Tick bite and Lyme disease-related emergency department encounters in New Hampshire, 2010-2014.

Lyme disease (LD) is a common tick-borne disease in New Hampshire (NH). While LD is a reportable condition and cases are counted for public health surveillance, many more people receive care for tick bites or diagnoses of LD than are reflected in surveillance data. NH's emergency department (ED) data system was queried for tick bite and LD-related encounters. Chief complaint text was queried for words related to LD or tick bites. International Classification of Diseases 9th Revision (ICD-9) codes were queried for the LD diagnosis code (088.81). Emergency department patient data were matched to reportable disease data to determine the proportion of ED patients reported to the health department as a suspected LD case. Data were analysed to calculate frequencies for key demographic and reporting characteristics. From 2010 to 2014, 13,615 tick bite or LD-related ED encounters were identified in NH, with most due to tick bites (76%). Of 3,256 patients with a LD-related ED encounter, 738 (23%) were reported to the health department as a suspected LD case. The geographic distribution of ED patients was similar to reported LD cases; however, the regions of the state that experienced higher rates of ED encounters were different than the regions that observed higher rates of reported LD cases. Seasonal distribution of ED encounters peaked earlier than reported LD cases with a second peak in the fall. While age and sex distribution was similar among ED patients and reported LD cases, the rates for children 5 years and younger and adults 65 years and older were greater for ED encounters. Patients frequently visit the ED to seek care for tick bites and suspected LD. Results of ED data analyses can be used to target education, in particular for ED providers and the public through timely distribution of evidence-based educational materials and training programmes.

Symposium on compassionate care and the dying experience. Hope: its spheres and dimensions.

The phenomenon of hope has been described according to spheres and dimensions. The two spheres and six dimensions of hope, deduced from interviews and observations of elderly patients with cancer and tested on another population, serve as a theoretical model for understanding the complex nature of hope. They provide a perspective for assessing hope and for therapeutically influencing hope in persons during the last phases of life and in their families. Analysis of data suggests hope is a multidimensional, dynamic life force rather than trait-oriented and unidimensional. Therefore, there is always hope. The nursing challenge is to understand how hope may be operative, in order to facilitate and support this indispensable resource throughout the illness experience, but perhaps most importantly, during the last phase of a person's life.