Predicting aggressive behaviour in acute forensic mental health units: A re‐examination of the dynamic appraisal of situational aggression's predictive validity

In the present study, we explored the predictive validity of the Dynamic Appraisal of Situational Aggression (DASA) assessment tool in male (n = 30) and female (n = 30) patients admitted to the acute units of a forensic mental health hospital. We also tested the psychometric properties of the original DASA bands and novel risk bands. The first 60 days of each patient's file was reviewed to identify daily DASA scores and subsequent risk‐related nursing interventions and aggressive behaviour within the following 24 hours. Risk assessments, followed by documented nursing interventions, were removed to preserve the integrity of the risk‐assessment analysis. Receiver–operator characteristics were used to test the predictive accuracy of the DASA, and generalized estimating equations (GEE) were used to account for repeated risk assessments, which occurs when analysing short‐term risk‐assessment data. The results revealed modest predictive validity for males and females. GEE analyses suggested the need to adjust the DASA risk bands to the following (with associated odds ratios (OR) for aggressive behaviour): 0 = low risk; 1, 2, 3 = moderate‐risk OR, 4.70 (95% confidence interval (CI): 2.84–7.80); and 4, 5, 6, 7 = high‐risk OR, 16.13 (95% CI: 9.71–26.78). The adjusted DASA risk bands could assist nurses by prompting violence‐prevention interventions when the level of risk is elevated.     

Paecilomyces lilacinus eumycetoma

Eumycetoma is a chronic granulomatous infection of the skin, subcutaneous tissue, fascia, and bone caused by true fungi. Most commonly, it affects the foot or hand. Fungi commonly reported to cause eumycetoma are Madurella mycetomatis , Madurella grisea , Phialophora jeanselmei , Cephalosporium recifei , etc. There have been several previous reports of human invasive infections by Paecilomyces lilacinus causing endophthalmitis, keratitis, chronic sinusitis, skin and soft tissue infections, and catheter-related infections. We report a case of eumycetoma caused by P. lilacinus . To our knowledge, this is the first report of P. lilacinus causing eumycetoma of the foot in the English literature.     

Initiation of antiretroviral therapy in HIV‐infected adults with skin complaints in northern Tanzania

Abnormal skin findings are identified in over 90% of human immunodeficiency virus (HIV)‐infected persons globally. A prospective cohort study of HIV‐infected patients with skin complaints commencing antiretroviral therapy (ART) in northern Tanzania was undertaken. Consecutive HIV‐infected subjects presenting with skin complaints, who met criteria for ART initiation, were recruited at a Tanzanian Regional Dermatology Training Center. A single dermatologist evaluated all subjects; baseline skin biopsies were performed, and CD4⁺ cell counts and plasma HIV RNA levels were measured. All subjects received a fixed‐dose combination of stavudine, lamivudine, and nevirapine. A total of 100 subjects were enrolled; 86 subjects completed six months of follow‐up. Median baseline CD4⁺ cell counts and plasma HIV RNA levels were 120 cells/μl and 5.2 log₁₀ copies/ml. The most common dermatologic condition was papular pruritic eruption (47%). The median baseline score on the Burn Scale was 38%. After six months, 10 subjects had achieved the complete resolution of skin abnormalities. In those without complete resolution, the median Burn Scale score improved to 7%. Five patients developed new eruptions by month 3, which in two cases were attributed to drug reactions. In the 86 subjects remaining on ART after six months, the median CD4⁺ cell count had increased to 474 cells/μl, and plasma HIV RNA levels were <400 copies/ml in 85 (99%) subjects. Patients with HIV infection with skin complaints experienced marked clinical improvements following ART initiation.     

Nosocomial outbreak of hepatitis B virus infection in a pediatric hematology and oncology unit in South Africa: Epidemiological investigation and measures to prevent further transmission

Background

Hospital‐acquired hepatitis B virus (HBV) infection has been well described and continues to occur worldwide. Recent nosocomial outbreaks have been linked to unsafe injection practices, use of multi‐dose vials, and poor staff compliance with standard precautions. This report describes a nosocomial outbreak that occurred in a pediatric hematology and oncology unit of a large academic hospital, the epidemiological investigation of the outbreak, and preventive measures implemented to limit further in‐hospital transmission.

Methods

Outbreak investigation including contact tracing and HBV screening were initially carried out on all patients seen by the unit during the same period as the first three cases. Routine screening for the entire patient population of the unit was initiated in February 2013 when it was realized that numerous patients may have been exposed.

Results

Forty‐nine cases of HBV infection were confirmed in 408 patients tested between July 2011 and October 2013. Phylogenetic analysis of the HBV preC/C gene nucleotide sequences revealed that all tested outbreak strains clustered together. Most (67%) patients were HBeAg positive. The cause of transmission could not be established. Preventive measures targeted three proposed routes. HBV screening and vaccination protocols were started in the unit.

Conclusions

The high number of HBeAg positive patients, together with suspected lapses in infection prevention and control measures, are believed to have played a major role in the transmission. Measures implemented to prevent further in‐hospital transmission were successful. On‐going HBV screening and vaccination programs in pediatric hematology and oncology units should become standard of care. Pediatr Blood Cancer © 2015 Wiley Periodicals, Inc.