Nurse prescribing in low-resource settings: professional considerations

AIM: This paper reviews the professional issues relating to nurse prescribing in low-resource countries. BACKGROUND: In order to meet community healthcare need, nurses in low-resource settings often perform roles such as prescribing medication, for which they may not have had adequate training, often in the absence of supervision, legislation and regulation. In general, however, there is a paucity of published evidence relating to nurse prescribing in low-resource settings. Several studies have demonstrated improved health and social outcomes resulting from nurse-prescribing interventions. Alternatively, other studies have shown unsatisfactory nurse-prescribing patterns, such as overuse of antibiotics and poor adherence to national treatment guidelines. There are several examples of how nurse prescribing in low-resource countries has been recognized and addressed at national level; these are discussed in detail. However, given that it is widely acknowledged how crucial nurses are for the delivery of health care in regions where there are no medical personnel, international policy and guidance relating to this issue is only just beginning to acknowledge and address the relevant issues. CONCLUSION: Where there is a need for nurses to extend their role in the ordering of medicines and other treatments, the responsibilities, training, rights and roles of these nurses need to be clearly defined and recognized at all levels of the health service. There is a need for rigorous evaluations incorporating health, social and economic outcomes of nurse-prescribing interventions, in addition to close monitoring of legislative and regulatory changes related to nursing roles.     

Natural cycle in-vitro fertilization in couples with unexplained infertility: impact of various factors on outcome

This study evaluated outcome in 117 couples with unexplained infertility who underwent 162 attempts at natural cycle in-vitro fertilization (NIVF) between 1991 and 1993. An egg was obtained in 138 cycles and a single embryo was transferred in 89 cycles. There were 16 implantations (four biochemical pregnancies, three clinical abortions and nine live births). The implantation rate per embryo was 16/89 (18.0%), which translated into a live birth rate per egg collection of 9/138 (6.5%). The impact factors that were assessed included oocyte quality, sperm quality, embryo quality and woman's age. The outcome measures used were fertilization/inseminated egg and implantation/replaced embryo. All embryo transfers were of single embryos. We conclude that, in couples with unexplained infertility, outcome following NIVF is affected by both egg and sperm quality and by the age of the woman. Embryo quality was independent of the above factors but was also critical for successful implantation.      

Pituitary tumour apoplexy within prolactinomas in children: a more aggressive condition?

Objectives

To evaluate clinical presentations, diagnosis and management of paediatric patients presenting with pituitary apoplexy.

Methods

A retrospective case series describing a cohort of paediatric patients presenting with this condition from 2010–2016 to a tertiary referral children’s hospital in the United Kingdom.

Results

Pituitary apoplexy is a rare condition that seems to have a higher relative incidence in children than adults. Our series suggests that pituitary apoplexy in paediatric patients with adenomas appears more common than previously described. All our patients required surgery, either as an acute or delayed procedure, for visual compromise. Two patients had commenced growth hormone (GH) for GH deficiency two weeks prior to the onset of pituitary apoplexy.

Conclusions

With only a limited number of published case reports surrounding this topic our case series contributes to help further understand and manage this condition.

     

Emergency Physicians'' Perspectives on Smallpox Vaccination

OBJECTIVE: To evaluate emergency physician (EP) attitudes toward smallpox vaccination, the treatment of patients with suspected smallpox, and the threat of a bioterrorist attack. METHODS: This was a prospective study utilizing a standardized survey instrument that was distributed on November 16, 2002, and collected by February 1, 2003. EPs from a sample of 50 accredited emergency medicine programs were surveyed regarding their perspectives on smallpox vaccination. RESULTS: A total of 989 surveys were collected from 42 emergency medicine programs. Of the respondents, 43.4% would currently volunteer for smallpox vaccination. EPs previously vaccinated against smallpox were 1.46 times more likely to volunteer for vaccination (95% CI = 1.14 to 1.93). EPs who believed they were at risk for complications were less than half as likely to volunteer for vaccination. EPs who perceived a significant risk of a bioterrorist attack were 2.7 times more likely to volunteer for the vaccine compared with those who thought the risk was minimal (95% CI = 2.06 to 3.47). Of the respondents, 34.4% believed the risks of the vaccination outweighed the benefits, 33% did not, and 32.6% were unsure. CONCLUSIONS: Currently, fewer than half of EPs surveyed would volunteer for smallpox vaccination. Factors associated with a willingness to be vaccinated include previous smallpox vaccination and the perceived threat of a bioterrorist attack. The variation in EP attitudes toward smallpox vaccination may be due to uncertain risk-to-benefit ratio. The opinions and actions of EPs may be influential on current and future government policy and public opinion.