Creutzfeldt-Jakob disease presenting as refractory nonconvulsive status epilepticus

A 70-year-old woman was admitted to the intensive care unit with refractory nonconvulsive status epilepticus. Extensive evaluation including neuroimaging and cerebrospinal fluid examination was unrevealing. Brain biopsy revealed spongiosis, and prion disease was confirmed by immunostaining, providing the diagnosis of Creutzfeldt-Jakob disease.     

Patients' understanding of cardiac risk factors: a point-prevalence study

A 1-day point-prevalence study was conducted in our 141-bed tertiary cardiac care hospital in order to determine our patients' and their significant others' level of understanding of cardiac risk factors in general and of the patients' personal cardiac risk factors. There were 3 parts to the study: patient interviews, significant other (SO) interviews, and an audit of the participating patients' charts. Of the 87 patients who were able to participate, 71 completed the interviews as did 53 significant others. From recall, only 14 patients and 11 significant others were able to define what a cardiac risk factor was ("Habits or factors that contribute to heart disease") and they were unable to identify many general risk factors. However, when given a recognition task where cardiac risk factors were interspersed with sham factors, the overall mean general knowledge score was 13.6 for patients and 13.9 for significant others out of 16. The correlation between the patients' understanding of their cardiac risk factors and the significant others' understanding of them was reasonably good (r = 0.58, P < .0001), as was the correlation between the SOs' understanding and the charts (r = 0.58, P < .0001). There was less agreement between the patients' understanding and the chart documentation of cardiac risk factors (r = 0.36, P < .01). The findings of this study have implications for patient teaching as well as for documentation of cardiac risk factors.     

An intensive education programme for people with type 1 diabetes

In the year 2000, approximately 330,000 people in the UK had been diagnosed with type 1 diabetes (Williams and Pickup, 2000), and this number is growing yearly. It is usually diagnosed in children and young adults although it can occur at any age. The onset of diabetes is usually sudden and results from destruction of the insulin-producing cells of the pancreas leading to a total loss of insulin secretion. Insulin injections and dietary modification are necessary treatments after diagnosis. Some patients find these changes difficult--a case study used in this article Illustrates the challenges they face.     

Implications of and treatment options for retinal detachment

The retina is a complex structure that turns light falling onto it via a chemical reaction into nerve impulses, which then travel to the brain for interpretation into images. If the retina is damaged or moved from its correct location, a person's ability to interpret the world is compromised with all the physical, social and psychological effects this implies. Nurses have a key role in the recognition of signs and symptoms of retinal compromise as well as the care and treatment of patients who undergo therapy for retinal detachment, so that the best possible vision is achieved for each patient.     

Cataract: the role of nurses in diagnosis, surgery and aftercare

Cataract is a condition that affects many older people and causes reduced vision, contributing to a reduced quality of life. The whole cataract 'episode', from recognition to surgery and aftercare is described, together with the role that nurses play in the care of patients with cataract.     

The Loss Inventory: preliminary reliability and validity data for a new measure of emotional and cognitive responses to disability

PURPOSE: To examine the utility, reliability and validity of a new scale, The Loss Inventory (LI) for measuring symptoms unique to grief following disablement. METHODS: Prospective survey study in which two self-report measures, the LI and Zung Self-Rating Depression Scale, were administered to 103 hospitalized rehabilitation patients. Correlational analyses, t tests, t score conversions of raw data, and analysis of variance used to determine reliability (internal consistency) of the LI and compare means of scores across several variables. RESULTS: Cronbach's Alpha=0.90 for the LI. The Zung and the LI correlated 0.59 but study subjects were significantly (p<0.001) more likely to score higher on the LI than on the Zung. Certain LI items were significantly more frequently endorsed by depressed patients. Significant gender and ethnic differences were found. CONCLUSIONS: Rehabilitation patients sampled in this study were no more likely to be depressed than most people. Grief symptoms reported following functional losses are similar to those reported by persons who have experienced the death of someone close. The Loss Inventory reliably measures these grief symptoms. Gender and ethnicity affect the manner in which grief symptoms are reported. The LI may improve mental health clinicians' diagnostic accuracy in rehabilitation and medical settings.     

Mouse manipulation through single-switch scanning

Given the current extensive reliance on the graphical user interface, independent access to computer software requires that users be able to manipulate a pointing device of some type (e.g., mouse, trackball) or be able to emulate a mouse by some other means (e.g., scanning). The purpose of the present study was to identify one or more optimal single-switch scanning mouse emulation strategies. Four alternative scanning strategies (continuous Cartesian, discrete Cartesian, rotational, and hybrid quadrant/continuous Cartesian) were selected for testing based on current market availability as well as on theoretical considerations of their potential speed and accuracy. Each strategy was evaluated using a repeated measures study design by means of a test program that permitted mouse emulation via any one of four scanning strategies in a motivating environment; response speed and accuracy could be automatically recorded and considered in view of the motor, cognitive, and perceptual demands of each scanning strategy. Ten individuals whose disabilities required them to operate a computer via single-switch scanning participated in the study. Results indicated that Cartesian scanning was the preferred and most effective scanning strategy. There were no significant differences between results from the Continuous Cartesian and Discrete Cartesian scanning strategies. Rotational scanning was quite slow with respect to the other strategies, although it was equally accurate. Hybrid Quadrant scanning improved access time but at the cost of fewer correct selections. These results demonstrated the importance of testing and comparing alternate single-switch scanning strategies.     

The spirit feather: an ecologically based celebration of life

The final moments of a life pose a special and very important time for all participants. Sensitive arrangement of events can provide harmony and a peaceful and memorable transition event. A specific situation, in which a feather is used to symbolize the transition, is reported. Hospice programs can offer ecologically based celebration of life and provide a positive transition for patients, families, friends, and staff.