Piggyback-acquired hypertrichosis.

A 9-month-old girl exposed to 5% topical minoxidil for 2 months developed generalized hypertrichosis of the exposed and unexposed areas of her body. The infant's grandfather had been using minoxidil daily and then propping the baby on his shoulders for an hour or more a day. Minoxidil was eliminated from the child's environment and 4 months later her hair distribution returned to normal.

Capturing district nursing through a knowledge-based electronic caseload analysis tool (eCAT).

The Electronic Caseload Analysis Tool (eCAT) is a knowledge-based software tool to assist the caseload analysis process. The tool provides a wide range of graphical reports, along with an integrated clinical advisor, to assist district nurses, team leaders, operational and strategic managers with caseload analysis by describing, comparing and benchmarking district nursing practice in the context of population need, staff resources, and service structure. District nurses and clinical lead nurses in Northern Ireland developed the tool, along with academic colleagues from the University of Ulster, working in partnership with a leading software company. The aim was to use the eCAT tool to identify the nursing need of local populations, along with the variances in district nursing practice, and match the workforce accordingly. This article reviews the literature, describes the eCAT solution and discusses the impact of eCAT on nursing practice, staff allocation, service delivery and workforce planning, using fictitious exemplars and a post-implementation evaluation from the trusts.

How caseload analysis led to the modernization of the DN service.

As we move into a new century and care moves out of hospital and into the community, there is a drive to seek new models for providing nursing care to patients in their homes. Following a Caseload Analysis report, the District Nursing Modernization Project was launched in April 2004, aimed to redesign the structure and delivery of the district nursing services in South and East Belfast. The service was totally re-engineered within the existing budget and workforce. Nursing careers changed as new supporting services were developed and new job opportunities became available within the service. The structure of the services was designed on the basis of caseload analysis gathered over a number of years. Evaluation of the project indicated that the project aim and objectives had been achieved. Caseload Analysis was instrumental in establishing the need to modernize district nursing services and how this should be carried out.

Caseload analysis in district nursing: the impact on practice.

This paper describes a ten-year journey in managing a district nursing service using caseload analysis as a method of workforce planning and performance management. Caseload management is at the heart of district nursing practice and the process of measuring and comparing caseload information can be used to improve the quality of care. However, it is crucial to assess the information provided by district nurses for reliability and validity. Allocating staff to teams on the basis of accurate information on patient case-mix, nursing need, and dependency can result in every member of the population gaining equitable access to a consistent quality nursing service.

Case-finding in the community: the results 2.

Improving the health and well-being of the population is at the centre of policy development, and the vision is to involve individuals, families and communities. The Case-finding in the Community Project was designed to build upon the established relationship between district nursing and the local community of East Belfast, working together to improve the health of adults in the community using a case-finding approach. The aims were to improve the early detection of long-term conditions, to increase access to primary care and the specialist nursing services, and to further develop the working partnership with East Belfast Community Health Information Project. Between September 2006 and March 2007, 351 people attended 17 health fairs in East Belfast at a range of venues. There were 115 people with identified risk factors for respiratory, cardiac, diabetes and hypertension. From the results of this project, there is a need for 'case-finding' patients with the potential to develop chronic disease management.

District nursing workforce planning: a review of the methods.

District nursing services in Northern Ireland face increasing demands and challenges which may be responded to by effective and efficient workforce planning and development. The aim of this paper is to critically analyse district nursing workforce planning and development methods, in an attempt to find a suitable method for Northern Ireland. A systematic analysis of the literature reveals four methods: professional judgement; population-based health needs; caseload analysis and dependency-acuity. Each method has strengths and weaknesses. Professional judgement offers a 'belt and braces' approach but lacks sensitivity to fluctuating patient numbers. Population-based health needs methods develop staffing algorithms that reflect deprivation and geographical spread, but are poorly understood by district nurses. Caseload analysis promotes equitable workloads but poorly performing district nursing localities may continue if benchmarking processes only consider local data. Dependency-acuity methods provide a means of equalizing and prioritizing workload but are prone to district nurses overstating factors in patient dependency or understating carers' capability. In summary a mixed method approach is advocated to evaluate and adjust the size and mix of district nursing teams using empirically determined patient dependency and activity-based variables based on the population's health needs.

Case finding: a new approach to chronic disease prevention.

A working group of Specialist Nurses, Mental Health Nurses, DN Nurse Practitioners, and Community Development staff mapped the journey of a person identified with risk factors for chronic disease at a community health promotion event. The mapping exercise demonstrated that the GP was the main and only gatekeeper to a range of nursing and other services, and any health outcome depended upon the person seeking an appointment with the GP. Once a person was identified at an event, there was no follow up or mechanism of tracking the outcome.

Atopic dermatitis: a new treatment paradigm using pimecrolimus.

Atopic dermatitis (AD), often called eczema, is a disease characterized by intense pruritus, erythema, dry skin, and inflammation. Pimecrolimus is a novel steroid-free treatment for AD. Consistently positive results have been found with pimecrolimus treatment in infants, children/adolescents, and adults. Its safety record is excellent, and studies have found no clinically relevant drug-related systemic adverse events. In this article, we first review atopic dermatitis and conventional treatment strategies. We then discuss various aspects of pimecrolimus, including pharmacologic properties, toxicology, short- and long-term studies, and safety and adverse events. Finally, we propose a new steroid-sparing treatment strategy for AD.

Milia en plaque of the nose: report of a case and successful treatment with topical tretinoin.

Milia are benign, superficial keratinaceous cysts that present as fine, small white papules. Milia en plaque is a rare, challenging-to-treat variant most often seen in the posterior auricular region. A total of 9 cases of milia en plaque have been reported in the pediatric literature to date. We report a case of milia en plaque of the nose in a 7-year-old boy, a novel site of involvement in the pediatric population, and successful treatment with the use of topical tretinoin. Topical retinoids offer an effective treatment option for the management of milia en plaque in the pediatric population.