No abstract

Community psychologists have a long-standing interest in promoting systems

Information technology (IT) is now essential to the development and delivery of health services. Healthcare professionals, including nurses, need appropriate educational training to enable them to use IT adequately because care is shared within multiprofessional teams in both hospitals and the community. In particular, primary care nurses have had less access than other health professionals to IT training and fewer opportunities to benefit from IT. Furthermore, there is little evidence in the literature on the current situation of IT training needs and requirements for primary care nurses. The PRACTIS (PRimary care nurses Access to Communications Technology and Informatics Skills) UK-based project has addressed these issues through an empirical investigation to establish a picture of the current primary care situation. This was done using a questionnaire, followed by practicing nurse focus groups. Directions for further work in the IT training of primary care nurses are discussed, together with recommendations to investigate the effect that the organization of the work within primary care groups may have on nurses' use and access to communications technology and informatics skills.

No abstract

Background: Wild-type transthyretin amyloidosis (wtATTR) is an important cause of heart failure (HF); however, the prevalence and clinical significance of neurologic complications remains uncertain. Methods: This analysis reports findings from a single-centre experience of routine neuropathy screening at the time of wtATTR diagnosis by nerve conduction studies and neurologist assessment, compared with age-matched controls. Results: Forty-one wtATTR patients were included, 39 (95%) males, mean age 78.4 ± 7.7 years, 22 (54%) New York Heart Association (NYHA) class III–IV HF, along with 15 age-matched controls (mean age 77.1 ± 4.2 years, 80% male). Twenty-one (51%) wtATTR patients were diagnosed with polyneuropathy, 15 (37%) with spinal stenosis, 36 (88%) with carpal tunnel syndrome (CTS) and 14 (34%) with ulnar neuropathy. Comparison diagnoses among controls were 1 (7%), 0, 1 (7%) and 3 (20%), respectively. Among patients with NYHA class III–IV HF, 16 (73%) had polyneuropathy compared with 5 (26%) with class I–II (p < 0.01), odds ratio of 7.5 (95% confidence interval 1.9–29.9). After neuropathy screening, 19 (46%) patients were offered neurologic therapy and/or additional diagnostic evaluation. This included CTS release surgery (16, 39%), neuropathic pain medication (3, 7%), nerve block (1, 2%), wrist splinting (2, 5%) and foot care (1, 2%). Spine imaging was performed for 3 (7%) patients, and deltoid muscle and sural nerve biopsy for 1 (2%) patient. Conclusions: Screening of wtATTR patients for neurologic complications resulted in a management change for nearly half. CTS, polyneuropathy and ulnar neuropathy were common. This approach warrants consideration as part of routine assessment for newly diagnosed wtATTR patients.

Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction, characterized by fatigable weakness of the extraocular, bulbar, and limb musculature; prevalence is estimated at 14 to 32 per 100,000 in North America. Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults, resulting from clonal expansion of B-cells in blood, marrow, and secondary lymphoid tissues. The simultaneous presentation of MG and CLL is exceedingly rare. This article presents the case of 71-year-old man diagnosed simultaneously with MG and CLL. His MG was severe and refractory to treatment; therefore, a strategy of treating his coexisting CLL with obinutuzumab and chlorambucil was pursued. Following 6 cycles of obinutuzumab and chlorambucil, his CLL is in remission and his MG is almost entirely undetectable. This is the first case report describing the use of obinutuzumab, a novel anti-CD20 monoclonal antibody, in a patient with concurrent MG and CLL.

BACKGROUND: Approximately 40% of all traffic fatalities are associated with the use of alcohol. Hospitalization for serious injury after a motor vehicle crash related to use of alcohol may be an opportunity to change drinking behaviors in non-alcohol-dependent drinkers, thereby reducing the risk for future disability and death. OBJECTIVES: To determine the degree to which non-alcohol-dependent adults aged 18 to 45 years with alcohol-related vehicular trauma attributed their injury to use of alcohol. METHODS: During hospitalization, 132 subjects involved in alcohol-related motor vehicle crashes were interviewed. The interviews included the question, "To what extent do you believe your alcohol consumption was responsible for this injury?" Responses were measured on a 7-point scale ranging from 1 (not at all) to 7 (totally). RESULTS: In response to the question about attribution of injury to alcohol, 37.8% of subjects responded "not at all," 24.3 responded "somewhat," and 37.9% responded "mostly" or "totally." Spearman rank correlation between attribution of injury to alcohol involvement and blood alcohol content at admission was r = 0.440 (P &lt; .001). CONCLUSIONS: More than 60% of patients injured in alcohol-related motor vehicle crashes attributed their injury partly or totally to use of alcohol. When alcohol-free, hospitalized patients with higher blood levels of alcohol on admission were more likely than those with lower levels to attribute their injury to alcohol. Hospitalization for a motor vehicle crash related to use of alcohol provides an opportunity for interventions to decrease drinking.

Information technology (IT) is an integral part of the development and delivery of health services. Healthcare professionals, including nurses, are in need of appropriate educational training to enable them to use IT adequately. In particular, nurses in primary care have had less access to IT training and fewer opportunities to benefit from IT. Furthermore, little evidence is found in the literature on the current situation of IT training needs and requirements for nurses in primary care. This paper discusses critical issues in the training of primary care nurses in information technology. It then reports on the PRACTIS (PRimary care nurses Access to Communications Technology and Informatics Skills) project which is addressing these issues through an empirical investigation. Preliminary results are examined. Finally, directions for further work in the training of primary care nurses are also discussed.