End-of-life care: hospice or home?

BACKGROUND: Polar and borderline lepromatosis leprosy can be complicated by type 2 reactional states, including erythema nodosum leprosum. CASE REPORT: A 36-year-old man was treated for lepromatous leprosum. He consulted for recurrent erythema nodosum leprosum. Certain nodular lesions were bullous. Histopathology demonstrated major dermal edema causing bullous blisters. Treatment with thalidomide led to rapid regression. DISCUSSION: The bullous form of erythema nodosum leprosum is rarely described in the literature. It raises the diffential diagnosis with other bullous dermatoses, particularly Sweet's syndrome.     

Treating eating-disorder patients in a managed care environment. Contemporary American issues and Canadian response

This article addresses the effect of managed care on the treatment of eating disorders. We review strategies for negotiating limitations that managed care reviewers place on treatment. Finally, this article reviews the experiences of a Canadian program that has 10 years of experience in providing low-cost day treatment. While change is frustrating and difficult, it is inevitable and can be rejuvenating. These changes offer opportunities for creative development of quality low-cost care. If we do not adjust to these conditions, patients will not get treatment that they need.     

Patient-physician sexual involvement: a Canadian survey of obstetrician-gynecologists

OBJECTIVE: To determine obstetrician-gynecologists' (ob-gyns') awareness of and experience with sexual abuse of patients and former patients and their opinions about appropriate consequences. DESIGN: Mailed survey. SETTING: Canada. PARTICIPANTS: All 792 members of the Society of Obstetricians and Gynaecologists of Canada (SOGC); 618 (78%) responded. Approximately half of all ob-gyns in Canada belong to the SOGC. MAIN OUTCOME MEASURES: Knowledge of sexual involvement by an ob-gyn colleague with a patient or former patient (as defined by the respondents and by the College of Physicians and Surgeons of Ontario [CPSO]), self-report of such involvement, attitudes toward physician sexual abuse, desirable length of time a physician should wait before seeing a former patient in a situation that could lead to a sexual encounter, suggested consequences of sexual abuse. RESULTS: Overall, 10% of the respondents indicated that they knew about another ob-gyn who at some time had been sexually involved with a patient. In all, 3% of the male respondents and 1% of the female respondents reported sexual involvement with a patient; the corresponding proportions of those who reported having been accused of sexual abuse by a patient were 4% and 2%. Significantly more of the female ob-gyns than of their male counterparts (37% v. 19%) reported awareness of a colleague's sexual involvement with a patient that would meet the CPSO's definition of sexual impropriety, transgression or violation. Most of the respondents felt that the consequence of proven sexual impropriety should be reprimand and fine (chosen by 33%) or rehabilitation without loss of licence (28%). Most of the physicians supported loss of licence for proven sexual transgression (57%) or proven sexual violation (74%), but fewer felt that loss of licence should be permanent for these types of abuse (4% and 24% respectively). The female ob-gyns supported stronger sanctions against sexual transgression and sexual violation than the male ob-gyns. A wide range of opinion was seen regarding the propriety of sexual relationships with former patients. CONCLUSIONS: Ob-gyns have varied opinions about how sexual abuse of patients should be defined and how it should be sanctioned. There is a discrepancy between proposed public policy and the beliefs of physicians to whom the policy is to be applied.     

End-of-life decisions in the home care setting

Recent advances in the identification of genetic abnormalities associated with certain types of cancer have stimulated the development of screening and counseling programs for hereditary and familial forms of cancer. In 1995, such a program was established in a collaboration between three familial cancer clinics in Amsterdam. Given the potential impact of genetic screening and counseling on the psychosocial health of participants, it was considered essential that the program be evaluated from its inception to determine the participants' satisfaction with the services provided. A pilot study was initiated in which individuals who received genetic counseling for cancer were asked to provide feedback on the perceived quality of the services provided, and to identify areas in which additional services may be required. Preliminary results based on 36 counseled individuals indicated generally high levels of satisfaction with the care provided by the clinical geneticist and with the procedures at the familial cancer clinics. Several areas were identified that deserve additional attention: (1) the role of the family doctor in the genetic counseling; (2) communication of information regarding the possible impact of genetic counseling and testing on daily life; (3) communication between the clinical geneticist and other health care workers, and (4) psychosocial support during and after the process of genetic counseling.     

Male catheterization by female nurses: a small-scale survey

A small-scale questionnaire survey of nurses in one Welsh district general hospital examined the views of nurses in relation to catheterization of male patients. The findings demonstrate that while most nurses agree that it is acceptable for females to catheterize male patients, most female nurses do not undertake the procedure as they incorrectly believe there are either local or national policies that prevent patients from being catheterized by nurses of the opposite sex. This often results in patients waiting longer than necessary to be catheterized, and nurses (usually male nurses) from other clinical areas being requested to catheterize a patient for whom they are not caring. Such beliefs and practices stifle the development of knowledge on this issue.     

Do nurses avoid AIDS patients? Avoidance behaviours and the quality of care of hospitalized AIDS patients

This article explores the potential impact upon people with disability of some of the technological information being uncovered by the Human Genome Project. While the project has been promoted as promising positive benefits to society, its effect, in our present values climate, is potentially damaging. While we can map impairment, we cannot, as yet, cure it. And, in a society which embraces values such as utilitarianism and economic rationalism, we are choosing more and more to eliminate rather than care. We are seeing a conceptual transformation--the geneticization of self--which has enormous implications for the lives of people with disability. The author argues that scientific endeavor, which has been constructed as occurring within a culture of impartiality and empiricism, actually operates within an uncontested value base which devalues disability. She concludes that the Human Genome Project needs to be reframed within a broadened ethical framework of inclusion.     

Health nurses: attitudes towards treating AIDS patients

Many nurses working in hospitals, especially in the wards, as well as nurses in community clinics have been involved in treating AIDS sufferers. In spite of clear and widespread information available to professionals, strong apprehensions still exist as to the contagious nature of the disease. A survey was carried out in order to assess the attitudes of nurses in this regard. Participants were drawn from the nursing profession, all were Registered Nurses (R.N.) The survey was carried out in the centre of the country and involved 137 participants, 69 of whom were hospital nurses and 68 community health nurses. Their average age was 43 years with an average professional experience of 10 years. A questionnaire was issued containing 24 closed questions, based on professional knowledge, clinical experience, professional literature, and attitudes towards treatment, as well as obligations involving information to family members and other institutions and commitment to HIV patients.     

Professional self-concept of nurses: a comparative study of four strata of nursing students in a Canadian university

This study represents an effort to refine our understanding of measurement of professional self-concept by testing a tool across various strata of nursing students. The Professional Self Concept of Nurses Instrument, developed in studies of Australian nursing students, was applied to samples of basic undergraduate, post-basic and graduate students in a Canadian university nursing programme. The findings suggest that the tool is sensitive to the predictable development of professional self-concept as students advance through professional education, especially in the dimensions of professional practice and satisfaction. The authors propose that the instrument may have specific applications in evaluating the effects of traditional and innovative educational strategies upon the evolution of professional self-concept in nurses.     

Drug and alcohol use by Canadian university athletes: a national survey

To gauge the extent of drug and alcohol use in Canadian university athletes, we estimated the proportion of Canadian university athletes using social and/or ergogenic drugs through survey methods. A secondary purpose was to examine athletes' perceptions of the value of drug testing and drug education programs. Using a stratified random sampling procedure, 754 student athletes were surveyed in eight different sports from eight universities across Canada. Results showed that 17.7 percent of athletes have used major pain medications over the past twelve months, 3 percent reported use of weight loss products, 0.9 percent reported anabolic steroid use, 16.6 percent reported use of smokeless tobacco products, 94.1 percent reported use of alcohol, 65.2 percent reported use of caffeine products, 0.7 percent reported use of amphetamines, 1.0 percent reported use of barbiturates, 19.8 percent reported use of marijuana or hashish, 5.9 percent reported use of psychedelics and 0.8 percent reported use of cocaine/crack.     

Occupational stress in Canadian universities: A national survey.

Stress surveys in U.K. and Australian universities demonstrated high occupational stress levels among faculty. This study investigated whether the same occupational stressors and stress outcomes applied at Canadian universities. Randomly selected staff (n = 1440) from 56 universities completed a Web-based questionnaire. The response rate 27%, was similar to those in the U.K. and Australian studies, as were most of the results. With respect to strain, 13% of the respondents reported high psychological distress and 22% reported elevated physical health symptoms. Less secure employment status and work-life imbalance strongly predicted job dissatisfaction; work-life imbalance strongly predicted increased psychological distress. Overall study participants were satisfied with their jobs and emotionally committed to their institutions. These results warrant consideration of contemporary academic work by both academic staff associations and university administrations with respect to the implementation of changes in policies and procedures that might lead to reductions in work-related stress and strain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Culturally competent health care: a challenge for nurses in Saudi Arabia

An emerging global reality is the presence of a culturally diverse workforce in health care environments. Not only are nurses delivering care to culturally diverse clients, the nurses themselves may come from different cultural and educational backgrounds. In order to provide culturally competent health care, such diversity must be molded into professional collaboration and respect. To date, health care to the citizens of Saudi Arabia has been provided largely by a foreign labor force, the vast majority of whom are non-Arabic speaking. This paper explores a number of strategies aimed at educating expatriate non-Saudi health professionals in the provision of culturally competent and culturally congruent health care. Leininger's transcultural health care theory is identified as the framework for achieving this goal. The theory has proved to be of great relevance in a hospital setting where some 40 different nationalities are represented among the work force. In such a setting, the potential for cultural conflict and stress is very real. Health professionals new to the Kingdom are introduced to the cultural dimensions of health care as it relates to patient care modes, as well as living and working together in a transcultural environment. Transcultural nursing is a major component of a professional nurse practice model which provides a visionary perspective for nursing care. Within the practice model, transcultural care principles are used to guide education, clinical practice and nursing research. Furthermore, Leininger's theory serves to grasp a comprehensive view of generic (folk) and professional health systems and to identify ethical issues confronted by nurses in the transcultural setting.     

Undergraduate statistics in psychology: A survey of Canadian institutions.

Studied the curriculum in statistics courses required by undergraduate psychology departments in Canada. Questionnaires examining the content of undergraduate statistics courses were sent to 51 Canadian post-secondary institutes offering major degrees in psychology. Responses received from 59% of the institutions suggest that several basic statistical procedures constitute a small core content covered in almost all undergraduate statistics courses and that the incorporation of computer applications is relatively common. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disseminated Mycobacterium genavense infection in Canadian AIDS patients

Mycobacterium genavense is a recently described mycobacterial species which thus far has been identified only in persons with advanced HIV disease. It appears to be a rare pathogen with an undefined reservoir. We describe the first two cases of M. genavense infection in Canadian AIDS patients. The clinical presentation of fever and wasting with extremely low CD4 lymphocyte counts was indistinguishable from disseminated M. avium complex (MAC) infection. However, blood cultures in BACTEC 13A medium required a mean of 58 days (range 41-87) to detect growth of M. genavense in contrast to a mean of 10 days for MAC in our laboratory. M. genavense infection is underdiagnosed due to the lack of universal use of BACTEC liquid medium and the use of relatively short incubation times (only 6 weeks) by some laboratories. The value of antimycobacterial therapy for M. genavense is unknown, but anecdotal data suggest that treatment with a regimen appropriate for MAC may be beneficial.     

Legal issues and behaviour modification: A Canadian perspective.

The use of behavior modification techniques has been a matter of litigation in the US courts. The resulting judicial decisions have limited some aspects of the application of behavior modification techniques. Similar litigation is beginning to take place in Canada. The US cases will probably have some value as legal precedents before the Canadian courts. These US judicial decisions as well as related articles from legal and behavioral psychology journals and texts are reviewed. A series of guidelines is presented that behavior modification practitioners might adopt to prevent a similar legal-behavior modification conflict from developing in Canada. (French abstract) (53 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)