Does the taught content of care planning live up to mental health student nurses experiences and perceptions of practice?

Care planning should be a collaboration between the service user, caregivers and the relevant professionals. It is based on recovery principles, where clients identify their goals and how to work to reach them, rather than concentrating on illness, symptoms and problems. Mental health nursing students were taught the theory but observed that, in their clinical placements, this approach was often not followed in practice. These issues were explored in two teaching sessions with six students. Subsequent focus groups were recorded, transcribed and analysed, yielding four main themes: care planning custom and practice, collaboration, organisational culture and student assumptions about their mentors. Participants detailed how care planning might not be person-centred in practice. It was suggested that this might be due to clinical customs, strains and restrictions, lack of collaboration between service users and the multidisciplinary team, and inept organisational culture. The main challenge for services has been how to manage risk as well as the person-centred approach, and the ‘competing dilemmas associated with care-versus-control issues’.

Community-Acquired Pneumonia in Sub-Saharan Africa

Community-acquired pneumonia (CAP) in sub-Saharan Africa is a common cause of adult hospitalization and is associated with significant mortality. Human immunodeficiency virus (HIV) prevalence in the region leads to differences in CAP epidemiology compared with most high-income settings: patients are younger, and coinfection with tuberculosis and opportunistic infections is common and difficult to diagnose. Resource limitations affect the availability of medical expertise as well as radiological and laboratory diagnostic services. These factors impact on key aspects of health care, including pathways of investigation, severity assessment, and the selection of empirical antimicrobial therapy. This review summarizes recent data from sub-Saharan Africa describing the burden, etiology, risk factors, and outcome of CAP. We describe the rational and context-appropriate approach to CAP diagnosis and management, including supportive therapy. Priorities for future research to inform strategies for CAP prevention and initial management are suggested

A brilliant thing...just doing my own little bit

It’s almost impossible to go to the doctor or open a newspaper without being told that physical exercise is good for us. The World Health Organisation (WHO 2010) says that regular, moderate intensity physical activity can have significant health benefits, such as reducing the risk of cardiovascular disease, diabetes, colon and breast cancer, and depression. But there is also evidence that exercise can have more specific health benefits for people with dementia, for example by improving quality of life, neurocognitive function and affective symptoms (mood), and that it can possibly influence the rate of cognitive decline (Erikson 2011; Scarmeas et al 2011). This led to a collaboration between the Liverpool-based exercise service Liveability and a European research project called Innovate Dementia to evaluate the role of exercise for people with dementia. Liveability is a NHS nurse-led award winning service which provides instructor-led exercise classes and gym sessions to the over-50s in the south of the city. In general, Liveability is designed to deliver health messages, increase physical activity and reduce social isolation by offering structured exercise classes followed by opportunities for social interaction between participants. In the dementia collaboration, the key aim was to increase access to Liveability for people living with the condition and to enable them to take a full part in the programme

The whole blood phagocytosis assay: a clinically relevant test of neutrophil function and dysfunction in community-acquired pneumonia.

ObjectiveTo refine and validate a neutrophil function assay with clinical relevance for patients with community-acquired pneumonia (CAP).DesignTwo phase cross-sectional study to standardise and refine the assay in blood from healthy volunteers and test neutrophil phagocytic function in hospital patients with CAP.ParticipantsPhase one: Healthy adult volunteers (n = 30). Phase two: Critical care patients with severe CAP (n = 16), ward-level patients with moderate CAP (n = 15) and respiratory outpatients (no acute disease, n = 15).ResultsOur full standard operating procedure for the assay is provided. Patients with severe CAP had significantly decreased neutrophil function compared to moderate severity disease (median phagocytic index 2.8 vs. 18.0, p = 0.014). Moderate severity pneumonia neutrophil function was significantly higher than control samples (median 18.0 vs. 1.6, p = 0.015). There was no significant difference between critical care and control neutrophil function (median 2.8 vs. 1.6, p = 0.752).ConclusionsOur whole blood neutrophil assay is simple, reproducible and clinically relevant. Changes in neutrophil function measured in this pneumonia cohort is in agreement with previous studies. The assay has potential to be used to identify individuals for clinical trials of immunomodulatory therapies, to risk-stratify patients with pneumonia, and to refine our understanding of 'normal' neutrophil function in infection

Do third-year mental health nursing students feel prepared to assess physical health?

Background The life expectancy for people with mental health issues is significantly lower than the general population, however, their physical health needs are often unrecognised by health professionals. Aim To investigate whether third-year mental health nursing students are clinically prepared to undertake a pre-defined set of physical health checks. Method A 34-item questionnaire was completed by two cohorts of mental health nursing students in their third and final year. Participants self-reported on their competence to assess a range of physical health checks. 37 questionnaires were completed and analysed. Findings Three groups emerged: group 1 – 100% of students self-declared competence in assessments including temperature and pulse, group 2 – more than 50% of students self-declared competence in assessments including urinalysis and pulse oximetry, and group 3 – less than 50% of students self-declared competence in taking electrocardiograms and using the hydration assessment tool. Conclusion The student participants of this study were not adequately prepared to undertake a complete range of physical health assessments for people with mental health issues

Human Immunodeficiency Virus-Associated Chronic Lung Disease in Children and Adolescents in Zimbabwe: Chest Radiographic and High-Resolution Computed Tomographic Findings.

Background: Chronic respiratory symptoms are common among children living with human immunodeficiency virus (HIV). We investigated the radiological features of chronic lung disease in children aged 6-16 years receiving antiretroviral therapy for ≥6 months in Harare, Zimbabwe. Methods: Consecutive participants from a HIV clinic underwent clinical assessment and chest radiography. Participants with an abnormal chest radiograph (assessed by a clinician) and/or those meeting a clinical case definition for chronic lung disease underwent high-resolution computed tomography (HRCT). Radiological studies were scored independently and blindly by 2 thoracic radiologists. Relationships between radiological abnormalities and lung function were examined. Results: Among 193 participants (46% female; median age, 11.2 years; interquartile range, 9.0-12.8 years), the median CD4 cell count was 720/µL (473-947/µL), and 79% had a human immunodeficiency virus (HIV) load of <400 copies/mL. The most common chest radiographic finding was ring/tramline opacities (55 of 193 participants; 29%). HRCT scans were evaluated in 84 participants (69%); decreased attenuation (present in 43%) was the dominant abnormality seen. The extent of decreased attenuation was strongly correlated with both the severity and extent of bronchiectasis (rs = 0.68 and P < .001 for both). The extent of decreased attenuation was also negatively correlated with forced expiratory volume in first second of expiration (rs = -0.52), forced vital capacity (rs = -0.42), and forced expiratory flow, midexpiratory phase (rs = -0.42) (P < .001 for all). Conclusions: The HRCT findings strongly suggest that obliterative bronchiolitis may be the major cause of chronic lung disease in our cohort. Further studies to understand the pathogenesis and natural history are urgently needed