first clinical experiences with Medpor for facial augmentation procedures. PATIENTS AND METHODS: We treated 27 patients between 2001 and 2005 (11 female, 16 male) with 48 Medpor-implants. The indications for application of porous polyethylene implants in our clinic were congenital malformations (15), post-traumatic defects (10), and reconstructions after tumor resection (2). The implants were used for nasal/paranasal augmentations (16), for zygomatico-orbital augmentations (18), and for augmentations of the chin and malar region (11). The procedures were performed in a standardized manner. We used prefabricated, self-contoured implants and fixed them subperiosteally with titanium osteosynthesis screws. All operations were performed under general anesthesia. We evaluated the aesthetic results and the ingrowth behavior clinically and histologically. RESULTS: We achieved good aesthetic results and the patients showed no signs of discomfort or rejection. Four patients required a second intervention. These revision surgeries included two cases of local infections and two for aesthetic contouring. The necessary reduction of the implants allowed the harvesting of tissue and implant samples for microscopy. CONCLUSION: Porous polyethylene implants showed a good fibrovascular integration without encapsulation under the light microscope. Giant cells were detected on the surface of the implants. Besides this there was evidence for resorption of the implant material. Fixation with titanium screws is very effective. No implant dislocation or implant fracture occurred. The implants showed high volume stability and were easily handled and contoured. It is not possible to visualize Medpor implants with current imaging techniques, because polyethylene shows no contrast.     

Cardiac nurses: coping with stress

This paper describes issues relating to coping with stress as expressed by nurses in cardiology. The data were collected at a 1-day workshop on 'Coping with Stress', sponsored by the Israel Cardiac Nursing Association in response to repeated requests from nurses in cardiology. The programme included theoretical presentations. Group work focused on the nurses' self-evaluation of coping with stress, rather than on patients' needs. Twenty-two groups of 15 nurses each worked with pre-trained group leaders on the following issues: causes and origins of stress; coping strategies and mechanisms; feelings and emotions accompanying the different coping strategies; suggestions and alternatives for improving coping skills. The group process also included experiential exercises. Analysis of the nurses' coping strategies in relation to staff, patients and their families, and work-related issues suggests four distinct coping modes. Nurses' overall responses were positive and emphasized practical benefits for future work.     

Osteonecrosis of the jaw in patients treated with denosumab: A multicenter case series

Purpose

Osteonecrosis of the jaw has been recently reported in patients receiving denosumab for the treatment of metastatic bone disease and osteoporosis. It is essential to investigate this disease as a new osteonecrosis entity in order to recognize its optimal management strategies.

Comparison of the bactericidal effect of cold atmospheric pressure plasma (CAPP), antimicrobial photodynamic therapy (aPDT), and polihexanide (PHX) in a novel wet surface model to mimic oral cavity application

Purpose

Cold atmospheric pressure plasma (CAPP) is increasingly used for medical applications. The first devices are available from commercial manufactures, promising to improve wound healing and disinfection. The underlying antimicrobial mechanisms of CAPP are discussed, while the first results on its bactericidal efficiency against common bacterial species have already been published, with promising results. Most of the plasma sources used in these studies were built by the investigators themselves, and are not commercially available or licensed for clinical use. To evaluate the postulated bactericidal effects in clinical practice, we studied a commercially available, ready-to-use CAPP-device, which is also designed to be used in the field of dental, oral, and maxillofacial treatment.

Monocyte function in rheumatoid arthritis

Monocytes derived from peripheral blood of patients with rheumatoid arthritis (RA) had a marked defect in their bactericidal activity against Staphylococcus albus and Listeria monocytogenes; whereas the phagocytic capacity of monocytes from RA patients for both Staph. albus and Shigella flexneri was similar to that of monocytes from healthy subjects. There were no significant differences between the patient and control groups with regard to antibody dependent cellular cytotoxicity (ADCC) of monocyte against antibody-coated EL4 leukemia tumor cells. No correlation was observed between the rheumatoid factor (RF) titer in the serum of RA patients and the ADCC capacity of their monocytes. The ADCC of normal monocytes was reduced markedly following their incubation with serum from RA patients. It suggested that the defect in bactericidal activity in monocytes from RA patients may explain, at least in part, the susceptibility of RA patients to infections.