Immune evasion by Mycobacterium tuberculosis: living with the enemy

Mycobacterium tuberculosis is successful as a pathogen because of its ability to persist in an immunocompetent host. This bacterium lives within the macrophage, a cell whose function is the elimination of microbes. Recent advances have improved our understanding of how M. tuberculosis evades two major antimicrobial mechanisms of macrophages: phagolysosome fusion and the production of toxic reactive nitrogen intermediates. M. tuberculosis also modulates antigen presentation to prevent the detection of infected macrophages by CD4(+) T cells.     

Retrospective review of the reduction of oral pressure ulcers in mechanically ventilated patients: a change in practice

Hospital-acquired pressure ulcers (HAPU) are a growing concern in patient care. Mucosal pressure ulcers (PUs) on the lips, mouth, gums, and tongue caused by oral intubation and their securement devices can be difficult to identify and prevent. In an effort to address this problem and reduce mucosal PU, implementation of an alternative securement device, the Hollister ETAD endotracheal (ET) tube securing device, in conjunction with the B&B Medical Universal Bite Block, was introduced at our institution, a level 1 trauma and burn center, in July 2007. The ETAD was later replaced by the Hollister AnchorFast ET tube securing device in December 2007. By April 2009, they became the standard devices and method used to secure oral ET tubes. We hypothesized the use of the new securement devices and bite block would lead to a decrease of HAPUs on the lips, mouth, gums, and tongue of orally intubated critical care patients because these allow for better oral assessment and ET tube manipulation to redistribute pressure. Using data collected from our electronic medical record and our HAPU incidence tracking system, we analyzed the number of PUs on the lips, mouth, gums, and tongue of orally intubated patients in our preintervention (phase 1) group compared with the data from our postintervention (phases 2 and 3) groups. A clinically significant decrease in the reported incidence of HAPUs on the lips, mouth, gums, and tongue was noted in our phases 2 and 3 groups following introduction of the ETAD, AnchorFast, and Universal Bite Block in our institution.     

Psychometric evaluation of the Spanish and English versions of the spiritual coping strategies scale

The Spiritual Coping Strategies (SCS) Scale measures how frequently religious and nonreligious (spiritual) coping strategies are used to cope with a stressful experience. This study's purpose is to evaluate the psychometric properties of the newly translated Spanish version of the SCS. A total of 51 bilingual adults completed the SCS in Spanish and English, with 25 completing them again 2-3 weeks later. Internal consistency reliability for the Spanish (r = 0.83) and English (r = 0.82) versions of the SCS in the total sample were good. Test-retest reliability was .84 for the Spanish and .80 for the English version. Spanish and English responses to the SCS items and the resulting score for the subscales and the total scale were not significantly different. Scores on the English and Spanish versions were correlated as expected with time since the stressful event and happiness with family and with spouse or partner, supporting the validity of the Spanish SCS. Study findings support the reliability and validity of the newly translated Spanish SCS.     

Moving towards a culture of inquiry

The number of inpatients with limited English proficiency is not well known in our community hospital. We wanted to identify the languages patients and nurses are comfortable using when communicating about health care needs. For this study, we surveyed a convenience sample of patients registering for hospital admission during a one-week period and nursing staff employed in the inpatient setting. The results of the surveys will help our organization better plan for the types and frequency of interpretive services required by our patients. In addition to the information gained from the research, the process allowed us to broaden the nursing research program to include multidisciplinary teams and research questions.