BackgroundCurrently there is great interest in antibiotic prescribing practices in the UK, but little is known about the experiences of the increasing numbers of recent migrants (those present in the UK for >1 year but <5 years) registered at GP practices. Qualitative research has suggested that reasons for not prescribing antibiotics may not be clearly communicated to migrants.AimThis study aimed to explore the factors that shape migrants’ experiences of and attitudes to antibiotics, and to suggest ways to improve effective communication around their use.Design and settingA qualitative study on recent migrants’ health beliefs, values, and experiences in a community setting in primary care.MethodTwenty-three recent migrants were interviewed in their preferred language by trained community researchers. The research team conducted a thematic analysis, focusing on health beliefs, engaging with health services, transnational medicine, and concepts of fairness. Experiences around antibiotics were a strong emerging theme.ResultsThree reasons were identified for antibiotics seeking: first, holding an ‘infectious model’ of illness implying that antibiotics are required quickly to avoid illness becoming worse or spreading to others; second, reasoning that other medications will be less effective for people ‘used to’ antibiotics’; and third, perceiving antibiotic prescription as a sign of being taken seriously. Some participants obtained antibiotics from their country of origin or migrant networks in the UK; others changed their mind and accepted alternatives.ConclusionPrimary care professionals should aim to understand migrants’ perspectives to improve communication with patients. Further research is needed to identify different strategies needed to respond to the varying understandings of antibiotics held by migrants.
Introduction
Mishandled endotracheal cuff pressure may either make ventilation difficult or cause damage to the airway. Therefore, the aim of this audit was to assess the knowledge about endotracheal cuff pressure monitoring with a manometer and manual palpation of pilot balloon among critical care providers.
Methods
This audit includes 150 critical care providers having experience of handling endotracheal tube (ETT) cuff at critical care area of National Institute of Cardiovascular Diseases (NICVD), Karachi from April 2017 to June 2017. Knowledge about endotracheal cuff pressure monitoring with the manometer and deleterious effects of mishandled ETT cuff was assessed using a self-reported questionnaire. Enrolled healthcare providers were asked to palpate the patient and cuff pressure was recorded and categorized.
Results
Out of 150 participants, 66 (44.0%) were doctors. Only 46 (30.67%) participants had prior knowledge about ETT cuff manometer and 110 (73.33%) had never used a manometer. Similarly only 42 (28.0%) had knowledge of hazardous effects of mishandled ETT cuff. Kappa coefficient of 0.155 with p=0.015 showed significant yet low agreement between participant prediction and the actual amount of air in cuff balloon. Agreement level was comparatively higher for staff as compared to doctors with a Kappa coefficient of 0.210 (p=0.018) vs. 0.133 (p=0.099).
Conclusion
In this study of knowledge and practice of ETT tube cuff pressure monitoring, we observed low levels of knowledge (30.67%), poor adherence to standard practice (73.33%) and were able to demonstrate poor agreement (Kappa coefficient 0.155; p=0.015) between the palpation method and cuff manometer measurements for assessing cuff pressure.
The Scottish Mathematics Support Network (SMSN) was formed in July 2008 with the aim of creating a support network for people working in Scottish universities who were involved with, or wished to be involved with, providing mathematical and/or statistical support for their students. The consensus of the SMSN is that increasingly more students need assistance with their basic mathematical and statistical skills than was the case in the past, and that consequently mathematics support is an area on which universities will need to focus on in future years. Through networking and professional development opportunities with other practitioners in the field of mathematics and statistics support, the SMSN have developed and maintained strong links with individual practitioners, and more broadly with like-minded groups such as the sigma Network and the Irish Mathematics Learning Support Network. With the provision of mathematics and statistics support becoming more prevalent in UK Higher Education institutions, it seemed timely to assess the current state of this provision in Scotland, and to compare with the rest of the British Isles. At the 2016 SMSN AGM, it was unanimously agreed that such a study should be carried out with the SMSN committee taking responsibility for conducting the research.
Duodenal lymphoma accounts for a small percentage of gastrointestinal tumors and has a very poor prognosis. The majority of patients have little or no cure with limited time of remission. Median survival is 5 to 10 years, and most patients die of lymphoma, its complications, or complications of therapy. We report a patient with lymphoma refractory to treatment with cyclophosphamide, vincristine, and prednisone, who was successfully treated with rituximab, a CD-20 monoclonal antibody.
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