[Amatoxin-containing mushroom poisoning: An update]. / Syndrome phalloïdien : mise au point.

Amatoxin-containing mushroom poisoning occurs after consumption of certain mushroom species, of the genera Amanita, Lepiota and Galerina. Amanita phalloides is the most implicated species, responsible for over more than 90% of mushroom-related deaths. The α-amanitin is responsible for most of the observed effects. Symptoms are characterized by severe delayed gastrointestinal disorders (more than six hours after ingestion). The liver being the main target organ, outcome is marked by an often severe hepatitis which can evolve towards terminal liver failure, justifying orthotopic liver transplantation. Acute renal failure is common. Diagnosis of amatoxin-containing mushroom poisoning is based primarily on clinical data; it can be biologically confirmed using detection of amatoxins, especially from urine samples. In the absence of an antidote, early hospital management is essential. It is based on supportive care (early compensation of hydroelectrolytic losses), gastrointestinal digestive decontamination, elimination enhancement, amatoxin uptake inhibitors and antioxidant therapy. Combined therapy associating silibinin and N-acetylcysteine is recommended. Prognosis of this severe poisoning has greatly benefited from improved resuscitation techniques. Mortality is currently less than 10%. In the event of a suspected or confirmed case, referral to a Poison Control Center is warranted in order to establish the diagnosis and guide the medical management of patients in an early and appropriate way.

[Adverse effects of licorice consumed as food: An update]. / Toxicités de l'exposition alimentaire à la réglisse : mise au point.

The word "licorice" refers to the plant, its root, and its aromatic extract. From a commercial point of view, Glycyrrhiza glabra is the most important species with a wide range of uses (herbal medicine, tobacco industry, cosmetics, food and pharmaceutical). Glycyrrhizin is one of the main constituents of licorice. Glycyrrhizin is hydrolyzed in the intestinal lumen by bacterial ß-glucuronidases to 3ß-monoglucuronyl-18ß-glycyrrhetinic acid (3MGA) and 18ß-glycyrrhetinic acid (GA), which are metabolized in the liver. Plasma clearance is slow due to enterohepatic cycling. 3MGA and GA can bind to mineralocorticoid receptors with very low affinity, and 3MGA induces apparent mineralocorticoid excess syndrome through dose-dependent inhibition of 11ß-hydroxysteroid dehydrogenase type 2 in renal tissue. The cases of apparent mineralocorticoid excess syndrome reported in the literature are numerous and sometimes severe, even fatal, most often in cases of chronic high dose consumption. Glycyrrhizin poisonings are characterized by hypertension, fluid retention, and hypokalemia with metabolic alkalosis and increased kaliuresis. Toxicity depends on the dose, the type of product consumed, the mode of consumption (acute or chronic) and a very large inter-individual variability. The diagnosis of glycyrrhizin-induced apparent mineralocorticoid excess syndrome is based on the history, clinical examination, and biochemical analysis. Management is primarily based on symptomatic care and stopping licorice consumption.

[Severe cytomegalovirus-associated protein losing gastropathy in an immunocompetent adult]. / Entéropathie exsudative sévère compliquant une primo-infection à cytomégalovirus chez un adulte immunocompétent.

INTRODUCTION: Clinical expression of cytomegalovirus (CMV) infection is numerous and depends on the immune status of the host. In immunocompromised patients, CMV disease corresponds to reactivation of the virus with tissue damage responsible for significant morbidity and mortality. In immunocompetent adults, primary CMV infection is usually asymptomatic but may rarely result in severe organ damage. OBSERVATION: We report the case of a 28-year-old man, considered immunocompetent and without medical history, presenting with a primary CMV infection revealed by a severe protein-losing gastroenteropathy (serum albumin level: 18.9g/L). The CT scan showed a gastro-duodeno-jejuno-ileitis pattern. Upper intestinal endoscopy revealed diffuse ulcerated and congestive gastritis predominantly in the fundus. Histological analysis of the biopsies showed no viral inclusion and no immunohistochemical staining reaction, but a high viral load (5.61 log). Treatment was symptomatic associated with anticoagulation due to the major hypoalbuminemia. The patient slowly recovered, and normal clinical examination and blood tests were observed two months after the onset of symptoms. CONCLUSION: Severe CMV organ involvement in the immunocompetent patient is very rare but potentially serious. Digestive involvement complicated by exudative enteropathy is possible. Evolution is usually favorable without the need for antiviral treatment.

Possible impact of the COVID-19 pandemic on the recreational use of nitrous oxide in the Paris area, France.

INTRODUCTION: Recreational use of nitrous oxide (N2O) is increasing in Western countries, including France. During the COVID-19 pandemic, some authors warned that recreational N2O use could increase further as the supply of illicit drugs was impacted by various containment measures. METHODS: We retrospectively analyzed N2O exposures reported to the Paris Poison Control Center (France) from 2010/01/01 to 2021/04/15. The Poison Severity Score was used to grade severity. RESULTS: During the study period, 93 cases of N2O recreational exposures were reported (male/female ratio: 1.1; median age: 20.9 years range: [14.8-49.0]). The first case was reported in 2012, 84/93 (90%) and 65/93 (70%) were reported since 2019 and March 17th 2020 (first lockdown in France) respectively. Most of the patients were symptomatic (88/93; 95%) and developed neurological symptoms (78/93; 84%). Among the fourteen patients who developed moderate to severe symptoms, eleven were reported after March 2020. CONCLUSION: Despite a marked increase in recreational N2O exposures during the COVID-19 pandemic, the exact impact of COVID-19 on this increase remains to be determined as it was observed from 2019.

Psychiatric Nurses' Lived Experiences of Workplace Violence in Acute Care Psychiatric Units in Western Canada.

Workplace violence directed at nurses in healthcare settings is a common occurrence across the globe resulting in negative nurse and organizational implications that may impact the quality of care provided. Psychiatric nurses working on acute care psychiatric units are at an increased risk and are frequently subjected to patients' violent and aggressive behaviors. These implications pose significant threats to the nurses' emotional, physical, and psychological health. Efforts to reduce workplace violence on acute care psychiatric units requires an examination of psychiatric nurses' lived experiences. A qualitative descriptive phenomenological inquiry was conducted using semi-structured interviews with 10 registered psychiatric nurses within a Western Canada health region to explore their lived experiences of patient-to-nurse workplace violence. The findings of this study highlight the implications of workplace violence and substantiates the urgent need to improve the safety on acute care psychiatric units.

[Acute and chronic toxicities associated with the use and misuse of nitrous oxide: An update]. / Toxicités aiguës et chroniques associées à l'usage et au mésusage du protoxyde d'azote : mise au point.

Nitrous oxide (N2O) is used since the eighteenth century as an anesthetic and analgesic but also for recreational use. If the labelled uses of N2O and their modalities are nowadays perfectly framed, the misuse of N2O takes very alarming proportions among teenagers and young adults. This misuse is the cause of acute (hypoxia, barotrauma, burns, neuropsychiatric disorders) and chronic complications if repeated (myeloneuropathy, anemia, thrombosis, inhalant use disorder). The main mechanism of the latter is mainly related to a functional deficit in vitamin B12 induced by N2O. The management of acute complications is symptomatic. The management of chronic complications is based on vitamin B12 supplementation. The best biomarker of chronic N2O exposure is the elevation of the plasmatic level of methylmalonic acid. In all cases of recreational misuses, addiction treatment is necessary to prevent complications or their worsening by providing information in order to stop consumption.

[Autoimmune hemolytic anemia and immune thrombocytopenia associated with Hodgkin disease: Retrospective monocentric study]. / Cytopénies auto-immunes associées au lymphome de Hodgkin : étude rétrospective monocentrique.

INTRODUCTION: Hodgkin's lymphoma (HL) is less common than non-Hodgkin lymphoma and is rarely associated with autoimmune cytopenia. METHOD: We report a consecutive, monocentric and retrospective series of HL patients diagnosed with concomitant or subsequent autoimmune cytopenia over a period of 8 years. RESULTS: We report 4 out of 84 HL patients (4.8%) diagnosed with autoimmune cytopenia (4 immune thrombocytopenia including 2 Evans' syndromes). They were 4 males (average age 24 years for the 3 youngest, and one over 60 years old). Autoimmune cytopenia revealed lymphoma in 2 patients and occurred after HL treatment in the two other patients (5 and 36 months from the end of chemotherapy) without HL relapse. All cytopenias were resistant to conventional treatments (glucocorticoids, intravenous immune globulin, rituximab) and sensitive to chemotherapy when indicated for HL treatment. CONCLUSION: In our series, the predominance of males, a higher frequency of immune thrombocytopenia than autoimmune hemolytic anemia, the resistance to usual treatments and the efficacy of specific chemotherapy were consistent with the literature. Unexpectedly, patients were young and with nodular sclerosis morphology (vs. mixed cellularity) in 3 of 4 cases.

Impact of Role Stressors on the Health of Nurse Managers: A Western Canadian Context.

OBJECTIVE: A qualitative exploratory inquiry was used to understand nurse managers' (NMs') perceptions of their role stressors, coping strategies, and self-health related outcomes as a result of frequent exposure to stressful situations in their role. BACKGROUND: Strong nursing leadership is required for desirable staff, patient, and organizational outcomes. A stressed NM will negatively influence staff nurse satisfaction and retention, patient outcomes, and organizational performance. Stress can affect NMs' mental and physical heath, leading to job dissatisfaction and turnover. METHODS: A qualitative exploratory inquiry was conducted using semistructured interviews with 23 NMs and 1 focus group interview. RESULTS: Findings suggest that coping strategies may be inadequate, given the intensity and demands of the manager role, and could negatively impact NMs' long-term health. CONCLUSIONS: Senior nurse leaders can significantly impact the health and productivity of NMs by minimizing the adverse effects of role stress and foster a positive work environment.

Role stressors and coping strategies among nurse managers.

Purpose The purpose of this paper is to share preliminary evidence about nurse managers' (NMs) role stressors and coping strategies in acute health-care facilities in Western Canada. Design/methodology/approach A qualitative exploratory inquiry provides deeper insight into NMs' perceptions of their role stressors, coping strategies and factors and practices in the organizational context that facilitate and hinder their work. A purposeful sample of 17 NMs participated in this study. Data were collected through individual interviews and a focus group interview. Braun and Clarke's (2006) six phase approach to thematic analysis guided data analysis. Findings Evidence demonstrates that individual factors, organizational practices and structures affect NMs stress creating an evolving role with unrealistic expectations, responding to continuous organizational change, a fragmented ability to effectively process decisions because of work overload, shifting organizational priorities and being at risk for stress-related ill health. Practical implications These findings have implications for organizational support, intervention programs that enhance leadership approaches, address individual factors and work processes and redesigning the role in consideration of the role stress and work complexity affecting NMs health. Originality/value It is anticipated that health-care leaders would find these results concerning and inspire them to take action to support NMs to do meaningful work as a way to retain existing managers and attract front line nurses to positions of leadership.

Nurse managers' work stressors and coping experiences: unravelling the evidence.

This pilot study explored (a) front-line nurse managers' stressor experiences and (b) coping strategies used in order to respond to the myriad of challenges and demands of their role. The nurse managers who participated indicated that limited resources, ever-increasing challenges and work expectations contributed to the stressors they experience. Coping responses included support, cognitive, personal and social strategies, but findings indicated managers still lacked the ability to cope effectively. Managers faced considerable job stress and conflicting demands, often caught between focusing on staff relations and organizational productivity. Equipping managers with appropriate preparation and support may make the role of nurse manager more attractive and facilitate succession planning. These findings will assist senior nurse leaders in formulating directives for appropriate structures and processes in advancing a multidimensional approach to support managers. Resolving this issue is critical for creating reasonable and realistic work expectations for nurse managers and for supporting the pivotal role that managers play to achieve organizational outcomes while preserving their personal health and well-being.

"Hit the ground running": perspectives of new nurses and nurse managers on role transition and integration of new graduates.

The workplace for new graduates must be a constructive learning environment to facilitate their development. Nurse managers need new graduates who can "hit the ground running." Conflict between the needs of new nurses and the realities of the workplace often creates role confusion and tension in new graduates and threatens employers' ability to retain them. As part of a larger study that examined the effectiveness of a new strategy on new nurse retention and workplace integration, we conducted focus groups with new nurses and nurse managers. This paper discusses the perspectives of new nurses on their role transition from graduates to practising professionals and the perspectives of nurse managers on the workplace integration of new nurses. The thematic findings integrate new nurses' perspectives on their needs during role transition with the perspectives of nurse managers in meeting those needs. The discussion includes strategies to facilitate successful transition and integration of new nurses into the workplace within the context of recruitment and retention.

Recognizing and avoiding intercultural miscommunication in distance education a study of the experiences of Canadian faculty and aboriginal nursing students.

Language differences and diverse cultural norms influence the transmission and receipt of information. The online environment provides yet another potential source of miscommunication. Although distance learning has the potential to reach students in cultural groups that have been disenfranchised from traditional higher education settings in the past, intercultural miscommunication is also much more likely to occur through it. There is limited research examining intercultural miscommunication within distance education environments. This article presents the results of a qualitative study that explored the communication experiences of Canadian faculty and Aboriginal students while participating in an online baccalaureate nursing degree program that used various delivery modalities. The microlevel data analysis revealed participants' beliefs and interactions that fostered intercultural miscommunication as well as their recommendations for ensuring respectful and ethically supportive discourses in online courses. The unique and collective influences of intercultural miscommunication on the experiences of faculty and students within the courses are also identified. Instances of ethnocentrism and othering are illustrated, noting the effects that occurred from holding dualistic perspectives of us and them. Lastly, strategies for preventing intercultural miscommunication in online courses are described.

Setting the climate for evidence-based nursing practice: what is the leader's role?

Nurses are being challenged today to justify their practice. Many clinical and policy decisions in nursing are based upon isolated, ritualistic and unsystematic forms of clinical practice. The growing movement towards establishing evidence-based nursing practice (EBNP) is situated in a systematic appraisal of the best evidence available. Nurse leaders have an obligation to cultivate sound clinical and economic practices leading to quality patient care and positive work life environments for nurses.

Grade inflation: should we be concerned?

Grade inflation is defined as an increase in grade point average without an associated increase in overall student ability. The literature supports the idea that grade inflation is rampant throughout higher education. Shoemaker and DeVos described the scope of the problem in higher education in general and note the lack of existing empirical information in nursing education. Given the perceived problem in faculties of nursing, the widespread nature of the issue of grade inflation across universities and colleges, and the lack of empirical data, understanding the nature of grade inflation is important. This article will discuss a study designed to investigate the extent to which grade inflation is an issue within a western Canadian faculty of nursing. Recommendations related to grade inflation are discussed.

Perceptions of first-line nurse managers. What competencies are needed to fulfill this role?

First-line nurse managers have experienced an unprecedented shift in their roles and responsibilities as a result of health care reform. Consequently, there is a need to identify competencies required of first-line nurse managers in a changing health care environment. A descriptive, exploratory study of nurse managers in a western Canadian province was conducted using a combined quantitative and qualitative approach. The research instrument was comprised of three parts: a questionnaire that grouped five categories of competencies (technical, human, conceptual, leadership, and financial management); demographic data; and a critical incident technique that allowed the subjects to elaborate on a specific incident in their practice when they "performed at their best" as a manager. Findings revealed that nurse managers' need for knowledge and understanding was greater than their ability to implement managerial competencies. The exploration of competencies of first-line nurse managers has implications for curriculum development in leadership and management courses in nursing programs, as well as managerial development in health care agencies. Results will assist educators and administrators in addressing the changing needs of current and future nurse managers.

Meeting the continuing education needs of rural nurses in role transition.

BACKGROUND: The community health center (CHC) model of care delivery is gaining acceptance throughout Canada's newly created rural health regions. The resulting change in nursing functions presents a challenge to regional health authorities to ensure the attainment and maintenance of practice competencies. METHOD: This qualitative study examined strategies used in selected parts of Canada to prepare and support rural diploma-prepared nurses for role transition from acute care into CHCs. RESULTS: In light of CHC nurses' increased degree of autonomy, skill level, and focus on community wellness, the findings indicate a need for additional educational preparation and supportive strategies for transitioning nurses. CONCLUSION: Regions should educate the public and staff about the principles of primary health care, population health, and factors that determine health to help stakeholders understand their community, the current gaps in service delivery, and the role of CHC nurses. Key players at the provincial level should work together to address competency issues and continuing education needs of nurses in career transition.

Unravelling the unknowns of reflection in classroom teaching.

BACKGROUND: The use of reflection in education has emerged as an effective means of connecting theory with practice. However, the literature reveals limited empirical work on the conceptualization of reflection. AIM OF THE STUDY: The purpose of this qualitative research study was to understand more fully the meaning and use of reflection in teaching, and how reflection contributes to the development of teaching expertise in the classroom. Ethical approval. The study received ethical approval from the Faculty of Nursing Ethical Review Committee, University of Manitoba. Issues related to confidentiality of information, and power relationships between the investigators were addressed. Students were reassured that no data were collected about them during participant observations in the classrooms. METHODS: The investigators were the sources of data. Data were collected using five different methods over the course of two academic years, including written autobiographies, critical incident journals, classroom observations, debriefing following classroom observations and research team meetings. FINDINGS: The data were analysed using content analysis, and four themes were identified (i) making connections, (ii) developmental aspects, (iii) influence of context on reflection, and (iv) influence of emotions on reflection. Study limitations. The interpretation of the findings of this study should be used with caution given the qualitative design and small number of participants. CONCLUSION: Participation in the study increased the awareness of the investigators' personal use of reflection. The process of studying our own use of reflection allowed us to step outside the performance treadmill to better understand, accept and reshape what we do over and over in the classroom. This study supports an examination of one's experiences as a means of understanding reflection and its use in the classroom.

Lessons learned in developing and delivering Web-based graduate courses: a faculty perspective.

The increased demand for graduate distance education by RNs create many challenges for nurse educators. This article describes the trials and tribulations of developing and delivering two Web-based graduate nursing courses at a western Canadian university. The authors describe the background and rationale for developing Web-based courses, the relevant literature, and the lessons learned in planning and delivering these courses.