Empowering communities--a strategy used in Malawi

In Malawi, community health nurses and environmental health officers are helping communities to solve their own health problems. Below, the lessons learned in one district.     

Empowering GPs as purchasers

FHSAs have defined their role in purchasing primary care FHSAs have also found themselves intermediaries between district health authorities and general practitioners All of the purchasing authorities recognise the need to educate general practitioners on how to use their influence in the purchasing process General practitioners should be involved in the purchasing process as they purchase the bulk of health care; are the first point of contact for the users of the health service; need to have input on what is purchased; and need to be able to manage the changes resulting from the shift in the balance of power towards primary care The involvement of general practitioners in the purchasing process at present varies considerably among health authorities. Several district health authorities have developed models of purchasing that enable different levels of involvement     

A predischarge unit in a long-stay hospital for subnormality

A newly built residential ward in the grounds of a long-stay mental subnormality hospital was converted into a predischarge unit to cater for those patients who could probably be discharged after some special training. So far 31 residents have been trained over the past two years; 18 (58%) have been discharged to community residences, and five were waiting for discharge. The high success rate shows the value and usefulness of a predischage unit in a long-stay hospital, and also shows that a purpose-built building is not necessary so long as the staff have the initiative and will to succeed.     

Psychiatric disorder and disability in New Zealand long-stay psychiatric patients

A study was undertaken of the prevalence of physical disease, psychiatric disorder and deviant behaviour in a sample of 137 long stay psychiatric patients at Porirua Hospital near Wellington, New Zealand. Patients were in the main male, single, middle-aged to elderly and of European descent. Schizophrenia was the most common diagnosis. Psychiatric symptoms were moderately severe, the most common being unusual mannerisms and posturing, anxiety, blunted affect, tension, unusual thought content and somatic concerns. Known physical disorders were present in 66 patients. Levels of neuroleptic medication were high and tardive dyskinesia was observed in almost 60% of patients. Frequency of deviant behaviour was low in absolute terms but nonetheless problematic. The frequency of deviant behaviour was similar to those reported for British patients.     

Sex on the wards: Conundra for clinicians

Should psychiatric inpatients be allowed to engage in sexual activities? Do clinicians have a right to prevent them from doing so? If so, when may sexual interaction be restricted? What sorts of clinical issues and problems are posed for nursing staff, and how should psychiatrists and administrators respond to these? These and related questions have received little attention from either medical or legal scholars, in sharp contrast to the extensive analysis devoted to other issues affecting the lives of psychiatric inpatients, and in especially sharp contrast to our culture's inundation with media messages about sex. This article summarizes the modest body of scholarship concerning sexual interactions among hospitalized patients, the clinical and administrative questions faced by psychiatrists who work with inpatients, and the potential medicolegal problems that inpatients' sexual activities can create. It concludes with a conceptual framework that clinicians can use to devise solutions to the problems arising from inpatients' sexuality.     

Reducing sleepiness on the roads and on the wards

Killian-Pallister syndrome is a rare dysmorphic condition characterized by specific clinical manifestations and tetrasomy 12p. Although the association of this condition with congenital heart disease has been previously documented, no cases have been reported in association with Fallot's tetralogy. We report one such case.     

Broadening the educator's role. The use of support staff in implementing staff empowerment

The move to empowerment is on. Healthcare organizations are beginning to recognize the benefits of staff empowerment to both the organization and the staff members. The question for educators is how can skills be best used to support the organization throughout the change. In this article, the role of the educator in the implementation of staff empowerment at a large tertiary care center is described.     

Empowering parents of children with special needs

Partnership and empowerment are very much in vogue. In this paper the authors question whether the rhetoric of partnership matches the reality as experienced by families of children with special needs. Research in this area is reviewed and models of good practice are examined.     

Letter: Locked wards in Canadian mental hospitals

A case of multilobed malignant melanoma with a haemorrhagic retinal detachment which mimicked a postoperative choroidal detachment is described. Because the lesion showed no resolution six weeks after cataract surgery a tumour evaluation was undertaken. The diagnosis was established with a positive radioactive phosphorus uptake (32P) test and biopsy of the intraocular mass. A suggested approach to the diagnosis in such difficult cases is proposed.     

Assessment of the social atmospheres of psychiatric wards.

Describes the development of a Ward Atmosphere Scale, which differentiates between the social atmospheres of psychiatric inpatient wards. An initial form of the scale was given to Ss and staff on 14 wards from Veterans Administration, state, community, private, and university hospitals. The 2nd form of the scale consists of items which significantly differentiate between wards for Ss and/or staff. This form includes 12 subscales, e.g., Spontaneity, Autonomy, Affiliation, Aggression, Variety, and Support, each of which measures the emphasis on 1 dimension of ward atmosphere. Ward profiles which compare average S perceptions of different wards have been constructed. The importance of developing measures of psychological environments and the implications relating to the matching of individual needs and environmental press are discussed. (30 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical staff in Russia

Teeth are the most durable structures in the human body. The timing and sequence of their development, as contained in dental development charts, have been used as valid criteria for age determination. The third molars however are the last teeth to erupt and are regarded as the most variable in the dentition. Age estimation in a legal context, using developing third molars must be carefully applied otherwise justice may miscarry. A case of wrongful use of the technique is presented here.     

Nursing burn wounds on general wards

In this article, the author predicts that patients with intermediate and minor burn injuries will be increasingly nursed on general wards. In this context, she describes developments in the treatment and management of wounds caused by burns, and examines the advantages and drawbacks of current nursing treatments and how these should be used.     

Effects of hospital closure on mortality rates of the over-65 long-stay psychiatric population

We describe a girl with a brain-stem tumour and symptoms very similar to those of Rett syndrome (RS). Her early history was uneventful and development was normal (except for hypotonia). At the age of 6 months her development slowed. Subsequently, deterioration occurred and the features characteristic of RS were seen: loss of purposeful hand use, stereotypic hand movements, impaired social contact, decelerated head growth, and ataxia. Cerebral CT at the age of 3 years and 4 months revealed a tumour in the region of the pons and hydrocephalus. We suggest that a pons/midbrain tumour appearing at an early age may affect the developing CNS and cause symptoms similar to those of RS. A possible causal connection between midbrain pathology and RS is supported by this case.     

The assessment of acute stroke in general medical wards

In order to assess the completeness of clinical clerking, a retrospective study was made of the medical notes of 194 patients admitted with acute stroke over a 1-year period. The noting of clinical features associated with disease severity and prognosis, such as level of consciousness, proprioception, neglect, mental test score and continence was assessed. These features were rarely noted. Factors likely to influence placement following recovery were also poorly reported. In order to allow an accurate guide to stroke severity and prognosis these factors must be noted. An alternative form of clinical clerking is suggested in order to improve patient management.     

Patients' information needs in intensive care and surgical wards

Meeting the information and psychosocial support needs of surgical patients who have been in intensive care can contribute significantly to their recovery. In this article, the author examines the nursing opportunities for meeting these needs and suggests how they can be addressed.     

Epidemiology of S. aureus cross-infections in dermatological wards

Over a three-year period, 196 of 3115 patients admitted in a dermatological department became infected with S. aureus (6,2 %). 205 strains of S. aureus were isolated. Serologic typing, phage-typing and antibiotic sensitivity tests revealed 3 epidemic and 2 endemic strains. The 3 epidemic strains infected 24 patients: 12 from july to november 1972 were infected with a serotype 66438 S. aureus resistant to fusidic acid. 6 patients (male) were infected with a serotype III in february and march 1972; 8 patients were contaminated with a serotype 18 S. aureus from december 1973 to february 1974, after staying in a surgical department. Of the 2 endemic strains 1, phage-pattern 53/79, is non-typable by serologic-typing; this strain has been observed only in the dermatological department and 20 patients were infected with, from january to october 1974. The second endemic strain, phage-pattern 81/+ serotype I, cross-infected 16 patients during this three-year survey; 12 of them were admitted repeatedly. During this three-year survey, it could be proved that, at least, 1 out of 3 patients is infected with an epidemic or an endemic strain. We can suggest that the factors enhancing cross-infection in dermatological department are: the sex of patients (80 % were male); presence of a tween splitting enzyme by S. aureus promotes growth of Staphylococci on the skin; patients transfered from a department to another or repeatedly admitted are more often infected. But, as they are source of some outbreaks, they need special measures (asepsis and hygiene); cortico?ds or immunodepressors enhance cross-infection; antibiotics must not be only limited but varied too.     

Nosocomial gastroenteritis in two infant wards over 26 months

We retrospectively reviewed 209 cases of nosocomial diarrhea in two infant wards at St G?ran's Children's Hospital. They occurred from April 1987 to May 1989, when 3105 patients spent 26,355 hospital days. The hospital is a 250-bed tertiary center with university affiliation. Fourteen percent of patients at risk developed nosocomial diarrhea, and the relative attack rate was 1.1 episodes per 100 hospital days. A probable viral etiology was found in 47% of patients. Rotavirus was most frequent and occurred during the community rotavirus seasons. Also small, round, structured viruses were common, and two outbreaks of astrovirus gastroenteritis occurred. Failure to detect a virus was particularly common among infants younger than 4 months. However, a seasonal distribution and peaks concordant with defined clusters in older patients, suggest also that some of these detection-negative cases may have a viral etiology.