Bulimia A Review of Nutritional and Health Behaviors

Nurses working with adolescents need an understanding of the clinical syndrome of bulimia in order to identify individuals at risk for this disorder and implement preventive and therapeutic interventions. The epidemiology, early precipitants, physiology, and biochemistry of bulimia nervosa are reviewed. From this integrated framework, implications for treatment are explored with an emphasis on holistic nursing care including health education.     

Education of nurse practitioners in academic nurse-managed centers: student perspectives

Clinical experiences for advanced practice nurses are increasingly a challenge. Finding settings that demonstrate primary care nursing practice in its finest form can be difficult. This article reports on nurse practitioner (NP) student feedback on clinical placements in the academic nurse-managed centers (ANMCs) associated with four Michigan schools or colleges of nursing. Student feedback was solicited over three years through site and preceptor evaluation tools and focus groups. Students were overwhelmingly satisfied with their experience in ANMCs. Being mentored by an NP preceptor in an ANMC was a valuable experience for students. They valued the role modeling of the NP and the quality of their preceptors' instruction. Students stated that the nursing model of care to which they were exposed was congruent with classroom learning. They reported learning to apply an understanding of their patients' economic, social, and cultural situations to treatment decisions and patient-education efforts and learning to understand the role of community-based care. One limitation of ANMCs from the students' perspective was a relatively low volume of patients, particularly in the initial years. However, the benefit of having time to spend with clients and to reflect on clinical practice was also articulated.     

Nursing home resuscitation policies and practices for residents without DNR orders

The purpose of this study was to explore the policies and practices of nursing homes with respect to the resuscitation of residents who do not have a do-not-resuscitate (DNR) order. Responses from a survey of 36 facilities revealed that most residents had DNR orders and most facilities were capable of providing basic cardiopulmonary resuscitation (CPR). Less than 30% had performed CPR in the past 6 months, and 22.8% had no written CPR policies. More facilities required CPR in witnessed arrests of non-DNR residents (79.3%) than in unwitnessed arrests (24%). Methods for identifying CPR status need improvement to enable accurate identification and prompt resuscitation of residents who want CPR.     

Psychosocial Aspects of Injured Workers’ Returning to Work (RTW) in Hong Kong

Introduction: This study was designed to explore the psychosocial aspects of injured workers, their self-perceived capacity and how these factors influence their success in Return To Work (RTW). Method: Seventy-five subjects were recruited from the Hong Kong Workers’ Health Centre and were assessed on three occasions consisting of interviews and four self-rated instruments including the Chinese Lam’s Assessment of Employment Readiness (C-LASER), the SF-36 health survey, the Chinese State Trait and the Anxiety Inventory (C-STAI). Results: Results showed that the contemplation and pre-contemplation sub-scores of C-LASER appeared to be the determining factors in predicting subjects’ return-to-work status. Subjects who were more “ready for action” (the Actioners) were found to have significantly higher confidence and advocacy in job seeking than the Pre-Contemplators. Their employment readiness was shown to be affected by psychosocial factors such as perceived functioning and bodily pain, Discussion: From this study, the injured workers’ employment readiness appeared to associate with their RTW outcomes. Further studies would be needed to find out how the employment readiness of injured workers could be enhanced.     

意识障碍患者发生鼻蝇蛆病1例及文献复习

鼻蝇蛆病是一种较为罕见的寄生虫病,蝇蛆在鼻腔内生长对鼻腔、鼻窦造成损伤,一旦移行,会导致眼、颅腔等周围结构受损,妥善治疗和积极防控才能减少和避免严重并发症的出现.2020年5月14日中南大学湘雅医院收治的1例脑梗死昏迷患者发生了鼻蝇蛆病.该患者在治疗原发病的过程中,发现感染了蝇蛆.给予脱水降颅压、护脑、控制血糖和血压、抗感染等,积极治疗原发疾病,对鼻腔进行了鼻内镜检查/取虫、鼻腔冲洗等以治疗鼻蝇蛆病,然后对患者进行了妥善安置和隔离防控,以防止蝇蛆病在病区内播散.入院第16天后,患者神志恢复,鼻腔内未再发现虫体,病情好转出院.随访6个月,患者鼻腔未再发现蝇蛆,未诉鼻腔不适,收治病区无患者及医务人员感染蝇蛆.蝇蛆病重在预防,应当积极采取措施以降低社区及医院感染的风险.     

Specificity of the helper T cell for the cytolytic T lymphocyte response to influenza viruses

We have described a model system in which helper T cells are required to mount a primary antiviral cytolytic T lymphocyte response. The radioresistant helper cell can be found in the spleens of mice that have been immunized subcutaneously with influenza viruses 6-8 d previously. These helper cells appear to be type specific but cross-reactive among the subtypes of influenza A viruses. The phenotypes of the interacting cell populations were determined.     

Frequent Users of the Emergency Department: Can We Intervene?

Objective: To determine whether the use of individualized patient care plans and multidisciplinary case management would decrease ED utilization by frequent ED users.
Methods: The authors performed a prospective, randomized clinical trial of the impact of a care plan on ED use by adults with frequent ED visits. Patients with >10 ED visits to a university hospital in 1993 were identified. Patients were matched for age, sex, and number of visits and then randomized into 2 groups. The control group received standard emergency care. The treatment group was managed by a multidisciplinary team and treated in the ED according to individualized care plans. ED use was tracked at the university hospital and at the other 5 community hospitals in the city.
Results: Of the 70 enrolled patients, 25 of 37 control patients and 27 of 33 treatment patients made visits to the university hospital during the 1-year study period. Only those patients with follow-up visits were included in the data analysis. Patients remaining in the control group made 247 total visits (range 1–65) to the university hospital and 179 total visits (range 0–38) to the community hospitals during the study period. Patients in the treatment group made 320 total visits (range 1–72) to the university hospital and 254 total visits (range 0–135) to the community hospitals during the study period. There was no significant difference in the median number of visits made to either the university hospital or the community hospitals by the patients in the control group and those in the treatment group.
Conclusions: The use of individualized care plans and case management did not significantly decrease ED utilization by frequent ED users. However, the impact of individualized care plans and case management on other quality-of-care measures (e.g., patient satisfaction, ED length of stay, hospitalizations, primary care visits, and health care costs) remains to be determined.