Clinical study of nail changes in leprosy and comparison with nail changes in diabetic patients

Background Nail changes in leprotic patients are not specific to leprosy, and may be observed in other peripheral neuropathies. Diabetes is one of the diseases that present with nail dystrophy secondary to peripheral neuropathy, vasculopathy, trauma and infections. Therefore, nail changes in diabetic neuropathy are expected to be very similar to that of leprosy. Objectives To evaluate the frequency and pattern of nail changes in Egyptian leprotic patients with the different spectrums of the disease, and to compare nail changes in leprosy with those seen in patients with diabetic neuropathy. Methods The study included 115 leprosy patients and 60 patients with diabetic peripheral neuropathy. Nail examination was thoroughly carried out and various nail changes were recorded including the location of the involved nails (fingers, toes). Results Our study detected similar incidence of nail changes in both multibacillary (MB) (86%) and paucibacillary (PB) patients (86%). Flag sign (alternating horizontal bands of whitish and pinkish discoloration of the nail) observed in our study was not reported before. It was more commonly seen in MB patients (21%) than in PB patients (14%). Our results also revealed that the nail changes were more commonly seen in leprosy patients (86%) than in diabetic patients (68%). Conclusion Nail changes in leprosy are multifactorial, and could be related to one or more of the following: neuropathy, endarteritis, trauma, drugs or superimposed infections. Nail changes in leprosy may be used as an additional clue that helps in the diagnosis.     

Lamp light on leadership: clinical leadership and Florence Nightingale

stanley d. & sherratt a. (2010) Journal of Nursing Management  18, 115–121
Lamp light on leadership: clinical leadership and Florence Nightingale Aims The purpose of the present study was to use the example of Florence Nightingales’ nursing experience to highlight the differences between nursing leadership and clinical leadership with a focus on Miss Nightingales’ clinical leadership attributes. Background 2010 marks the centenary of the death of Florence Nightingale. As this significant date approaches this paper reflects on her contribution to nursing in relation to more recent insights into clinical leadership. Evaluation Literature has been used to explore issues related to nursing leadership, clinical leadership and the life and characteristics of Florence Nightingale. Key issues There are a few parts of Florence’s character which fit the profile of a clinical leader. However, Miss Nightingale was not a clinical leader she was a powerful and successful role model for the academic, political and managerial domains of nursing. Conclusion There are other ways to lead and other types of leaders and leadership that nursing and the health service needs to foster, discover and recognize. Implications for nursing management Clinical leaders should be celebrated and recognized in their own right. Both clinical leaders and nursing leaders are important and need to work collaboratively to enhance patient care and to positively enhance the profession of nursing.     

Sports-related muscle injuries: evaluation with MR imaging

Sports-related muscle pain is frequent in both trained and untrained persons; however, its severity and significance may be difficult to assess clinically. The authors used magnetic resonance (MR) imaging to evaluate acute strains and delayed-onset muscle soreness in sedentary subjects and postmarathon myalgia in trained runners. MR imaging documented the distribution of affected muscles and the absence of focal hematoma, fascial herniation, subsequent fibrosis, and fatty infiltration. Pain associated with strain and that occurring several days after exercise were both associated with prolongation of muscle T1 and T2. In a prospective evaluation of delayed-onset muscle soreness, abnormalities depicted at MR imaging persisted longer than symptoms by up to 3 weeks, indicating that MR imaging is sensitive to tissue alteration that is not apparent clinically. Highly trained marathon runners tended to have relatively mild abnormalities involving the myotendinous junctions.     

The Importance of Mode of Birth After Previous Cesarean: Success,Satisfaction, and Postnatal Health

Introduction: The recent National Institutes of Health consensus conference on vaginal birth after cesarean (VBAC) recommended a focus on strategies that increase women's opportunities to make informed choices about VBAC. This study aimed to expand knowledge of women's experiences of planned VBAC by focusing on postnatal experiences of women who participated in an Australian birth‐after‐cesarean study. Methods: At 6 to 8 weeks after birth, 165 women who experienced childbirth after a previous cesarean rated satisfaction with their birth experiences using a 10‐point visual analogue scale, reported on postnatal health problems, and indicated whether they would make the same birth choice again. Results: Significant differences were found in satisfaction scores by mode of birth. Mean scores out of a possible score of 10 ranged from 8.86 for spontaneous vaginal birth, 7.86 for elective repeat cesarean delivery, 6.71 for emergency cesarean delivery, to 6.15 for instrumental vaginal birth (F= 5.33; P= .002). Mean satisfaction scores for spontaneous vaginal birth and elective repeat cesarean delivery were statistically higher than for instrumental vaginal birth and emergency cesarean birth. Women who experienced instrumental vaginal birth and emergency cesarean birth also reported a higher number of postnatal health‐related problems and were least likely to agree that they would make the same birth choice again. Discussion: Mode of birth was the most important determinant of postnatal satisfaction, postnatal health, and whether women felt they would make the same birth choice again. Clinicians, researchers, and policymakers should identify effective labor management practices that enhance women's opportunities to achieve spontaneous vaginal birth during planned VBAC.     

Perineal Injury in Nulliparous Women Giving Birth at a Community Hospital: Reduced Risk in Births Attended by Certified Nurse‐Midwives

Introduction : Our objective was to determine if there is a difference in rates of perineal injury sustained by nulliparous women attended by obstetricians compared with certified nurse‐midwives (CNMs) at a US community hospital. Methods : We analyzed retrospective data for 2819 women who spontaneously gave birth to singleton, vertex, term, live infants between 2000 and 2005. The independent variable was attendant type (obstetrician or CNM). The main outcome variables were intact perineum, episiotomy, and spontaneous perineal lacerations. Multivariate logistic regression was used to adjust for six potential confounders: macrosomia, maternal age, epidural anesthesia, oxytocin administration, medical insurance status, and ethnicity. Results : The odds ratios (ORs) for obstetrician‐attended births versus CNM‐attended births were significant for a spontaneous minor perineal laceration versus intact perineum (OR = 1.82; 95% confidence interval [CI], 1.33–2.48), spontaneous major laceration versus intact perineum (OR = 2.29; 95% CI, 1.13–4.66), and episiotomy use versus no perineal injury, with or without extension (OR = 2.94; 95% CI, 2.01–4.29). Discussion : We found that the prevalence and severity of perineal injury, both spontaneous and from episiotomy use, were significantly lower in CNM‐attended births. J Midwifery Womens Health 2010;55:243–249 c̊ 2010 by the American College of Nurse‐Midwives.     

Perinatal Outcomes of Women Intending to Give Birth in Birth Centers in Australia

Abstract: Background: A recent Australian study showed perinatal mortality was lower among women who gave birth in a birth center than in a comparable low‐risk group of women who gave birth in a hospital. The current study used the same large population database to investigate whether perinatal outcomes were improved for women intending to give birth in a birth center at the onset of labor, regardless of the actual place of birth. Methods: Data were obtained from the National Perinatal Data Collection (NPDC) in Australia. The study included 822,955 mothers who gave birth during the 5‐year period, 2001 to 2005, and their 836,919 babies. Of these, 22,222 women (2.7%) intended to give birth in a birth center at the onset of labor. Maternal and perinatal factors and outcomes were compared according to the intended place of birth. Data were not available on congenital anomalies, or cause, or timing of death. Results: Women intending to give birth in a birth center at the onset of labor had lower rates of intervention and of adverse perinatal outcomes compared with women intending to give birth in a hospital, including less preterm birth and low birthweight. No statistically significant difference was found in perinatal mortality for term babies of mothers intending to give birth in a birth center compared with term babies of low‐risk women intending to give birth in a hospital (1.3 per 1,000 births [99% CI = 0.66, 1.95] vs 1.7 per 1,000 births [99% CI = 1.50, 1.80], respectively). Conclusions: Term babies of women who intended to give birth in a birth center were less likely to be admitted to a neonatal intensive care unit or special care nursery, and no significant difference was found in other perinatal outcomes compared with term babies of low‐risk women who intended to give birth in a hospital labor ward. Birth center care remains a viable option for eligible women giving birth at term. (BIRTH 37:1 March 2010)