Experiences of nursing students providing end of life care for children and young people: A focus group study

BACKGROUND

End of life care for Children and Young People (CYP) is known to be an emotive area of practice. Previous studies involving qualified nurses have demonstrated that nurses feel they need more end-of-life care education, as well as a platform for sharing experiences and discussing them with others. Evidence relating to nursing students remains limited despite being widely acknowledged as a difficult aspect of nursing education.

AIMS

This study aims to help improve understanding of the lived experiences of children's nursing students who have cared for a patient at, during, or immediately following end-of-life. The study describes the emotions experienced by children's nursing students and explores the student nurses' perceptions of education and support needs around caring for CYP during end-of-life care.

METHODOLOGY

A qualitative inquiry methodology allowed for a pragmatic approach to design this focus group study. Nine undergraduate student children's nurses participated in two focus groups. Ethical approval was granted by the host university. Thematic data analysis using Braun and Clarke's (2019) thematic analysis was conducted.

FINDINGS

Six themes emerged from the data; Emotional practice (1), the heart of the care (2), a lasting impact (3), hierarchy of grief (4), experience, knowledge and understanding (5), and the value of support (6). End of life care for children and young people is recognised by students as a sad but important part of the job role, which can have a lasting impact and which students required improved education and support for.

IMPLICATIONS FOR PRACTICE

Improved education on end-of-life care is required. This should be introduced early, encompassing practical approaches to the varied nature of end-of-life care, normalising a range of emotions and delayed responses. Furthermore, improved support is required for both student nurses and qualified staff, who are supporting students caring for CYP at the end of life.

A brief guide to immunisation and the immunocompromised child or young person

Immunisation in children with a compromised immune system is not straightforward. Children with autoimmune disorders are especially at risk of vaccine-preventable diseases due to their underlying disease and the immunosuppressive treatment that is often required for a long period. This article explores some of the complexities that need to be considered when planning individual vaccination programmes.

Hypothermia and cold injuries in children and young people

Although hypothermia and cold injuries are rare in children and young people in the UK, the risk is persistent and requires urgent medical management when it does occur. This article outlines some considerations for professionals who may be caring for hypothermic patients or those at risk of becoming hypothermic.

Faith-sensitive end of life care for children, young people and their families

This article is part of an at a glance series on palliation and end of life care in paediatrics and focuses on the provision of faith-sensitive end of life care. Particular religions are discussed, with some key points for care of patients from some of the most prevalent religions within the UK. This article is intended to give points for discussion and consideration, but health professionals are encouraged to speak to every patient and family on an individual level to ensure an understanding of their personal beliefs. Although there is a range of literature discussing faith during end-of-life care, there is litte that outlines the practical specifics and for this reason some of the supporting literature in this article is dated and, where possible, this has been supported with contemporary sources.

A guide to central venous access devices in children

Central venous access devices (CVADs) are commonly used in the care of children both in the short term and long term. Health professionals providing care for children who have CVADs in place are required to have a clear understanding of the benefits and risks associated with their use. This article introduces the different types of CVADs commonly used in paediatrics and provides step-by-step guidance on the use and care of these devices.

Alpha band disruption in the AD-continuum starts in the Subjective Cognitive Decline stage: a MEG study

The consideration of Subjective Cognitive Decline (SCD) as a preclinical stage of AD remains still a matter of debate. Alpha band alterations represent one of the most significant changes in the electrophysiological profile of AD. In particular, AD patients exhibit reduced alpha relative power and frequency. We used alpha band activity measured with MEG to study whether SCD and MCI elders present these electrophysiological changes characteristic of AD, and to determine the evolution of the observed alterations across AD spectrum. The total sample consisted of 131 participants: 39 elders without SCD, 41 elders with SCD and 51 MCI patients. All of them underwent MEG and MRI scans and neuropsychological assessment. SCD and MCI patients exhibited a similar reduction in alpha band activity compared with the no SCD group. However, only MCI patients showed a slowing in their alpha peak frequency compared with both SCD and no SCD. These changes in alpha band were related to worse cognition. Our results suggest that AD-related alterations may start in the SCD stage, with a reduction in alpha relative power. It is later, in the MCI stage, where the slowing of the spectral profile takes place, giving rise to objective deficits in cognitive functioning.

Collision time measurements in a sonoluminescing microplasma with a large plasma parameter

The plasma which forms inside of a micron-sized sonoluminescing bubble in water for under a nanosecond has been probed with 3 ns long laser pulses. A comparison of the response to 532 and 1064 nm light indicates that the plasma number density is about 2×10(21)  cm(-3) and that transport properties are dominated by strong screening and correlation effects. The spherical shape, well-defined atomic density, and blackbody temperature make the sonoluminescing plasma a test bed for theories of strongly coupled plasmas. The plasma in this experiment distinguishes between competing theories of strong, intermediate, and weak effective screening.

Treatment delay affects clinical severity of tuberculosis: a longitudinal cohort study

OBJECTIVES

To describe the risk factors for treatment delay and the effect of delay on the severity of tuberculosis (TB) in a prospectively followed TB cohort at the Bandim Health Project in Guinea-Bissau.

BACKGROUND

Treatment delay in patients with TB is associated with increased mortality and transmission of disease. However, it is not well described whether delay influences clinical severity at diagnosis. Previously reported risk factors for treatment delay vary in different geographical and cultural settings. Such information has never been investigated in our setting. Change in delay over time is rarely reported and our prospectively followed TB cohort gives an opportunity to present such data.

PARTICIPANTS

Patients were included at the time of diagnosis at three local TB clinics and the national TB reference hospital. Inclusion criteria were age >15 years and diagnosis of TB by either sputum examination or by the WHO clinical criteria. Patients with extrapulmonary TB were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was treatment delay. Delay was assessed by patient questionnaires. The secondary outcome was Bandim TBscore as a measure of TB morbidity and all-cause mortality.

RESULTS

A total of 1424 persons were diagnosed with TB in the study area between 2003 and 2010. We included 973 patients with TB in the study. The median treatment delay was 12.1 weeks. Risk factors for delay were low educational level, HIV-1+HIV-2 dual infection and negative sputum smear. TB treatment delay decreased by 10.3% (7.9-12.6%) per year during the study period. Delay was significantly associated with clinical severity at presentation with 20.8% severe TB cases in the low delay quartile compared with 33.9% if delay was over the median of 12.1 weeks.

CONCLUSIONS

Long treatment delay was associated with more severe clinical presentation. Treatment delay in TB cases is decreasing in Guinea-Bissau.

Impact of tuberculosis treatment on CD4 cell count, HIV RNA, and p24 antigen in patients with HIV and tuberculosis

OBJECTIVES

To describe HIV RNA levels during tuberculosis (TB) infection in patients co-infected with TB and HIV. Moreover, to examine the p24 antigen profile during TB treatment.

METHODS

We examined the changes in CD4 cell count, HIV RNA, and p24 levels during anti-tuberculous therapy in a group of TB/HIV-1 co-infected and HIV-untreated patients from Guinea-Bissau.

RESULTS

A total of 365 TB patients were enrolled, of whom 76 were co-infected with HIV-1 and 19 were dually infected with HIV-1 + HIV-2. No significant changes in CD4, HIV RNA, or p24 levels were found during 8 months of TB treatment. HIV RNA levels correlated well with p24 (Spearman's R(2)=0.52, p<0.00001) and both markers were strong predictors of mortality. Initial HIV RNA levels correlated with a clinical TB severity index--the TBscore (Spearman's R(2)=0.23, p=0.02)--and the TBscore decreased dramatically during TB treatment although HIV RNA levels remained unchanged.

CONCLUSION

We found no significant changes in CD4, HIV RNA, or p24 antigen levels during 8 months of TB treatment among TB/HIV co-infected individuals, who did not receive antiretroviral treatment. The markers were unaffected by a strong improvement in TBscore and all three markers showed predictive capacity for mortality risk.

High prevalence of HIV-1, HIV-2 and other sexually transmitted infections among women attending two sexual health clinics in Bissau, Guinea-Bissau, West Africa

The objective was to examine the prevalence of HIV-1, HIV-2 and 10 other sexually transmitted infections (STIs), and to explore the relationship between HIV and those STIs in women attending two sexual health clinics in Bissau, Guinea-Bissau. In all, 711 women with urogenital problems were included. Clinical examination was performed and HIV-1, HIV-2, human T-cell lymphotropic virus (HTLV)-1, HTLV-2 and syphilis were diagnosed by serology. Trichomonas vaginalis was examined using wet mount microscopy. Cervical samples (and swabs from visible ulcers, if present) were used for polymerase chain reaction (PCR) diagnosis of Chlamydia trachomatis, Mycoplasma genitalium, Haemophilus ducreyi, herpes simplex virus (HSV)-1 and HSV-2, and culture diagnosis of Neisseria gonorrhoeae. The prevalence of HIV-1, HIV-2, and HIV-1 and HIV-2 (dual infection) was 9.5%, 1.8% and 1.1%, respectively. The prevalence of HTLV-1 was 2.8%, HTLV-2 0%, HSV-1 1.4%, HSV-2 7.7%, T. vaginalis 20.4%, syphilis 1.0%, N. gonorrhoeae 1.3%, H. ducreyi 2.7%, M. genitalium 7.7% and C. trachomatis 12.6%. HIV-1 and/or HIV-2 infection was significantly associated with active HSV-2 and HIV-1 was significantly associated with M. genitalium infection. In conclusion, HIV-1 and HIV-2 prevalence was higher compared with previous studies of pregnant women in Guinea-Bissau. The prevalence of co-infection of HIV and other STIs is high. National evidence-based guidelines for the management of STIs in Guinea-Bissau are essential.

Serum procalcitonin in pulmonary tuberculosis

OBJECTIVE

To evaluate the level and prognostic value of procalcitonin (PCT) in a West African out-patient cohort with pulmonary tuberculosis (PTB).

METHOD

Patients were clinically scored (TB score), grouped into severity classes (SCs) upon diagnosis and followed for 12 months. Patients were categorised by comparisons of severity class (SC I+II or SC III) and levels of PCT and C-reactive protein (CRP) at diagnosis. Fifty healthy volunteers from the study area were used as controls. The association with TB score was explored using Spearman's rank correlation test. Survival curves stratified after baseline levels of PCT and CRP were compared using the log-rank test.

RESULTS

We included 218 patients in the study. PCT and CRP levels were low, but were significantly higher in patients than in controls (P < 0.001), and were higher for SC III compared to SC I+II patients (P = 0.021 for PCT, P < 0.001 for CRP). Human immunodeficiency virus (HIV) status did not influence results. We found positive correlations between both PCT and CRP and TB score. There was a significantly increased risk of mortality with increasing baseline PCT (P = 0.01), whereas high CRP did not predict mortality rate (P = 0.887).

CONCLUSION

In West African PTB patients, PCT levels were low but increased significantly with increasing severity of disease, and can predict mortality risk.

Psoriasis: an epidemiological evaluation of disease burden in 590 patients

BACKGROUND

There are limited data available on the economical burden of psoriasis and its impact on everyday life.

OBJECTIVE

The aim of this study was to evaluate the impact of psoriasis on personal and professional life, and to evaluate the cost of psoriasis for the patient.

METHODS

We performed a cross-sectional study in psoriasis patients. All patients aged >or=18 years with a diagnosis of plaque-psoriasis confirmed by a physician were included. A self-administered questionnaire evaluating everyday life was constructed with members of the French association of psoriasis patients. In addition, the Dermatology Life Quality Index (DLQI), Working Productivity and Activity Impairment and individual costs were assessed.

RESULTS

A total of 590 patients completed the study. Mean age of the responders was 56 years. The mean DLQI score was 8.5 for patients with severe psoriasis vs. 6.4 for mild psoriasis. Global loss of productivity was 10.7% without significant difference according to the disease severity. Daily activities alteration was most important in patients with severe psoriasis. In this study, 36.8% of patients with severe psoriasis reported a negative impact on their professional life vs. 19.6% for patients with mild psoriasis (P = 0.002). Time devoted to phototherapy was on average 33 h/year/patient and the application of emollients took 25 h/year/patient; 47.3% of patients had a feeling to clean the house more often, in correlation with the severity of the disease. Mean out-of-pocket expenses for the disease was estimated to be 543 euro/year/patient. High impact of psoriasis on quality of life (DLQI >10), age <40 years and joint involvement were significantly associated with an increased risk of loss of work productivity.

CONCLUSION

Psoriasis, particularly severe psoriasis, is a true burden for patients and impacts significantly everyday life and patient's economical resources.

[Selenium deficiency and oxidative stress in asymptomatic HIV1-infected patients in Côte d'Ivoire]

The aim of the present study was to evaluate the oxidative stress and selenium status and the antioxidant capacity of asymptomatic HIV1-infected patients in Côte d'Ivoire. This study involved 30 asymptomatic HIV1-infected patients, aged from 18 to 50 years old, selected in CIRBA (Centre Intégré de Recherche Bioclinique d'Abidjan). They were not yet treated by antiretroviral medicine. Oxidative stress indicators MDA (malondialdehyde) and AOPP (advanced oxidation protein products) were measured respectively by spectrofluorimetric method and spectrophotometric method. Selenium, vitamin E and vitamin A concentrations were evaluated according to the HPLC method. Our results show that all patients were deficient in selenium (0.58 +/- 0.12 micromol/L vs 1.80 +/- 0.31 micromol/L, p < 0.0001). Patient Vitamin E plasma level (27.47 +/- 8.33 micromol/L vs 19.10 +/- 5.33 micromol/L, p < 0.0001) and oxidative stress indicators MDA (3.32 +/- 0.40 nmol/L vs 0.99 +/- 0.26 nmol/L p < 0.0001) and AOPP (62.49 +/- 13.75 micromol/L vs 39.49 +/- 21.27 micromol/L p < 0.0001) were significantly higher in the infected group. These results reveal a severe selenium deficiency and oxidative stress in VIH1-infected asymptomatic Persons in Côte d'Ivoire.

Removal of carbaryl, linuron, and permethrin by Lupinus angustifolius under hydroponic conditions

The metabolism of organic pollutants by plants normally requires contaminant direct uptake by cells. Factors affecting this uptake and the later distribution of chemicals within the plant include the physicochemical properties of the compounds (concentration, structure, solubility, log k(ow), diffusion rate) and the biochemical characteristics of the plant. This paper reports the tolerance, uptake, and effects of the pesticides carbaryl, linuron, and permethrin on Lupinus angustifolius germination and growth as well as contaminant intraplant distribution and possible degradation. Lupine plants were grown in hydroponic culture containing either 1 or 5 mg of the individual pesticides, or combinations of these (1, 5, or 10 mg of each), in 100 mL nutrient and water solutions. Analysis of the remaining solutions 8 days post-germination showed the water solutions to have higher remaining pesticide concentrations than nutrient solutions. Furthermore, in the presence of pesticides, germination was more frequent in the water solutions. After 16 days of growth, the plants were harvested, and their tissues were microwaved digested and analyzed by reversed-phase liquid chromatography. Although only minor quantities of each pesticide were detected in plant tissues, their amount in the roots was higher than in the stems. No accumulation was noted in the cotyledons, and only 2% of linuron was detected in the leaves. Mass recovery at the end of the experiment showed that 57, 53, and 55% of carbaryl, linuron, and permethrin, respectively, were degraded and/or bound in an irreversible manner to plant material. The results suggest that L. angustifolius could be useful for the cleaning/remediation of pesticide-contaminated water.

Blackbody spectra for sonoluminescing hydrogen bubbles

The dynamical motion of sonoluminescing bubbles formed from a mixture of water and hydrogen gas indicates that these bubbles contain hydrogen. Their spectrum is well matched by an ideal 6000 K blackbody radiating from a surface with a radius less than 1/4 microm. According to this model, the state of matter inside the collapsed bubble is so stressed that the photon mean free path is much smaller than 1 microm. Implications for various theories of the light-emitting mechanism and the role of chemical reactions are discussed.

Coupling pervaporation to AAS for inorganic and organic mercury determination. A new approach to speciation of Hg in environmental samples

The design and development of a new approach for Hg speciation in environmental samples is described in detail. This method, consisting of the coupling of pervaporation and atomic absorption spectrometry, is based on a membrane phenomenon that combines the evaporation of volatile analytes and their diffusion through a polymeric membrane. It is proposed here as an alternative to gas chromatography for speciation of inorganic and organic Hg compounds, as the latter compounds are volatile and can be separated by applying the principles mentioned above. The interest of this method lies in its easy handling, low cost, and rapidity for the analysis of liquid and solid samples. This method has been applied to Hg speciation in a compost sample provided by a waste water treatment plant.

Sonoluminescence: nature's smallest blackbody

The transduction of sound into light through the implosion of a bubble of gas leads to a flash of light whose duration is delineated in picoseconds. Combined measurements of spectral irradiance, Mie scattering, and flash width (as determined by time-correlated single-photon counting) suggest that sonoluminescence from hydrogen and noble-gas bubbles is radiation from a blackbody with temperatures ranging from 6000 K (H(2)) to 20,000 K (He) and a surface of emission whose radius ranges from 0.1 microm (He) to 0.4 microm (Xe) . The state of matter that would admit photon-matter equilibrium under such conditions is a mystery.

[Skin toxicity of thiacetazone (TB1) at a hospital service in Dakar]

From 1980 to 1997 we had observed 50 cases of cutaneous side effects of thiacetazone. There were 25 cases of Steven-Jonhson syndrome, 23 cases of Lyell syndrome, a case of erythrodermia and a case of lichenoid toxidermia. The mortality was 40% with 16 cases of Lyell syndrome and 4 cases of Steven Johnson syndrome. Thiacetazone is a minor tuberculostatic drug used widely in the national program against tuberculosis. Our results confirm the seriousness of cutaneous side effects due to this drug. So like in other neighboring countries, we suggest to avoid use of this drug in Senegal.

Removal of atrazine and four organophosphorus pesticides from environmental waters by diatomaceous earth-remediation method

A new viable remediation technique based on the use of diatomaceous earth is proposed to improve the ecological system. Its ability to remove atrazine and the four organophosphorus pesticides parathion-methyl, chlorpyriphos, fenamiphos and methidathion from river and waste waters has been proven. A series of experiments including variable conditions, such as temperature, pH, contact time, pesticide concentration and adsorbent quantity, were performed to demonstrate the efficiency of pesticide removal from three different water samples. The batch experiments showed that diatomaceous earth was able to remove 95% of chlorpyriphos, 75% of methidathion and parathion-methyl and 55% of atrazine and fenamiphos from all types of waters tested. The individual adsorption of each pesticide on diatomaceous earth could be described by the Freundlich isotherm and a tentative adsorption mechanism was proposed. The Freundlich coefficient (Kf) and Freundlich constant (1/n) appeared to be closely related to the physicochemical properties (Kow, solubility) of the compounds. The actual results support the conclusion that diatomaceous earth has the potential to serve as an extractant in remediation techniques.

NuMA: evaluation of a new biomarker for the detection of low stage colorectal cancer

An enzyme immunoassay for NuMA was evaluated in a retrospective clinical study for its potential utility in the detection of colorectal cancer. The concentrations of NuMA and CEA (Abbott IMx) were measured in sera from 86 patients (presurgical) with colorectal cancer, 72 subjects with benign gastrointestinal diseases, 80 subjects with risk factors for colorectal cancer, and 141 age-matched healthy subjects. Reference values for NuMA and CEA were calculated by two methods: 95% cumulative distribution and ROC analyses versus healthy subjects. By the first method, NuMA and CEA both had approximately 20% sensitivity for colorectal cancer. By the second method (which generated lower reference values), NuMA was more sensitive than CEA for colorectal cancer. This improved sensitivity was most evident in Dukes B subjects. By either analysis method, NuMA was more sensitive than CEA for subjects at risk for developing colorectal cancer, whereas CEA was more specific for benign gastrointestinal diseases.

Physical acoustics of ultrasound-assisted lipoplasty

The acoustic fields generated by probes and cannulas used for ultrasound-assisted lipoplasty (UAL) are sources of cavitation and sonoluminescence. The localized stress fields and heating caused by cavitation are strong enough to lyse cells and, in the authors' opinion, constitute the means of therapeutic action of UAL. The spectrum of sonoluminescence extends into the ultraviolet. Various devices have been calibrated and various issues relating to health risks are discussed.