Community home-based care in a rural village: challenges and strategies.

In Botswana, there has been an increase in community home-based care (CHBC) following a shift from hospital care to CHBC because of the HIV/AIDS epidemic. Yet the health care system has limited resources. To fulfill one of the terms of reference of the World Health Organization Collaboration Centre at the Department of Nursing, University of Botswana, an outreach program was developed in collaboration with 18 lay volunteers in a nearby village, Mmopane. This article discusses the process of establishing the CHBC committee and the challenges faced by faculty, students, and lay caregivers in working with a diverse CHBC group to render culturally sensitive care. Strategies for dealing with these challenges are discussed.     

Physical activity patterns in chronic hemodialysis patients: comparison of dialysis and nondialysis days.

OBJECTIVE: To determine physical activity patterns in chronic hemodialysis patients with a specific emphasis on the difference between dialysis and nondialysis days. Design A cross-sectional single-center study. SETTING: Vanderbilt University Outpatient Dialysis Unit. PATIENTS: Twenty current chronic hemodialysis patients: 10 male, 10 female; 15 black, 5 white; mean age, 50.1 +/- 9.9 years; height, 164.5 +/- 10.9 cm; weight, 82.5 +/- 15.4 kg; length on dialysis, 57.3 +/- 45.3 months. METHODS: Minute-by-minute physical activity was assessed over a 7-day period using a triaxial accelerometer, which consists of raw numbers or counts calculated by the 3 axes of the accelerometer (PA counts). PA counts were extrapolated on a daily and hourly basis. Physical functioning tests included: sit-to-stand, 6-minute walk, and 1-repetition maximal leg press exercise. Laboratory values for serum concentrations of albumin, prealbumin, C-reactive protein, and cholesterol were also collected. MAIN OUTCOME MEASURE: PA counts. RESULTS: Total PA counts were significantly lower on dialysis days when compared with nondialysis days (128,279 +/- 74,009 versus 168,744 +/- 95,168, respectively, P = .025). The average PA counts during the 4-hour dialysis time period were significantly lower on dialysis days when compared with nondialysis days (3,086 +/- 3,749 versus 11,070 +/- 7,695, respectively, P = .001). At postdialysis hours 1 and 2, PA counts on dialysis days were significantly higher than on nondialysis days (11,410 +/- 5,340 versus 9,082 +/- 6,646, P = .008, and 14,048 +/- 9,728 versus 8,662 +/- 6,433, P = .016, respectively). By postdialysis hour 4, PA counts on dialysis days had significantly decreased when compared with nondialysis days (6,068 +/- 6,268 versus 10,512 +/- 7,420 PA counts, P = .01, respectively). From postdialysis hours 5 to 20, there was no significant difference in PA counts between dialysis and nondialysis days. CONCLUSION: This study shows that physical activity is lower on dialysis days when compared with nondialysis days, and this decrease is caused by the lack of activity during the 4-hour hemodialysis procedure. New behavior modification strategies involving physical activity, both during hemodialysis and on nondialysis days, must be examined in this patient population.     

'SOUND'AND THE 'SENSE'OF SOUND IN THE THERAPEUTIC RELATIONSHIP: A FACTOR IN THE MECHANISM OF PROJECTIVE IDENTIFICATION

ABSTRACT This paper will discuss the dual nature of sound and explore its effects in the therapeutic relationship. I will begin by looking at the auditory sensory perception of sound and its role in the development of the infant, our perception of the world, the self and others. I will then focus on the objective, physiological nature of sound in an attempt to answer some of the questions raised in my own mind about the possibility of this playing a vital role in our subjective experience of being with patients, with particular reference to the phenomenon of projective identification.     

Diagnosis of fetal hydronephrosis in utero using ultrasound

Detection of fetal hydronephrosis in utero, subsequent investigation, and surgical treatment is described. With the increasing use of ultrasound for obstetrical problems and greater experience with fetal sonography, more urologic abnormalities will be diagnosed prenatally.     

Does the Amygdala Mediate Anesthetic-induced Amnesia?: Basolateral Amygdala Lesions Block Sevoflurane-induced Amnesia

Background: Amnesia for aversive events caused by benzodiazepines or propofol depends on the basolateral amygdala (BLA). Whether the amnesia of volatile anesthesia is also mediated through the BLA is unknown. If so, a general principle of anesthetic-induced amnesia may be emerging. Here, using an inhibitory avoidance paradigm, the authors determine whether BLA lesions prevent sevoflurane-induced amnesia.

Methods: Male Sprague-Dawley rats were separated into two groups: sham-operated controls (n = 22) and rats given bilateral N-methyl-d-aspartate lesions of the BLA (n = 32). After a 1-week recovery, the rats were randomly assigned to be trained during either air or sevoflurane (0.3% inspired, 0.14 minimum alveolar concentration) exposure. Animals learned to remain in the starting safe compartment of a step-through inhibitory avoidance apparatus for 100 consecutive seconds by administering foot shock (0.3 mA) whenever they entered an adjacent shock compartment. Memory was assessed at 24 h. Longer latencies to enter the shock compartment at 24 h imply better memory.

Results: Sham-air (n = 10) animals had a robust memory, with a median retention latency of 507 s (interquartile range, 270-600 s). Sham-sevoflurane (n = 6) animals were amnesic, with a latency of 52 s (27-120 s) (P < 0.01, vs. sham-air). Both the air-exposed (n = 5) and the sevoflurane-exposed (n = 8) animals with BLA lesions showed robust memory, with latencies of 350 s (300-590 s) and 378 s (363-488 s), respectively. The latencies for both did not differ from the performance of the sham-air group and were significantly greater than the latency of the sham-sevoflurane group (both P < 0.01).