Leading interagency planning and collaboration in mass gatherings: public health and safety in the 2012 London Olympics.

OBJECTIVES: Planning and implementing public health initiatives in mass gatherings such as the Olympic Games pose unique challenges for interorganizational collaboration, which involves interaction among multiple and diverse agencies. Nonetheless, there is limited empirical evidence to support interagency collaboration and public health planning decisions in mass gatherings and how leadership can shape such interactions. We empirically explored these topics in the 2012 London Olympics to identify lessons to inform planning for future mass gatherings. STUDY DESIGN: This is a qualitative case study. METHODS: Data comprised 39 semistructured interviews with key informants conducted before, during, and after the games; in addition, direct observations of field exercises and documentary analysis were also used. Open coding and thematic analysis was used to analyze the data. RESULTS: We identified two main leadership challenges that influenced interagency collaboration: organizational public health leadership and coordinating collaborative decision-making. Two facilitative conditions helped overcome the previous challenges: nurturing interorganizational linkages and creating shared understanding by activating codified frameworks at the organizational level. CONCLUSIONS: Our study highlights leadership issues in interagency collaboration in mass gatherings. Practical implications arising from this study may inform the ways the organizers of mass gatherings, public health and safety agencies, and professionals can engage in effective partnerships and joint working.

Review of dietetic service provision and activity in spinal cord injury centres: a multicentre survey in the UK and Republic of Ireland.

OBJECTIVES: The present study was undertaken to review the service provision in spinal cord injury (SCI) centres (SCICs); to establish and compare how much time dietitians spend in direct and indirect contact with patients; and to document current nutritional screening practices. METHODS: All 12 SCICs in the United Kingdom and the Republic of Ireland were surveyed by a postal questionnaire in April 2014. Data collected included the number of whole-time-equivalent (WTE) staff available, whether a nutrition team was present and the use of nutrition screening tools. A work sampling tool was used to capture dietetic activity for a period of 1 week. RESULTS: Eight (66.7%) SCICs responded (390/531 of total SCI beds) and the average numbers of patients per WTE staff, including consultants, nurses, dietitians, physiotherapists, occupational therapists were recorded. Six out of eight SCICs used a validated nutritional screening tool. Thirty-two work sampling tools were analysed, revealing that spinal dietitians spend 39.1% of the working day in direct patient-related activities. Staffing levels varied and were below clinical recommendations in six out of eight SCICs. CONCLUSION: The resources allocated to nutritional care in SCICs appear to be varied and limited. This suggests malnutrition may continue to be under-recognised and under-treated. To address the complex nutritional needs of this special population group there is a clear need to establish staffing level for dietitians. Information collected from the present study could contribute to the supply analysis of a future workforce planning exercise in SCIC dietetic service.

Postinfectious irritable bowel syndrome may occur after non-gastrointestinal and intestinal infection.

Postinfectious functional gastrointestinal disorders (FGIDs) may not be specific to gastroenteritis. This pilot study aimed to ascertain the 3- and 6-month incidence of functional gut disorders in people with non-gastrointestinal (GI) infection, gastroenteritis and healthy controls. This was a prospective study of three cohorts recruited from hospital (non-GI infections) and the community (others). FGIDs were diagnosed using self-completed Rome II modular questionnaires administered at baseline, 3 and 6 months. Thirty-six subjects with non-GI infection, 219 healthy subjects and 108 with bacterial gastroenteritis participated. No difference in incidence of FGID was detected between the GI and non-GI infection cohorts. Any FGID was more frequent in people who had a non-GI infection than in controls at both 3 [odds ratio: 4.34 (95% CI: 3.60-16.45)] and 6 months [4.76 (4.42-27.92)]. Irritable bowel syndrome (IBS) alone was more frequent in people with non-GI infections than in controls at 3 months (6.12 [1.30-29.12]) but did not quite reach statistical significance at 6 months (4.58 [0.79-26.46]). Our findings were unexpected. Postinfectious FGIDs may be related to non-GI and GI infection, although not all potential biases were controlled in study design. Further studies need to explore these preliminary findings and, if confirmed, the underlying mechanisms.

Undiagnosed hypercoagulable state: a case study.

Vascular nursing presents constant challenges. The natural history of vascular disease coupled with the complexity of the patient population provides an environment for constant learning. Providing care to these unique individuals demands a thorough knowledge of vascular anatomy and physiology, diagnostic interventions, treatment modalities, multidisciplinary resources, and nursing interventions. This case study explores the multifaceted realm of vascular nursing by examining the hospital course and multidisciplinary plan of care of a 22-year-old man whose hospital course began with a lower extremity deep venous thrombosis and progressed to pulmonary embolus, phlegmasia cerulea dolens, compartment syndrome, sepsis, arterial thrombosis, severe coagulopathy, priapism, laryngeal bleeding/laryngospasm, and subsequent notification of having received a unit of blood from a donor whose human immunodeficiency virus status was later determined to be positive. The intent of this article is not to define a specific means of practice but to share with colleagues the wealth of knowledge that was gained from this experience.

The accuracy of adult limb radiograph interpretation by emergency nurse practitioners: A prospective comparative study.

BACKGROUND: One of the extensions to practice for the emergency nurse practitioner role is to appropriately order and interpret radiographs in the emergency department. OBJECTIVE: The aim of the study was to compare the accuracy in interpreting isolated adult limb radiographs between emergency nurse practitioners and emergency physicians. DESIGN: A prospective comparative study was undertaken. SETTING: Emergency department in a large metropolitan hospital. PARTICIPANTS: 200 adult patients with isolated limb injuries were consented. METHODS: Six emergency nurse practitioners and ten emergency physicians participated. One emergency physician and emergency nurse practitioner independently clinically assessed each patient, determined the need for radiograph and separately recorded their interpretation of the radiograph as either definite fracture, no fracture or possible fracture. A single consultant radiologist reviewed each radiograph and their interpretation was seen as the gold standard. The sensitivity and specificity of emergency physicians and emergency nurse practitioners were calculated. To measure the level of agreement between the two-clinician groups, the weighted Kappa statistic was used. RESULTS: The sensitivity for the emergency nurse practitioners was 91% and 88% for the emergency physicians. The specificity for the emergency nurse practitioners was 85% and for the emergency physicians 91%. The weighted Kappa on the presence of a fracture between the emergency nurse practitioners and emergency physicians was 0.83. CONCLUSIONS: This study validates the clinical and diagnostic skills of emergency nurse practitioners assessed in the interpretation of isolated adult limb injury radiographs.

Starch granulomata of the endocardium.

Two cases of granuloma of the endocardium following cardic catherterisation are described. In each case the granuloma consisted essentially of macrophages associated with intracellular and extracellular starch granules, derived presumably from the glove powder used at operation. No previous cases of this condition have been found in the literature.

Endometrial carcinoma after cyclical oestrogen-progestogen therapy for Turner's syndrome.

A case of endometrial adenocarcinoma in a patient with Turner's syndrome who had received long term combined oestrogen-progestogen therapy is described.

PIP: This is a case report of endometrial adenocarcinoma in a patient with Turner's syndrome who had received estrogen-progestogen therapy for 13 years. At age 22 she was treated for primary amenorrhea and absence of secondary sexual characteristics. Urinary gonadotropin assay exceeded 32 mouse units/24 hours and infantile external genitalia, uterine hypoplasia, and impalpable ovaries were found. Cytogenetic studies confirmed a 45XO karyotype. For 13 years she received stilbestrol cyclically for 21 days with ethisterone, 5 mg twice daily, added for Days 16-21 of each cycle. Secondary sexual characteristics developed. After 13 years anemia developed, the uterus was found to be the size of a 20-week pregnancy, and an endometrial polyp protruding through the cervix showed squamous metaplasia. Following hysterectomy, histologic studies showed well-differentiated adenocarcinoma of the endometrium with some squamous metaplasia and osteoid formation. Metastases were not found. Similar cases treated with stilbestrol alone have been reported. Genetic predisposition is possible with this patient's X chromosome abnormality. However, estrogen therapy is thought to be a causative factor. Those receiving such therapy should have periodic gynecological examinations with curettage even when progestogens are also being used.