Staff confidence in dealing with aggressive patients: a benchmarking exercise

Interacting with potentially aggressive patients is a common occurrence for nurses working in psychiatric intensive care units. Although the literature highlights the need to educate staff in the prevention and management of aggression, often little, or no, training is provided by employers. This article describes a benchmarking exercise conducted in psychiatric intensive care units at two Western Australian hospitals to assess staff confidence in coping with patient aggression. Results demonstrated that staff in the hospital where regular training was undertaken were significantly more confident in dealing with aggression. Following the completion of a safe physical restraint module at the other hospital staff reported a significant increase in their level of confidence that either matched or bettered the results of their benchmark colleagues.     

Paraganglioma of the Cauda Equina Region – Report of two Cases and Review of the Literature

Summary  A paraganglioma of cauda equina region is extremely rare and except for secreting tumour, the pre-operative diagnosis of paraganglioma is very difficult. Two cases of non-functional paragangliomas of the cauda equina region are reported, one was attached to the filum terminale and the other to a rootlet looking very much like a vascular neurinoma. Both were successfully removed by surgery. An extensive review of the literature permits one to find 77 other cases. The clinical, radiological, pathological (ultrastructural and immunohistochemical) features and surgical findings of all theses cases are discussed. Surgery remains the treatment of choice. No effect of radiotherapy on recurrence prevention has ever been demonstrated.     

Catastrophic familial rhabdomyolysis: compartment syndrome with muscle fiber regeneration

Two reports of patients with rhabdomyolysis are described. Patient 1 was a 4-year-old-girl who had a 48-hour history of pyrexia and a 24-hour history of vomiting, drowsiness, polydipsia oliguria, and back pain. She could not walk easily because of tenderness in the calves. She was treated with furosemide and dopamine. On day 9, she was mobilized with the aid of physiotherapy. After 2 years, she tired easily but could walk normally. Patient 2 was a 3-year-old girl who had a 24-hour history of general malaise, peripheral aches and pain, and increasing drowsiness. She had severe swelling in the calves. Full-leg four compartment fasciotomies were performed on both calves. After patient 2 healed, she was observed to have muscle regeneration, which is very rare.     

Mammographic Screening Downstages Breast Carcinomas at Time of Diagnosis: A Community-Based Experience

Abstract: To determine the effectiveness of screening mammography in a community medical setting, data from a population-based, retrospective study was analyzed. Medical records of 827 patients with newly diagnosed breast cancer in California between October 1994 and March 1996 were reviewed. The primary care physician's record was abstracted for clinical history, including recommendation of screening mammography. The facility records where final diagnosis was made were abstracted for stage and treatment data. Among the patients who did not have previous screening mammography, 65.7% were diagnosed with "advanced" breast cancer (stages II, III, IV), while only 39.9% who had previous screening mammography were diagnosed with advanced breast cancer (p < 0.001). This study has reaffirmed that screening mammography of adult females generates downstaging at the time of diagnosis of breast cancer. Despite possession of a health insurance program and receiving educational materials, only 65% of patients over 50 years of age had screening mammography. As opposed to the once-a-year mailing of general reminders to all women 40 years old and older, developing a longitudinal electronic medical record in the managed care setting will support a more coordinated and individualized intervention based on age, date of last mammogram, and relative risk, among other factors. Continuing education efforts must also be directed to referring physicians, who may not yet recognize the value of screening mammography.     

Liver transplantation for metastatic hemangiopericytoma associated with hypoglycemia

We report a case of successful liver transplantation in a young man with metastatic hemangiopericytoma confined to the liver. He had a primary retroperitoneal hemangiopericytoma removed in 1982 and was diagnosed as having liver metastases 8 years later. Subsequently, he developed hypoglycemia, which did not respond to chemotherapy. Hepatectomy and transplantation resolved his hypoglycemic attacks. He remained well and symptom free for 4 years. Liver transplantation can provide effective palliation and should be considered in carefully selected patients with localized metastatic cancer.